Assessing the impact of the "one-child policy" in China: A synthetic control approach.

There is great debate surrounding the demographic impact of China's population control policies, especially the one-birth restrictions, which ended only recently. We apply an objective, data-driven method to construct the total fertility rates and population size of a 'synthetic China', which is assumed to be not subjected to the two major population control policies implemented in the 1970s. We find that while the earlier, less restrictive 'later-longer-fewer' policy introduced in 1973 played a critical role in driving down the fertility rate, the role of the 'one-child policy' introduced in 1979 and its descendants was much less significant. According to our model, had China continued with the less restrictive policies that were implemented in 1973 and followed a standard development trajectory, the path of fertility transition and total population growth would have been statistically very similar to the pattern observed over the past three decades.

The effects of China's universal two-child policy.

In October, 2015, China's one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include: a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. All of these effects should improve health outcomes. Effects of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime, more sound policy actions are needed to meet the social, health, and care needs of the elderly population.

Contraceptive vaccines for wildlife: a review.

Wildlife, free-ranging and captive, poses and causes serious population problems not unlike those encountered with human overpopulation. Traditional lethal control programs, however, are not always legal, wise, safe, or publicly acceptable; thus, alternative approaches are necessary. Immunocontraception of free-ranging wildlife has reached the management level, with success across a large variety of species. Thus far, the immunocontraceptive research and management applications emphasis have been centered on porcine zona pellucida and gonadotropin-releasing hormone vaccines. Contraceptive success has been achieved in more than 85 different wildlife species, at the level of both the individual animal and the population. At the population management level with free-ranging species, the primary focus has been on wild horses, urban deer, bison, and African elephants. The challenges in the development and application of vaccine-based wildlife contraceptives are diverse and include differences in efficacy across species, safety of vaccines during pregnancy, the development of novel delivery systems for wild and wary free-ranging animals, and the constraints of certain non-contraceptive effects, such as effects on behavior. Beyond the constraints imposed by the public and a host of regulatory concerns, there exists a real limitation for funding of well-designed programs that apply this type of fertility control.

Stall in fertility decline in Eastern African countries: regional analysis of patterns, determinants and implications.

We use data from the Demographic and Health Surveys to examine the patterns of stall in fertility decline in four Eastern African countries. Contrary to patterns of fertility transition in Africa that cut across various socio-economic and geographical groups within countries, we find strong selectivity of fertility stall across different groups and regions in all four countries. In both Kenya and Tanzania where fertility decline has stalled at the national level, it continued to decline among the most educated women and in some regions. While fertility has remained at pre-transition level in Uganda over the past 20 years, there are signs of decline with specific groups of women (especially the most educated, urban and those in the Eastern region) taking the lead. For Zimbabwe, although fertility has continued to decline at the national level, stall is observed among women with less than secondary education and those in some of the regions. We link these intra-country variations to differential changes in socio-economic variables, family planning programme environment and reproductive behaviour models. The results suggest that declines in contraceptive use, increases in unmet need for family planning, increasing preferences for larger families, and increases in adolescent fertility were consistently associated with stalls in subgroup fertility across all four countries. These results are consistent with models that emphasize the role of declines in national and international commitments to family planning programmes in the premature stall in sub-Saharan fertility transition.

To have or not to have: the critical importance of reproductive rights to the paradox of population policies in the 21st century.

Reproductive rights continue to be under threat, even some 15 years after the landmark International Conference on Population and Development in Cairo declared the importance of a satisfying and safe sex life, the capability to have children, and the right to decide on the timing, number, and spacing. The right to choose whether and when to have children is at risk both from some who seek to increase birth rates through pronatalist policies and from some who seek a return to "population control" as a response to global climate change, environmental degradation, endemic poverty, global recession, and food shortages. This paper argues the success of the rights-based approach to family planning, reproductive health and health education, and outlines issues and policy responses related to low fertility. This is contrasted with the unmet need for family planning in the poorest countries. It calls for health providers to advocate for reproductive rights, affirming that the freedom of women to control their fertility is the basis for other essential freedoms.

