The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Declining world fertility: trends,causes, implications

This Bulletin examines the evidence that the world's fertility has declined in recent years, the factors that appear to have accounted for the decline, and the implications for fertility and population growth rates to the end of the century. On the basis of a compilation of estimates available for all nations of the world, the authors derive estimates which indicate that the world's total fertility rate dropped from 4.6 to 4.1 births per woman between 1968 and 1975, thanks largely to an earlier and more rapid and universal decline in the fertility of less developed countries (LDCs) than had been anticipated. Statistical analysis of available data suggests that the socioeconomic progress made by LDCs in this period was not great enough to account for more than a proportion of the fertility decline and that organized family planning programs were a major contributing factor. The authors' projections, which are compared to similar projections from the World Bank, the United Nations, and the U.S. Bureau of the Census, indicate that, by the year 2000, less than 1/5 of the world's population will be in the "red danger" circle of explosive population growth (2.1% or more annually); most LDCs will be in a phase of fertility decline; and many of them -- along with most now developed countries -- will be at or near replacement level of fertility. The authors warn that "our optimistic prediction is premised upon a big IF -- if (organized) family planning (in LDCs) continues. It remains imperative that all of the developed nations of the world continue their contribution to this program undiminished."     

Theoretical explanation of rapid decline in China's fertility]

China's fertility decline is widely acknowledged. The 1982 census and a random survey of 1/1,000th of the nation's population set the total fertility rate at 2.6%. Bureau of statistics data collected in 1984 showed the nation's birth rate as 1.7% and total fertility rate 1.94%. Friendly observers call this a miracle; others blame the decline on forced government family planning policy. Scientific pursuit of the causes for the decline is an issue of practical and realistic value. First, favorable conditions for fertility decline have been fostered by the socialist system and are deeply rooted in the country's economic development. China's industrialization and urbanization have brought new lifestyles and liberated individuals and families from the constraints of traditional family life. Couples have chosen to limit the number of children, to enhance the quality of life and education potential of their children, thus altering the traditional high fertility in China. Education of women has played a role in raising women's consciousness; a 1982 census placed the fertility rate of women with high-school level education or above, lower than that for less or uneducated women. Neonatal mortality rate decline is also related to the spontaneous decline in fertility rate, as high fertility has historically been intended to compensate for high child mortality rates. Welfare and social security systems for the elderly have also helped change the traditional mentality of having many children as assurance of life support in old age. Social organizations have accelerated knowledge and methods of planned fertility. Later marriages are also a factor: in 1970 the average marriage age was 19 - 20 and had increased by 1976 to 22 - 23. Other favorable social factors include free birth control and the view of population planning as an essential part of national welfare.     

Aging in America: Limits to life span and elderly care options

Expanding longevity among the elderly and fertility decline are contributing to an aging US population. The number of persons 65 years or older is projected to double from about 32 million in 1990 to 66 million by 2030; the elderly proportion is expected to increase from 13 to 22 percent over the same period. Chronic illness and functional disability afflicts a significant proportion of older persons. An estimated 80–85 percent of people over age 65 have at least one chronic illness, and nearly one-half of older people report that chronic illness limits their activity to some degree. Altogether, about one-third of the population over 65 may need some kind of medical or social assistance. This paper discusses the three primary modes of care available to older persons: (1) the informal network of the family, (2) the more formal arrangements of home and community care, and (3) the institutionalized care of nursing homes. Of particular policy interest are the questions: Who provides the care? What type of care is available? Who receives the care? How much does each type of care cost? and Who pays? The current patterns and costs especially of long-term care provide a framework for planning future options. A discussion of research and policy recommendations concludes the paper.     

Social and economic factors in Hong Kong's fertility decline

Abstract In both developed and underdeveloped areas, many attempts have been made to alter the course of fertility through family planning intervention. Doubtless the availability of such services facilitates birth control for those who already desire to use it. Whether or not such exogenous interventions have any independent effect upon the operation of endogenous forces in the economy and society is, however, more problematical. Where fertility declines have been observed, family planning services have often been made widely available only after the decline in fertility had already set in. Nonetheless, observers have often attempted to attribute some fraction of the continuing decline in fertility to the operation of family planning activities. One especially notable case is that of Hong Kong, which provides some of the more persuasive evidence about the independent effects of family planning intervention.     

