POPULATION POLICIES, DEMOGRAPHIC ASPECTS OF

Population projections made in the 1950s predicted the large expansion in human numbers that subsequently occurred in the second half of the twentieth century. When these projections were first published they led to widespread concern about the potential adverse consequences of rapid population growth for human welfare and the environment, especially in the poor countries of Asia, Latin America and Africa where growth was expected to be most rapid. As a result, in the 1960s and 1970s funding and technical assistance expanded enormously for developing country governments that were willing to take action. Efforts by these governments to curb rapid population growth focused on reducing high birth rates through the implementation of voluntary family planning programs. These programs aimed to provide information about and access to contraception to permit women and men to take control of their reproductive lives and avoid unwanted childbearing. Only rarely, most notably in China, has coercion been used. Newly available contraceptive methods, such as the pill and intrauterine device (IUD), greatly facilitated the delivery of family planning services. Successful implementation of such programs in a few countries in the early 1960s (for example, in Taiwan and Korea) encouraged other governments to follow this approach.

Rationale for Family Planning Programs

The choice of voluntary family planning programs as the principal policy instrument is based largely on the documentation of a substantial unsatisfied demand for contraception. In surveys, large proportions of married women in the developing world report that they do not want a pregnancy at the time of the interview. Some of these women want no more children because they have already achieved their desired family size, while others want to wait before having the next pregnancy. A substantial proportion of these women (more than one-half in some countries) risk pregnancy by not practicing effective contraception (including sterilization) and, as a result, unintended pregnancies are common. In the mid-1990s, 36 percent of all pregnancies in the developing world were unplanned and 20 percent ended in abortion (Alan Guttmacher Institute).

Why do apparently motivated individuals fail to practice contraception? The answer lies in a mixture of social and health service-related reasons. In the past, a lack of access to services or information was a dominant obstacle. But access in the geographic sense has improved with the widespread implementation of family planning programs and the expansion of the role of private-sector providers. These efforts have not eliminated all unmet need, however, because many service points still offer too few methods and little if any information, or they are otherwise deficient in quality. In addition, other factors—such as fear of side effects of contraceptive methods and overt or suspected disapproval of husbands/partners and other family members—are significant barriers to use in many societies.

The existence of this unmet need for contraception was first documented in the 1960s, and it convinced policymakers that family planning programs were needed and would be acceptable and effective. The health and human rights benefits of family planning and reproductive health programs have provided additional rationales for this policy approach, which was endorsed at the 1994 United Nations International Conference on Population and Development. The Programme of Action adopted by the participating governments encourages the expansion of reproductive health and family planning programs as a means to improve women's reproductive freedom and health. Coercion of any kind is strongly opposed.

Demographic Impact

Over the past three decades large changes in reproductive behavior have occurred in most of the developing world. Around 1960, only a tiny fraction of couples practiced contraception, and knowledge of methods was very limited. In contrast, contraceptive knowledge is now widespread and more than one-half of married women in the developing world are current users of contraception. The large majority of these current users rely on modern methods, including male and female sterilization, the IUD, and the pill.

As a consequence of this widespread adoption of contraception, birth rates have declined sharply. In the past, fertility was high and relatively stable at over 6 births per woman. Since a precipitous decline began in the 1960s, the fertility of the developing world has been reduced by almost one-half, reaching 3.1 births per woman in the years from 1995 to 2000 (United Nations). The largest fertility declines occurred in Asia (−52%) and Latin America (−55%) and the smallest in sub-Saharan Africa (−15%). On average, the pace of change in reproductive behavior in the developing world has been faster than was the case in Europe and North America in the late-nineteenth and early-twentieth centuries.

A key factor contributing to this rise in contraception has been the diffusion of information about and access to contraceptive methods, aided by a rapid expansion of family planning programs. Experiments have provided the most direct and convincing evidence of the value of well-designed family planning services. An example of a large and influential experiment is the one conducted in the Matlab district of rural Bangladesh (Cleland et al.). When this experiment began in the late 1970s, Bangladesh was one of the poorest and least developed countries, and there was considerable skepticism that reproductive behavior could be changed in such a setting. Comprehensive family planning and reproductive health services were provided in the treatment area of the experiment. A wide choice of methods was offered, the quality of referral and follow-up was improved, and a cadre of well-trained women replaced the traditional birth attendants as service providers. The results of these improvements in the quality of services were immediate and pronounced with contraceptive use rising sharply. No such change was observed in the comparison area. The differences between these two areas in contraceptive use and birth rates have been maintained over time. The success of the Matlab experiment demonstrated that appropriately designed services can reduce unmet need for contraception even in very traditional settings with low levels of development.

