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TABLE 13-1

Change in Disapproval of Abortion (all white respondents)


were still unable to obtain them. More than half
of all abortions after 1973 were carried out in Percentage of disapproval
specialized clinics, while public hospitals (which Reason for abortion 1962 1965 1968 1969
provide most medical services to the poor) were
lagging even behind private hospitals in provid- Mother's health endangered 16 15 10 13
Child may be deformed 29 31 25 25
ing services. Only one in five U.S. public hospi- 74 74 72 68
Can't afford child
tals reported performing any abortions in 1975. No more children wanted - - 85 79
Thus in many areas it was substantially more
difficult for poor women to obtain abortions than Source: Judith Blake, Abortion and public opinion.
for middle-class or wealthy women, even though
government funds were available to cover the
costs. Teenagers, who account for about one- abortion services from Foreign Aid grants to
third of the need for abortion services and for a LDCs. In 1976, Congress also passed a law
large and growing portion of the illegitimate forbidding federal assistance for abortions in the
birth rate, also seem to have poor access to safe U.S., a move that denies these services to low-
abortions. Finally, abortion services were found income women—precisely the group whose
to be generally less available in the southern and chances for a decent and productive life are most
central regions of the U.S. than on either coast. likely to be jeopardized by an unwanted child.
In the United States, the majority of abortion Whether the courts will consider such a dis-
recipients are young and/or unmarried. There is criminatory law constitutional is another ques-
some debate over the degree to which legal tion. Right-to-life groups have also played a part
abortion has affected American fertility overall, in harassing clinics, hospitals, and other organi-
but it seems to have had a significant effect on the zations that provide abortion. This activity often
rate of illegitimate births. In 1971 reductions in embarrasses clients and possibly has also dis-
illegitimate births in states with legal abortion couraged other institutions from providing
ranged as high as 19 percent, while in most states abortion services.
without legal abortion they continued to in- Action by right-to-life groups in Boston re-
crease/ Following the Supreme Court decision, sulted in the trial and conviction for manslaugh-
the rising rate of illegitimacy halted briefly, then ter in early 1975 of physician Kenneth Edelin
began again. The rise was accounted for by an following a late-term abortion (about 20 weeks).
increase in teenage pregnancy. The prosecution maintained that the fetus might
There is no evidence that abortion has re- have survived if given life-supporting treatment.
placed contraceptives to any significant degree, (The conviction was overturned in December
despite the apprehensions of antiabortion groups 1976 by the Massachusetts Supreme Judicial
on this score. Most women seeking abortion have Court.)'1 The consequence of the original verdict
a history of little or no contraceptive practice, nevertheless was to discourage late second-
and many are essentially ignorant of other means trimester abortions (31 states already had laws
of birth control. Those who return for sub- against them except to protect the mother's life
sequent abortions have been found to be still or health; in most states abortion by choice was
ignorant of facts of reproduction, using contra- available only through the 20th week). Unfortu-
ceptives improperly, or to have been poorly nately, this change also will affect mainly the
guided by their physicians." poor and/or very young women, who through
Paralleling the trend toward liberalized abor- ignorance or fear are more likely to delay seeking
tion policies in the U.S. has been the growth of an abortion until the second trimester.
right-to-life groups who are adamantly opposed In 1976, a Right-to-Life political party was
to abortion. These groups have lobbied actively formed, centering on the abortion issue. Its
against reform of state laws and, since the candidate, Ellen McCormack, entered primaries
Supreme Court decision, have tried to persuade in several states, but never succeeded in winning
Congress to reimpose sanctions against abortion more than 5 percent of the vote. Most Ameri-
through Constitutional amendments. Under cans, it appears, accept the present legal situation
their pressure, Congress has removed funds for at least as the lesser of evils.
1. Sklar and B. Berkov, Abortion, illegitimacy, and the * Time and Nescstceek, March 3, 1975. Both magazines covered
American birth rate. the trial and the issues it raised in some detail. See also Barbara
"Blame MD mismanagement for contraceptive failure, Family Culliton's thoughtful article, Edelin trial; jury not persuaded,
Planning Perspectives, vol. 8, no. 2, March/April 1976, pp. and Edelin conviction overturned, Science, vol. 195, January 7,
72-76. 1977, pp. 36-37.
758 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

admitted having had an abortion; under Italian law she 1950s. Abortion brought birth rates so low that Bulgaria,
had committed a crime and could be sent to prison. Some Czechoslovakia, and Hungary tightened their regulations
years ago in a confidential survey of 4000 married women in 1973. Romania severely restricted access to abortion in
of all classes, all admitted to having had abortions, most 1966, with the result that its birth rate virtually doubled
of them many times.48 the following year. Since then, the birth rate has declined
A movement is now underway to loosen the laws toward the 1966 level, indicating an increase in illegal
against abortion in Italy, following the limited legaliza- abortions. The rates of hospitalizations and deaths from
tion of the pill in 1971, despite strong opposition from abortion complications have also risen substantially.
the Vatican and conservative political elements. The Meanwhile the huge cohort of children born in 1967 has
Italian constitutional court in early 1975 ruled that caused havoc in the Romanian school systems.50
abortion is legal if doctors determine that the pregnancy Canada has relaxed its abortion law somewhat; prac-
threatens the physical or mental health of the mother. tice is considerably short of "on request," but widely
Before the 1970s, variations on the Italian abortion liberal interpretation of the new law might make it close.
tragedy prevailed in several other Western European Canadians denied abortions often go to the United
countries. In France, contraceptives were available but States. Australia is moving toward liberal policies, al-
not openly, and the illegal abortion rate and attendant though access varies by state. New Zealand remains
rates of death and injury nearly matched those of Italy. In restrictive, but discussion of change has begun.
late 1974, abortion was legalized in France, shortly after
a new law was passed greatly increasing public access to Abortion in LDCs. The tragedy of illegal abortion
contraceptive devices and information. thus is rapidly becoming a thing of the past in most of the
Similar reversals have occurred in many DCs since developed world, but change is coming more slowly in
1965. West Germany, Denmark, and Austria legalized much of the less developed world. In some countries the
abortion on request between 1973 and 1975, although its problem of illegal abortion is increasing because the need
status in Germany was changed by a court decision and for abortion seems to be rising. There are important
remains to be reestablished by legislation. In 1975 exceptions, particularly China, where abortion has been
Sweden changed its already moderately liberal law to liberally provided by medical services since 1957. In
allow abortion up to the twelfth week as a decision for the India abortion was legalized in 1972, but there was so
woman alone to make. Finland, Norway, and Iceland little publicity that even large segments of the medical
have long had liberal policies, but they fall short of community as well as the public were unaware of it for
availability on request. Laws against abortion in Greece the first few years. For those who knew, high costs and
and the Netherlands have been neither observed nor excessive red tape were effective deterrents. For at least
enforced and soon may be reversed. The same was the first three years, the number of legal abortions was
formerly true of Switzerland, which in 1975 moved to extremely low (41,000 in the first five months), while the
liberalize its abortion laws. Great Britain has in effect number of nonmedical illegal abortions was appallingly
permitted abortion on request since 1967. Spain, Por- high (at least 4 million a year).51
tugal, Belgium, and Ireland still had very restrictive laws Elsewhere in Asia, abortion has been legalized in
in 1976.4' South Korea (1973), North Vietnam (1971), Hong Kong
In most of Eastern Europe, abortion has long been (1972), and Singapore (1969, further liberalized in 1974).
legal and usually subsidized by the state. Abortion has Abortion is firmly illegal in Taiwan, but apparently
been legal since 1920 in the Soviet Union, and in most easily obtainable from medical practitioners, nonethe-
Eastern European countries (except Albania) since the less. Laws are still restrictive in Indonesia, Pakistan, Sri
Lanka, Thailand, and the Philippines, but there are signs
•"L. Zanetti, The shame of Italy.
50
"Zimmerman, Abortion, law and practice; C. Tietze and M. C. Teitze and Murstein, Induced abortion; Charles F. Westoff, The
Murstein, Induced abortion: a factbook, 1975. These two are the major populations of the developed countries.
sources for what follows. 51
The abortion dilemma, Atlas, November 1974, pp. 16-18.
POPULATION POLICIES / 759

that they may soon be changed in several of these 400,000 women per year are treated in hospitals for
countries. illegal abortions; the abortion rate is conservatively
In the Middle East and North Africa, laws are estimated at one-fourth the birth rate.53 For South
generally very restrictive, except in Tunisia (which has America as a whole, some authorities believe that one-
had abortion on request in the first trimester since 1973) fourth of all pregnancies end in abortion; others estimate
and Cyprus, which partially liberalized its law in 1974. that abortions outnumber births.
Israel's tough anti-abortion law was weakened by a Liberalizing abortion laws in various countries has
challenging court decision in 1952 and is seldom ob- been shown to have two important effects. The first is a
served today. Abortions reportedly are also available very large decline in maternal deaths and morbidity
through medical facilities in Egypt despite a strict (illness) associated with illegal abortion. The degree of
anti-abortion law. reduction of death and illness depends on the degree of
In Africa south of the Sahara, abortion is generally change in the law, the previous rate of illegal abortions,
prohibited (the exceptions being Zambia since 1972 and and how they were usually performed (i.e., self-inflicted
some liberalization in South Africa). Ironically, these under unsanitary circumstances or performed clandes-
restrictive laws are holdovers from colonial times; they tinely by medical personnel). The number of annual
are not rooted in local culture.52 abortion deaths in the U.S. dropped from over 150 per
Abortion is still illegal in most Latin American year before 1970 to 47 (25 of which were from illegal
countries, although laws have recently been relaxed to abortions) in 1973; in England the decline was from 60
permit it under certain circumstances in El Salvador, before 1968 to 11 in 1974.54 Declines in many European
Guatemala, Mexico, Panama, Brazil, Chile, Argentina, countries and LDCs, where crude self-abortion has been
Ecuador, and Peru. Abortion essentially on request is more common, will probably be much greater. Con-
available only in Uruguay and Cuba (since 1968 in both versely, the number of deaths in Romania, where abor-
cases). tion regulations were tightened, rose from about 70 in
Illegal abortion is rampant in Latin America. Contra- 1965 to over 370 in 1971.»
ceptives are legally available in most Latin American The other result of liberalizing abortion laws is to
countries, but in practice only accessible to the rich. The provide such services safely to low-income women.
illiterate poor, who make up a large share of the Latin When abortion is illegal, the rich can usually still obtain a
American population are generally unaware of the exis- safe illegal procedure or can afford to travel to another
tence of birth control other than by ancient folk methods, country where legal abortion is available. The poor have
and could not afford modern methods even if they knew no such options; it is they who suffer most either from the
of them. There are exceptions where governments and burdens of large families or from dangerously unsafe
volunteer organizations such as Planned Parenthood illegal abortions.
have established free birth control clinics (see next
section). Although these can help, they as yet reach only a The moral issue. The greatest obstacles to freely
small fraction of the population, mainly in cities. In rural available, medically safe abortion in many developed
areas where hunger and malnutrition are often wide- countries and in Latin America are the Roman Catholic
spread, a failure of primitive birth control methods Church and other religious groups that consider abortion
leaves women with no alternative but to practice equally immoral. The crux of the Catholic argument is that the
crude forms of abortion. embryo is, from the moment of conception, a complete
In the 1960s bungled abortions were estimated to individual with a soul. In the Catholic view, induced
account for more than 40 percent of hospital admissions abortion amounts to murder. Some Catholics also oppose
in Santiago, Chile. In that country, an estimated one- 53
/4r/as, The abortion dilemma; Tuckwell, Abortion, p. 20.
third of all pregnancies end in abortion. In Mexico, '4C. Tietze and M. C. Murstein, Induced Abortion: a factbook. The
rate of abortion deaths was declining during the 1960s, especially after
1967 when several states relaxed laws to permit more legal abortions.
"Sue Tuckwell, Abortion, the hidden plague. "Ibid.
POPULATION POLICIES / 761

