PHM-Exch> An End to Population Growth: Why Family Planning Is Key to a Sustainable Future

[Claudio Schuftan]

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An End to Population Growth: Why Family Planning Is Key to a Sustainable
Future

By Robert Engelman<http://r20.rs6.net/tn.jsp?llr=aajwdndab&et=1105827551725&s=1746&e=001sIREPsYDQjBO6xr10sVIGWXSVBHKssMl1rsNk2E3k3rmkpnTfXCchAQjh7_J0Ad-8izeJbt0um6Q1IAYQMH1_NMvCCpafe96t_npJm6UvnYc9fzY5hWcvmyuEdEKH4FXl37qjI4PHnbHnfUr8q33hw==>,
Vice president for programs at the Worldwatch Institute



*In Brief*

The widespread assumption that world population, now at 6.9 billion, will
inevitably grow to 9 billion by midcentury is wrong. Population could peak
before then and at a lower level, ameliorating environmental risks
associated with climate change, water scarcity, biodiversity loss, and food
and energy insecurity.

The equally widespread belief that an earlier, lower population peak would
require coercive "population control" is also incorrect. Population growth
rates and average family size worldwide have fallen by roughly half over the
past four decades, as modern contraception has become more accessible and
popular. The average number of children born to each woman worldwide is not
much higher than replacement fertility, an average that would eventually end
population growth. Yet more than 40 percent of all pregnancies are
unintended, with higher proportions in developed than in developing
countries.

As these figures suggest, it might be possible to end and then reverse human
population growth through a strategy aimed at elevating women's status and
increasing access to contraceptive services, so that essentially all births
result from intended pregnancies. Preliminary calculations based on
conservative assumptions suggest that global fertility would immediately
move slightly below replacement levels, putting world population on a path
toward an early peak followed by gradual decline. The success of such a
strategy would have many other benefits, such as reducing disability and
deaths among mothers and their children and freeing more women to earn money
and participate actively in social affairs.

There are many barriers to a global movement to assure that almost all
births result from intended pregnancies. Foremost among them are the views
of certain religious and political leaders and economic thinkers. Better
public understanding of the benefits of universal intended childbearing is
needed to counteract these obstacles and bring such a vision closer to
reality.



*Key Concepts *

Even though most women of reproductive age now use contraception, we are far
from a world in which all births result from intended pregnancies. Based on
survey data, approximately 40 percent of pregnancies are unintended in
developing countries, and 47 percent in developed ones.



More than one in five births worldwide result from pregnancies women did not
wish to occur.



An estimated 215 million women in developing countries have an unmet need
for family planning: they are sexually active, don't want to become
pregnant, and yet for various reasons-including lack of access-are not using
contraception.



If all births resulted from women actively intending to conceive, fertility
would immediately fall slightly below the replacement level; world
population would peak within a few decades and subsequently decline.



Assuring that all women are fully in control of the timing and frequency of
childbearing is not expensive. Religious, cultural, and political opposition
to contraception or the possibility of population decline is the key
obstacle to such assurance. More research and a public better educated about
sexuality and reproduction could engender a global social movement that
would make possible a world of intended pregnancies and births.



Those who ponder humanity's future in the twenty-first century generally
take at face value demographic projections suggesting that the world
population will reach something like 9 billion around 2050 and will then
stabilize at about that level.1 The widespread belief that this 30 percent
increase from today's 6.9 billion people is inevitable undermines
consideration of the role of population size in climate change, water
scarcity, biodiversity loss, rising energy prices, and food security.
Contributing to this is the related view that efforts to prevent population
growth would require coercive government policies that constrain couples
from having the children and the family sizes they want. While some analysts
are confident that the world can feed, house, and otherwise support 9
billion or more people, others are less certain, and voices of caution about
population growth are heard more often than in the past.2 A logical
application of the precautionary principle in the face of current
environmental problems would suggest that humanity could more easily
accomplish these feats in an environmentally sustainable manner with a
smaller population.



