A Global Population Policy To Advance Human Development in the Twenty-First Century, With Particular Reference t o Su b-Saharan Africa by Robert S. McNamara Global Coalition for Africa Kampala, Uganda May 1992 A Global Population Policy To Advance Human Development in the Twenty-First Century, With Particular Reference to Sub-Saharan Africa by Robert 5. McNamara Global Coalition for Africa Kampala, Uganda May 1992 Table of Contents Preface I Introduction II The Consequences of Rapid Population Growth Ill Population Growth: Past and Projected IV The Relation Between Population Growth and Sustainable Development Population, Consumption and Environmental Damage The Outlook for Reduction in Environmental Damage Land and Water Resources Forests Energy and Climate Change Conclusions on Sustainability Limits V The Relationship of Population Growth to Economic Development and the Alleviation of Poverty VI The Impact of Current Population Growth Rates on the Status of Women and Children VII The Implications of the Adverse Effects of High Fertility Rates for Population Policy Vlll The Urgency of Acting Now IX The Path to Reductions in Rates of Population Growth X Financial Requirements XI Organizing to Reduce Population Growth XI1 A Proposed Program to Accelerate Reductions in SSA's Population Growth Rates Xlll Conclusion Tables I Basic Indicators II Population and Population Growth Rates: Past and Current Ill Projected Population Levels by Country IV Fertility Rates and Contraceptive Use in Developing Countries V Trends in Average Number of Children Desired among Married Women VI Evaluation of Family Planning Programs in Developing Countries 50 VII Sources of Foreign Assistance for Population Activities 51 Glossary 52 Acknowledgements 54 Preface The Advisory Committee of the Global Coalition for Africa, meeting in Kampala, Uganda May8-9,1992, hasplaced on itsagenda a discussion of fertility trends in Sub-SaharanAfrica and their implica- tions for futureeconomic and social advance. At their request, and as a basis for the discussion in Kampala, I have prepared this statement. It is an adaptation of the Raphael M. Salas memorial Lecture, which I presented at the United Nations on December 10, 1991. 1 know of no problem which will so influence human development in the region as the current explosive growth of population. It must be brought under control. The paper presents a program for doing so. Needless to say, at this stage, I am solely responsible for its contents. Robert 5. McNamara Washington, D.C. May 1992 A Global Population Policy to Advance Human Development in the 21st Century, with Particular Reference to Sub-Saharan Africa I. Introduction In September 1968, in my first speech as President of the World Bank. speaking to the Finance Ministers of the world at the annual meeting of the Bank and International Monetary Fund, I stated: " The rapid growth of population is one of the greatest barriers to economic growth and social well-being of [the people of] our member states."' That was my view in 1968. It is my view today. In the intervening 23 years, the world's population has grown faster than ever before, from 3.4 billion to 5.4 billion, an increase of over 60%. Sub-Saharan Africa (SSA) has grown over 100%. from 264 million to 548 million. Growth ratesfor both theworld and the region are still extraordinarily high. If the fertility rates continue their present decline, three billion people will be added to global population over the next thirty years. During the same period, after taking account of AIDS, about which I will have more to say later, SSA's population will increase by approximately 600 million. Is this a cause for concern? For many, the answer is not immediately clear. In spite of the increase of 2 billion people in the past quarter century, during the same period of time there have been remarkable advances in eco- nomic and social welfare in most of the developing countries where 80% of the world's population lives. Infant mortality rates have fallen; literacy rates have increased; average nutritional levels, in all regions other than SSA, have improved; life expectancy has risen; and, for the developing countries, excluding SSA, consumption per capita rose by 0 % 7 S -A S was a notable exception, it registered almost no growth. But in spite of such progress: 1. "Address t o the Board of Governors." Robert S. McNamara. World Bank, Wash., D.C., 9130168. The number of human beings suffering from hunger has in- creased to over 1 billion, including 180 million in SSA.' The number of illiterates has risen to 900 million, 249 million in SSA.' Maternal mortality has increased: 500,000 women now die each year from pregnancyand childbirth-relatedcauses, with 140,000 occurring in SSA.2 Infant and child mortality remains at totally unacceptable levels: 47,000 children, including 11,000 in SSA2-at least half of whom could be saved--die each day. So, 1 return to the basicquestion: Is the increase in human numbers and its environmental and development ramifications a cause for concern? I will argue that it is; that the interests of both developing and developed countries-particularly the interests of women and hildren in the developing world-demand immediate action to accelerate the reduction in population growth rates; that there is clear evidence this is possible; and that the action can be undertaken within acceptable expenditure limits. I will conclude by suggesting how such a program can be initiated. II. The Consequences of Rapid Population Growth3 When the World Bank began to discuss population issues system- atically in the late 19601s,and made its first family planning loan in 1970, there was broad agreement among most scholars that popu- lation growth has generally negative consequences for development. The arguments were not as simplistic as those of Malthus who, in the 18th Century, argued that food production would not keep pace with population growth. Nor did they project such catastrophic conse- 2. SSA IS far worse off than other regions in the developing world when measured by each of these factors: 33% of the population in all developing countries are suffering from hunger vs. 47% in SSA; 45% are illiterate in all UIC's vs. 59% In SSA; maternal mortality in all LDC's is 290 per 100,000 live births vs. 530 in SSA; and ~nfant mortality In all LDC's is 67 per 1.000 births vs. 100 in SSA. 3. This sectton draws in part on an unpublished paper by Steven W. Srnding of the Rockefeller Foundation, 1990; on Bonomic Consequences o f Population Change in the Third World, by Allen C. Kelley, Journal of Economic Literature. Vol XXVI, Dec. '88, pp 1685-1728; and on an as yet unpubl~shed new study on the subject by the same author. quencesas Paul ErhlichinThePopulationBomb (1968)andJayForrester in World Dynamics (1971) or Donella H.Meadows, et al. in theclub of Rome's report The Limits o f Growth (1972)-the latter predicted that the world had only about 100 years remaining before economic and/ or biosystemscollapsed. Instead, I and my associatesinthe Bankbelieved that lack of capital, and surplus labor in the rural areas, were major constraints to human advance in the developing countries-and that rapid population growth aggravated both of these handicaps. By the late 1970is, this argument began to be questioned. What might be characterized as "revisionist" thinking came into vogue. It was suggested that if decisions regarding familysize were made at the family level based on market signals (e.g. the value of additional children as farm labor), these decisions would maximize not only individual welfare but social welfare as well, unless there were clear market failures. The pendulum appeared toswing back in the mid- and late 1980's. A major report by the World Bank in 19844 emphasized that there wereindeed institutional and market failuresand that high population growth rates could, and were, severely inhibiting economic growth and human development throughout most of the developing coun- tries. In the seven years that have passed since publication of that World Bank report, we have learned much more about the adverse conse- quences of rapid population growth. In sections IV, V, and VI, I will present evidence that high population growth rates: Aggravate degrading poverty in the developing countries, which is affecting ever greater numbers, if not ever greater percentages, of their inhabitants. Adversely affect the role and status of women and the health and opportunities of their children. Increase the danger that the present paths of economic devel- opment-in developing and developed countries alike-are unsustainable and risk the destruction of their physical environment. It is this evidence which leads me to urge a renewed effort-an effort which, as I will explain later, must be concentrated in this 4. World Development Report 1984, World Bank, Oxford Univers~ty Press, NY, 1984. decade-to reduce rates of population growth and long-term popu- lation stabilization levels. Before turning to a more extended discus- sion of theadverseconsequencesof high population growth rates and howto deal with them, it will be helpful to examine in moredetail past and projected population trends. Ill. Population Growth: Past and Projected For thousands of years, as the table below indicates, the world's population grew at a snail's pace. It took over a million years to reach 1 billion in 1800. But then the pace quickened. The second billion was added in 130 years, the third in 30 and the fourth in 15. The Rate of Growth of the World's Population YhL -P Total Yrs to Add I Billion 1,000,000 B.C a few thousand 8,000 B.C. 8 million 1 A.D. 300 million 1800 1 billion one million 1930 2 billion 130 1960 3 billion 30 1975 4 billion 15 1987 5 billion 12 1998 6 billion 11 Reference Bureau, based on UN and World Bank Estimates Source:Populat~on SSA's growth during the past 70 years has been even more explosive--from 130 million in 1930 to 170 million in 1950 and over 700 million in 2000. During this decade alone, one billion people will be added to the planet, including 200 million in SSA. Where will it end? The United Nations prepares long-range population projections which it revises every 10 years. The last such projection, prepared in 1982, estimated that population would stabilize at about 10.2 billion by 2085. But today the situation looks less promising. Population growth will stop much later and at much higher levels than previously t h ~ u g h t . ~ A new UIV estimate, now in preparation, will raise the figures 5. The State of the World Population - 199 1 , UNFPA substantially. The World Bank has just completed, but not yet pub- lished, a similar calculation. The Bank's new "standard projection" will indicate the stationary level will not be less than 12.4 billion, with 2.7 billion in SSA (after adjustment for AIDS) compared to 548 million today. And Dr. Nafis Sadik, Executive Director of UNFPA, has stated "theworld could be headed toward an eventual total of 14 billion" in which case the numbers for SSA would be even higher.=Whatwould such population levels mean in terms of the alleviation of poverty, the status of women and children, and the sustainability of development programs? To what degree are we consuming today the very capital required to achieve decent standards of living for future generations? IV. The Relationship Between Population Growth and Sustainable Development to determinewhethertheworld-ora particular region such as SSA- is on a path of sustainable development, one must relate future population levels and future consumption patterns to their impact on the environment. I will do so in this section. Population, Consumption and Environmental Damage The relationship can be expressed in the form of an equation:' Ed = P x C x D Where: Ed = Environmental Damage P = Population C = Consumption per capita D = the Environmental Damage per unit of consumption. Our task is to look into the next century and insert values into the equation. We can do so in terms of multiples of present levels. 