will lead to genocide. It is hard to see how this could According to at least one study, availability of abortion
happen if the decision is left to the mother. A mother who (legal or illegal) may be necessary in order for a
takes the moral view that abortion is equivalent to population to reach and maintain fertility near replace-
murder is free to bear her child. If she cannot care for it, ment level, given current contraceptive technology and
placement for adoption is still possible in most societies. patterns of sexual behavior.59 Liberalization of abortion
Few people would claim that abortion is preferable to policies in those countries where it is still largely or
contraception, not only because of moral questions, but entirely illegal is therefore justifiable both on humani-
also because the risk of subsequent health problems for tarian and health grounds and as an aid to population
the mother may be greater. Death rates for first- control.
trimester, medically supervised abortions are a fraction
of those for pregnancy and childbirth but considerably
higher in later months.58 Large and rapidly growing POPULATION POLICIES IN
numbers of people nevertheless feel that abortion is LESS DEVELOPED NATIONS
vastly preferable to the births of unwanted children,
especially in an overpopulated world. Until more effec- In response to rising alarm during the 1950s over the
tive forms of contraception than now exist are developed, population explosion in less developed countries, both
and until people become more conscientious in use of private and governmental organizations in the United
contraceptives, abortion will remain a needed back-up States and other nations began to be involved in popula-
method of birth control when contraception fails. tion research and overseas family planning programs.
Attitudes on abortion have changed in most countries First among these, naturally, was the International
in recent years, and they can reasonably be expected to Planned Parenthood Federatiork which grew out of the
change more in the future. The female part of the world's established national groups. By 1975 there were Planned,,
population has long since cast its silent vote. Every year Parenthood organizations in 84 countries, supported by
over one million women in the United States, and an their own governments, private donations, government
estimated 30 to 55 million more elsewhere, have made grants from developed countries, or some combination of
their desires abundantly clear by seeking and obtaining these sources.60
abortions. Until the 1970s, these women were forced to Various other private and governmental organizations
seek their abortions more often than not in the face of followed Planned Parenthood into the field, including
their societies' disapproval and of very real dangers and the Ford and Rockefeller Foundations, the Population _
difficulties. Millions still must do so. Council, the U.S. Agency for International development
There is little question that legalized abortion can (AID), and agencies of several other DC governments.
contribute to a reduction in birth rates. Wherever liberal International organizations such as the World Bank and
laws have been enacted, they have been followed by various UN agencies, particularly the UN Fund for
lowered fertility. Longstanding evidence is available Population Activities,, had joined bv 197CL The 1960s
from Japan and Eastern Europe, where abortion was the brought a great proliferation of family planning pro-
primary effective form of birth control available for some grams in LDCs, which were assisted or administered by
years after liberalization, and where the decline in one or another of these groups. Most assistance from
fertility was substantial. The extent of decline is bound DCs was provided through one of the international or
to be related to the availability of other birth control private organizations. In 1960 some $2 million was spent
methods; but even in the United States and England, by developed countries (and the U.S. was not then among
where contraceptives have been widely available, the them) to assist LDC family planning programs; by 1974
decline in fertility after reversal of abortion policies was 59
C. Tietze and J. Bongaarts, Fertility rates and abortion rates:
significant. simulations of family limitation, Studies in familv planning, vol. 6, no. 5.
May 1975, p. 119.
^Population Reference Bureau, World population growth and response,
58
Tietze and Murstein, Induced abortion. pp. 243-248.
TABLE 13-2
Family Planning in LDCs

Population Have official support


(millions, Have an official policy to of family planning Neither have policy nor
1975) reduce population growth rate for other reasons support family planning

400+ People's Republic of China (1962)


India (1952, reorganized 1965)

100-400 Indonesia (1968) Brazil (1974)

50-100 Mexico (1974) Nigeria (1970)


Pakistan (1960, reorganized 1965)
Bangladesh (1971)

25-50 Turkey (1965) Zaire (1973) Burma


Egypt (1965) Ethiopa
Iran (1967) Argentina
Philippines (1970)
Thailand (1970)
South Korea (1961)
Vietnam (1962 in North)

15-25 Morocco (1968) Tanzania (1970) North Korea


Taiwan (1968) South Africa (1966) Peru
Colombia (1970) Afghanistan (1970)
Sudan (1970)
Algeria (1971)

10-15 Nepal (1966) Venezuela (1968)


Sri Lanka (Ceylon) (1965) Chile (1966)
Malaysia (1966) Iraq (1972)
Kenya (1966) Uganda (1972)

Less than 10 Tunisia (1964) Cuba (early 1960s) Cameroon


Barbados (1967) Nicaragua (1967) Angola
Dominican Republic (1968) Syria (1974) Malawi
Singapore (1965) Panama (1969) Jordan
Hong Kong (1973) Honduras (1966) Lebanon
Jamaica (1966) Dahomey (1969) Saudi Arabia
Trinidad and Tobago (1967) Gambia (1969) Syria
Laos (1972, possibly discontinued) Rhodesia (1968) Yemen
Ghana (1969) Senegal (1970) Mali
Mauritius (1965) Ecuador (1968) Upper Volta
Puerto Rico (1970) Honduras (1965) Mozambique
Botswana (1970) Benin (early 1970s) Burundi
Fiji (1962) Haiti (1971) Central African Republic
El Salvador (1968) Papua-New Guinea (1969) Chad
Gilbert and Ellice Islands (1970) Paraguay (1972) Comoros
Guatemala (1975) Liberia (1973) Congo
Grenada (1974) Lesotho (1974) Equatorial Guinea
Bolivia (1968, reorganized 1973) Western Samoa (1971) Guinea-Bisseau
Costa Rica (1968) Madagascar (1974) Ivory Coast
El Salvador (1968) Sierra Leone (early 1970s) Libya
Swaziland (1969) Mauritania
Togo (early 1970s) Niger
Zambia (early 1970s) Rwanda
Cambodia (1972, possibly discontinued) Seychelles
Guyana (1975) Somalia
Surinam (1974) Namibia
Uruguay (1971) Israel
Other small Caribbean countries (1960s)
Sources: Berelson, Population control programs; Nortman, Population and family planning programs, 1975; Population Reference Bureau, World
population growth and response.
POPULATION POLICIES 763

•the amount was over $200 million, more than half of it contrast, still want to increase their usually already rapid
from USAID. Yet less than two percent of all foreign growth. Many others are beginning to reevaluate their
assistance goes to LDC family planning programs, and pronatalist policies as consequences of rapid growth
most LDCs allot less than one percent of their budgets become increasingly evident. The following discussion
to it.61 sums up these various approaches by continent.65
During the 1960s national family planning programs
were established in some 25 LDCs, while 17 other Africa. Africa, an extremely diverse continent, grow-
governments began supporting or assisting the activities ing at about 2.6 percent per year, includes some of the
of private Planned Parenthood organizations. The early world's poorest and most rapidly growing nations. Be-
1970s saw a further proliferation of these programs until cause high mortalities, especially of infants, are also
by 1975,34 less developed countries officially favored the commonly found in these countries, concern over rapid
reduction of population growth, and 32 more supported growth and action to curb it have developed only
family planning activities for other reasons. Some 55 relatively recently in most of them. Indeed, some African
additional LDCs still did not support family planning, or governments remain staunchly pronatalist.
in a few cases opposed it. But the combined 1973 The belief that more people are needed for develop-
populations of the pro-family planning countries were ment is common among African nations south of the
nearly 2.5 billion, whereas the total combined population Sahara. Policies in Cameroon, Malawi, and Upper Volta
of the anti-family planning nations was only about 250 still frankly favor growth, while Zambia and the Mala-
million.62 Table 13-2 shows details. gasy Republic have only recently reversed their positions
(in 1975). Concern about poorly controlled migration is
Government Policies in LDCs greater in many of these countries than concern about
high birth rates.
So far family planning programs are the primary In general, family planning on a private basis has long
policies that have been brought into action against the been available in former African colonies of England,
population explosion in most LDCs. Outstanding ex- but not in those of such Catholic countries as France,
ceptions are the People's Republic of China,63 Indonesia, Belgium, Spain, Italy, and Portugal. Former English
India, Pakistan, South Korea, Singapore, Tunisia, Egypt, colonies were among the first to establish national family
and a few other countries where other social and eco- planning policies, although emphasis in some cases is put
nomic policies have been adopted to supplement family on health and family welfare justifications. Kenya and
planning.64 However, many family planning programs Ghana have two of the oldest and strongest family
have been established and are even being supported by planning programs in subSaharan Africa, and both have
governments for reasons other than reduction of popula- goals of reducing population growth. Interest in family
tion growth, usually to protect the health and welfare of planning at least for health reasons is growing in most
mothers and children. Although no country has yet former English colonies, although a few such as Malawi
adopted attainment of ZPG as a goal, many have aimed at still discourage or ignore the activities of private family
an ultimate reduction of growth rates to DC levels— planning organizations. Nigeria, the most populous and
around 1 percent per year or less. A few countries, by one of the richest (in terms of resource endowment)
"Dorothy Nortman, Population and family planning programs: A African countries, was only beginning to show interest in
factbook, 1974. Population Reference Bureau, World population growth family planning for health reasons in 1976, despite rapid
and response.
W
D. Nortman, Population and family planning programs, 1974 and growth.
1975.
"See Edgar Snow, Report from China—III: population care and "For country-by-country details of policies and recent demographic
control, for an early report on China. More recent reports have generally trends, Population Reference Bureau, World population growth and
confirmed that first impression: for example, Pi-Chao Chen, China: response, prepared with the assistance of the U.S. Agency for International
population program at the grass roots, in Population: perspective 1973, H. Development, is invaluable.Schroeder and Vumbaco each provide useful
Brown, J, Holdren, A. Sweezy, B. West, eds, summaries, as does the more recent D. Nortman and E. Hofstatter,
M
Vumbaco, Recent law and policy changes. Population and family planning programs: a factbook, 1976.
764 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

In South Africa and Rhodesia, the dominant European reduced, especially among infants and children. R is
populations have traditionally practiced birth control. vitally important to change this point of view so that
These countries are now trying to extend family plan- efforts can be made to lower birth rates along with death
ning services to their African populations. South Africa's rates; that most family planning efforts have begun in
family planning is offered through its Planned Parent- African countries as a part of maternal and child health
hood affiliate and funded by the government; Rhodesia's services is an encouraging sign.
services are government-supported, but operated by
several private international groups. Latin America. Latin America as a region, despite
Former French colonies have begun to relax their having some of the highest population growth rates in the
prohibitions to allow the commercial sale of contracep- world (about 2.9 percent for the entire region), has also
tives and to support some family planning activities. The been very reluctant to accept a need for population
first family planning clinics in French-speaking conti- control. This is probably due in part to the influence of
nental Africa have been established in Senegal, whose the Roman Catholic Church, but there is also a wide-
government is beginning to show interest in family spread belief, at least in South America, that the conti-
planning. Most former French colonies, however, re- nent still contains vast untapped resources of land and
main complacent about their rates of population growth. minerals, that the answer to all problems is development,
An exception is Mauritius, an island nation with one of and that more people are needed for development. Latin
the highest population densities in the world (see Chap- American politicians, moreover, tend to view proposals
ter 5). Mauritius has a vigorous and comparatively originating in the United States for birth control with
successful family planning program. Since the 1950s, the understandable suspicion. Some seem to believe the U.S.
growth rate has been reduced to about 2.1, despite an is trying to impose a new and subtle form of imperial-
unusually low death rate of 7 per 1000 population. ism.66 In some countries, this reaction has even had the
The Portuguese colonies, Mozambique and Angola, effect of inhibiting the teaching of demography and
remained pronatalist and strongly opposed to birth family planning in universities.
control until they achieved independence in 1975. Es- Latin American economists and politicians have come
tablishment of population programs must await the to accept family planning (often referred to as "respon-
stabilization of the new governments. sible parenthood") mainly on health and welfare grounds
Some North African countries have initiated family and as a means of reducing the horrendous illegal
planning programs; Egypt, Tunisia, and Morocco have abortion rate. Some leaders are beginning to realize,
fairly strong, antinatalist policies. Tunisia, in particular, however, that the galloping population growth rate is
has ventured beyond family planning to legalize sterili- swallowing all the economic progress each year, leaving a
zation (considered immoral and against Moslem law in per-capita rate of progress of zero or less. A few countries
most Islamic countries) and abortion, to limit financial have established essentially, though not always explic-
allowances for children to four per family, raise the legal itly, antinatalist policies as a result—notably Chile.
marriage age, and ban polygamy. In addition, women's Colombia, several Caribbean countries, and all of the
rights, usually very restricted in Moslem societies, are Central American countries. The efforts of some family
being promoted. Some other North African countries— planning programs in the Caribbean (mainly former
Algeria, Libya, Mauritania—remain pronatalist or British colonies) have been counted among the most
uninterested. successful, especially those of Barbados and Trinidad
Many African countries still have death rates above 20 and Tobago. Birth rates have declined there since the
per thousand, and some even more than 30. A number of early 1960s, and have declined as well in Chile, Colom-
demographers and family planning officials believe that bia, Costa Rica, Nicaragua, Panama and Venezuela.
interest in population control will remain low in those "National Academy of Sciences, In starch of population policy: views
countries until the death rates have been substantially from the developing world; Population policy in Latin America.
POPULATION POLICIES / 765