Temporal and spatial analysis of fertility decline in Taiwan

Abstract The conventional mode of evaluating the success of family planning programmes has frequently emphasized the activities of the programmes, rather than their ultimate effects. This paper examines the role of family planning programmes in inducing fertility decline in Taiwan. First it presents the secular trends of Taiwanese fertility changes, pointing out that family planning programmes began only after the birth rate had already shown a substantial decline. Secondly, it specifically evaluates the impact of family planning programmes in the Taichung areas, since its success has been widely proclaimed. Finally, it is stipulated that the dynamics of Taiwanese fertility changes may be related to declining infant mortality and accelerating educational development, and that these institutional effects, rather than the family planning programmes, should be credited with changes in fertility.     

India's population in transition

This demographic profile of India addresses fertility, family planning, and economic issues. India is described as a country shifting from economic policies of self-reliance to active involvement in international trade. Wealth has increased, particularly at higher educational levels, yet 25% still live below the official poverty line and almost 66% of Indian women are illiterate. The government program in family planning, which was instituted during the early 1950s, did not change the rate of natural increase, which remained stable at 2.2% over the past 30 years. 1993 marked the first time the growth rate decline to under 2%. The growth rate in 1995 was 1.9%. The total population is expected double in 36 years. Only Nigeria, Pakistan, and Bangladesh had a higher growth rate and higher fertility in 1995. India is geographically diverse (with the northern Himalayan mountain zone, the central alluvial plains, the western desert region, and the southern peninsula with forest, mountains, and plains). There are regional differences in the fertility rates, which range from replacement level in Kerala and Goa to 5.5 children in Uttar Pradesh. Fertility is expected to decline throughout India due to the slower pace of childbearing among women over the age of 35 years, the increase in contraceptive use, and increases in marriage age. Increased educational levels in India and its state variations are related to lower fertility. Literacy campaigns are considered to be effective means of increasing the educational levels of women. Urbanization is not expected to markedly affect fertility levels. Urban population, which is concentrated in a few large cities, remains a small proportion of total population. Greater shifts are evident in the transition from agriculture to other wage labor. Fertility is expected to decline as women's share of labor force activity increases. The major determinant of fertility decline in India is use of family planning, which has improved in access and use during the 1980s. If India is to keep a stable population under 1.6 billion in the future, Indians may have to accept only one child per family.     

A cohort analysis of the fertility of the July 1 People's Commune in Shanghai, County]

The survey was conducted in February-March 1981. The population of this commune at the end of 1980 was 18,608. The cultural and educational levels, economic condition, and work in family planning of this commune form a typical example among numerous similar communes in Shanghai County. The birthrate, natural growth rate, and average fertility rate began to decline in the later half of 1950s and reached the lowest level in 1974. The survey shows a delay in the marriage age. The fertility rate also dropped by 21.31% from 1963 to 1980. The average fertility rate dropped by 162.73% from 1963 to 1980. Among the women of childbearing age, 99% of them have a knowledge of birth control measures, 95% of them have used them before, and 78% are currently using them. All these figures show that the work in family planning in the commune has reached a high level by world standards. 3 factors which have a strong impact on fertility are: the economic and educational level, formation of population elements, and family planning work. A rise in the standard of living and improvement in education normally leads to late marriage and a decline in fertility. An increase in the number of women of childbearing age causes a rise in fertility. The population growth after 1974 is a reflection of this situation. The survey shows that the decline in fertility before 1973 was caused mainly by family planning work.     