6 The State o f the World Populat~on - 1990. UNFPA pp 1-2 7. The equatlon overs~mpl~f~es the relat~onsh~pbetween populat~on, consumpt~on and the envlronment. Env~ronmental damage has many causes. wasteful consump- tlon and technology, bad management and poor pol~cyHowever, the polnt I w ~ s h to emphas~ze IS that, other th~ngs be~ng equal, the Impact of human actlvlty on the envlronment IS not proport~onal to changes In population alone, but rather t o the producr of populat~on levels and consumpt~on w ~ l rlse per caplta, both of w h ~ c h l sharply In the future I begin with population. Were population to rise to the figure projected by the World Bank- 12.4 billion-there would be 2.3-fold increase in P (12.4 billion divided by 5.4 billion) for the world and a 5-fold increase in P for SSA (2.7 billion divided by 548 million). To approximate C-the growth of consumption per capita-one can begin by recognizingthe heavilyskewedincomedistribution, both within the developed countries and between the developed and developing countries. Within the U S the income per capita of the top fifth of the population is 10 times that of the bottom fifth. Between developed and developing countries, on the basis of purchasing power parities, the ratio isapproximately7 to 1-the ratio for S SA may beon theorder of 14 to 1. Although thesedifferentials may ultimately be affected by the redistribution of income within nations and between nations, both developed and developing countries must put primary emphasis on raising production per capita, if they are to meet the demands of their people for a better life. "Economic Growth" must continue if the quality of life is to be improved for the billions of poor across theglobe. For decades ahead, no other course will be acceptable. Were con- sumption per capita to grow in the future at 2% per annum-about two-thirds the rate realized during the past 25 yearss and roughly the level planned for SSA at the end of thisdecad+it would double in 35 years, quadruple in 7Oyears, and by the end of the next century would be 8 times greater than today. Some may say it is unreasonable to consider an 8-fold increase in the per capita incomes of the peoples in the developing countries in the next century. They are wrong. Per capita incomes in the U S rose at least as much in thiscentury, starting from a much higher base. A substantial i n c r e a s m n the order of 8- fold-in per capita incomes in developing countries is both economi- cally and socially desirable and politically justifiable. If one multipliesan 8-fold increasein consumption per capita by the respective increases in population (2.3-fold for the world and 5-fold for SSA), the globe's production output would be approximately 20 times, and SSA's 40 times, greater than today. The impact on non- 8.See table 1 . renewable and renewable resources would be 20 and 40 times greater, assuming no change in the environmental damage per unit of production. On the assumptions I have made, thequestion becomes: can a 20- fold (or a 40-fold) increase in the consumption of physical resources be sustained? The answer is almost certainly "No". If not, can substantial reductions in environmental damage per unit of produc- tion be achieved? Here, the answer is clearly "Yes". The Outlook for Reduction in Environmental Damage Environmental damage per unit of production can-and will-be cut drastically. There is much evidence that the environment is being stressed today. But there are equally strong indications that we have barely scratched the surface in minimizing the consumption of resources and the generation of pollution and waste per unit of "human advance." I will elaborate on both these points. With each passing year we are learning more about the environ- mental damage which is caused by present population levels and present consumption patterns. The superficial signs are clearly visible. Our water and air are being polluted, whether we live in Los Angeles, Mexico City or Lagos. Disposal of both toxic and non-toxic wastes is a world-wide problem. And the ozone layer, which protects us all against skin cancer, is being destroyed by the concentration of chlorofluorocarbons in the upper atmosphere. But for each of these problems there are known remedies-at least for today's population levels and current consumption patterns. The remedies arecostly, politically difficult to implement, and require years to become effective, but they can be put in place. New compounds will be substituted for chlorofluorocarbons at a cost of 835 billiong over the next several decades. Steps are being taken to reduce packaging materials per unit of GNP: for example, the weight of containers (cans, bottles, pots) has been reduced by 50 percent in recent years.I0 9. The New York Times. 1011/91. 10. The London Economist, 411 3191 Water and air pollution are being reduced-at least in the developed world-although at a heavy cost. The impact, however, of the huge increments of growth on basic ecosystems such as land, water, forests, and climate is far more difficult to appraise. As Robert V. Ayres points out, the growth of complex systems such as these is essentially non-linear and subject to discontinuities." Therefore, they are very difficult to predict. Nathan Keyfitz in a recent article makes the same point." Land and Water Resources Can the world's land and water resources produce the food required to feed a population of 12.4 billion, including SSA's 2.7 billion, at acceptable nutritional levels? Modern agricultural techniques have greatly increased crop yields per unit of land, and have kept food production ahead of population growth-in all major regions of the world except SSA-for several decades. The global increase has been achieved mainly through the Green Revolution: high-yield cropvarieties, increased use of fertilizers and pesticides, and the expansion of irrigated land. As the population doubled from 1950 to 1987, global grain production rose even faster: per capita output increased 25%. But the costs of all of this are proving to be high: widespread acceleration of erosion and nutrient depletion of soils; pollution of surface waters; overuse and contamination of groundwater resources; rapid deforestation; and desertification of over-cultivated or over- grazed lands in many regions.13 The early gains of the Green Revolution now have nearly run their course. Since the mid-1980s increases in worldwide food production have lagged behind population growth. And as I indicated earlier, in Sub-Saharan Africa a "harvest deficit" has existed for several decades. 1 1. Robert V. Ayres. Eco-Restructuring: Managing the Transition to an Ecologically Sustainable Economy, IlASA and Carnegie-Mellon Un~versity, 6/12/91, p2O. 1 2. Nathan Keyfitz. Seven Ways of Caus~ng the Less Developed Countries' Popula- tion Problem to Disappear - in Theory, IIASA, 6/1 1/91. p2. 13. L. Brown et al, 1990 and 1991. State o f the World 1990 and State o f the World 1991, W.W. Norton, New York; World Resources Institute, International lnst~tute for Environmental and Development, and Un~ted Nations Environment Programme, World Resources 1988-89. Basic Books, New York. During the 1960s food production barely kept pace with population growth. 'thereafter growth in food output slowed considerably, averaging only half the rate of population growth. Today food production per capita is down about 20% compared to 1970. What, then, of the future? Today, in terms of grain equivalent, the 4 billion people in the developing countries consume about 250 kilograms per capita per year. That compares to 450 kilograms in the European Community and 840 kilograms in the U.S.14Asu bstantial percentageof the people in the developing world-well over 25%-are malnourished.And the extent of malnourishment is far greater in SSA. Caloric intake per capita, in the region, would have to be increased 30% to equal that of China and 70% to approximate that of the developed world. As incomes rise, diets of populations in the developing countries will rise in terms of consumption of plant energy. Therefore, looking to the future, weshould plan on an increase, in developing countries, of about 50% per capita in food consumption-the comparable figure for SSA would be about 7 % o 0t- a level of 375 kilograms of grain equivalent per capita per year. For a population of 12.4 billion this would require a 3.5-fold increase-and for SSA a nearly 9-fold increase-over today's production. Are such increases feasible? Bernard Gilland considers a 3.5-fold increase for the globe impos- sible.15 He estimates that, on average, per capita food consumption approximates 6,000 calories of plant energy and should be planned to increase to 9,000 (an increase of 50% as I have suggested). B y increasing thearea of land under cultivation, and by using land-saving technology, especially genetic engineering, Gilland estimates that maximum global food output would support a population of not more than 7.5 billion. More recent studies16are somewhat more optimistic with respect to the global food potential. They conclude that if a variety of actions were taken, beginning with a substantial increase in agricultural 14. "Global Food Resources and Prospects" an unpublished World Bank paper, Aug 1991, Chap 2, p l 1. 15. "Considerations on World Population and Food Supply." Bernard Gilland, Population and Development Review 9.1983, 2:203--11. 16. In particular, the unpublished study by the World Bank that is referred to in footnote 13. research, the world's agricultural system could have the capacity to meet food requirements for at least the next forty to fifty years. However, they underline capacity. It seems clear that the actions required t o realize that capacity are not now being taken. As a result there will be severe regional shortfalls within the global capacity- particularly in SSA, as the paragraph below indicates. As the period of time is extended and the population continues to increase, the likelihood of meeting the requirement will become ever more doubt- ful. In 1990, SSA's 524 million people produced about 90 million metric tons of food (maize equivalent). With consumption of 100 million tons, there was a gap of 10 million tons which was met by imports. If population, and food consumption per capita, were to rise to the levels I have assumed (2.7 billion people consuming at levels somewhat below those of the developed world today), consumption would total nearly 900 million tons. I know of no reputable study which projects SSA's production potential at anywhere close to that figure. Even if consumption per capita did not increase above today's levels-levels which leave a high percentage of the population mal- nourished-the production shortfall by 2025 is likely to rise from 10 million tons to approximately 100 million tons, an alarming prospect. -the conclusion is clear: SSA will not be able to feed its people if population growth continues at projected rates. Forests Turning to forests, we are beginning to understand their impor- tance, particularly theimportanceof tropical forests. They are both the primary source of genetic diversity, harboring perhaps 50% or more of all species, and they are a major factor affecting our ability to minimize the concentration of greenhouse gases in the atmosphere and its potential