Despite the undoubtedly crucial role of family planning programs, they are not the only or even the principal cause of changes in reproductive behavior in the developing world. Instead, socioeconomic change is considered by most analysts to be the dominant driving force of the fertility transition. As traditional agricultural societies are transformed into modern industrial ones the cost of children(e.g., for education) and a decline in their value (e.g., for labor and old-age security) to parents leads to declines in desired family size. In addition, with fewer children dying at young ages, fewer births are needed to ensure the survival of the number of children that parents desire. A rise in human development and, in particular, improvements in health and education, appear to be the principal determinants of progress through the fertility transition (Jejeebhoy; Sen; Cleland). In fact, it is possible for poor populations to reach low fertility levels, provided literacy and life expectancy are high. Well-known examples of this occurred in Sri Lanka and the state of Kerala in India.

The primary role of family planning programs is and has been to reduce unintended births by assisting couples with the implementation of their preferences for smaller families through contraception and abortion. Family planning programs have accelerated fertility transitions, so that, on average, these transitions have occurred about a decade earlier than they would have without the programs. Because small changes in fertility have relatively large effects on long term population growth this acceleration of fertility decline attributable to programs probably has reduced the eventual population size of the developing world by a few billion (Bongaarts, 1997).

Demographic Causes of Future Population Growth

Despite recent fertility declines, population growth continues at a rapid pace throughout most of the developing world. According to United Nations projections, the expected increase in population of the developing world as a whole between 2000 and 2050 (from 4.87 to 8.14 billion) is about the same as the historically unprecedented increase that occurred between 1950 and 2000 (from 1.71 to 4.87). This future growth can be attributed to three demographic factors (Bongaarts, 1994).

First, the past decline still leaves average fertility about 50 percent above the two-child level per woman needed to bring about population stabilization. With more than two surviving children per woman, every generation is larger than the preceding one and as long as that is the case population growth will continue. High fertility can in turn be attributed to two distinct underlying causes: unwanted childbearing and a desired family size above two surviving children. Many couples continue to want large numbers of children, partly because of fears of child mortality and partly because of the need for a sufficient number of surviving children to assist them in family enterprises and support them in old age. In most developing countries, the completed family size desired by women still exceeds two children; in some areas, such as sub-Saharan Africa, desired family size is typically above four children.

Second, declines in death rates—historically the main cause of population growth—will almost certainly continue. Higher standards of living, better nutrition, greater investments in sanitation and clean water supplies, expanded access to health services, and wider application of public health measures such as immunization, will insure longer and healthier lives in most countries. The exceptions will be mostly in sub-Saharan African countries, where the AIDS epidemic is severest.

The third growth factor is what demographers call population momentum. This refers to the tendency for a population to keep growing even if fertility could immediately be brought to the replacement level of 2.1 births per woman with constant mortality and zero migration. Due to a young population age structure, the largest generation of adolescents in history will enter the childbearing years in the first decade of the twenty-first century. Even if each of these young women has only two children they will produce more than enough births to maintain population growth over the next few decades.

Population momentum is the most important of these three factors, contributing about one-half of projected future growth. Further large increases in the population of the developing world are therefore virtually certain.

Future Policy Options

To be effective, population policies should address all these sources of continuing growth, except declining mortality, by implementing several strategies.

REDUCE UNINTENDED PREGNANCIES BY EXPANDING HIGH QUALITY FAMILY PLANNING SERVICES. Unintended pregnancies occur when women and men who want to avoid pregnancy do not practice effective fertility regulation. Offering individuals and couples appropriate services is a priority of many governments in the developing world. Despite considerable progress over the last several decades, the coverage and quality of family planning services remain less than satisfactory in many countries. In addition, some countries have imposed demographic and provider targets on family planning programs, thus actively interfering with trust between clients and providers. To ensure that family planning programs appropriately assist individuals in reaching personal fertility goals, family planning should be a strictly voluntary service linked with other reproductive health services. The quality of most existing programs can be improved by extending services to under served areas, broadening the choice of methods available, (including safe pregnancy termination where it is legal), improving information exchanges between client and provider, promoting empathetic client/provider relationships, assuring the technical competence of providers, including men in programs, adding service elements to address related health problems, such as diagnosis and treatment of sexually transmitted diseases and treatment following unsafe abortion, and increasing public awareness of the value of and means available for fertility regulation, responsible/safe sex, and the location of services.

