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From the Wilson Center
Political Demography: How Population Changes Are Reshaping International Security and National Politics (Book Launch)
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“The world’s population is changing in ways that are historically unprecedented,” said Jack Goldstone, George Mason University professor and co-editor of the new book, Political Demography: How Population Changes Are Reshaping International Security and National Politics. [Video Below]
Topics: Africa, aging, conflict, demography, development, economics, family planning, From the Wilson Center, global health, Middle East, military, population, security, South Asia, U.S., video, youth -
Book Review: ‘World Population Policies’ Offers Sweeping Overview of a Complex Field
July 2, 2012 // By Elizabeth Leahy MadsenMOREWith much attention in the international family planning community directed to the impending anniversary of the 1994 International Conference on Population and Development and the closing date of the Millennium Development Goals, the fact that 2012 is the 60th anniversary of two other milestones in population programming may have escaped notice. In 1952, the International Planned Parenthood Federation was created, and India became the first country to formulate a national policy to reduce population growth.
These and many other landmarks are highlighted in World Population Policies: Their Origin, Evolution and Impact, a new book by demographer John May that reviews several decades of policies, advocacy, and program interventions addressing the full range of diverse demographic trends seen globally.May, who spent more than two decades working on population issues at the World Bank and other international institutions before recently assuming a fellowship at the Center for Global Development, is well-positioned to provide such an ambitious overview. Although the breadth of material included in the book means that some topics receive less coverage than a specialist might wish, it serves as a sound introduction to this diverse field, and offers some particularly interesting case studies.
The book’s main chapters begin with a summary of current population trends, including a comprehensive array of figures and statistics about population size, distribution, and projections. Some important concepts, such as the demographic transition and dividend, are perhaps covered too quickly, and in such cases the book would have benefited from more than a handful of figures, charts, and graphs. May classifies regions and countries as demographic “hotspots,” where the number of people outstrips available resources, and “coldspots,” which have too few residents. He makes an ambitious suggestion that high-density countries facing resource challenges, such as Bangladesh, should consider promoting rapid fertility decline below replacement level to stop population growth, then reverse course and increase to a rate that promotes a stable population – but such a reversal from low fertility is a feat that has stymied several countries in Europe and East Asia.
Evolution of the “Population Movement”
In addition to summarizing the ways that demographic issues have been framed in the past several decades, May briefly describes the long-running debate between demographers and economists about the ways in which population is theorized to affect economic development.
Three points in this chapter were particularly striking: First, the concept of family planning as a human right dates from well before the 1994 International Conference on Population and Development. In 1968, the Tehran International Conference on Human Rights defined the ability to choose family size and spacing as a fundamental right; still, some programs, such as India’s under the Emergency-era government of the late 1970s, adopted coercive practices. Second, population policies are not limited to official initiatives targeting fertility, mortality, and migration, but also encompass implicit or “passive” policy measures that arise without advance planning or that have an unintended effect on demographic trends. Related to this, May suggests that “contextual variables” such as education, health, gender, culture, and religion can have a greater impact on population policies’ effectiveness and demographic outcomes than government structures or funding.
Although population policies are most often designed at the national level, May’s discussion of the “population movement” highlights the influence of international networks and donors on such policies. By the late 1960s, the U.S. Agency for International Development had begun funding family planning programs overseas, and the United Nations Population Fund (UNFPA) was active. Although the United States has become less dominant over time, population programming remains a Northern-driven movement.
Beginning with a meeting in Belgrade in 1965, a series of international population conferences successfully raised the prominence of population issues on the global development agenda and built consensus around international goals, while also becoming increasingly political.
May’s cautions about such conferences are timely given this month’s London Family Planning Summit: “Consensus-building through international conferences and their preparatory meetings is often inefficient as a process, whereas such events could be used to promote learning among policymakers and experts…The gap between the conferences’ resolutions and the actual policies implemented at country level is important to remember” (110).
Growth and Aging Distinguish the Demographic Divide
In his chapter focusing on the developing world, May notes that population policies have become broader in the nearly 20 years since the Cairo conference, incorporating a reproductive rights framework while also addressing new issues such as the environment, HIV/AIDS, and poverty. But under this more holistic approach, national policies are susceptible to becoming overly diffuse, with an ambitious agenda not matched by concrete action plans.
