“A great book which should wake up humankind!” –Klaus Schwab, World Economic Forum
Chapter 7. Eradicating Poverty, Stabilizing Population: Stabilizing Population
Some 43 countries now have populations that are either essentially stable or declining slowly. In countries with the lowest fertility rates, including Japan, Russia, Germany, and Italy, populations will likely decline somewhat over the next half-century. 21
A larger group of countries has reduced fertility to the replacement level or just below. They are headed for population stability after large numbers of young people move through their reproductive years. Included in this group are China and the United States. A third group of countries is projected to more than double their populations by 2050, including Ethiopia, the Democratic Republic of the Congo, and Uganda. 22
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 9.2 billion by 2050. The high one reaches 10.8 billion. The low projection, which assumes that the world will quickly move below replacement-level fertility to 1.6 children per couple, has population peaking at just under 8 billion in 2041 and then declining. If the goal is to eradicate poverty, hunger, and illiteracy, we have little choice but to strive for the lower projection. 23
Slowing world population growth means that all women who want to plan their families should have access to the family planning services they need. Unfortunately, at present 201 million couples cannot obtain the services they need. Former U.S. Agency for International Development official J. Joseph Speidel notes that “if you ask anthropologists who live and work with poor people at the village level...they often say that women live in fear of their next pregnancy. They just do not want to get pregnant.” Filling the family planning gap may be the most urgent item on the global agenda. The benefits are enormous and the costs are minimal. 24
The good news is that countries that want to help couples reduce family size can do so quickly. My colleague Janet Larsen writes that in just one decade Iran dropped its near-record population growth rate to one of the lowest in the developing world. When Ayatollah Khomeini assumed leadership in Iran in 1979, he immediately dismantled the well-established family planning programs and instead advocated large families. At war with Iraq between 1980 and 1988, Khomeini wanted large families to increase the ranks of soldiers for Islam. His goal was an army of 20 million. In response to his pleas, fertility levels climbed, pushing Iran’s annual population growth to a peak of 4.2 percent in the early 1980s, a level approaching the biological maximum. As this enormous growth began to burden the economy and the environment, the country’s leaders realized that overcrowding, environmental degradation, and unemployment were undermining Iran’s future. 25
In 1989 the government did an about-face and 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 responsibility for raising awareness of population issues and of the availability of family planning services. Some 15,000 “health houses” or clinics were established to provide rural populations with health and family planning services. 26
Religious leaders were directly involved in what amounted to a crusade for smaller families. Iran introduced a full panoply of contraceptive measures, including the option of 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. 27
In addition to the direct health care interventions, a broad-based effort was launched to raise 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 with TV sets. As a result of this initiative, family size in Iran dropped from seven children to fewer than three. From 1987 to 1994, Iran cut its population growth rate by half. Its overall population growth rate of 1.3 percent in 2006 is only slightly higher than the U.S. growth rate. 28
While the attention of researchers has focused on the role of formal education in reducing fertility, soap operas on radio and television can even more quickly change people’s attitudes about reproductive health, gender equity, family size, and environmental protection. A well-written soap opera can have a profound short-term effect on population growth. It costs relatively little and can proceed even while formal educational systems are being expanded.
The power of this approach was pioneered by Miguel Sabido, a vice president of Televisa, Mexico’s national television network, when he did a series of soap opera segments on illiteracy. The day after one of the characters in his soap opera visited a literacy office wanting to learn how to read and write, a quarter-million people showed up at these offices in Mexico City. Eventually 840,000 Mexicans enrolled in literacy courses after watching the series. 29
Sabido dealt with contraception in a soap opera entitled Acompáñeme, which translates as Come With Me. Over the span of a decade this drama series helped reduce Mexico’s birth rate by 34 percent. 30
Other groups outside Mexico quickly picked up this approach. The U.S.-based Population Media Center (PMC), headed by William Ryerson, has initiated projects in some 15 countries and is planning launches in several others. The PMC’s work in Ethiopia over the last several years provides a telling example. Their radio serial dramas broadcast in Amharic and Oromiffa have addressed issues of reproductive health and gender equity, such as HIV/AIDS, family planning, and the education of girls. A survey two years after the broadcasts began in 2002 found that 63 percent of new clients seeking reproductive health care at Ethiopia’s 48 service centers reported listening to one of PMC’s dramas. 31
Among married women in the Amhara region who listened to the dramas, there was a 55-percent increase in those who had used family planning methods. Male listeners sought HIV tests at a rate four times that of non-listeners, while female listeners were tested at three times the rate of female non-listeners. The average number of children born per woman dropped from 5.4 to 4.3. And demand for contraceptives increased 157 percent. 32
The costs of providing reproductive health and family planning services are small compared with their benefits. Joseph Speidel estimates that expanding these services to reach all women in the developing countries would take close to $17 billion in additional funding from both industrial and developing countries. 33
The United Nations estimates that meeting the needs of the 201 million women who do not have access to effective contraception could each year prevent 52 million unwanted pregnancies, 22 million induced abortions, and 1.4 million infant deaths. Put simply, the costs to society of not filling the family planning gap may be greater than we can afford. 34
Shifting to smaller families brings generous economic dividends. For Bangladesh, analysts concluded that $62 spent by the government to prevent an unwanted birth saved $615 in expenditures on other social services. Investing in reproductive health and family planning services leaves more fiscal resources per child for education and health care, thus accelerating the escape from poverty. For donor countries, filling the entire $7.9 billion gap needed to ensure that couples everywhere have access to the services they need would yield strong social returns in improved education and health care. 35
21. Countries with stable or declining populations retrieved from Population Reference Bureau (PRB), Datafinder, electronic database, at www.prb.org/DataFind/datafinder7.htm, updated 2007; U.N. Population Division, op. cit. note 4.
22. U.N. Population Division, op. cit. note 4; United Nations, “Total Population (Both Sexes Combined) By Major Area, Region and Country, Annually for 1950–2050,” table in World Population Prospects: The 2006 Revision, Extended Dataset, CD-ROM (Rome: 15 June 2007).
23. U.N. Population Division, op. cit. note 4.
24. Program for Appropriate Technology in Health (PATH) and U.N. Population Fund (UNFPA), Meeting the Need: Strengthening Family Planning Programs (Seattle: 2006), pp. 5–11; quote from All Party Parliamentary Group, op. cit. note 7, p. 22.
25. 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; Iran population growth rate from United Nations, World Population Prospects: The 2004 Revision (New York: 2005).
26. Larsen, op. cit. note 25.
28. Ibid; population growth rates from PRB, 2005 World Population Data Sheet, wall chart (Washington, DC: August 2005), and from U.N. Population Division, op. cit. note 4.
29. Pamela Polston, “Lowering the Boom: Population Activist Bill Ryerson is Saving the World—One ‘Soap’ at a Time,” Seven Days, at www.populationmedia.org/archives/archives2.html, viewed 5 October 2007.
33. Additional spending from J. Joseph Speidel et al., Family Planning and Reproductive Health: The Link to Environmental Preservation (San Francisco: Bixby Center for Reproductive Health and Research Policy, University of California, 2007), p. 10, and from J. Joseph Speidel, discussion with J. Matthew Roney, Earth Policy Institute, 16 October 2007.
34. PATH and UNFPA, op. cit. note 24, p. 18.
35. “Bangladesh: National Family Planning Program,” Family Planning Programs: Diverse Solutions for a Global Challenge (Washington, DC: PRB, 1994); gaps from Speidel et al., op. cit. note 33, p. 10, and from Speidel, op. cit. note 33.
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