At the other extreme, Brazil and Argentina have activity in the private sector. Among these is Israel, for
policies generally promoting growth. Brazil does permit obvious reasons. At the furthest extreme is Saudi Arabia,
private family planning groups to operate, however, which has outlawed importation of contraceptives.
especially in the poverty-stricken Northeast. Argentina, Nearly all Middle Eastern countries are growing rapidly
having a relatively low birth rate and feeling threatened with relatively high, although declining death rates.
by rapidly growing Brazil, in 1974 banned dissemination
of birth control information and closed family planning The United Nations. For many years, the United
clinics. Since the practice of birth control is well Nations limited its participation in population policies to
established in the Argentine population, the action is not the gathering of demographic data. This, however, was
likely to have great effect except perhaps to raise the instrumental in developing awareness of the need for
already high abortion rate, mostly illegal. population policies, especially among LDCs, whose
governments often had no other information about their
Asia. Asia includes over half of the human population population growth. Since the late 1960s the UN has taken
and is growing at about 2.3 percent per year. Both an active role in coordinating assistance for and directly
mortality and birth rates are generally lower than those in participating in family planning programs of various
Africa, and both have been declining in several countries. member nations, while continuing the demographic
Asia presents a widely varied picture in regard to studies. A special body, the UN Fund for Population
population policies. At one extreme, China, India, Thai- Activities (UNFPA), advises governments on policies
land, Indonesia, Sri Lanka, Hong Kong, Singapore, and programs, coordinates private donors and contribu-
Taiwan, and South Korea are pursuing strong family tions from DC governments, and sometimes directly
planning policies, in several cases reinforced by social provides supplies, equipment, and personnel through
and economic measures, some of which are described other UN agencies.
below. All of these countries have recorded declines in In 1967 the UN Declaration on Social Progress and
birth rates, some of them quite substantial. Family Development stated that "parents have the exclusive
planning programs have also been established in Paki- right to determine freely and responsibly the number and
stan, Bangladesh, Nepal, Malaysia, and the Philippines, spacing of their children."67 The statement affirmed the
but the impact, if any, on birth rates is negligible so far. UN's increasing involvement in making family planning
A few rapidly growing countries, notably Cambodia available to all peoples everywhere and contained an
and Burma, currently are pursuing pronatalist popula- implicit criticism of any government policy that might
tion policies, although family planning is privately deny family planning to people who wanted it. The
available in the latter country. Other "centrally planned" statement has sometimes been interpreted as a stand
countries in Southeast Asia seem to be following China's against compulsory governmental policies to control
example in population policies; North Vietnam has had a births; however, the right to choose whether or not to
family planning program for some time, which presum- have children is specifically limited to "responsible"
ably was extended to South Vietnam when the nation was choices. Thus, the Declaration also provides govern-
unified. Policies in North Korea are unknown. ments with the right to control irresponsible choices.
Middle Eastern nations are still largely pronatalist in In 1974 the United Nations' World Population Con-
their outlook, with the exceptions of Turkey and Iran ference, the first worldwide, government-participating
which have national family planning programs. Several forum on the subject, was convened in Bucharest.
countries, including Afghanistan, Bahrain, Cyprus, Iraq, Publicity attending the event gave an impression of
Jordan, Lebanon, and Syria, are interested in establish- enormous disagreement among participating groups. But
ing family planning services for health and welfare in fact it provided a valuable forum for an exchange of
reasons. The remaining countries favor continued "Declaration on Population, Teheran, 1968, Studies in Family Plan-
growth, although they may tolerate family planning ning, no. 16, January, 1967.
BOX 13-6 China: An Apparent Success Story
Any brief treatment of Chinese society is We believe China's policy benefits many aspects
difficult and necessarily contains elements of of life—national construction, the emancipation of
overgeneralization. First of all, the huge geo- women, protection of mothers and women and
graphical expanse and the vastness of the popu- children, proper bringing up of the young, better
health for the people and prosperity for the nation. It
lation—nearly a billion people—are difficult to is, in other words, in the interests of the masses of the
envision. Second, the Chinese people possess a people.''
cultural diversity possibly as rich as that of
In recent years, as China has begun to open up
Europe, and even older traditions. Finally, it
to the outside world, it has become increasingly
seems that there is no overall, systematic keeping
clear not only that "birth planning," as it is
of vital statistics and population figures in China,
called, is seriously advocated and supported by
and those statistics that do exist are not readily
available to outsiders. The Chinese are tradi- the government, but that it has begun to reap
results. Exactly how successful the policy has
tionally xenophobic, and the Western intrusion
of the last century and a quarter—from the been overall is impossible to say because there
Opium Wars through the United States debacle are no reliable nationwide population statistics.
in Vietnam and Soviet pressure on northern The last reasonably comprehensive census was
conducted in 1953 (when a total mainland popu-
Chinese borders—have only heightened this tra-
lation of about 583 million was found), and
ditional aloofness. The available information is
estimates of vital rates since then are basically
therefore fragmentary and has to some extent
guesswork.1' Hence the estimates of total popu-
been filtered by a highly centralized and auto-
lation in 1975 range from below 800 million to
cratic regime. Still, the accounts of foreign
962 million/ China specialist Leo Orleans has
travellers in China and the release of official
statements and figures allow some conclusions to proposed a set of estimates and projections of
be drawn about the nature of population policy China's population from 1954 to 1980, and his
arguments in support of them are convincing. He
in the People's Republic."
Superficially, the expressed population poli- suggests that the 1975 population was about 850
cies of the People's Republic of China seem million, with a birth rate of 27 per thousand, a
slightly schizophrenic. Official rhetoric preached death rate of 12 per thousand, and a natural
abroad roundly condemns Malthusian ideas: increase of 1.5 percent. These figures are slightly
"The poor countries have not always been poor. above those of the UN.
Nor are they poor because they have too many China's efforts to curb population growth
people. They are poor because they are plun- began in the 1950s following the release of the
dered and exploited by imperialism."6 The same census results and a period of heated discussions
article goes on to blame "relative overpopulation of the pros and cons of birth control. An
and widespread poverty" in the United States organized campaign implemented by the Minis-
and the Soviet Union on "ruthless oppression try of Public Health was launched in 1957 but
and exploitation which the superpowers practice then was suspended in 1958 during the Great
at home." Leap Forward, an intensive effort at economic
But, despite assertions that there is no such development. The period 1959-1961 was one of
thing as overpopulation, China admits to having food shortage and economic crises, and, although
a policy of "planned population growth," with established birth control clinics continued to
this rationale: Ibid.
rf
Leo A. Orleans, China: Population in the People's Republic.
We do not believe in anarchy in material produc- This is an excellent source for historical background, although
tion, and we do not believe in anarchy in human otherwise somewhat out of date.
c
reproduction. Man must control nature, and he must Orleans, China's population figures: Can the contradictions be
also control his numbers. . resolved? The lowest are based on casual statements by Chinese
officials at the UN; the highest are from the World Population
Estitnates of the Environmental Fund, which bases its estimates
"For a recent overview, see International Planned Parenthood on the figures of John Aird, a demographer in the U.S.
Federation, China 1976: a new perspective. Department of Commerce Foreign Demographic Analysis
'China on the Population Question, China Reconstructs. Division.
POPULATION POLICIES / 771

function, there was no official encouragement for 1000 population in 1949 to about 17 per 1000 in
their use. 1970* and perhaps 13 in 1974.j Infant mortality,
While China was recovering from this crisis which fairly accurately reflects levels of both
period, the government again began advocating health care and nutrition, is thought to have been
"birth planning" to protect the health of mothers between 20 and 30 per 1000 births in 1974.k In
and children. An important part of this campaign some urban communes (which apparently do
was promotion of late marriage (23 to 25 for keep careful demographic statistics), the crude
women, 25 to 28 for men) and the two-child death rate is 5 or less, and an infant mortality rate
family spaced by 3 to 5 years/ Both abortion and of 8.8 per 1000 live births has been claimed for
sterilization were legal from the start, but the the city of Shanghai.'
middle 1960s were a period of active expansion China's unique health care system, together
of facilities (along with expansion of health care with greatly improved distribution of the food
in general) and experimentation in improved supply, can claim credit for this remarkable
techniques. It was men that the Chinese devel- change. At the time of the Revolution, a grossly
oped the vacuum technique for abortion, which inadequate corps of trained medical personnel
has made the procedure much safer than before, existed, mainly concentrated in the large cities.
and which has since been adopted around the While actively training thousands of doctors,
world. Active research was also carried out on paramedics, and nurses and establishing hospi-
simplified sterilization procedures. It appears, tals and health centers in smaller cities, the
for instance, that the Chinese may have been the Chinese also promptly tackled sanitation and
first to do female sterilizations with very small hygiene at the grass-roots level through educa-
incisions." tional campaigns.
China has all along manufactured all its own More recently, selected people have been
contraceptive devices and Pharmaceuticals, un- given four to six months' basic medical training
like other LDCs. The latest invention is the and assigned part-time to care for basic health
"paper pill," sheets of water-soluble paper im- needs in their production brigades. These indi-
pregnated with oral contraceptives, which are viduals are called "native doctors" in the cities
easy to transport, store, and distribute.* Each and "barefoot doctors" in the country. Their
sheet contains a month's supply of "pills" in responsibilities include giving injections and
perforated squares that dissolve in the mouth innoculations, administering first aid and simple
when eaten. This development is expected to treatments for diseases, supervising sanitation
increase use of oral contraceptives considerably, measures, teaching hygiene in schools, and dis-
especially in remote rural areas where the pills tributing contraceptive materials. For medical
have been less accepted than in the cities. treatment beyond their competence (including
Virtually every method of birth control is abortions and sterilizations), the barefoot doctors
being actively used in China: sterilization, abor- refer patients to the nearest regional hospital.
tion, the combined steroid pill and the progestin Barefoot doctors in turn are assisted by part-time
mini-pill, long-term injections, lUDs (the Chi- volunteer health aides, usually housewives,
nese developed their own, a stainless steel ring), whom they train themselves.'"
condoms, diaphragms, foams, and jellies. It now appears that China is attempting to
The various forms of birth control have long upgrade the quality of grass-roots health care by
been available to the people in the major cities sending fully trained medical personnel from
and their suburbs. During the 1960s, health care, city hospitals on rotation to rural health centers,
including birth control services, was increasingly where, among other things, they provide addi-
extended to more remote rural areas. As an tional training for local health workers. Some
indication of the success of the health care barefoot doctors have thereby become qualified
programs, the death rate for the entire country is to do abortions, IUD insertions, and steriliza-
estimated to have dropped from nearly 35 per
'Orleans, China: Population in the People's Republic.
Ti-Chao Chen, China's population program at the grass-roots 'Norman Myers, Of all things people are the most precious.
level. "•Ibid.
'Orleans, Family planning developments in China, 1960- 'Joe Wray, How China is achieving the unbelievable.
1966: abstracts from medical journals. '"Pi-Chao Chen, China's population program at the grass-roots
*Carl Djerassi, Fertility limitation through contraceptive level; V. W. Sidel and R. Sidel, The delivery of medical care in
steroids in the People's Republic of China. China.

