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.     

The Bangladesh fertility decline: an interpretation

The claim has been made, notably in a 1994 World Bank report, that the Bangladesh fertility decline shows that efficient national family planning programs can achieve major fertility declines even in countries that are very poor, and even if females have a low status and significant socioeconomic change has not occurred. This article challenges this claim on the grounds that Bangladesh did experience major social and economic change, real and perceived, over the last two decades. This proposition is supported by official data and by findings of the authors' 1997 field study in rural southeast Bangladesh. That study demonstrates that most Bangladeshis believe that conditions are very different from the situation a generation ago and that on balance there has been improvement. Most also believe that more decisions must now be made by individuals, and these include decisions to have fewer children. In helping to achieve these new fertility aims, however, the services provided by the family planning program constituted an important input.     

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.     

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.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

The spread of health services and fertility Transition

We use detailed measures of social change over time, increased availability of various health services, and couples' fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.     

Fertility in botswana: The recent decline and future prospects

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period. Fertility apparently began to rebound in the late 1980s in response to improved conditions, which came about as a result of a successful drought relief program. Future declines in fertility depend on the continued success of the family planning program, particularly in rural areas.     

Adolescent sexuality in Asia: new focus for population policy

As the age at marriage continues to rise in East and Southeast Asia, the fertility behavior of unmarried teenagers is receiving more attention from population policymakers. In addition to fertility reduction through family planning, Asian societies today consider population planning strategies in relation to national needs and social goals, including such matters as the population's growth rate, age structure, educational quality and skills. The number of single youth in Asia is growing much more rapidly than the total youth population. By the year 2010, for example, India is projected to have nearly 70 million single teenagers, aged 15-19, 188% more than in 1980. In many developing countries today, such as the Philippines and Korea, the rising age at marriage has combined with rapid urbanization, improved status for women, and more educational opportunity to alter both the behavioral norms of young people and the traditional means of social control over youth. Studies of contemporary adolescent sexuality have been conducted in 4 Asian countries. In the Philippines an overt independent youth homosexual culture was found to exist in urban and to some extent rural areas. In Thailand research revealed little conservative resistance to family planning or to contraceptives for young unmarried people. Surveys in Taiwan indicate that behavior related to dating and choice of spouse has become more liberal, and a survey in Hong Kong revealed a higher level of premarital sex and use of prostitutes among Chinese men than expected. Population policy perspectives that need to be considered in these changing times include: 1) issues of access to family planning services by unmarried people below the legal age of maturity; 2) the development of social institutions, such as exist in Thailand and the Philippines, to guide adolescents' behavior; 3) more extensive study of adolescent sexuality; 4) establishment of the scope of family policy.     

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."     

Socialist system creates favourable social environment for fertility decline in China

The Chinese experience suggests that the socialist system can create more favorable conditions for a decline in fertility than the capitalist system. This is related to 5 factors: 1) changes in the traditional functions of the nuclear family; 2) popularization of education and the transmission of culture; 3) improvements in the status of women; 4) rapid decreases in mortality, especially infant mortality; and 5) social security for the aged. In addition, the structure of social organizations and the widespread dissemination of information about birth control methods have facilitated family planning practice. The impact of theswe structural factors has been intensfied by the Chinese social environment, which has changed individual attitudes toward family size. Overall, the social environment has created attitudinal change while implementaton of the national family planning policy has made the fertility decline in China possible.     

Microcredit,Family Planning Programs,and Contraceptive Behavior: Evidence From a Field Experiment in Ethiopia

The impact of community-based family planning programs and access to credit on contraceptive use, fertility, and family size preferences has not been established conclusively in the literature. We provide additional evidence on the possible effect of such programs by describing the results of a randomized field experiment whose main purpose was to increase the use of contraceptive methods in rural areas of Ethiopia. In the experiment, administrative areas were randomly allocated to one of three intervention groups or to a fourth control group. In the first intervention group, both credit and family planning services were provided and the credit officers also provided information on family planning. Only credit or family planning services, but not both, were provided in the other two intervention groups, while areas in the control group received neither type of service. Using pre- and post-intervention surveys, we find that neither type of program, combined or in isolation, led to an increase in contraceptive use that is significantly greater than that observed in the control group. We conjecture that the lack of impact has much to do with the mismatch between women’s preferred contraceptive method (injectibles) and the contraceptives provided by community-based agents (pills and condoms).     

