TABLE 13-1
Change in Disapproval of Abortion (all white respondents)
were still unable to obtain them. More than half
of all abortions after 1973 were carried out in
specialized clinics, while public hospitals (which
provide most medical services to the poor) were
lagging even behind private hospitals in provid-
ing services. Only one in five U.S. public hospi-
tals reported performing any abortions in 1975.
Thus in many areas it was substantially more
difficult for poor women to obtain abortions than
for middle-class or wealthy women, even though
government funds were available to cover the
costs. Teenagers, who account for about one-
third of the need for abortion services and for a
large and growing portion of the illegitimate
birth rate, also seem to have poor access to safe
abortions. Finally, abortion services were found
to be generally less available in the southern and
central regions of the U.S. than on either coast.
In the United States, the majority of abortion
recipients are young and/or unmarried. There is
some debate over the degree to which legal
abortion has affected American fertility overall,
but it seems to have had a significant effect on the
rate of illegitimate births. In 1971 reductions in
illegitimate births in states with legal abortion
ranged as high as 19 percent, while in most states
without legal abortion they continued to in-
crease/ Following the Supreme Court decision,
the rising rate of illegitimacy halted briefly, then
began again. The rise was accounted for by an
increase in teenage pregnancy.
There is no evidence that abortion has re-
placed contraceptives to any significant degree,
despite the apprehensions of antiabortion groups
on this score. Most women seeking abortion have
a history of little or no contraceptive practice,
and many are essentially ignorant of other means
of birth control. Those who return for sub-
sequent abortions have been found to be still
ignorant of facts of reproduction, using contra-
ceptives improperly, or to have been poorly
guided by their physicians."
Paralleling the trend toward liberalized abor-
tion policies in the U.S. has been the growth of
right-to-life groups who are adamantly opposed
to abortion. These groups have lobbied actively
against reform of state laws and, since the
Supreme Court decision, have tried to persuade
Congress to reimpose sanctions against abortion
through Constitutional amendments. Under
their pressure, Congress has removed funds for
1. Sklar and B. Berkov, Abortion, illegitimacy, and the
American birth rate.
"Blame MD mismanagement for contraceptive failure, Family
Planning Perspectives, vol. 8, no. 2, March/April 1976, pp.
72-76.
Percentage of disapproval
Reason for abortion 1962 1965 1968 1969
Mother's health endangered 16 15 10 13
Child may be deformed 29 31 25 25
74 74 72 68
Can't afford child
No more children wanted - - 85 79
Source: Judith Blake, Abortion and public opinion.
abortion services from Foreign Aid grants to
LDCs. In 1976, Congress also passed a law
forbidding federal assistance for abortions in the
U.S., a move that denies these services to low-
income women—precisely the group whose
chances for a decent and productive life are most
likely to be jeopardized by an unwanted child.
Whether the courts will consider such a dis-
criminatory law constitutional is another ques-
tion. Right-to-life groups have also played a part
in harassing clinics, hospitals, and other organi-
zations that provide abortion. This activity often
embarrasses clients and possibly has also dis-
couraged other institutions from providing
abortion services.
Action by right-to-life groups in Boston re-
sulted in the trial and conviction for manslaugh-
ter in early 1975 of physician Kenneth Edelin
following a late-term abortion (about 20 weeks).
The prosecution maintained that the fetus might
have survived if given life-supporting treatment.
(The conviction was overturned in December
1976 by the Massachusetts Supreme Judicial
Court.)'1 The consequence of the original verdict
nevertheless was to discourage late second-
trimester abortions (31 states already had laws
against them except to protect the mother's life
or health; in most states abortion by choice was
available only through the 20th week). Unfortu-
nately, this change also will affect mainly the
poor and/or very young women, who through
ignorance or fear are more likely to delay seeking
an abortion until the second trimester.
In 1976, a Right-to-Life political party was
formed, centering on the abortion issue. Its
candidate, Ellen McCormack, entered primaries
in several states, but never succeeded in winning
more than 5 percent of the vote. Most Ameri-
cans, it appears, accept the present legal situation
at least as the lesser of evils.
* Time and Nescstceek, March 3, 1975. Both magazines covered
the trial and the issues it raised in some detail. See also Barbara
Culliton's thoughtful article, Edelin trial; jury not persuaded,
and Edelin conviction overturned, Science, vol. 195, January 7,
1977, pp. 36-37.
758 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
admitted having had an abortion; under Italian law she
had committed a crime and could be sent to prison. Some
years ago in a confidential survey of 4000 married women
of all classes, all admitted to having had abortions, most
of them many times.48
A movement is now underway to loosen the laws
against abortion in Italy, following the limited legaliza-
tion of the pill in 1971, despite strong opposition from
the Vatican and conservative political elements. The
Italian constitutional court in early 1975 ruled that
abortion is legal if doctors determine that the pregnancy
threatens the physical or mental health of the mother.
Before the 1970s, variations on the Italian abortion
tragedy prevailed in several other Western European
countries. In France, contraceptives were available but
not openly, and the illegal abortion rate and attendant
rates of death and injury nearly matched those of Italy. In
late 1974, abortion was legalized in France, shortly after
a new law was passed greatly increasing public access to
contraceptive devices and information.
Similar reversals have occurred in many DCs since
1965. West Germany, Denmark, and Austria legalized
abortion on request between 1973 and 1975, although its
status in Germany was changed by a court decision and
remains to be reestablished by legislation. In 1975
Sweden changed its already moderately liberal law to
allow abortion up to the twelfth week as a decision for the
woman alone to make. Finland, Norway, and Iceland
have long had liberal policies, but they fall short of
availability on request. Laws against abortion in Greece
and the Netherlands have been neither observed nor
enforced and soon may be reversed. The same was
formerly true of Switzerland, which in 1975 moved to
liberalize its abortion laws. Great Britain has in effect
permitted abortion on request since 1967. Spain, Por-
tugal, Belgium, and Ireland still had very restrictive laws
in 1976.4'
In most of Eastern Europe, abortion has long been
legal and usually subsidized by the state. Abortion has
been legal since 1920 in the Soviet Union, and in most
Eastern European countries (except Albania) since the
•"L. Zanetti, The shame of Italy.
"Zimmerman, Abortion, law and practice; C. Tietze and M. C.
Murstein, Induced abortion: a factbook, 1975. These two are the major
sources for what follows.
1950s. Abortion brought birth rates so low that Bulgaria,
Czechoslovakia, and Hungary tightened their regulations
in 1973. Romania severely restricted access to abortion in
1966, with the result that its birth rate virtually doubled
the following year. Since then, the birth rate has declined
toward the 1966 level, indicating an increase in illegal
abortions. The rates of hospitalizations and deaths from
abortion complications have also risen substantially.
Meanwhile the huge cohort of children born in 1967 has
caused havoc in the Romanian school systems.50
Canada has relaxed its abortion law somewhat; prac-
tice is considerably short of "on request," but widely
liberal interpretation of the new law might make it close.
Canadians denied abortions often go to the United
States. Australia is moving toward liberal policies, al-
though access varies by state. New Zealand remains
restrictive, but discussion of change has begun.
Abortion in LDCs. The tragedy of illegal abortion
thus is rapidly becoming a thing of the past in most of the
developed world, but change is coming more slowly in
much of the less developed world. In some countries the
problem of illegal abortion is increasing because the need
for abortion seems to be rising. There are important
exceptions, particularly China, where abortion has been
liberally provided by medical services since 1957. In
India abortion was legalized in 1972, but there was so
little publicity that even large segments of the medical
community as well as the public were unaware of it for
the first few years. For those who knew, high costs and
excessive red tape were effective deterrents. For at least
the first three years, the number of legal abortions was
extremely low (41,000 in the first five months), while the
number of nonmedical illegal abortions was appallingly
high (at least 4 million a year).51
Elsewhere in Asia, abortion has been legalized in
South Korea (1973), North Vietnam (1971), Hong Kong
(1972), and Singapore (1969, further liberalized in 1974).
Abortion is firmly illegal in Taiwan, but apparently
easily obtainable from medical practitioners, nonethe-
less. Laws are still restrictive in Indonesia, Pakistan, Sri
Lanka, Thailand, and the Philippines, but there are signs
50
Teitze and Murstein, Induced abortion; Charles F. Westoff, The
populations of the developed countries.
51
The abortion dilemma, Atlas, November 1974, pp. 16-18.

that they may soon be changed in several of these
countries.
In the Middle East and North Africa, laws are
generally very restrictive, except in Tunisia (which has
had abortion on request in the first trimester since 1973)
and Cyprus, which partially liberalized its law in 1974.
Israel's tough anti-abortion law was weakened by a
challenging court decision in 1952 and is seldom ob-
served today. Abortions reportedly are also available
through medical facilities in Egypt despite a strict
anti-abortion law.
In Africa south of the Sahara, abortion is generally
prohibited (the exceptions being Zambia since 1972 and
some liberalization in South Africa). Ironically, these
restrictive laws are holdovers from colonial times; they
are not rooted in local culture.52
Abortion is still illegal in most Latin American
countries, although laws have recently been relaxed to
permit it under certain circumstances in El Salvador,
Guatemala, Mexico, Panama, Brazil, Chile, Argentina,
Ecuador, and Peru. Abortion essentially on request is
available only in Uruguay and Cuba (since 1968 in both
cases).
Illegal abortion is rampant in Latin America. Contra-
ceptives are legally available in most Latin American
countries, but in practice only accessible to the rich. The
illiterate poor, who make up a large share of the Latin
American population are generally unaware of the exis-
tence of birth control other than by ancient folk methods,
and could not afford modern methods even if they knew
of them. There are exceptions where governments and
volunteer organizations such as Planned Parenthood
have established free birth control clinics (see next
section). Although these can help, they as yet reach only a
small fraction of the population, mainly in cities. In rural
areas where hunger and malnutrition are often wide-
spread, a failure of primitive birth control methods
leaves women with no alternative but to practice equally
crude forms of abortion.
In the 1960s bungled abortions were estimated to
account for more than 40 percent of hospital admissions
in Santiago, Chile. In that country, an estimated one-
third of all pregnancies end in abortion. In Mexico,
"Sue Tuckwell, Abortion, the hidden plague.
POPULATION POLICIES / 759
400,000 women per year are treated in hospitals for
illegal abortions; the abortion rate is conservatively
estimated at one-fourth the birth rate.53 For South
America as a whole, some authorities believe that one-
fourth of all pregnancies end in abortion; others estimate
that abortions outnumber births.
Liberalizing abortion laws in various countries has
been shown to have two important effects. The first is a
very large decline in maternal deaths and morbidity
(illness) associated with illegal abortion. The degree of
reduction of death and illness depends on the degree of
change in the law, the previous rate of illegal abortions,
and how they were usually performed (i.e., self-inflicted
under unsanitary circumstances or performed clandes-
tinely by medical personnel). The number of annual
abortion deaths in the U.S. dropped from over 150 per
year before 1970 to 47 (25 of which were from illegal
abortions) in 1973; in England the decline was from 60
before 1968 to 11 in 1974.54 Declines in many European
countries and LDCs, where crude self-abortion has been
more common, will probably be much greater. Con-
versely, the number of deaths in Romania, where abor-
tion regulations were tightened, rose from about 70 in
1965 to over 370 in 1971.»
The other result of liberalizing abortion laws is to
provide such services safely to low-income women.
When abortion is illegal, the rich can usually still obtain a
safe illegal procedure or can afford to travel to another
country where legal abortion is available. The poor have
no such options; it is they who suffer most either from the
burdens of large families or from dangerously unsafe
illegal abortions.
The moral issue. The greatest obstacles to freely
available, medically safe abortion in many developed
countries and in Latin America are the Roman Catholic
Church and other religious groups that consider abortion
immoral. The crux of the Catholic argument is that the
embryo is, from the moment of conception, a complete
individual with a soul. In the Catholic view, induced
abortion amounts to murder. Some Catholics also oppose
53
/4r/as, The abortion dilemma; Tuckwell, Abortion, p. 20.
'4C. Tietze and M. C. Murstein, Induced Abortion: a factbook. The
rate of abortion deaths was declining during the 1960s, especially after
1967 when several states relaxed laws to permit more legal abortions.
"Ibid.

