Population

Given what is known about the determinants of fertility, a government that is interested in lowering fertility in its country has a number of options. Through legislation, commitment of funds, and public statements, a government can affect the availability of family planning and primary health care services; the range of contraceptives available in the country; public education for family planning; marriage age; schooling opportunities, especially for girls; legal status of women; work opportunities for women; and other aspects of women's status. The discussion that follows is intended to apply to a developing country with relatively high fertility and low status of women, where not everyone has ready access to health care, either privately or publicly provided. It is assumed that not all children are in school, either at the primary or the secondary level. It is further assumed that incomes are quite low and that a significant portion of the country is rural and agricultural. The government would want a complete supply of the full range of contraceptives available for everyone wanting them, It should lift any trade barriers or bans on the import of particular contraceptive commodities and encourage the domestic manufacture of contra ceptives. If budgets allowed, it might want to support research into new contraceptives. Legal restrictio~s on the use of contraceptives would need to be lifted. A government interested in the fllIIL'st range of family planning services would ensure that abortion is legal and readily available, It is widely agreed that achieving replacement-level fertility with current contra ceptive technologies-and human nature-is not possible without the option of abortion. Of course, abortion raises religious and moral questions that not all countries answer permis sively. Also important are doctors, nurses, and other health professionals trained in family planning. A government can subsidize medical training, either at home or abroad, and encourage or require the inclusion of family planning in such training. In addition to the sheer legal availability of contraceptives and abortion, the government would want to ensure that family planning services are actually available to everyone regardless of income or geographic location. Thus it might want to fund public family planning clinics, including mobile units to reach even the remotest areas. An enormously effective and inexpensive method of public education in family planning takes very little effort on the part of a govern ment: announcements and other public mes sages that having fewer children is the right thing to do now, amounting to a patriotic act. A government can also encourage the promulga tion of similar messages, as well as practical information about locations of clinics and availability of services, in the media. Family planning services are best offered in the larger context of primary health care, particularly maternal and child health care. In a very poor country, where the status of women is low, having many children makes economic and cultural sense, and many children die in infancy. At best, offering family planning services in isolation, apart from other health care, may simply elicit no interest. At worst, it may seem a cruel joke to parents struggling to keep children alive. Within a system of primary health care, too, it makes sense-both from the point of view of population stabilization and for humanitarian reasons-to encourage breast- feeding and to focus on the package of immuni zation, nutrition, and sanitation practices that contribute to keeping inants and children alive. A government can pass laws raising the legal age at first marriage, which may technically hold hope of reducing fertility. A law alone, however, may change nothing about marnage practices without accompanying public educa tion and efforts to change cultural habits. Cultural changes such as these usually take more than the passage of a law. Moving toward universal enrollment of both boys and girls in primary and secondary school works on several levels to encourage lower fertility. Better educated people are open to new ideas and can take better advantage of work opportunities. Education specifically on family planning and health care for infants and children can lead directly to lower fertility and smaller, healthier families. Every year that a girl stays in school usually reduces the ultimate size of her future family. Keeping girls in school also improves their chances for well-paid employment, participation in public life, self- determination, and other indicators of higher status. A large package of legal and other reforms beyond education is needed to raise the status of women more broadly in a society. For example, women need the right to own and inherit property and to borrow money to have the fullest range of economic opportunities; in many countries, women do not have these rights. Marriage may disadvantage women by putting all family property in the husband's name or by making it easier for men to divorce their wives than it is for women to divorce their husbands, and then requiring no child support or alimony. In many countries, too, the notion of equal pay for equal work is a foreign one; women receive lower wages than men, whether it is for equal work or not. Another area of law relating to the status of women involves domestic violence. The status of women can never be truly equal to that of men, or even higher than it is today, if women are at risk of injury and even death in their own homes. Thus laws and customs that overlook domestic violence, that make it nearly impossible for women to be protected from violence at the hands of their husbands, and that leave domes tic violence unpunished all contribute to the low status of women and, directly and indi rectly, to higher fertility. A government interested in raising the status of women would look beyond strict legalities and develop programs to complement the kinds of changes mentioned above. For example, in addition to enacting laws requiring equal pay for equal work or nondiscrimination in the workplace, a government could fund programs that provide credit to women to begin small businesses-indeed, in many Third World countries today, programs that make "microloans" to women already enjoy consider able success. A government could institute programs to train women for a wider range of work. It could also fund private groups work ing to improve women's lives, from groups that deal with domestic violence to those that provide health care and family planning. A final area of interest to a government wishing to encourage a fertility decline involves incentives and disincentives in family planning programs. Incentives and disincentives are, generally, rewards and penalties designed to promote the use of contraception and the adoption of a small-family norm, or the replace ment-level fertility required for population stabilization. They can be part of the adminis tration of a family planning program, such as the payment of small sums to people who accept a family planning method or to doctors or family planning workers for recruiting acceptors. They can also be larger-scale efforts that link development projects for a community