effect on global climate. Yet we continue to destroy them at alarming rates. A recent forest cover survey by the Food and Agriculture Organiza- tion reveals that we are now losing 17 million hectares of tropical forest every year: an area more than half again as large as previously reported." In SSA, 3.3 million hectares of forests and woodlands- out of a total of 660 million-have been lost each year of the 1980's. Reforestation has reversed only 3% of the acreage lost. Degradation and destruction of forests has already had a severe impact on the wildlife habitat and biodiversity. The World Conservation Union estimates that 64% of the original wildlife habitat in SSA has already been lost. Of even greater concern to the average African family is that in the moredensely populated savannah zoneof SSA, only 25-30% of total fuelwood needs can now be met from annual regrowth. Al- though conditions for tree regrowth are favorable in many countries, rapid population growth is causing immense problems. According to FA0 and World Bankestimates, eleven countries in SSAfacedfuelwood shortages in 1980: Burkina Faso, Burundi, Chad, The Gambia, Kenya, Malawi. Niger, Rwanda, Swaziland,Tanzania and Uganda. By the end of the century, seven more are projected to join the list: Ethiopia, Madagascar, Mali, Nigeria, Senegal, Sierra Leone and Zimbabwe. Changes in macro-economic policy and changes in forest manage- ment. along with technological advances, can, of course, reduce the rate of loss of forest cover. Over time, these factors can even expand thecover. But, as in thecaseof food production, thechanges required are financially costly, politically difficult, and very time consuming. I know of no one who predicts our present course will lead to "sustainable tropical forest managementn-and certainly not in SSA- over the next century. **** More generally, with regard to sustainability, many biologists are beginning to stress that there are biological limits to the size of population which the globe can support at acceptable standards of living. They say, in effect, "we don't know where those limits are but they clearly exist." Energy and Climate Change One of the potential biological limits is related to energy use and its effects. The release of carbon dioxide into the atmosphere has been measured since the mid 1950's. It isonly, however, in recent yearsthat it has become widely-but still not universally-accepted that the 17. Food and Agriculture Organizat~on An lntertm Report on of the United Nat~ons, the State o f Forest Resources in the Developtng Countries. FAO, Rome 1988; and World Resources 1990-91.Oxford University Press, 1990, pp. 101-102. concentration of CO,, together with the other greenhouse gases, carries the risk of a general warming of the earth's surface and worldwide climate change. If greenhouse gas emissions are not limited, it is estimated that over the next century mean temperatures will increase between 2.6 and 5.8 degrees Celsius, and the level of the sea will rise between 30 and 100 centimeter^.'^ SSA is contributing substantially to greenhouse gas concentrations. The Max Plank Insti- tute (Germany) reports that fires, associated with the "slash and burn" agricultural practices of the region, add nearly three times as much carbon dioxide and particles to the atmosphere as do all the fires set by farmers and settlers in South America, including the dramatic fires of Amazona. Uncertainties abound, all vastly complicating the efforts of politi- cians to come t o grips with the problem. If global warming occurs, what are its likely consequences? How soon will changes appear? What specific changes in weather and rainfall patterns might occur in any given place? Who wins and who loses in the lottery of climate change? How will agriculture and natural ecosystems be affected? I don't have answers to these questions. But the risks of procrasti- nation aresogreat, I believewemust begin to act nowto stabilize, and then reduce, greenhouse gas emissions across the globe. I am confident that within a decade or two that objective can be achieved at acceptable cost, and without penalizing economic growth in the developing countries. In the US., for example, energy consumption per capita and per unit of GNP is approximately twice the level in Germany and Japan. And yet those two nationsare planning to reduce per capita consumption below present levels. Therefore, the U.S. should be able to make cuts of 50 to 60%. Movement in that direction is already occurring. On May 20, 1991, the Southern California Edison Company, the second largest power generating company in the U.S., announced it would reduce CO, emissions from electricity generating sources by 10% over the next decade. There will be a further 10% reduction by the year 2010. Such reductions, in the face of a growing population 18. J.T. Houghton. G.J. Jenkins and J.J. Ephraums, eds., Intergovernmental Panel on Climate Change. Climate Change, the lPCC Scientific Assessment. Report prepared for lPCC Working Group I, WMD and UNEP, Cambridge Univ. Press. 1990. in the area served by the Company and rising production per capita, point to the potential for dramatic changes in both technology and consumption patterns. Conclusions o n Sustainability Limits Within the past decade, four global environmental phenomena have surfaced: the loss of bio-diversity, acid rain, destruction of the ozone layer and climate change. All area function of rising population levels and increasing consumption per capita. They should cause us t o wonder when other unseen, but silentlyaccumulating, environmental damage will come to our attention. When it does, will we have time to deal with i t without coercive limits on population growth or economic activity? Advances in technology will reduce resource use in relation to production. Wecan look forward, therefore, &substantial population growth and continuing growth in consumption without comparable increases in environmental damage. But we have no assurance that the globe--or the SSA region-can tolerate production increases of anything approaching the magnitude I have hypothesized. How much might population grow and production increase with- out going beyond sustainable levels, levels which are compatible with the globe's capacity for disposal of waste, and which do not deplete essential resources? Jim MacNeil, Peter Winsemausand Taizo Yakushiji tryto answer the question in "Beyond Interdependence." They begin by stating: "Even at present levels of economic activity, there is growing evidence that certain critical global thresholds are being approached, perhaps even passed."Ig They then estimate that if developing nations were to provide their present populations with the level of consumption now prevailing in the industrialized world, energy supply with current forms of energy development would have to increase by a factor of 5. With respect to population levels, the authors state: "If human numbers double [i.e. t o 10 billion], a five- to ten-fold increase in economic activity would be required to enable them t o meet their basic needsand minimal aspirations." They ask the question: "Is there, 19. Beyond Interdependence, J~rnMacNe~l, Press. NY, 1991, et al, Oxford Un~vers~ty p19. in fact, anywayto multiply economic activitya further fiveto ten times, without it undermining itself and compromising the future com- pletely?"20 They clearly believe the answer is "No." Such a conclusion would be shared, I believe, by the World Commission on Environment and Development, chaired by Prime Minister Bruntland. The Commission report Our Common Future states: "In many partsof the world, the population is growing at rates that cannot be sustained by available resource^."^' Even if the ultimate "carrying capacity" of the earth and SSA could support population levels and a total output of the size I have dis- cussed-a 2.6- fold increase in population and a 20-fold increase in "output" for the globe, and a nearly 6-fold increase in population and 40-fold increase in output for SSA,by the end of the next century-it is highly unlikelythat the technical, institutional and political changes would occur fast enough, and evenly enough across regions, t o meet the output requirements during the intervening years. Similar questions and doubts exist in the minds of many experts in the field. In July of last year, Murray Gell-Mann, Nobel Laureate and Professor of Physics at Cal Tech, Gustave Speth, President of World Resources Institute, and John Steinbruner, Director of Foreign Policy Studies at the Brookings Institution instituted a multi-year project to tryto understand how "humanitycan make the shiftto sustainability." They point out that "such a change, if it could be achieved [emphasis added] would require a series of transitions in fields ranging from technology to social and economic organization and i d e ~ l o g y - " . ~ ~ The implication of their statement is not that we should assume the outlook for sustainable development is hopeless, but rather that we must begin now to identify and introduce the changes necessary t o achieve i t if we are to avoid more precipitate and costly action in the future. I fully share that view and, as I will conclude later, one of the changes which would enhancethe prospectsfor sustainable develop- ment in almost all developing countries-and certainly in SSA-would be a reduction in prospective population growth rates. 20. lbid, p5. 21. Our Common Future, The World Commission On Env~ronment and Develop- ment, Oxford University Press. NY. 1987, p l 1. 22. Speth letter of invitation t o the conference, 4/1/91. V. The Relationship of Population Growth to Economic Development and the Alleviation of Povertyz3 As I stated earlier, the developing world has made enormous eco- nomic progress over the past three decades. But at the same time, the number of human beings living in "absolute povertyM-if such a condition can be properly described as living-has risen sharply. That is true both for the developing countries as a group, and in particular for SSA. "Absolute poverty" is a word of art. When I coined it in the late 1960's I did so to distinguish a particular segment of the poor in the developing world from the billions of others who would be classified as poor in Western terms. The "absolute poor" are those living, literally, on the margin of life. Their lives are so characterized by malnutrition, illiteracy and disease as to be beneath any reasonable definition of human dignity. Todaythenumber of such individualsexceedsone billion, including 185 million in SSA. As a proportion of total global population, the absolute poor have decreased over the past two decades, but in absolute numbers they have increased. In SSA they have increased both percentage-wise and absolutely. The total number of absolute poor is likely to rise by nearly another 100 million in this decade with nearly all of that increase in SSA.24 A major concern raised by poverty of this magnitude lies in the possibilityof physical and intellectual impairment of children. Parental investments of both money and time are critical in the early years of development if a child is t o reach its full potential. The distribution of family size by family income in many countries is such that the great majority of children are born into poor families. They are disadvan- taged at birth. In Colombia and Malaysia during the 19701s, for example, the number of children in the poorest 20 percent of the households, was 3 times as great as in the richest 20 percent. Surveys have shown that millions of the children in these low- income families receive insufficient protein and calories to permit 23. This section draws. in part, on: World Development Report 1990, World Bank, Oxford Un~vers~ty Press, NY, June 1990. 