The challenges expand to policy implementation as well. Kenya is profiled as emblematic of the difficulties facing population programs in fast-growing sub-Saharan Africa, particularly political disinterest, mismanagement, opposition from some religious groups, and commodity shortages. But when implemented well, such policies can be very successful. The book offers a thorough summary of research findings on the common features of effective family planning programs (such as leadership, monitoring performance data, and opening access to contraceptive methods at lower levels of the health system), as well as their demographic impact. Several country examples are cited to show that family planning programs reduce lifetime fertility rates by 0.5 to 1.5 children per woman, while also benefiting individual and social health, income, and well-being.
While population policies have been often effective at shaping demographic trends in high-fertility settings, even in changing cultural norms about family size, May notes that their impact has been notably weaker in reversing the trajectory of declining fertility in developed countries. While countries such as France have maintained a fertility rate close to, albeit still below, replacement level thanks to generous paid parental leave, housing initiatives and public child care facilities, policies that try to boost low fertility through financial compensation have been particularly ineffective.
Developed countries are less likely to have formal population policies and tend to address demographic issues through incentives and disincentives implemented by multiple agencies. Aging and immigration are receiving greater attention in such countries, along with low fertility rates. Population aging raises policy concerns that are both economic and social, and May focuses largely on the benefit of reducing incentives for early retirement. He notes that thanks to improvements in health and life expectancy, “today’s 65-year-old persons are young compared to their counterparts” of previous generations (180). Despite their economic soundness, government efforts to raise retirement ages are widely unpopular, and France’s newly elected president has promised to cut the retirement age from 62 to 60 for some workers.
What Comes Next
Some observations are intriguing and could have been further detailed. For example, May notes a recent “fragmentation” of organizations working on population issues, and suggests that “too many institutions and NGOs appear to support their own limited mandates as they also struggle for resources that are less abundant” (5). Decentralization and integration within health systems is a growing trend that could have been discussed in more detail, along with the legacy of pronatalist laws and attitudes by colonial powers in Africa, the effect of recent European efforts to tighten immigration policies, and the achievements of forums designed for collaboration on population policy issues (for example, the United Nations Commission on Population and Development or the Reproductive Health Supplies Coalition).
Looking towards the future, May foresees continued integration of demography with related development issues, such as poverty reduction and equitable growth, gender and youth perspectives, environmental issues, and conflict prevention. He notes a few challenges, including sub-Saharan Africa’s lag in fertility decline and the overall ineffectiveness of policies aimed at addressing the pressures of urbanization on infrastructure and resources.
In high-fertility settings, May recommends that instead of framing reproductive health writ large, policies should more specifically target family planning and women’s empowerment, including education and income-generation opportunities as well as legal rights. Bangladesh is presented as a model for other countries, as a setting where cultural change and economic development laid the groundwork for successful family planning outreach efforts. Most of all, May entreats government leaders to maintain a policy focus on population issues, regardless of where they stand in the demographic divide.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Photo Credit: “Crowded Shopping District,” courtesy of flickr user EnvironmentBlog.Topics: Africa, aging, Bangladesh, demography, development, economics, environment, family planning, gender, global health, India, population, security, urbanization, USAID, youth -
Indonesia: Pioneering Community Outreach Creates Success Story
January 31, 2012 // By Elizabeth Leahy MadsenMOREThis is the third post in a series profiling the process of building political commitment in countries whose governments have made strong investments in family planning. Previous posts have profiled Rwanda and Iran.
While the two other countries profiled in this series, Rwanda and Iran, have only reinvigorated their family planning programs within the past 20 years, Indonesia’s story begins in the 1960s. In this respect, the world’s fourth most populous country is classified among the pioneers of family planning in the developing world and has been described as a “world leader” and “one of the developing world’s best.” An extensive community outreach program combined with a centralized government that made family planning a priority were key to Indonesia’s success story.
Jakarta Pilot and Religious Support Motivates National Scale-up
For a decade and a half after the struggle for independence from the Dutch ended in 1949, the government of President Sukarno ruled out any government support for family planning. According to a Demographic and Health Survey (DHS) report, the rate of contraceptive use among married women at the time was essentially zero. Fertility rose slightly during this period, from an average of 5.5 in the early 1950s to 5.6 children per woman a decade later. However, in 1965, Sukarno was overthrown, and the next year, a military general named Suharto assumed power in an uprising that left as many as half a million people dead.
