Martha M' Campbell, Ph'D'

1
Fertility, Development and the Politics of
Population

• Martha M. Campbell, Ph.D.
• Center for Entrepreneurship in International
  Health and Development (CEIHD)
• School of Public Health, UC Berkeley

2
(No Transcript)
3
A progression
1 billion 1800 200,000? years 2
billion 1930 130 years 3
billion 1960 30 years 4 billion 1975
15 years 5 billion 1987 12 years 6
billion 1999 12 years
4
A contentious subject

• Why?
• Involves sensitive subjects including sex
  and traditional values around reproduction
• At least tough ethical questions, rarely
  examined
• Causality hard to define in a complex system

5
Confusion

• between 2 Qs is population a problem? and
  what reduces fertility?
• Caution, fertility has two meanings
• Demography how many children a woman (or a
  couple) has
• Biology whether a living being is able to
  produce offspring
• between necessary and sufficient.

6
A range of positions

• Population and poverty
• Population Growth and Economic Development
  Policy Question. US National Research Council of
  the National Academy of Sciences, 1986
• Population Matters Demographic Change,
  Economic Growth, and Poverty in the Developing
  World. Nancy Birdsall, Steven Sinding, Allen
  Kelley, Oxford University Press 1991
• Population and environment Obvious vs. doubts
  or math
• Ecological footprint, overshoot, Mathis
  Wackernagel, Redefining Progress
• Nile - Ethiopia/Sudan/EgyptChina, water tables

7
Population Summit of the Worlds Scientific
Academies New Delhi,1993
If current predictions of population growth
prove accurate and patterns of human activity on
the planet remain changed, science and technology
may not be able to prevent irreversible
degradation of the natural environment and
continued poverty for much of the world.
8
Defining the Schools of Thought around the Earth
Summit at Rio, 1992

• Influential in international policy arena
• Common objectives and beliefs
• Line up behind their more vocal proponents

9
(No Transcript)
10
VTC
POP
WIN
MKT
DST
11
Asymmetry
in the population policy arena
POP MKT DST WIN
VTC
Primary interests Issues re population Chosen
policy actions Beliefs Subjects not
included \
12
Asymmetry
in the population policy arena
POP MKT DST WIN
VTC
Primary interests Issues re population Chosen
policy actions Beliefs Subjects not
included \
13
Population-and-Environment a
sensitive, taboo subject.
Many people now feel it is inappropriate to say
that slowing population growth will make it more
possible to preserve the environment (including
ecosystems, species, water) for future
generations.
14
Population-and-Environment a
sensitive, taboo subject.
Many people now feel it is inappropriate to say
that slowing population growth will make it more
possible to preserve the environment (including
ecosystems, species, water) for future
generations.
15
Population-and-Environment a
sensitive, taboo subject.
Many people now feel it is inappropriate to say
that slowing population growth will make it more
possible to preserve the environment (including
ecosystems, species, water) for future
generations.
Decision in UN at Cairo Prepcom IV, 1994
16
Population-and-Environment a
sensitive, taboo subject.
Many people now feel it is inappropriate to say
that slowing population growth will make it more
possible to preserve the environment (including
ecosystems, species, water) for future
generations.
1992 to 2002, Rio to Johannesburg
17
Why?An unintended legacy of Cairo
Cairo ignored the Academies statement, and
fostered a belief that focusing on demographic
outcomes as one reason for offering family
planning will lead to coercion or may be
inherently coercive. This belief assumes that
family planning is asking people to do something
that they do not want to do. (In reality,
all over the world there is a very large unmet
need for family planning.)
18
The new shift, around the Johannesburg summit
19
Theories of fertility decline
POP MKT DST WIN
VTC
Primary interests Issues re population Chosen
policy actions Beliefs Subjects not
included \
FP S-E S-E
S-E S-E
20
New observations by the
United Nations Population Division
In a number or countries we are seeing fertility
decline that cant be explained by education or
economic development. Dr. Larry Heligman,
United Nations, Population Division, April 2002
21
Dr. Heligmans examples
the S-E model has not predicted
Date TFR Ghana 1985-90 6 today
4.9 Cote dIvoire 1985-90 6.9 today
4.6 Bangladesh 1992 4.9 2001
3.3 Today, the average woman age 20 to 24
in Bangladesh wants 2 children.
22
The new shift goes public
Only a few years ago, some experts argued that
economic development and education for women were
necessary precursors for declines in population
growth. Today, village women and slum families
in some of the poorest countries are beginning to
prove them wrong, as fertility rates drop faster
than predicted toward the replacement
level. Barbara Crossette, NY Times Aug. 20, 2002
23
The Global Science Panels statement for
JohannesburgPopulation in Sustainable
Development July 2002
Lowering fertility leads to slower population
growth, allowing more time for coping with the
adverse effects of that growth, and easing stress
on the environment.
24
The Global Science Panels
statement for Johannesburg, July 2002
Population in Sustainable Development
Recommending investment in voluntary family
planning and reproductive health programs
Since research has shown that many women in
high-fertility countries have more children than
they actually want, these programs allow couples
to have the number of children they desire, thus
reducing unwanted childbearing and lowering
fertility rates.
25
Bongaarts
At the Population Council, Dr. John Bongaarts
questions the assumption that when fertility
declines begin they will continue to go down at
the same pace, especially if good family planning
services are not widely available. Barbara
Crossette, NY Times, Aug. 20, 2002
26
The Population and Sustainability Dialog Group
of the Stakeholder
Forum for WSSD, U.K.
August 2002
Solution Ensuring that women have access to
information and to RHC services and modern
reproductive technologies usually results in
women making conscious decisions to reduce the
size of their families. The impact of
opportunity on demand
27
Ms
Even in countries where poverty and illiteracy
are still widespread, population is declining.
But feminist health advocates have always known
that women who are afforded the right to decide
about the size of their families, coupled with
the resources to implement this decision, usually
opt for fewer children. Ellen Sweet, Ms
Magazine, summer 2002 The impact of opportunity
on demand
28
Implications?