will lead to genocide. It is hard to see how this could
happen if the decision is left to the mother. A mother who
takes the moral view that abortion is equivalent to
murder is free to bear her child. If she cannot care for it,
placement for adoption is still possible in most societies.
Few people would claim that abortion is preferable to
contraception, not only because of moral questions, but
also because the risk of subsequent health problems for
the mother may be greater. Death rates for first-
trimester, medically supervised abortions are a fraction
of those for pregnancy and childbirth but considerably
higher in later months.58 Large and rapidly growing
numbers of people nevertheless feel that abortion is
vastly preferable to the births of unwanted children,
especially in an overpopulated world. Until more effec-
tive forms of contraception than now exist are developed,
and until people become more conscientious in use of
contraceptives, abortion will remain a needed back-up
method of birth control when contraception fails.
Attitudes on abortion have changed in most countries
in recent years, and they can reasonably be expected to
change more in the future. The female part of the world's
population has long since cast its silent vote. Every year
over one million women in the United States, and an
estimated 30 to 55 million more elsewhere, have made
their desires abundantly clear by seeking and obtaining
abortions. Until the 1970s, these women were forced to
seek their abortions more often than not in the face of
their societies' disapproval and of very real dangers and
difficulties. Millions still must do so.
There is little question that legalized abortion can
contribute to a reduction in birth rates. Wherever liberal
laws have been enacted, they have been followed by
lowered fertility. Longstanding evidence is available
from Japan and Eastern Europe, where abortion was the
primary effective form of birth control available for some
years after liberalization, and where the decline in
fertility was substantial. The extent of decline is bound
to be related to the availability of other birth control
methods; but even in the United States and England,
where contraceptives have been widely available, the
decline in fertility after reversal of abortion policies was
significant.
58
Tietze and Murstein, Induced abortion.
POPULATION POLICIES / 761
According to at least one study, availability of abortion
(legal or illegal) may be necessary in order for a
population to reach and maintain fertility near replace-
ment level, given current contraceptive technology and
patterns of sexual behavior.59 Liberalization of abortion
policies in those countries where it is still largely or
entirely illegal is therefore justifiable both on humani-
tarian and health grounds and as an aid to population
control.
POPULATION POLICIES IN
LESS DEVELOPED NATIONS
In response to rising alarm during the 1950s over the
population explosion in less developed countries, both
private and governmental organizations in the United
States and other nations began to be involved in popula-
tion research and overseas family planning programs.
First among these, naturally, was the International
Planned Parenthood Federatiork which grew out of the
established national groups. By 1975 there were Planned,,
Parenthood organizations in 84 countries, supported by
their own governments, private donations, government
grants from developed countries, or some combination of
these sources.60
Various other private and governmental organizations
followed Planned Parenthood into the field, including
the Ford and Rockefeller Foundations, the Population _
Council, the U.S. Agency for International development
(AID), and agencies of several other DC governments.
International organizations such as the World Bank and
various UN agencies, particularly the UN Fund for
Population Activities,, had joined bv 197CL The 1960s
brought a great proliferation of family planning pro-
grams in LDCs, which were assisted or administered by
one or another of these groups. Most assistance from
DCs was provided through one of the international or
private organizations. In 1960 some $2 million was spent
by developed countries (and the U.S. was not then among
them) to assist LDC family planning programs; by 1974
59
C. Tietze and J. Bongaarts, Fertility rates and abortion rates:
simulations of family limitation, Studies in familv planning, vol. 6, no. 5.
May 1975, p. 119.
^Population Reference Bureau, World population growth and response,
pp. 243-248.
TABLE 13-2
Family Planning in LDCs

Population Have official support

(millions, Have an official policy to of family planning Neither have policy nor
1975) reduce population growth rate for other reasons support family planning

400+ People's Republic of China (1962)

India (1952, reorganized 1965)

100-400 Indonesia (1968) Brazil (1974)

50-100 Mexico (1974) Nigeria (1970)

Pakistan (1960, reorganized 1965)
Bangladesh (1971)

25-50 Turkey (1965) Zaire (1973) Burma

Egypt (1965) Ethiopa
Iran (1967) Argentina
Philippines (1970)
Thailand (1970)
South Korea (1961)
Vietnam (1962 in North)

15-25 Morocco (1968) Tanzania (1970) North Korea

Taiwan (1968) South Africa (1966) Peru
Colombia (1970) Afghanistan (1970)
Sudan (1970)
Algeria (1971)

10-15 Nepal (1966) Venezuela (1968)

Sri Lanka (Ceylon) (1965) Chile (1966)
Malaysia (1966) Iraq (1972)
Kenya (1966) Uganda (1972)

Less than 10 Tunisia (1964) Cuba (early 1960s) Cameroon

Barbados (1967) Nicaragua (1967) Angola
Dominican Republic (1968) Syria (1974) Malawi
Singapore (1965) Panama (1969) Jordan
Hong Kong (1973) Honduras (1966) Lebanon
Jamaica (1966) Dahomey (1969) Saudi Arabia
Trinidad and Tobago (1967) Gambia (1969) Syria
Laos (1972, possibly discontinued) Rhodesia (1968) Yemen
Ghana (1969) Senegal (1970) Mali
Mauritius (1965) Ecuador (1968) Upper Volta
Puerto Rico (1970) Honduras (1965) Mozambique
Botswana (1970) Benin (early 1970s) Burundi
Fiji (1962) Haiti (1971) Central African Republic
El Salvador (1968) Papua-New Guinea (1969) Chad
Gilbert and Ellice Islands (1970) Paraguay (1972) Comoros
Guatemala (1975) Liberia (1973) Congo
Grenada (1974) Lesotho (1974) Equatorial Guinea
Bolivia (1968, reorganized 1973) Western Samoa (1971) Guinea-Bisseau
Costa Rica (1968) Madagascar (1974) Ivory Coast
El Salvador (1968) Sierra Leone (early 1970s) Libya
Swaziland (1969) Mauritania
Togo (early 1970s) Niger
Zambia (early 1970s) Rwanda
Cambodia (1972, possibly discontinued) Seychelles
Guyana (1975) Somalia
Surinam (1974) Namibia
Uruguay (1971) Israel
Other small Caribbean countries (1960s)
Sources: Berelson, Population control programs; Nortman, Population and family planning programs, 1975; Population Reference Bureau, World
population growth and response.

•the amount was over $200 million, more than half of it
from USAID. Yet less than two percent of all foreign
assistance goes to LDC family planning programs, and
most LDCs allot less than one percent of their budgets
to it.61
During the 1960s national family planning programs
were established in some 25 LDCs, while 17 other
governments began supporting or assisting the activities
of private Planned Parenthood organizations. The early
1970s saw a further proliferation of these programs until
by 1975,34 less developed countries officially favored the
reduction of population growth, and 32 more supported
family planning activities for other reasons. Some 55
additional LDCs still did not support family planning, or
in a few cases opposed it. But the combined 1973
populations of the pro-family planning countries were
nearly 2.5 billion, whereas the total combined population
of the anti-family planning nations was only about 250
million.62 Table 13-2 shows details.
Government Policies in LDCs
So far family planning programs are the primary
policies that have been brought into action against the
population explosion in most LDCs. Outstanding ex-
ceptions are the People's Republic of China,63 Indonesia,
India, Pakistan, South Korea, Singapore, Tunisia, Egypt,
and a few other countries where other social and eco-
nomic policies have been adopted to supplement family
planning.64 However, many family planning programs
have been established and are even being supported by
governments for reasons other than reduction of popula-
tion growth, usually to protect the health and welfare of
mothers and children. Although no country has yet
adopted attainment of ZPG as a goal, many have aimed at
an ultimate reduction of growth rates to DC levels—
around 1 percent per year or less. A few countries, by
"Dorothy Nortman, Population and family planning programs: A
factbook, 1974. Population Reference Bureau, World population growth
and response.
W
D. Nortman, Population and family planning programs, 1974 and
1975.
"See Edgar Snow, Report from China—III: population care and
control, for an early report on China. More recent reports have generally
confirmed that first impression: for example, Pi-Chao Chen, China:
population program at the grass roots, in Population: perspective 1973, H.
Brown, J, Holdren, A. Sweezy, B. West, eds,
M
Vumbaco, Recent law and policy changes.
POPULATION POLICIES 763
contrast, still want to increase their usually already rapid
growth. Many others are beginning to reevaluate their
pronatalist policies as consequences of rapid growth
become increasingly evident. The following discussion
sums up these various approaches by continent.65
Africa. Africa, an extremely diverse continent, grow-
ing at about 2.6 percent per year, includes some of the
world's poorest and most rapidly growing nations. Be-
cause high mortalities, especially of infants, are also
commonly found in these countries, concern over rapid
growth and action to curb it have developed only
relatively recently in most of them. Indeed, some African
governments remain staunchly pronatalist.
The belief that more people are needed for develop-
ment is common among African nations south of the
Sahara. Policies in Cameroon, Malawi, and Upper Volta
still frankly favor growth, while Zambia and the Mala-
gasy Republic have only recently reversed their positions
(in 1975). Concern about poorly controlled migration is
greater in many of these countries than concern about
high birth rates.
In general, family planning on a private basis has long
been available in former African colonies of England,
but not in those of such Catholic countries as France,
Belgium, Spain, Italy, and Portugal. Former English
colonies were among the first to establish national family
planning policies, although emphasis in some cases is put
on health and family welfare justifications. Kenya and
Ghana have two of the oldest and strongest family
planning programs in subSaharan Africa, and both have
goals of reducing population growth. Interest in family
planning at least for health reasons is growing in most
former English colonies, although a few such as Malawi
still discourage or ignore the activities of private family
planning organizations. Nigeria, the most populous and
one of the richest (in terms of resource endowment)
African countries, was only beginning to show interest in
family planning for health reasons in 1976, despite rapid
growth.
"For country-by-country details of policies and recent demographic
trends, Population Reference Bureau, World population growth and
response, prepared with the assistance of the U.S. Agency for International
Development, is invaluable.Schroeder and Vumbaco each provide useful
summaries, as does the more recent D. Nortman and E. Hofstatter,
Population and family planning programs: a factbook, 1976.
764 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
In South Africa and Rhodesia, the dominant European
populations have traditionally practiced birth control.
These countries are now trying to extend family plan-
ning services to their African populations. South Africa's
family planning is offered through its Planned Parent-
hood affiliate and funded by the government; Rhodesia's
services are government-supported, but operated by
several private international groups.
Former French colonies have begun to relax their
prohibitions to allow the commercial sale of contracep-
tives and to support some family planning activities. The
first family planning clinics in French-speaking conti-
nental Africa have been established in Senegal, whose
government is beginning to show interest in family
planning. Most former French colonies, however, re-
main complacent about their rates of population growth.
An exception is Mauritius, an island nation with one of
the highest population densities in the world (see Chap-
ter 5). Mauritius has a vigorous and comparatively
successful family planning program. Since the 1950s, the
growth rate has been reduced to about 2.1, despite an
unusually low death rate of 7 per 1000 population.
The Portuguese colonies, Mozambique and Angola,
remained pronatalist and strongly opposed to birth
control until they achieved independence in 1975. Es-
tablishment of population programs must await the
stabilization of the new governments.
Some North African countries have initiated family
planning programs; Egypt, Tunisia, and Morocco have
fairly strong, antinatalist policies. Tunisia, in particular,
has ventured beyond family planning to legalize sterili-
zation (considered immoral and against Moslem law in
most Islamic countries) and abortion, to limit financial
allowances for children to four per family, raise the legal
marriage age, and ban polygamy. In addition, women's
rights, usually very restricted in Moslem societies, are
being promoted. Some other North African countries—
Algeria, Libya, Mauritania—remain pronatalist or
uninterested.
Many African countries still have death rates above 20
per thousand, and some even more than 30. A number of
demographers and family planning officials believe that
interest in population control will remain low in those
countries until the death rates have been substantially
reduced, especially among infants and children. R is
vitally important to change this point of view so that
efforts can be made to lower birth rates along with death
rates; that most family planning efforts have begun in
African countries as a part of maternal and child health
services is an encouraging sign.
Latin America. Latin America as a region, despite
having some of the highest population growth rates in the
world (about 2.9 percent for the entire region), has also
been very reluctant to accept a need for population
control. This is probably due in part to the influence of
the Roman Catholic Church, but there is also a wide-
spread belief, at least in South America, that the conti-
nent still contains vast untapped resources of land and
minerals, that the answer to all problems is development,
and that more people are needed for development. Latin
American politicians, moreover, tend to view proposals
originating in the United States for birth control with
understandable suspicion. Some seem to believe the U.S.
is trying to impose a new and subtle form of imperial-
ism.66 In some countries, this reaction has even had the
effect of inhibiting the teaching of demography and
family planning in universities.
Latin American economists and politicians have come
to accept family planning (often referred to as "respon-
sible parenthood") mainly on health and welfare grounds
and as a means of reducing the horrendous illegal
abortion rate. Some leaders are beginning to realize,
however, that the galloping population growth rate is
swallowing all the economic progress each year, leaving a
per-capita rate of progress of zero or less. A few countries
have established essentially, though not always explic-
itly, antinatalist policies as a result—notably Chile.
Colombia, several Caribbean countries, and all of the
Central American countries. The efforts of some family
planning programs in the Caribbean (mainly former
British colonies) have been counted among the most
successful, especially those of Barbados and Trinidad
and Tobago. Birth rates have declined there since the
early 1960s, and have declined as well in Chile, Colom-
bia, Costa Rica, Nicaragua, Panama and Venezuela.
"National Academy of Sciences, In starch of population policy: views
from the developing world; Population policy in Latin America.