Suharto’s regime would last until 1998. Though he operated with a “heavy hand” amidst personal corruption, Suharto also aggressively pursued economic development and brought about a policy shift towards promoting family planning. Despite initial reservations – Suharto believed that the people would oppose family planning on religious grounds – various domestic and international advisers convinced him otherwise.
General Ali Sadikin, the governor of Jakarta – a city of three million even then – was particularly influential in convincing Suharto. According to Australian demographer Terence H. Hull, who has written extensively about population issues in Indonesia, Sadikin was “quickly learning demographic lessons in his attempts to renovate a city with poor housing, schooling, transport, and basic services,” and he began to regularly speak out about the challenges that rapid population growth posed to his goals of urban development.Sadikin decided to support the Indonesian Planned Parenthood Association, which had a network of clinics offering family planning, but lacked the funding to meet more than a small amount of demand. With the public support of Sadikin, a Jakarta-wide pilot program was operational in 1967.
Hull reports that a second integral event in the early years was a 1967 meeting between government officials and Muslim, Protestant, Catholic, and Hindu leaders representing four of the country’s major religions. Following the meeting, a pamphlet called “Views of Religions on Family Planning” was published, representing “a tipping point when national consensus around the morality of birth control was turning from strongly negative to strongly positive.”
A Strong Coordinating Board Reaches out to Communities
By late 1968, efforts were in place to scale up the family planning program in Jakarta to the national level. The National Family Planning Coordinating Board (BKKBN in Indonesian) was created and quickly became entrenched throughout the country thanks to generous funding, including from international donors.
The BKKBN’s emphasis on the community level, which ensured that family planning services and awareness-generating activities were reaching people around the country through multiple channels, was a key factor in the program’s achievements. The organizations involved in promoting family planning messages at the community level included youth, women’s and religious groups, employers, and schools, with high-level support reiterated regularly by the president. Hull described the BKKBN’s efforts as “a true collaboration because the program emphasized institutions not normally associated with family planning, but did so in a way that was both socially acceptable and socially invigorating.”
In the program’s first two decades, the contraceptive prevalence rate for modern methods rose from almost nonexistent to 44 percent, and fertility subsequently fell from 5.5 to 3.3 children per woman. These changes are widely attributed to robust government sponsorship from the highest levels, together with effective grassroots implementation that fostered support from nearly all sectors of society.
In subsequent years, Indonesia experienced rapid economic and social development. Per capita income increased more than 20 times over between 1966 and 1996, with initial growth largely due to oil revenues. Other development indicators also improved dramatically. The literacy rate is now over 90 percent, nearly all girls attend school, and half of women are members of the labor force. However, Hull cautions against proclaiming the family planning program the primary causal factor in these successes. Family planning and other development programs would not have been as effective, he says, without changes in the political structure, which steadily became more centralized and stable in its oversight of a very heterogeneous society.
A Recent PlateauAs Indonesia continued to develop and its political system evolved, the family planning program has faced some challenges in the past 15 years. Suharto resigned in the face of widespread opposition in 1998, after more than 30 years in power. While this brought positive movement towards democracy, the ensuring political uncertainty shifted the government’s energies away from reproductive health and other aspects of social development.
In the early 2000s, the family planning program was decentralized to district and municipal levels, in line with political reforms aimed at diminishing the role of central hierarchy nationwide. District leaders were charged with planning, budgeting, and implementing family planning and other primary health services. In accordance, BKKBN modified its strategies to become even more community-oriented. Still, observers judge the family planning program to have “weakened” following decentralization.
With strong logistics, popular support, and donor assistance, contraceptive use continued rising during the years of political transition. By 2002-2003, 57 percent of married women were using a modern contraceptive method and the fertility rate had reached 2.6 children per woman. However, these indicators remained unchanged in the next national survey, conducted in 2007. Fertility in Indonesia is at the median for Southeast Asia – higher than Thailand and Vietnam and lower than Cambodia and the Philippines.