In a joint statement in 1993, representatives of 58 national scientific
academies stressed the complexities of the population-environment
relationship but nonetheless concluded, "As human numbers increase, the
potential for irreversible changes of far-reaching magnitude also increases.
... In our judgment, humanity's ability to deal successfully with its
social, economic, and environmental problems will require the achievement of
zero population growth within the lifetime of our children."3 In 2005, the
United Nations' Millennium Ecosystem Assessment identified population growth
as a principal indirect driver of environmental change, along with economic
growth and technological evolution.4



In October 2010, a group of US and European climate and demographic
researchers published findings from an integrated assessment model
calculating the impact of various population scenarios on fossil-fuel carbon
dioxide emissions over the coming century. If world population peaked at
close to 8 billion rather than 9 billion, along the lines described in a
low-fertility demographic projection published by the UN Population
Division, the model predicted there would be a significant emissions
savings: about 5.1 billion tons of carbon dioxide by 2050 and 18.7 billion
tons by century's end.5



What if we could prove wrong the popular conviction that a future with 9
billion people and a growing population is inevitable? Suppose we could
demonstrate that world population size might peak earlier and at a lower
level if government policies aimed not at reproductive coercion but at
individual reproductive freedom? Suppose such policies aimed to help all
women and girls prevent unwanted pregnancies and conceive only when they
want to bear a child? This article presents new data on births resulting
from women's active intentions to become pregnant. The hypothesis it probes
may appear counterintuitive: if, starting at any moment, all pregnancies in
the world resulted from each woman's intent to give birth, human population
would immediately shift course away from growth toward decline within a few
decades.

* *

*An Ethical Basis for Action to Slow Population Growth*



What can societies that value democracy, self-determination, human rights,
personal autonomy, and privacy do to include demographic change among
strategies for environmental sustainability? An important answer may lie in
a relatively untested set of principles adopted by almost all the world's
nations at a 1994 UN conference held in Cairo. The third of three
once-a-decade governmental conferences on population and development, it
produced a program of action that abandoned the strategy of "population
control" by governments in favor of a focus on the health, rights, and
well-being of women.6 An operating assumption of this program is that when
women have access to the information and means that allow them to choose the
timing of pregnancy, the intervals between births lengthen, average family
size shrinks, and teen births become less frequent. All of these improve
maternal and child survival and slow population growth.7



Experts disagree on how reproductive autonomy compares with other strategies
in slowing that growth. Some assume economic growth is the most effective
means, although birthrates rose along with prosperity in many countries
after World War II and remain relatively high in several wealthy
oil-exporting nations in which women have fewer rights and lower status than
men.8 Moreover, some analysts argue that the arrow of causation operates
more in the other direction, with low fertility stoking economic growth.9



There is a more robust and demonstrable correlation between female
educational attainment and fertility. Worldwide, women with no schooling
have an average of 4.5 children, while those who have spent at least a year
or more in primary school have just three. Women who complete at least a
year or two of secondary school have 1.9 children-well below replacement
fertility rates. With one or two years of advanced education for women,
average childbearing rates fall even further, to 1.7.10 On this basis alone,
those interested in depressing population growth rates might want to focus
on improving women's educational attainment.



Questions remain about whether education alone can bring about declines in
fertility without other supporting conditions, especially easy, affordable
access to a range of contraceptive options. Similar uncertainties cloud
understanding of exactly how improved child survival and the empowerment of
women affect fertility. Improving both factors certainly contributes to
later births and smaller families and is valuable regardless of its
demographic impacts. But without clear data on the magnitude of these
influences, interventions related to schooling, child survival, and women's
empowerment are rarely seen as core aspects of governmental population
policy.