(Continued)
BOX 13-6 (Continued)
tions, as well as other minor operations." sons. Large numbers of urban youth are a
Both child bearing and birth control are fully potential source of insurgent trouble, especially
supported and helped in China, Paid maternity if insufficient jobs are available. Scattering the
leave, time off for breast-feeding, free nursery young people in the countryside could effec-
care, and all needed medical attention are pro- tively defuse that threat. Moreover, the relatively
vided for mothers. Paid leave is also given for well-educated city youth could help spread the
abortion, sterilization, and IUD insertions, and ideology of the central government to remote
all birth control services are essentially free. rural areas. But it appears that the policy may
While the means of birth control are provided also have had demographic effects. Most of the
through the health care system in China, primary city children are not happy down on the farm;
responsibility for motivating couples to make use consequently, they are reluctant to marry, settle,
of them rests with the Revolutionary Committee and raise families there. Nor are rural young
(or governing council) of the production brigade people eager to marry the sophisticated city
or commune. Usually one member of the com- people with their strange ways.'
mittee is the "responsible member" for birth The official Chinese position on birth plan-
planning.0 In rural areas, "women's cadres" — ning—an ideal of late marriage and a small,
married women with children, who are known well-spaced family of two children—appears to
and respected by their neighbors—carry contra- have been overwhelmingly accepted in cities and
ceptives and the pro-birth control message house is rapidly gaining acceptance in rural areas,
to house." according to reports from foreign visitors." The
In some of the cities, low birth rates have been prevailing attitude is that early marriage and
so enthusiastically adopted as a goal that neigh- having more than two children are prime exam-
borhoods collectively decide how many births ples of irresponsible behavior. Nevertheless,
will be allowed each year and award the privilege there is still resistance from older generations,
of having babies to "deserving couples."" Prior- especially mothers-in-law, who by tradition have
ity is given to newlyweds, then to couples with long wielded considerable power within families
only one child who have waited the favored and apparently still do.
period of time for the second birth/ The result Besides official encouragement to limit fami-
has been phenomenally low birth rates for these lies, there are other incentives built into the
neighborhoods, ranging from 4 to 7 per 1000 social and economic system as well. Emancipa-
population. The center city of Shanghai report- tion of women and their incorporation as full
edly had a 1972 birth rate of 6.4, while that for working members of society was an early, im-
the city plus suburbs was 10.8.s The 1972 birth portant goal of the Revolution. It has apparently
rate for Peking was reported by Joe Wray to have been realized to a great extent, especially among
been about 14 per 1000 population; Myers younger women, and undoubtedly exerts a pow-
placed it at 18.8 for city and suburbs combined. erful influence on childbearing.
Joe Wray has speculated that these low rates Pi-Chao Chen has pointed out disincentives to
may have been helped by a relatively low pro- family limitation in the per capita grain allow-
portion of women in their child-bearing years. ance, which augments a family's supply when a
Given the recent Chinese policy of sending child is added, and in the addition of another
urban young people to rural areas to work, this worker (preferably a boy who will remain in the
may be so, even though China's demographic family) to contribute to family income.1' But it
history would indicate a relatively large and has also been observed that, even though another
growing proportion of people in their teens and worker may help increase a family's total income,
twenties for the country as a whole by 1975. that income must still be divided among all
Exiling young people "temporarily" to rural family members. Additional members reduce the
communes probably was done for political rea- share available per person."' Furthermore, since
"Chen, China's population program. 'Joseph Lelyveld, The great leap farmward.
"Wray, How China is achieving the unbelievable. "Tameyoshi Katagiri, A report on the family planning program
"Han Suyin, The Chinese experiment. in the People's Republic of China; Sidel and Sidel, Medical
"Wray, Achieving the unbelievable; Han, Chinese experiment. care; Han, Chinese experiment; Myers, People are the most
Treedman and Berelson, The record of family planning precious; Chen, China's population program; Wray, Achieving
programs. the unbelievable.
8
Wray, Achieving the unbelievable; Myers, People are the most ''Chen, China's population program.
precious. '"Sterling Wortman, Agriculture in China.
773

1. PERMANENTLY
compulsory primary education is rapidly be- STERILIZED
coming the rule in China, children's productivity Tubal ligation
is inevitably deferred at least until the teenage
years. Vasectomy
While there is no question whatever about the 2. PRACTICING
Chinese leadership's position on birth planning, CONTRACEPTION
Pill
coercion does not appear to be a part of the
program beyond the extensive use of peer pres-
sure and the dissemination of propaganda on all
levels. There were reports of curtailed maternal
benefits, reduced grain rations, and discrimina-
tory housing and employment assignments for 3. NOT PRACTICING
parents of three or more children in some areas CONTRACEPTION
during the 1960s, but these measures seem to
have been largely abandoned. Possibly they 10 20 30 -0
aroused more resentment than cooperation and
COUPLES (%)
were found to be less than beneficial to the
children.
FIGURE 13-4
By the mid-1970s, China's far-reaching pop-
ulation program evidently had been extended to Contraceptive practices in an urban area (light grey)
the far corners of the nation—no mean trick in and in a rural area (dark grey) in China are
itself. What the results have been is impossible to compared; the urban sample is from the city of
assess with accuracy, but it is becoming increas- Hangchow, a provincial capital, and the rural
ingly clear that they are significant indeed. The sample is from a commune outside Peking.
remarkable vital rates prevailing in major cities Sterilization is nearly three times commoner in
have already been cited, but those of rural the urban than in the rural sample, and
communes for which data exist, while higher substantially fewer rural males use contraceptives.
than the cities', show significant reductions from The bias seems to be reflected in the difference
pre-revolutionary levels (birth rate about 45, between urban and rural birth rates: below 10 per
death rate 34 to 40, infant mortality above 200). * 1000 in some urban areas and above 20 per 1000
Reported birth rates for rural districts in the in some rural ones. (From Sidel and Sidel, 1974.)
early 1970s range from as low as 14 in an area
near Shanghai" to 20-24 in communes near
Peking- and some others in more remote prov- If available estimates of vital rates for all of
inces.™ These areas generally report very low China reflect reality, there has already been a
death rates also. Levels of contraceptive usage in substantial reduction in birth and death rates.
urban and rural areas are compared in Figure Norman Myers of the FAO quotes birth rate
13-4. Certainly the communes visited by outsid- estimates for large cities of between 10 and 19
ers are among the most successful by Chinese per 1000 population, for medium-sized cities, 14
standards, and so their birth and death rates to 23, and for rural areas 20 to 35. He put the
should not be taken as representative of the national 1974 birth rate at 29 and the death rate at
entire country. But they may represent the 13, giving a natural increase of 1.6 percent per
leading edge of an established trend. That the year. Comparison of these estimates with those
policy has been so successful in many areas, of other Asian nations at similar levels of devel-
especially where it is long established, indicates opment is striking, to say the least. And no doubt
that similar success can be expected elsewhere in other less developed countries—and perhaps
time. some developed countries as well—can learn a
great deal from the Chinese experience.66
'Orleans, China: Population in the People's Republic.
"Katagiri, A report.
M
'Sidel and Sidel, Medical care. Chen, Lessons from the Chinese experience: China's planned
QS
Chen, China's population program. birth program and its transferability.
780

customs are also subject to varying attitudes and mores. employment outside the home, the provision of social
These conflicting attitudes allow societies to fine-tune security for old age, and the costs to families of raising
their responses to external changes without having to and educating each child. The more extensive each of
change the basic ideological structure itself. Thus, when these factors is, the lower fertility generally will be. In
overpopulation threatens food supplies, for example, addition, later marriage, lower tolerance for illegitimacy,
antinatalist behavior can be encouraged, and when low infant mortality, and extended breast-feeding all
epidemics or war have decimated a population, antina- operate directly to reduce fertility. In most LDCs, levels
talism can again be discouraged. Pronatalist attitudes are of health care, education, and women's status remain low
very strong in traditional societies because through most for the poor majority, while marriage comes early and
of humanity's evolutionary history they have been infant mortality rates are high.
needed to maintain populations and to allow a moderate Most family planning programs in the 1960s made
amount of growth when warranted. little effort to influence any of these factors, as demogra-
The sudden introduction of death control, Western pher Kingsley Davis pointed out in 1967.84 Those that
morality, and access to communications and other re- tried to influence people at all confined themselves to
sources, as Western technology impinged upon the emphasizing the economic and health advantages of
.underdeveloped world in the wake of the colonial era and small families to parents and their children.
World War II, disrupted social perceptions of the In the 1950s and 1960s, government officials, eco-
consequences of high birth rates in those areas. The nomic advisors, and many demographers believed that
impact was characterized by "rapid and fluctuating the process of economic development would automati-
changes in agricultural productivity, labor demand, cally bring about the higher levels of education and
urbanization, emigration, and military expansion, often urbanization in LDCs that have elsewhere been asso-
coupled with introduced epidemic disease."83 Because ciated with declines in fertility, and thus would cause
most of these disturbed societies have adopted Western a "demographic transition" in LDCs. These people
ideology, their traditional methods of controlling popu- favored family planning because they thought it would
lation have been abandoned and unfortunately replaced facilitate the supposedly inevitable demographic transi-
by less efficient and less desirable ones, mainly self- tion, although they believed that no significant reduction
induced abortion and disguised infanticide through in fertility could occur until the prerequisite (but
neglect, abuse, and even starvation. Dickeman concludes unknown) degree of development had been reached.
that the world population can only be controlled when Numerous studies have established quite clearly that
less developed societies are socially stabilized and inte- population growth is in itself a major barrier to economic
grated and the people can realistically assess their actual development. Economist Goran Ohlin wrote in 1967:
resource and ecological position. Then, she feels, the
The simple and incontestable case against rapid popu-
people will make reasonable family-size choices in lation growth in poor countries is that it absorbs very
accordance with that position. large amounts of resources which may otherwise be
used both for increased consumption and above all, for
The Demographic Transition development . . . The stress and strain caused by
rapid demographic growth in the developing world is
A great many social and economic factors have been actually so tangible that there are few, and least of all
associated in the past with declining fertility in various planners and economists of the countries, who doubt
societies. Among them are the general level of education, that per capita incomes would be increased faster if
the availability and quality of health care, the degree of fertility and growth rates were lower . . . .85
urbanization, the social and economic status of women
and the opportunities open to them for education and "Population policy: will current programs succeed? See also Davis,
Zero population growth: The Goal and the Means.
"Ibid. ^Population control and economic development, p. 53.
The potential value of population control in aid century Europe.88 And, as was pointed out in Chapter 5,
programs to LDCs has also been studied intensively. The conditions in contemporary LDCs in many ways are
late economist Stephen Enke did much of the analysis, markedly different from those in Europe and North
and his conclusions may be summarized in three points: America one to two centuries ago when fertility began to
(1) channeling economic resources into population con- decline there.
trol rather than into increasing production "could be 100 By the mid-1960s, although several LDCs had ap-
or so times more effective in raising per capita incomes in parently reached quite advanced degrees of industrial
many LDCs"; (2) an effective birth control program development, there was little sign of a general decline in
might cost only 30 cents per capita per year, about 3 fertility. Birth rates dropped in some countries, but they
percent of current development programs; and (3) the use remained high, or in a few cases even rose, in other,
of bonuses to promote population control is "obvious in supposedly eligible countries. Because of this unex-
countries where the 'worth* of permanently preventing a pected result, there has been some argument among
birth is roughly twice the income per head."86 demographers whether the theory of the demographic
Enke's results were strongly supported by computer transition can even be applied to LDCs and whether
simulation work by systems analyst Douglas Daetz, who there is good reason to hope that it will occur in most of
examined the effects of various kinds of aid in a them.
labor-limited, nonmechanized agricultural society.87 His An analysis of fertility trends in some Latin American
results brought into sharp question the desirability of aid countries (often cited as prime examples of nonconfor-
programs not coupled with population control programs. mity to demographic transition theory) by demographer
They might provide temporary increases in the standard Stephen Beaver indicates that a demographic transition
of living, but these would soon be eaten up by population has begun or is at least incipient in the countries he
expansion. In many circumstances, population growth examined.89 But, he suggests, cultural and economic
and aid inputs may interact to cause the standard of living factors can cause time lags in the process. A considerably
to decline below the pre-aid level. broader spectrum of factors may influence fertility than
As a result of studies like Ohlin's, Enke's, and Daetz', just reduced mortality (especially of infants), increasing
family planning began to be incorporated into assistance urbanization, and industrialization, which are classically
programs for LDCs in the 1960s. But the purpose in most believed to be the primary causes of declining fertility.
cases was only to reduce growth rates to more "manage- It is becoming increasingly clear that industrializa-
able" levels by eliminating "unwanted births." This tion—the style of development undertaken by most
great faith of economists and demographers in the developing countries—is not conducive to a demo-
potential of industrial development to bring about a graphic transition. This seems to be so because industry
spontaneous demographic transition, which, aided by in most LDCs employs and benefits only a fraction of the
family planning, would reduce population growth and population, creating a two-tiered society in which the
accelerate the development process, encouraged LDC majority are left untouched by modernization.90 Such
governments to relax under the illusion that all their unequal distribution of the benefits of modernization
social and economic problems were being solved. Un- (access to adequate food, clothing, decent shelter, educa-
fortunately, their faith was misplaced. tion, full-time employment, medical and health care,
Reliance on a demographic transition was misplaced etc.) is most pronounced in rural areas, where some 70
for many reasons, not the least of which is uncertainty as percent of the population of LDCs live.
to exactly what caused the original one in nineteenth- ss
Michael S. Teitelbaum, Relevance of demographic transition theory
for developing countries; Alan Svreezy, Recent light on the relation
""Birth control for economic development. between socioeconomic development and fertility decline.
*~ Energy utilization and aid effectiveness in non-mechanised agriculture: ^Demographic transition theory reinterpreted.
a computer simulation of a socioeconomic system. PhD. diss.. University of '"James E. Kocher, Rural development; and James P. Grant, Develop-
California, 1968. ment: the end of trickle down?
55

