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Chapter 10. Responding to the Social Challenge: Stabilizing Population
Some 36 countries now have populations that are either stable or declining slowly. All are in Europe, except Japan. In countries with the lowest fertility rates, including Japan, Russia, Germany, and Italy, populations will actually decline over the next half-century. But other countries are projected to more than double their populations by then, including Pakistan, Nigeria, and Ethiopia. India, growing at nearly 2 percent a year, is projected to reach 1.5 billion people by 2050, adding 515 million in just 50 years—roughly twice as many people as currently live in the United States. Well before then it will become the world's most populous country.2
A larger group of countries has reduced fertility to the replacement level or just below. They are headed for population stability after large groups of young people move through their reproductive years. Included in this group are China, the world's most populous country, and the United States, the third most populous one.
U.N. projections show world population growth under three different assumptions about fertility levels. The medium projection, the one most commonly used, has world population reaching 8.9 billion by 2050. The high projection has population going to 10.6 billion. The low projection, which has population peaking at 7.5 billion in 2039 and then declining, assumes that the world will quickly move below replacement-level fertility to 1.7 children per couple. If the goal is to eradicate hunger and illiteracy, we have little choice but to strive for the lower projection.3
Slowing world population growth means that all women who want to plan their families should have access to the family planning services needed to do so. Unfortunately, at present more than 100 million couples cannot obtain the services they need to limit the size of their families. Since most of them are in countries where water scarcity is already a major issue, filling the family planning gap may be the most urgent item on the global agenda. The benefits are enormous and the costs are minimal.4
The good news is that countries that want to reduce the size of families quickly and stabilize their population can do so. For example, my colleague Janet Larsen describes how, in just one decade, Iran dropped its population growth rate from one of the world's fastest to one similar to that in the United States. When Ayatollah Khomeini assumed leadership in Iran in 1979, he immediately dismantled the family planning programs that the Shah had put in place in 1967 and advocated large families. At war with Iraq between 1980 and 1988, Khomeini wanted large families to increase soldiers for Islam. His goal was an army of 20 million. In response to his pleas, fertility levels climbed, pushing Iran's population growth up to 4.4 percent per year, a level approaching the biological maximum. As this enormous growth began to burden the economy and overburden the environment, Iran's leaders began to see that overcrowding, environmental degradation, and unemployment were becoming serious problems.5
In 1989 the government did an about-face and Iran restored its family planning program. In May 1993, a national family planning law was passed. The resources of several government ministries, including education, culture, and health, were mobilized to encourage smaller families. Iran Broadcasting was given the responsibility for raising awareness of population issues and of the availability of family planning services. Some 15,000 "health houses" were established to provide rural populations with health services and family planning.6
Religious leaders were directly involved in what amounted to a crusade for smaller families. Iran introduced a full panoply of contraceptive measures, including male sterilization—a first among Muslim countries. All forms of birth control, including contraceptives such as the pill and sterilization, were free of charge. In fact, Iran became a pioneer—the only country to require couples to take a class on modern contraception before receiving a marriage license.7
In addition to the direct health care interventions, a broad-based effort was made to increase female literacy, boosting it from 25 percent in 1970 to more than 70 percent in 2000. Female school enrollment increased from 60 to 90 percent. Television was used to disseminate information on family planning throughout the country, taking advantage of the 70 percent of rural households that had television. As a result of the impressive effort launched in 1989, the average family size in Iran has dropped from seven children to less than three. During the seven years from 1987 to 1994, Iran cut its population growth rate by half, setting an example for other countries whose populations are still growing rapidly. The overall population growth rate of 1.2 percent in 2001 is only slightly higher than that of the United States.8
If a country like Iran, with a strong tradition of Islamic fundamentalism, can move quickly toward population stability, other countries should be able to do the same. Countries everywhere have little choice but to strive for an average of two children per couple. There is no feasible alternative. Any population that increases or decreases continually over the long term is not sustainable. The time has come for world leaders—including the Secretary-General of the United Nations, the President of the World Bank, and the President of the United States—to publicly recognize that the earth cannot easily support more than two children per family.