At the other extreme, Brazil and Argentina have
policies generally promoting growth. Brazil does permit
private family planning groups to operate, however,
especially in the poverty-stricken Northeast. Argentina,
having a relatively low birth rate and feeling threatened
by rapidly growing Brazil, in 1974 banned dissemination
of birth control information and closed family planning
clinics. Since the practice of birth control is well
established in the Argentine population, the action is not
likely to have great effect except perhaps to raise the
already high abortion rate, mostly illegal.
Asia. Asia includes over half of the human population
and is growing at about 2.3 percent per year. Both
mortality and birth rates are generally lower than those in
Africa, and both have been declining in several countries.
Asia presents a widely varied picture in regard to
population policies. At one extreme, China, India, Thai-
land, Indonesia, Sri Lanka, Hong Kong, Singapore,
Taiwan, and South Korea are pursuing strong family
planning policies, in several cases reinforced by social
and economic measures, some of which are described
below. All of these countries have recorded declines in
birth rates, some of them quite substantial. Family
planning programs have also been established in Paki-
stan, Bangladesh, Nepal, Malaysia, and the Philippines,
but the impact, if any, on birth rates is negligible so far.
A few rapidly growing countries, notably Cambodia
and Burma, currently are pursuing pronatalist popula-
tion policies, although family planning is privately
available in the latter country. Other "centrally planned"
countries in Southeast Asia seem to be following China's
example in population policies; North Vietnam has had a
family planning program for some time, which presum-
ably was extended to South Vietnam when the nation was
unified. Policies in North Korea are unknown.
Middle Eastern nations are still largely pronatalist in
their outlook, with the exceptions of Turkey and Iran
which have national family planning programs. Several
countries, including Afghanistan, Bahrain, Cyprus, Iraq,
Jordan, Lebanon, and Syria, are interested in establish-
ing family planning services for health and welfare
reasons. The remaining countries favor continued
growth, although they may tolerate family planning
POPULATION POLICIES / 765
activity in the private sector. Among these is Israel, for
obvious reasons. At the furthest extreme is Saudi Arabia,
which has outlawed importation of contraceptives.
Nearly all Middle Eastern countries are growing rapidly
with relatively high, although declining death rates.
The United Nations. For many years, the United
Nations limited its participation in population policies to
the gathering of demographic data. This, however, was
instrumental in developing awareness of the need for
population policies, especially among LDCs, whose
governments often had no other information about their
population growth. Since the late 1960s the UN has taken
an active role in coordinating assistance for and directly
participating in family planning programs of various
member nations, while continuing the demographic
studies. A special body, the UN Fund for Population
Activities (UNFPA), advises governments on policies
and programs, coordinates private donors and contribu-
tions from DC governments, and sometimes directly
provides supplies, equipment, and personnel through
other UN agencies.
In 1967 the UN Declaration on Social Progress and
Development stated that "parents have the exclusive
right to determine freely and responsibly the number and
spacing of their children."67 The statement affirmed the
UN's increasing involvement in making family planning
available to all peoples everywhere and contained an
implicit criticism of any government policy that might
deny family planning to people who wanted it. The
statement has sometimes been interpreted as a stand
against compulsory governmental policies to control
births; however, the right to choose whether or not to
have children is specifically limited to "responsible"
choices. Thus, the Declaration also provides govern-
ments with the right to control irresponsible choices.
In 1974 the United Nations' World Population Con-
ference, the first worldwide, government-participating
forum on the subject, was convened in Bucharest.
Publicity attending the event gave an impression of
enormous disagreement among participating groups. But
in fact it provided a valuable forum for an exchange of
"Declaration on Population, Teheran, 1968, Studies in Family Plan-
ning, no. 16, January, 1967.
 BOX 13-6 China: An Apparent Success Story
Any brief treatment of Chinese society is
difficult and necessarily contains elements of
overgeneralization. First of all, the huge geo-
graphical expanse and the vastness of the popu-
lation—nearly a billion people—are difficult to
envision. Second, the Chinese people possess a
cultural diversity possibly as rich as that of
Europe, and even older traditions. Finally, it
seems that there is no overall, systematic keeping
of vital statistics and population figures in China,
and those statistics that do exist are not readily
available to outsiders. The Chinese are tradi-
tionally xenophobic, and the Western intrusion
of the last century and a quarter—from the
Opium Wars through the United States debacle
in Vietnam and Soviet pressure on northern
Chinese borders—have only heightened this tra-
ditional aloofness. The available information is
therefore fragmentary and has to some extent
been filtered by a highly centralized and auto-
cratic regime. Still, the accounts of foreign
travellers in China and the release of official
statements and figures allow some conclusions to
be drawn about the nature of population policy
in the People's Republic."
Superficially, the expressed population poli-
cies of the People's Republic of China seem
slightly schizophrenic. Official rhetoric preached
abroad roundly condemns Malthusian ideas:
"The poor countries have not always been poor.
Nor are they poor because they have too many
people. They are poor because they are plun-
dered and exploited by imperialism."6 The same
article goes on to blame "relative overpopulation
and widespread poverty" in the United States
and the Soviet Union on "ruthless oppression
and exploitation which the superpowers practice
at home."
But, despite assertions that there is no such
thing as overpopulation, China admits to having
a policy of "planned population growth," with
this rationale:
We do not believe in anarchy in material produc-
tion, and we do not believe in anarchy in human
reproduction. Man must control nature, and he must
also control his numbers. .
"For a recent overview, see International Planned Parenthood
Federation, China 1976: a new perspective.
'China on the Population Question, China Reconstructs.
We believe China's policy benefits many aspects
of life—national construction, the emancipation of
women, protection of mothers and women and
children, proper bringing up of the young, better
health for the people and prosperity for the nation. It
is, in other words, in the interests of the masses of the
people.''
In recent years, as China has begun to open up
to the outside world, it has become increasingly
clear not only that "birth planning," as it is
called, is seriously advocated and supported by
the government, but that it has begun to reap
results. Exactly how successful the policy has
been overall is impossible to say because there
are no reliable nationwide population statistics.
The last reasonably comprehensive census was
conducted in 1953 (when a total mainland popu-
lation of about 583 million was found), and
estimates of vital rates since then are basically
guesswork.1' Hence the estimates of total popu-
lation in 1975 range from below 800 million to
962 million/ China specialist Leo Orleans has
proposed a set of estimates and projections of
China's population from 1954 to 1980, and his
arguments in support of them are convincing. He
suggests that the 1975 population was about 850
million, with a birth rate of 27 per thousand, a
death rate of 12 per thousand, and a natural
increase of 1.5 percent. These figures are slightly
above those of the UN.
China's efforts to curb population growth
began in the 1950s following the release of the
census results and a period of heated discussions
of the pros and cons of birth control. An
organized campaign implemented by the Minis-
try of Public Health was launched in 1957 but
then was suspended in 1958 during the Great
Leap Forward, an intensive effort at economic
development. The period 1959-1961 was one of
food shortage and economic crises, and, although
established birth control clinics continued to
Ibid.
rf
Leo A. Orleans, China: Population in the People's Republic.
This is an excellent source for historical background, although
otherwise somewhat out of date.
c
Orleans, China's population figures: Can the contradictions be
resolved? The lowest are based on casual statements by Chinese
officials at the UN; the highest are from the World Population
Estitnates of the Environmental Fund, which bases its estimates
on the figures of John Aird, a demographer in the U.S.
Department of Commerce Foreign Demographic Analysis
Division.

