Les antibiotiques sont produits sous des formes pharmaceutiques telles que des pilules antibiotiques en ligne
elles permettent d'injecter la quantité de préparation strictement nécessaire.
Documents freelance stark
from Lester R. Brown, Eco-Economy: Building an Economy for the Earth
(W. W. Norton & Co., NY: 2001)
2001 Earth Policy Institute®. All Rights Reserved.
Stabilizing Population by Reducing Fertility
by Reducing Fertility
World population has more than doubled since 1950. Those bornbefore 1950 are members of the first generation in history to wit-ness such a doubling during their lifetime. Stated otherwise, morepeople have been added to the world's population since 1950 thanduring the 4 million preceding years since we first stood upright.1
Throughout most of these 4 million years, we were few—num-
bering only in the thousands. When agriculture began, world popu-lation was estimated at 8 million—less than a third the size of To-kyo today. After farming got under way, population growth slowlygained momentum. With the Industrial Revolution, it acceleratedfurther. After 1950, it soared.
We are struggling to understand the dimensions of population
growth over the last half-century. We can relate to 100,000 people,the number filling a large stadium for an athletic event or a con-cert, but relating to an annual increase of 80 million is difficult. Tograsp the dimensions of this growth, we can equate it to the com-bined population of the United Kingdom, Belgium, Denmark, andSweden today. As someone who spends more time than I wouldlike in planes and airports, it is easier for me to relate populationgrowth to the passenger capacity of a jumbo jet. It takes the world's
growing population less than 3 minutes to fill a jumbo jet with400 passengers.
Despite the stresses associated with continuing population
growth, the United Nations projects that our numbers will growfrom 6.1 billion in 2000 to 9.3 billion in 2050. Of even more con-cern, all of the 3.2 billion additional people will be added in devel-oping countries. Given the analysis in this book, there is reason todoubt that this will actually happen. What is unclear is whetherthe projections will not materialize because we accelerate the shiftto smaller families in time or because we fail to do so and deathrates begin to rise.
Many countries that have experienced rapid population growth
for several decades are showing signs of demographic fatigue. Gov-ernments struggling with the simultaneous challenge of educatinggrowing numbers of children, creating jobs for swelling ranks ofyoung job seekers, and dealing with the environmental effects ofpopulation growth are stretched to the limit. Without a concertedeffort by national governments and the international communityto shift quickly to smaller families, land scarcity and water short-ages could become unmanageable—leading to political instability,economic decline, and rising death rates.
In this situation, when a major new threat arises—such as the
HIV epidemic or aquifer depletion—governments often cannotcope. Problems routinely managed in industrial societies are be-coming full-scale humanitarian crises in many developing ones. Asthe HIV epidemic continues to spread, rising death rates in someAfrican countries will likely bring their population growth to ahalt. This rise in the death rate marks a tragic new development inworld demography.
The issue is not whether population growth will slow, but how.
In its 1998 update of long-range population projections, the UnitedNations reduced the predicted population for 2050 by some 500million. Two thirds of this reduction was due to fertility fallingfaster than projected. But the other one third was the result of aprojected rise in death rates, largely because of HIV in Africa. Forthe first time in nearly half a century of world population updates,projections were being reduced by rising mortality. The challengeis to slow population growth in all developing countries by lower-ing birth rates, because if we fail, it will be slowed by rising deathrates.2
Stabilizing Population by Reducing Fertility
Breaking Out or Breaking Down
Today we find ourselves in a demographically divided world, one
where national projections of population growth vary more widely
than at any time in history. In most European countries and Japan,
population has stabilized or is declining; but in others, such as Ethio-
pia, Pakistan, and Saudi Arabia, population is projected to double
or even triple before stabilizing.
Demographers use a three-stage model to understand how popu-
lation growth rates change over time as modernization proceeds.
In the first stage, birth and death rates are both high, resulting inlittle or no population growth. In the second stage, death rates fallwhile birth rates remain high, leading to rapid growth. In the thirdstage, birth rates fall to a low level, balancing low death rates andagain leading to population stability while offering greater possi-bilities for comfort and dignity than in stage one. It is assumed thatcountries will progress from stage one to stage three. 3
Today there are no countries in stage one; all are either in stage
two or stage three. However, instead of progressing steadily for-ward toward stage three as expected, some countries are fallingback toward stage one as the historical fall in death rates is re-versed, leading the world into a new demographic era. If countriesdo not break out of the middle stage of the demographic transitionin a matter of decades, rapid population growth will eventuallyoverwhelm natural systems, leading to economic decline and forc-ing societies back into stage one as mortality rises. Over the longterm, there is no middle ground. Countries either break out orbreak down. Unfortunately, a number of countries, mostly in Af-rica, are showing signs of breaking down.