This brings us to family planning. Access to safe and reliable contraception
has exploded since the mid-twentieth century. An estimated 55 percent of all
heterosexually active women worldwide now use modern contraceptive methods,
while an additional seven percent use less reliable traditional
methods.11As the use of birth control has spread, fertility has
plummeted from a
global average of five children per woman in 1950 to barely more than 2.5
today.1



While not necessarily sufficient to depress fertility on a population-wide
basis, family planning is essential to the phenomenon. Women may begin
sexual activity later in life and may resort to abortion to terminate
unwanted pregnancies. But humanity's average family size could not have
plummeted simply because women had diplomas, contractual rights, or
confidence that their children would survive. To have small families,
heterosexually active women and their partners need safe and effective
contraception-modern birth control.



Lessons from history suggest that women have sought and employed
contraceptives since ancient times to avoid unwanted pregnancy when
circumstances were inauspicious for the 15 to 18 years of parental
commitment a new birth entails. Egyptian papyri that date back 4,000 years
describe pessaries, ancient precursors to the diaphragm, made of acacia oil
and crocodile dung.12 Literature from Asia to North America documents herbs
used for centuries as emmenagogues, substances that induce immediate
menstruation and hence expel recently fertilized eggs. In the Mediterranean,
in the ages of ancient Greece and Rome, a booming trade in the
contraceptive, or possibly abortifacient, silphium helped drive its source,
a wild giant fennel, into extinction. And an ecclesiastical court record
from 1319 preserves the personal account of a young widow in southwestern
France who provided details of her use of an herbal contraception during an
extended affair with a priest.13



We know, too, that women and their partners historically have moderated
their reproduction in response to their external environments, natural and
economic. (Until modern times, these were generally the same thing.) In
eighteenth- and nineteenth-century Sweden, for example, birthrates neatly
tracked the price of grain crops with a roughly nine-month delay.14 The
Japanese population during the eighteenth-century Tokugawa shogunate
declined during several decades of food scarcity-until a government
propaganda campaign against infanticide (the dominant method of family-size
control at the time) pushed fertility well above replacement levels in the
nineteenth century, restoring demographic growth.15



Similar responses of fertility to external circumstances are evident today.
The high cost of housing in Japan is prominent among the reasons offered by
young people for delaying marriage and childbearing.16 In the United States,
a two percent decline in the country's birthrate in 2008 was attributed
largely to the deterioration of the economy.17

* *

*Implications of Personal Fertility-Management Aspirations*

History and recent fertility phenomena thus suggest the likelihood that the
interest in safely and effectively managing the timing of pregnancy and
childbirth may be nearly universal among women. Lack of education,
affluence, and equality may simply be barriers-along with others related to
patriarchal, pronatalist, and even medical cultural norms-to existing
aspirations to avoid unwanted pregnancies.18



Data exist for the likely demographic impact of establishing conditions
worldwide that would facilitate women's choices about the timing of
pregnancy. According to the Guttmacher Institute, a US reproductive
health-care research organization, an estimated 215 million women in
developing countries have an "unmet need for family planning."19 This
applies to women who are sexually active and express the desire to avoid
pregnancy yet are not using contraception. Estimates of their number derive
from demographic and health surveys conducted in certain developing
countries every few years.20 Many women in developed countries may be in the
same circumstances, but data are insufficient in most cases to suggest their
numbers.



In early 2010, researchers with the Futures Group in Washington, DC,
estimated the demographic impact of meeting unmet family-planning demand in
99 developing countries and one developed one. The researchers excluded
China, on the assumption that government population policies aimed at
limiting most families to a single child rule out births from unintended
pregnancies. And they supplemented their country list with the United
States, the world's most populous developed county and one for which there
is some data suggesting the magnitude of unmet need.21 Using accepted models
for the impact of rising contraceptive prevalence on birthrates, the
researchers concluded that satisfying unmet need for contraception in these
100 countries-with a cumulative 2005 population of 4.3 billion-would produce
a population of 6.3 billion in 2050. Under the United Nations' medium
projection, the countries' population would be 400 million higher, at 6.7
billion. Average global fertility at midcentury would be 1.65 children per
woman, well below the population replacement fertility level-and would
continue to fall.



