NPG Position Paper: Beyond Family Planning by Anthony Wayne Smith

The African famine, with the probable death of hundreds of thousands of people from starvation, despite heroic efforts at food relief, points up the serious imbalance between population and resources.

Recent studies forewarn us that Sub-Saharan Africa may be going through a fundamental process of permanent desiccation as a result of over-grazing and deforestation, both stemming from catastrophic population pressures on the land.

The need for an accelerated program of population stabilization and reduction, certainly not only in Africa, becomes glaringly apparent. The warning signals were flying forty years ago and more. How can the leadership of the human race have failed so miserably'?

Two schools of thought have been at war for twenty years and longer: the socioeconomic development school and the family planning school. The former has held that development brings demographic stabilization; the latter that planned parenthood does so.

The difficulty with the developmental theory is that the experience of the last decade in too many countries disproves it. In more and more nations, development has been overwhelmed by the population explosion. The cost of merely keeping people alive in abject poverty has prevented the investments in agriculture, industry. education, health, and balances of trade which are necessary to complete the demographic transition.

The need for an accelerated program of population stabilization and reduction, certainly not only, in Africa, becomes glaringly apparent. The warning signals were flying forty years ago and more. How can the leadership of the human race have failed so miserably?

This is not to dispute the obvious: that the industrialized countries have low fertility rates, and that these have been associated with urbanization and industrialization by processes which are well understood. There are exceptions, of course, such as the baby boom in the United States, which suggest that something more than blind developmental economics will be needed for long-term demographic security. But the trouble is that in a rising number of the emerging nations socioeconomic development efforts have not kept pace with population growth, and the situation is going from bad to worse.

In one sense, of course, the dispute is irrelevant. Taken separately or together, development as it has been practiced and family planning as it has been practiced, have as a matter of history, failed. Famine, civil war, social conflict, poverty, political and economic instability, and environmental and ecological breakdown are among the dominant realities of our times. True, some little corners have been turned: fertility and rates of growth have declined slightly in recent years world-wide (in large part due to China), but absolute growth has accelerated as the result of generational momentum; actual population climbs and will continue to climb for a long time toward levels far beyond the carrying capacity of the planet. A greatly intensified effort at stabilization and reduction is needed.

And now comes Donald J. Hernandez with his book Success or Failure? Family Planning Programs in the Third World, (Greenwood Press. Westport. CT ($29.95)) to say that family planning has been but marginally successful, and that such reductions in birth rates as have occurred would have taken place anyway for the most part as the result of changes in the socioeconomic situation, and that neither family planning nor socioeconomic development as presently conducted will be sufficient. Incentives for small families, and development targeted toward family size reduction, will be necessary. The imprimatur of Kingsley Davis as editor of the series in which the book appears, Studies in Population and Urban Demography, helps to stamp it with authority.

The rigorous application of scientific method is always a pleasure to behold. Hernandez looks at the methodologies used in the past in judging the efficacy of family planning programs and concludes that they have been seriously flawed. He examines the potentials of controlled scientific inquiry and designs approaches better fitted to get the facts.

He then undertakes to apply the improved methodologies to the experience of four countries and to a transnational aggregate. He concludes that the family planning program in Taiwan accounted for only 11 percent of the reduction in the crude birth rate between 1965 and 1975; in South Korea between 1 and 10 percent between 1968 and 1971; in Costa Rica between 4 and 13 percent, but probably closer to 4 percent between 1968 and 1971; and in Mauritius a dubious 34 to 51 percent between 1965 and 1975. In the cross-national study of 83 Third World countries, family planning accounted for between 3 to 10 percent of the fall between the late 1960's and the early 1970's. In all these cases, trends were already in evidence which, if properly projected, would have indicated most of the result anyway. Conclusion: that whatever the value of family planning as a humanitarian measure, it has not been markedly successful as a means of population stabilization. One might add that population stabilization is the world's most desperate humanitarian cause.

Does this mean that the family planning effort should be relaxed or abandoned'? Of course not; even the marginal contribution it makes to fertility reduction is to be welcomed. And its contribution to maternal and child health and, in terms of contraception, to the reduction of abortion and infanticide, justifies itself. If conducted with a view toward the reduction of desired family size, and not merely reproductive freedom, it can serve the necessary moral education. But it cannot be relied upon, without more, for population stabilization.