Carrots and sticks: fertility effects of China's population policies.

For 20 years following 1949, average total fertility per woman in China hovered just above six children. The year 1970 marked the beginning of persistent fertility declines. By 1980, the rate had dropped to 2.75, and since 1992 it has remained under 2. While some of this transition can be accounted for by broad socioeconomic developments, the extent to which it is attributable to China's unique population policies remains controversial. This paper analyzes household data from the 1992 Household Economy and Fertility Survey (HEFS) to provide the first direct microeconomic empirical evidence on the efficacy of these policies.

Whither the global population problem.

Growth of the human population has been underway for thousands of years and was never a problem until recently. It is now expanding exponentially, and today global population stands at nearly 6 billion with 97 million being added each year. Currently, overpopulation has led to serious social and environmental problems such as poverty, overcrowded slums, crime, terrorism, pollution of air and water, and depletion of the protective ozone layer. Warnings were sounded, but few listened. The enthusiasm once generated for solving the problem of too many people was short-lived. The press with puzzling abrogation of its responsibility to the public managed to allay all fears of population overgrowth. Two U.S. presidents welcomed such growth as a stimulus to economic development. Although modern contraceptives are safe, effective, and widely available, more are badly needed, but none are in the pipeline. Research is being hampered by hostile attitudes and by the high cost in time and money of bringing a new contraceptive to an uncertain market with the added threat of litigation. At the present rate of growth, the population will double in the next century. This is believed to be beyond the carrying capacity of our planet. Corrective measures by man or nature need to be undertaken.

PIP: The size of the world's human population is growing exponentially at 97 million people annually from the current level of almost 6 billion. Human population growth has only recently become problematic, with overpopulation having led to serious social and environmental problems such as poverty, overcrowded slums, crime, terrorism, air and water pollution, and the depletion of the ozone layer. Few listened to warnings of the danger of runaway human population growth, with 2 US presidents welcoming such growth as a stimulus to economic development. More modern contraceptives are sorely needed. Contraceptive research, however, is being impeded by hostile attitudes and the high cost in time and money of bringing a new contraceptive to an uncertain market with the threat of litigation. At the current growth rate, human population size will double in the next century to a level most likely beyond the carrying capacity of the planet. Either manmade or natural corrective measures are needed to check population growth and achieve a sustainable global human population size.

Determinants of induced abortion and their policy implications in four counties in north China.

A retrospective survey conducted in four counties in North China in 1991-92 shows that the probability of aborting a pregnancy is strongly related to parity. No induced abortions are found prior to the first live birth, and almost universal abortion is shown after the second. Women had a high risk of undergoing abortion after their first live birth because most (82 percent) had become pregnant again without meeting official requirements for late second births with long spacing between births. The likelihood that a pregnancy will be aborted is strongly determined by official family planning policy and regulations. Individual and household socioeconomic status plays a relatively insignificant role. Great variation in the prevalence of induced abortion exists at the county and village levels. In recent years, the incidence of induced abortion has increased among women with one living child. Even a two-child policy, with late childbearing and spacing, can have high social and health costs in a country where childbearing is universal and begins relatively early.

Implementing the ICPD's message.

PIP: The International Conference on Population and Development held in Cairo in September 1994 recognized the need for reducing unwanted fertility and promoting smaller families within reproductive health services along with improving women's equality in education, health, and economic opportunity. The implementation of the main message would require an ideological transformation both for the population and for the development establishments. The implementation of a broadened population policy must incorporate the reduction of gender disparities as the primary goal. The problem is that the UNFPA has no influence over resources allocated to child health, female education, economic opportunities for women, or empowerment of women. Reproductive health and family planning programs should be integrated within the broader health services; however, reproductive health may not receive the desired high priority. Family planning programs are also expected to solve two problems: to improve individual well-being and to reduce overall fertility. Managers are likely to implement the reproductive health approach if it is a cost-effective way of reducing total fertility. However, no evidence exists to show that treating reproductive tract infections is a cost-effective way of reducing fertility. The primary objective of family planning programs should be empowerment of individuals to achieve their own reproductive goals in a healthful manner. Fertility reduction should be linked to fertility reduction by focusing on unwanted childbirth and to reproductive health services. The redesign of contraceptive services from a reproductive health perspective would deal with the contraindications of each method by developing standards for screening and focusing as well on the diagnosis and treatment of these conditions. The suggested role of the population sector in the tasks of development and family planning lies in promoting the main message to a wider national and international audience, organizing family planning programs for attaining replacement level fertility, building professional alliances, and mobilizing resources.^ieng