Recent changes in Negro fertility

Crude birth rates for the Negro population of the United States indicate that fertility declined while Negroes remained in the South and them climbed in the last twenty-five years as Negroes became urbanized. Cohort rates show more precisely the effects of the Depression upon childbearing as well as the magnitude and persistence of the post-Depression rise in fertility. More Negro women now become mothers, average family size has increased, and the proportion of women bearing six, seven, or eight children has risen. Negro fertility has risen despite the urbanization of Negroes and improvements in their socio-economic characteristics. Negro fertility rates present the paradox of falling when demographic transition theory would predict the maintenance of high rates and then rising when a decline would be expected. Urbanization does not appear to have reduced Negro fertility. Traditionally, urban living has dampened childbearing in two ways—first, health conditions in cities were inferior to those of rural areas, and thus urbanization affected fecundity adversely; second, city residents are more likely to know about and adopt birth control than rural residents. Negroes migrated to cities at the very time when diseases were being controlled and when public health and welfare facilities were being expanded to serve all residents. This has contributed to higher Negro fertility rates. If fertility rates are to fall because of family planning, not only must birth control be available but there must be a desire to limit family size. Such a desire may be linked to opportunities for social mobility. Negroes have not been assimilated into urban society as previous in-migrant groups were, and opportunities for mobility have been restricted. For these reasons Negroes may be slow to adopt stable monogamous families and the intentional control of fertility.     

Population and environment in the twenty-first century

In the past 50 years global population grew by 3.7 billion. There is a large unmet need for family planning and wherever women have been given the means and the information to decide if or when to have the next child, then family size has fallen, often rapidly. However, since the UN 1994 Cairo conference on population and development, support for international family has collapsed and fertility declines in many of the poorest countries have stalled. Amongst some of the most vulnerable groups family size has risen. The investment made in voluntary family planning will largely determine whether, in the next 50 years, the global population grows to something less than 8 billion or to over 10. The trajectory taking us to the higher figure could jeopardize any possibility of transitioning the global economy to a biological sustainability. Much precious time has been lost. Almost all the additional growth in population will take place in the world’s poorest countries, and it is imperative that the international community act to improve access to family planning in those countries, within a human rights frame framework.     

Social change,population policies,and fertility decline in Colombia and Venezuela

This paper takes a comparative case-study approach to examine the social and policy correlates of fertility decline. The analysis compares fertility behavior across a mature and young cohort of women in Colombia and Venezuela, two countries that experienced rapid demographic change under dissimilar socioeconomic and population policy conditions. Based on the distinction between birth-spacing and birth-stopping behavior the analysis tests several propositions derived from the adaptation and innovation explanations of fertility decline. Results show that fertility regulation at low parities was largely absent among mature women in both countries, representing an innovative behavior among younger women. The introduction of fertility control, however, was highly dependent on women's socioeconomic position, particularly their educational and occupational characteristics. The strong family planning programs in Colombia resulted in a more rapid extension of contraceptive use, particularly female sterilization, and stopping behavior after two children relative to Venezuela. Results highlight the diversity of conditions under which fertility can decline in developing countries and the importance of family planning and other policy initiatives to understanding the different pathways towards lower fertility.     

Status of National Family Planning Programmes of Developing Countries in relation to demographic targets

Abstract Having arisen within the context of social and economic development plans, demographic targets associated with family planning programmes in developing countries stipulate levels deemed desirable or necessary to implement economic goals. Since an optimum fertility path for economic development is open to conjecture, targets tend to be vague or arbitrary, and generally imply a fertility decline that goes beyond family limitation based on health considerations. While on the one hand, programme administrators have assumed responsibility for these targets, on the other hand they have structured their programmes toward health, not demographic, goals. As a result, they have minimized rather tham maximized the contribution of the programmes to the targets. of the 24 countries with programmes designed to reduce birth rates, the demographic variable is on target in seven; in six, review is premature; five cannot be evaluated because targets are non-quantifiable or vital data are too uncertain; and in six, including India and Pakistan, progress has been poor, at least in relation to targets. The demographic target is only one of many models and techniques for programme evaluation, although many require data not often available in developing countries. An estimate of births averted based directly on programme activities is not only complex but speculative. However, in contrast to the target criterion, cost benefit analyses involving the estimated return for an averted birth indicate that the programmes are a highly profitable investment.     

A review of the studies on fertility transition in China]

This article is a summary of papers and analysis in recent years on fertility transition and the association between fertility decline and socioeconomic development in China. These papers discuss the causes of fertility decline and the role of family planning programs in demographic transition. The major points are: 1. The demographic transition in China has the same characteristics as in the countries that have completed the transition. The transition had already started in the more developed areas or completed in a few large cities before family planning programs were implemented. 2. The role of family planning programs is to lead and to accelerate the demographic transition, which is the key idea of the "induced fertility transition". 3. The socioeconomic development and family planning programs worked together to affect the fertility decline, however socioeconomic development is the fundamental factor. Without the existence of the socioeconomic development, which included the changes in the function of family, traditional ideas on fertility, increased level of education, the status of women and social security system; the family planning program is not likely to make an impact.     