Most emphatically, on the other hand, the findings do not mean that we can fall back on generalized socioeconomic development as the solution to the population problem. The leaders of too many less-developed countries know by now full well that development, in which they trusted so implicity as recently as the Population Conference of 1974, will not take place if burdened with run-away populations. They said so at the Population Commission meetings in New York a year ago, and again ai Mexico City last summer.

The answer, first of all, is to drive ahead with incentive systems to reduce desired family size. Such systems must be added to development and family planning. They must get an increasing share of domestic and international budgets. We can no longer afford reliance on either hoped-for development or planned parenthood without more. It has to be planned parenthood for sub-replacement families induced by incentive systems, and development targeted at family-size reduction. This runs against the grain of most conventional thinking about voluntary parenthood. That thinking has to change.

The customary distinction between incentives and disincentives is useful. An incentive is a benefit given to a family which keeps its family small, such as a cash payment to persons accepting voluntary sterilization. A disincentive is a penalty imposed on parents with large families, such as the loss of scholarships for the third and fourth child. Hernandez argues for incentives and against disincentives, on the ground that disincentives limit freedom. But freedom is never unlimited, and in respect to population matters, human welfare is more gravely undercut by congestion than by limits on the size of families induced by disincentives.

This is a tragic day for the family planning movement. The agencies and organizations which have carried the burden for so many years are under assault by the present American Administration, responding to the pressures of the Reactionary Right. Funds for the International Planned Parenthood Federation and the UN Fund for Population Activities have been heavily cut on the ground that programs or countries availing themselves of their support in some measure permit or support abortion (though no American funds are used for these purposes). The result will be the diminished use of contraceptives, more unwanted pregnancies, and more abortions, indeed more infanticide. And so one hesitates before the facts; that family planning has not been sufficiently successful as a program for the reduction of fertility. But the truth has to be faced.

Whether one thinks that disincentives, imposing minor burdens in comparison with the greater good, should also be employed, may depend on one's appraisal of the seriousness of the situation. The evidence runs against complacency from both the humanitarian and the ecological-point of view. Southeast Asia, Sub-Saharan Africa, the Amazon basin, all tell us that time is running out. All the non-coercive approaches - including in that category, social counter-pressures against the traditional large family, and including cash payments to acceptors - will have to be employed. Or else the result will shortly be indescribable human misery and the collapse of the global biosystem.

The necessary acceleration, in the opinion of a growing number of observers, means socioeconomic incentives and disincentives, both individual and community. It means social counter pressures to neutralize traditional pressures for large families. It means targeting for sub-replacement fertility rates; that is, for the two-child family, and in many countries, as in China, the one-child family. It means the universal availability of family planning materials and services by the year 2000 at the latest. And it should mean a crusade by religious organizations for the humane purposes of the small family.

It means expanded, not contracted, development aid, but focussed on programs useful for population stabilization; e.g., education, not dams; local food production by indigenous methods; the employment of women outside the home. It means the conditioning of loans and grants by unilateral and multilateral public and private credit institutions on the adoption and implementation of population stabilization programs, and strict reporting on compliance. It means warnings that food aid cannot go on indefinitely unless population is brought under control.

It means total fertility rates of two or less by the year 2000; if Bangladesh can set that target, others can. It means population stabilization everywhere by 2020 as a goal, not a complacent 2080 or later; but not as a goal only, but coupled with specific and realistic programs to reach the goal, with annual reports to a world agency on the measure of progress. And it means a world-wide effort directed toward individual couples to teach the morality of the small family in terms of the welfare of family members, the local community, and the nation and society as a whole. Human beings are driven by conscience no less than economics; and conscience in the end by reason; every man and woman on the planet needs to understand what the population crisis is, so that the family may adjust its conduct accordingly.

Governments everywhere should be setting up official policies and programs for the stabilization and reduction of population. The programs must be more than words, and must include schedules for implementation. They should be supported by realistic budgetary analysis; that is, they should attempt to forecast the beneficial effects of stabilization on reduced costs for health care, education, housing,. food, and welfare, and the increased ability to finance industrial growth, agricultural modernization, environmental protection, and trade-deficit reduction.