Direct and judgmental measures of family planning program inputs.

This report compares two different approaches to measuring the strength of family planning programs in Bangladesh and Kenya. The first approach, the judgmental approach, has been used in a number of studies during the past two decades; scores on the characteristics of family planning programs are derived from the responses knowledgeable persons give to a series of questions. The second approach is to obtain direct measures of each item being considered. In Bangladesh, the total score varied trivially between the direct and the judgmental approaches. In Kenya, the total direct score was substantially higher than the judgmental score. The primary advantage of the judgmental approach is that comparative scores can be obtained for a larger number of countries for the same time period at a much lower cost than would be required by the direct approach.

PIP: Two different approaches were compared to measure the strength of family planning programs in Bangladesh and Kenya. The judgmental approach has been used in a number of studies in the past two decades: scores on the characteristics of family planning programs are derived from the responses given by knowledgeable persons to a series of questions. The direct approach obtains measures of key program inputs based on direct evidence. The sources for the two measures were leaders' favorable statement, use of the civil bureaucracy, multiministry and agency involvement, import law and regulations, involvement of private sector agencies budgets, and social marketing. Of the 16 feasible variables, scores were obtained for 13 in Bangladesh and for all 16 in Kenya. In addition, scores were also developed for 11 other variables in Bangladesh and 6 others in Kenya. In Bangladesh, the total program effort score for 1993 for both the direct and the judgmental approaches was 72%; while in Kenya the scores differed substantially: 61% for the direct approach and 53% for the judgmental approach. In Bangladesh, the 1993 direct score was 73% of the maximum, above the judgmental score of 67%. In Kenya, the direct score for the feasible variables was 64%, above the judgmental score of 55%. There was a definite decline in effort in Bangladesh from 1989 to 1993 (75% to 67%) and a mild one in Kenya (59% to 55%). However, the full set showed little change in Bangladesh (74% to 72%) and essentially no change in Kenya (54% to 53%). The family planning program in Bangladesh was pushed vigorously in the late 1980s; however, the intensity lessened in the latter part of 1991 until 1993. The primary advantage of the judgmental approach is that scores can be obtained for a larger number of countries at much lower cost than by the direct approach.

From birth control to reproductive health.

During the 1960s birth control was seen as the only means of curbing the very rapid population growth that resulted from decreased mortality without a parallel decrease in fertility. Birth control was considered such a priority that the means used to achieve it were not always respectful of human rights, and, for the same reason, it did not work as expected. During the 1970s and 1980s, birth control policy was re-evaluated. Concepts such as the need to balance birth control with socioeconomic development, to avoid target-oriented programs that imposed particular contraceptive methods on people, to integrate contraceptive services within a comprehensive women's health care program, and to emphasize the importance of quality of care became accepted. This led to the understanding that a reproductive health care approach was a more efficient way to achieve people's wellbeing and, at the same time, to reduce fertility. The need for greater dialog between women/clients and men/providers is emphasized.

Philippines 1993: results from the National Demographic Survey.