For the first time since China's great famine claimed 30 million
lives in 1959–61, world population growth is being slowed by ris-ing death rates. (See Figure 10–1.) Although rapid populationgrowth continues in scores of countries, the world is beginning todivide into two parts: one where population growth is slowing asfertility falls, and another where population growth is slowing asmortality rises. One way or the other, population growth will slow.
That rising death rates from AIDS have already reduced the pro-jected population for 2050 by more than 150 million represents afailure of our political institutions unmatched since the outbreakof World War II.4
The world is starting to reap the consequences of past neglect of
the population issue. The two regions where death rates either arealready rising or are likely to do so are sub-Saharan Africa and theIndian subcontinent, which together contain 1.9 billion people—nearly one third of humanity. Without clearly defined governmentstrategies in countries with rapid population growth to lower birthrates quickly and a commitment by the international communityto support them, one third of humanity could slide into a demo-graphic black hole.
After nearly half a century of continuous population growth,
the demand in many countries for food, water, and forest productsis simply outrunning the capacity of local life-support systems. Inaddition, the ever growing number of young people who need healthcare and education is exceeding the availability of these services. Ifbirth rates do not come down soon, these natural systems and so-cial services are likely to deteriorate to the point where death rateswill rise.
But what will cause death rates to go up in individual coun-
tries? Will it be starvation? An outbreak of disease? War? Socialdisintegration? At some point as population pressures build, gov-ernments are simply overwhelmed and are not able to respond tonew threats. There are now three clearly identifiable threats thateither are already pushing death rates up or have the potential todo so—the HIV epidemic, aquifer depletion, and land hunger.
Of these three, the HIV epidemic is the first to spiral out of
Stabilizing Population by Reducing Fertility
control in developing countries. The epidemic should be seen forwhat it is: an international emergency of epic proportions, one thatcould claim more lives in the early part of this century than WorldWar II did in the last one. In sub-Saharan Africa, HIV infectionrates are soaring, already affecting one fifth to one third or more ofadults in Botswana, Namibia, South Africa, Zambia, and Zimba-bwe.5
Barring a medical miracle, many African countries will lose a
fifth or more of their adult populations to AIDS by the end of thisdecade. To find a precedent for such a potentially devastating lossof life from an infectious disease, we have to go back to the deci-mation of New World Indian communities by the introduction ofsmallpox in the sixteenth century or to the Bubonic plague thatclaimed roughly a third of Europe's population during the four-teenth century.6
Ominously, the virus has also established a foothold in the In-
dian subcontinent. With 3.7 million adults now HIV-positive, In-dia is home to more infected individuals than any other nationexcept South Africa. And with the infection rate among India'sadults at roughly 1 percent—a critical threshold for potentially rapidspread—the epidemic threatens to engulf the country if the gov-ernment does not move quickly to check it. The virus is also spread-ing rapidly in Myanmar, Cambodia, and China.7
One consequence of continuing population growth is poten-
tially life-threatening water shortages. If rapid population growthcontinues indefinitely, the demand for water eventually exceeds thesustainable yield of aquifers. The result is excessive water with-drawals and falling water tables. (See Chapter 2.) Since 40 percentof the world's food comes from irrigated land, water shortages canquickly translate into food shortages.8
Dozens of developing countries face acute water shortages, but
none illustrate the threat better than India, whose population—expanding by 18 million a year—has already surpassed 1 billion.
New estimates for India indicate that in some areas water with-drawals are now double the rate of aquifer recharge. As a result,water tables are falling by 1 meter or more per year over parts ofthe country. Overpumping today means water supply cutbacks to-morrow, a serious matter where half of the harvest comes fromirrigated land.9
The International Water Management Institute estimates that
aquifer depletion and the resulting cutbacks in irrigation water couldoverride technology gains, reducing the grain harvest in water-shortregions of India. In a country where 53 percent of all children arealready malnourished and underweight, a shrinking harvest couldincrease hunger-related deaths, adding to the 6 million worldwidewho die each year from hunger and malnutrition. In contrast toAIDS, which takes a heavy toll among young adults, hunger claimsmostly infants and children.10
The third threat hanging over the future of countries with rapid
population growth is land hunger. Once cropland per person shrinksto a certain point, people can no longer feed themselves and theyeither turn to imported food or go hungry. The risk is that coun-tries will not be able to afford the imported food or that food sim-ply will not be available if world import needs exceed exportablesupplies.