REDUCE HIGH DESIRED FERTILITY BY CREATING FAVORABLE CONDITIONS FOR SMALL FAMILIES. Even if unintended fertility could be reduced or eliminated, a desire for large families remains a key cause of population growth in many countries. Several social and economic measures have substantial effects on desired family size:

Increase Educational Attainment, Especially Among Girls. Mass education changes the value placed on large families and encourages parents to invest in fewer "higher quality" children. Higher levels of education are also associated with the spread of nontraditional roles and values, including less gender-restricted behaviors. Educated women want (and have) fewer children with higher survival rates.

Improve Child Health and Survival. No developing country has had a sustained fertility decline without a prior substantial decline in child mortality. A high child death rate discourages investments in children's health and education and encourages high fertility by requiring excess births to insure that at least the desired number of children will survive to adulthood.

Improve Women's Status and Provide Them with Economic Prospects and Social Identities Apart from Motherhood. Improvements in the economic, social, and legal status of girls and women is likely to increase their bargaining power over family reproductive and productive decisions. Increased women's autonomy reduces the dominance of husbands and other household members, the societal preference for males, and the value of children as insurance against adversity and as securers of women's social positions.

CURB THE MOMENTUM OF POPULATION GROWTH. While a young age structure—the key demographic cause of population momentum—is not amenable to modification, an option to reduce momentum is available that has received little attention in past policy debates. Further reductions in population growth can be achieved if the average age at which women begin childbearing rises (by delaying the first birth) and through wider spacing between births. Young women often have little choice about whether or not to have sexual relations, when or whom to marry, and whether to defer childbearing. Governments that wish to encourage later childbearing have several options at their disposal. Legislation to raise the age at marriage has been moderately effective in a few countries. However, legislation has the drawback that it forces rather than encourages changes in marriage customs. Indirect approaches are likely to be more effective. A greater investment in the education of girls, particularly at the secondary level, is the most obvious example. The longer girls stay in school, the later they marry and the greater the delay in childbearing. Delaying the onset of childbearing will therefore not only reduce population momentum, it also significantly improves individual welfare.

Well-designed population policies are broad in scope, socially desirable, and ethically sound. Mutually reinforcing investments in family planning, reproductive health, and a range of socioeconomic measures operate beneficially at both the macro and micro levels: The same measures that slow population growth increase productivity, and improve individual health and welfare.

john bongaarts

SEE ALSO: Fertility Control; International Health; Population Ethics; Population Policies, Strategies for Fertility Control

BIBLIOGRAPHY

Alan Guttmacher Institute. 1999. Sharing Responsibility: Women, Society and Abortion Worldwide. New York: Author.

Bongaarts, John. 1994. "Population Policy Options in the Developing World." Science 263: 771–776.

Bongaarts, John 1997. "The Role of Family Planning Programmes in Contemporary Fertility Transitions." In The Continuing Demographic Transition, ed. Gavin W. Jones, John C. Caldwell, Robert M. Douglas, et al. Oxford: Oxford University Press.

Caldwell, John. C. 1980. "Mass Education as a Determinant of the Timing of Fertility Decline." Population and Development Review 6(2): 225–255.

Cleland, John. 2001. "The Effects of Improved Survival on Fertility: A Reassessment." In Global Fertility Transition, ed. Rodolfo A. Bulatao and John B. Casterline (supplement to Population and Development Review 27: 60–92.

Cleland, John; Phillips, James F.; Amin, Sajeda; et al. 1994. The Determinants of Reproductive Change in Bangladesh: Success in a Challenging Environment. Washington, D.C.: The World Bank.

Jejeebhoy, Shireen J. 1995. Women's Education, Autonomy, and Reproductive Behaviour: Experience from Developing Countries. Oxford: Clarendon Press.

Sen, Amartya. 1999. Development as Freedom. New York: Knopf.

United Nations. 2001. World Population Prospects: The 2000 Revision. New York: United Nations Population Division.