![]() | The Value of Family Planning Programs in Developing Countries (RAND, 1998, 98 p.) |
![]() | ![]() | Chapter Three - THE RECORD OF FAMILY PLANNING |
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Socioeconomic factors are not always favorable when national programs are launched. Does it follow that programs have to wait for incomes to grow, education levels to rise, and cities to come to dominate the countryside before they have any effect? Apparently not. No socioeconomic thresholds are evident in such data as those in Table 2. Fertility decline started in East Asia, in the 1960s and1970s, at income levels typical of low-income economies today. In Indonesia, in particular, GNP per capita was about US$250, which is below the mean level for low-income economies. Even lower income levels were typical of South Asian countries at the start of their transitions. Latin America was different, with a number of countries not starting transitions until reaching much higher income levels, up to US$1,500 per capita. Where transitions have started most recently, in sub-Saharan Africa, income levels at the start were intermediate between Asian and Latin American levels.
Table 2 - Socioeconomic Indicators at the Start of Fertility Transition, Selected Countries, and Comparative Aggregate Data
Region and Country |
Start of Fertility Transitiona |
GNP per Capitab |
Infant Mortality Rate |
Female Secondary Enrollment |
Percent Urban |
Start of Population Program | |
East Asia | |
| | | | | |
|
Indonesia |
1975 |
253 |
109 |
15 |
19 |
1968 |
|
Korea, Rep. of |
1960 |
550 |
70 |
14 |
28 |
1961 |
|
Philippines |
1970 |
488 |
66 |
50 |
33 |
1970 |
|
Thailand |
1970 |
471 |
73 |
15 |
13 |
1970 |
South Asia | |
| | | | | |
|
Bangladesh |
1975 |
138 |
138 |
11 |
9 |
1971 |
|
India |
1965 |
218 |
150 |
13 |
19 |
1965 |
|
Pakistan |
1985 |
304 |
113 |
8 |
30 |
1960 |
|
Sri Lanka |
1965 |
216 |
63 |
35 |
20 |
1965 |
Latin America |
| | |
| | | |
|
Brazil |
1965 |
889 |
104 |
16 |
50 |
1974 |
|
Colombia |
1965 |
676 |
86 |
16 |
54 |
1970 |
|
Costa Rica |
1965 |
1,109 |
72 |
25 |
38 |
1968 |
|
Mexico |
1975 |
1,504 |
64 |
28 |
63 |
1974 |
Sub-Saharan Africa |
| | |
| | | |
|
Botswana |
1980 |
721 |
63 |
22 |
15 |
1971 |
|
Kenya |
1980 |
358 |
83 |
16 |
16 |
1967 |
|
Zimbabwe |
1970 |
544 |
96 |
6 |
17 |
1968 |
Comparative data (1995)c | |
| | |
| ||
|
Low-income economies (except China and India) |
290 |
89 |
21 |
28 | | |
|
Lower-middle income economies |
1,670 |
41 |
62 |
56 | | |
|
Upper-middle income economies |
4,260 |
35 |
75 |
73 | |
SOURCES: World Bank (1993, pp. 20-21). Comparative data from World Bank (1996, 1997b).
aFertility transitions are dated from initial declines of at least 0.7 points in total fertility over a five-year period, following Bulatao and Elwan (1985).bConstant 1987 U.S. dollars. These and the other indicators are as of the transition date, except for the comparative data, which are given as of 1995.
cFemale enrollment is as of 1993. The enrollment figure for upper-middle-income economies is the median across 13 countries.
The changes in personal aspirations and in the acceptability of family planning that trigger fertility transition appear to have occurred at many different socioeconomic levels. For the countries in Table 2, fertility transition started at infant mortality levels as high as 150 deaths per thousand or as low as 632; where female secondary enrollment was only 6 percent or already 50 percent; and where anywhere from 9 percent to 63 percent of the population was urban. Fertility transition can therefore start with social indicators practically anywhere in the range typical of low-income or even lower-middle-income economies, with no specific levels triggering decline.
2But see Bulatao and Elwan (1985) for a possible mortality threshold (see also Bongaarts and Watkins, 1996).
Nevertheless, socioeconomic development does contribute to lower fertility. Cross-national comparisons suggest that the pace of decline, once it has started, is faster in more advanced developing countries (Bongaarts and Watkins, 1996), either because higher levels of development condition people to be more favorable to smaller families or because they allow programs to operate more efficiently. And once the transition is under way, contraceptive use appears to spread in a diffusion process that takes on a life of its own.
If low levels of socioeconomic development do not deter family planning programs, neither do cultural obstacles. Skeptics have cited one obstacle or another practically everywhere programs were launched. None appears to be an effective impediment. In East Asia the cultural barriers included Confucian traditions (in Taiwan and South Korea) that made the family central and gave household heads control over extended families, including the childbearing of their children. A strong preference for sons to carry on the family line has also often been cited. Political opposition of various sorts has existed to family planning, for instance among Islamic fundamentalists in Indonesia and the Catholic hierarchy in the Philippines. Such opposition was even more important in Latin America. Although the predominant Catholicism did not deter couples from voluntarily adopting contraception, the opposition of the church legitimized intellectual opposition to limiting population growth. In addition, the split in many Latin American countries between the dominant elite and the peasant masses slowed the spread of contraception. In South Asia, the barriers included such factors as traditional family structures, the subordinate social position of women, and continuing dependence on child labor. Similar barriers have been adduced for sub-Saharan Africa, where decisions on childbearing have been assumed to be controlled by older generations who consider children and grandchildren essential assets.
Yet in each of these settings, despite the cultural obstacles and despite varying and often low socioeconomic levels, some degree of interest in smaller families or demand for contraception appears to have existed. Near the start of fertility transition in South Korea, Thailand, and Indonesia, ideal family size was recorded at around four children, already below existing fertility. For a number of Latin American countries, substantial demand for contraception probably exceeded the capacity of early programs. Even in Bangladesh, substantial "latent demand" appears to have existed, with fertility preferences similar to those in other Asian countries at a similar stage of fertility transition (Cleland et al., 1994, p. 48). Sub-Saharan Africa initially presents a different picture, with large families still often highly prized, but in this region considerable interest exists in spacing births.