Among the larger countries where shrinking cropland per per-
son threatens future food security are Ethiopia, Nigeria, and Paki-stan, all countries with weak family planning programs. As Nigeria'spopulation goes from 114 million today to a projected 278 millionin 2050, its grainland per person will shrink from 0.16 hectares to0.06 hectares. Pakistan's projected growth from 141 million todayto 344 million by 2050 will reduce its grainland per person from0.09 hectares at present to 0.04 hectares—scarcely the size of atennis court. Countries where this number has shrunk to 0.03 hect-ares, such as Japan, South Korea, and Taiwan, import 70 percentor more of their grain.11
The threats from HIV, aquifer depletion, and shrinking crop-
land are not new or unexpected. We have known for more than adecade that AIDS could decimate human populations if it were notcontrolled. In each of the last 18 years, the number of new HIVinfections has risen. Of the 58 million infected by the year 2000,22 million people have died. In the absence of a low-cost cure,nearly all the remaining 36 million will die by 2010. It is hard tobelieve, given our advanced medical knowledge, that a control-lable disease could devastate human populations in so many coun-tries.12
Similarly, it is hard to imagine that falling water tables, which
may prove an even greater threat to future economic progress andpolitical stability, could be so widely ignored. The arithmetic ofemerging water shortages is not difficult. A growing population
Stabilizing Population by Reducing Fertility
with a water supply that is essentially fixed by nature means thatthe water per person will diminish over time, eventually droppingbelow the level needed to meet basic needs for drinking water, foodproduction, and sanitation.
The same holds true for cropland per person. The mystery is
not in the arithmetic. That is straightforward. The mystery is inour failure to respond to the threats associated with continuingpopulation growth.
Africa Breaking Down
A generation ago, virtually the entire world appeared to be pro-
gressing economically and socially. A better future was in prospect
for all. Now that has changed as the HIV epidemic ravages Africa.
It is not only causing millions of deaths, it is undermining the
continent's economic future. If issues rooted in population growth,
such as land hunger and water shortages, are not addressed, they
could be equally disastrous. By analyzing what happened in Af-
rica, perhaps we can avoid a social catastrophe of similar dimen-
History offers few examples of leadership failure comparable to
that of Africa's in response to the HIV crisis. The HIV epidemicthat is raging across Africa is now taking some 6,030 lives eachday, the equivalent of 15 fully loaded jumbo jets crashing daily—with no survivors. This number, climbing higher each year, is ex-pected to double during this decade.13
Public attention has initially focused on the dramatic rise in adult
mortality and the precipitous drop in life expectancy. But we neednow to look at the longer-term economic consequences—fallingfood production, deteriorating health care, and disintegrating edu-cational systems. Effectively dealing with this epidemic and the heavyloss of adults will make the rebuilding of Europe after World WarII seem like child's play by comparison.
While industrial countries have held the HIV infection rate
among adults to less than 1 percent, in 16 African countries thefigure is over 10 percent. In South Africa, it is 20 percent. In Zim-babwe and Swaziland, 25 percent. And in Botswana, which hasthe highest infection rate, 36 percent of adults are HIV-positive.
These countries are expected to lose one fifth to one third of theiradults by the end of this decade.14
Attention is focusing on the high cost of treating those already
ill, but the virus is continuing to spread. As deaths multiply, lifeexpectancy—the sentinel indicator of economic development—isfalling. Without AIDS, countries with high infection rates, likeBotswana, South Africa, and Zimbabwe, would have a life expect-ancy of some 65 years or more. With the virus continuing to spread,life expectancy could drop to 35 years—a medieval life span.15
Whereas infectious diseases typically take their heaviest toll
among the eldest and the very young who have weaker immunesystems, AIDS claims mostly young adults, depriving countries oftheir most productive workers. In the epidemic's early stages, thevirus typically spreads most rapidly among the better educated,more socially mobile segment of society. It claims the agronomists,engineers, and teachers needed for economic development.
The HIV epidemic is affecting every segment of society, every
sector of the economy, and every facet of life. For example, close tohalf of Zimbabwe's health care budget is used to treat AIDS pa-tients. In some hospitals in Burundi and South Africa, AIDS pa-tients occupy 60 percent of the beds. Health care workers laboruntil the point of exhaustion. This epidemic could easily produce40 million orphans by 2010, a number that will overwhelm theresources of extended families.16
Education is also suffering. In Zambia, the number of teachers
dying with AIDS each year approaches the number of new teach-ers being trained. In the Central African Republic, the reduction ofthe teaching force by AIDS closed 107 primary schools, leavingonly 66 open. At the college level, the damage is equally devastat-ing. At the University of Durban-Westville in South Africa, 25 per-cent of the student body is HIV-positive.17
In addition to the continuing handicaps of a lack of infrastruc-
ture and trained personnel, Africa must now contend with the ad-verse economic effects of the epidemic. AIDS dramatically increasesthe dependency ratio—the number of young and elderly who de-pend on productive adults. This in turn makes it much more diffi-cult for a society to save. Reduced savings means reduced invest-ment and slower economic growth or even decline.
At the corporate level, firms in countries with high infection
rates are seeing their employee health care insurance costs double,triple, or even quadruple. Companies that were until recently com-fortably in the black now find themselves in the red. Under thesecircumstances, investment inflows from abroad are dwindling and
Stabilizing Population by Reducing Fertility
could dry up entirely.18
Even as disease consumes Africa, food security is deteriorating.
