Topic 4 – Population Policy

Topic 4 – Population Policy A – Fertility Policies B – Mortality Policies

A Fertility Policies • 1. Population Policy • 2. Fertility Enhancement • 3. Fertility Decline • 4. Family Planning • 5. Missing Female Population

1 Population Policy • Context • Fairly recent phenomenon. • Few nations had formal population policies prior to the 1950s: • Developed and developing world alike. • India was the first country to have a family planning policy in 1951. • Still today the place where the needs are among the most urgent. • Became an issue with the population explosion. • The world undertook a reproductive revolution. • About 80% of the population of developing countries is subject to population policies. • Most of them are words without meaning.

1 Population Policy • Definition • Official government strategy. • Set of guidelines specifically intended to affect: • Size of the population. • Rate of growth of a population: fertility (enhance or reduce). • Distribution. • Composition (ethnic). • Population program (direct policies) • Means to make to policy operational. • Public or private initiatives. • Services, information, persuasion or legitimation. Government Policy Intentional Program Impacts Population

1 Population Policy • Indirect policies • Economic and social programs can have an impact on population. • Taxation (credits and deductions for children). • Health and education. • Welfare. • Migration • Either promote emigration or immigration. • Often related to the labor market. • Becoming a very sensitive issue in several developed countries: • The United States and Europe facing migration pressures.

1 Population Policy

1 Population Policy • Labor force • Population in age of working: • On average between 15-65. • Composition and quality are two major concerns. • Substantial changes forthcoming: • More workers and they will be better educated. • More minorities and more women. • Older retirement age. • Size of the labor force • Size of the working age population: • Determined by the population’s age structure. • How many people fall between the ages of 15 and 65. • Rate of labor force participation: • Participation rates are affected by many factors. • The role of women in the society in general.

1 Employment as % of Population Aged 15-64, 2001

2 Fertility Enhancement • Pro-natal policies • Exist in many European nations currently experiencing population decline or ZPG. • Policies: • Generous welfare benefits. • Liberal maternity / paternity leave programs. • Substantial investment in child day care facilities. • Free education through University level. • Sweden: • 12 months maternity leave. • At least 1 month paternity leave. • Payments of $160 per month through age 16 (1st and 2nd child). • $240 per month (3rd and 4th child).

3 Fertility Decline • Context • Lower the number of new children. • Policies and programs oriented toward fertility decline have been increasingly common during the past 30 years. • Controlling population growth is often a politically controversial issue. • Third World Nations: • Attained the 3rd stage of the Demographic Transition. • The promotion of birth control policies for Third World nations has often been viewed as racist.

4 Family Planning

4 Family Planning • Concept • Designed to help families achieve a desired size. • 1/3 of the population growth in the world is the result of incidental or unwanted pregnancies. • 210 million pregnancies in the world per year, of which 100 million are unwanted pregnancies (47%). • 46 million abortion per year. • 500,000 women die each year from unsafe abortions. • 49% of pregnancies in the US are unwanted. • If women could have only the number of children they wanted, the TFR in many countries would fall by nearly to 1.

4 Family Planning • Contraceptive use • Significant increase in the 1960s and 1970s. • From 10% to 50% in the 1990s. • Traditional methods • Abstinence. • Withdrawal. • Douche. • Modern methods • Oral contraceptives. • Intra Uterine Devices (IUD; e.g. diaphragm) • Injectables and implants. • Male and female condoms. • Spermicides. • Emergency contraception (day after pill). • Voluntary sterilization. • Abortion.

4 Percentage of Users Becoming Pregnant During 1st Year of Contraception, United States

4 Contraception Methods used among Married Women, 15-49

4 Abortion Rates in Western Industrialized Countries

4 Main Events Related to Family Planning

4 Family Planning • US view on family planning • Contributes between 40 and 50% of international FP aid. • Characterized by paradoxes: • Between the religious ethics of the leaders and a liberal urban society. • Strongly supportive of FP in the 1960s and 1970s. • Change in the 1980s: • Reagan stopped support to the United Nations Population Fund. • Revoked by Clinton in 1993. • Current policies: • Anti-abortion and increasingly anti-family planning (anti-contraception) domestic policies. • Promote a conservative moral and religious agenda. • First action of President Bush in 2001 was to ban funding to international agencies promoting abortion (and thus FP). • Growing violence against family planning and abortion clinics.

4 Family Planning • Controlling population growth • Natural increase: • Biggest factor in population growth in most countries. • Reducing this component will require substantial progress in social and economic development. • Empowerment of women: • Guarantee of their human rights: • No jobs, no education, no money, • Equal access to nutrition, health care and education • Unable to own land or inherit property • Right to reproductive and sexual health. • Reproductive health services: • Family planning. • Contraception. • Abortion.