function, there was no official encouragement for
their use.
While China was recovering from this crisis
period, the government again began advocating
"birth planning" to protect the health of mothers
and children. An important part of this campaign
was promotion of late marriage (23 to 25 for
women, 25 to 28 for men) and the two-child
family spaced by 3 to 5 years/ Both abortion and
sterilization were legal from the start, but the
middle 1960s were a period of active expansion
of facilities (along with expansion of health care
in general) and experimentation in improved
techniques. It was men that the Chinese devel-
oped the vacuum technique for abortion, which
has made the procedure much safer than before,
and which has since been adopted around the
world. Active research was also carried out on
simplified sterilization procedures. It appears,
for instance, that the Chinese may have been the
first to do female sterilizations with very small
incisions."
China has all along manufactured all its own
contraceptive devices and Pharmaceuticals, un-
like other LDCs. The latest invention is the
"paper pill," sheets of water-soluble paper im-
pregnated with oral contraceptives, which are
easy to transport, store, and distribute.* Each
sheet contains a month's supply of "pills" in
perforated squares that dissolve in the mouth
when eaten. This development is expected to
increase use of oral contraceptives considerably,
especially in remote rural areas where the pills
have been less accepted than in the cities.
Virtually every method of birth control is
being actively used in China: sterilization, abor-
tion, the combined steroid pill and the progestin
mini-pill, long-term injections, lUDs (the Chi-
nese developed their own, a stainless steel ring),
condoms, diaphragms, foams, and jellies.
The various forms of birth control have long
been available to the people in the major cities
and their suburbs. During the 1960s, health care,
including birth control services, was increasingly
extended to more remote rural areas. As an
indication of the success of the health care
programs, the death rate for the entire country is
estimated to have dropped from nearly 35 per
Ti-Chao Chen, China's population program at the grass-roots
level.
'Orleans, Family planning developments in China, 1960-
1966: abstracts from medical journals.
*Carl Djerassi, Fertility limitation through contraceptive
steroids in the People's Republic of China.
POPULATION POLICIES / 771
1000 population in 1949 to about 17 per 1000 in
1970* and perhaps 13 in 1974.j Infant mortality,
which fairly accurately reflects levels of both
health care and nutrition, is thought to have been
between 20 and 30 per 1000 births in 1974.k In
some urban communes (which apparently do
keep careful demographic statistics), the crude
death rate is 5 or less, and an infant mortality rate
of 8.8 per 1000 live births has been claimed for
the city of Shanghai.'
China's unique health care system, together
with greatly improved distribution of the food
supply, can claim credit for this remarkable
change. At the time of the Revolution, a grossly
inadequate corps of trained medical personnel
existed, mainly concentrated in the large cities.
While actively training thousands of doctors,
paramedics, and nurses and establishing hospi-
tals and health centers in smaller cities, the
Chinese also promptly tackled sanitation and
hygiene at the grass-roots level through educa-
tional campaigns.
More recently, selected people have been
given four to six months' basic medical training
and assigned part-time to care for basic health
needs in their production brigades. These indi-
viduals are called "native doctors" in the cities
and "barefoot doctors" in the country. Their
responsibilities include giving injections and
innoculations, administering first aid and simple
treatments for diseases, supervising sanitation
measures, teaching hygiene in schools, and dis-
tributing contraceptive materials. For medical
treatment beyond their competence (including
abortions and sterilizations), the barefoot doctors
refer patients to the nearest regional hospital.
Barefoot doctors in turn are assisted by part-time
volunteer health aides, usually housewives,
whom they train themselves.'"
It now appears that China is attempting to
upgrade the quality of grass-roots health care by
sending fully trained medical personnel from
city hospitals on rotation to rural health centers,
where, among other things, they provide addi-
tional training for local health workers. Some
barefoot doctors have thereby become qualified
to do abortions, IUD insertions, and steriliza-
'Orleans, China: Population in the People's Republic.
'Norman Myers, Of all things people are the most precious.
"•Ibid.
'Joe Wray, How China is achieving the unbelievable.
'"Pi-Chao Chen, China's population program at the grass-roots
level; V. W. Sidel and R. Sidel, The delivery of medical care in
China.
(Continued)
 BOX 13-6 (Continued)
tions, as well as other minor operations."
Both child bearing and birth control are fully
supported and helped in China, Paid maternity
leave, time off for breast-feeding, free nursery
care, and all needed medical attention are pro-
vided for mothers. Paid leave is also given for
abortion, sterilization, and IUD insertions, and
all birth control services are essentially free.
While the means of birth control are provided
through the health care system in China, primary
responsibility for motivating couples to make use
of them rests with the Revolutionary Committee
(or governing council) of the production brigade
or commune. Usually one member of the com-
mittee is the "responsible member" for birth
planning.0 In rural areas, "women's cadres" —
married women with children, who are known
and respected by their neighbors—carry contra-
ceptives and the pro-birth control message house
to house."
In some of the cities, low birth rates have been
so enthusiastically adopted as a goal that neigh-
borhoods collectively decide how many births
will be allowed each year and award the privilege
of having babies to "deserving couples."" Prior-
ity is given to newlyweds, then to couples with
only one child who have waited the favored
period of time for the second birth/ The result
has been phenomenally low birth rates for these
neighborhoods, ranging from 4 to 7 per 1000
population. The center city of Shanghai report-
edly had a 1972 birth rate of 6.4, while that for
the city plus suburbs was 10.8.s The 1972 birth
rate for Peking was reported by Joe Wray to have
been about 14 per 1000 population; Myers
placed it at 18.8 for city and suburbs combined.
Joe Wray has speculated that these low rates
may have been helped by a relatively low pro-
portion of women in their child-bearing years.
Given the recent Chinese policy of sending
urban young people to rural areas to work, this
may be so, even though China's demographic
history would indicate a relatively large and
growing proportion of people in their teens and
twenties for the country as a whole by 1975.
Exiling young people "temporarily" to rural
communes probably was done for political rea-
"Chen, China's population program.
"Wray, How China is achieving the unbelievable.
"Han Suyin, The Chinese experiment.
"Wray, Achieving the unbelievable; Han, Chinese experiment.
Treedman and Berelson, The record of family planning
programs.
8
Wray, Achieving the unbelievable; Myers, People are the most
precious.
sons. Large numbers of urban youth are a
potential source of insurgent trouble, especially
if insufficient jobs are available. Scattering the
young people in the countryside could effec-
tively defuse that threat. Moreover, the relatively
well-educated city youth could help spread the
ideology of the central government to remote
rural areas. But it appears that the policy may
also have had demographic effects. Most of the
city children are not happy down on the farm;
consequently, they are reluctant to marry, settle,
and raise families there. Nor are rural young
people eager to marry the sophisticated city
people with their strange ways.'
The official Chinese position on birth plan-
ning—an ideal of late marriage and a small,
well-spaced family of two children—appears to
have been overwhelmingly accepted in cities and
is rapidly gaining acceptance in rural areas,
according to reports from foreign visitors." The
prevailing attitude is that early marriage and
having more than two children are prime exam-
ples of irresponsible behavior. Nevertheless,
there is still resistance from older generations,
especially mothers-in-law, who by tradition have
long wielded considerable power within families
and apparently still do.
Besides official encouragement to limit fami-
lies, there are other incentives built into the
social and economic system as well. Emancipa-
tion of women and their incorporation as full
working members of society was an early, im-
portant goal of the Revolution. It has apparently
been realized to a great extent, especially among
younger women, and undoubtedly exerts a pow-
erful influence on childbearing.
Pi-Chao Chen has pointed out disincentives to
family limitation in the per capita grain allow-
ance, which augments a family's supply when a
child is added, and in the addition of another
worker (preferably a boy who will remain in the
family) to contribute to family income.1' But it
has also been observed that, even though another
worker may help increase a family's total income,
that income must still be divided among all
family members. Additional members reduce the
share available per person."' Furthermore, since
'Joseph Lelyveld, The great leap farmward.
"Tameyoshi Katagiri, A report on the family planning program
in the People's Republic of China; Sidel and Sidel, Medical
care; Han, Chinese experiment; Myers, People are the most
precious; Chen, China's population program; Wray, Achieving
the unbelievable.
''Chen, China's population program.
'"Sterling Wortman, Agriculture in China.

compulsory primary education is rapidly be-
coming the rule in China, children's productivity
is inevitably deferred at least until the teenage
years.
While there is no question whatever about the
Chinese leadership's position on birth planning,
coercion does not appear to be a part of the
program beyond the extensive use of peer pres-
sure and the dissemination of propaganda on all
levels. There were reports of curtailed maternal
benefits, reduced grain rations, and discrimina-
tory housing and employment assignments for
parents of three or more children in some areas
during the 1960s, but these measures seem to
have been largely abandoned. Possibly they
aroused more resentment than cooperation and
were found to be less than beneficial to the
children.
By the mid-1970s, China's far-reaching pop-
ulation program evidently had been extended to
the far corners of the nation—no mean trick in
itself. What the results have been is impossible to
assess with accuracy, but it is becoming increas-
ingly clear that they are significant indeed. The
remarkable vital rates prevailing in major cities
have already been cited, but those of rural
communes for which data exist, while higher
than the cities', show significant reductions from
pre-revolutionary levels (birth rate about 45,
death rate 34 to 40, infant mortality above 200). *
Reported birth rates for rural districts in the
early 1970s range from as low as 14 in an area
near Shanghai" to 20-24 in communes near
Peking- and some others in more remote prov-
inces.™ These areas generally report very low
death rates also. Levels of contraceptive usage in
urban and rural areas are compared in Figure
13-4. Certainly the communes visited by outsid-
ers are among the most successful by Chinese
standards, and so their birth and death rates
should not be taken as representative of the
entire country. But they may represent the
leading edge of an established trend. That the
policy has been so successful in many areas,
especially where it is long established, indicates
that similar success can be expected elsewhere in
time.
'Orleans, China: Population in the People's Republic.
"Katagiri, A report.
'Sidel and Sidel, Medical care.
QS
Chen, China's population program.
773
1. PERMANENTLY
STERILIZED
Tubal ligation
Vasectomy
2. PRACTICING
CONTRACEPTION
Pill
3. NOT PRACTICING
CONTRACEPTION
10 20 30 -0
COUPLES (%)
FIGURE 13-4
Contraceptive practices in an urban area (light grey)
and in a rural area (dark grey) in China are
compared; the urban sample is from the city of
Hangchow, a provincial capital, and the rural
sample is from a commune outside Peking.
Sterilization is nearly three times commoner in
the urban than in the rural sample, and
substantially fewer rural males use contraceptives.
The bias seems to be reflected in the difference
between urban and rural birth rates: below 10 per
1000 in some urban areas and above 20 per 1000
in some rural ones. (From Sidel and Sidel, 1974.)
If available estimates of vital rates for all of
China reflect reality, there has already been a
substantial reduction in birth and death rates.
Norman Myers of the FAO quotes birth rate
estimates for large cities of between 10 and 19
per 1000 population, for medium-sized cities, 14
to 23, and for rural areas 20 to 35. He put the
national 1974 birth rate at 29 and the death rate at
13, giving a natural increase of 1.6 percent per
year. Comparison of these estimates with those
of other Asian nations at similar levels of devel-
opment is striking, to say the least. And no doubt
other less developed countries—and perhaps
some developed countries as well—can learn a
great deal from the Chinese experience.66
M
Chen, Lessons from the Chinese experience: China's planned
birth program and its transferability.
780
customs are also subject to varying attitudes and mores.
These conflicting attitudes allow societies to fine-tune
their responses to external changes without having to
change the basic ideological structure itself. Thus, when
overpopulation threatens food supplies, for example,
antinatalist behavior can be encouraged, and when
epidemics or war have decimated a population, antina-
talism can again be discouraged. Pronatalist attitudes are
very strong in traditional societies because through most
of humanity's evolutionary history they have been
needed to maintain populations and to allow a moderate
amount of growth when warranted.
The sudden introduction of death control, Western
morality, and access to communications and other re-
sources, as Western technology impinged upon the
.underdeveloped world in the wake of the colonial era and
World War II, disrupted social perceptions of the
consequences of high birth rates in those areas. The
impact was characterized by "rapid and fluctuating
changes in agricultural productivity, labor demand,
urbanization, emigration, and military expansion, often
coupled with introduced epidemic disease."83 Because
most of these disturbed societies have adopted Western
ideology, their traditional methods of controlling popu-
lation have been abandoned and unfortunately replaced
by less efficient and less desirable ones, mainly self-
induced abortion and disguised infanticide through
neglect, abuse, and even starvation. Dickeman concludes
that the world population can only be controlled when
less developed societies are socially stabilized and inte-
grated and the people can realistically assess their actual
resource and ecological position. Then, she feels, the
people will make reasonable family-size choices in
accordance with that position.
The Demographic Transition
A great many social and economic factors have been
associated in the past with declining fertility in various
societies. Among them are the general level of education,
the availability and quality of health care, the degree of
urbanization, the social and economic status of women
and the opportunities open to them for education and
"Ibid.
employment outside the home, the provision of social
security for old age, and the costs to families of raising
and educating each child. The more extensive each of
these factors is, the lower fertility generally will be. In
addition, later marriage, lower tolerance for illegitimacy,
low infant mortality, and extended breast-feeding all
operate directly to reduce fertility. In most LDCs, levels
of health care, education, and women's status remain low
for the poor majority, while marriage comes early and
infant mortality rates are high.
Most family planning programs in the 1960s made
little effort to influence any of these factors, as demogra-
pher Kingsley Davis pointed out in 1967.84 Those that
tried to influence people at all confined themselves to
emphasizing the economic and health advantages of
small families to parents and their children.
In the 1950s and 1960s, government officials, eco-
nomic advisors, and many demographers believed that
the process of economic development would automati-
cally bring about the higher levels of education and
urbanization in LDCs that have elsewhere been asso-
ciated with declines in fertility, and thus would cause
a "demographic transition" in LDCs. These people
favored family planning because they thought it would
facilitate the supposedly inevitable demographic transi-
tion, although they believed that no significant reduction
in fertility could occur until the prerequisite (but
unknown) degree of development had been reached.
Numerous studies have established quite clearly that
population growth is in itself a major barrier to economic
development. Economist Goran Ohlin wrote in 1967:
The simple and incontestable case against rapid popu-
lation growth in poor countries is that it absorbs very
large amounts of resources which may otherwise be
used both for increased consumption and above all, for
development . . . The stress and strain caused by
rapid demographic growth in the developing world is
actually so tangible that there are few, and least of all
planners and economists of the countries, who doubt
that per capita incomes would be increased faster if
fertility and growth rates were lower . . . .85
"Population policy: will current programs succeed? See also Davis,
Zero population growth: The Goal and the Means.
^Population control and economic development, p. 53.
 The potential value of population control in aid
programs to LDCs has also been studied intensively. The
late economist Stephen Enke did much of the analysis,
and his conclusions may be summarized in three points:
(1) channeling economic resources into population con-
trol rather than into increasing production "could be 100
or so times more effective in raising per capita incomes in
many LDCs"; (2) an effective birth control program
might cost only 30 cents per capita per year, about 3
percent of current development programs; and (3) the use
of bonuses to promote population control is "obvious in
countries where the 'worth* of permanently preventing a
birth is roughly twice the income per head."86
Enke's results were strongly supported by computer
simulation work by systems analyst Douglas Daetz, who
examined the effects of various kinds of aid in a
labor-limited, nonmechanized agricultural society.87 His
results brought into sharp question the desirability of aid
programs not coupled with population control programs.
They might provide temporary increases in the standard
of living, but these would soon be eaten up by population
expansion. In many circumstances, population growth
and aid inputs may interact to cause the standard of living
to decline below the pre-aid level.
As a result of studies like Ohlin's, Enke's, and Daetz',
family planning began to be incorporated into assistance
programs for LDCs in the 1960s. But the purpose in most
cases was only to reduce growth rates to more "manage-
able" levels by eliminating "unwanted births." This
great faith of economists and demographers in the
potential of industrial development to bring about a
spontaneous demographic transition, which, aided by
family planning, would reduce population growth and
accelerate the development process, encouraged LDC
governments to relax under the illusion that all their
social and economic problems were being solved. Un-
fortunately, their faith was misplaced.
Reliance on a demographic transition was misplaced
for many reasons, not the least of which is uncertainty as
to exactly what caused the original one in nineteenth-
""Birth control for economic development.
*~ Energy utilization and aid effectiveness in non-mechanised agriculture:
a computer simulation of a socioeconomic system. PhD. diss.. University of
California, 1968.
century Europe.88 And, as was pointed out in Chapter 5,
conditions in contemporary LDCs in many ways are
markedly different from those in Europe and North
America one to two centuries ago when fertility began to
decline there.
By the mid-1960s, although several LDCs had ap-
parently reached quite advanced degrees of industrial
development, there was little sign of a general decline in
fertility. Birth rates dropped in some countries, but they
remained high, or in a few cases even rose, in other,
supposedly eligible countries. Because of this unex-
pected result, there has been some argument among
demographers whether the theory of the demographic
transition can even be applied to LDCs and whether
there is good reason to hope that it will occur in most of
them.
An analysis of fertility trends in some Latin American
countries (often cited as prime examples of nonconfor-
mity to demographic transition theory) by demographer
Stephen Beaver indicates that a demographic transition
has begun or is at least incipient in the countries he
examined.89 But, he suggests, cultural and economic
factors can cause time lags in the process. A considerably
broader spectrum of factors may influence fertility than
just reduced mortality (especially of infants), increasing
urbanization, and industrialization, which are classically
believed to be the primary causes of declining fertility.
It is becoming increasingly clear that industrializa-
tion—the style of development undertaken by most
developing countries—is not conducive to a demo-
graphic transition. This seems to be so because industry
in most LDCs employs and benefits only a fraction of the
population, creating a two-tiered society in which the
majority are left untouched by modernization.90 Such
unequal distribution of the benefits of modernization
(access to adequate food, clothing, decent shelter, educa-
tion, full-time employment, medical and health care,
etc.) is most pronounced in rural areas, where some 70
percent of the population of LDCs live.
ss
Michael S. Teitelbaum, Relevance of demographic transition theory
for developing countries; Alan Svreezy, Recent light on the relation
between socioeconomic development and fertility decline.
^Demographic transition theory reinterpreted.
'"James E. Kocher, Rural development; and James P. Grant, Develop-
ment: the end of trickle down?
 55