• Renewed attention to the connection between
  population factor and environmental problems in
  the present and future. (Problem def.)
• Broader recognition that in the population factor
  in the population-environment equation is
  amenable to change not a given.
• A benefits for individual a benefits for
  community

29
Implications?
The world summit on sustainable development, by
overlooking the population factor, brought out
the first broad group statements on the
importance of this factor for sustainability, and
on the value of family planning for both women
and the environment at the same time after
years of silence. Competing schools are coming
together. The Schools of Thought pattern is
breaking down.
30
Is Replacement Level Fertility Possible Without
Access to Abortion? Martha M. Campbell, Ph.D. and
Kimberly Adams, M.P.H. The Center for
Entrepreneurship in International Health and
Development (CEIHD, seed) School of Public
Health, University of California, Berkeley
What about the anomalies? Some countries with
high fertility have liberal abortion laws, and
some countries with low fertility have
restrictive abortion laws. What is going on
here?   Zambia (TFR 5.3, law 4) Zambia has a
liberal law but with a critical restriction it
requires approval by 3 ObGyn physicians. Few
people are able to have legal abortions in
Zambia. India (TFR 3, law 4) A liberal abortion
law since 1970s, but restrictive in that only
university-trained doctors can provide this
service, and those doctors dont live in most of
Indias million villages, which are home to most
of Indias low income people. Tajikistan (TFR 4,
law 5) We dont know about this country, or
similar situations in Turkmenistan, Uzbekistan,
Kyrgystan. Ireland (TFR 1.9, law 1) The law
forbids abortion but safe abortion services are
widely accessed across the channel in
England. Republic of Korea (TFR 1.7, law 2) The
law is restrictive but has been interpreted
liberally for decades, to make safe abortion
available. Singapore (TFR 1.7, law 3) The law
permits abortions for health reasons only, but it
is interpreted liberally. Mauritius (TFR 1.9, law
1) Abortion is not legal and we dont know what
is going on here. One possibility a single
illegal abortion provider could make the
demographic difference in a country of only 1
million people. Myanmar (TFR 2.3, law 1) Abortion
is not legal but it is no secret that it is
widely practiced in this country. Many procedures
are done with unsafe methods. Thailand (TFR 1.7,
law 2) Abortion law is restrictive in language,
but safe and low cost abortion services are
widely available. Bangladesh (TFR 3, law 1)
Abortion is not permitted, but menstrual
regulation (vacuum aspiration in the first 8
weeks to bring on a late menstrual period) is a
legal part of family planning. Bangladesh has
over 10,000 providers of trained manual vacuum
aspiration (MVA) services, only 50 of whom are
doctors. Sri Lanka (TFR 2.1, law 1) Abortion is
not formally legal but clinics provide large
numbers of safe menstrual regulation
services. Spain (TFR 1.1, law 3) Abortion is
permitted for health reasons, but the law is
interpreted liberally.
Hypothesis We have observed that all countries
with 2 or fewer children have widespread,
realistic availability of safe abortion for poor
women. (We recognize that rich women have access
to safe abortion in virtually every country.)
We hypothesize that all high fertility countries
have constrained access to abortion, and that it
is necessary to have relatively unconstrained
access to back up imperfect use of family
planning, to achieve low fertility. (Access to
safe abortion is also critically important for
reproductive health, including low maternal
mortality.) This graph demonstrates the
relationship between countries TFR and their
types of abortion laws by degree of restriction,
across 170 countries.
Conclusions   1. What is stated in the law
is less important than how the abortion providers
interpret the law.  2. A country is not
likely to get to replacement level fertility
without access to safe abortions for low income
women.
Sources The State of the Worlds Children 2000,
UNICEF and the Center for Reproductive Law and
Policy, 2000
31

• We must be courageous in speaking out on the
  issues that concern us
• We must not bend under the weight of spurious
  arguments invoking culture or traditional values.
• No value worth the name supports the oppression
  and enslavement of women.
• The function of culture and tradition is to
  provide a framework for human well being.
• If they are used against us, we will reject them,
  and move on. We will not allow ourselves to be
  silenced.
•    Dr. Nafis Sadik, Exec. Director, UNFPA,
  Under-Secretary of UN, at the United Nations
  Conference on Women, Beijing, China, September
  1995

32
The Global Science Panels statement for
JohannesburgPopulation in Sustainable
Development
July 2002
Signatories Wolfgang Lutz, Mahendra Shah,
IIASA, Schlossplatz 1, A-2361 Laxenburg, Austria,
coordinators and R. E. Bilsborrow, J. Bongaarts,
P. DasGupta, B. Entwisle, G. Fischer, B. Garcia,
D. J. Hogan, A. Jernelov, Z. Jiang, R. W. Kates,
S. Lall, F. L. MacKellar, P. K.
Makinwa-Adebusoye, A. J. McMichael, V. Mishra, N.
Myers, N. Nakicenovic, S. Nilsson, B. C. O'Neill,
X. Peng, H. B. Presser, N. Sadik, W. C.
Sanderson, G. Sen, M. F. Strong, B. Torrey, D.
van de Kaa, H. J. A. van Ginkel, B. Yeoh, H.
Zurayk. Full address details and affiliations are
available on the panel's website at
www.iiasa.ac.at/gsp/