Land hunger, water scarcity, and nutrient depletion are reducingthe grain produced per person. In East, Central, and Southern Af-rica, the undernourished share of the population has increased overthe last two decades.19
Making matters worse, food security is declining as the epidemic
progresses. At the family level, food supplies drop precipitouslywhen the first adult develops full-blown AIDS. This deprives thefamily not only of a worker in the fields, but also of the work timeof the adult caring for the AIDS sufferer. A survey in Tanzaniafound that a woman whose husband had AIDS spent 60 percentless time tending the crops. Declines in food production from theepidemic have been reported in Burkina Faso, Côte d'Ivoire, andZimbabwe. In pastoral economies, such as Namibia, the loss ofthe male head of household is often followed by the loss of cattle,the family's livelihood.20
Sub-Saharan Africa, a region of 600 million people, is moving
into uncharted territory. There are historical precedents for epi-demics on this scale, but not for such a concentrated loss of adults.
The good news is that some countries are halting the spread of thevirus. The key is strong leadership from the top. In Uganda, wherethe epidemic first took root, the active personal leadership of Presi-dent Yoweri Museveni over the last dozen years has reduced theshare of adults infected with the virus from a peak of 14 percentdown to 8 percent. In effect, the number of new infections hasdropped well below the number of deaths from AIDS. Senegal alsoresponded early to the threat from the virus. As a result, it pre-vented AIDS from gaining momentum and held the infection rateto 2 percent of its adults, a number only slightly higher than inindustrial countries.21
Saving Africa depends on a Marshall Plan–scale effort on two
fronts: one to curb the spread of HIV and the other to restore eco-nomic progress. Winning the former depends directly on Africa'snational political leaders. Unless they personally lead, the effortwill almost certainly fail. Once a leader outlines the behavioralchanges needed to contain the virus—such as delaying first inter-course, reducing the number of sexual partners, and usingcondoms—then others can contribute. This includes the medicalestablishment within the country, religious leaders, nongovernmen-
tal groups, and international health and family planning agencies.
To compensate for the "missing generation," countries will need
assistance across the board in education. This is an area where theU.S. Peace Corps and its equivalents in other countries can play acentral role, particularly in supplying the teachers needed to keepschools open. Social workers are needed to work with orphans. Aprogram of financial assistance is necessary for the extended fami-lies trying to absorb the projected millions of orphans.
Given the high cost of doing business in an AIDS-ridden soci-
ety, special incentives in the form of tax relief are needed to attractcorporate investors, incentives that could be underwritten by inter-national development agencies. And debt relief is essential to therebuilding of sub-Saharan Africa.
The bottom line is that there is no precedent in international
development for the challenge the world now faces in Africa. Thequestion is not whether we can respond to this challenge. We can.
We have the resources to do so. If we fail to respond to Africa'spain, we may not only witness the economic decline of an entirecontinent, but in the process we will forfeit the right to call our-selves a civilized society.
Filling the Family Planning Gap
Given the immediate need to slow world population growth, it
would be easy to assume that couples everywhere by now have
access to family planning services. Unfortunately, despite the piv-
otal influence of family planning services on the global future, there
is still a huge gap between people who want to plan their families
and their access to family planning services.
The first step in stabilizing population is to remove the physical
and social barriers that prevent women from using family plan-ning services. John Bongaarts of the Population Council reportsthat 42 percent of all pregnancies in the developing world are un-intended. Of these, 23 percent end in abortion. This leads Bongaartsto conclude that one third of projected world population growthwill be due to unintended pregnancies. Of all the unmet social needsin the world today, none is more likely to adversely affect the hu-man prospect more than the unmet need for family planning.22
There are several reasons why couples are not planning their
families despite their desire for fewer children. In many countries,such as Saudi Arabia and Argentina, government policies restrict
Stabilizing Population by Reducing Fertility
access to contraceptives. Geographic accessibility also affects use;in some rural areas of sub-Saharan Africa, it can take two hours ormore to reach the nearest contraceptive provider. For those withlow incomes, family planning services can be expensive. Even wherefamily planning clinics are accessible, they are often underfunded,leaving them short of supplies and understaffed.23
Women who want fewer children may also be constrained from
using family planning by a lack of knowledge, prevailing culturaland religious values, or the disapproval of family members. Studieshave shown that a husband's opposition to family planning con-strains the efforts to limit family size in numerous countries, in-cluding Egypt, Guatemala, India, Nepal, and Pakistan. Moreover,some 14 countries require a woman to obtain her husband's con-sent before she can receive any contraceptive services, while 60 re-quire spousal authorization for permanent birth control methods.