Ethiopia
•-Afghanistan
Algeria
Nigeria • Iran
Sudan* • "Kenya .
Morocco • Iraq
• Tanzania
Indonesia _. Uganda
• • Nepal North Korea
~ Pakistan
• Zaire
•
Philippines • • •
•
Bangladesh Colombia Mexico
Thailand •
cc India •
Peru
LU South Vietnam •
Q_ Burma South Africa Venezuela
CC
Turkey •
<
LU
> Malaysia
North Vietnam •
Eg'ypt Brazil

03
35
I
F
cc
CD

• China
30
Sri Lanka
South Korea

25
•
Taiwan
Argentina
20
75 100 150 250 400 600 1000 1500

GROSS NATIONAL PRODUCT ($ PER CAPITA)

FIGURE 13-5

There is an absence of any clear relation between the birth rate and the level of development (as
measured by per-capital GNP) in the less developed countries with more than 10 million population.
A decline in birth rates has occurred recently in a number of these nations. (From Demeny, 1974.)

Per capita Gross National Product is a statistic often
used to measure the extent of "development" that has
taken place in a given country; per-capita GNP, however,
is an averaged figure that may conceal very large differ-
ences among income groups. And the correlation of
degrees of development as measured by per-capita GNP
with reduction in fertility is extremely mixed, to say the
least (Figure 13-5). One explanation is that, in strongly
two-tiered societies, birth control may be adopted by the
affluent, educated minority, but not by the majority still
living in poverty. The conclusion from this is that
fertility will decline significantly only when the benefits
of modernization are extended to all economic levels.
Economist Alan Sweezy has pointed out that, while
this explanation may account for fertility declines in
some instances, the expected declines have not occurred
in some countries—notably in Latin America—even
among the affluent and middle classes.90" He suggests
that lingering strong traditions, including pro-natalist
attitudes, may be a reason. In Latin America such
traditions are supported by the Roman Catholic Church,
which still officially opposes "artificial" methods of birth
control and abortion.
If a demographic transition should take place in
""'Economic development and fertility change.

LDCs, a decline from present high fertility to replace-
ment level alone would require considerable time, prob-
ably at least a generation. And time is running very short.
If appropriate kinds of development and vigorous family
planning programs had been initiated just after World
War II, when death control and the ideas of economic
assistance were first introduced in LDCs, the population
problem might be of more manageable dimensions
today. But plainly it would still be with us. Without such
a history, even if the strongest feasible population control
measures were everywhere in force today, the time lag
before runaway population growth could be appreciably
slowed, let alone arrested, would still be discouragingly
long. For most LDCs it will be at least four generations
before their populations cease to expand—unless catas-
trophe intervenes—because of the age composition of
their populations. Even if replacement reproduction
were attained by 2005, most LDC populations would at
least double their 1970 populations, and some would
increase 3.5-fold!*1
This built-in momentum virtually guarantees that, for
many less developed countries, shortage of resources and
the environmental and social effects of overpopulation
will combine to prevent sufficient "development" to
induce a demographic transition. Complacently counting
on either a spontaneous demographic transition or on
voluntary family planning programs—or even a combi-
nation—to reduce population growth and thereby ensure
successful development would therefore be a serious
mistake. The establishment of family planning programs
may make it easier to improve social conditions in poor
countries, but it is no substitute for appropriate develop-
ment; and it is also clear that development alone cannot
lead to a reduction of population growth on the needed
scale.
POPULATION CONTROL:
DIRECT MEASURES
Before any really effective population control can be
established, the political leaders, economists, national
planners, and others who determine such policies must
be convinced of its necessity. Most governments have
91
Thomas trejka, The future of population growth; alternative patlis to
equilibrium.
POPULATION POLICIES / 783
been reluctant to try measures beyond traditional family
planning that might be effective because they considered
them too strong, too restrictive, and too much against
traditional attitudes. They are also, reasonably enough,
concerned about resistance from political opponents or
the populace at large. In many countries such measures
may never be considered until massive famines, political
unrest, or ecological disasters make their initiation im-
perative. In such emergencies, whatever measures are
economically and technologically expedient will be like-
liest to be imposed, regardless of their political or social
acceptability. A case in point was the sudden imposition
in 1976 of compulsory sterilization in some Indian states
and for government employees in Delhi, following two
decades of discouraging results from voluntary family
planning.
People should long ago have begun exploring, devel-
oping, and discussing all possible means of population
control. But they did not, and time has nearly run out.
Policies that may seem totally unacceptable today to the
majority of people at large or to their national leaders
may be seen as very much the lesser of evils only a few
years from now. The decade 1965-1975 witnessed a
virtual revolution in attitudes toward curbing population
growth among LDC leaders, if not necessarily among
their people. Even family planning, easily justified on
health and welfare grounds alone and economically
feasible for even the poorest of countries, was widely
considered totally unacceptable as a government policy
as recently as 1960.
Among objections to population control measures
cited by demographer Bernard Berelson in 1969 were the
need for improved contraceptive technology; lack of
funds and trained personnel to carry out all proposed
programs; doubt about effectiveness of some measures,
leading to failure to implement them; and moral object-
ions to some proposals such as abortion, sterilization,
various social measures, and especially to any kind of
compulsion.92
Most objections to population control policies, how-
92
See Berelson's Beyond family planning, for a conservative view of
potential measures for population control. Since 1969, Berelson has found
many formerly unacceptable measures to have become much more
acceptable: for instance, An evaluation of the effects of population control
programs; and Freedman and Berelson, The record of family planning
programs, published in 1974 and 1975 respectively.
784 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
ever, can be overcome or are likely to disappear with time
and changing conditions; indeed man}' of them already
have. Contraceptive technology has been improved in
recent years (see Appendix 4). Promising methods of
birth control that are not now technologically possible
should also be developed, so that they can be made
available.92" Further generous assistance from developed
countries could remove remaining economic and lack of
personnel barriers to population-control programs in
LDCs. The effectiveness of a measure can only be
evaluated after it has been tried. Moral acceptability is
very likely to change as social and economic conditions
change in most societies, as demonstrated by the rever-
sal of abortion policies in many countries between 1967
and 1975.
The struggle for economic development in the LDCs
is producing considerable social upheaval, which will
particularly affect such basic elements of society as
family structure. Radical changes in family structure and
relationships are inevitable, whether population control
is instituted or not. Inaction, attended by a steady
deterioration in living conditions for the poor majority,
will bring changes everywhere that no one could consider
beneficial. Thus, it is beside the point to object to
population-control measures simply on the grounds that
they might change the social structure or family
relationships.
Among proposed general approaches to population
control are family planning, the use of socioeconomic
pressures, and compulsory fertility control. Maximum
freedom of choice is provided by traditional family
planning; but family planning alone should not be
regarded as "population control" when it includes no
consideration of optimum population size for the society
and makes no attempt to influence parental goals.
The use of abortion and voluntary sterilization to
supplement other forms of birth control can quite
properly be included as part of family planning and made
""Unfortunately, this area is still being seriously neglected. It has been
estimated that funds could fruitfully be tripled over 1974 levels to take
advantage of existing knowledge and trained personnel in research on
reproduction and development of new contraceptives. (M. A. Koblinsky,
F. S. Jaffe, and R. O. Greep, Funding for reproductive research: The
status and the needs.) See also Barbara J. Culliton, Birth control: Report
argues new leads are neglected (Science, vol. 194, pp. 921 -922, November
26, 1976) for a discussion of a forthcoming Ford Foundation Report,
Reproduction and human welfare.
available at costs everyone can afford. This, of course, has
been done in a few countries with considerable apparent
success (Table 13-4). Moreover, there is still a good deal
of room for expansion of family planning services in
LDCs, where they are not yet available to more than a
fraction of most populations. Family planning programs
not only provide the means of contraception, but,
through their activities and educational campaigns, they
spread the idea of birth control among the people. These
programs should be expanded and supported throughout the
world as rapidly and asfully as possible, but other measures
should lie instituted immediately as well. Given the family
size aspirations of people everywhere, additional mea-
sures beyond family planning will unquestionably be
required in order to halt the population explosion—quite
possibly in many DCs as well as LDCs.
Socioeconomic Measures
Population control through the use of socioeconomic
pressures to encourage or discourage reproduction is the
approach advocated by, among others, demographer
Kingsley Davis, who originated many of the following
suggestions.93 The objective of this approach would be to
influence the attitudes and motivations of individual
couples. An important aspect would be a large-scale
educational program through schools and communica-
tions media to persuade people of the advantages of small
families to themselves and to their society. Information
on birth control, of course, must accompany such educa-
tional efforts. This is one of the first measures that can be
adopted, and it has been increasingly employed in many
of the more active family planning programs in LDCs. It
has also been used in some DCs, notably the U.S. and
England, mainly, but not entirely, by private groups such
as Planned Parenthood and ZPG.
As United States taxpayers know, income tax laws
have long implicitly encouraged marriage and child-
bearing, although recent changes have reduced the effect
somewhat. Such a pronatalist bias of course is no longer
appropriate. In countries that are affluent enough for the
majority of citizens to pay taxes, tax laws could be
adjusted to favor (instead of penalize) single people,
''Davis, Population policy.