For example, the rapid adoption of payments to acceptors for voluntary sterilization, a program which has been successful in Sri Lanka and elsewhere, accompanied by thorough-going education as to practical irrevocability, and with strong safeguards against actual compulsion, could solve many national budgetary problems in a generation's time and set a country on a road to stable prosperity.

Millions of people starve and sink in poverty. The world credit structure totters. Austerity is imposed which imperils fragile democracies. Unemployment rises world-wide. American industry, pursuing cheap labor, moves abroad. American consumers, pursuing cheap goods, buy from abroad. The American trade deficit overtakes the budgetary deficit. Third World development founders in the crowding. The family planning movement demurs as to incentives. The environmental -movement avoids the issue. The labor movement slumbers in peace. New leadership is needed; it cannot come from the United States government while the present negative mood persists. Can it come from China? India? Africa?

Hernandez has contributed enormously to an understanding of the facts; his book should help launch a new epoch in the population stabilization movement.

Organized efforts to cope with the population explosion have been underway for about 55 years. They have not been remarkably successful.

The first efforts went to sounding the alarm. The great names we associate with those times are William Vogt, Fairfield Osborne, Robert Cook and Hugh Moore. Guy Irving Burch, founder of the Population Reference Bureau, was an even earlier pioneer. The problem of what to do about it, however, was left largely unanswered.

Research in the techniques of family limitation was obviously needed. Generous foundation funding and eventually public financing, were poured into this approach. A wide variety of contraceptive methods is now available. The difficulty is to get people to use them.

Great quantities of contraceptive materials have been produced and shipped into the less developed countries over the years. Large numbers of technicians have been trained and dispersed to teach people how to use them. Clinics have been established everywhere. The problem of acceptance remains.

The development of the sciences and institutions of demography has been another essential response to the challenge. Again the financing provided by foundations and eventually public agencies has been commendable and indispensable. While there has been a tag in the production of statistics on desired family size, the world has been provided with an admirable and necessary body of information. But without action, information is sterile.

The birth control movement, later known as voluntary parenthood or family planning, preceded the population stabilization effort. Insofar as the family planning movement works for freedom to limit family size, its purposes parallel those of the population stabilization effort. But though the family planning movement assumes and contends that family planning will result in smaller families, the movement disavows any such purpose, and substantial evidence now indicates that the necessary reduction is not taking place.

All of us are familiar with the facts and theory of the demographic transition. Urbanization, industrialization, and rising living standards have resulted in lower birth rates in many places. But there is evidence that this may not occur everywhere. There is also abundant evidence that rising population levels impede economic development and rising living standards. Population stabilization and reduction will be needed in many places if economic take-off is to be achieved.

While Vogt and Osborne warned as far back as 1948 that the planetary ecosystem could be gravely endangered if the population trends of that time were to continue, a wide recognition of the deepening crisis by conservationists and environmentalists has been relatively recent. Economists have been slow to acknowledge the impact of population pressures on resources and productivity. It is ardently hoped that economics, ecology, and demography may now be converging.

All these efforts were commendable and indispensable and must be continued, but more is necessary if the challenge of the times is to be met. A growing body of evidence indicates that birth rates, fertility rates, and population growth rates are not falling rapidly enough, if at all, nor in enough places, to result in stabilization, let alone reduction, in time to forestall planetary disaster with untold misery for millions of human beings.

The problem, as more and more people see it, is one of motivation. Warnings about famine, pollution, unemployment and economic breakdown go unheeded by couples all over the world, who see their personal security and prosperity dependent on large families. While they may make use of contraceptives and clinics for spacing, desired family size appears too often to remain four children or more, as does the total fertility rate, indicating that people are having, the number of children they want in most cases, even though four children to a couple will mean doubling of populations every generation, a growth rate the world cannot sustain.

More attention must be given to problems of ethical norms and economic and other motivation. If the facilities available for population stabilization and reduction are to be used by the people who make the crucial decisions as part of their personal lives, the desire for small fan-Lilies and the understanding of their importance must be achieved by the great majority of human beings all over the world. Only so, incidentally, can we avoid those changes in the weather of public opinion which often undo vital advances from generation to generation.

