Why the Silence on Population

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Why the Silence on Population?
The Impact of the Human Population on the
Environment Originally prepared and presented by

• Martha M. Campbell, Ph.D.
• School of Public Health
• University of California, Berkeley
• Venture Strategies for Health and Development
• www.venturestrategies.org

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Population/Environment is considered a
sensitive subject

• To many, we are not supposed to say
• Successfully combating population growth will
  render it possible to preserve the environment
  (incl. ecosystems, biological species, aquatic
  environments, our forests, the atmosphere, etc)
  for future generations.
• However, the human population is the one most
  important component of the current environmental
  equation.

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Ergo

• Since many believe that couples have the number
  of children they want to have,
• And since many believe it is difficult to bring
  down family size without limiting peoples
  freedom,
• Then, although we know that accelerating the
  decline in family size will help preserve the
  environment and ecosystems,
• The Connection between population and Environment
  remains a sensitive topic. For many, it is
  even taboo. Many others prefer not to discuss it
  openly for fear of conflict. Politicians are
  particularly afraid because of past emotional
  reactions.

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The Human Population a contentious
subject

• Why?
• It involves sensitive subjects including sex
  and traditional values concerning birth control
  and reproduction.
• Tough ethical questions are rarely examined
  unemotionally.
• Causality is hard to define in a complex
  system.

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There is much disagreement
between 2 questions
1, Is population growth a problem?
and 2, 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 We will use the former
meaning exclusively!
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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
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South
White Nile
Blue Nile
Ethiopia 2002 72.1 million
2050 173.3 million
Sudan 2002 38.1 million 2050
84.2 million
Nile
An environmental challenge the Nile
Egypt 2002 71.2 million 2050
127.4 million
Today the Nile is nearly depleted before it
reaches the Mediterranean.
Total population dependent on the Nile
2002 194 million projected for 2050 385
million essentially doubled.
Mediterranean
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Sinhalese and Tamil Youth Bulges
major anti-Tamil rioting in Colombo
Sinhalese insurgency
peak Tamil insurgency
20 critical level
Gray Fuller. CIA The Challenge of Ethnic
Conflict. Washington, DC 1995.
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Socioeconomic (SE) paradigm

• People want many children, until changes occur in
  external conditions that increase the desire to
  limit childbearing. These include
• Education (particularly girls education).
• Economic development (increased wealth).
• Reasonable assurance children will survive to
  maturity.
• People make rational decisions about family size,
  and when socioeconomic conditions driving lower
  fertility are in place, they find ways to control
  family size.

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Specific problems of the socioeconomic model

• It does not explain the connection between
  decision and results.
• It uses an inappropriate model of reproductive
  decision making by basing the choice on economic
  circumstances alone it therefore makes
  assumptions which do not fit human reproductive
  biology.
• It is not successfully predictive.

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The demographic conundrum

• The dilemma is that there is no consensus on an
  alternative theory to replace demographic
  transition theorySo the debate continues with a
  plethora of contending theoretical frameworks,
  none of which has gained wide adherence.
• Charles Hirschman. Why fertility changes.
  Annual Review of Sociology 20 203-233. 1994.
  Page 214.

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Alternative paradigm Ease model

• Countries with easy access to family planning
  options, backed up with safe abortion, have low
  or rapidly declining fertility regardless of
  economic conditions or culture.
• ALL countries with replacement level TFR or lower
  have access to safe abortion for ALL (including
  poor) women.
• Where family planning is easy to get,
  contraceptive prevalence between groups of
  different socioeconomic characteristics falls
  away.
• This model can be tested.

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Time taken to go from 6.0 to 3.5 children in a
family
Iran
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Scientific theories are likely to be correct if
they make correct predictions.

• The current, dominant SE paradigm
• Did not predict replacement fertility in
  industrialized nations.
• Does not explain why the use of contraception is
  equally high among educated and uneducated women
  where family planning is easy to obtain.
• Cannot explain why desired family size always
  declines ahead of actual family size.
• Does not explain why Irans fertility fell from 6
  to 2 in record time when birth control was
  promoted.

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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
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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 unconstrained access to
achieve low fertility. (Access to safe abortion
is also critically important for reproductive
health, including low maternal mortality.) The
graph demonstrates the relationship between
countries TFR and their types of abortion laws
by degree of restriction, across 170 countries.

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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. 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. 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.
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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.
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Percentage Currently Married Women who had an
Unplanned Pregnancy (standardized for age,
parity, income and intention)
Grady et al Fam Plan Perspectives 18200-209.
1986
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Why does the paradigm matter?

• The socioeconomic model has had unintended
  consequences
• Population and environmental issues are met with
  fear and Silence.
• Control of Demographic fertility is politically
  incorrect.
• Foreign aid for population control is spent
  unproductively family planning is still
  hard to get for the poor.
• Population is viewed as the given in the
  population/ environment equation, not as a factor
  amenable to change.

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Realistic family planning accelerates falls in
family size
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What are the barriers to fertility
regulation methods?

• Religions constrain providers
• Mothers-in-law are in charge.
• Young brides lack power.
• Unmarried young females are excluded from
  services.
• Prices are too high.
• Outlets are unreachable.
• Medical rules make getting contraception
  difficult.
• Misinformation about contraception.

• Govt services are poor.
• Advertising isnt allowed.
• Paramedicals are not activated.
• Pills are either restricted or not understood.
• Method choices are limited.
• Safe abortion is hard for poor women to get.

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Which of the barriers can be reduced on a large
scale by a foundation?

• Religions constrain providers
• Mothers-in-law are in charge.
• Young brides lack power.
• Unmarried young females are excluded from
  services.
• Prices are too high.
• Outlets are unreachable.
• Medical rules make getting contraception
  difficult.
• Misinformation about contraception.

• Govt services are poor.
• Advertising isnt allowed.
• Paramedicals are not activated.
• Pills are either restricted or not understood.
• Method choices are limited.
• Safe abortion is hard for poor women to get.

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• 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

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VTC
POP
WIN
MKT
DST
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The Refrigerator Model of Fertility
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Human sex and reproduction do not fit the
standard economic model
The nature of decision making about family size
differs from rational choice in the purchase of a
normally marketed good or service. Human sexual
intercourse is frequent and usually unrelated to
desired reproduction. The decision to have a
child is not a positive one of turning
childbearing on, but a negative one of turning
childbearing off and negative, preventive
action must be taken repeatedly, persistently,
perfectly.
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The Refrigerator Model of Fertility
To buy a refrigerator Call Sears. Send a
fridge. If buying a refrigerator is like human
reproduction We must call Sears X times a week
and say Do not send a refrigerator. If we fail
to call Sears every time we do NOT want a
refrigerator - repeatedly, persistently,
perfectly -
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The Refrigerator Model of Fertility
there are consequences
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The Refrigerator Model of Fertility AND MORE
CONSEQUENCES