Maternity benefit

Magazine: The Times Higher Education Supplement
Issue: Septembet 2, 1994
Title: Maternity benefit
Author: Jonathon Porritt

United Nations conferences on population take a long time to come to the boil, but when they do, they have a way of boiling all over the place. Such an outcome can be forecast with some degree of certainty for the 1994 Conference on Population and Development which moves into full session in Cairo on Monday. It's going to be a tempestuous week.

Population has always been the most controversial of the great global issues over which the UN has wrestled. The 1974 Bucharest Conference deteriorated into a stand-up confrontation between those arguing that what really mattered was not population but "development" ("development is the best contraceptive", argued Dr Karan Singh, India's Minister of Health), and those who wanted, as an absolute priority, to set firm numerical targets for reducing human numbers. This line was argued most fo rcefully by the United States. Ten years on, in Mexico, the US delegation was taking a diametrically opposite position, claiming that "population growth is, of itself, neither good nor bad" and announcing that it was withdrawing all funding from any organisation deemed to be in any way pro-abortion. It was one of the clearest (and possibly the most damaging) of the moral majority's many impacts on US foreign policy during that time. In Cairo, the United States will be back in 1974-mode.

The Reagan/Bush policy on population is one of the first things that the Clinton/Gore administration swept aside, restoring funding to the United Nations Population Fund and other international agencies, and taking an extremely active role in the preparation of the draft programme of action which the conference is being asked to agree on. It is so easy to be cynical about UN communiques and action plans, that the significance of this programme may well be overlooked. It's like no other programme of action that's gone before it, driven as much by its concern for women's health, education and reproductive rights as by the usual time-honoured concerns about population, poverty and the environment. In this, it reflects the slow but steady re-orientation of the world's family planning agencies over the last twenty years, with the emphasis shifting more and more to programmes based on "quality of care" (rather than the usual quantitative measures of the numbers of women using contraceptives), and "real choice" - enabling women to choose for themselves what method of contraception is right for them in their own particular circumstances. It's not just the content, but the very tone of this programme that's so different. Bitter lessons from a session of coercive family planning programmes in the 1960s and 1970s had already sunk in by 1984, and the Mexico conference, but this year's categorical rejection of anything even remotely bordering on the coercive is new. In the interim, it has been possible for commentators to start coming to terms with China's one-child family policy. This includes the use of draconian measures such as compulsory sterilisation and abortion, and has led to high levels of female infanticide, particularly in rural areas where the cult of the male child is as strong as ever. Even those who uphold the effectiveness of the Chinese programme question whether it is really necessary to go about it in such afashion.

Both Thailand and Sri Lanka have achieved very similar reductions in average fertility (the number of children per woman of reproductive age) in the same period of time. China sticks out like a sore thumb in any consideration of family planning programmes around the world today. It is morally offensive, and may well not deliver the results in the longer term. As the programme for action makes abundantly clear, lasting success in family planning depends on women having both the capacity to decide for themselves about their fertility and the motivation to make that decision stick. For those who have not been side-tracked by the fulminations of the Vatican and the last-minute histrionics of a small minority of Muslim fundamentalists, it is the potential for convergence and reconciliation that is most astonishing about this conference.

Women's groups, academic demographers, environmentalists, aid and development organisations, let alone the vast majority of participating governments, have all found that the common ground identified in the programme is considerably larger and more important than the areas of continuing disagreement. This potential breakthrough has only become possible as a consequence of a series of 'dominant assumptions' in the population debate having been progressively set aside over the last few years. The first of these was the argument that "development is the best contraceptive". Just keep on priming the development pump (in terms of national GNP and per capita income levels) and population growth will decline - as it did in the world's industrialised nations while they climbed their own particular growth curves. This assumption owes much to the theory of a 'demographic transition'. Countries moving from a less developed to a more developed situation move from one equilibrium to another: from high death rates and high birth rates to low death rates and low birthrates. But as a result of better health standards and nutrition, the low death rates will often precede the low birth rates by several decades, and that is where the momentum of population growth builds up. Because it took most of the industrialised countries around 100 years to complete the transition (from one equilibrium to another, with average incomes improving all the time), it was always assumed that the same would be the case for developing countries. In fact, this theory has now been blown sky high.

