"It is the most interesting book I have ever read and inspires me to do something immediate to save our civilization." —Hanh Lien, translator for the Vietnamese edition of World on the Edge
Chapter 7. Eradicating Poverty and Stabilizing Population: Stabilizing Population
There are now two groups of countries where populations are projected to shrink, one because of falling fertility and the other because of rising mortality. In the first group, some 33 countries with roughly 674 million people have populations that are either essentially stable or declining slowly as a result of declining fertility. In countries with the lowest fertility rates—including Japan, Russia, and Germany—populations will likely decline measurably over the next half-century. 54
The second group—countries with population declining due to a rising death rate—is a new one. Projections by the Washington-based Population Reference Bureau in 2008 show two countries in this group—Lesotho and Swaziland—both with high HIV infection rates and widespread hunger. Unfortunately, the number of countries in this group could expand in the years ahead as populations in low-income countries outgrow their land and water resources. 55
In addition to 33 countries with essentially stable or declining populations, another group of countries, including China and the United States, have reduced fertility to replacement level or just below. But because of inordinately large numbers of young people moving into their reproductive years, their populations are still expanding. Once this group of young people moves through their high-fertility years, however, these countries too will be reaching population stability. The 29 countries in this category contain some 2.5 billion people. 56
In stark contrast to these situations, a large group of countries are projected to continue expanding their populations in the years ahead—with some of them, including Ethiopia, the Democratic Republic of the Congo, and Uganda, projected to more than double in size by 2050. 57
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 10.5 billion. The low projection, which assumes that the world will quickly move below replacement-level fertility, reaching 1.5 children per couple by 2050, has population peaking at just over 8 billion in 2042 and then declining. If the goal is to eradicate poverty, hunger, and illiteracy, then we have little choice but to strive for the lower projection. 58
Slowing world population growth means that all women who want to plan their families should have access to the family planning services they need to do so. Unfortunately, this is currently not the case for 201 million women. 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.” 59
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. 60
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. 61
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. 62
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. 63
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—an impressive achievement. 64
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 near-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. 65
Sabido dealt with contraception in a soap opera entitled Acompáñame, which translates as Come With Me. Over the span of a decade this drama series helped reduce Mexico’s birth rate by 34 percent. 66
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 had listened to one of PMC’s dramas. 67
Among married women in the Amhara region of Ethiopia who listened to the dramas, there was a 55-percent increase in those using family planning. 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 per woman in the region dropped from 5.4 to 4.3. And demand for contraceptives increased 157 percent. 68
The costs of providing reproductive health and family planning services are small compared with the benefits. Joseph Speidel estimates that expanding these services to reach all women in developing countries would take close to $17 billion in additional funding from industrial and developing countries. 69
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, filling the family planning gap may be the most urgent item on the global agenda. The costs to society of not doing so may be greater than we can afford. 70
Shifting to smaller families brings generous economic dividends. In Bangladesh, for example, 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, ensuring that couples everywhere have access to the services they need would yield strong social returns in improved education and health care. 71
Helping countries that want to slow their population growth brings with it what economists call the demographic bonus. When countries move quickly to smaller families, growth in the number of young dependents—those who need nurturing and educating—declines relative to the number of working adults. In this situation, productivity surges, savings and investment climb, and economic growth accelerates. 72
Japan, which cut its population growth in half between 1951 and 1958, was one of the first countries to benefit from the demographic bonus. South Korea and Taiwan followed, and more recently China, Thailand, and Viet Nam have benefited from earlier sharp reductions in birth rates. This effect lasts for only a few decades, but it is usually enough to launch a country into the modern era. Indeed, except for a few oil-rich countries, no developing country has successfully modernized without slowing population growth. 73
54. Countries with more than 1 million people and natural rate of increase of 0.4 percent or less retrieved from U.N. Population Division, World Population Prospects: The 2008 Revision, Extended Dataset, CD-ROM (New York: 9 April 2009).
55. Lesotho and Swaziland population data from Population Reference Bureau (PRB), Datafinder, electronic database, at www.prb.org.
56. U.N. Population Division, op. cit. note 54.
59. Program for Appropriate Technology in Health (PATH) and UNFPA, Meeting the Need: Strengthening Family Planning Programs (Seattle, WA: 2006), pp. 5–11; quote from All Party Parliamentary Group, op. cit. note 11, p. 22.
60. 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.
61. Ibid.; 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).
62. Larsen, op. cit. note 60.
64. Ibid.; population growth rates from PRB, 2005 World Population Data Sheet, wall chart (Washington, DC: August 2005); U.N. Population Division, op. cit. note 2.
65. Pamela Polston, “Lowering the Boom: Population Activist Bill Ryerson is Saving the World—One ‘Soap’ at a Time,” Seven Days, 21 August 2005.
69. 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.
70. PATH and UNFPA, op. cit. note 59, p. 18.
71. “Bangladesh: National Family Planning Program,” Family Planning Programs: Diverse Solutions for a Global Challenge (Washington, DC: PRB, 1994); Speidel et al., op. cit. note 69, p. 10.
72. UNFPA, The State of World Population 2004 (New York: 2004), pp. 14–15.
73. United Nations, op. cit. note 61; UNFPA, op. cit. note 72, p. 39.
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