Although it has been argued that these practices lessen conflictsbetween spouses and health care personnel, they are serious im-pediments to a woman's ability to control her fertility.24
One way of reducing the unplanned pregnancies that account
for a large share of world population growth is through medicalabortions. A prescription drug used for many years in France toinduce abortion, RU 486 (also known as mifepristone), is nowavailable in several other European countries, the United States,China, India, Pakistan, and several smaller countries in Asia. An-other drug, methotrexate, used worldwide in cancer therapy, workswell as a "morning after" pill when used in combination withmisoprostol. This procedure, prescribed by many U.S. doctors be-fore RU 486 was approved in 2000, typically induces abortionwithin 72 hours. Although medical abortions are widely used inindustrial countries, such as France and the United States, they areof even greater value in developing countries, where many peopledo not have access to family planning services and, even if they do,where supplies of contraceptives sometimes run out.25
Information about contraceptives and family planning for young
men and women facilitates the use of birth control. In Thailand,people of all ages have been educated on the importance of familyplanning. Mechai Viravidaiya, the charismatic founder of the ThaiPopulation and Community Development Association (PCDA),encouraged familiarity with contraceptives through demonstrations,ads, and witty songs. Math teachers even use population-related
examples in their classes. As a result of the efforts of Mechai, thePCDA, and the government, the growth of Thailand's populationhas slowed from more than 3 percent in 1960 to approximately 1percent in 2000—the same as that of the United States.26
More recently, Iran has emerged as a leader in population policy.
After the Islamic revolution in 1979, when Ayatollah Khomeinicame to power, the family planning programs put in place by theShah were dismantled. Khomeini exhorted women to have morebabies to create "soldiers for Islam," pushing annual populationgrowth rates to over 4 percent—some of the highest ever recorded.
By the late 1980s, the social and environmental costs of such growthrates were becoming apparent. As a result, policy shifted. Religiousleaders argued that having fewer children was a social responsibil-ity. Eighty percent of family planning costs were covered in thebudget. Some 15,000 "health houses" were established to providefamily planning and health services to Iran's rural population. Asliteracy levels among rural women climbed from 17 percent in 1976to nearly 90 percent, fertility dropped to an average of 2.6 childrenper woman. Within 15 years, Iran's population growth rate hasfallen from over 4 percent a year to scarcely 1 percent, making it amodel for other developing countries.27
A comparison of population trends in Bangladesh and Pakistan
illustrates the importance of acting now. When Bangladesh wascreated in a split with Pakistan in 1971, the former had 66 millionpeople and the latter 62 million, roughly the same population sizes.
Then their demographic trends diverged. Bangladesh's political lead-ers made a strong commitment to reduce fertility rates, while theleaders in Islamabad wavered over the need to do so. As a result,the average number of children per family in Bangladesh today is3.3, compared with 5.6 in Pakistan. Each year the gap in the popu-lation trajectories of the two countries widens. By putting familyplanning programs in place sooner rather than later, Bangladesh—the poorer country—is projected to have 79 million fewer peoplethan Pakistan in 2050. (See Figure 10–2.)28
The world now faces a similar choice. The United Nations
projects that the number of people on the earth could reach any-where from 7.9 billion to 10.9 billion by 2050. According to itslatest medium-level projections, population in the developing worldis projected to rise from 4.9 billion in 2000 to 8.1 billion in 2050.
Such an increase would likely lead to organizational overload and
Stabilizing Population by Reducing Fertility
ecosystem collapse in dozens of countries.
Heading off such a prospect depends on filling the family plan-
ning gap by ensuring that women everywhere have access to a fullcomplement of family planning services, including the "morningafter" pill. The second front in this worldwide effort to stabilizepopulation is to help create the social conditions that will lead tosmaller families, specifically by improving the status of women.