In one country after another, average fertility has been falling dramatically in ways that are clearly not dependent on per capita income growth. The average number of children that a woman in a developing country bears today has dropped from 6.1 in 1965 to just 3.7. In some parts of East Asia, fertility has fallen to near Western levels, which are now below the replacement level of 2.1 per cent in many countries. The most compelling summary of this evidence was presented by three eminent demographers (Bryant Robey, Shea Rutstein and Leo Morris) in the December issue of "Scientific American". Using the most recent survey data they came to the following conclusion:

"Of the direct influences on fertility, the most powerful is family planning. A country's contraceptive prevalence rate - the percentage of married women of reproductive age who use any method of contraception - largely determines its total fertility rate. Indeed, the data revealed that differences in contraceptive prevalence explain about 90 per cent of the variation in fertility rates. The survey results indicate that fertility levels have dropped most sharply where family planning has increased most dramatically."
Development is therefore not the best contraceptive. Contraception is! Although it is true that incentives for poorer families in rural areas to have large families are still considerable, most of the evidence today shows that rapid population growth has actually slowed development in many countries, and increased the numbers of people living in poverty. Whole nations can become trapped by high fertility in a vicious circle of poverty. And an ever larger number of people (in countries like Bangladesh for instance) are choosing to have fewer children precisely because each additional child is seen to exacerbate rather than to relieve poverty. The UN Population Fund's 1992 "State of World Population" report compared income growth and population growth in 82 developing countries. In the 1980s, the 41 countries where population was growing more slowly managed an average income growth of 1.23 per cent a year. In the 41 countries with faster population growth, incomes fell by an average 1.25 per cent a year. The difference between these two groups was a massive 2.5 per cent. The second "dominant assumption" that has been challenged in recent years is that in terms of the global environment, more damage is done by the consumption of the world's richest one billion than by all the rest of the world put together.

The argument goes on that therefore, the problem of so-called over-population is irrelevant; it would be better by far to target all available resources on reducing the over-consumption of the richer northern nations. There need be no dispute about the first half of this proposition. If consumption levels do not change, the 57.5 million extra people who will be born in northern countries in the 1990s will pollute the global environment more than the extra 900 million people in the south. And nor is this imbalance all down to straight consumption.

Paul Harrison (author of The Third Revolution, which remains the definitive text for those, seeking guidance through these lethal minefields) has recently completed a study on population in the United States. Every year, there are an extra 2.6 million Americans. If each one pumps 20 tonnes of carbon dioxide into the atmosphere (the current US average), then population growth in the United States is responsible for an extra 52 million tonnes of carbon dioxide per year. India grows by 17 million people a year, but at much lower consumption levels. Between them, they add only an extra 13 million tonnes of carbon dioxide. China's annual increase of 17 million people adds just under 37 million tonnes. What that means is simple: population growth in the United States has at present more impact on the global climate than population growth in the two biggest countries on Earth. But the second half of this assumption is as erroneous now as it's ever been. Family planning is not primarily about the global environment. It is primarily about the health and well-being of women and children, about the ability of each country to improve the living standards of its people (and not see those improvements written off by the sheer increase in the numbers of people laying claim to them), and about the integrity of local and regional ecological services provided by soil fertility, water quality, forest cover etc. >From that perspective, campaigning to reduce over-consumption in the north and campaigning to reduce average fertility levels in the south are not mutually exclusive. Indeed, from the perspective of long term global sustainability (i.e. the whole human family improving its quality of life within the Earth's carrying capacity), the one depends utterly on the other. With these two dominant assumptions effectively neutralised, the Cairo Action Plan has been able to locate family planning concerns within an overall strategy for improving women's health and education. Family planning is specifically promoted as an important health measure in its own right. It has been shown that where women have six or more children, the lifetime risk of dying from maternal causes is five times higher than where they have two or less. If women could have only the number of children they desired, maternal deaths could be cut by anything from 17 per cent in Africa to up to 35 per cent in Latin America.

As Nafis Saduq, Secretary-General of the UN Population Fund argued in launching this year's World Population Report, the degree of consensus around this core position is quite astonishing. As ever, however, it's the opposition that has attracted the world's attention. As was the case in both 1974 and 1984, that opposition has been spearheaded by the Vatican, this time around with the very active involvement of Pope John Paul II. It remains the Vatican's immovable position (confirmed in the recently published Catechism of the Catholic Church) that all artificial contraception is "intrinsically evil". Although that is emphatically not the position adopted by Islamic leaders, the position has been further complicated at the Cairo Conference by the fact that some of the wording in the programme for action has fallen foul of a handful of Muslim delegations, on the grounds that it promotes extra-marital sex, ignores traditional values and undermines the family. And all Muslim countries are at one with the Vatican in their outright condemnation of abortion.

A Conference on Population and Development is no place to try and resolve the abortion issue. The essence of the debate is about family planning and contraception. If reducing average fertility does indeed depend more than anything else on the availability of contraceptives, and on the empowerment of women in their use of them (as the latest evidence would appear to demonstrate), the implacable opposition of the Vatican becomes a major impediment to anything remotely resembling sustainable development. The outcome of the Cairo Conference is still very much in the balance. Arguably, a great deal more rested on these decisions than it did on the outcome of the much-hyped 1992 Earth Summit. That is especially the case if you are young and wondering what the world's population will be in 2050: a manageable 7.8 billion (the United Nation's lowest projection, but still achievable if the Programme for Action can be implemented with expedition and commitment) or a nightmarish 12.5 billion. It is worth comparing the difference between those two figures (4.7 billion) with today's total population figure of 5.7 billion. It's that comparison which is concentrating their minds in Cairo today.

Jonathon Porritt

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