PIP: Data were collected in the Philippines National Demographic Survey from 12,995 households with complete interviews conducted among 15,029 women aged 15-49 years over the period April-June 1993. Results are presented under the following headings: general population characteristics; distribution of survey sample population by socioeconomic characteristics, percent women; fertility trends; fertility differentials, 1989-92; age-specific fertility; mean ideal number of children by age and number of living children for all women; desire to stop childbearing among currently married women; planning status of births in the five years preceding the survey by birth order; contraceptive prevalence differentials; contraceptive prevalence by age and parity; percentage distribution of current users of modern methods by most recent source of supply, according to method; knowledge and use of methods among currently married women; intention to use contraception in the future among currently married nonusers, by number of living children; reasons for nonuse among currently married women, by age group; current marital status; differentials in median age at first birth; union and contraceptive status; median duration of postpartum interval; differentials in duration of breastfeeding and amenorrhea; infant mortality trends; infant mortality differentials, 1984-93; children ever-born and surviving; percent of children 12-23 months of age ever vaccinated and percent receiving specific vaccines, according to health card or mother's report; percent of children under five years of age with diarrhea in two weeks prior to survey, and of those, percent consulting health facility and percent receiving different ORT treatments; and type of assistance during delivery for births in five years prior to survey.^ieng

Taiwan's transition from high fertility to below-replacement levels.

This article compares the fertility experience of Taiwanese in the eight years since the total fertility rate reached 2.1 with that before fertility reached replacement levels. During the earlier period, two-thirds of the fertility decline resulted from falling marital fertility and one-third from higher age at marriage. The changing age distribution retarded this decline. Since 1983, the further decline to 1.7-1.8 has been entirely the result of the trend toward later marriage. Older age distributions now facilitate the decline. Births postponed by those marrying later make the conventional TFR misleading. Computation based on parity-progression ratios raise TFRs from 1.7 to 2.0, a number less alarming to policymakers. Contraceptive prevalence is at saturation levels in all major populations strata. The "KAP-GAP" has disappeared. What would have happened without Taiwan's effective family planning program is impossible to determine, but clearly, contraceptive services supplied by the program were the major proximate cause of Taiwan's fertility decline.

PIP: In Taiwan, even though fertility in 1991 was 1.6, indicating below replacement fertility, the crude birth rates were still higher than the crude death rates. Zero population growth will occur in 2023, when the age distribution of reproductive age women will stabilize at replacement level. The main trends in fertility and nuptiality have indicated large fertility declines among women aged 30-34 years and older since 1983. The proportion currently married at age 15-19 years and 20-24 years has declined sharply during the period 1956-91. Fertility was highest among women aged 25-29 years, and nuptiality decline in this age group has had considerable impact on fertility. Marital fertility affected 66% of fertility decline, and nuptiality affected 33% of fertility decline. Between 1983 and 1991, nuptiality decline alone accounted for the crude birth rate decline. Another feature of change has been the increase in marital fertility among women aged 15-19 years and the decrease in marital fertility among women aged 20-24 years. The mean length of a generation reached 27.2 years by 1991. The shift to later childbearing might lessen the concern about too low fertility. There has not been a shift to greater childlessness or only children. The fertility pattern has reflected a shift to a greater concentration of fertility in a short time period. The percentage decline in the total fertility rate was reflected in Taipei, all cities, and urban and rural townships by 1991. Wife's education has been strongly correlated with fertility since 1966. By 1991, all educational differences were removed. The increasing levels of education among women assured the rapid transition. If 1983 educational levels had remained constant, fertility would have only declined by 10%. The main features prior to 1991 were a changing age/sex structure due to fertility decline, a rising marriage age, period effects of marriage postponement, and a rapid rise in educational levels. Family surveys have shown fertility to have been larger than preferences in 1985 and to reflect persistent son preference; contraceptive need was fulfilled by 1991. In 1992, a new population policy was formulated to attain replacement level fertility. Regardless of the projections, the proportion of older persons will rise. Pro- and anti-natalist influences on growth exist. The small stem family has been and will likely continue to be the popular family type.

From population control to reproductive health: an emerging policy agenda.

This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in women's health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and women's empowerment generally.

How economic development and family planning programs combined to reduce Indonesian fertility.

This paper examines the contributions of family planning programs, economic development, and women's status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single "structural" proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.