George Moffett, author of Critical Masses, observes quite rightlythat "There's a critical connection between a woman's productiverole—the improved legal, educational, and economic opportuni-ties that are the source of empowerment—and a woman's repro-ductive role."29
In some developing countries, having many children is seen as a
matter of survival: children are a vital part of the family economyand a source of security in old age. Institutions such as the GrameenBank in Bangladesh, which specializes in microenterprise loans,are attempting to change this situation by providing credit to wellover a million villagers—mostly impoverished women. These loansare empowering women, helping to end the cycle of poverty, andthus reducing the need for large families.30
Rapid economic growth is not always a prerequisite for reduced
fertility rates. Bangladesh has reduced fertility rates from nearly 7children per woman in the early 1970s to 3.3 children today de-
spite incomes averaging only $200 a year, among the lowest in theworld. In the struggle to slow population growth, government lead-ership, access to family planning services, and improvement in so-cial conditions are proving to be more important than the growthof a nation's economy.31
Slowly, governments are realizing the value of investing in popu-
lation stabilization. One study found that the government ofBangladesh spends $62 to prevent a birth, but saves $615 on so-cial services expenditures for each birth averted—a 10-fold differ-ence in cost. Based on the study's estimate, the program prevents890,000 births annually. The net savings to the government total$547 million each year, leaving more to invest in education andhealth care.32
At the 1994 International Conference on Population and De-
velopment in Cairo, the governments of the world agreed to a 20-year population and reproductive health program. The UnitedNations estimated that $17 billion a year would be needed for thiseffort by 2000 and $22 billion by 2015. (By comparison, $22 bil-lion is less than is spent every 10 days on military expenditures.)Developing countries and countries in transition agreed to covertwo thirds of the price tag, while donor countries promised to paythe rest—$5.7 billion a year by 2000 and $7.2 billion by 2015.33
Unfortunately, while developing countries are largely on track
with their part of the expenditures, having covered about two thirdsof their allotted payments, donor countries have fallen far behind—honoring only one third of their commitment. As a result of short-falls following the Cairo conference, the United Nations estimatedthat there were an additional 122 million unintended pregnanciesby 2000. An estimated one third of these were aborted. Moreover,an estimated 65,000 women who did not wish to be pregnant diedin childbirth and 844,000 suffered chronic or permanent injuryfrom their pregnancies.34
Slowing population growth depends on simultaneously creat-
ing the social conditions for fertility decline and filling the familyplanning gap. "Global population problems cannot be put on holdwhile countries reform their health care, rebuild their inner cities,and reduce budget deficit[s]. Avoiding another world populationdoubling.requires rapid action," notes Sharon Camp, former vicepresident of Population Action International. The difference be-tween acting today and putting it off until tomorrow is the differ-
Stabilizing Population by Reducing Fertility
ence between population stabilizing at a level the earth can sup-port and population expanding until environmental deteriorationdisrupts economic progress.35
The Role of Female Education
Over the last two decades, scores of studies have analyzed the rela-
tionship between female education and fertility and have concluded
that the more education women have, the fewer children they bear.
A 1999 survey of research by the U.S. National Academy of Sci-
ences (NAS) analyzes studies that compare countries with varying
levels of female education and studies that examine changing levels
of female education in individual countries over time. Both groups
of studies support this basic hypothesis.36
The NAS study contrasts Sri Lanka and Pakistan, for example.
Sri Lanka, which has a female literacy level of 87 percent for womenover age 15, has a total fertility rate of just over two children perwoman. In Pakistan, where only 24 percent of adult women canread and write, the fertility rate is 5.6 children. Pakistan is typicalof most countries, but there are occasional exceptions. For example,in Jordan 86 percent of the women are literate, but the fertility rateis the same as in Pakistan. Bangladesh is also something of ananomaly, because although only 26 percent of its women are liter-ate, its fertility rate has dropped by half over the last generation.37
As the NAS survey notes, the relationship between educational
level and fertility is not always a simple one. For example, whilerising female educational levels lead to smaller family size, so doesthe desire to educate children. Once couples decide that they wantto educate their children, including girls, they are faced with thecost of education. This in itself is apparently reducing family size.38
In Bangladesh, as noted earlier, the fertility rate was almost cut
in half within 16 years. One factor apparently affecting family sizewas spreading land poverty as land was divided and subdividedfrom one generation to the next. Among families with relativelysmall plots of land to begin with, fragmentation leads to basicchanges in thinking. At one time, economic security came fromowning land. It was always a source of employment and food. Butas the land per family shrinks, this security diminishes, leading manycouples to define economic security for their children, and thusindirectly for themselves, in the form of a wage-paying job. Get-ting such a job requires education. This is costly, leading to a con-
scious reduction in family size that is not necessarily dependent onany gains in income or female literacy.39
Research in Bangladesh shows that thinking about family size
is not occurring in a vacuum. As people are exposed to higher liv-ing standards elsewhere in the world, they begin to think abouthow to achieve the same thing for their children. Again, they comeback to education. Investment in education is the key both to abetter life for their children and to their old age security. Largefamilies, which were an asset when there was more land to farm,have now become a liability.
While sociologists have looked at the relation between educa-
tion and family size, economists have looked at the economics ofthis relationship. Lawrence Summers, while Director of Researchat the World Bank, pointed out that at prevailing levels of educa-tion, each additional year of female education reduces fertility byroughly 10 percent. Using this information to analyze the econom-ics of educating girls, he noted that raising female enrollment inprimary school to the same level as that of males in developingcountries would mean adding some 25 million girls to the currentprimary school enrollment. This, he estimated, would cost $938million per year. Gender balancing in secondary schools would meanadding 21 million girls to current enrollment at a cost of roughly$1.4 billion per year.40
Summers then went on to estimate that this investment of $2.3
billion would yield a return of 20 percent annually. He noted thatit was the most effective way of breaking the cycle of poverty. Asfemale education levels rise, women have healthier, better-educatedchildren, a gain that is typically passed from one generation to thenext. The difficult part is the initial break out of poverty.41
This 20-percent annual return dwarfs that of almost any other
investment in development. For example, the roughly $1 trillionthat developing countries were planning to spend on new powergenerating facilities over the next decade would yield an annualreturn of at most 6 percent, and sometimes substantially less. Di-verting a small amount of investment from power generation tothe education of girls and young women could both raise familiesout of poverty and accelerate development.42
Stabilizing Population by Reducing Fertility
Using Soap Operas and Sitcoms
While the attention of researchers has focused on the role of for-
mal education in reducing fertility, soap operas on radio and tele-
vision can even more quickly change people's attitudes about re-
productive health, gender equity, family size, and environmental
protection. A well-written soap opera can have a profound short-
term effect on population growth. It costs little and can proceed
even while formal educational systems are being expanded.