Ethiopia
•-Afghanistan
Algeria
Nigeria • Iran
Sudan* • "Kenya .
Morocco • Iraq
• Tanzania
Indonesia _. Uganda
• • Nepal North Korea
~ Pakistan
• Zaire

Philippines • • •

Bangladesh Colombia Mexico
Thailand •
cc India •
Peru
LU South Vietnam •
Q_ Burma South Africa Venezuela
CC
Turkey •
<
LU
> Malaysia
North Vietnam •
Eg'ypt Brazil

03
35
I
F
cc
CD

• China
30
Sri Lanka
South Korea

25

Taiwan
Argentina
20
75 100 150 250 400 600 1000 1500

GROSS NATIONAL PRODUCT ($ PER CAPITA)

FIGURE 13-5

There is an absence of any clear relation between the birth rate and the level of development (as
measured by per-capital GNP) in the less developed countries with more than 10 million population.
A decline in birth rates has occurred recently in a number of these nations. (From Demeny, 1974.)

Per capita Gross National Product is a statistic often Economist Alan Sweezy has pointed out that, while
used to measure the extent of "development" that has this explanation may account for fertility declines in
taken place in a given country; per-capita GNP, however, some instances, the expected declines have not occurred
is an averaged figure that may conceal very large differ- in some countries—notably in Latin America—even
ences among income groups. And the correlation of among the affluent and middle classes.90" He suggests
degrees of development as measured by per-capita GNP that lingering strong traditions, including pro-natalist
with reduction in fertility is extremely mixed, to say the attitudes, may be a reason. In Latin America such
least (Figure 13-5). One explanation is that, in strongly traditions are supported by the Roman Catholic Church,
two-tiered societies, birth control may be adopted by the which still officially opposes "artificial" methods of birth
affluent, educated minority, but not by the majority still control and abortion.
living in poverty. The conclusion from this is that If a demographic transition should take place in
fertility will decline significantly only when the benefits
of modernization are extended to all economic levels. ""'Economic development and fertility change.
POPULATION POLICIES / 783

LDCs, a decline from present high fertility to replace- been reluctant to try measures beyond traditional family
ment level alone would require considerable time, prob- planning that might be effective because they considered
ably at least a generation. And time is running very short. them too strong, too restrictive, and too much against
If appropriate kinds of development and vigorous family traditional attitudes. They are also, reasonably enough,
planning programs had been initiated just after World concerned about resistance from political opponents or
War II, when death control and the ideas of economic the populace at large. In many countries such measures
assistance were first introduced in LDCs, the population may never be considered until massive famines, political
problem might be of more manageable dimensions unrest, or ecological disasters make their initiation im-
today. But plainly it would still be with us. Without such perative. In such emergencies, whatever measures are
a history, even if the strongest feasible population control economically and technologically expedient will be like-
measures were everywhere in force today, the time lag liest to be imposed, regardless of their political or social
before runaway population growth could be appreciably acceptability. A case in point was the sudden imposition
slowed, let alone arrested, would still be discouragingly in 1976 of compulsory sterilization in some Indian states
long. For most LDCs it will be at least four generations and for government employees in Delhi, following two
before their populations cease to expand—unless catas- decades of discouraging results from voluntary family
trophe intervenes—because of the age composition of planning.
their populations. Even if replacement reproduction People should long ago have begun exploring, devel-
were attained by 2005, most LDC populations would at oping, and discussing all possible means of population
least double their 1970 populations, and some would control. But they did not, and time has nearly run out.
increase 3.5-fold!*1 Policies that may seem totally unacceptable today to the
This built-in momentum virtually guarantees that, for majority of people at large or to their national leaders
many less developed countries, shortage of resources and may be seen as very much the lesser of evils only a few
the environmental and social effects of overpopulation years from now. The decade 1965-1975 witnessed a
will combine to prevent sufficient "development" to virtual revolution in attitudes toward curbing population
induce a demographic transition. Complacently counting growth among LDC leaders, if not necessarily among
on either a spontaneous demographic transition or on their people. Even family planning, easily justified on
voluntary family planning programs—or even a combi- health and welfare grounds alone and economically
nation—to reduce population growth and thereby ensure feasible for even the poorest of countries, was widely
successful development would therefore be a serious considered totally unacceptable as a government policy
mistake. The establishment of family planning programs as recently as 1960.
may make it easier to improve social conditions in poor Among objections to population control measures
countries, but it is no substitute for appropriate develop- cited by demographer Bernard Berelson in 1969 were the
ment; and it is also clear that development alone cannot need for improved contraceptive technology; lack of
lead to a reduction of population growth on the needed funds and trained personnel to carry out all proposed
scale. programs; doubt about effectiveness of some measures,
leading to failure to implement them; and moral object-
POPULATION CONTROL: ions to some proposals such as abortion, sterilization,
DIRECT MEASURES various social measures, and especially to any kind of
compulsion.92
Before any really effective population control can be Most objections to population control policies, how-
established, the political leaders, economists, national
92
planners, and others who determine such policies must See Berelson's Beyond family planning, for a conservative view of
potential measures for population control. Since 1969, Berelson has found
be convinced of its necessity. Most governments have many formerly unacceptable measures to have become much more
acceptable: for instance, An evaluation of the effects of population control
91
Thomas trejka, The future of population growth; alternative patlis to programs; and Freedman and Berelson, The record of family planning
equilibrium. programs, published in 1974 and 1975 respectively.
784 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

ever, can be overcome or are likely to disappear with time available at costs everyone can afford. This, of course, has
and changing conditions; indeed man}' of them already been done in a few countries with considerable apparent
have. Contraceptive technology has been improved in success (Table 13-4). Moreover, there is still a good deal
recent years (see Appendix 4). Promising methods of of room for expansion of family planning services in
birth control that are not now technologically possible LDCs, where they are not yet available to more than a
should also be developed, so that they can be made fraction of most populations. Family planning programs
available.92" Further generous assistance from developed not only provide the means of contraception, but,
countries could remove remaining economic and lack of through their activities and educational campaigns, they
personnel barriers to population-control programs in spread the idea of birth control among the people. These
LDCs. The effectiveness of a measure can only be programs should be expanded and supported throughout the
evaluated after it has been tried. Moral acceptability is world as rapidly and asfully as possible, but other measures
very likely to change as social and economic conditions should lie instituted immediately as well. Given the family
change in most societies, as demonstrated by the rever- size aspirations of people everywhere, additional mea-
sal of abortion policies in many countries between 1967 sures beyond family planning will unquestionably be
and 1975. required in order to halt the population explosion—quite
The struggle for economic development in the LDCs possibly in many DCs as well as LDCs.
is producing considerable social upheaval, which will
particularly affect such basic elements of society as Socioeconomic Measures
family structure. Radical changes in family structure and
relationships are inevitable, whether population control Population control through the use of socioeconomic
is instituted or not. Inaction, attended by a steady pressures to encourage or discourage reproduction is the
deterioration in living conditions for the poor majority, approach advocated by, among others, demographer
will bring changes everywhere that no one could consider Kingsley Davis, who originated many of the following
beneficial. Thus, it is beside the point to object to suggestions.93 The objective of this approach would be to
population-control measures simply on the grounds that influence the attitudes and motivations of individual
they might change the social structure or family couples. An important aspect would be a large-scale
relationships. educational program through schools and communica-
Among proposed general approaches to population tions media to persuade people of the advantages of small
control are family planning, the use of socioeconomic families to themselves and to their society. Information
pressures, and compulsory fertility control. Maximum on birth control, of course, must accompany such educa-
freedom of choice is provided by traditional family tional efforts. This is one of the first measures that can be
planning; but family planning alone should not be adopted, and it has been increasingly employed in many
regarded as "population control" when it includes no of the more active family planning programs in LDCs. It
consideration of optimum population size for the society has also been used in some DCs, notably the U.S. and
and makes no attempt to influence parental goals. England, mainly, but not entirely, by private groups such
The use of abortion and voluntary sterilization to as Planned Parenthood and ZPG.
supplement other forms of birth control can quite As United States taxpayers know, income tax laws
properly be included as part of family planning and made have long implicitly encouraged marriage and child-
bearing, although recent changes have reduced the effect
""Unfortunately, this area is still being seriously neglected. It has been
estimated that funds could fruitfully be tripled over 1974 levels to take somewhat. Such a pronatalist bias of course is no longer
advantage of existing knowledge and trained personnel in research on appropriate. In countries that are affluent enough for the
reproduction and development of new contraceptives. (M. A. Koblinsky,
F. S. Jaffe, and R. O. Greep, Funding for reproductive research: The majority of citizens to pay taxes, tax laws could be
status and the needs.) See also Barbara J. Culliton, Birth control: Report adjusted to favor (instead of penalize) single people,
argues new leads are neglected (Science, vol. 194, pp. 921 -922, November
26, 1976) for a discussion of a forthcoming Ford Foundation Report,
Reproduction and human welfare. ''Davis, Population policy.
POPULATION POLICIES / 785