24. World Development Report 1990, World Bank, Oxford University Press. optimal development of their brains, thereby limiting their capacity to learn and to lead fully productive lives. Additional millions die each year, before the age of five, from debilitating diseasedirectly attribut- able to nutritional deficiencies. The penalizing effects at the family level are compounded by weak educational systems. Hig h-fertilitycountries facea doubling or tripling of their school age population within a decade or two. This is bound to lead to a reduction in the already poor quality of education. A culture of poverty is being transmitted down the generations, sacrific- ing human resources and impeding social mobility. It is adisgrace that we in the developed countries, as well as theelite within the developing nations, permit such a situation to exist. To what extent do high population growth rates contribute to the problem? All would agree they are not the only factor affecting economic and social advance: political organization, macro-economic policies, institutional structures, growth in the industrial nations all affect the rate of growth in developing nations. And, as I mentioned in Section II, economists continue to debate the quantitative impact of population growth on economic development. But intuitively we recognize that the immediate effects are adverse. This is particularly the case in countries where markets are not fully effective, and where institutions capable of offsetting the effects of rapidly rising popula- tion levels are not strong. Our intuition is supported by facts: in Latin America, during the 1970fs, when school-age population expanded dramatically, public spending per primary school student fell by 45% in real terms. In Mexico, life expectancy for the poorest 10 percent of the population is twenty years less than for the richest 10 percent. In Cote d'lvoire, the primary enrollment rate of the poorest fifth is less than half that of the In 'Thailand, the fewer the numbers of children in thefamily, the more likely that a child will stay in Based on such analyses, the World Bank stated that "up to a point population growth can be accommodated: in the past three decades 25. World Development Report 1990, World Bank, Oxford University Press, NY, Julf 1990, p2. 26. Family Size and Family Well Being in Thailand, by Napaporn Havanon. John Knodel, Weras~t Sittitral. many countries have managed to raise average incomes even as their populations grew rapidly. In that strict sense, population growth has been accommodated. But the goal of development extends beyond accommodation of an ever larger population: i t is t o improve people's lives. Rapid population growth in developing countries has resulted in less progress than might have been-lost opportunities for raising living standards, particularly among the large numbers of the world's The Bank concluded by stating: "The evidence points over- whelmingly t o the conclusion that population growth at the rates common in most of the developing world slows development -. Policies to reduce population growth can make an important contri- bution to [social a d v a n ~ e ] . " ~ ~ I strongly agree with such a judgment. It accords with my experi- ence in 13 years of endeavoring to help the developing countries maximize their rates of economic and social advance, particularly for the absolute poor. VI. The Impact of Current Population Growth Rates on the Status of Women and Children Most economists and policy makers have approached population issues as I have so far, i.e. from the point of view of the effects of rapid population growth on the national and international objectives of maximizing economic growth, alleviating poverty and assuring envi- ronmental sustainability. There is nothing wrong or illogical about this approach, but we are learning it is seriously incomplete. It is crucial to look at rapid population growth, as well, in terms of its meaning to individuals and families. From theviewpoint of thefamily, the most important effect of high growth rates is too many children, too closely spaced. The result is lost opportunities for both women and children. The first benefit of family planning-of choosing the number and spacing of children-is the benefit of better health for the mother and child. Press, NY. July 27. World Development Repor? 1984, World Bank, Oxford Un~vers~ty 1984, p79. 28. lbid, plO5. The health benefits of family planning have been proven by study after study over recent decades.2q The World Fertility Surveys (1 972-1984) first showed birth-spacing's health benefitsfor infantsand children.The more recent Demographic and Health Surveys reinforce this finding. They both conclude that high mortality rates accompany more frequent pregnancies. Babies born less than two years after their next oldest brother or sister are more likely to be underweight and anemic at birth. They start life with a huge disadvantage: on average, they are almost twice as likely to die as those born after a two-year interval. In many countries, birthspacing alone could prevent one in every five infant deaths and the reduction in maternal mortality would be substantial as well. As I pointed out in Section V, similar arguments can be made about the effects of high population growth rates on the ability of families t o educate their children. Education is inevitably costly-in terms of school fees, school clothing, transportation, and income foregone- especially as children stay in school longer. In the face of such costs- costs paid by both society and the individual family-higher growth rates contribute t o less education per child. And the penalty falls most heavily on females. The discrimination against females is seen in many other facets of life. Although in subsistence economies, and in poor families, women do substantially more of thework connected with agricultural produc- tion than do men, the women generally suffer the highest level of malnutrition. Men are given first claim on such food as is available, children second, and the mothers last.The malnourished mothersgive birth t o weakand unhealthy infants, and have problems nursing them adequately. The mothers, constantly pregnant or nursing infants, are unable t o play a larger role in the outside-the-home work force. This diminishes their occupational and economic status, which in turn reinforces the concept that males are more important. This makes sons more desirable than daughters. When only daughters are born, another pregnancy must ensue in order t o try again for a son. Repeated 29. Safeguarding the Future, Nafls Sad~k,UNFPA, NY 1989. pl8; and Family 2nd Edition, Pop. Ref. Bureau. Wash DC, 1991. Planning Saves Lives, pregnancy not only increases the family size, but exhausts the mother and weakens her health. Thus the whole cycle begins again. Such a phenomenon is evident in demographic data. Arecent UNDP report states: "1 00 million women are missing."30In societies in which girls are treated much the same as boys, there are about 106 females for every 100 males because females, on average, live longer. But if women do not receive equal treatment, the story changes. In most of Asia and North Africa, far fewer female children and women survive becausethey suffer active discrimination: there are only94 femalesfor 100 males. The UNDP calculates, therefore, there is a shortage of 12O/0 from the natural figure, a "shortfall" of 100 million women. At the extreme, the male attitude toward females is represented by the recent event at a school in a developing country where a midnight raid of male students resulted in the deaths of 19 girls and the rape of 71 others. The Deputy Principal of the school was quoted as saying: "The boys never meant any harm-. They just wanted to rape."3' Newspapers, in both thedeveloped and developing nations, cited the incident as evidence that in many parts of the world males think of females as objects t o serve their pleasure. As a result of such attitudes, women are being denied the right to m a k e o r to share in making-the most fundamental decisions regarding their own lives. Family planning is an important means by which women can begin to enhance their role and status. VII. The Implications of the Adverse Effects of High Fertility Rates for Population Policy Any one of the adverse consequences of the high population growth rates-environmentally unsustainable development; adverse effects on the rate of economic and social advance and the alleviation of poverty; and the impact on the status and welfare of women and children-would be reason enough for developing nations across the globe to move more quickly to reduce fertility rates. Taken together they make an overwhelming case. Press, NY. 199 1, 30. Human Development Report 199 1 , UNDP. Oxford Un~vers~ty p27. 3 1 . Time Magazine, W 1 219 1, p43 If a nation were to decide to lower population growth, what would be a reasonable objective and how might it be accomplished? As I indicated in Section Ill, the World Bank projects that current trends may lead to national growth patterns which, for the world as a whole, would not stabilize below 12.4 billion, including 2.7 billion in SSA. Such an estimate assumes that adoption of contraceptive practices in the developing world-now at over 50% of all couples in their reproductive years (only 10.8% in SSA, Table IV)-will continue to increase at a moderate pace. Could the rate of increase be acceler- ated? The answer is clearly "Yes". In Section IX, I will suggest how that might be done. The point I wish to emphasize here is that each developing nation has the opportunity to act now to establish-within broad limits-its future population growth, and to set the rate of growth at levels that will maximize the welfare of both present and future generations. Should not every such developing country, therefore, formulate long-term population objectives on that basis? They would be con- strained only by the maximum feasible rate at which the use of contraception could be increased in the particular nation. If this were done the individual country contraception targets mig ht approximate those shown in Table IV, leading to the population stabilization levels shown inTable III.Theytotal9.7 billion, including 1,549 million in SSA. That is an 80% increase for the globe, and a nearly 200% increase for SSA, over today's population levels of 5.4 billion and 548 million. But population levels of 12.4 billion and 2.7 billion would be 28% and 90% larger. And by the end of the next century, the additional SSA population of 1.2 billion p e o p l e o n the assumption of an 8-fold increase in consumption per capita-would require a production output nearly 18 times greater than SSA's total output today. Think of it: the increment of African population, that I am suggesting can be avoided, would consume 18 times today's total African production. VIII. The Urgency of Acting Now Before turning to a discussion of how acceleration of the rate of increase in contraception prevalence rates can be accomplished, I want to stress that if SSA and other developing nations wish to hold to a minimum thelevels at which their populations ultimatelystabilize, they must act now. Populations stabilize when total fertility rates (the average number of children a female produces during her reproductive years) reach replacement levels (approximately 2.1) and when age distribution stabilizes. Developing nations are far from stable age distributions today. The difference in age distributions between high-birth rate and low-birth rate