This conclusion, if backed up by further research, is momentous. By
implication, simply providing safe and effective contraceptive options to
all sexually active women who do not want to become pregnant would end and
then reverse world population growth. The effect is independent of any
further fertility reductions that might occur as a result of greater
educational attainment for women, improved child survival, women's
empowerment, and general economic advancement.



To some experts the idea that simply facilitating women's childbearing
intentions would end population growth, without significant demand creation
for family planning through cultural shifts and other means, goes against
survey findings from many African and some Asian countries. These findings
suggest that in parts of these continents women's average desired family
size is as high as six or seven children.20 Wouldn't facilitating
*these*women's childbearing intentions undermine any hope of ending
world
population growth? Not necessarily. For one thing, women expressing such
high desired family sizes are at most a relatively small proportion of the
world's population (albeit significant in Africa's). But the more important
point is that a high desired family size can easily coexist with high levels
of unintended pregnancy that, if prevented, would result in significantly
lower birthrates than if not prevented.



The reason for this is not hard to understand: women's individual
reproductive decisions arrive at their desired family size, if at all, only
cumulatively. Decisions about the desirability of pregnancy are made singly,
in individual acts of sexual intercourse in which conception is possible.
Whatever one's hopes for an eventual number of children, pregnancy decisions
occur in the context of current personal, economic, and social
circumstances. Desired family size can be compared to house size and the
number of cars owned. We may wish to have a large house and many cars, but
our circumstances may not allow for us to have either without endangering
our finances and well-being. We decide moment by moment whether working
toward that goal makes sense for us. So it is with reproductive intentions;
every step of a woman and her partner's reproductive lives is governed by
their immediate circumstances.



It seems likely that even in countries where women respond in health surveys
that they desire six or seven children, they would end up with fewer,
possibly many fewer, if at each step of their reproductive lives they were
able to choose precisely when to become pregnant. In some developed
countries with low fertility, women express a desire to have two children
yet have closer to one on average. With the right partner, the right job,
the right apartment, and the right economic and social-support systems, a
woman in Japan, for example, might have the two children she desires. But
with options to prevent or terminate pregnancies, many Japanese women have
one child or none; the national average is 1.3.16



All of this suggests the value of developing and testing the hypothesis that
meeting the needs of women and their partners for personal control of
pregnancy could lead to the end of population growth. Physician and
reproductive specialist Malcolm Potts has found that in all countries where
women can choose from a range of contraceptive options, backed by access to
safe and legal abortion services, total fertility rates are at or below
replacement fertility levels.22



If these findings can be borne out consistently by additional research,
those who worry about the impact of global population growth on
environmental and social sustainability might usefully advocate for
worldwide universal access to family-planning services. The need for such
access is enshrined in the second target of the fifth UN Millennium
Development Goal, which calls for developing countries to "achieve, by 2015,
universal access to reproductive health."23 This concept embraces more than
family planning, including a holistic state of sexual and reproductive
well-being that encompasses maternal and child health, prevention of AIDS
and other sexually transmitted infections, access to safe abortion services
(where these are legal), and post-abortion care.



*A Thought Experiment with Data*

The Futures Group study has not yet gained the widespread attention its
findings merit. Among the reasons for this may be that the concept of "unmet
need" for contraception is not widely understood among the public, news
media, and policymakers. Moreover, because of lack of data the study
excluded not only China, with a fifth of the world's population, but dozens
of other developing countries-and all the world's industrialized countries
other than the United States.



Newly available data on unintended pregnancy in many countries, assembled by
the Guttmacher Institute, support an alternative research approach to the
question of the demographic impacts of births that result from pregnancies
women never sought or wanted to have. These data, based on a range of
surveys worldwide, provide the basis for beginning to answer an intriguing
and valuable question: What would happen to world population growth if every
pregnancy worldwide, starting tomorrow, were the outcome of a woman's active
intention to become pregnant and bear and help raise a child? If no
pregnancies were unintended, in other words, how many births would there be
compared to current births, and how would this new birthrate affect the
future of human population?