working wives, and small families. Other tax measures children at least three years apart and had no more than
might also include high marriage fees, taxes on luxury three. If more children were born, the payments were
baby goods and toys, and removal of family allowances reduced. Since managers of the tea estates were already
where they exist. paying maternity and health benefits, the costs of the
Other possibilities include the limitation of maternal pension fund were at least partially offset by savings from
or educational benefits to two children per family. These those. A large majority of the women signed up for the
proposals, however, have the potential disadvantage of program, and within the first four years there were
heavily penalizing children (and in the long run society substantial drops not only in fertility, but in infant
as well). The same criticism may be made of some other mortality and in worker absenteeism.96 The first pilot
tax plans, unless they can be carefully adjusted to avoid project included only about 700 women; it remains to be
denying at least minimum care for poor families, regard- seen whether implementation of the pension plan on
less of the number of children they may have. other tea estates and in other situations in India will be
A somewhat different approach might be to provide equally successful.
incentives for late marriage and childlessness, such as There are many possibilities in the sphere of family
paying bonuses to first-time brides who are over 25, to structure, sexual mores, and the status of women that can
couples after five childless years, or to men who accept be explored.97 With some exceptions, women have
vasectomies after their wives have had a given number of traditionally been allowed to fulfill only the roles of wife
children.94 Lotteries open only to childless adults have and mother. Although this has changed in most DCs in
also been proposed. The savings in environmental de- recent decades, it is still the prevailing situation in most
terioration, education, and other costs would probably LDCs, particularly among the poor and uneducated.
justify the expenditure. All of these measures, of course, Anything that can be done to diminish the emphasis
suffer the drawback of influencing the poor to a greater upon these traditional roles and provide women with
degree than the rich. That would be unfortunate, since equal opportunities in education, employment, and other
the addition of a child to an affluent family (which has a areas is likely to reduce the birth rate. Measures that
disproportionate impact on resources and environment) postpone marriage and then delay the first child's birth
is in many ways more harmful to society than the also help to encourage a reduction in birth rates. The
addition of a child to a poor family. later that marriage and the first child occur, the more time
Adoption to supplement small families for couples the woman will have to develop other interests. One of
who especially enjoy children can be encouraged through the most important potential measures for delaying
subsidies and simplified procedures. It can also be a way marriage, and directly influencing childbearing goals as
to satisfy couples who have a definite desire for a son or well, is educating and providing employment for women.
daughter; further research on sex determination should Women can be encouraged to develop interests outside
be pursued for the same reason. A special kind of the family other than employment, and social life could
social-security pension or bond could be provided for be centered around diese outside interests or the couple's
aging adults who have few or no children to support them work, rather than exclusively within the neighborhood
in their old age. and family. Adequate care for pre-school children should
The latter idea, proposed in detail by economist be provided at low cost (which, moreover, could provide
Ronald Ridker, has been tried with some success on tea an important new source of employment). Provision of
estates in southern India.95 As implemented, the plan child care seems more likely to encourage employment
made monthly deposits in a pension fund for each female outside the home, with concomitant low reproduction,
worker enrolled in the plan as long as she spaced her than to encourage reproduction. Women represent a
M
A study has been made o; :he economic feasibility of such a policy for "V. I. Chacko, Family planners earn retirement bonus on plantations
the United States by Larry D. Barnett (Population policy: payments for in India.
97
fertility limitation in the U.S.). Judith Blake. Demographic science and the redirection of population
"Synopsis of a proposal for a family planning bond; and Saving policy; Reproductive motivation; Alice Taylor Day, Population control
accounts for family planning, an illustration from the tea estates of India. and personal freedom: are they compatible?
786 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

large, relatively untapped pool of intellectual and tech- pregnant single women to marry or have abortions,
nical talent; tapping that pool effectively could help perhaps as an alternative to placement for adoption,
reduce population growth and also would provide many depending on the society.
other direct benefits to any society. Somewhat more repressive measures for discouraging
Social pressures on both men and women to marry and. large families have also been proposed, such as assigning
have children must be removed. As former Secretary of __ public housing without regard for family size and
Tptprjnr Stewart Udall observed, "All lives are not. removing dependency allowances from student grants or
enhanced by marital union; parenthood is not necessarily military pay. Some of these have been implemented in
a fulfillment for every married couple."98 If society were crowded Singapore, whose population program has been
convinced of the need for low birth rates, no doubt the counted as one of the most successful.
stigma that has customarily been assigned to bachelors, All socioeconomic measures are derived from knowl-
spinsters, and childless couples would soon disappear. edge of social conditions that have been associated with
But alternative lifestyles should be open to single people, low birth rates in the past. The more repressive sugges-
and perhaps the institution of an informal, easily dis- tions are based on observations that people have volun-
solved "marriage" for the childless is one possibility. tarily controlled their reproduction most stringently
Indeed, many DC societies now seem to be evolving in during periods of great social and economic stress and
this direction as women's liberation gains momentum." insecurity, such as the Depression of the 1930s.101 In a
It is possible that fully developed societies may produce sense, all such proposals are shots in the dark. Not
such arrangements naturally, and their association with enough is known about fertility motivation to predict the
lower fertility is becoming increasingly clear. In LDCs a effectiveness of such policies. Studies by demographer
childless or single lifestyle might be encouraged deliber- Judith Blake102 and by economist Alan Sweezy103 for
ately as the status of women approaches parity with that instance, have cast serious doubt on the belief that
of men. economic considerations are of the greatest importance in
Although free and easy association of the sexes might determining fertility trends. Sweezy has shown that the
be tolerated in such a society, responsible parenthood decline of fertility in the 1930s in the United States was
ought to be encouraged and illegitimate childbearing merely a continuation of an earlier trend. If their views
could be strongly discouraged. One way to carry out this are correct, then severely repressive economic measures
disapproval might be to insist that all illegitimate babies might prove to be both ineffective and unnecessary as a
be put up for adoption—especially those born to minors, vehicle for population control, as vrell as socially
who generally are not capable of caring properly for a undesirable. At the very least, they should be considered
child alone.100 If a single mother really wished to keep only if milder measures fail completely.
her baby, she might be obliged to go through adoption
proceedings and demonstrate her ability to support and Involuntary Fertility Control
care for it. Adoption proceedings probably should re-
The third approach to population limitation is that of
main more difficult for single people than for married
involuntary fertility control. Several coercive proposals
couples, in recognition of the relative difficulty of raising
deserve discussion, mainly because some countries may
children alone. It would even be possible to require
ultimately have to resort to them unless current trends in
9S
7976: Agenda for tomorrow. birth rates are rapidly reversed by other means.104 Some
"Judith Blake, The changing status of women in developed countries;
E. Peck and J. Senderowitz (eds.), Pronatalism, the myth ofnioni and apple 101
Richard A. Easterlm, Population, labor force, and long swings in
pie; Ellen Peck, The baby trap. economic growth. Further discussion of Easterlies ideas can be found in
100
The tragedy of teenage single mothers in the U.S. is described by Deborah Freedman. ed., Fertility, aspirations and resources: A sympo-
Leslie Aldridge Westoff in Kids with kids. The adverse health and social sium on the Easterlin hypothesis.
102
effects of teenage child-bearing in an affluent society have recently betn Are babies consumer durables? and Reproductive motivation.
documented by several studies. One good sample can be found in a special ""The economic explanation of fertility changes in the U.S.
io4
issue of Family planning perspectives, Teenagers. USA. Edgar R. Chasteen, The case for compulsory birth control.
POPULATION POLICIES / 787

involuntary measures could be less repressive or dis- Boulding.105 His proposal was to issue to each woman at
criminatory, in fact, than some of the socioeconomic maturity a marketable license that would entitle her to a
measures suggested. given number of children—say, 2.2 in order to have an
In the 1960s it was proposed to vasectomize all fathers NRR = 1. Under such a system the number could be two
of three or more children in India. The proposal was if the society desired to reduce the population size slowly.
defeated then not only on moral grounds but on practical To maintain a steady size, some couples might be
ones as well; there simply were not enough medical allowed to have a third child if they purchased "deci-
personnel available even to start on the eligible candi- child" units from the government or from other women
dates, let alone to deal with the new recruits added each who had decided not to have their full allotments of
day! Massive assistance from the developed world in the children or who found they had a greater need for the
form of medical and paramedical personnel and/or a money. Others have elaborated on Boulding's idea,
training program for local people nevertheless might discussing possible ways of regulating the license scheme
have put the policy within the realm of possibility. India and alternative ways of alloting the third children.106
in the mid-1970s not only entertained the idea of com- One such idea is that permission to have a third child
pulsory sterilization, but moved toward implementing might be granted to a limited number of couples by
it, perhaps fearing that famine, war, or disease might lottery. This system would allow governments to regu-
otherwise take the problem out of its hands. This deci- late more or less exactly the number of births over a given
sion was greeted with dismay abroad, but Indira Gandhi's period of time.
government felt it had little other choice. There is too Social scientist David Heer has compared the social
little time left to experiment further with educational effects of marketable license schemes with some of the
programs and hope that social change will generate a more repressive economic incentives that have been
spontaneous fertility decline, and most of the Indian proposed and with straightforward quota systems.107 His
population is too poor for direct economic pressures conclusions are shown in Table 13-5.
(especially penalties) to be effective. Of course, a government might require only implan-
A program of sterilizing women after their second or tation of the contraceptive capsule, leaving its removal to
third child, despite the relatively greater difficulty of the the individual's discretion but requiring reimplantation
operation than vasectomy, might be easier to implement after childbirth^ Since having a child would require
than trying to sterilize men. This of course would be positive action (removal of the capsule), many more
feasible only in countries where the majority of births are births would be prevented than in the reverse situation.
medically assisted. Unfortunately, such a program Certainly unwanted births and the problem of abortion
therefore is not practical for most less developed coun- would both be entirely avoided. The disadvantages
tries (although in China mothers of three children are (apart from the obvious moral objections) include the
commonly "expected" to undergo sterilization). questionable desirability of keeping the entire female
The development of a long-term sterilizing capsule population on a continuous steroid dosage with the
that could be implanted under the skin and removed contingent health risks, and the logistics of implanting
when pregnancy is desired opens additional possibilities capsules in 50 percent of the population between the ages
for coercive fertility control. The capsule could be of 15 and 50.
implanted at puberty and might be removable, with Adding a sterilant to drinking water or staple foods is a
official permission, for a limited number of births. No suggestion that seems to horrify people more than most
capsule that would last that long (30 years or more) has proposals for involuntary fertility control. Indeed, this
yet been developed, but it is technically within the realm
of possibility. lG5
The meaning ofiht 20th csnmrv, pp. 135—136.
J
106
Bruce M. Russect. Licensing: for cars and babies; David M. Heer,
Various approaches to administering such a system Marketing licenses for babies; Boulding's proposal revisited.
have been offeredj including one by economist Kenneth '"Ibid.
TABLE 13-5
Evaluation of Some Relatively Coercive Measures for Fertility Reduction
Effect Marketable license systems Financialjucentiaie^ystems Quota systems
CBqby licenses'} /monthly subsidy\ / Monthly tax*\ .^
that may be sold to persons X on persons \ f One-time tax \
Boulding proposal or lent at interest \ uith no more than Jl with more than 1 1 for excess babies J Identical quota
for baby licenses to the government \^ two children ^X N ^ f r o o children^/ \^^ over j
two / for all couples
^^*^~~ ,
Restriction on Moderately severe Moderately severe Moderately severe Moderately severe Moderately severe Very severe
individual
liberty
Effect on quality Probably Probably Unknown Unknown Probably Slightly beneficial
of children's beneficial beneficial beneficial
financial
support
Effecti%7eness and Effective Effective Fairly effective Fairly effective Effective Effective
acceptability of enforcement at enforcement at enforcement enforcement enforcement at enforcement at
enforcement possible price possible price possible price possible price
mechanisms of depriving of depriving of depriving of depriving
some children some children some children some children
of a family of a family of a family of a family
environment environment environment environment
Effectiveness for Moderate High Low Low Low Moderate
precise
regulation of
the birth rate
Source: Adapted from David Heer, Marketing licenses.