societies can be seen in the age profiles of Kenya and Sweden. In Kenya over 60% of the females are 19 or younger compared to only 23% in Sweden. Cornparleon 0 1 Kenyan a n d Swedieh Age D i e t r l b u t l o n e KENYA ( 1 0 0 0 ) SWEDEN ( 1 0 0 0 ) MALE 1 FEMALE 66-69 66-69 mp 60-64 mZa 1- 60-64 43-49 1 - 40 0 36-39 1 0 9 ~ 7 8 6 4 3 2 1 0 1 2 3 4 6 ~ 7 8 9 14 03 2 1 0 1 2 3 4 P E R C E N T OF TOTAL P O P U L A T I O N P E R C E N T O F TOTAL P O P U L A T I O N Were Kenya to suddenly drop to replacement-level fertility rates, its population would continue to grow rapidly for approximately 50 years. Sweden with replacement level rates has stopped growing because of its stabile age distribution. Because developing countries across both SSA and the world tend to have age distributions similar to Kenya's, were their fertility rates to drop instantaneously from 3.9 (Table IV) to replacement levels of 2.1, their populations would continue to grow for another 50 years. The UN estimates that even under such a totally implausible assumption, the world's population would ultimately reach a total of approxi- populations mately8.4 b i l l i ~ n . ~ ~ T he will continue t o grow becausethe high birth rates of the past have produced an age distribution with a relatively high proportion of males and females in, or still t o enter, their reproductive years. The age distribution of today cannot be changed, but by acceler- ating the rate of use of family planning, it is possible to accelerate the movement toward stability. The table below shows, for four develop- ing countries, the effect of accelerating the achievement of replace- ment level fertility by 25 or 30 years. Population size scenarios (population in milllions) Ult~mate Ultimate Difference due to delay Population Population in reachina NRR=l 1990 ~fNRR= 1 ~fNRR =l in % of 1990 Country Pooulation ~n201 0 pred~cted year Pooulation Pooulation Bangladesh 1 14.8 277 300.0 23.0 20.0 Ghana 15.0 46 66.2 20.2 134.9 Nigeria 118.8 341 617.3 276.3 232.6 Pakistan 114.6 334 556.2 222.2 193.9 Pred~ctedyear for NRR=l; Bangladesh 2015; Ghana 2035; Nigeria and Pakistan 2040; 1 Source: World Bank estimates for column 2; Population Reference Bureau estimates for column 3. If Nigeria, forexample, wereto realizethecontraception prevalence objective for the year 2000 which is shown in Table IV, and thereby achieve a Net Reproduction Rate of 1 (replacement level fertility) in 2010 instead of 2040, its population, now about 1 19 million, would level off at approximately 341 million instead of 617 million. The difference is equal to 233% of today's population. Not all developing countries would see as great a change as Nigeria by acting now t o achieve the contraception objectives listed in Table IV. But stabilization levels for all would be substantially lower. 32.Long-Range World Population Projections (Advance Unedited Copy, 8/27/91), UN. NY. Before turning to the next section, I should address a question which, at this point, may be in the minds of many readers. Will not the effects of the spread of AIDS across SSA make unnecessary special efforts to reduce fertility rates?The short answer is No: let me explain. WHO estimates that the prevalence of the AIDSvirus (HIV) in SSA has risen from 2 million cases in 1988 to more than 6 million in 1991. This figure is expected to grow to 10 million by 1994. The plague will impose enormous costs on society and will inflict immense suffering on individuals. Preliminary studies on Uganda and Tanzania reveal AIDs will strike heaviest among the working-age population. Produc- tive capacity-through loss of skilled labor and increased morbidity- will be reduced; purchasing power and savings capacity will be reduced; and dependency ratios will be pushed even higher than they are now. Uganda's dependency ratio-because of AIDS and high fertility-is likely to climb to about 113 by 201 0, compared to about 67 in the average developing country. The increase in the number of orphans will exacerbate the heavy dependency burden. The primary effect of AIDS will be, as I say, to impose a heavy economic burden on nations and immense suffering on human beings. A secondary effect will be to reduce population levels in SSA below what they would otherwise be. Preliminary estimates indicate that the stabilization level of 2.7 billion which I referred to in Section Ill would have been approximately200 million higher if it were not for ~ ~i t is clear that even in the face o f AIDSSSA's population will A I D s . So explode. The cost the disease will impose will multiply the burden of the high population growth rates. But the increasing recognition of these facts offers the opportunity to vastly expand the rate at which family planning is accepted. At present-and very likely for a considerable time in the f u t u r e thereare only three methods by which the transmission, and eventual death from AIDs, can be prevented: abstinence, monogamy between 33 Thls does not Imply that In SSA 200 mlll~on will d ~ e from AIDS The f~gure ~ncludes d~rectly those d y ~ n g of AIDS as well as blrths averted because over t ~ m e l marry and w ~ l not those dylng w ~ l not l have fam~l~es partners without the HIV virus, and use of condoms in all other contexts. There is evidence-based on the increased demand for condoms in Kenya and Uganda-that this fact is being increasingly recognized. It can and should bethe basis for a rapid expansion in the use of condoms across the whole of SSA. IX. The Path to Reductions in Rates of Population Growth Assuming a nation wishes to reducefertility rates to replacement levels at the fastest possible rate, what should be done? The Bucharest Conference, in 1974, emphasized that high fertility is in part a function of "low" development. Experience has, indeed, shown that as economic growth occurs, particularly when it is accompanied by broadly based social advance, birth rates tend to decline. But Kenya in the 19701s,and Brazil in the 1950's and 19601s, advanced economically while, at the same time, fertility rates re- mained high or actually increased. Hence it is generally recognized today that not all economic growth leads to immediate fertility reductions and, in any event, such reductions can be accelerated by direct action to increase the use of contraceptives. It follows, therefore, that any campaign to accelerate reductions in fertility rates should focus on two components: 1. For sustained medium and long-term effect, increasing the pace of economic and social advance, with particular emphasis on enhanc- ing the status of women and on reducing infant mortality; 2. For maximum short-term impact, introducing or expanding comprehensive family planning programs. Much has been learned in recent years about how to raise rates of economic and social advance in developing countries. I won't try to summarize the lessons here other than to stress the need to place special emphasis on: Increasing the percentage of females attending primary and secondary schools. This is particularly required in SSA. Female literacy in SSA is far below male levels. Table I indicates, for example, that in SSA in 1 985 only 36% of females were literate vs 57% of males; Sudan shows 10% vs 39%. Raising school enrollments of females affects fertility by: delaying marriage age; improving female employment opportunities; and increasing the probability of greater attention by the females to the health of the children. Improving the health of both women and children. Infant mortality remains high in many developing countries, including SSA. On average, for theyears 1985-90 it amounted to 100 per 1000 births in SSA compared to 32 in China (Table I). High infant mortality rates keep women on a treadmill of reproduction with high cost to society and grave consequences to their health. I do wish, however, to expand on the magnitude of the increases required, during the decade, in the use of familiy planning, if popu- lation levels in individual countries are not to rise substantially above the figures projected in Table Ill. Thechart below shows the number of married women in reproduc- tive ages in 1960, 1990, and 2000 for all developing countries. MARRIED WOMEN IN CHILD-BEARING AGES 1960-2000 I960 MORE DNEUlPED 1990 COUNTRIES 2000 I I960 LESS DNEUlPED 1990 COUMalOi 717 I 2000 NOTE: CONTRACEPTIVE USE IN 2000 IS LEVEL NEEDED m ACHIEVE F E U T I L ~A S S U M ~ O N S I N TAB= IV AND POPULATION PROJECTIONS I N TABLE I11 SOURCE: POPULATION REVERENCE BUREAU. 10/91 The number of married women in ch~ld-bearing ages in developing countries is projected to increase from 71 7 million in 1990 to 874 million in 2000, an increase of 22% in one decade. If the contraception prevalence objectives shown in Table IV are to be met, the number of those women in families using contracep- tion must rise by nearly 60% from 257 million in 1990 to 565 million in 2000. The required increase of 206 million in one decade compares with the actual increase of 175 million in the 20 years 1970 - 1990. The comparable projections for SSA show a 37% increase during the decade in married women in child-bearing ages (from 89 million in 1990 to 122 million in 2000), and a required increasein the number of families using contraception of over 400% (from 10 million in 1990 to 54 million in 2000) to meet the objectives shown in Table IV. The contraception prevalence objectives for the developing coun- tries as a group will be difficult to achieve by the year 2000 and those for SSA appear unattainable. In Section XI1 however, I will propose a family planning program for SSA which, I believe, will permit achieve- ment of the objectives. It draws on the experience of Thailand, Indonesia, Bangladesh and Mexico, all of which realized dramatic increases in contraception prevalence rates. The actions those coun- tries took are known and their experience can be exported. It is available to all who ask. Almost all successful family planning programs have: Provided services-contraception methods--diverse enough to meet the needs of populations with widely different mores, income levels, and personal habits. Put great emphasis on the health benefits from family planning to both women and children. Used both public and private sectors, government and non- government organizations, for the support of the programs. Drawn on political leaders-especially those at the local levels- and religious leaders for support. This has been particularly true of the Indonesian program. In one major respect, the task for the decade ahead is far less difficult than it appears to be. Contraception prevalence rates rise when there is both a demand for services and a supply available. Often the "demand" factor is the most diff icult to create. But all the evidence indicates that todaythere isa large unmet demand waiting to befilled. Fertility surveys, for example, indicate that significant proportions of women have had unwanted births. In addition, substantial numbers of women who wish t o limit or spacetheir children report they are not practicing c~ntraception~~-in SSA, the figures range between 20 and 40%. TableV supports the conclusion. It shows that in many countries- including, for example, Burundi, Ghana, Kenya and Mali--desired family size has decreased substantially in recent years, indicating a rising demand for contraception services. Yet the UIVFPA estimates that 300 million couples are still not now served by family planning networks, or live in areas where such services are unavailable. The gap between demand and supply-the "Unmet Demandu-is particularly large in Africa, but it exists across the developing world. "Unmet Demand" for Contraception in Selected Countries f% of Married Women) Contraception "Unmet Prevalence Rate Demand" Burundi Ghana Kenya Mall Morocco Ecuador Peru Average (all LDC's) Source: The KAP-Gap and the Unmet Need for Contraception. John Bongaarts, Population and Development Review. Vol 17, No. 2 . June '91, p308. The "Unmet Demand" can be overcome by improving family planning services and contraceptive distribution. It is estimated that thisaction alonewould reduce population stabilization levels by about 2.2 billion,35including 400 or 500 million in SSA. One of the factors standing in the way of meeting the unmet demand is lack of financial resources. 