CONTRIBUTIONS OF POPULATION PROGRAMS
According to Dr. Ronald Freedman, Roderick D. McKenzie Distinguished Professor Emeritus of Sociology of the University of Michigan Population Studies Center, governments, international agencies, and private organizations have responded to the real and perceived consequences of demographic change by trying to alter, on an unprecedented scale, the course of demographic trends. As a result, since 1960 fertility, mortality, and rates of population growth have declined significantly. Moreover, an inexorable trend toward urbanization continues to tax already sprawling cities, and the age structure of the population is undergoing change.
Much more is known today about the basic demographic processes and the methods for their study. This has stimulated creation of a worldwide network of demographic research and training institutions that employ an increasing number of social and public health scientists who are undertaking theoretical and applied work in population.
According to estimates by the United Nations, the world's population was 3 billion in 1960, 70 percent of which was located in the developing countries. By 1985 it had grown to 4.8 billion, of which 75 percent was found in Third World countries. Thus, 89 percent of this 25-year growth took place in the developing world, now the home of three-quarters of the world's population.
In 1960-1965, the world's population was growing at a very high rate of 2 percent per annum, largely as a result of the very high growth rate - 2.4 percent - found in the Third World. This substantial growth rate stemmed mainly from an earlier large drop in mortality in these countries, made possible by medical and public health programs, as well as by improvements in the standard of living.
Between 1960-1965 and 1980-1985 the rate of world population growth declined from 2.0 to 1.6 percent, in part due to the decline in fertility in the Third World. Although this decline was substantial in some countries, Freedman noted that it is still not evident in large parts of the Third World, particularly in sub-Saharan Africa, Southwest Asia, and the Arab world.
The total fertility rate for developing countries has fallen by about 33 percent in the last 25 years (22 percent, excluding China). In some developing countries, fertility rates have fallen even more sharply - for example, about 70 percent in Taiwan in the 25 years after 1960 and 45 percent in Thailand during the same period. The decline has levered off in some countries, but it is uncertain whether this is a temporary deviation from the long-term decline.
Further major mortality declines in the Third World are almost certain if we apply what we know and if there is reasonable progress in social and economic development.
Fertility declines in the Third World have had only a moderate effect on the population growth rate because of the simultaneous decline in mortality, and for this reason some scientists have denigrated the fertility decline in developing countries. Freedman finds this to be a rather short-sighted view, however, for three reasons. First, the decline in mortality is important because it saves lives and is a crucial facilitating condition for further fertility declines. Second, the fertility decline under way is likely to continue. And finally, the decline will lead to fewer children in the population. The burgeoning numbers of children and the investments in health, education, and employment that they require are a major problem in many countries.
Methodological and Substantive Contributions of Social Demography
"A major contribution of social demography in recent decades has been the development of 'indirect' methods for utilizing poor Third World data to [estimate the] basic demographic measures needed for population and development research and policy analysis," stated Freedman. Demographic data and the basic principles for their interpretation are, of course, indispensible in the development and implementation of population policy. "This does not mean that there is a direct line between demographic data and population policy," he warned. "Demographic facts and relationships attract the attention of policymakers when their relevance to central problems of government are obvious."
Another important finding of social demography is that even when fertility in Third World countries has fallen to replacement levels with two-child families and low mortality, populations continue to grow for decades because of the very young age structures that resulted from the previous history of high fertility. Japan, for example, reached a replacement fertility level of 2.1 in 1957 and has been at or below that level ever since. Its population has grown by about 31 million since then, however - and will not stop growing until about 2015 - because there was such a high proportion of young couples of childbearing age in 1957.
The female population aged 20-35 in developing countries will increase by about 36 percent over the next 20 years (compared with a 4 percent decline in the more developed countries). The developing countries can therefore count on further population growth. Yet another important finding is that an increase in the interval between births lowers the birthrate. Thus, policies constructed to reduce population growth should consider the timing as well as the number of births in each family, noted Freedman.
With the recent development of demographic survey methods and new population models, demographers can now estimate the notable increase in the use of family planning measures in the Third World. According to Freedman, contraception is the primary immediate cause of the decline in fertility, with rising age at marriage and abortion as the secondary causes.
The work on new effective, convenient, and safe methods [of birth control], and especially male methods is an important technological and scientific issue for the future of population and family planning However, . . . very considerable increases i-n contraceptive prevalence are possible with the currently available contraceptives.
In 1960 only a small percentage of Third World women were deliberately using fertility control measures. This proportion rose to an estimated 41 percent (about 260 million women) by 1984. The increase in the practice of contraception has been especially rapid in East Asia and parts of Latin America.