The Program Moves Forward
As democracy became more secure in the early 2000s, the country’s next generation of leaders kept sight of demographic issues. In 2005, President Susilo Bambang Yudhoyono stated, “High population growth without rapid economic growth will result in poverty and setbacks … Large numbers of children and high populations will only bring advantages if they are skilled.” BKKBN and the Ministry of Health worked with USAID, public health researchers, NGOs and others to develop national family planning standards for quality of care, which were devised and implemented in the early 2000s.
Judging the program’s achievements to have been substantial and its momentum sustainable, USAID graduated Indonesia from population assistance in 2006, after 35 years. Though gaps remain, women’s fertility preferences are largely being met.
Today, 80 percent of all births are intended, and unmet need for family planning – the share of married women who wish to delay or prevent pregnancy but are not using contraception – stands at nine percent, two percentage points below the average for Southeast Asia and all developing countries. Meanwhile, Indonesia’s demographic profile looks much different than it might have. At the time of graduation, USAID reported that without its long-standing and well administered family planning program, Indonesia’s 2006 population would have been larger by 80 million people, or 35 percent.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Sources: Demographic and Health Surveys; Hull (2007); Management Sciences for Health; New York Times; UN Population Division; USAID.
Photo Credit: “Jakarta,” courtesy of flickr user frostnova. -
Iran: A Seemingly Unlikely Setting for World’s Fastest Demographic Transition
January 11, 2012 // By Elizabeth Leahy MadsenMOREThis is the second post in a series profiling the process of building political commitment in countries whose governments have made strong investments in family planning. Read the first post, on Rwanda’s recent rapid demographic changes, here.
To date, only 11 countries outside of the developed world, China, and a handful of small island states have reached the end of the demographic transition, with fertility rates declining from more than four children per woman to replacement level or lower.* Of these, only two countries have completed the transition in 15 years or less – and both might surprise you. One is Cuba, whose government dispensed family planning services to its relatively small population in the 1970s through accessible primary health care facilities and legalized safe abortion eight years before the United States did. The other: Iran.
Following the 1979 revolution, Iran’s new theocracy adopted a socially conservative, pro-natalist outlook. Half of the population lived in rural areas, which typically constrains access to health services. In addition, abortion was illegal in most circumstances. According to the UN, Iranian women had an average of 6.5 children each in the early 1980s and the population was growing nearly four percent annually, a rate high enough for it to double in 19 years.
But, by the early 2000s, Iran’s fertility rate had dropped below two children per woman. The swift changes can be attributed to the efforts of government officials concerned about meeting the employment needs of a growing population, supported by public health experts who wanted to rebuild the eroded family planning program.
A Dramatic Policy ShiftThe turning point came after the end of Iran’s eight-year war with Iraq in 1988. With military demands high – several hundred thousand people were killed during the war – population growth was viewed positively. But as the war ended, policy directives did an about-face.
Although public health officials had framed the need for reinvigorated family planning programs in health-related terms for years, the motivation for government officials to change policy appears to have been economic. The national budget agency informed the prime minister that after nearly a decade of conflict, the country lacked adequate funding to both rebuild and to meet the needs of its people. The prime minister responded quickly, directing that demographic factors be integrated into the new development plan and stating that “Iranians’ standard of living was being eroded by the growth of the country’s population.”
“Pragmatism Has Prevailed Over Pure Ideology”
After convincing their superiors, Iranian government officials who supported family planning faced the added challenge of garnering the backing of the influential religious establishment. Shortly after the revolution, Ayatollah Khomeini officially sanctioned the use of contraception, though his perspective was not universal among clerics. Once the prime minister decided to introduce a national family planning program, officials sought support from additional religious authorities. Opposition was minimal after two key institutions offered endorsements. The High Judicial Council determined that there was “no Islamic barrier to family planning” in late 1988, and the Expediency Council approved the government’s plans soon after.
By late 1989, a new family planning program had been officially introduced. The program’s aims were to lengthen spacing between births; limit pregnancies in the early and late reproductive years; and lower fertility by educating the population and ensuring access to free and diverse contraceptive methods. By the mid-1990s, the government had fully integrated family planning into the existing primary health system.
Iran thus followed the example of other majority-Muslim countries where religion was not an impediment to family planning, including Egypt, Indonesia, Jordan, and Oman. Just as in countries where highly Catholic populations have low fertility rates (Italy, Poland, Spain, and many others), religious guidance has been interpreted in varying ways in different settings and is not necessarily a central factor in individual fertility decisions. As Akbar Aghajanian and Amir H. Merhyar write in a summary of Iran’s family planning program, “Pragmatism has prevailed over pure ideology when necessary.”
