Too Many People?

In Tumuhun on Bali, 65-year-old Men Tunjung measures progress by the declining births in her family. One of 10 children, of whom 4 survived, she had no schooling, had five children, and labored with her husband in the rice fields. Her 40-year-old daughter, Jro Pasek, had more opportunity. She finished junior high and had just three children. As converts to Indonesia's family-planning program, moreover, Jro and her husband got a government loan to start a chicken farm. They earn $2,100 a year--vs. the village average of $175. Two of Jro's children are still in school, and 19-year-old Ayu Indrayani, a high school grad, is training to be a cashier. She plans to work, then marry--and have two or three children. Her grandmother approves. "Progress happens so fast," says Men Tunjung.

Millions of such families will be the focus when 180 nations meet in Cairo on Sept. 3 for the U.N.'s International Conference on Population & Development. The third such gathering in 20 years promises to be a watershed. For the first time, rich and poor countries may set aside ideological disputes and agree on a basic proposition: "Population growth exaggerates all the crises we are trying to cope with...lack of resources, limited educational opportunities, dearth of skills, poverty, and ill health," sums up Vice-President Al Gore.

CULTURAL SHIFT. In Cairo, the delegates intend to ink the most ambitious population plan ever: It calls for spending up to $17.5 billion by 2000 in poor nations. In addition to providing family planning to 100 million women who want it but don't have it, the goal will be to create conditions that lead people to want fewer children. Thus, the U.N. plan aims to give girls more schooling, improve the health of infants and mothers, and open up economic opportunities for women.

In essence, the plan calls for a profound cultural shift that would enhance the social and economic status of women. It would do so by helping close a gender gap that has left women in poor countries lagging in health, education, workforce participation, and basic rights. Experience shows that better-educated women who earn incomes have children later in life, have fewer of them, and give better care and education to the ones they have. So the Cairo plan--combined with conventional economic aid from industrialized nations--should make it easier for developing nations to provide social services and generate jobs.

In many ways, in fact, the initiative is a development plan with a human-capital focus. Poor nations now realize that spending on education and health can be as beneficial as investments in factories, says Allen C. Kelley, professor of economics at Duke University. And women offer a high return. In poor countries, they do 50% of the farm work and head about 30% of households. Their income is likely to go first for health care, schooling, and food for children. Therefore, advocates say, the focus on women should raise skill levels, boost productivity, and help the poor. "There's an economic cost to gender inequality," says Minh Chau Nguyen, a World Bank expert on the subject. "Paying attention to women is central to growth."

Despite the promised gains, the U.N. agenda raises alarms in some quarters. Its changes don't appeal to conservative tribes in Africa and Muslim fundamentalists in Asia, for instance. Some economists, meanwhile, see the plan as Malthusian alarmism clothed in new rhetoric. Julian Simon, a University of Maryland economist, says the emphasis in Cairo on curbing population deflects attention from a more vital issue: implementing free markets and other policies that let population take care of itself. Beyond that, the Vatican is fighting language on abortion, the right of women to choose family planning, and birth control for adolescents.

CHECKERED PAST. Still, proponents see plenty of reasons to go forward. True, global population is rising at only 1.6% a year, the lowest since World War II. That's largely because fertility rates--average births per woman--in China and India, among other places, have plunged from 6 to 3.48 since 1960. Still, the number of women of childbearing age in such countries will rise 62% between 1980 and 2000. By the projections the U.N. considers most likely, world population will leap from 5.6 billion in 1992 to 8.3 billion by 2025--93% of those new births in poor countries. That rise "will make population one of the most significant factors on the global scene for the next 30 years," says Joseph Chamie, director of the U.N.'s population division.

Developing nations will have trouble coping. The 1992 Earth Summit in Rio de Janeiro underscored the environmental damage that population pressures can help cause. That can ruin a nation's chances to build industries based on natural resources and makes it more costly to feed people. Cairo plan advocates, including Timothy E. Wirth, Under Secretary for Global Affairs at the U.S. State Dept., group these concerns under the rubric "human security"--or access to water, food, shelter, medical care, and a clean environment. When that's lacking, political instability and conflicts between countries are possible. In a sense, then, Cairo is part of "an emerging diplomacy of crisis prevention," says J. Brian Atwood, administrator of the U.S. Agency for International Development (USAID).

The anticipated consensus there will be an exception in the history of the population debate. Frequent clashes between rich and poor nations have centered on whether economic development or family planning should take priority, and how--and by whom--schemes should be financed. In the 1980s, moreover, population programs lost momentum as policymakers heeded economists who argued that population growth doesn't hamper economic progress. That view was confirmed in a 1986 National Academy of Sciences study which found, among other things, that improved technology for such jobs as food-production largely offsets the effects of rising population.