More effective methods of contraception are also being used. Sterilization utilizing relatively safe and inexpensive methods is increasing rapidly, but Freedman speculated that Norplant(R), an implant that is effective for five years, is likely to replace much sterilization, if essentially commercial problems in its introduction are overcome.
Role of Family Planning Programs in Declines in Fertility
In 1960 only a few developing countries had official policies for either reducing their birthrates or supporting family planning activities. By 1984, however, 76 percent of the people in the Third World were living in countries with official policies to reduce birthrates, and an additional 17 percent were in countries supporting family planning activities for health and welfare reasons. Those countries with neither policy were mainly small ones containing only 7 percent of the total Third World population.
Longer birth intervals and smaller families contribute to the health of the mothers and children, and to the development and education of the children. That makes family planning a form of investment in human capital which is a crucial ingredient of social and economic development.
He then posed a question 'To what extent have family planning programs produced fertility declines in addition to what would have happened anyway as a result of social and economic development?' Lapham and Mauldin found in their study of 93 developing countries that socioeconomic development and family planning each had an independent effect on contraceptive use and fertility decline, but that together they had a major effect. Other evidence indicates that, given historical precedent, the rapidity with which the disadvantaged in Thailand, Taiwan, and Indonesia, for example, have adopted contraception is unlikely to have occurred without their well-organized family planning programs.
Twenty-five years ago, observed Freedman, experts believed that social and economic development, urbanization, higher educational levels, and work in the modern nonfamilial economy increased the cost and decreased the benefits of children. They also believed that these factors increased the value of investing more in a small number of children and that small families planned with the use of contraception would become the norm.
In recent decades, however, empirical studies have indicated that the causes of the transition from high to low fertility are not so simple. Historical studies have demonstrated that the decline in fertility began in various parts of Europe under widely varying social and economic conditions and were considerably influenced by cultural factors. In the Third World, fertility has declined especially rapidly in countries with considerable social and economic development - for example, Taiwan, Hong Kong, Singapore, Korea, Mexico, and Japan - but it has also declined in countries having only some of the prescribed classical socioeconomic conditions - for example, Sri Lanka and the state of Kerala in India, which are poor and agricultural but strong in education, health, and nutrition.
Freedman pointed out that the World Fertility Survey of 42 developing countries (see box, page 9) found that such structural variables as education, labor force activity, and urbanization are only modestly related to contraceptive use and fertility.
"Partly [because] socioeconomic factors fall far short of explaining everything about reproductive levels and trends, the so-called 'ideational' hypothesis is becoming more prominent," said Freedman. According to this theory, ideas in themselves make a difference apart from socioeconomic factors. "Most obviously, the diffusion of the idea of family limitation as legitimate in marriage greatly facilitates the adoption of fertility control and of choice about family size." Ideas also play a role in the rising aspirations fomented by the exposure of Third World populations to worldwide networks of markets, transportation, and communication. These aspirations in turn affect reproductive choices when people desire more consumer goods and wealth than they have.
Importance of Pilot Projects
Although social and economic development is important for its own sake, Freedman suggested that in many of the poorest developing countries high-quality family planning services may help families adopt contraception to improve the health and welfare of the mothers and children, as well as to reduce fertility. He warned, however, that well-monitored pilot projects are a necessary first step in establishing such services.
The highly successful family planning programs of the 1960s and 1970s in Taiwan, Korea' and Thailand were initiated by just such projects. In Taiwan, for example, the total fertility rate was about 6 in 1960, and contraceptive use was still at low levels. By 1976 the total fertility rate had fallen over 70 percent to 1.7, below replacement levels. In the five years from 1965 to 1970 alone the level of contraceptive use doubled, from 28 to 56 percent. More important, among illiterate women contraceptive use increased from 19 to 51 percent in that same five-year period. By 1975 the differentials in contraceptive use among strata defined by education, urbanization, or income had virtually disappeared. By 1985 contraceptive use was virtually universal.
In following its guiding principle, the Taiwan program offered high-quality services to women who wanted no more children - initially women with at least two children and one son. It did not seriously attempt to persuade couples that they should want fewer children.
The program was initiated with what was learned from a large, carefully designed and monitored pilot project in the city of Taichung. It has been guided since by sample surveys and studies, and new ideas have been tested in pilot studies before their application on a large scale.
The success of Taiwan's family planning program was undoubtedly influenced by that country's rapid social and economic development. Historical precedent elsewhere, however, makes it unlikely that the disadvantaged poor, rural dwellers, and illiterate would have adopted family planning so rapidly without this program.
Freedman then pointed out that the Korean family planning program has been comparable to Taiwan's program in many respects - with similar but not equal results - because of its large rural sector. "The very rapid decline of fertility in Thailand, associated with its family planning program, is particularly notable because social and economic development were not as favorable as in Taiwan and Korea," he explained. Both Thailand and Korea, like Taiwan, began their programs with carefully monitored pilot projects.