4 Family Planning • Family Planning programs • Still considerable unmet demand for reproductive health services. • Require financing. • Must be equitable: • Disparity between accessibility to the poor and the wealthy. • Better access in cities. • Fertility levels among the poor are generally higher: • In rural areas, unwanted fertility reduces the ability to provide for the children. • Put stress on local resources and local environments. • Help push people into migration.

4 Family Planning • Efficient Family planning activities • Strong government support. • Must be medically, economically and culturally acceptable. • Counseling ensures informed consent in contraceptive choice. • Provision of contraceptives. • Training of staff and education of public. • Monitoring the results. • Research for new or improved methods. • Privacy and confidentiality are ensured. • Impact • Much evidence to support the idea that family planning programs have been having a great affect. • Economic development and socioeconomic transformations are a necessary precondition for family planning programs to have an impact?

4 Female Literacy and Fertility in Selected Countries, 1997

4 Family Planning • Family planning in the United States • Birth control use: • 20% of sexually active U.S. teens reported using no birth control • 4% in Great Britain, 6.5% in Sweden, 12% in France and 13% in Canada. • Between 50% and 70% of girls in other countries used birth control pills, only 32% did so in the United States. • Different attitudes of developed countries: • Accepting attitude about teen-age sexual relationships. • Clearer expectations for responsible sexual behavior. • More accessible reproductive health services. • The U.S. is the only country with a formal policy promoting abstinence only. • One-third of school districts teaching sex ed mandate as an abstinence-only program.

5 Missing Female Population • Missing female population • About 100-135 million females are missing from the world population. • Normal ratio at birth is about 100 girls to 105 boys. • Boys are weaker and the ratio evens out after 5 years. • Since 1900 the ratio has been declining, especially after 1990. • Particularly the case for China and India (0-4 age group): • China accounts for about 60 million missing females; India for 25 million. • 1990: 110 boys per 100 girls. • 1995: 118 boys per 100 girls. • 2000: 119 boys per 100 girls. • Ratios even higher for second and third child. • Problems exacerbated by declining fertility and growing standards of living.

5 Sex Ratio (males per 100 females), 2000

5 Infant Mortality Rate (per 1000 under age 5), by Sex, Selected Countries, 2000

5 Missing Female Population • Missing female population in India • Sex determination tests outlawed (1994): • Nobody ever convicted of infringing the law. • Ultrasound for “abdominal cyst”: 500 rupees ($11). • Abortion: 2,000 rupees ($44). • 25% of all female deaths between the age 16 and 24 are due to “accidental burns”. • Between 5,000 and 12,000 “dowry deaths” per year. • Sex ratio is still declining: • 962 girls for 1000 boys (1981). • 945 girls for 1000 boys (1991). • 927 girls for 1000 boys (2001). • Can go as low as 770 in some regions.

5 Missing Female Population, 1998

5 Males minus Females, China, 2000

5 Missing Female Population • Gender roles and the missing female population • Sons are perceived as an asset: • Farm work. • Security for old age (no social security in several countries). • Take over the family name. • Sons get better health care, food and schooling. • 100% of them must find a bride and produce an heir. • In China, the birth of a boy is labeled as “big happiness” while the birth of a girl is labeled as “small happiness”. • Daughters are perceived as a liability: • Marry and leave home to provide labor to another family. • Dowries are often to be paid.

5 Missing Female Population • Causes of the missing female population • High female mortality in infancy or childhood: • Preferential treatment for boys; better food and health care. • Infanticide. • Excess female mortality in utero: • Sex-selective abortion. • 500,000 and 750,000 unborn Chinese girls are aborted every year after sex screening. • Net out-migration of female children: • International adoptions. • Abandon; Orphanage are strictly populated by girls. • In some cases 90% of the girls in orphanages will die. • Sex-selective undercount of children: • Daughters are not declared. • No education provided by the state. • “Sold” / “rented” as a factory worker, wife or prostitute.

5 Missing Female Population • Consequences of the missing female population • Demographic “backlash”: • May help achieve demographic stability. • Fast decline in fertility. • Fast decline of population growth and then of absolute population. • Social consequences: • Limit the advancement of women in society. • The “value” of females will increase considerably in the future: • Millions of men will not be able to find a wife. • Changes in the economics of marriage. • Inverted dowry; “Bride prices” are becoming more common (about $4,000 in China). • Daughters increasingly an asset for industrial work.