Averaged over the 73 countries for which data exist, and comprising 83
percent of the world's births, just under ten percent of births result from
pregnancies occurring among women who never wanted to have another child.
Even under the most conservative scenario-extrapolated globally, with all
births from pregnancies that are merely mistimed considered equivalent to
births from intended pregnancies-a hypothetical world population in which
women only become pregnant when they want to would reduce today's global
total fertility rate to 2.29 births per woman. That figure is slightly below
today's global replacement fertility rate-placing world population on a
direct path toward future decline, albeit at a very slow pace given
population momentum (and assuming neither future fertility decline nor
improvement in mortality among young people). Under the less conservative
assumption that one-quarter of births from mistimed pregnancies are
equivalent to unwanted pregnancies, the total fertility rate sinks lower, to
2.22 births per woman-resulting in a somewhat faster track toward a human
population peak, even with no future fertility decline. These calculations
are, at best, first-order analyses of the impact on world population growth
of an idealized scenario in which all births are the outcomes from intended
pregnancies. As noted, they do not take into account the possibility that
global fertility would continue its decline once all births resulted from
intended pregnancies. More survey research and data on pregnancy intention
among individual women in all countries would be needed to make a more
robust determination of demographic impacts.



But the essence of research on this question remains hopeful-and little
known: a successful global effort that assured all women the capacity to
decide for themselves whether and when to become pregnant would also place
world population on a path toward a reasonably imminent peak followed by
slow demographic decrease. Additional efforts to see that women have the
educational, economic, legal, and political opportunities they deserve would
accelerate this transition.
  Toward a World of Intended Pregnancies and Wanted Children

Given the feasibility of such a transition, why isn't it happening today?
Why aren't higher proportions of births the result of intended pregnancies?
And what might we do to overcome the obstacles and actually bring that world
about?



Popular as it is with women and couples, contraception remains a deeply
sensitive issue for much of the public. Vehemently opposed by the Catholic
Church and regarded with suspicion by many other Christian, Islamic, and
even some Jewish religious leaders, open advocacy for contraceptive
availability and use inevitably risks stoking religious opposition.
Influence of the Catholic Church hierarchy has blocked efforts in the
Philippines, for example, to include access to modern contraception in the
country's government health system.24 Opposition from the Holy See, which
has permanent observer status within the UN system, led to silence on
reproductive health in the UN Millennium Development Goals when they were
forged in 2000-even though representatives of the world's governments had
pledged to achieve universal access to reproductive health by 2015 at the UN
conference in Cairo in 1994.25 Only in 2007 was language aiming at that
reproductive health access target added to Millennium Development Goal
number five. Seven years of opportunities to achieve the target had been
squandered.



Perhaps more destructive than religious opposition is a relative denigration
in most cultures of concerns that lie principally in the sphere of women.
Access to contraception is clearly one such concern, since women bear the
babies and undergo most of the risks to life and health associated with
reproduction. At least since the rise of agricultural, urban, and
hierarchical societies, male interests in reproduction have differed
markedly from those of women. Men are often anxious to produce a multitude
of future heirs, soldiers, laborers, farmers, and followers. Women tend to
be strategically concerned with the survival and well-being of each of their
children.13 These gender differences are anything but ironclad, and in many
cultures the gender gap in attitudes has narrowed in recent decades,
especially as women's status has risen relative to men's. In other cultures,
however, the gap not only remains wide, it demands the subjugation of women,
sex, and reproduction to male needs.



Beyond male reproductive dominance lies the conviction among neoclassical
economists that endless economic growth is possible and that it requires
endless population growth. Politicians often measure their self-worth based
on the size of their electorates. They happily side with economists on the
idea that endless economic and demographic growth is both possible and
desirable.