In contrast, the lesser success of programs in some large Asian countries, for example, has resulted partly from the initial application of uniform national policies without sufficient reference to local conditions and without adequate testing and continuous monitoring. Even where official family planning programs have been unsuccessful in either increasing contraception or reducing fertility to any significant extent - almost all of these are in countries in which both the development levels and the family planning program efforts are at low levels - there is evidence of a latent demand, at least as a means of spacing births and in some cases of limiting family size.
In Bangladesh, for example, the conventional view has been that high fertility and low interest in family planning are inevitable in a country so poor, and with young couples so dependent on children and relatives for subsistence and support. Many women with three or four living children had begun to say when surveyed that they wanted no more children, but this evidence of latent demand for fertility control was written off by most respected observers because it was not followed by the adoption of contraception.
A pilot project launched in the Matlab area of Bangladesh to provide a carefully designed, intensive program of family planning services as well as modest maternal and child health services rather quickly brought contraceptive use up from very little to 45 percent, with a commensurate fall in fertility. Whether application of what was learned in Matlab can make a major difference on a national level is a scientific and policy question of great importance both for Bangladesh and for other very poor developing countries.
Freedman emphasized that the significance of this project is that the latent demand indicated by the survey was real and that many couples adopted contraception when offered a high-quality service by a well-organized program. He then described a family planning program at Chogoria in Kenya somewhat similar to the Matlab project, but functioning in a completely different cultural and social situation. This program too brought contraceptive prevalence up to the 40 percent level and showed that the potential demand was real.
In many developing countries, including Bangladesh and Kenya, lower mortality means higher child survival so that many Third World women, by the time they are about 30, already have alive the number of children they want. Thus, more and more women with years of childbearing still ahead are saying that they want no more children. The increasing number of living children creates pressures on traditional institutions that were developed on the implicit assumption that many children would die. Many women too are feeling the pressure caused when traditional values and institutions clash with new realities and ideas. For some of these women sound family planning information and services can help crystallize latent demand for contraception. "In both the Bangladesh and Chogoria pilot projects a significant part of contraceptive acceptance is for spacing rather than limiting births, basically a health and welfare motivation, but with a fertility-reducing effect," summarized Freedman.
Finally, Freedman noted that part of the contribution of social science to population policies has been the development of methodologies useful to population and family planning programs. These include estimates of fertility and mortality trends' population structure, and changing reproductive patterns; microstudies of the quality and content of client-provider relations in clinics; and field research to evaluate new initiatives in family planning programs in their local contexts.
Each country should, so far as possible, study the evolving changes in its population and population policy just as it studies its economy.
These developments require a variety of personnel in demography, epidemiology, public health, and medicine. Fortunately, the few centers for population research and training existing 25 years ago are now complemented by more than 20 centers in the United States alone. Outstanding centers are also located in Australia, England, and France. These centers have trained hundreds of population and family planning specialists, a large number of whom are from the Third World, where they now staff a growing number of indigenous centers and train others.
"The development of new methodologies that have been crucial to the informed development and monitoring of population policies has largely been done either directly at the population centers or by personnel trained there. The fundamental importance of these centers and their networking function is not fully appreciated," concluded Freedman.
At an invitational dinner held in conjunction with the Symposium on Science and Technology for Development: Prospects Entering the Twenty-first Century, nine organizations were honored for their substantial contributions to furthering the application of science and technology to development over the past quarter century.
In addressing the award recipients and guests, Frank Press, president of the National Academy of Sciences and chairman of the National Research Council, observed that the honorees "represent a wide range of interests but share the characteristics of being nongovernmental and of having contributed leadership, innovation, and sustained effort in applying science and technology to development needs." He cautioned, however, that although their accomplishments give us hope for the future, "this hope will have to be reinforced with continued support and leadership in focusing science and technology on development needs."
In his remarks, former USAID Administrator M. Peter McPherson saluted the honorees as having "literally changed the face of the developing world - changed it for the better." Citing accomplishments of the past 25 years and development challenges that lie ahead for science and technology, he closed by saying, "I am very proud to have had the opportunity to lead USAID during these especially productive last six years and to be head of an organization that's done so much in partnership with all of you. I truly believe the best is yet to come."
The honored organizations and their citations follow:
Pictured above are representatives of these organizations. They are, from left to right, Alastor North, Peter Osler, S.K. DeDatta, William B. Greenough, Thomas S. Carroll, D.A. Henderson, Robert L. Clodius, George, Zeidenstein and Ken Prewitt. Presenting the award is Frank Press.
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