would pose some very difficult political, legal, and social motivated to have small families. Subfertile and func-
questions, to say nothing of the technical problems. No tionally sterile couples who strongly desired children
such sterilant exists today, nor does one appear to be would be medically assisted, as they are now, or en-
under development. To be acceptable, such a substance couraged to adopt. Again, there is no sign of such an
would have to meet some rather stiff requirements: it agent on the horizon. And the risk of serious, unforeseen
must be uniformly effective, despite widely varying side effects would, in our opinion, militate against the use
doses received by individuals, and despite varying de- of any such agent, even though this plan has the
grees of fertility and sensitivity among individuals; it advantage of avoiding the need for socioeconomic pres-
must be free of dangerous or unpleasant side effects; and sures that might tend to discriminate against particular
it must have no effect on members of the opposite sex, groups or penalize children.
children, old people, pets, or livestock. Most of the population control measures beyond
Physiologist Melvin Ketchel, of the Tufts University family planning discussed above have never been tried.
School of Medicine, suggested that a sterilant could be Some are as yet technically impossible and others are and
developed that would have a very specific action—for probably will remain unacceptable to most societies
example, preventing implantation of the fertilized (although, of course, the potential effectiveness of those
ovum.108 He proposed that it be used to reduce fertility least acceptable measures may be great).
levels by adjustable amounts, anywhere from 5 to 75 Compulsory control of family size is an unpalatable
percent, rather than to sterilize the whole population idea, but the alternatives may be much more horrifying.
completely. In this way, fertility could be adjusted from As those alternatives become clearer to an increasing
time to time to meet a society's changing needs, and there number of people in the 1980s, they may begin demand-
would be no need to provide an antidote. Contraceptives ing such control. A far better choice, in our view, is to
would still be needed for couples who were highly expand the use of milder methods of influencing family
""Fertility control agents as a possible solution to the world popula- size preferences, while redoubling efforts to ensure that
tion problem, pp. 687-703. the means of birth control, including abortion and
POPULATION POLICIES / 789

sterilization, are accessible to every human being on "triggered" a decline in fertility—no particular level of
Earth within the shortest possible time. If effective action infant mortality or per-capita GNP, for instance—a
is taken promptly against population growth, perhaps the constellation of factors does often seem to be associated
need for the more extreme involuntary or repressive with such declines. Among these are rural development
measures can be averted in most countries. and land reform favoring small, family-owned farms;
availability of adequate food, basic health care, and
education (especially of women) to the entire population;
POPULATION CONTROL
industries favoring labor-intensive, rather than capital-
AND DEVELOPMENT
intensive, means of production; and a relatively small
income gap between the richest and poorest segments of
Population control cannot be achieved in a social or
the population.110
economic vacuum, of course. To formulate effective
Table 13-6 compares some of these interrelated factors
population control measures, much greater understand-
in nine less developed nations, four of which have shown
ing is needed about all peoples' attitudes toward repro-
significant drops in fertility since 1960 and five of which
duction, and how these attitudes are affected by various
have not. While each of the nine countries, like nearly all
living conditions, including some that seem virtually
LDCs, exhibits some of the salient factors listed above,
intolerable to people in developed countries. Even more,
those with substantially reduced fertility much more
it is essential to know what influences and conditions will
commonly manifest them. Understanding of the impor-
lead to changes in attitudes in favor of smaller families.
tant influences on reproductive behavior and how they
The economists and demographers who believed that
operate is so far sketchy at best. Achieving a solid base for
urbanization and industrialization of LDCs would auto-
population policy may be one of the most important—
matically induce a demographic transition in those
and perhaps most difficult—research assignments for the
societies seem to have been disastrously wrong. While
next decade.
they waited for the birth rate to fall, one billion people
Since the goals of both development and population
were added to the human population. At the very least, it
control are supposedly identical—an improvement in the
is obvious that the causes of demographic transitions are
well-being of all human beings in this and future
far more complex than was once believed. But the social
generations—it seems only reasonable to plan each to
scientists may have been wrong mainly in their approach.
reinforce the other. Emphasis accordingly should be
Many aspects of modernization may indeed have impor-
placed on policies that would further the goals of both
tant influences on reproductive behavior.
family limitation and development—for example, rural
Such influences, of course, fall outside the purview of
development and land tenure reform; increased agricul-
population programs; they are an integral part of devel-
opment as it affects—or fails to affect—each member of a tural output; universal primary education for children;
society. When development is the kind that improves the old-age support schemes; and improved health care and
nutrition, especially for mothers and children.
living conditions of everyone down to the poorest farm
worker, development that starts at the grass roots level, Survival of human society nevertheless seems likely to
then there is hope that poverty, hunger, disease, and require the imposition of direct population control
hopelessness might be reduced—and along with them the measures beyond family planning in most LDCs. There
desire for many children.109 is no guarantee that processes of modernization can
The general problems of LDC development are dis- quickly enough induce the necessary changes in attitudes
cussed in detail in Chapter 15, but its indirect effects on that might bring growth to a halt. High priority should be
fertility are worth mentioning here. While no one factor given to stimulating those attitude changes and counter-
of development can be singled out as ever having acting the effects of pronatalist traditions.

""William Rich, Smaller families through social and economic prog- "°Ibid. See also Freedman and Bcrclson, The record of family
ress; Kocher, Rural development; Grant, Development. planning programs.
POPULATION POLICIES / 791

But while some people seek the best means of achiev- despite the ultimate ratification of a World Population
ing population control, in other quarters the debate Plan of Action and 21 resolutions.114
continues as to whether it is necessary—or even A very useful summary of all the various views of the
desirable. population problem and how (or whether) to deal with it
has been compiled by demographer Michael S. Teitel-
baum.''' Because it is the best listing we have seen, we
Population Politics are borrowing Teitelbaum's outline for the framework of
the following discussion.115
/ am not sure that the dictatorship of the proletariat,
especially if led by an elite, will solve the problem of
social justice; I am certain starvation will not solve Positions Against Special Population
the problem of overpopulation. Programs and Policies
-Tom O'Brien,
Marrying Malthas and Marx Pronatalist. This viewpoint favors rapid population
growth to boost economic growth and an expanding
Family planning programs have spread throughout the labor supply, as well as to increase opportunities for
less developed world and are now established in the economies of scale in small countries. Pronatalists be-
majority of less developed countries. Many countries, lieve there is strength in numbers (both political and
especially those with long-established programs that military) and are more concerned about competition with
have been frustrated by lack of success in reducing birth rapidly growing neighboring countries or among seg-
rates simply through making means of birth control ments of their own populations than about the disadvan-
available, have progressed to measures beyond family tages of rapid growth. This group now seems to be a
planning. As could be expected, this has aroused opposi- diminishing minority.
tion, informed and uninformed, from many quarters.
Some groups see threats to their personal liberties; even Revolutionist. Revolutionaries oppose population
more commonly, people see threats to their economic or programs because they may alleviate the social and
political interests. In addition, there are many propo- political injustices that might otherwise lead to the
nents of population control who strongly disagree on the revolution they seek. This view is particularly common
most appropriate approach.'n By 1974, when the United in Latin America.1'7 (Conversely, many politicians sup-
Nations World Population Conference took place in port family planning in the hope that it will dampen the
Bucharest, the chorus of clashing viewpoints was almost revolutionary fires.)
deafening."2 Most press reports and coverage of the
Conference by special groups conveyed an impression of Anti-colonial and genocide positions. This group
enormous confusion and prevailing disagreement,113 is very suspicious of the motives of Western population
1
control advocates. Some believe that effective population
' 'National Academy of Sciences, In search of population policy.
"2J. Mayone Stycos, Demographic chic at the UN. programs would retard development and maintain LDCs
"3The list of accounts is very long, even leaving out a plethora of in economic subservience to DCs. Others see population
anticipatory books and articles. Here is a partial one: Anthony Astrachan,
People are the most precious; Donald Gould, Population polarized; P. T. '"UnitedNarions, Report ofthe UN World Population Conference, 1974.
Piotrow, World plan of action and health strategy approved at population "'Population and development: is a consensus possible?
11
conferences; Conrad Taeuber, Policies on population around the world; 'Bernard Berelson has also described the conflicting views on
Brian Johnson, The recycling of Count Malthus; M. Carder and B. Park, population in the Population Council Annual Report 1973, pp. 19—27, and
Bombast in Bucharest; D. B. Brooks and L. Douglas, Population, The great debate on population policy. The latter was written as a dialog
resources, environment: the view from the UN; W. P. Mauldin, et al., A among three 'Voices," representing the family planning advocates, those
report on Bucharest; Marcus P. Franda, Reactions to America at who see "development" as the important issue, and academic critics of the
Bucharest; Concerned Demography, Emerging population alternatives; family planning approach to population control. The dialog is informa-
International Planned Parenthood Federation, (IPPF) People, special tive, often witty, but unfortunately leaves the reader with an impression
issue, vol. 1, no. 3,1974; in addition, Ifff published a daily newspaper of much greater consensus than probably exists among the viewpoints.
called Planet during the conference. "7J. Mayone Stycos, Family planning: reform and revolution.
792 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

programs as an effort by DCs to "buy development Barry Commoner121 subscribes to it, but he quotes a
cheaply." The most extreme position is taken by those formula devised by AID. Whether the relationship is as
who regard population control as a racist or genocidal clear as is commonly believed has been called into
plot against nonwhite citizens of LDCs. Holders of this question by Alan Sweezy, among others.122
position blame resource shortage and environmental The other side of this coin is social security-the need
problems exclusively on the greediness of rich countries. for children, especially sons, to support parents in old
To the extent that high fertility in LDCs is a problem,
they emphasize that it is due to their poverty, which in
Status and roles of women. Social pressures defin-
turn is caused by overconsumption in DCs.118
ing the role of women as wives and mothers, with status
attached primarily to that role, are a major cause of high
Accommodationist. This viewpoint is basically
fertility, according to this view. Large families are likely
anti-Malthusian: because history shows that Earth is
to prevail until alternative roles are made available to all
capable of supporting far more people than Malthus
women.124
thought, he was wrong; these people believe that further
improvements in agriculture and technology will permit The religious doctrinal position. There are two
accommodation of a much larger population than distinct, but not necessarily mutually exclusive views
today's. To them what is called overpopulation is really here. One is essentially fatalistic: "Be fruitful and
underemployment; restructuring the economic system multiply, God will provide." This view is common
will allow societies to provide jobs and meet the basic among both Western and Eastern religions. The other
needs of everyone, no matter how many. The slogan (mainly the Roman Catholic Church) sees population
adopted by the New Internationalist for the Population growth as a problem, but regards most forms of birth
Conference—"Look after the people and population will control as more or less immoral.125
look after itself—epitomizes this position.119
Medical risk. People holding this view are more
The problem-is-population-distribution. Some impressed by the risks that attend the use of contracep-
people holding this view simplistically compare popula- tives such as the pill and the IUD, and surgical proce-
tion densities of different regions without regard to dures such as abortion and sterilization than by the risks
available resources and means of support. They also run by not using them. (The risk of death from child-
focus on the serious problem of urban migration in bearing alone is considerably higher, especially among
LDCs and conclude that policies should concentrate on the poor in LDCs, than any of these, and both maternal
population redistribution rather than on birth control.120 and infant mortality are known to be reduced substan-
tially by the use of birth control for birth spacing.)126 A
Mortality and social security. This view concen- milder version of this view is held by large segments of
trates on the significance of infant and child mortality in the medical profession who oppose the distribution of
motivating reproductive behavior; if infant mortality the pill without prescription and the insertion of ITJDs
were reduced, fertility would automatically decline. This by paramedical personnel, despite the established safety
view is also held in varying degrees by many pro- of both procedures compared to the consequences of not
population control advocates as well as those against it. using them.127
"8This perspective has been put forth by Barry Commoner, How 12
'Commoner, How poverty breeds overpopulation.
poverty breeds overpopulation (and not the other way around); and Pierre '"Recent light.
Pradervand, The Malthusian man. Pradervand and Commoner, among '"Mamdani, Myth of population control.
others, also oppose present population programs on anticolonialist '24Blake, Reproductive motivation; Day, Population control and
grounds. personal freedom; Ceres, Women: a long-silent majority.
119 125
Peter Adamson, A population policy and a development policy are Pope Paul VI, Humanae Viiae.
126
one and the same thing. A. Omran, Health benefits; Buchanan, Effects of childbearing;
l20
Maaza Bekele, False prophets of doom. This article expresses this Eckholm and Newland, Health.
and the above three viewpoints dearly. '27Mauldin, Family planning programs and fertility declines.
POPULATION POLICIES / 793

Holistic development. Holders of this view are is required. "Mutual coercion, mutually agreed
"demographic transition" believers who are convinced upon."131
that social and economic development are responsible for . . . Population programs are fine as far as they go,
whatever declines in fertility have occurred in LDCs, not but they are wholly insufficient in scope and strength
to meet the desperate situation.132
family planning programs, which they consider a waste
of effort and funds that should be put into
Provision of services. This viewpoint holds that
development.128
family planning programs are essential for reducing birth
Social justice. This position emphasizes redistribu- rates and that there is still a great unmet demand for birth
tion of wealth within and among nations to improve the control in LDCs; what is needed is to expand family
condition of the poor.129 It is related to the idea of planning services to meet the demand.133 Part of the
grassroots development, but is somewhat more extreme failure of family planning is due to provision of inade-
in that many of its proponents feel that redistribution of quate contraceptive technologies.134 This position is held
wealth is the only policy that will reduce population most strongly by administrators and associates of family
growth and solve other problems as well. planning programs and their donor agencies.