with the acceptance of family planning or the achievement of certain goals such as numbers of births. Or they can impose penalties on families that exceed a certain number of births. The oldest and most common incentive is a small one-time payment or in-kind contribution (such as a clean garment) to a person who accepts a family planning method, usually sterilization. First used in India in the 1950s, this kind of incentive is offered in some two dozen countries around the world. Experience shows that offering incentives can in fact increase the number of acceptors of steriliza tion. In most cases, a payment is intended to compensate the acceptor for lost wages, the costs of travel, and meals involved in coming to a family planning clinic to be sterilized. In fact, however, even small payments can act as an inducement, especially in very poor countries. Some critics of these incentives argue that the risk of coercion is so great that they should be eliminated, especially for sterilization, a perma nent and surgical method of birth control. Coercion occurs when an incentive is so attrac tive to a person that it exerts what is called in law undue influence on a person's decision; that is, voluntary, informed consent becomes impossible because the extreme attractiveness of the incentive is substituted for true weighing of alternatives. Others argue that well-designed programs, with counseling and payments matched to actual costs incurred, can insure informed consent in family planning programs. Two other kinds of incentive schemes attempt to improve people's lives significantly by changing the circumstances that lead them to have many children. They are deferred incentive schemes and community develop ment incentives. Deferred incentive schemes involve periodic payments to an account or fund for people who limit their families. The idea is to substitute future payments for the security that children bring. Payments can take the form of old-age pensions, life insurance, education funds, and the like, and are collected in the future, when people have succeeded in having a small family. Deferred incentive schemes leave the choice of birth control method to the individual and reward behavior over a long period of time that requires deliber ate thought. This avoids the last-minute pres sure and risk of undue influence that can be present in one-time payment schemes. A number of imaginative deferred incentive schemes have been devised; a few of these have been tried in pilot programs in Taiwan and Inda, with some success in reducing fertility. The problem is that to have a national effect on birth rates the program would have to be national in scope and would thus cost a great deal of money; indeed, it would amount to nothing short of a national social security or social welfare program. Finally, for such a program to work, a national government needs to have meaningful contact with its citizens, who in turn have confidence in the solvency and good faith of their government. Such is not the rule in many poor countries in the world today. Community development incentives have most of the advantages of deferred payment programs and few of the disadvantages. The government agrees to reward a community with a project that will increase its wealth. This might be a well, irrigation, a diesel pump, livestock, a biogas plant, a school, roads, parasite control, or low-interest loans. The projects are funded as the community complies with specified family planning or fertility goals, such as contraception practiced by 60% of couples, or fertility not exceeding an average of two or three children per family. The programs are sometimes quite complex, involving de ferred payments and participation by individu als earning shares in a common fund. Thailand and Indonesia have community development projects linked to family planning and have seen some local successes. Such programs can be carried out locally and enforced through local mechanisms, avoiding the problem of lack of contact and confidence that national govern ments can experience with villages in poor countries. On the other hand, a successful community project requires social cohesion in villages, which does not exist everywhere. And these programs rely on local peer pressure, which can come from elites and be the most direct kind of coercion. Disincentives are the other side of the coin from incentives; these measures impose costs on large families or withhold benefits such as housing subsidies, employment benefits, or preference in school admission. Singapore has the longest experience with disincentives, and China has disincentive policies in place in some regions. Disincentives are not widely used, in part because few countries wealthy enough for them to be meaningful have population policies that limit family size. And Singapore has in recent years moved away from its low fertility policies and is attempting to encourage births, without significant success. Disincentives are economical; they deprive people of things that would otherwise cost the government money. But they have their share of drawbacks. A disincentive can impose a cost so high, or deprive an individual of something so fundamentally necessary, that it amounts to coercion. Withholding food from the poor if they have many children, for example, is so punitive that it becomes pure compulsion. If not fashioned carefully, too, disincentives can punish the innocent. It can be argued that denying children admission to the best schools because they come from a large family punishes them for their parents' acts. All incentives and disincentives involving family planning have advantages and disad vantages. In any given country, whether the good aspects outweigh the bad depends on the particular circumstances. Whatever else is true of incentives and disincentives, they are not the first or the only step a government or family planning program should take to curb popula tion growth. Indeed, without a larger context of improving the health of mothers and babies, raising the status of women, and offering the full range of family planning services to every one, incentives and disincentives have very little chance of affecting fertility behavior and have a very great chance of doing violence to an individual's bodily integrity and free choice.

Questions

Answer the following questions in the text area below and enter your full name and E-mail address.

This section spoke exclusively about the kinds of policies that the government of a developing nation could consider adopting to reduce population growth in its own country. We, in Canada, usually have a different perspective: how Canada through financial assistance to developing countries, can affect population growth rates in those countries.

1) Make a list of policies, similar to the ones discussed, that Canada might promote in developing countries through financial assistance.

2) Do we have an obligation to promote or support certain activities in other countries ?

3) What is acceptable in your view, for Canada to promote in other countries?

4) Are some things/policies unacceptable? Why?

5) How would you feel if Canada also adopted the list of policies you came up with in question 1 ? Would they be acceptable to you?