The costs of providing reproductive health and family planning services are not that high. At the International Conference on Population and Development held in 1994 in Cairo, it was estimated that a fully funded population and reproductive health program for the next 20 years would cost roughly $17 billion annually by 2000 and $22 billion by 2015. Developing countries agreed to cover two thirds of this, while industrial countries were to cover one third. Unfortunately, developing countries have fallen short of their pledge by roughly one third, while donor countries have fallen short by two thirds, leaving a combined gap of roughly $10 billion per year.9
The United Nations calculated that these shortfalls were leading to a cumulative 122 million unintended pregnancies by 2000. Of these, an estimated one third ended in abortion. The remaining two thirds led to 65,000 deaths during childbirth and 844,000 women who suffered chronic or permanent injury from their pregnancies. The social costs of not filling the family planning gap are high.10
Reinforcing these U.N. calculations are data from the grassroots showing how access to family planning services helps couples achieve their desired family size. Surveys in Honduras show poor women having twice as many children as they want, while women in high socioeconomic groups are highly successful at having the number of children they desire. (See Table 10-1.)11
The benefits of restricting family size have been calculated for Bangladesh, where analysts concluded that the $62 spent by the government to prevent an unwanted birth saved $615 on other social services. Investing in reproductive health and family planning leaves more fiscal resources for education and health care. These numbers suggest that, for donor countries, providing the additional $10 billion or so needed to ensure that all couples who wanted to limit family size have access to the services they need would yield high social returns in improved education and health care.12
|Table 10-1. Honduras: Ideal and Actual Number of Children Born per Woman, According to Socioeconomic Level|
|Source: See endnote 11.|
2. Population projections from United Nations, op. cit. note 1.
3. Population Reference Bureau (PRB), 2002 World Population Data Sheet, wall chart (Washington, DC: August 2002).
4. Ibid.; unmet need from John A. Ross and William L. Winfrey, "Unmet Need for Contraception in the Developing World and the Former Soviet Union: An Updated Estimate," International Family Planning Perspectives, September 2002, pp. 138-43.
5. Janet Larsen, "Iran's Birth Rate Plummeting at Record Pace," in Lester R. Brown, Janet Larsen, and Bernie Fischlowitz-Roberts, The Earth Policy Reader (New York: W.W. Norton & Company, 2002), pp. 190-94; see also Homa Hoodfar and Samad Assadpour, "The Politics of Population Policy in the Islamic Republic of Iran," Studies in Family Planning, March 2000, pp. 19-34, and Farzaneh Roudi, "Iran's Family Planning Program: Responding to a Nation's Needs," MENA Policy Brief, June 2002.
6. Larsen, op. cit. note 5.
9. U.N. Population Fund (UNFPA), "Meeting the Goals of the ICPD: Consequences of Resource Shortfalls up to the Year 2000," paper presented to the Executive Board of the U.N. Development Programme and the UNFPA, New York, 12-23 May 1997; UNFPA, Population Issues Briefing Kit (New York: Prographics, Inc., 2001), p. 23.
10. UNFPA, "Meeting the Goals of the ICPD," op. cit. note 9.
11. Table 10-1 from Honduran Ministry of Health, Encuesta Nacional de Epidemiología y Salud Familiar (National Survey of Epidemiology and Family Health) (Tegucigalpa: 1996), cited in George Martine and Jose Miguel Guzman, "Population, Poverty, and Vulnerability: Mitigating the Effects of Natural Disasters," in Environmental Change and Security Project Report (Washington, DC: Woodrow Wilson International Center for Scholars, summer 2002), pp. 45-68.
12. "Bangladesh: National Family Planning Program," Family Planning Programs: Diverse Solutions for a Global Challenge (Washington, DC: PRB, February 1994).
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