With all these factors in play, it is not surprising that the world's
governments are nowhere close to allocating the resources the Cairo
conference had estimated would be needed for all women in developing
countries to have reasonable access to decent family-planning services. This
was roughly $18 billion for the year 2010, a third of which was to be
contributed by industrialized-country governments (the 1993 dollars in the
UN document are here converted to current dollars).6 Despite that
commitment-and an increase in the population of reproductive-age people in
developing countries, from 2.3 to 2.9 billion-actual expenditures from these
governments on international family-planning assistance fell from $723
million in 1995 to $338 million in 2007.26,27 Assistance has changed little
since the latter year.



A global social movement is needed to pressure policymakers and influential
cultural and thought leaders to reverse this dismal trend. Raising $9
billion a year from wealthy governments that currently spend just a few
hundred million on international family-planning assistance shouldn't be as
difficult as it is. As much money is allocated for a few days worth of
military activities worldwide. A comparable or greater amount probably would
be needed to assure that the vast majority of pregnancies in wealthy
countries are intentional, but this sum has never been estimated.
Significant investments in all countries in education on sexuality and
reproduction are also needed, but what these should be is unknown as well.



Still, the point undoubtedly still holds: a world in which almost all births
result from intended conceptions would not be prohibitively expensive or
difficult, aside from cultural barriers, to bring about. Yet due to
contraception's sensitivity-complicated by a history pockmarked with
episodes of contraceptive coercion in China, India, Peru, and a few other
countries-environmentalists and advocates for women's rights and health have
never succeeded in forging an activist alliance capable of raising the
modest sums needed for all to have access to family planning.



Several elements are needed if a global social movement to promote family
planning and intentional pregnancy is ever to have its own birth. One is
more research about the likely population and environmental outcomes of a
world of fully intended pregnancies-and the policies, programs, and costs
that could lead to such a world. Another is agreement that any such policies
and programs must be based on reproductive rights rather than on coercion,
and therefore on the intentions of women and their partners rather than on
those of anyone else. And a third is the creativity to shape-or the courage
to stand up to-the religious, economic, and other cultural forces that
promote population growth and oppose the gender and reproductive health
conditions that undermine it.



There is nothing fated about a world of 9 billion people-in 2050, or ever.
While true control of population is beyond our aspirations and capacities,
policy choices are available that will nudge our numbers closer to
environmentally and socially sustainable levels. The choices are rooted in
human development and human rights, specifically the right of all, and most
directly of women, to decide for themselves when it is the right time to
bring a new child into the world.


   1.

Glossary of Terms

*Total fertility rate* refers to the average number of children a woman
would bear over her lifetime if at each point in her reproductive age she
had the number of live births typical of women at that age. Note that the
total fertility rate differs from the *population growth rate*, which is the
percentage by which a population grows each year, and from the *birthrate*,
which is the number of live births each year per thousand people in the
population. The global total fertility rate currently stands at 2.53
children per woman.



*Replacement fertility rate* refers to the total fertility rate in a
population that, if held steady over time and absent net migration, would
result in a nonchanging population. This rate is often mischaracterized as
uniformly and precisely 2.1 children per woman, but not all children survive
to reproductive age, and the proportion of those who do not varies over time
and by population. For the world as a whole, with many low-income regions
still experiencing high death rates among young people, the replacement
fertility rate currently stands at 2.35 children per woman.28 Surprisingly,
the gap between global total fertility and replacement fertility is now less
than one-fifth of one birth.



Even achievement of global replacement fertility would not stop population
growth for several decades, due to *population momentum*. This is the
tendency of a population, influenced by its age structure, to continue its
current growth dynamic even as fertility changes. Because there are so many
young people of reproductive age in any population that has had
above-replacement fertility for some time, for example, even low fertility
can produce an overall number of births that statistically overwhelms deaths
among the smaller cohorts of older individuals. It can take decades before
subreplacement fertility actually halts growth. If total fertility falls
well below replacement however, this momentum is weakened and a peak in
population will come sooner, followed by a decline. These demographic
phenomena are evident in Japan, with a total fertility rate of 1.3 children
per woman and a population that has already peaked and is now slowly
shrinking.16
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