34. The Demographic Impact o f Family Planning Programs, John Bongaart, et al, Vol. 21, 1990, p305. Studies in Family Plann~ng 35. lbld, p306. X. Financial Requirements Developing countries in 1990 spent $4 to $4.5 billion of public funds on family planning, $3 to $3.5 billion from domestic sources and about $800 million from external sources (Table VII). Comparable figures for SSA are difficult to obtain, but it is clear that expenditures of public funds for such purposes areverysmall, perhaps $160 million from domestic sources and $150 million from foreign donors. I estimate that a global family planning program of the size I am proposing for theyear 2000 would require approximately $8 billion in public funds in 1990 dollars,36including something on the order of $1.5 billion for SSA. Becauseof thesubstantial increase in cost, I believe that the portion financed by foreign donors should be increased above the 1990 level. If local currency expenditures, in relation to GDP, were held to the 1990 levels they would rise from $3 to $3.5 billion in 1990 to about $4.5 billion in 2000. And the foreign funds required would increase from $800 million to approximately $3.5 billion, of which a significant share would have to be earmarked to finance a major part of SSA's program. While the increment of $2.7 billion in external funds- required for the global program-appears large, it is very, very small in relation to GNP and Official Development Assistance (ODA) pro- jected for theOECD countries. In theyear2000 itwould amount to less than two-hundredths of one percent of GNP and 5% of ODA. Clearly, it is within the capabilities of the industrialized nations and the multilateral financial institutions to assist thedeveloping countries to finance expanded family planning programs. The World Bank has already started on such a path, doubling its financing of population projects in the current fiscal year (from $169 m~llion in 1990 to an estimated $340 million in 1991). Others should follow its lead. The funds required are so small and the benefits to both families and nations so large that money should not be allowed t o stand in the way of reducing fertility rates as rapidly as desired by the developing countries. This applies particularly t o SSA. 36. The est~mate is at best a rough approxlmatlon. However, it IS sufficiently representative to permit judgments to be made as to whether family planning programs should be continued at present levels or sharply expanded. XI. Organizing to Reduce Population Growth If i t were agreed that the interests of SSA and the other developing nations would be served by mobilizing a massive global effort during the 1990s t o expand family planning services as I have proposed, what specific action is required? I urge that emphasis be placed on six steps: 1. Each developing country, including the countries of SSA, with the assistance of UNFPA, the World Bank and whatever other organi- zations it wishes to call on should establish a target for its own long- term stabilization level, and support that target with a series of quantifiable and monitorable sub-objectives for the decade of the 1990's. Such sub-targets should include: fertility rates, contraceptive prevalence, family-planning expenditures, sources of finance, and so forth. 2 . Each developing countryshould develop specific plans to achieve the objectives and report to its own people each year on the degree t o which the objectives are being achieved. 3. The World Bankshould assumethe responsibilitytoorganizethe external financing required t o support the country plans and serve as a financing source of last resort. 4. The UNFPA should exercise overall surveillance and monitoring of the Global Program. 5. The Economic and Social Council of the UN, meeting at minis- terial level, should receiveannual reports from UNFPA on the progress or lack thereof and determine what further action is required to assure that the nations of the world are on a path towards sustainable development and are making satisfactory progress in alleviating the disgraceful levels of poverty so evident across the globe. 6. And, finally, I strongly recommend that a "Population Commis- sion," similar in structure and purpose t o the Pearson, Brandt, Palme and Nyeye commissions, be established, chaired preferably by a Third World woman, t o assist in the preparation of the 1994 World Conference on Population. Now, before concluding, I turn to a brief discussion of a specific program to reduce population growth rates in SSA. XII. A Proposed Program to Accelerate Reductions in SSA's Population Growth Rates I recognize that most governments in 55A officially endorse programs to reduce fertility rates. To date, however, with few exceptions (most notably Mauritius and Zimbabwe and to a somewhat lesser degree Botswana and Kenya), they have failed. In general, total fertility rates are the highest in the world, exceeding 6.5 for many countries, and contraception prevalence ratesare the lowest, ranging from near zero to an average of 10% for the region (Table IV). The prevalence rates must rise sharply-they should quadruple4uring this decade, if acceptable rates o f economic and social advance in the 2 1st Century are to be realized. Fifteen to twenty points of the thirty-point increase in the contra- ceptive prevalence rate, required in this decade to meet thefertilityand population targets listed for SSA countries in TABLE IV, can be achieved by meeting the existing "unmet" demand, i.e. by providing easy uninterrupted access to contraceptives suitable to client needs. To attain the additional 10 to 15 point increase required, by the year 2000, and to continue to increase contraception prevalence rates, in theearly yearsof the next century, until they reach approximately75% by 2025, will require strengthening all aspects of the population control program. To meet these goals, changes in both the organizational structure and the substance of the family planning and associated welfare programs are required: 1. Establish National Population Councils. Establishment of Na- tional Population Councils, and where appropriate regional sub- councils in each country would appear to be essential. These should function at the highest levels of government to affirm sustained and unequivocal commitment to the rapid reduction of population growth. The Councils would need to coordinate the involvement of the public and private sectors, and monitor programs. Over 25 countries have developed population policies or are in the process of doing so. But these policies have yet to be translated into effective programs. The Population Councils would be an instrument for doing so. 2. Set National Goals. As a first step, the Councils, after consulta- tion with local and national groups, should establish the national population goals, which I referred to earlier. These should be sup- ported by a series of quantifiable and monitorable sub-objectives- fertility rates, contraceptive prevalence, family-planning expenditures, sources of funds, etc.-for the decade of the 1990s. 3. Expand the Roles o f NGO's and the Private Sector. Successful programs in other developing countries have been based on a full partnership-which does not now exist in most SSA nations-among government and non-governmental organizations, including private sector enterprises. These organizations can playa crucial role, particu- larly in the earlystages, in desensitizing the issues, reaching the people with client-oriented services and preparing the way for rapid expan- sion of programs. Because the capacity of NGO's is limited in SSA, donors should give increased support to the International Planned Parenthood Federation and its local affiliates to help them expand their capacities. 4. Meet the "Unmet Needs. " Many countries in SSA are today experiencing shortages of contraceptives, in part because of the stimulus to demand arising from the AIDS crisis. Donors should immediately express a willingness to provide the foreign exchange required to finance the needed imports of condoms and other materials. And the local governments should move just as rapidly to expand the outlets for contraceptive services. Recent Demographic and Health Surveys reveal that more than 20% of the population in much of rural SSA is not even within five kilometers of a family planning clinic, pharmacy or health center. No other developing region is so poorly served. 5. Promote Reproductive and Sexual Health.IVever before has the concept of reproductive and sexual health assumed such importance in SSA as now when all types of sexually transmitted diseases, including but not limited to AIDS,are rampant in the region. The use of mass media, traditional and religious leaders and other means of communication should be expanded to promote the use of contracep- tives for reproductive health. 6. Enhance the Role o f Women. By any standard, the educational situation of SSA women, as indicated by their literacy levels, is appalling. Most SSA women are illiterate (64% in 1985) and in many nations the illiteracy rate exceeds 75% (Table 1). As I have already indicated, female literacy in SSA compares unfavorably with what has been achieved in other developing countries, for examplechina (55%) and Indonesia (64%). SSA women are illiterate because they have not been in school to learn to read or they remained but a short time. School enrollment and retention ratesfor girls are both extremely low. Both must be increased. It is difficult to exaggerate the importance of the links between education and the greater acceptance of contraception and lower infant mortality-this linkage exists in SSA as it does throughout the developing world. The process at work here is far broader than the learning that is directly conveyed in classrooms; rather it stems from the 'empowerment' effect that school attendance can imply for girls and women. School attendance is the first step in a process of familiarization with the outside, modern world. Women who have had such exposure are better prepared to move beyond the traditional confines of household and village and to see themselves as able and entitled to cope with that world. The more educated a woman is, the more likelysheis to want, and beabletoobtain: contraception services for herself; and immunization, modern health care, and education for her children. 7. Reach and Involve the People. The participation of the people in national population programs is essential if the programs are to be socially and culturally acceptable. The African Population Advisory Committee has developed an "Agenda for Action to Improve Popula- tion Program Implementation" to assure participation of both rural and urban populations. 