Wow thanks for that last post very informative. That full document which is the full source from 1969 is astounding. It breaks it all down:
A PUBLICATION OF THE POPULATION COUNCIL
Studies in Family Planning
BEYOND FAMILY PLANNING
The following paper reviews various proposals made for dealing with "the population problem" beyond the current efforts of national programs of voluntary family planning. It was written by Bernard Berelson of The Population Council.
A condensed version is appearing in a current issue of Science magazine.
This paper rests on these propositions:
(1) among the great problems on the world agenda is the population problem;
(2) that problem is most urgent in the developing countries where rapid population growth retards social and economic development;
(3) there is a time penalty on the problem in the sense that, other things equal, anything not done sooner may be harder to do later, due to increased numbers ; and accordingly
(4) everything that can properly be done to lower population growth rates should be done, now.
As has been asked on other occasions, the question is: what is to be done? There is a certain agreement on the general objective (i.e., on the desirability of lowering birth rates, though not on how far how fast), but there is disagreement as to means.
The 1960's have witnessed a substantial increase of awareness and concern with population matters throughout the world' and of efforts to do something about the problem, particularly in the developing countries. That something typically turns out to be the establishment of national family planning programs, or rough equivalents thereof. There are now 20 to 25 countries with efforts along this line, on all three developing continents, all of them either set up or revitalized in this decade. Thus, the first response to too high growth rates deriving from too high birth rates is to introduce voluntary contraception on a mass basis, or try to.
Why is family planning the first step taken on the road to population control? Probably because from a broad political standpoint it is the most acceptable one:since closely tied to maternal and child care it can be perceived as a health measure beyond dispute; and since voluntary it can be justified as a contribution to the effective personal freedom of individual couples. On both scores, the practice ties into accepted values and thus achieves political viability. In some situations, it is an oblique approach, seen as the politically acceptable way to start toward "population control" on the national level by promoting fertility control and smaller family size among individual couples. Moreover, it is a gradual effort and an inexpensive one, both of which contribute to its political acceptability. Though the introduction of family planning as a response to a country's population problem may be calculated to minimize opposition, even that policy has been attacked in several countries by politicians who are unconvinced and/ or see an electoral advantage in the issue.
How effective have family planning programs been as a means toward population control? There is currently some controversy among qualified observers as to their efficacy,2 and this is not the place to review that issue. But there is sufficient agreement on the magnitude and consequence of the problem that additional efforts are needed to reach a "solution", however that is responsibly defined.
For the purpose of this paper, then, let us assume that today's national family planning programs, mainly via voluntary contraception, are not "enough"—where "enough" is defined not necessarily as achieving zero growth in some extended present but simply as lowering birthrates quickly and substantially. "Enough" begs the question of the ultimate goal and only asks that a faster decline in population growth rates be brought about than is presently in process or in prospect—and, within the range of the possible, the faster the better.3 Just to indicate the rough order of magnitude, let us say that the proximate goal is the halving of the birth rate in the developing countries in the next decade or two— from, say, over 40 births per thousand per year to 20-25.4 For obvious reasons, both emigration and increased death rates are ruled out of consideration.
What is to be done to bring that about, beyond present programs of voluntary family planning ?5 I address that question in two ways : first, by listing the programs or policies more or less responsibly suggested to this end in recent years; and second, by reviewing the issues raised by the suggested approaches.
Here is a listing of the several proposals, arranged in descriptive categories. (There may be a semantic question involved in some cases: when is a proposal a proposal? Are "suggestions" or "offers for consideration" or lists of alternatives to be considered as proposals? In general, I have included all those cases presented in a context in which they were readily perceived as providing a supplementary or alternative approach to present efforts. The list may include both proposals for consideration and proposals for action.)
A. Extensions of Voluntary Fertility Control
1. Institutionalization of maternal care in rural areas of developing countries : a feasibility study of what would be required in order to bring some degree of modern medical or paramedical attention to every pregnant woman in the rural areas of five developing countries with professional back-up for difficult cases and with family planning education and services a central component of the program aimed particularly at women of low parity (Taylor & Berelson 6).
2. Liberalization of induced abortion (Davis 7, Ehrlich 8, Chandrasekhar 9).
B. Establishment of Involuntary Fertility Control
1. Mass use of "fertility control agent" by government to regulate births at acceptable level: the "fertility control agent" designed to lower fertility in the society by five per cent to 75 per cent less than the present birth rate, as needed; substance now unknown but believed to be available for field testing after 5-15 years of research work; to be included in water supply in urban areas and by "other methods" elsewhere (Ketche110); "addition of temporary sterilants to water supplies or staple food" (Ehrlich").
2. "Marketable licenses to have children", given to women and perhaps men in "whatever number would ensure a reproduction rate of one", say 2.2 children per couple: for example, "the unit certificate might be the `deci-child', and accumulation of ten of these units by purchase, inheritance or gift, would permit a woman in maturity to have one legal child" (Boulding12).