working wives, and small families. Other tax measures
might also include high marriage fees, taxes on luxury
baby goods and toys, and removal of family allowances
where they exist.
Other possibilities include the limitation of maternal
or educational benefits to two children per family. These
proposals, however, have the potential disadvantage of
heavily penalizing children (and in the long run society
as well). The same criticism may be made of some other
tax plans, unless they can be carefully adjusted to avoid
denying at least minimum care for poor families, regard-
less of the number of children they may have.
A somewhat different approach might be to provide
incentives for late marriage and childlessness, such as
paying bonuses to first-time brides who are over 25, to
couples after five childless years, or to men who accept
vasectomies after their wives have had a given number of
children.94 Lotteries open only to childless adults have
also been proposed. The savings in environmental de-
terioration, education, and other costs would probably
justify the expenditure. All of these measures, of course,
suffer the drawback of influencing the poor to a greater
degree than the rich. That would be unfortunate, since
the addition of a child to an affluent family (which has a
disproportionate impact on resources and environment)
is in many ways more harmful to society than the
addition of a child to a poor family.
Adoption to supplement small families for couples
who especially enjoy children can be encouraged through
subsidies and simplified procedures. It can also be a way
to satisfy couples who have a definite desire for a son or
daughter; further research on sex determination should
be pursued for the same reason. A special kind of
social-security pension or bond could be provided for
aging adults who have few or no children to support them
in their old age.
The latter idea, proposed in detail by economist
Ronald Ridker, has been tried with some success on tea
estates in southern India.95 As implemented, the plan
made monthly deposits in a pension fund for each female
worker enrolled in the plan as long as she spaced her
M
A study has been made o; :he economic feasibility of such a policy for
the United States by Larry D. Barnett (Population policy: payments for
fertility limitation in the U.S.).
"Synopsis of a proposal for a family planning bond; and Saving
accounts for family planning, an illustration from the tea estates of India.
POPULATION POLICIES / 785
children at least three years apart and had no more than
three. If more children were born, the payments were
reduced. Since managers of the tea estates were already
paying maternity and health benefits, the costs of the
pension fund were at least partially offset by savings from
those. A large majority of the women signed up for the
program, and within the first four years there were
substantial drops not only in fertility, but in infant
mortality and in worker absenteeism.96 The first pilot
project included only about 700 women; it remains to be
seen whether implementation of the pension plan on
other tea estates and in other situations in India will be
equally successful.
There are many possibilities in the sphere of family
structure, sexual mores, and the status of women that can
be explored.97 With some exceptions, women have
traditionally been allowed to fulfill only the roles of wife
and mother. Although this has changed in most DCs in
recent decades, it is still the prevailing situation in most
LDCs, particularly among the poor and uneducated.
Anything that can be done to diminish the emphasis
upon these traditional roles and provide women with
equal opportunities in education, employment, and other
areas is likely to reduce the birth rate. Measures that
postpone marriage and then delay the first child's birth
also help to encourage a reduction in birth rates. The
later that marriage and the first child occur, the more time
the woman will have to develop other interests. One of
the most important potential measures for delaying
marriage, and directly influencing childbearing goals as
well, is educating and providing employment for women.
Women can be encouraged to develop interests outside
the family other than employment, and social life could
be centered around diese outside interests or the couple's
work, rather than exclusively within the neighborhood
and family. Adequate care for pre-school children should
be provided at low cost (which, moreover, could provide
an important new source of employment). Provision of
child care seems more likely to encourage employment
outside the home, with concomitant low reproduction,
than to encourage reproduction. Women represent a
"V. I. Chacko, Family planners earn retirement bonus on plantations
in India.
97
Judith Blake. Demographic science and the redirection of population
policy; Reproductive motivation; Alice Taylor Day, Population control
and personal freedom: are they compatible?
786 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
large, relatively untapped pool of intellectual and tech-
nical talent; tapping that pool effectively could help
reduce population growth and also would provide many
other direct benefits to any society.
Social pressures on both men and women to marry and.
have children must be removed. As former Secretary of __
Tptprjnr Stewart Udall observed, "All lives are not.
enhanced by marital union; parenthood is not necessarily
a fulfillment for every married couple."98 If society were
convinced of the need for low birth rates, no doubt the
stigma that has customarily been assigned to bachelors,
spinsters, and childless couples would soon disappear.
But alternative lifestyles should be open to single people,
and perhaps the institution of an informal, easily dis-
solved "marriage" for the childless is one possibility.
Indeed, many DC societies now seem to be evolving in
this direction as women's liberation gains momentum."
It is possible that fully developed societies may produce
such arrangements naturally, and their association with
lower fertility is becoming increasingly clear. In LDCs a
childless or single lifestyle might be encouraged deliber-
ately as the status of women approaches parity with that
of men.
Although free and easy association of the sexes might
be tolerated in such a society, responsible parenthood
ought to be encouraged and illegitimate childbearing
could be strongly discouraged. One way to carry out this
disapproval might be to insist that all illegitimate babies
be put up for adoption—especially those born to minors,
who generally are not capable of caring properly for a
child alone.100 If a single mother really wished to keep
her baby, she might be obliged to go through adoption
proceedings and demonstrate her ability to support and
care for it. Adoption proceedings probably should re-
main more difficult for single people than for married
couples, in recognition of the relative difficulty of raising
children alone. It would even be possible to require
9S
7976: Agenda for tomorrow.
"Judith Blake, The changing status of women in developed countries;
E. Peck and J. Senderowitz (eds.), Pronatalism, the myth ofnioni and apple
pie; Ellen Peck, The baby trap.
100
The tragedy of teenage single mothers in the U.S. is described by
Leslie Aldridge Westoff in Kids with kids. The adverse health and social
effects of teenage child-bearing in an affluent society have recently betn
documented by several studies. One good sample can be found in a special
issue of Family planning perspectives, Teenagers. USA.
pregnant single women to marry or have abortions,
perhaps as an alternative to placement for adoption,
depending on the society.
Somewhat more repressive measures for discouraging
large families have also been proposed, such as assigning
public housing without regard for family size and
removing dependency allowances from student grants or
military pay. Some of these have been implemented in
crowded Singapore, whose population program has been
counted as one of the most successful.
All socioeconomic measures are derived from knowl-
edge of social conditions that have been associated with
low birth rates in the past. The more repressive sugges-
tions are based on observations that people have volun-
tarily controlled their reproduction most stringently
during periods of great social and economic stress and
insecurity, such as the Depression of the 1930s.101 In a
sense, all such proposals are shots in the dark. Not
enough is known about fertility motivation to predict the
effectiveness of such policies. Studies by demographer
Judith Blake102 and by economist Alan Sweezy103 for
instance, have cast serious doubt on the belief that
economic considerations are of the greatest importance in
determining fertility trends. Sweezy has shown that the
decline of fertility in the 1930s in the United States was
merely a continuation of an earlier trend. If their views
are correct, then severely repressive economic measures
might prove to be both ineffective and unnecessary as a
vehicle for population control, as vrell as socially
undesirable. At the very least, they should be considered
only if milder measures fail completely.
Involuntary Fertility Control
The third approach to population limitation is that of
involuntary fertility control. Several coercive proposals
deserve discussion, mainly because some countries may
ultimately have to resort to them unless current trends in
birth rates are rapidly reversed by other means.104 Some
101
Richard A. Easterlm, Population, labor force, and long swings in
economic growth. Further discussion of Easterlies ideas can be found in
Deborah Freedman. ed., Fertility, aspirations and resources: A sympo-
sium on the Easterlin hypothesis.
102
Are babies consumer durables? and Reproductive motivation.
""The economic explanation of fertility changes in the U.S.
io4
Edgar R. Chasteen, The case for compulsory birth control.

involuntary measures could be less repressive or dis-
criminatory, in fact, than some of the socioeconomic
measures suggested.
In the 1960s it was proposed to vasectomize all fathers
of three or more children in India. The proposal was
defeated then not only on moral grounds but on practical
ones as well; there simply were not enough medical
personnel available even to start on the eligible candi-
dates, let alone to deal with the new recruits added each
day! Massive assistance from the developed world in the
form of medical and paramedical personnel and/or a
training program for local people nevertheless might
have put the policy within the realm of possibility. India
in the mid-1970s not only entertained the idea of com-
pulsory sterilization, but moved toward implementing
it, perhaps fearing that famine, war, or disease might
otherwise take the problem out of its hands. This deci-
sion was greeted with dismay abroad, but Indira Gandhi's
government felt it had little other choice. There is too
little time left to experiment further with educational
programs and hope that social change will generate a
spontaneous fertility decline, and most of the Indian
population is too poor for direct economic pressures
(especially penalties) to be effective.
A program of sterilizing women after their second or
third child, despite the relatively greater difficulty of the
operation than vasectomy, might be easier to implement
than trying to sterilize men. This of course would be
feasible only in countries where the majority of births are
medically assisted. Unfortunately, such a program
therefore is not practical for most less developed coun-
tries (although in China mothers of three children are
commonly "expected" to undergo sterilization).
The development of a long-term sterilizing capsule
that could be implanted under the skin and removed
when pregnancy is desired opens additional possibilities
for coercive fertility control. The capsule could be
implanted at puberty and might be removable, with
official permission, for a limited number of births. No
capsule that would last that long (30 years or more) has
yet been developed, but it is technically within the realm
of possibility.
Various approaches to administering such a system
have been offeredj including one by economist Kenneth
POPULATION POLICIES / 787
Boulding.105 His proposal was to issue to each woman at
maturity a marketable license that would entitle her to a
given number of children—say, 2.2 in order to have an
NRR = 1. Under such a system the number could be two
if the society desired to reduce the population size slowly.
To maintain a steady size, some couples might be
allowed to have a third child if they purchased "deci-
child" units from the government or from other women
who had decided not to have their full allotments of
children or who found they had a greater need for the
money. Others have elaborated on Boulding's idea,
discussing possible ways of regulating the license scheme
and alternative ways of alloting the third children.106
One such idea is that permission to have a third child
might be granted to a limited number of couples by
lottery. This system would allow governments to regu-
late more or less exactly the number of births over a given
period of time.
Social scientist David Heer has compared the social
effects of marketable license schemes with some of the
more repressive economic incentives that have been
proposed and with straightforward quota systems.107 His
conclusions are shown in Table 13-5.
Of course, a government might require only implan-
tation of the contraceptive capsule, leaving its removal to
the individual's discretion but requiring reimplantation
after childbirth^ Since having a child would require
positive action (removal of the capsule), many more
births would be prevented than in the reverse situation.
Certainly unwanted births and the problem of abortion
would both be entirely avoided. The disadvantages
(apart from the obvious moral objections) include the
questionable desirability of keeping the entire female
population on a continuous steroid dosage with the
contingent health risks, and the logistics of implanting
capsules in 50 percent of the population between the ages
of 15 and 50.
Adding a sterilant to drinking water or staple foods is a
suggestion that seems to horrify people more than most
proposals for involuntary fertility control. Indeed, this
lG5
The meaning ofiht 20th csnmrv, pp. 135—136.
J
106
Bruce M. Russect. Licensing: for cars and babies; David M. Heer,
Marketing licenses for babies; Boulding's proposal revisited.
'"Ibid.
TABLE 13-5
Evaluation of Some Relatively Coercive Measures for Fertility Reduction
Effect Marketable license systems Financialjucentiaie^ystems Quota systems
CBqby licenses'} /monthly subsidy\ / Monthly tax*\ .^
that may be sold to persons X on persons \ f One-time tax \
Boulding proposal or lent at interest \ uith no more than Jl with more than 1 1 for excess babies J Identical quota
for baby licenses to the government \^ two children ^X N ^ f r o o children^/ \^^ over j
two / for all couples
^^*^~~ ,
Restriction on Moderately severe Moderately severe Moderately severe Moderately severe Moderately severe Very severe
individual
liberty
Effect on quality Probably Probably Unknown Unknown Probably Slightly beneficial
of children's beneficial beneficial beneficial
financial
support
Effecti%7eness and Effective Effective Fairly effective Fairly effective Effective Effective
acceptability of enforcement at enforcement at enforcement enforcement enforcement at enforcement at
enforcement possible price possible price possible price possible price
mechanisms of depriving of depriving of depriving of depriving
some children some children some children some children
of a family of a family of a family of a family
environment environment environment environment
Effectiveness for Moderate High Low Low Low Moderate
precise
regulation of
the birth rate
Source: Adapted from David Heer, Marketing licenses.