8. Monitor Progress-or the Lack o f It.Only by each nation estab- lishing goals for its population program and-annually-reporting progress against them, will action be initiated to assure that the explosive rates of population growth are reduced to levels which are compatible with acceptable rates of economic and social advance. Today no more than 3 or 4 governmentsare performing the monitor- ingfunction, and thereis nocomprehensiveannual reporton progress- or lackof it-for the region as a whole. The Global Coalition for Africa should assume the responsibility for preparing such a statement. XIII. Conclusion Given the severity of the environmental and poverty problems facing SSA and the other developing countries and the global community, reducing population growth rates below currently projected levels, is a necessary, humane and low-cost step which will contribute to their solution. Reducing fertility will allow political leaders more time to come to grips with the immense pressures building on natural resources, and it will permit Third World governments to devote more resources to human development by increasing investment in educa- tion, health, welfare, and job creation. The subject of "population" has only recently been placed on the agenda of the United Nation's Conference on the Environment and Development, to be held in Rio this year. Surely it deserves extended discussion there. And should there not be initiated there as well a discussion-which will require decades to c o m p l e t e o f how we in thedeveloped world, consuming seven timesas much per capita asdo the citizens of the developing countries, may both adjust our con- sumption patterns, and reduce theenvironmental impact of each unit of consumption, so as to help assure a sustainable path of develop- ment for all the inhabitants of our planet. It will be neither morally defensible nor politically acceptable to do less. - TABLE I Basic Indicators ONP R r Cadta lnhnt % Age Orowth Mortdlty t Srt u.' Ran (par 1000 Ufa % Utaratee' 0-14 -- Amount' 1986- blrthl' Ex~aomnoy' F m d r M . l.l ~ . n World' 3,784 3.0 70 64 SO 71 36 More Developed 17,676 2.5 16 74 94 98 22 Less Developed 766 3.0 78 62 49 71 37 Sub Saharan 340 0.6 100 62 36 67 46 Low income 242 -0.1 112 47 36 67 47 Benin 380 0.1 90 46 12 26 47 Burkina Faso 320 1.2 138 47 6 23 44 Burundi 220 3.0 119 48 32 53 45 Central African Rep. 390 -0.5 104 49 19 45 45 Chad 190 -2.0 132 46 13 34 43 Ethiopia 120 -0.1 137 44 -- -- 46 Gambia 240 -- 143 43 11 30 44 Ghana 390 -1.6 90 54 42 63 45 Guinea 430 -- 145 43 8 26 47 Guinea-Bissau 180 -- 151 42 18 43 41 Kenya 360 1.9 72 58 53 77 50 Lesotho 470 5.2 100 56 84 62 43 Liberia -- -- 142 53 21 43 45 Madagascar 230 -1.8 120 54 68 86 45 Malawi 180 1.1 151 47 31 52 49 Mali 270 1.6 169 44 15 31 47 Mauritania 500 -0.4 127 46 16 40 45 Mozambique 80 -- 142 47 16 39 44 Niger 290 -2.3 135 45 11 32 48 Nigeria 250 0.9 105 51 31 55 47 Rwanda 320 1.5 122 49 32 59 49 Sierra Leone 220 -- 154 41 6 21 44 Somalia 170 0.5 132 45 9 27 47 Sudan -- 0.0 108 50 10 39 45 Tanzania 130 -0.5 106 53 88 93 49 Togo 390 0.0 94 53 25 51 45 Uganda 250 -3.1 103 51 29 57 50 Zaire 260 -2.1 83 52 53 79 46 Zambia 390 -2.1 80 53 59 77 49 Medium income 1,464 1.3 88 67 36 68 43 Angola 610 -- 137 45 23 50 45 Botswana 1,600 8.6 67 59 60 82 49 Cameroon 1.000 3.7 94 52 36 61 47 Source: World Bank, World Development Reports 1990 and 1991, New York. Oxford University Press, 1990 and 1991: United Nations, World Population Pmspects, 1990 (STIESAISERAI~~O). New York 1991: and United Notiom Development Pro ramme, Human Development Report, 1990. New York, Oxford ~nivwsity bress, 1990. ' Excludes countries with populatiom of less than 1 million. '1989; '1 985-90; '1985-90; *1985: '1990. - TABLE I Basic Indicators (continued) GNP Per Capita lnhnt Qrowth Mortdly -- Rat* Amount' 186688 1p.r 1000 U h b l b l Expaoasnoy' Congo Cote d'lvoire Gabon Mauritius Nemibia Reunion South Africa Senegal Zimbabwe North A r i a Algeria Egypt L bia d0~OCCO Tun~s~a Latin Amcvica and the Caribbean A entina ~zvia Brazil Chile Colombia Costa Rica Cuba Dominican Rep. Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico Trinidad 81Tob. Uruguay Venezuela Asia 8 Middle East 631 3.7 73 59 47 71 35 Afghanistan -- -- 172 41 9 38 42 Bangladesh 180 0.4 119 51 19 45 44 Bhutan -- -- 128 48 19 45 40 Cambodia -- -- 130 48 17 41 35 China 350 5.4 32 69 55 80 26 Cyprus 7,040 -- 12 76 85 93 26 Fiji 1,650 -- 27 64 75 85 37 - TABLE I Bask lndkatm Icontinuad) Hong Kong 10,350 India 340 Indonesia 500 Iran, Islamic Rep. 3,200 Iraq -- Israel 9,790 Jordan 1,1640 Korea, PDR -- Korea, Rep 4.400 Kuwait 16,150 Lao, PDR 180 Lebanon -- Malaysia 2,160 Mongolia -- Myanmar -- Nepal 180 Oman 5,220 Pakistan 370 Papua New Guinea 890 Phdippines 710 Saudi Arabia 6,020 Sin apore 10,450 Sri fanka 430 Syrian Arab Rep. 980 Taiwan" -- Thailand 1,220 Turkey 1,370 U. Arab Emirates 18,430 Vietnam -- Yemen 650 Eastern Evope Albania Bulgaria Czechoslovakia Hungary Poland Romania Yugoslavia U.S.S.R. OECD countrbs Australia 14.360 1.7 8 76 -- -- 22 Austria 17,300 2.9 11 74 -- -- 17 Belgium 16,220 2.5 10 75 -- -- 18 Canada 19.030 2.7 7 77 -- -- 21 Finland 22;120 3.2 6 75 -- -- 19 France 17,820 2.5 8 76 -- -- 20 Germany 20,440 2.4 9 75 -- -- 16 'A province of China: 7data not available: these are approximations. - TABLE I Basic Indicators - (continued) ONP R r Carlta Inhnt % Ap. Oromh Mod* Smut.' -- Rah Amount' 1966-88 (wr 1000 blrth.l' Uh h r m ~ v ' % Ubntd 0-14 Ireland 8,710 2.0 9 74 -- -- 28 Italy 15,120 3.0 11 76 96 98 17 Japan 23,810 4.3 5 78 -- -- 18 Netherlands 15.920 1.9 8 77 -- -- 18 .- - - New Zealand 12;070 . .- 0.8 11 7 75 77 -- -- -- -- 23 19 Norway 22,290 3.5 Sweden 21,570 1.8 6 77 -- -- 17 Switzerland 29,880 1.5 7 77 -- -- 16 United Kingdom 14,610 1.8 9 10 75 76 -- -- -- -- 19 21 United States 20,910 1.6 TABLE II - Population and Population Growth Rates: Past and Current Growth Ratw - Population (in millions) Average Annual World' 2,516.4 5,292.2 6,260.8 1.9 1.7 1.7 More Developed 788.6 1,150.1 1,206.4 1.1 0.6 0.5 Less Developed 1,678.4 4,070.6 4,978.3 2.3 2.1 2.0 Africa 221 .O 639.3 862.7 2.6 3.0 3.0 Sub Saharan 178.4 624.1 717.6 3.9 4.6 3.0 Low income 146.0 429.7 692.6 2.6 3.1 3.2 Benin 2 .O 4.6 6.4 1.8 2.9 3.2 Burkina Faso 3.7 9.0 12.1 2.1 2.6 3.0 Burundi 2.5 5.5 7.4 1.7 2.8 3.0 Central African Ren. 1.3 3 .O 4.1 1.9 2.7 2.9 Chad Ethiopia Gambia Ghana Guinea Guina-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambtque Niger Nigeria Rwanda Sierra Leone Somalia Sudan Tanzania Togo Uganda Zaire Zambia Medium income 33.4 94.4 126.0 2.6 2.8 2.8 Angola 4.1 10.0 13.3 2.1 2.6 2.8 Botswana 0.4 1.3 1.8 2.8 3.7 3.3 Cameroon 4.5 11.8 16.7 2.2 3.1 3.4 Conoo 0.8 - ~- 2.3 3.2 2.4 3.1 3.3 ~oted'lvoire 2.8 12.0 17.6 3.6 3.8 3.8 Gabon 0.5 1.2 1.6 1.8 3.7 3.2 Souce: Population Council, New York, September 1991. Excludes countries with popdatiotw of leas than half a million. ' Baaed on UN median ro-ection in United Natione. World Popuhtion Prospects, 1990, New Y W ~ 1991. , TABLE II - Population and Population Growth Rates: Past and Current (continuedl Growth Rates - Population (in millions) Averaqe Annual Reunion 0.3 0.6 0.7 2.3 1.6 1.5 Mauritius 0.5 1.1 1.2 2.2 1.1 1.0 Namibia 0.7 1.8 2.4 2.2 3.1 3.1 S. Africa 13.7 35.3 43.7 2.4 2.2 2.1 Senegal 2.5 7.3 9.7 2.7 2.8 2.8 Zimbabwe 2.7 9.7 13.1 3.2 3.1 3.0 North Africa 42.6 116.2 145.1 2.4 2.6 2.3 Algeria Eav~t LiLya Morocco Tunisia Latin Amerka and the Caribbean 164.2 445.2 536.2 2.6 2.1 1.8 A entina 17.1 dvia 2.8 Brazil 53.4 Chile 6.1 Colombia 11.9 Costa Rica 0.9 Cuba 5.9 Dominican Republic 2.4 Ecuador 3.3 El Salvador 1.9 Guatemala 3.O Guyana 0.4 Haiti 3.3 Honduras 1.4 Jamaica 1.4 Mexico 28 . O Nicaragua 1.1 Panama 0.9 Paraguay 1.4 Peru 7.6 Puerto Rico 2.2 Trinidad & Tobago 0.6 Uruguay 2.2 Venezuela 5.0 Ania a Middle Eaet 1,294.4 Afghanistan 9.0 Bangladesh 41.8 Bhutan 0.7 Cambodia 4.3 China 554.8 Cyprus 0.5 Fiji 0.3 Hong Kong 2.0 India 357.6 Indonesia 79.5 - TABLE I1 Population and Population Growth Rates: P a t and Cwrent (continued) Growth Raten - Population (in millions) Average A n n d 1950- 1980- 1990- Country - 1960 - 1990 2000' 1980 1990 2000 Iran, Islamic Rep. Iraq Israel Jordan Korea, PDR Korea, Rep Kuwait Lao. PDR ~ebanon Malaysia Mongolia Myanmar Nepal Oman Pakistan Papua New Guine Philippines Saudi Arabia Sin apore Sri tanka Syria TaiwanZ Thailand Turkey U. Arab Emirates Vietnam Yemen Eaetern Europe Albania Bulgaria Czechoslovakia Hungary Poland Romania Yugoslavia U.S.S.R. OECD countriee Australia Austria Belgium Canada Denmark Finland France Germany Ireland Italy A province of China. TABLE P - Population and Poplrlation Growth Rot-: Post ond Curent lcontinuedl Po~ulation (in milliina) Growth R a m Avwaae Annual - Japan 83.6 123.5 128.5 1.1 0.6 0.6 Netherlands 10.1 15.0 15.8 1.1 0.6 0.6 New Zealand 1.9 3.4 3.7 1.6 0.9 0.8 Norway 3.3 4.2 4.3 0.7 0.3 0.3 Sweden 7.O 8.4 8.6 0.6 0.2 0.1 Switzerland 4.7 6.6 6.8 1.0 0.4 0.2 United Kingdom 50.6 57.2 58.4 0.4 0.2 0.2 United States 152.3 249.2 266.1 1.3 0.9 0.7 - TABLE Ill Projected Population Levds by Country (in millione) County - 1990 zoo0 2026 2060 2100 World' 6,220.8 6,023.3 7,766.6 8,911.9 9.706.6 More Developed 1,160.1 1,212.9 1,318.4 1,338.0 1,347.0 Less Developed 4,070.6 4,832.8 6,447.2 7,673.9 8,369.0 Africa 639.3 827.4 1,226.9 1,647.6 1,807.8 Sub Saharan 626.1 687.7 1,033.2 1,314.1 1,649.3 Low income 429.7 567.6 866.9 1,094.0 1.296.9 Benin 4.6 6.2 9.2 11.7 13.7 Burkina Faso 9.O 11.3 16.0 19.8 23.1 Burundi 5.5 7.2 10.7 13.8 16.5 Central African Rep. 3.0 3.8 5.5 6.9 8 .O Chad 5.7 6.9 9.5 11.5 13.6 Ethiopia 49.2 67.3 101.9 130.1 155.4 Gambia 0.9 1.1 1.5 1.8 2.1 Ghana 15.0 19.4 28.9 36.6 42.8 Guinea 5.8 7.1 9.9 12.2 14.4 Guinea-Bissau 1.O 1.2 1.6 2.0 2.4 Kenya 24.0 32.6 51.3 66.9 77.9 Lesotho 1.8 2.2 3.2 4.0 4.6 Liberia 2.6 3.3 5.O 6.2 7.2 Madagascar 12.0 14.9 21.7 27.1 31.7 Malawi 8.8 11.3 17.2 21.7 25.8 Mali 9.2 10.7 15.8 20.0 23.6 Mauritania 2.0 2.4 3.5 4.3 5.1 Mozambique 15.7 20.3 29.8 37.4 44.2 Niger 7.7 9.9 14.8 18.8 22.4 Nigeria 108.5 155.0 236.5 303.3 359.3 Rwanda 7.2 10.0 16.5 21.9 26.8 Sierra Leone 4.2 5.O 6.7 8.1 9.4 Somalia 7.5 O 8. 11.5 14.3 16.8 Sudan 25.2 32.2 46.6 58.4 68.7 Tanzania 27.3 32.0 47.9 60.8 71.7 Togo 3.5 4.9 7.4 9.7 11.5 Uganda 18.8 23.2 35.8 46.5 55.6 Zaire 35.6 47.0 72.9 94.4 112.7 Zambia 8.4 11.1 18.0 23.7 28.5 Mediumincome 94.4 120.2 176.3 220.1 263.6 Angola 10.0 12.6 18.2 22.7 26.8 Botswana 1.3 1.6 2.3 2.9 3.2 Cameroon 1 1.8 15.9 25.3 33.3 39.4 Congo 2.3 3.1 5 .O 6.6 7.9 Cote d'lvoire 12.0 17.1 27.9 36.6 44.2 Gabon 1.2 1.5 2.1 2.8 3.3 ~auritius Namibia Reunion Source: World Bank Data Files Note: The projections asrume that each "Less Developed" country will increeae in the use of contreceptives at the maximum ossible rate. They approximate the World Bank's emtimate of "rapid" reducgns in H i rat-. Excludes countries with poprdatione of less than half a million. - TABLE Ill Projected Population Levelr by Country (In millions) (continued) South Africa 35.3 42.6 57.7 68.3 75.4 Senegal 17.3 9.3 13.8 17.6 20.9 Zimbabwe 9.7 12.4 18.1 22.3 24.6 North Africa 115.2 139.7 193.7 233.3 268.5 Algeria & t : ''; a Morocco Tunisia Latin America and the Caribbean 446.2 516.3 686.9 798.9 860.6 A entina Bxvia Brazil Ch~le Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala ~uyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico Trinidad & Tobago Uruguay Venezuela Asia & Middle Eart 2,990.7 Afghanistan Bangladesh Bhutan Cambodia China Cyprus Fiji 0.8 Hong Kong 5.9 India 853.1 Indonesia 184.3 Iran, Islamic Rep. 54.6 Iraq 18.9 Israel 4.6 Jordan Korea, PDR TABLE Ill - Rojectetd Population Levels by Country (in rnillimrm) (continued) Korea, R~D. 42.8 46.7 53.4 55.2 55.1 Kuwait . 2 .O 2.8 3.9 4.4 4.6 Lao, PDR 4.1 5.3 7.7 9.7 11.4 Lebanon 2.7 2.9 3.9 4.8 5.2 Malavsia 17.9 21.4 - 29.3 -. 