B Mortality Control • 1. Context • 2. Major Epidemics • 3. Human Health • 4. Genocide

1 Context • Mortality control • Goal of most governments. • Seek to improve the health standards and life expectancy of their populations. • Expenditures for such health programs are often diminished by conflicting priorities for limited government funds: • Health programs lose out to military spending. • Grandiose infrastructure development programs whose benefits accrue to a small minority of the overall population. • Surveys have shown that small investments over the most threatening causes of death lead to significant increase in health. • More accepted (culturally and socially) than fertility control.

1 Context • Health • Key component of human development. • Broad indicators of human health show that significant progress has been made over the past few decades. • Globalization has enabled new threats of diffusion. • Conditions in many Third World countries remain difficult, especially for the poorest groups. • Health conditions in Third World countries are not necessarily related to climate, but mostly to poverty. • Density issues • Human densities favor the diffusion of diseases. • Strong urbanization can be linked with declining health conditions.

1 Context • Endemic • Many diseases exists in a state of equilibrium within a population. • Many develop an immunity. • Saps energy, lowers resistance, shortens lives. • Epidemic • Sudden outbreak at local, regional scale. • Generally short lived. • Pandemic • Worldwide spread.

2 Major Epidemics • Black Death • Europe, 14th century (the Plague) • Bacteria originating in Asia. • Moved through the trade routes. • Entered Europe in 1347. • Transmission by rats and coughing and sneezing. • 90% death rate of those infected. • 25 million deaths; 25-33% of the European population. • 75 million deaths in Eurasia out of a population of 300 million.

2 Estimated Population of Europe, 1000-1500

2 Major Epidemics • Smallpox • New World, 16th Century. • Virus introduced by Spanish conquistadors and European colonists. • Spread through respiratory system and physical contact. • Between 10 and 20 million killed. • Decimation of the Inca, Aztec and Native American civilizations. • Was officially eradicated in 1977.

2 Major Epidemics • Influenza • Global, 1918-1919 (Spanish Flu). • Virus brought by troops. • Spread through transport routes all over the world. • Transmission through respiratory channels. • Between 25 and 40 million killed (1.2-2.2 % of the global population). • WWI (1914-1918) killed 9 million people.

2 Major Epidemics • HIV/AIDS • Global (Pandemic), 1980 to present. • Originated in Africa. • Mutation of a primate virus to infect humans. • Transmission by body fluids. • 28 million deaths so far. • 68 million infected (0.5% of the global population). • 14,000 new infections per day. • More than 20% of the population infected in several African countries.

2 Global Estimates of Cumulative HIV/AIDS Infections and Deaths Worldwide, 1980-2002 (in millions)

3 Place of Death, 2001 • Deaths per year • 56 million deaths. • 12 million in developed countries. • 44 million in developing countries. • In the poorest regions, 1 in 5 children will die before their 5th birthday. • Contribution to mortality (world) • Tobacco use : 6% (4 million). • Hypertension: 5.8%. • Inadequate water and sanitation: 5.3%. • STDs: 2.2%. • Alcohol use: 1.5%. • Contribution to mortality (USA) • Smoking: 18% • Poor diet and physical activity: 17% • Alcohol-related: 4%

3 Cause of Death, 2001

3 Causes of death in developed and developing countries, 1997 (in %)

3 Cigarette Consumption per Person, 1960-2002

3 Human Health • Major infectious diseases (2001) • Respiratory infections: • 3.9 million deaths. • Pneumonia affects mainly children under 5. • Mainly linked to deteriorating air quality. • Tuberculosis: • 1.6 million deaths. • 30% of humanity carry the TB bacteria. • Growing resistance to antibiotics. • Diarrheal diseases: • 2.0 million deaths. • Improper sanitation of drinking water. • Mainly affect young children. • AIDS: • 2.8 million deaths (see case study 3).

3 Human Health • Malaria: • 1.1 million deaths. • Growing because of resistance to antimalarial drugs and to insecticides. • Related to mosquito prevalence. • Linked to urban areas (stagnant water). • Obesity • 300 millions adults obese in the world (“Globesity”) • Increase risk of heart attack, stroke, diabetes and cancer: • Could reduce life expectancy by 2 to 5 years. • United States: • About 97 million adults, or 55% of people over 20, are overweight or obese. • $33 billion a year on weight-loss products and services. • $70 billion estimated annual health-related costs of treating obesity.

3 Current and Projected Causes of Deaths Worldwide, 1990 and 2020 (in millions)

3 Human Health • Environmental factors • 25% of deaths related to environmental factors. • 1.4 billion people exposed to polluted air: • Relationship between air pollution and hearth attacks. • Urbanization. • Infectious and parasitic diseases: • Accounted for 43% of the 40 million deaths in developing countries. • Almost 40% were due to chronic diseases such as circulatory diseases, cancers and respiratory diseases. • Mosquito is public enemy number 1.

Topic 4 – Population Policy