would pose some very difficult political, legal, and social
questions, to say nothing of the technical problems. No
such sterilant exists today, nor does one appear to be
under development. To be acceptable, such a substance
would have to meet some rather stiff requirements: it
must be uniformly effective, despite widely varying
doses received by individuals, and despite varying de-
grees of fertility and sensitivity among individuals; it
must be free of dangerous or unpleasant side effects; and
it must have no effect on members of the opposite sex,
children, old people, pets, or livestock.
Physiologist Melvin Ketchel, of the Tufts University
School of Medicine, suggested that a sterilant could be
developed that would have a very specific action—for
example, preventing implantation of the fertilized
ovum.108 He proposed that it be used to reduce fertility
levels by adjustable amounts, anywhere from 5 to 75
percent, rather than to sterilize the whole population
completely. In this way, fertility could be adjusted from
time to time to meet a society's changing needs, and there
would be no need to provide an antidote. Contraceptives
would still be needed for couples who were highly
""Fertility control agents as a possible solution to the world popula-
tion problem, pp. 687-703.
motivated to have small families. Subfertile and func-
tionally sterile couples who strongly desired children
would be medically assisted, as they are now, or en-
couraged to adopt. Again, there is no sign of such an
agent on the horizon. And the risk of serious, unforeseen
side effects would, in our opinion, militate against the use
of any such agent, even though this plan has the
advantage of avoiding the need for socioeconomic pres-
sures that might tend to discriminate against particular
groups or penalize children.
Most of the population control measures beyond
family planning discussed above have never been tried.
Some are as yet technically impossible and others are and
probably will remain unacceptable to most societies
(although, of course, the potential effectiveness of those
least acceptable measures may be great).
Compulsory control of family size is an unpalatable
idea, but the alternatives may be much more horrifying.
As those alternatives become clearer to an increasing
number of people in the 1980s, they may begin demand-
ing such control. A far better choice, in our view, is to
expand the use of milder methods of influencing family
size preferences, while redoubling efforts to ensure that
the means of birth control, including abortion and

sterilization, are accessible to every human being on
Earth within the shortest possible time. If effective action
is taken promptly against population growth, perhaps the
need for the more extreme involuntary or repressive
measures can be averted in most countries.
POPULATION CONTROL
AND DEVELOPMENT
Population control cannot be achieved in a social or
economic vacuum, of course. To formulate effective
population control measures, much greater understand-
ing is needed about all peoples' attitudes toward repro-
duction, and how these attitudes are affected by various
living conditions, including some that seem virtually
intolerable to people in developed countries. Even more,
it is essential to know what influences and conditions will
lead to changes in attitudes in favor of smaller families.
The economists and demographers who believed that
urbanization and industrialization of LDCs would auto-
matically induce a demographic transition in those
societies seem to have been disastrously wrong. While
they waited for the birth rate to fall, one billion people
were added to the human population. At the very least, it
is obvious that the causes of demographic transitions are
far more complex than was once believed. But the social
scientists may have been wrong mainly in their approach.
Many aspects of modernization may indeed have impor-
tant influences on reproductive behavior.
Such influences, of course, fall outside the purview of
population programs; they are an integral part of devel-
opment as it affects—or fails to affect—each member of a
society. When development is the kind that improves the
living conditions of everyone down to the poorest farm
worker, development that starts at the grass roots level,
then there is hope that poverty, hunger, disease, and
hopelessness might be reduced—and along with them the
desire for many children.109
The general problems of LDC development are dis-
cussed in detail in Chapter 15, but its indirect effects on
fertility are worth mentioning here. While no one factor
of development can be singled out as ever having
""William Rich, Smaller families through social and economic prog-
ress; Kocher, Rural development; Grant, Development.
POPULATION POLICIES / 789
"triggered" a decline in fertility—no particular level of
infant mortality or per-capita GNP, for instance—a
constellation of factors does often seem to be associated
with such declines. Among these are rural development
and land reform favoring small, family-owned farms;
availability of adequate food, basic health care, and
education (especially of women) to the entire population;
industries favoring labor-intensive, rather than capital-
intensive, means of production; and a relatively small
income gap between the richest and poorest segments of
the population.110
Table 13-6 compares some of these interrelated factors
in nine less developed nations, four of which have shown
significant drops in fertility since 1960 and five of which
have not. While each of the nine countries, like nearly all
LDCs, exhibits some of the salient factors listed above,
those with substantially reduced fertility much more
commonly manifest them. Understanding of the impor-
tant influences on reproductive behavior and how they
operate is so far sketchy at best. Achieving a solid base for
population policy may be one of the most important—
and perhaps most difficult—research assignments for the
next decade.
Since the goals of both development and population
control are supposedly identical—an improvement in the
well-being of all human beings in this and future
generations—it seems only reasonable to plan each to
reinforce the other. Emphasis accordingly should be
placed on policies that would further the goals of both
family limitation and development—for example, rural
development and land tenure reform; increased agricul-
tural output; universal primary education for children;
old-age support schemes; and improved health care and
nutrition, especially for mothers and children.
Survival of human society nevertheless seems likely to
require the imposition of direct population control
measures beyond family planning in most LDCs. There
is no guarantee that processes of modernization can
quickly enough induce the necessary changes in attitudes
that might bring growth to a halt. High priority should be
given to stimulating those attitude changes and counter-
acting the effects of pronatalist traditions.
"°Ibid. See also Freedman and Bcrclson, The record of family
planning programs.

But while some people seek the best means of achiev-
ing population control, in other quarters the debate
continues as to whether it is necessary—or even
desirable.
Population Politics
/ am not sure that the dictatorship of the proletariat,
especially if led by an elite, will solve the problem of
social justice; I am certain starvation will not solve
the problem of overpopulation.
-Tom O'Brien,
Marrying Malthas and Marx
Family planning programs have spread throughout the
less developed world and are now established in the
majority of less developed countries. Many countries,
especially those with long-established programs that
have been frustrated by lack of success in reducing birth
rates simply through making means of birth control
available, have progressed to measures beyond family
planning. As could be expected, this has aroused opposi-
tion, informed and uninformed, from many quarters.
Some groups see threats to their personal liberties; even
more commonly, people see threats to their economic or
political interests. In addition, there are many propo-
nents of population control who strongly disagree on the
most appropriate approach.'n By 1974, when the United
Nations World Population Conference took place in
Bucharest, the chorus of clashing viewpoints was almost
deafening."2 Most press reports and coverage of the
Conference by special groups conveyed an impression of
enormous confusion and prevailing disagreement,113
1
' 'National Academy of Sciences, In search of population policy.
"2J. Mayone Stycos, Demographic chic at the UN.
"3The list of accounts is very long, even leaving out a plethora of
anticipatory books and articles. Here is a partial one: Anthony Astrachan,
People are the most precious; Donald Gould, Population polarized; P. T.
Piotrow, World plan of action and health strategy approved at population
conferences; Conrad Taeuber, Policies on population around the world;
Brian Johnson, The recycling of Count Malthus; M. Carder and B. Park,
Bombast in Bucharest; D. B. Brooks and L. Douglas, Population,
resources, environment: the view from the UN; W. P. Mauldin, et al., A
report on Bucharest; Marcus P. Franda, Reactions to America at
Bucharest; Concerned Demography, Emerging population alternatives;
International Planned Parenthood Federation, (IPPF) People, special
issue, vol. 1, no. 3,1974; in addition, Ifff published a daily newspaper
called Planet during the conference.
POPULATION POLICIES / 791
despite the ultimate ratification of a World Population
Plan of Action and 21 resolutions.114
A very useful summary of all the various views of the
population problem and how (or whether) to deal with it
has been compiled by demographer Michael S. Teitel-
baum.''' Because it is the best listing we have seen, we
are borrowing Teitelbaum's outline for the framework of
the following discussion.115
Positions Against Special Population
Programs and Policies
Pronatalist. This viewpoint favors rapid population
growth to boost economic growth and an expanding
labor supply, as well as to increase opportunities for
economies of scale in small countries. Pronatalists be-
lieve there is strength in numbers (both political and
military) and are more concerned about competition with
rapidly growing neighboring countries or among seg-
ments of their own populations than about the disadvan-
tages of rapid growth. This group now seems to be a
diminishing minority.
Revolutionist. Revolutionaries oppose population
programs because they may alleviate the social and
political injustices that might otherwise lead to the
revolution they seek. This view is particularly common
in Latin America.1'7 (Conversely, many politicians sup-
port family planning in the hope that it will dampen the
revolutionary fires.)
Anti-colonial and genocide positions. This group
is very suspicious of the motives of Western population
control advocates. Some believe that effective population
programs would retard development and maintain LDCs
in economic subservience to DCs. Others see population
'"UnitedNarions, Report ofthe UN World Population Conference, 1974.
"'Population and development: is a consensus possible?
11
'Bernard Berelson has also described the conflicting views on
population in the Population Council Annual Report 1973, pp. 19—27, and
The great debate on population policy. The latter was written as a dialog
among three 'Voices," representing the family planning advocates, those
who see "development" as the important issue, and academic critics of the
family planning approach to population control. The dialog is informa-
tive, often witty, but unfortunately leaves the reader with an impression
of much greater consensus than probably exists among the viewpoints.
"7J. Mayone Stycos, Family planning: reform and revolution.
792 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
programs as an effort by DCs to "buy development
cheaply." The most extreme position is taken by those
who regard population control as a racist or genocidal
plot against nonwhite citizens of LDCs. Holders of this
position blame resource shortage and environmental
problems exclusively on the greediness of rich countries.
To the extent that high fertility in LDCs is a problem,
they emphasize that it is due to their poverty, which in
turn is caused by overconsumption in DCs.118
Accommodationist. This viewpoint is basically
anti-Malthusian: because history shows that Earth is
capable of supporting far more people than Malthus
thought, he was wrong; these people believe that further
improvements in agriculture and technology will permit
accommodation of a much larger population than
today's. To them what is called overpopulation is really
underemployment; restructuring the economic system
will allow societies to provide jobs and meet the basic
needs of everyone, no matter how many. The slogan
adopted by the New Internationalist for the Population
Conference—"Look after the people and population will
look after itself—epitomizes this position.119
The problem-is-population-distribution. Some
people holding this view simplistically compare popula-
tion densities of different regions without regard to
available resources and means of support. They also
focus on the serious problem of urban migration in
LDCs and conclude that policies should concentrate on
population redistribution rather than on birth control.120
Mortality and social security. This view concen-
trates on the significance of infant and child mortality in
motivating reproductive behavior; if infant mortality
were reduced, fertility would automatically decline. This
view is also held in varying degrees by many pro-
population control advocates as well as those against it.
"8This perspective has been put forth by Barry Commoner, How
poverty breeds overpopulation (and not the other way around); and Pierre
Pradervand, The Malthusian man. Pradervand and Commoner, among
others, also oppose present population programs on anticolonialist
grounds.
119
Peter Adamson, A population policy and a development policy are
one and the same thing.
l20
Maaza Bekele, False prophets of doom. This article expresses this
and the above three viewpoints dearly.
Barry Commoner121 subscribes to it, but he quotes a
formula devised by AID. Whether the relationship is as
clear as is commonly believed has been called into
question by Alan Sweezy, among others.122
The other side of this coin is social security-the need
for children, especially sons, to support parents in old
Status and roles of women. Social pressures defin-
ing the role of women as wives and mothers, with status
attached primarily to that role, are a major cause of high
fertility, according to this view. Large families are likely
to prevail until alternative roles are made available to all
women.124
The religious doctrinal position. There are two
distinct, but not necessarily mutually exclusive views
here. One is essentially fatalistic: "Be fruitful and
multiply, God will provide." This view is common
among both Western and Eastern religions. The other
(mainly the Roman Catholic Church) sees population
growth as a problem, but regards most forms of birth
control as more or less immoral.125
Medical risk. People holding this view are more
impressed by the risks that attend the use of contracep-
tives such as the pill and the IUD, and surgical proce-
dures such as abortion and sterilization than by the risks
run by not using them. (The risk of death from child-
bearing alone is considerably higher, especially among
the poor in LDCs, than any of these, and both maternal
and infant mortality are known to be reduced substan-
tially by the use of birth control for birth spacing.)126 A
milder version of this view is held by large segments of
the medical profession who oppose the distribution of
the pill without prescription and the insertion of ITJDs
by paramedical personnel, despite the established safety
of both procedures compared to the consequences of not
using them.127
12
'Commoner, How poverty breeds overpopulation.
'"Recent light.
'"Mamdani, Myth of population control.
'24Blake, Reproductive motivation; Day, Population control and
personal freedom; Ceres, Women: a long-silent majority.
125
Pope Paul VI, Humanae Viiae.
126
A. Omran, Health benefits; Buchanan, Effects of childbearing;
Eckholm and Newland, Health.
'27Mauldin, Family planning programs and fertility declines.