Why the silence on population?

The tripling of the world’s population growth since 1960 has received little public attention the past decade. Six reasons for the silence around this subject constitute a “perfect storm”. The first five are: visibility of actual fertility decline in the developed countries as well as a number of the developing ones; well justified attention to the impact of high levels of consumption on the environment; an implicit welcome by conservative political and religious forces to reduced needs for family planning; the tragedy of AIDS dominating international health concerns; and the 1994 Cairo conference’s focus on examples of coercive family planning while nearly ignoring the coercion of women forced into unwanted childbearing. These five relatively new developments have been supported by standard demographic theory containing an assumption that couples naturally want many children, making it difficult to see the many barriers blocking women’s options to manage their own childbearing.     

Asia's demographic future: the next 20 years

Even with the decline of fertility rates in most of Asia, the problem of population growth is still very serious. It is important to stress to Asian leaders and Western researchers that the problem is by no means solved just because fertility rates have declined. In many countries the number of young people is quite substantial and when they increase their numbers, certain problems will develop. Over the next 20 years, urban areas will see a marked increase in population and the resultant problems. Unemployment, increased pollution, and overcrowding will greatly decrease the quality of life for millions of people. This will happen because of natural increases and from the migration of the rural communities. In the rural areas, because of high fertility rates, population will continue to grow in spite of the large numbers of peoples moving to the city. Asia has some of the most densely populated agricultural communities and as their numbers increase, poverty and its associated problem will follow. The solutions to these problems include continued efforts in family planning, maternal and child health, and the improvement of the status of women.     

Pakistan's population growth: the need for action

Despite the existence of a national family planning program that dates to 1965 Pakistan has not seen a reduction in the fertility rate. One of the poorest countries in the world, Pakistan has 1 of the highest population growth rates in the world at about 3.0% annually. For over 2 decades, the average woman in Pakistan has given birth to more than 6 children. At the current fertility rate, the country's current population of 120 million will increase to over 150 million by the year 2000, and it will increase to 280 million by 2020. And even if today every woman were to begin having only 2 children, the population would still reach 160 million before leveling off. But reducing fertility in Pakistan will prove difficult. One of the leading obstacles is the low status of women. Few women in Pakistan have advanced education or professional jobs. Only 1/4 of those women without education or who are not working have any knowledge concerning contraception. Family size and composition also fuel the high rate of fertility. On the average, women desire 5 children (the fact that women average more than 5 suggests an unmet need for contraception). And due to social, cultural, and economic conditions, Pakistanis generally prefer male offsprings. Islamic opposition to family planning has also contributed to the continued high rates of fertility. Finally, administrative and management weaknesses have hindered Pakistan's family planning program. In order to overcome these obstacles, Pakistan will have to enlist the commitment of political, religious, and community leaders. The status of women will have to be improved, and the attitudes of people will need to change.     

Economic development and fertility decline: lessons from Asia's newly industrialized countries

The general thesis that economic development and fertility decline are interrelated is substantiated in literature that discusses the successes of the newly industrialized countries of Hong Kong, Korea, Singapore, and Taiwan. When countries are developing rapidly, family planning accelerates the rate of fertility change, particularly among the poor uneducated rural population. Relying on economic and social development is not enough. National policy in Hong Kong, Singapore, Korea, and Taiwan recognized that population growth drains resources and the family planning programs operating since the 1960s contributed to a drop from 5 children/woman to 2 by 1988, and 70% of married couples used contraception. Coupled with this, age at marriage rose, contraception became more available, and educational and employment opportunities increased. Economically, the growth rate in the 1980's was 6-10% annually, with growth in the manufacturing and service sectors and export trade. Close economic ties evolved between governments and private sectors. Social development programs had been fully funded and gains evident in education, living standards, health care and nutrition, and life expectancy. The success of family planning is attributed to encouraging contraceptive awareness and use. Fertility reduction may occur with social and economic development, but no developing countries have reduced fertility without family planning. The relative importance of family planning may change over time, and reducing the cost through government sponsored family planning programs and encouraging the acceptability of contraceptive usage.     