34.7 37.3 ~ondolia 2.2 2.6 3.8 4.7 - 5.2 Myanmar 41.7 50.1 68.0 81.2 90.0 Nepal 19.1 23.5 32.6 39.6 45.5 Oman 1.5 2.2 3.6 4.8 5.6 Pakistan 122.6 149.9 225.7 285.8 332.4 Papua New Guinea 3.9 4.8 6.5 8.1 9.3 Ph~lippines 62.4 72.9 98.5 117.2 128.3 Saudi Arabia 14.1 20.7 - 33.5 44.0 51.7 Sin apore 2.7 3 .O 3.4 3.5 3.5 Sri fanke 17.2 18.9 23.7 26.5 27.9 Syrian Arab Rep. 12.5 17.4 28.5 37.8 44.2 Taiwan' -- 22.1 25.7 26.7 26.6 Thailand 55.7 63.8 82.6 94.1 100.4 Turkey 55.9 67.2 89.1 103.8 112.4 U. Arab Emirates 1.6 1.9 2.4 2.5 2.7 Vietnam 66.7 81 .O 112.3 135.0 147.4 Yemen 11.7 15.6 24.4 31.8 38.1 Eastern Ewopo 124.0 128.0 139.7 146.9 162.7 Albania 3.2 3.8 4.9 5.6 5.9 Bulgeria 9.O 8.4 8.4 8.5 8.6 Czechoslovakia 15.7 16.1 17.6 18.4 19.1 Hungary 10.6 10.4 10.4 10.4 10.5 Poland ...- ~ .-. 38.4 - - .. 39.5 43.7 46.4 48.7 .- ~ Romania 23.3 24.5 27.1 29;i 30.6 Yugoslmia 23.8 25.2 27.6 28.6 29.3 US2S.R. 288.6 307.9 362.6 379.3 397.4 OECD counfrh 733.0 771.6 819.0 803.9 788.8 Australia 16.9 19.5 23.1 23.9 23.9 Austria Belgium Canada Denmark Finland France Germany Ireland Italy Japan Netherlands New Zealand Norway Sweden Switzerland 6.6 6.9 6.9 6.5 6.2 United Kingdom 57.2 58.9 61.36 1.2 60.9 United States 249.2 271.7 309.1 314.1 315.9 ' A province of China. - TABLE IV FerUity Rah. and Contraceptive Use in D w d o in Countries ( h r o c b t a d with the population projection in la& )!I Fertilitv Rates Contraceptive Use' Country - - 2000 19ab isso - - - 2626 1930 - - 2000 2026 World' 6.0 3.48 2.65 2.13 53.8 66.4 73.6 MoreDwJoped 2.6 1.92 1.88 2.04 71.3 70.7 66.6 h s Developed 6.1 3.92 2.83 2.14 60.6 64.4 74.7 Afrka 6.8 6.13 4.14 2.20 16.6 43.7 72.9 SubSaharan 6.6 6.09 4.13 2.19 10.8 44.6 73.6 Low income 6.8 6.69 4.63 2.23 7.8 37.4 72.2 Benin Burkina Faeo Burundi Central Afr. Rep. Chad Ethiopia Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambique Niger Nigeria Rwanda Sierra Leone Somalia Sudan Tanzania Togo Uganda Zaire Zambia Medium income 6.6 6.49 3.73 2.16 32.6 61.6 74.9 Angola 6.4 6.47 4.40 2.28 3.0 32.8 68.6 Botswana 6.9 4.81 2.72 2.06 35.0 65.0 75.0 Cameroon 6.1 6.47 4.72 2.13 2.0 28.6 71.5 Congo 6.1 6.56 5.13 2.17 11.2 30.1 74.0 Cote d'lvoire 7.4 7.32 5.28 2.24 3.0 30.0 73.8 Gabon 4.1 5.71 4.89 2.22 30.8 39.8 75.7 Source: F M i rat- are from World Bank D a u Files: contraceptive uee ie from The Population Council Data Bank. Exdudes counirms with populatiom of lees than half a million. ' Pwcentage of married women of childbearingage hf a m i l i ushg contracep- tion. - TABLE IV Fertiltty Rater and Contraceptive Uue in Developing Countriw (continued) Fertilitv Rates Contraceptive Use' Country - - - 1965 1990 2000 2026 1990 2000 2026 Mauritius Namibia Reunion S. Africa Senegal Zimbabwe North Africa Algeria ; : i t Morocco Tunisia Latin America and the Caribbean 6.8 3.37 2.36 2.09 60.3 72.6 76.3 A entins ~ % vai Brazil Chile Colombia Costa Rica Cuba Dominican Rep. Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico Trinidad & Tob. Uruguay Venezuela Asia & Middle East 6.0 3.63 2.69 2.13 66.1 68.2 76.0 Afghanistan 7.1 6.90 4.50 2.61 1.6 35.0 65.1 Bangladesh 6.8 4.88 3.20 2.28 32.9 55.3 70.0 Bhutan 5.9 5.53 3.52 2.38 8.9 41.3 62.8 Cambodia 6.3 4.56 3.20 2.20 23.8 46.8 65.8 China 6.0 2.47 2.12 2.08 74.9 78.5 79.0 Cyprus 3.1 2.23 2.09 2.07 71.1 73.4 73.6 Fi~i 5.3 3.05 2.18 - ~ 2.08 44.7 61.9 64.0 ~blno Kono 4.7 1.55 1.60 2.00 82.6 81.9 75.8 lndia - 5.7 4.00 2.68 2.14 44.9 64.1 72.7 Indonesia 5.5 3.25 2.27 2.10 52.2 68.0 70.9 Iran, Islam. Rep. 7.1 6.0'3 3.50 2.12 30.8 58.7 77.1 - TABLE IV Fertaity Rater and Coneaceptive Ure in Developing CounViea (continued) Fertility Rates Contraceptive Use' Countrl - - 2026 - 2000 1966 1990 - - 1990 - 2000 - 2026 Iraq Israel Jordan Korea, PDR Korea, Rep Kuwait Lao, PDR ~ebanon Malaysia Mongolia Myanmar Nepal Oman Pakistan P. New Guinea Philippines Saudi Arabia Sin apore ~ r i fanka Syrian Arab Rep. Taiwan' Thailand Turkey U. Arab Emirates Vietnam Yemen Eartern Euope 2.4 2.06 2.04 2.08 67.6 67.8 67.3 Albania 5.4 2.97 2.18 2.08 60.9 72.2 73.8 Bulgaria 2.2 1.90 1.91 2.06 76.0 75.8 73.5 Czckhoslovakia 2.2 2.00 2.01 2.06 75.0 74.9 74.0 Hungary 1.9 1.81 1.83 2.05 74.0 73.6 69.5 Poland 2.5 -.- 2.10 -. .- 2.11 2.09 -. .- 75.0 . - .. 75.0 . - .- . - .- 75.3 ~omania 2.5 2.13 5:ii 2.08 58.0 58.5 59.2 Yugoslavia 2.6 2.00 2.01 2.07 55.0 54.8 52.9 U.S.S.R. OECD counviea Australia Austria Belgium Canada Denmark Finland France Germany Ireland Italy Japan Netherlands New Zealend ' A province of China. TABLE IV - Fertility Ratea and Contraceptive Use in Developing Countrks (continued) Fertilitv Ratee Contraceptive Use' Couney - - 2000 1965 1990 - - - 2025 1990 2000 2026 Norway 2.8 1.80 1.82 2.03 71.0 70.5 66.2 Sweden 2.2 1.98 1.98 2.06 74.8 74.6 73.4 Switzerland 2.4 1.65 1.69 2.02 71.0 70.1 62.4 United Kingdom 2.7 1.84 1.86 2.04 82.5 82.3 80.1 United States 2.9 1.88 1.89 2.04 68.2 67.9 64.7 - TAME V lends in Average Number of Children D w i e d among Married Women. 1 9 7 h vs. 1980s Data of Mean Number of F i d Work Children Desied Percent Countw - 1970s - 1980s - 1970a - 1980s - Decline Sub-Saharan Africa Ghana 1979180 1988 6.0 5.5 9 Kenya 1977ff8 1988189 7.2 4.7 35 Senegal 1978 1986 8.3 7.1 14 North Afrim Egypt 1980 1988189 4.1 2.9 29 Morocco 1979180 1987 4.9 3.7 24 Tunisia 1978 1988 4.1 3.5 17 Ask Indonesia 1976 1987 4.1 3.2 22 Sri Lenka 1975 1987 3.8 3 .O 21 Thailand 1975 1987 3.7 2.8 24 Latin America Colombia 1976 1986 4.1 3 .O 27 Dominican Rep. 1975 1986 4.6 3.6 22 Ecuador 1979 1987 4.1 3.3 19 Mexico 1976 1987 4.4 3.3 26 Peru 1977178 1986 3.8 2.9 24 Trinidad 81Tob. 1977 1987 3.8 3.1 18 Souce: Charles F. Wwtoff, "ReproductiveReferences: A Com arative View,' Demographic and HemM Survey# Comparative Studioa, no. Reaouce DwelopmentNacro Systems, Inc., February 1991. g, I~~~titute,for TABLE V I - Evaluation of Family Planning Programs in Developing Countrb Very Weak Strong Moderate or None Bangladesh Algeria Afghanistan Argentina Botswana Chlle Angola Bhutan China Colombia Benin Cambodia El Salvador Costa Rica Bolivia Chad India Cuba Brazil Cote d'lvoire Indonesia Dominican Rep. Burkina Faso Gabon Korea, Rep. Ecuador Burundi Iraq Mexico Cameroon Kuwait Sri Lanka Taiwan' :BY,:\ Guatemala Central African Rep. Lao, PDR Congo Lib a Thailand Guyana Ethiopia ~arawi Tunisia Honduras Guinea Myanmar Vietnam Iran, Islamic Rep. Guinea-Bissau Namibia Jamaica Haiti Oman Kenya Jordan Saudi Arabia Korea, PDR Lesotho Somalia Lebanon Madagascar Sudan Malaysia Mali U. Arab Emirates Maur~tius Mauritania Morocco Mozambique Nepal Niger Pakistan Nigeria Panama Papua New Guinea Peru Paraguay Philippines Rwanda South Africa Senegal Singapore Sierra Leone Trin~dad & Tob. Syrian Arab Republic Venezuela Tanzania, United Republic Zambia Togo Zimbabwe Turkey Uganda Uruguay Yemen Zaire Source: W. Parker Maudlin and John A. Rosa, "Family Plannin Programs: Efforts and Results. 1982-1989," Studies in Famiw Uantdng, vof 22, no. 6. Nov./Dec. 1991. ' A province of China. TABLE VII - Sources of Foreign Aesmtance for Population Activiiee - 1989 (in millin US dollare) Counlry Amount Parcentaae of GDP Parcentage of ODA Australia 5.4 .00205 Austria 0.2 ,0001 4 Belgium 1 .O ,00064 Canada 31.9 .00603 Denmark 18.4 .01823 Finland 15.7 .01395 France 0.7 .00007 Germany 31 - 3 .0026 Italy 2.9 .00033 Japan 59.9 .00211 Netherlands 33.0 New Zealand 0.4 Norway 43.7 Soviet Union 0.5 Sweden 34.4 Switzerland 5.4 United Kingdom 28.5 United States 247.7 TOTAL 661.0 World Bank 125.4 Private Sources 39.3 UNFPA Trust Fund 31.1 GRAND TOTAL 766.8 Source: United Nations Population Fund, Global Population Adatanee Repor) 1982-1989, New York, 1989. Glossary Carrying Capacity: The maximum sustaninable size of a resident population in a given ecosystem. Contraceptive Prevalence Rate: The percentage of couples of repro- ductive age who are using some method of family planning. Crude Birth Rate (CBR): The number of births, per year, per 1,000 of population. Crude Death Rate (CDR): The number of deaths, per year, per 1,000 of population. Doubling Time: The number of years required for a population of an area t o double its present size, given the current rate of population growth. Infant Mortality Rate: The number of deaths, per year, of infants aged 0-12 months, per 1,000 live births. Life Expectancy at Birth: The average number of years newborn children would live if subject to mortality risks prevalent for the cross- section of the population at the time of their birth. Maternal Mortality Rate: The number of deaths to women due to pregnancy and childbirth complications per 100,000 live births in a given year. Net Reproductive Rate (NRR): The number of daughters a woman would have, under prevailing fertility and mortality patterns, who would survive t o the mean age of childbearing. Rate o f Natural Increase (N1):Thedifference between the crude birth rate and the crude death rate, usually expressed as a percentage. Rate o f Population Growth: The rate of natural increase, adjusted for migration, and expressed as a percentage of the total population in a given year. Replacement-Level Fertility: A level of fertility equivalent to a Net Reproductive Rate of 1 .O-thelevel at which childbearing women, on the average, have enough daughters t o replace themselves in the population. Stationary Population: A population that for a long time has had a constant replacement-level fertility and therefore also has a growth rate equal to zero and a constant age composition. Total Fertility Rate ('rFR):'rhenumber of live birthsan averagewoman would have if during her lifetime her childbearing behavior were the sameas that of the cross-section of women at tketimeof observation. A total fertility rate of 2.1 is equivalent to replacement-level fertility. "Unrnet Demands": The number or percentage of married women who say they either want to limit the number of births or space them more than two years apart but are not using family planning. Acknowledgements Although my association with global population issues extends back a quarter of a century, I have not been a student of thesubject in recent years. It would not have been possible, therefore, for me to prepare this statement without the assistance of experts in the field: demog- raphers, economists, physical scientists, and administrators of family planning programs. A host of them came to my aid. Needless to say, I, and not they, am totally responsible for the structure of the argument and the judgments, conclusions and recommendations which follow from it. I am particularly indebted to five organizations: The Population Crisis Committee, The Population Reference Bureau and The World Bank in Washington; and The Population Council and United Nations Population Fund in New York. Members of their staffs, from whom I received extensive assistance, are listed below, along with others who reviewed part or all of successive drafts. Their comments were occasionally caustic, often critical, but always stimulating. They added to my knowledge and frequently caused me to modify my premises and revise my conclusions: Hirofumi Ando, David E. Bell, Nancy Birdsall, John Bongaarts, Lester R. Brown, Lincoln C. Chen, Leif E. Christoffersen, Herman E. Daly, Paul Demeny, Alex De Sherbinin, Anne H. Ehrlich, Alene Gelbord, Ann 0. Hamilton, Donald D. Hinrichsen, Edward V. K. Jaycox, Sasha Loffredo, John L. Maddux, Jessica T. Mathews, John W. Mellor, Thomas W. Merrick, Gayl D. Ness, Sandra Purcell, Moeen A. Qureshi, Nafis Sadik, John W. Sewell, Steven W. Sinding, Jyoti 5 . Singh, James A. Socknat, J. Joseph Speidel, James Gustave Speth, Andrew D. Steer, Lawrence H. Summers, Nancy Yinger, and George Zeidenstein. lshrat Husain and Paul Shaw deserve particular recognition. They were responsible for much of the research relating to Sub-Saharan Africa. Jeanne Moore, my never complaining secretary, worked through innumerable drafts to produce the final text. I am enormously grateful to all.