This approach was pioneered by Miguel Sabido, a vice presi-
dent of Televisa, Mexico's national television network. The powerof this medium was first illustrated by Sabido when he did a seriesof soap opera segments on illiteracy. The day after one of the char-acters in his soap opera visited a literacy office wanting to learnhow to read and write, a quarter-million people showed up at theseoffices in Mexico City. Eventually 840,000 Mexicans enrolled inliteracy courses after watching the series.43
Sabido dealt with contraception in a soap opera entitled
Acompaneme, which translates as Come With Me. According toone observer, "This serial, which ran over two years, featured afairly typical, poor young family. The mother, a sympathetic butignorant character, was desperate to stop at the three children shealready had but didn't know how. Her husband, macho and lusty,resented her efforts to try the rhythm method. Over a period oftime, and many melodramatic arguments and tears, the womandecided to seek the advice of another woman she knew who had‘miraculously' restricted her family size. Eventually she learnedabout birth control. By the time she and her smiling husband walkedout of the gynecologist's office with a prescription in hand, valueshad changed—in this family and among viewers—about ideal familysize, about not having more children than one can afford and aboutthe woman's role in her family."44
As these family planning soap operas continued over the next
decade, the birth rate fell by 34 percent. In 1986, Mexico wasawarded the United Nations Population Prize for its outstandingachievement in slowing population growth. David Poindexter,founder of Population Communications International (PCI) in1985, used his new organization to promote Sabido's model as aprototype for other countries. Today PCI is operating in 6 of the10 most populous countries—China, India, Brazil, Pakistan, Nige-ria, and Mexico.45
In Kenya, PCI has developed a similarly oriented soap opera
that has aired on the radio, the medium of choice for 96 percent ofthe country's people. After the highly popular early evening news,people stay tuned for a radio serial entitled Ushikwapo Shikamana(which means If Assisted, Assist Yourself). With close to half thecountry's people following the twice weekly program, this has pro-vided an ideal vehicle for communicating information on a rangeof topics from reproductive health and family planning to environ-ment, gender equality, and protection from AIDS. These examplesare but two of many that illustrate the success of radio and televi-sion in raising public understanding and in changing attitudes.46
Stopping at Two
You do not need to be a mathematician to understand that there is
no long-term alternative to having only two children per couple,
the number needed for replacement. Joel Cohen, population ana-
lyst at Rockefeller University, makes this point rather effectively.
He notes that if the 1990 population growth rates in various re-
gions had continued until 2150, there would be 694 billion people
in the world. This compares with 6.1 billion people today. "No
way," says Cohen. "Not enough water falls from the sky to satisfy
the needs of such a vast human population."47
The basic arithmetic is not new. We have always known that a
seemingly innocuous growth of 3 percent a year, a rate that hasbeen common in many developing countries, would lead to a 20-fold increase in one century and a 400-fold increase in two centu-ries. Saudi Arabia today has 20 million people and a populationthat is expanding at this rate. If this were to continue throughoutthis century, it would have 440 million people in 2100—more thanthe current population of North America.
Or look at Nigeria, also growing at roughly 3 percent a year. A
century from now, Nigeria's 114 million people would total 2.46billion. Considering that all of Africa is supporting 800 milliontoday, it is impossible to visualize 2.46 billion people in Nigeriaalone. It is hard to argue with Cohen's basic point that the onlyviable long-term option is two children per couple. A populationthat is growing, however slowly, will eventually overwhelm its life-support systems. Conversely, a population that is declining, how-ever slowly, will eventually disappear.
The growth in world population over the last half-century is
Stabilizing Population by Reducing Fertility
sufficiently recent that we are still struggling to understand what itmeans. We may intuitively understand that a 20-fold increase in acentury is not possible, but we have yet to come to terms with thereasons why. For some threats to our future we have designed re-sponse systems. For example, an outbreak of a deadly infectiousdisease such as the Ebola virus sets off programmed responses tocontain and eradicate it. This response involves the World HealthOrganization, the U.S. Centers for Disease Control and Preven-tion, and the appropriate agencies in the government of the countyaffected. And if the currency of a country like Indonesia or Russiacollapses, the international monetary system is programmed to re-spond to that threat. Such is not the case when population growthcrosses key support system thresholds.