A note on measuring the independent impact of family planning programs on fertility Declines

This note critically evaluates recent cross-national studies that estimate the independent effect of family planning programs on the fertility of the developing world. The evaluation demonstrates that past research is biased to produce overestimates of net program impact. A new estimate is derived to account more completely for the effects of the social context and socioeconomic development on fertility. This estimate indicates that 5 percent of the variation in crude birth rate decline for 89 developing countries is due to family planning programs. This is substantially less than past estimates.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Demographic aspects of fertility in Thailand

Abstract Data from a national rural and urban sample survey are analysed in order to examine various demographic aspects of fertility in Thailand. Marital fertility rates found for Thailand are among the highest in Asia. Particularly noteworthy is the persistence of high fertility at older ages of childbearing for rural women. Cumulative fertility shows a pronounced relationship with age at marriage and current marital status. Women who marry at an older age or who experience disruption of their marriages are clearly more likely to have fewer children ever born. Differences in both current and cumulative fertility are strongly associated with residence. Rural women who constitute the vast majority of Thai women, experience the highest fertility, Bangkok-Thonburi women experience the lowest fertility and provincial urban women are characterized by an intermediate fertility level which is closer, however, to the experience of their counterparts in the capital than in the countryside. Rural-urban fertility differences are mitigated but by no means eliminated by differences in infant mortality. In both rural and urban areas a positive association between cumulative fertility and infant morality is evident. Breast-feeding, commonly practised for extended periods-among both rural and urban Thai women, undoubtedly serves to some extent as an intervening variable in this relationship. A comparison of current fertility with cumulative fertility strongly suggests that a decline in marital fertility has been under way recently among urban women, especially those residing in the capital, but not at all among rural women. Although it seems safe to assume that the urban fertility decline results in large part from an increasing use of contraception among urban women, those still in the reproductive ages who were using or had previously used birth control were characterized by higher cumulative fertility than women who had never practised contraception. Evidently couples resort to family planning only late in the family building process after they have already achieved or exceeded the number of children they wish to have.     

Population growth and poverty in the developing world

The links between rapid population growth and the absolute poverty currently affecting 780 million people in the developing countries (excluding China and other centrally planned economies) were examined. Absolute poverty is defined as having less than the income necessary to ensure a daily diet of 2150 calories per person ($200 per person a year in 1970 United States dollars). Focus is on poverty and demography in the developing world (defining poverty; income, fertility and life expectancy; demographic change and poverty), effect of poverty on fertility, family planning programs and the poor, and the outlook for the future. Rapid population growth stretches both national and family budgets thin with the increasing numbers of children to be fed and educated and workers to be provided with jobs. Slower per capita income growth, lack of progress in reducing income inequality, and more poverty are the probable consequences. Many characteristics of poverty can cause high fertility -- high infant mortality, lack of education for women in particular, too little family income to invest in children, inequitable shares in national income, and the inaccessibility of family planning. Experience in China, Indonesia, Taiwan, Colombia, Korea, Sri Lanka, Cuba and Costa Rica demonstrate that birthrates can decline rapidly in low income groups and countries when basic health care, education, and low-cost or free family planning services are made widely available.     

The Impact of Migration on Fertility under China’s Underlying Restrictions: A Comparative Study Between Permanent and Temporary Migrants

Compared with that in other countries, the issue of fertility in China is more complicated because of its restriction policy or system. Several major hypotheses have been proposed to explain and predict the impact of migration on China’s fertility regardless of China’s real situation. Therefore, this paper analyzes the impact of migration on fertility considering China’s underlying restrictions using the data from the Chinese General Social Survey carried out in 2008. The social class in this study was divided into two, namely urban class and rural class. By building the 2 × 2 mobility tables and the diagonal mobility model, the study determined the impact of migration on fertility and analyzed the influence of some restrictions, such as family planning, traditional fertility concept, and household registration system. Results show that migration greatly affects fertility: upward migration (i.e., from rural to urban) may decrease the fertility, whereas downward migration (i.e., from urban to rural) may increase it. The degree of decline on fertility is greater than that of increase. Family planning still plays a role in fertility decline. Traditional concepts on fertility, for example, bringing up sons to take care of parents in their old age and preferring boys to girls, are anchored on the people’s mind, which is detrimental to the stability of the fertility rate. Moreover, the household registration system primarily influences the fertility behavior of temporary migration, with a negative relationship between them.     