A look at Asia's changing youth population

This report summarizes findings from a recent East-West Center study on demographic and social changes among young people aged 15-24 years in 17 countries in East, Southeast, and South Asia. Nearly every country in Asia has experienced fertility decline. Decline began in Japan and Singapore during the 1950s, followed by declines in Hong Kong, South Korea, Sri Lanka, the Philippines, Brunei, Taiwan, Malaysia, Thailand, and China during the 1960s. Declines occurred during the 1970s in Indonesia, India, and Myanmar. A "youth bulge" occurred about 20 years later due to declines in infant and child mortality. This bulge varies by country with the timing and magnitude of population growth and subsequent fertility decline. The proportion of youth population rises from 16% to 18% about 20 years after the beginning of fertility decline and declines to a much lower stable level after several decades. The bulge is large in countries with rapid fertility decline, such as China. Governments can minimize the effects of bulge on population growth by raising the legal age at marriage, lengthening the interval between first marriage and first birth, and increasing birth intervals. School enrollments among adolescents are rising. In South Korea, the population aged 15-24 years increased from 3.8 to 8.8 million during 1950-90, a rise of 132% compared to a rise of 653% among school enrollments. It is expected that the number of out-of-school youths will decline from 5.1 to 3.6 million during 1990-2025. Youth employment varies by gender. Policies/programs in family planning and reproductive health will need to address the changing needs of youth population.     

Does low fertility call for new policies in some Asian countries?

Over the past 2 decades, Japan, China, Singapore, Hong Kong, and South Korea have completed a demographic transition from high birth and death rates and runaway population growth to reduced fertility and mortality and population growth approaching replacement levels. Among the outcomes of fertility decline, 3 have particularly far reaching effects: 1) Changes in family types and structures. Marriage and family formation are postponed, childbearing is compressed into a narrow reproductive span that begins later and ends earlier, and higher-order births become rare. Large families are replaced by small ones, and joint and extended families tend to be replaced by nuclear families. 2) Shifts in the proportions of young and old. Declining fertility means that the population as a whole becomes older. Decreases in the proportion of children provides an opportunity to increase the coverage of education. Increases in the proportion of the elderly means higher medical costs and social and economic problems about care of the aged. 3) Changes in the work force. There is concern that low fertility and shortages of workers will cause investment labor-intensive industries to shift to countries with labor surpluses. Another outcome may be an increase in female participation in the work force. The potential consequences of rapid fertility decline have sparked debate among population experts and policy makers throughout Asia. Current family planning programs will emphasize: 1) offering a choice of methods to fit individual preferences; 2) strengthening programs for sexually active unmarried people; 3) encouraging child spacing and reproductive choice rather than simply limiting the number of births; 4) making information available on the side effects of various family planning methods; 5) providing special information and services to introduce new methods; and 6) promoting the maternal and child health benefits of breast feeding and birth spacing.     

Change of marital fertility in China from 1964 to 1981]

In 1982 the Chinese National Family Planning Commission conducted a nationwide (excepting Taiwan and Tibet) .001 random sampling of the total population to gather data on the fertility and age structures of married women. In comparing general marital fertility and standardized fertility, findings show that from 1964 to 1970 both rates averaged 225.1/1000. When family planning work began on a wide scale in 1971, the rates steadily declined, reaching 116.7/1000 in 1980. However, in 1967-68 the standard fertility rate rose by 21.34% due to the chaos of the Cultural Revolution, and in 1980-81 the rate increased by 13.2%, indicating that problems still remain in family planning. The total marital fertility rate dropped 2.84/1000 from 1964 to 1981. The rate of decline in rural areas was greater than in the cities, but the cities had a larger percentage decline than the countryside. In the 5-year periods of 1965, 1970, 1975, and 1980, marital fertility rates tended to decline in 1970 and 1975 among women aged 30-40 years because during those periods greater control was placed on women having multiple children. For 1980 and 1975, combined total rates for 15-19 year olds dropped 17.1%, but the combined total rates of 30-49 year olds dropped by 61.2%, indicating that in recent years the drop in marital fertility is mostly among those over 30 years of age.