Holistic development. Holders of this view are
"demographic transition" believers who are convinced
that social and economic development are responsible for
whatever declines in fertility have occurred in LDCs, not
family planning programs, which they consider a waste
of effort and funds that should be put into
development.128
Social justice. This position emphasizes redistribu-
tion of wealth within and among nations to improve the
condition of the poor.129 It is related to the idea of
grassroots development, but is somewhat more extreme
in that many of its proponents feel that redistribution of
wealth is the only policy that will reduce population
growth and solve other problems as well.
Positions Supporting the Need
for Population Programs and Policies
Population hawks. Teitelbaum sums up this position
as follows:
. . . Unrestrained population growth is the principal
cause of poverty, malnutrition, and environmental
disruption, and other social problems. Indeed we are
faced with impending catastrophe on food and en-
vironmental fronts.130
. . . Such a desperate situation necessitates draconian
action to restrain population growth, even if coercion
' 28Bekele, False prophets; Commoner, How poverty breeds overpopu-
lation. A more sophisticated form is Adamson's (A population policy)—at
least he advocates development at the grass-roots level (see Social Justice
section).
129
Pradervand, Malthusian man; some writers for Concerned
Demography.
130
We, along with some colleagues, are considered among the principal
proponents of this position (see especially P. Ehrlich, The population
bomb, which is the most commonly cited source). Like most of the
statements in this summary, this one is both exaggerated and over-
simplified. We would not, for example, blame poverty or malnutrition
principally on overpopulation, although it certainly contributes to their
perpetuation. Likewise, population growth is one of three interacting
causes of environmental deterioration; the others are misused technology
and increasing affluence (see Chapter 12). As an aside, it is interesting that
the first edition of the Population bomb, written almost a decade before
this book, is still often cited both as if it reflected the situation in the
mid-1970s and as if we still held precisely the same views today as we did
then.
POPULATION POLICIES / 793
is required. "Mutual coercion, mutually agreed
upon."131
. . . Population programs are fine as far as they go,
but they are wholly insufficient in scope and strength
to meet the desperate situation.132
Provision of services. This viewpoint holds that
family planning programs are essential for reducing birth
rates and that there is still a great unmet demand for birth
control in LDCs; what is needed is to expand family
planning services to meet the demand.133 Part of the
failure of family planning is due to provision of inade-
quate contraceptive technologies.134 This position is held
most strongly by administrators and associates of family
planning programs and their donor agencies.
Human rights. This position, held by virtually
everyone who is in favor of family planning or other
population control policies, derives from the idea that
there is a fundamental human right for each person
responsibly to determine the size of his or her family.135
Another right that has been recognized in many
countries including the United States'36 is that of women
to control their bodies. This is especially relevant to the
issue of abortion, but applies also to contraception and
sterilization. Family planning also contributes to health,
especially of women and children; and one more human
right is that to health care.
Population programs plus development. Here
again we quote Teitelbaum, who expressed it well:
. . . Social and economic development are necessary
but not sufficient to bring about a new equilibrium of
population at low mortality and fertility levels. Special
population programs are also required.137
J
'' Garrett Hardin, The tragedy of the commons.
1
"Davis, Population policy; P. R. Ehrlich and A. H. Ehrlich, Popula-
tion resources environment, W. H. Freeman and Company, San Francisco,
1970 and 1972, chapter 10.
'"Stj'cos. Demographic chic; Berelson, Effects of Population Control
Programs.
m
Mauldin, Family planning programs and fertility declines.
115
UN Declaration on Population, Tehran, 1968, printed in Studies in
Family Planning, no. 16, January 1967 and no. 26, January 1968.
Teitelbaum omitted the important word "responsibly" in his discussion.
136
Supreme Court decision on abortion, 1973.
137
Advocates of this include Rich. Smaller families; James E. Kocher,
Rural development; Grant, Development; and Lester R. Brown, In the
human interest.
794 / THE HUMAN PREDICAMENT: FINDING A WAY OUT
While we are usually classified by others as "population
hawks," we agree more closely with this position in terms
of what should be done. What follows, however, is far too
mild a statement on the urgency of ending population
growth; Teitelbaum discusses only the social aspects and
completely leaves out environmental and resource con-
straints on population growth:
Too rapid population growth is a serious intensifier
of other social and economic problems, and is one,
though only one, of a number of factors behind lagging
social and economic progress in many countries.
Some countries might benefit from larger popula-
tions, but would be better served by moderate rates of
growth over a long period than by very rapid rates of
growth over a shorter period.
An effective population program therefore is an
essential component of any sensible development
program.
This general position (including the portion just quoted)
is widely held by social scientists, politicians, econ-
omists, and quite likely by Teitelbaum himself.
Like the blind men with the elephant, each viewpoint
grasps a piece of the truth, but none encompasses all of it.
As should be evident, the above positions are by no
means mutually exclusive, and probably none is held
monolithically by anyone. Rather, most people argue
from several related positions at once. Some apparently
violent disagreements, when analyzed, turn out to be
only a matter of emphasis or of leaving something out of
the picture.
Teitelbaum, Berelson, and others see the germ of a
consensus emerging from the debate. If so, and if the
consensus produces an effective approach to the popula-
tion problem that all can more or less agree on, the
controversy will have been worthwhile. But to the extent
that population policies are connected to the larger
confrontation between the rich developed world and the
poor less developed world (with waters frequently mud-
died by China and the Soviet Union who say one thing
about population control and practice another), con-
sensus may prove to be elusive. Even more important,
LDCs are unlikely to take very seriously population goals
and policies recommended by DCs that do not impose
such goals and policies upon their own people.
World Population Plan of Action
In view of the diversity of opinions held by various
individuals and groups on population control, it is not
surprising that the United Nations' World Population
Plan of Action turned out to be a bulky, nearly unread-
able document some 50 pages long.158 Summing it up is
almost impossible; the 20 resolutions and numerous
recommendations covered virtually every subject that
might affect or be affected by population growth. In the
initial statement of "Principles and Objectives," the Plan
declared:
The principal aim of social, economic and cultural
development, of which population goals and policies
are integral parts, is to improve levels of living and the
quality of life of the people. Of all things in the world,
people are the most precious. . . .
It then proceeded to affirm the rights of nations to
formulate their own population policies, of couples and
individuals to plan their families, and of women to
participate fully in the development process. It con-
demned racial and ethnic discrimination, colonialism,
foreign domination, and war. And it also expressed
concern for preserving environmental quality, for main-
taining supplies and distribution of resources, and for
increasing food production to meet growing needs.
More specifically with regard to population policies,
the following recommendations were made:139
• Governments should develop national policies on
population growth and distribution, and should
incorporate demographic factors into their devel-
opment planning.
• Developed countries should also develop policies
on population, investment, and consumption with
an eye to increasing international equity.
• Nations should strive for low rather than high
birth and death rates.
• Reducing death rates should be a priority goal,
aiming for an average life expectancy in all
1
"United Nations, Report of the UN World Population Conference,
1974.
1
"Adapted from a summary by Piotrow, World Plan of Action.
 POPULATION POLICIES / 795

countries of 62 by 1985 and 74 by 2000, and an the UN's Second Development Decade strategy,
infant mortality rate below 120 by 2000. reviewed every five years, and appropriately
All nations should ensure the rights of parents "to modified.
determine in a free, informed and responsible
Unfortunately, a sense of urgency about reducing
manner the number and spacing of their chil-
population growth, which had been present in the draft
dren," and provide the information and means for
Plan, was lost in the final version under the pressure of
doing so.
political disagreement. The environmental and resource
Family planning programs should be coordinated
constraints on population growth were essentially left out
with health and other social services, and the poor
of conference discussions and hence omitted from the
in rural and urban areas should receive special
Plan of Action.140 Also, the value of family planning
attention.
programs tended to be downgraded in favor of an
Efforts should be made to reduce LDC birth rates
overwhelming emphasis on "development" as the way to
from an average of 38 in 1974 to 30 per 1000 by
reduce birth rates.
1985.
The conference may not have blazed any radically new
Nations are encouraged to set their own birth rate
trails in its recommendations, but it still cannot be
goals for 1985 and to implement policies to reach
accused of taking a strictly narrow view of the population
them.
problem. Its neglect of environmental and resource
Nations should make special efforts to assist
aspects and the political problems that will accrue to
families as the basic social unit.
those limitations is deplorable, but social and economic
Equality of opportunity for women in education,
aspects were fully explored. Probably the conference's
employment and social and political spheres
greatest value was to expose participants (many of whom
should be ensured.
did hold narrow views or were uninformed about some of
Undesired migration, especially to cities, should
the issues) to the information and viewpoints of others.
be discouraged, principally by concentrating de-
And the mere existence of a world conference helped
velopment in rural areas and small towns, but
draw world attention to the population issue and empha-
without restricting people's rights to move within
sized that nations have a responsibility to manage their
their nation. populations. Before the conference most national gov-
International agreements are needed to protect
ernments still seemed to believe that population prob-
rights and welfare of migrant workers between lems were neither their concern nor within their ability to
countries and to decrease the "brain drain."
control.
Demographic information should be collected,
The final Plan of Action was adopted by consensus of
including censuses, in all countries. the 136 member nations (with reservations by the
More research is needed on the relation of
Vatican). Whether the resolutions and recommendations
population to various institutions and to social
will be taken with the seriousness the problem warrants
and economic trends and policies; on improving
remains to be seen. For many countries it will not be
health; on better contraceptive technologies; on
easy, given the overwhelming problems their govern-
the relation of health, nutrition, and reproduc-
ments face. But on the answer hangs the future of
tion; and on ways to improve delivery of social
humanity.
services (including family planning). It was repeatedly emphasized at Bucharest that popu-
Education programs in population should be lation control is no panacea for solving the problems of
strengthened. development or social and economic justice. This is
Population assistance from international, govern- perfectly true, of course; but unless the runaway human
mental, and private agencies should be increased.
WO
The Plan of Action should be coordinated with W. P. Mauldin et al., A report on Bucharest.
796 / THE HUMAN PREDICAMENT: FINDING A WAY OUT

population is brought under control—and soon—the
result will be catastrophe. What kind of catastrophe
cannot be predicted, but numerous candidates have been
discussed in this book: ecological collapses of various
kinds, large-scale crop failures due to ecological stress or
changes in climate and leading to mass famine; severe
resource shortages, which could lead either to crop
failures or to social problems or both; epidemic diseases;
wars over diminishing resources; perhaps even thermo-
nuclear war. The list of possibilities is long, and over-
population enhances the probability that any one of them
will occur. Population control may be no panacea, but
without it there is no way to win.

Recommended for Further Reading

Blake, Judith. 1971. Reproductive motivation and population policy. BioScience, vol. 21,
no. 5, pp. 215-220. An analysis of what sorts of policies might lower U.S. birth rate.
Berelson, Bernard. 1974. An evaluation of the effects of population control programs.
Studies in Family Planning, vol. 5, no. 1. An important contribution to the
controversy by a distinguished demographer active in the family planning field.
Chen, Pi-Chao. 1973. China's population program at the grass-roots level. Studies in
Family Planning, vol. 4, no. 8, pp. 219-227. Also published in Population
perspective: 1973, Brown, Holdren, Sweezy, and West, eds. Excellent summary'.
Davis, Kingsley. 1973. Zero population growth: The goal and the means. Daedalus, vol.
102, no. 4, pp. 15-30. Useful critique of population policies, actual and proposed,
especially of the United States.
Katchadourian, H. A., and D. T. Lunde. 1975. Fundamentals of human sexuality. 2nd ed.
Holt, New York. A superb text for sex education; useful for birth control information
also.
Kocher, James E. 1973. Rural development, income distribution and fertility decline.
Population Council Occasional Papers. An important work on the connection
between grass-roots development and fertility.
Population Reference Bureau, Inc. 1975. Family size and the black American. Population
Bulletin vol. 30, no. 4. A study of black reproductive behavior and attitudes in
the U.S.
—. 1976. World population grotvth and response 1965-1975: A decade of global action.
A compendium on recent demographic trends and the evolution of population
policies around the world.
Revelle, Roger. 1971. Rapid population growth: Consequences and policy implications.
Report of a study committee, National Academy of Sciences. Johns Hopkins Press,
Baltimore. Contains a number of interesting papers on social and economic effects of
population growth, but weak on environmental and resource aspects.
Teitelbaum, Michael S. 1974. Population and development: Is a consensus possible?
Foreign Affairs, July, pp. 742-760. An excellent discussion of the myriad viewpoints
on population control.