"SOCIAL TRIAGE." The Cairo meeting will sidestep the growth issue, focusing instead on the toll that high fertility takes on people. Each year, 500,000 women in developing countries die from complications of childbirth and illegal abortions--13 times the rate in industrialized nations. Children with many siblings feel the effects, too. "Families do social triage," says Judith Bruce, senior associate at the Population Council, and boys take priority in many countries. So girls are more apt to die before the age of 5, be undernourished, and not attend school. One result: Some two-thirds of the world's 950 million illiterates are women, according to U.N. statistics.

Exploding populations get short-changed in other ways. "Governance itself may become a scarce resource," says Duke's Kelley. Today, some 1.2 billion people lack clean drinking water, while some 1.7 billion are without adequate sanitation. Strains on governments will only get worse: 57% of developing nation populations will be urban by 2025, vs. 34% today. Slowing the population growth can ease those pressures. In Mexico, for instance, cutting fertility from 4, the 1980 level, to 2.12, the goal by 2010, will lower the number of new jobs needed by 50%.

Putting on the brakes means addressing three causes of population growth: Unwanted births account for up to 26% of overall fertility. Population momentum--the rising number of women of childbearing age--accounts for 49% more. And many couples actually want numerous children. In some societies, children are their parents' social security. And where infant mortality is high, couples have more children to compensate.

TEENAGE SEX. There are several ways to address this. China has cut fertility to 2 by imposing a draconian goal of one child per family. Most countries, though, reject coercion in favor of an approach combining birth control, lower infant mortality, education, and better economic prospects for women. Using such a mix, Colombia, Indonesia, Mexico, and Thailand have produced stunning declines in fertility--and have helped convince policymakers that the Cairo plan might stabilize world population by 2050 at 8 billion instead of 10 billion.

In each nation, the recipe "will change over time, depending on the stage of development," says Thomas W. Merrick, population adviser at the World Bank. But the right moves can work against all odds. Bangladesh, for instance, "goes diametrically against the notion that you must increase prosperity to lower fertility," says John G. Clelland, professor of medical demography at the London School of Hygiene & Tropical Medicine. With 116 million people shoehorned into an area no larger than Wisconsin, it has an annual per capita income of $210. Its predominantly Muslim society--85% rural--keeps women at home. The literacy rate for women 15 to 44 is only 27%. Yet infant mortality is on the decline. Some 40% of childbearing-age women use contraceptives, up from 10% in 1975. And over that period, the fertility rate has tumbled from 7 to 4.2.

These results stem from a government-run family-planning program that has been broadened to include infant health care, nutrition, and prenatal care instead of simply stressing numerical birth-rate targets. That makes it "easier to motivate women" says Halida Hanum Akhter, director of the Bangladesh Institute of Research. These efforts are bolstered when poor women get a chance to earn money. Grameen Bank in Dhaka will lend $500 million this year, in sums of $100 or so, to help women start businesses.

There's no limit on what can be tried. Since the late 1980s, Zimbabwe has pushed men to embrace family planning. Reaching teens is critical, too, since many in poor nations marry--as many as 50% in Africa. And as societies modernize, more teenagers become sexually active. Champa Development Unit, a private family-planning agency in the mountains north of Mexico City, is trying to head off early pregnancy and marriage. It uses teens to pass out contraceptives to their peers--and to counsel even 10-year-olds on sex and family planning.

In the long run, though, education for girls is the best strategy. One U.N. study of data gathered from 40 countries found that women who had seven or more years of schooling tended to have three fewer children than their unschooled peers. That's because school delays marriage and childbirth and boosts earning power. As a woman's earnings rise, her value as a stay-at-home mother goes down. And even some schooling gives women more self-confidence. The Population Council's Bruce says that educated women are more likely to discuss family size with their husbands and use contraceptives.

While the outlines of the U.N. plan are in place, key issues must be thrashed out. Setting goals for universal education, family planning, and lowering infant mortality makes some countries nervous. They "fear they will be translated into targets, which raises the specter of coercion," says Nafis Sadik, director general of the conference. In late August, U.N. officials also were jockeying with the Vatican over language--which Sadik says is meant only to end unsafe abortions. And implementing Cairo-style programs could be harder than passing them. Family planning will compete with other needs in countries where health budgets are $2 a person annually.

Still, momentum is building. Britain, Germany, Japan, the U.S., and the European Union have pledged increases in population aid. And USAID, the World Bank, and the Inter-American Development Bank are laying plans for Cairo-style programs. The World Bank is boosting spending on health, population, and education programs, and is drawing up a family-planning and women's education initiative for Pakistan. And countries such as Indonesia plan to share population expertise with novices, such as Vietnam.

Perhaps more important, the plan has logic on its side: "All the things in the Cairo agenda can be justified because they contribute to development," says Sadik. That, in the end, may give the program its best chance to succeed.

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