A number of countries have instituted motivational systems and brought fertility rates and desired family size down sharply. We know enough about these systems now to be reasonably sure that it can be done. Objectives and methods will vary from country to country. In most cases, eventually the norm will be the two-child maximum; in others, where more drastic measures are clearly needed, the one-child family will be the norm for several generations. Social pressures and economic incentives and disincentives must be applied toward these ends. Overseas aid programs should be directed toward these purposes.

There will be disagreement among private organizations about these conclusions. Many are engaged in other work from which they should not be diverted. What is needed is not the replacement of present efforts, but their supplementation. Persons and organizations free to focus in any measure on the problems of norms and incentives should undertake to do so; the others, precluded by circumstances or desire from participation, should facilitate and not impede their efforts.

Most of the factors of chaos can he mitigated in some measure by direct remedial attention. The polluting effects of industrialization can be abated to some extent by industrial development for the production of abatement equipment. The destructive effects of a polluter, like the internal combustion engine, can be mitigated by modification or abolition, or by getting the automobile under control. Even the explosion of electric power consumption might be contained in a minor measure by an inversion of rate schedules, or, for example, by going back to windows and sunlight in buildings.

But none of these measures will be adequate, alone or together, unless the population explosion can be contained. The per capita factor compounds every danger. All the signs indicate that for mere survival, let alone civilized living, this Nation and the world are already overcrowded. Population levels must be stabilized and reduced by a rapid lowering of birthrates, and in some countries, like the United States, by the curtailment of immigration.

We suggest that reliance can be placed on two essentially human characteristics: reason and morality. A rational standard of personal conduct must be created to which every individual can repair. The essence of this personal and social standard is a normal family size of not more than two children. The need for the standard must be explained in simple terms to as many human beings as possible and as quickly as possible around the planet, and their help must be obtained in adopting it in their personal lives and recommending it to others.

Population levels must be stabilized and reduced by a rapid lowering of birthrates, and in some countries, like the United States, by the curtailment of immigration.

Step one on a world program for population stabilization and reduction would be a planetary educational effort, coupled with technical and clinical assistance, not merely with respect to the facts and dangers of overpopulation, nor the gains for society in population stabilization and reduction, nor the advantages and methods of family planning, but with respect also to the moral obligation which people owe themselves, their children; their parents, and the community, to stop at two. The need is for both telical and technical education, and the materials and services for implementation, providing not merely facts, but orientation and motivation.

An educational and operating program of this kind, or any such program which is to be realistic and effective, must be couched and practiced in terms of the distinctive cultures and subcultures and by persons closely in touch with the economic and social conditions of the people involved. The work must be done by the teachers, social workers, physicians, and ministers, who are already serving the needs of the people, and in the dialects and against the background of the customs and religions of the particular communities. The necessary technical and economic assistance must come from the world community, in large part from the more affluent nations.

Step two in a rational planetary population program would be to offer economic motivation and security to persons consenting on a completely voluntary basis to terminate fertility permanently after two children. Simple low-risk techniques of oviduct ligation or cauterization are becoming available for women, involving, no external abdominal surgery, and vasectomy is available for men.

The levels at which economic rewards should be set can be determined only by experience. The compensation would be an immediate inducement, but if properly handled could afford a measure of the economic security which parents expect from children in countries without social security systems.

Not the slightest suggestion of any ethnic, economic, national, regional, or other prejudice or discrimination can be allowed to touch the program, lest it destroy itself.

... Mere human survival, and certainly the quality of life for all people on the planet, and even more assuredly the continuing existence of thousands of cherished forms of plant and animal life throughout the globe, hang now in substantial measure on dealing resolutely, intelligently, and with a profound moral understanding, with the basic issue of overcrowding. Let those who profess love for humanity turn their hands to the greatest mercy: toward the stabilization and reduction of human numbers.

Excerpted from an editorial that appeared in the May 1972 issue of National Parks & Conservation Magazine.

Anthony Wayne Smith is Special Counsel to NPG, and is one of the founders of the population stabilization movement in the United States. He served as a Fellow of the Population Reference Bureau at the time Robert C Cook was reorganizing it in 1948. Beginning even earlier, he was associated with William Vogt, Fairfield Osborne, and Hugh Moore, particularly with respect to the environmental aspects of the population explosion.

As president of the National Parks and Conservation Association front 1958 to 1980, Mr. Smith brought the population issue into its programs and writes extensively on population in its Magazine.