Human rights. This position, held by virtually


everyone who is in favor of family planning or other
population control policies, derives from the idea that
Positions Supporting the Need there is a fundamental human right for each person
for Population Programs and Policies responsibly to determine the size of his or her family.135
Another right that has been recognized in many
countries including the United States'36 is that of women
Population hawks. Teitelbaum sums up this position
to control their bodies. This is especially relevant to the
as follows:
issue of abortion, but applies also to contraception and
. . . Unrestrained population growth is the principal sterilization. Family planning also contributes to health,
cause of poverty, malnutrition, and environmental especially of women and children; and one more human
disruption, and other social problems. Indeed we are right is that to health care.
faced with impending catastrophe on food and en-
vironmental fronts.130
Population programs plus development. Here
. . . Such a desperate situation necessitates draconian
action to restrain population growth, even if coercion again we quote Teitelbaum, who expressed it well:
. . . Social and economic development are necessary
' 28Bekele, False prophets; Commoner, How poverty breeds overpopu- but not sufficient to bring about a new equilibrium of
lation. A more sophisticated form is Adamson's (A population policy)—at population at low mortality and fertility levels. Special
least he advocates development at the grass-roots level (see Social Justice
section). population programs are also required.137
129
Pradervand, Malthusian man; some writers for Concerned
J
Demography. '' Garrett Hardin, The tragedy of the commons.
130 1
We, along with some colleagues, are considered among the principal "Davis, Population policy; P. R. Ehrlich and A. H. Ehrlich, Popula-
proponents of this position (see especially P. Ehrlich, The population tion resources environment, W. H. Freeman and Company, San Francisco,
bomb, which is the most commonly cited source). Like most of the 1970 and 1972, chapter 10.
statements in this summary, this one is both exaggerated and over- '"Stj'cos. Demographic chic; Berelson, Effects of Population Control
simplified. We would not, for example, blame poverty or malnutrition Programs.
m
principally on overpopulation, although it certainly contributes to their Mauldin, Family planning programs and fertility declines.
115
perpetuation. Likewise, population growth is one of three interacting UN Declaration on Population, Tehran, 1968, printed in Studies in
causes of environmental deterioration; the others are misused technology Family Planning, no. 16, January 1967 and no. 26, January 1968.
and increasing affluence (see Chapter 12). As an aside, it is interesting that Teitelbaum omitted the important word "responsibly" in his discussion.
136
the first edition of the Population bomb, written almost a decade before Supreme Court decision on abortion, 1973.
137
this book, is still often cited both as if it reflected the situation in the Advocates of this include Rich. Smaller families; James E. Kocher,
mid-1970s and as if we still held precisely the same views today as we did Rural development; Grant, Development; and Lester R. Brown, In the
then. human interest.
794 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

While we are usually classified by others as "population World Population Plan of Action
hawks," we agree more closely with this position in terms
of what should be done. What follows, however, is far too In view of the diversity of opinions held by various
mild a statement on the urgency of ending population individuals and groups on population control, it is not
growth; Teitelbaum discusses only the social aspects and surprising that the United Nations' World Population
completely leaves out environmental and resource con- Plan of Action turned out to be a bulky, nearly unread-
straints on population growth: able document some 50 pages long.158 Summing it up is
almost impossible; the 20 resolutions and numerous
Too rapid population growth is a serious intensifier
of other social and economic problems, and is one, recommendations covered virtually every subject that
though only one, of a number of factors behind lagging might affect or be affected by population growth. In the
social and economic progress in many countries. initial statement of "Principles and Objectives," the Plan
Some countries might benefit from larger popula- declared:
tions, but would be better served by moderate rates of
growth over a long period than by very rapid rates of The principal aim of social, economic and cultural
growth over a shorter period. development, of which population goals and policies
An effective population program therefore is an are integral parts, is to improve levels of living and the
essential component of any sensible development quality of life of the people. Of all things in the world,
program. people are the most precious. . . .

This general position (including the portion just quoted) It then proceeded to affirm the rights of nations to
is widely held by social scientists, politicians, econ- formulate their own population policies, of couples and
omists, and quite likely by Teitelbaum himself. individuals to plan their families, and of women to
Like the blind men with the elephant, each viewpoint participate fully in the development process. It con-
grasps a piece of the truth, but none encompasses all of it. demned racial and ethnic discrimination, colonialism,
As should be evident, the above positions are by no foreign domination, and war. And it also expressed
means mutually exclusive, and probably none is held concern for preserving environmental quality, for main-
monolithically by anyone. Rather, most people argue taining supplies and distribution of resources, and for
from several related positions at once. Some apparently increasing food production to meet growing needs.
violent disagreements, when analyzed, turn out to be More specifically with regard to population policies,
only a matter of emphasis or of leaving something out of the following recommendations were made:139
the picture.
Teitelbaum, Berelson, and others see the germ of a • Governments should develop national policies on
consensus emerging from the debate. If so, and if the population growth and distribution, and should
consensus produces an effective approach to the popula- incorporate demographic factors into their devel-
tion problem that all can more or less agree on, the opment planning.
controversy will have been worthwhile. But to the extent • Developed countries should also develop policies
that population policies are connected to the larger on population, investment, and consumption with
confrontation between the rich developed world and the an eye to increasing international equity.
poor less developed world (with waters frequently mud- • Nations should strive for low rather than high
died by China and the Soviet Union who say one thing birth and death rates.
about population control and practice another), con- • Reducing death rates should be a priority goal,
sensus may prove to be elusive. Even more important, aiming for an average life expectancy in all
LDCs are unlikely to take very seriously population goals 1
"United Nations, Report of the UN World Population Conference,
and policies recommended by DCs that do not impose 1974.
such goals and policies upon their own people. 1
"Adapted from a summary by Piotrow, World Plan of Action.
POPULATION POLICIES / 795

countries of 62 by 1985 and 74 by 2000, and an the UN's Second Development Decade strategy,
infant mortality rate below 120 by 2000. reviewed every five years, and appropriately
All nations should ensure the rights of parents "to modified.
determine in a free, informed and responsible
Unfortunately, a sense of urgency about reducing
manner the number and spacing of their chil-
population growth, which had been present in the draft
dren," and provide the information and means for
Plan, was lost in the final version under the pressure of
doing so.
political disagreement. The environmental and resource
Family planning programs should be coordinated
constraints on population growth were essentially left out
with health and other social services, and the poor
of conference discussions and hence omitted from the
in rural and urban areas should receive special
Plan of Action.140 Also, the value of family planning
attention.
programs tended to be downgraded in favor of an
Efforts should be made to reduce LDC birth rates
overwhelming emphasis on "development" as the way to
from an average of 38 in 1974 to 30 per 1000 by
reduce birth rates.
1985.
The conference may not have blazed any radically new
Nations are encouraged to set their own birth rate
trails in its recommendations, but it still cannot be
goals for 1985 and to implement policies to reach
accused of taking a strictly narrow view of the population
them.
problem. Its neglect of environmental and resource
Nations should make special efforts to assist
aspects and the political problems that will accrue to
families as the basic social unit.
those limitations is deplorable, but social and economic
Equality of opportunity for women in education,
aspects were fully explored. Probably the conference's
employment and social and political spheres
greatest value was to expose participants (many of whom
should be ensured.
did hold narrow views or were uninformed about some of
Undesired migration, especially to cities, should
the issues) to the information and viewpoints of others.
be discouraged, principally by concentrating de-
And the mere existence of a world conference helped
velopment in rural areas and small towns, but
draw world attention to the population issue and empha-
without restricting people's rights to move within
sized that nations have a responsibility to manage their
their nation. populations. Before the conference most national gov-
International agreements are needed to protect
ernments still seemed to believe that population prob-
rights and welfare of migrant workers between lems were neither their concern nor within their ability to
countries and to decrease the "brain drain."
control.
Demographic information should be collected,
The final Plan of Action was adopted by consensus of
including censuses, in all countries. the 136 member nations (with reservations by the
More research is needed on the relation of
Vatican). Whether the resolutions and recommendations
population to various institutions and to social
will be taken with the seriousness the problem warrants
and economic trends and policies; on improving
remains to be seen. For many countries it will not be
health; on better contraceptive technologies; on
easy, given the overwhelming problems their govern-
the relation of health, nutrition, and reproduc-
ments face. But on the answer hangs the future of
tion; and on ways to improve delivery of social
humanity.
services (including family planning). It was repeatedly emphasized at Bucharest that popu-
Education programs in population should be lation control is no panacea for solving the problems of
strengthened. development or social and economic justice. This is
Population assistance from international, govern- perfectly true, of course; but unless the runaway human
mental, and private agencies should be increased.
WO
The Plan of Action should be coordinated with W. P. Mauldin et al., A report on Bucharest.
796 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

population is brought under control—and soon—the failures or to social problems or both; epidemic diseases;
result will be catastrophe. What kind of catastrophe wars over diminishing resources; perhaps even thermo-
cannot be predicted, but numerous candidates have been nuclear war. The list of possibilities is long, and over-
discussed in this book: ecological collapses of various population enhances the probability that any one of them
kinds, large-scale crop failures due to ecological stress or will occur. Population control may be no panacea, but
changes in climate and leading to mass famine; severe without it there is no way to win.
resource shortages, which could lead either to crop

Recommended for Further Reading


Blake, Judith. 1971. Reproductive motivation and population policy. BioScience, vol. 21,
no. 5, pp. 215-220. An analysis of what sorts of policies might lower U.S. birth rate.
Berelson, Bernard. 1974. An evaluation of the effects of population control programs.
Studies in Family Planning, vol. 5, no. 1. An important contribution to the
controversy by a distinguished demographer active in the family planning field.
Chen, Pi-Chao. 1973. China's population program at the grass-roots level. Studies in
Family Planning, vol. 4, no. 8, pp. 219-227. Also published in Population
perspective: 1973, Brown, Holdren, Sweezy, and West, eds. Excellent summary'.
Davis, Kingsley. 1973. Zero population growth: The goal and the means. Daedalus, vol.
102, no. 4, pp. 15-30. Useful critique of population policies, actual and proposed,
especially of the United States.
Katchadourian, H. A., and D. T. Lunde. 1975. Fundamentals of human sexuality. 2nd ed.
Holt, New York. A superb text for sex education; useful for birth control information
also.
Kocher, James E. 1973. Rural development, income distribution and fertility decline.
Population Council Occasional Papers. An important work on the connection
between grass-roots development and fertility.
Population Reference Bureau, Inc. 1975. Family size and the black American. Population
Bulletin vol. 30, no. 4. A study of black reproductive behavior and attitudes in
the U.S.
—. 1976. World population grotvth and response 1965-1975: A decade of global action.
A compendium on recent demographic trends and the evolution of population
policies around the world.
Revelle, Roger. 1971. Rapid population growth: Consequences and policy implications.
Report of a study committee, National Academy of Sciences. Johns Hopkins Press,
Baltimore. Contains a number of interesting papers on social and economic effects of
population growth, but weak on environmental and resource aspects.
Teitelbaum, Michael S. 1974. Population and development: Is a consensus possible?
Foreign Affairs, July, pp. 742-760. An excellent discussion of the myriad viewpoints
on population control.