The Contributions of Women’s Education and a Strong Health System
A new policy orientation was the critical first step, but successful implementation was necessary for Iran’s demographic trajectory to change in response. Fortunately, the government had some advantages in rolling out its new program, namely a strong existing health system, a history of past efforts to promote family planning, and an educated female population among whom demand for contraception was high.Rural development became a priority of the government after the revolution and resulted in improved access to an array of services. In rural areas, community health workers receive two years of training to provide family planning services along with other preventative care and treatment. Services are also available at rural health “houses,” urban clinics, and higher-level centers around the country.
The status of women has also played a major role. A research exercise conducted by IIASA estimated that improvements in educational attainment among women were responsible for about one-third of Iran’s fertility decline between 1980 and 2005. Women’s literacy was already rising during the period of the revolution and reached 74 percent by 1996, while attitudes toward female employment became more supportive. By the late 1990s, new classes of university students included more women than men. The response to the 1989 program indicated that women clearly had an unmet demand for family planning. Use of modern contraception jumped from 31 percent in 1989 to 51 percent just five years later, then rose more slowly over the subsequent decade.
A Dividend Squandered?
The rapid changes in Iran’s age structure, thanks to declining fertility, have opened a window of opportunity for the country to boost economic growth through lower dependency ratios – a phenomenon called the demographic dividend. However, the dividend is not an automatic bonus, and Iran’s capacity to capitalize on its demographic change is questionable.
The unemployment rate among young people today is over 20 percent, indicating that the economy is not generating sufficient jobs, which is a prerequisite to improving productivity. This inopportune climate may even contribute to a further decline in the fertility rate: Some observers have suggested that the country’s economic troubles and rising costs of living have motivated young people to delay marriage and have smaller families. “Unemployment and high costs of living, coupled with social and political restrictions, have made [life] increasingly difficult for young Iranians,” Farzaneh Roudi of the Population Reference Bureau (PRB) explained in a blog post last year.
Given Iran’s challenges in producing adequate jobs and other economic benefits for its population, President Mahmoud Ahmadinejad’s recent unusual pronouncements on population issues are especially puzzling. Last year, Ahmadinejad introduced a pro-natalist policy offering direct payments to each child born, continuing until they reach adulthood, and later suggested that girls should marry at age 16 or 17.
But despite a high level of international media attention, most observers expect the policy to have little impact. Widespread adoption of family planning has become entrenched in society: 60 percent of Iranian women now use a modern contraceptive method. As PRB’s Roudi wrote in response to Ahmadinejad’s proposal, “Iranian women and men have gotten used to exercising their reproductive rights and would expect to be able to continue to do so.”
*The 11 countries that have achieved replacement fertility or lower outside of developed regions, China, and small island states are Brazil, Chile, Costa Rica, Cuba, Iran, Lebanon, Myanmar, Thailand, Tunisia, and the United Arab Emirates.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Look for related analysis on the political implications of Iran’s changing age structure by Richard Cincotta on New Security Beat soon.
Sources: Abbasi-Shavazi, Lutz, Hosseini-Chavoshi and Samir (2008), Abbasi-Shavazi (2002), Aghajanian and Merhyar (1999), Christian Science Monitor, GlobalSecurity.org, The New York Times, Noble and Potts (1996), Population Reference Bureau, Roudi-Fahimi (2002), UN Population Division, World Bank.
Image Credit: “بیست و پنجم خرداد ۸,” courtesy of flickr user Recovering Sick Soul (Nima Fatemi); charts arranged by Sean Peoples and Elizabeth Leahy Madsen. -
Rwanda: Dramatic Uptake in Contraceptive Use Spurs Unprecedented Fertility Decline
November 8, 2011 // By Elizabeth Leahy MadsenMOREWith over 400 people per square kilometer, the highest rate on the African mainland, population density is perhaps the most widely-discussed factor of Rwanda’s demography. Some scholars, notably Jared Diamond, have argued that it played a primary role in sparking the 1994 genocide through competition for land (although others present a more complex theory based in policies and governance).
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