When the water use of a growing population surpasses the sus-
tainable yield of an aquifer and the water table starts to fall, thereis no alarm system that triggers a response in the councils of gov-ernment. As a result, the gap between the demand for water andthe sustainable yield of the aquifer widens. Each year, the drop inthe aquifer is greater than the year before, setting the stage for aneventual dramatic reduction in the water supply as an aquifer isdepleted and the amount pumped out is reduced to the rechargelevel. If overpumping is extensive, the drop in water supply couldbe traumatic, disrupting food production.
Unfortunately, no one regularly measures the water table level
under the North China Plain, the Punjab in India, or the southernGreat Plains of the United States, announcing when overpumpingbegins, how much water is left, and when the aquifer will be de-pleted. As a result, instead of societies planning for a soft landingby bringing the demand for water into balance with sustainableyield, they keep going until the inevitable crash occurs.
Societies with water demands surpassing the sustainable yield
of the aquifers and desiring more water per person in the futurewill have to consider the possibility of reducing population size, atrend already under way in some European countries. This meansshifting not to a two-child family, but to a one-child family.
In countries where rural populations continue to grow and hold-
ings are divided among the children in each generation, the landper family eventually shrinks to the point where survival is threat-ened. Halting the fragmentation that is creating a nightmarish situ-ation in many rural communities in Africa and Asia depends either
on moving quickly to replacement-level fertility or accepting mas-sive rural-urban migration.
Although population projections for the world have been avail-
able since the 1950s, remarkably little has been done to analyzethe relationship between the size of current and future populationsand the earth's capacity to satisfy people's needs for basic resources,such as water and cropland. Demographers who do the projec-tions have long since abandoned this area as a field of research. Inhis 1996 book How Many People Can the Earth Support?, JoelCohen analyzed the 1992 and 1993 annual meetings of the Popu-lation Association of America, where there were some 200 sympo-sia. Not one of these panels attempted to analyze the relationshipbetween projected population growth and the earth's natural re-source base.48
The good news is that the world is making progress in achiev-
ing replacement-level fertility. Fifty-four countries have now reducedaverage family size to two children or less. (See Table 10–1.) To-gether these countries contain 2.5 billion people. Family size inChina, at 1.8 children per couple, is now below the level in theUnited States (2.1). Even so, the large number of young peoplereaching reproductive age in China means that the population isstill expected to reach 1.49 billion by 2038, before its numbersbegin to decline, dropping to 1.46 billion in 2050. Some countrieshave seen fertility drop well below replacement level. For example,Russia's fertility rate is 1.2 children. As a result of this decline, anda rise in mortality over the last decade, Russia's population of 144million is now declining by 900,000 per year. Other countries wherepopulation is beginning to decline include Bulgaria, the Czech Re-public, Italy, and the Ukraine.49
Despite these trends, the threat of continuing population growth
in more than a hundred developing countries is all too real. Per-haps the most dangerous educational gap is the lack of understand-ing of the relationship between family size, the longer-term popu-lation trajectory, and the future availability of resources per person.
Filling this gap requires projections that link a range of family sizes—say, two, four, or six children—to the future availability of land,water, and other basic resources. Without this information, indi-viduals may simply not understand the urgency of shifting to smallerfamilies. And of even more concern, political leaders will not beable to make responsible decisions on population and related poli-
Stabilizing Population by Reducing Fertility
Table 10–1. Fertility Levels in Selected Countries in 2001
Countries with Fertility at
or Below Replacement Level Russia
Countries with Fertility
Above Replacement Level Brazil
Dem. Rep. of Congo
1The average number of children born to a woman in her lifetime is also known as the Total Fertility Rate. 2Replacement-level fertility is an average of 2.1 children per woman.
Source: Population Reference Bureau, 2001 World Population Data Sheet, wall chart (Washington, DC: 2001).
cies, such as investment in family planning services.
Discussions of future population growth in this chapter use the
U.N. medium projections, those that have world population goingfrom 6.1 billion at present to 9.3 billion by 2050. There is also ahigh projection, which has human numbers approaching 11 bil-
lion by 2050, and a low projection, which has population peakingat 7.9 billion in 2046 and then declining. (See Figure 10–3.)50
This low number assumes that the entire world will quickly
move below replacement-level fertility to 1.7 children per couple.
This is not only achievable, it is the only humane population op-tion. Otherwise the land and water scarcity that is already increas-ing hunger and deaths in some countries could spread to manymore.
Achieving this lower figure is the responsibility of national po-
litical leaders, but unless world leaders—the Secretary-General ofthe United Nations, the President of the World Bank, and the Presi-dent of the United States—urge governments and couples every-where to adopt a goal of two surviving children per couple, re-source constraints will likely lead to economic decline. The issuetoday is not whether individual couples can afford more than twochildren, but whether the earth can afford for couples to have morethan two children.
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