Family planning in Taiwan, Republic of China: Progress and prospects

Abstract The family planning programme in Taiwan is considered to have been most successful and has been systematically evaluated. In the light of some expressed scepticism, however, its impact on fertility will have to be carefully reviewed. The present article discusses six specific problems : How many women have accepted the Lippes loops or pills offered in the programme ? How long will the loop stay in utero ? What proportion of married women is currently wearing the loops ? What changes have occurred in the knowledge-attitude-practice (KAP) of family planning among the target population ? How many births have been prevented by the IUD programme ? And finally, How much has fertility declined ? The fertility decline in Taiwan has been accelerating since the programme started in 1964. Approximately 40% of the decline in the birth rate, from 36.3 in 1963 to 27.7 in 1969, or 8.5 points per 1,000 in six years, however, was due to changes in age structure and delayed marriage. An increasing proportion of girls of marriageable age and a possible increase in the fecundability of the population will work against the programme's objective. Concerted efforts and heavier investment are essential for the final success of the programme.     

Low Fertility Trap:Theories,Facts and Implications

The low Fertility Trap Hypothesis proposes that there are three self-reinforcing mechanism--demographic,sociological and economic,working towards a downward spiral in future fertility.Once TFR drops below 1.5,it will be difficult to recover.The fertility recovery emerging in many countries across the world has changed the lowfertility trap theory and also the justification of the theory itself.So low-fertility trap is more likely a pattern summarized from a short-time phenomenon than a generalized social law.As with China,the current fertility level is above 1.5 births per woman,and China is not in the "Low-fertility trap".Moreover,most recent surveys suggests that current fertility intention in China is above 1.8 births per woman and more than60 percent of people would have a second child if there is an adjustment of fertility policy.In addition,birth postponement is still playing an important role in reducing TFR in China.Thus,with the high fertility intention,adjustment of family planning policy and decreasing tempo effect,TFR in China will experience upturn but not further decline in the near future.It is lack of evidence to conclude that China has already been or is going to be trapped in low fertility.     

Europe's second demographic transition

By 1985, fertility rates in Europe were below the replacement level of 2.1 births/woman in all but Albania, Ireland, Malta, Poland, and Turkey, following a steady decline from a 1965 postwar peak well above 2.5 in Northern, Western, and Southern Europe and an erratic trend from a lower level in Eastern Europe. Natural decrease (fewer births than deaths) had begun already in Austria, Denmark, Hungary, and the Federal Republic of Germany and can be expected shortly in many other countries. According to current UN medium projections, Europe's population (minus the USSR) will grow only 6% between 1985 and 2025, from 492 to 524 million and 18.4% of the population in 2025 will be 65 and over. The decline to low fertility in the 1930s during Europe's 1st demographic transition was propelled by a concern for family and offspring. Behind the 2nd transition is a dramatic shift in norms toward progressiveness and individualism, which is moving Europeans away from marriage and parenthood. Cohabitation and out-of-wedlock fertility are increasingly acceptable; having a child is more and more a deliberate choice made to achieve greater self-fulfillment. Many Europeans view population decline and aging as threats to national influence and the welfare state. However, governments outside Eastern Europe, except for France, have hesitated to try politically risky and costly economic pronatalist incentives. As used in Eastern Europe, coupled with some restrictions on legal abortion, such incentives have not managed to boost fertility back up to replacement level. Immigration as a solution is unfeasible. All countries of immigration have now imposed strict controls, tried to stimulate return migration of guestworkers recruited during labor shortages of the 1960s and early 1970s, and now aim at rapid integration of minorities. Only measures compatible with the shift to individualism might slow or reverse the fertility decline, but a rebound to replacement level seems unlikely and long-term population decline appears inevitable for most of Europe.