3. Temporary sterilization of all girls via time-capsule contraceptives, and again after each delivery, with reversibility allowed only upon governmental approval; certificates of approval distributed according to popular vote on desired population growth for a country, and saleable on open market (Shockley 13).
4. Compulsory sterilization of men with three or more living children (Chandrasekhar 14); requirement of induced abortion for all illegitimate pregnancies (Davis 15).
C. Intensified Educational Campaigns
1. Inclusion of population materials in primary and secondary schools systems (Davis 16, Wayland 17, Visaria 18): materials on demographic and physiological aspects, perhaps family planning and sex education as well; introduced at the secondary level in order to reach next waves of public school teachers throughout the country.
2. Promotion of national satellite television systems for direct informational effect on population and family planning as well as for indirect effect on modernization in general: satellite broadcasting probably through ground relays with village receivers (Ehrlich 9, Meier & Meier 0, UNESCO 21, Schramm & Nelson 22).
D. Incentive Programs: This term requires clarification. As used here, it refers to payments, or their equivalent, made directly to contracepting couples and/or to couples not bearing children for specified periods. It does not refer to payments to field workers, medical personnel, volunteers, et al., for securing acceptance of contraceptive practice; that type of payment, now utilized in many programs, is better called a fee or a stipend in order to differentiate it from an incentive as used here. Beyond that distinction, however, the term is fuzzy at the edges : is the provision of free contraceptive consultation and supplies to be considered an incentive? or free milk to the infant along with family planning information to the mother? or free transport to the family planning service, which then provides general health care? or a generous payment in lieu of time off from work for a vasectomy operation? or even a financial burden imposed for undesirable fertility behavior? In the usage here, I try to limit the term to direct payment of money (or goods or services) to members of the target population in return for the desired practice. This usage is sometimes referred to as a "positive" incentive in distinction to the "negative" incentive inherent in tax or welfare penalties for "too many" children (E below).
1. Payment for the initiation or the effective practice of contraception: payment or equivalent (e.g., transistor radio) for sterilization (Chandrasekhar 23, Pohlmann 24, Samue1 25, Davis 26) or for contraception (Simon 2 7, Enke 2 8, Samuel 29).
2. Payment for periods of non-pregnancy or non-birth: a bonus for child spacing or non-pregnancy (Young 30, Bhatia 31, Enke32, Spengler, Leasure 34); a savings certificate plan for twelve-month periods of non-birth (Balfour 35); a lottery scheme for preventing illegitimate births among teenagers in a small country (Mauldin 36); "responsibility prizes" for each five years of childless marriage or for vasectomy before the third child, and special lotteries with tickets available to the childless (Ehrlich 37).
E. Tax and Welfare Benefits and Penalties: i.e., an anti-natalist system of social services in place of the present pro-natalist tendencies.
1. Withdrawal of maternity benefits, perhaps after N (3?) children (Bhatia 38, Samue1 39, Davis 40) or unless certain limiting conditions have been met, like sufficient child spacing, knowledge of family planning, or level of income (Titmuss & Abel-Smith 41).
2. Withdrawal of children or family allowances, perhaps after N children (Bhatia 42, Titmuss & Abel-Smith 43, Davis 44).
3. Tax on births after the Nth (Bhatia 45, Samue1 46, Spengler 47).
4. Limitation of governmentally provided medical treatment, housing, scholarships, loans and subsidies, etc., to families with fewer than N children (Bhatia 48, Davis 49).
5. Reversal of tax benefits, to favor the unmarried and the parents of fewer rather than more children (Bhatia 50, Titmuss & Abel-Smith 51, Samue1 52, Davis 53, Ehrlich 54, David 55).
6. Provision by the state of N years of free schooling at all levels to each nuclear family, to be allocated by the family among the children as desired (Fawcett 5 6).
7. Pensions for poor parents with fewer than N children as social security for their old age (Samue1 57, Ohlin 58, Davison 59).
F. Shifts in Social and Economic Institutions: i.e., broad changes in fundamental institutional arrangements that could have the effect of lowering fertility.
1. Increase in minimum age of marriage: through legislation or through substantial fee for marriage licenses (David 60, Davis 60; or through direct bonuses for delayed marriage (Young 62); or through payment of marriage benefits only to parents of brides over 21 years of age (Titmuss & Abel-Smith 63); or through a program of government loans for wedding ceremonies when the bride is of a sufficient age, or with the interest rate inversely related to the bride's age (Davis 64); or through a "governmental 'first marriage grant' . . . awarded each couple in which the age of both (sic) partners was 25 or more" (Ehrlich 65); or through establishment of a domestic "national service" program for all men for the appropriate two-year period in order to develop social services, inculcate modern attitudes including family planning and population control, and at the same time delay age of marriage (Berelson, Etzioni 66).
2. Promotion or requirement of female participation in labor force (outside the home) to provide roles and interests for women alternative or supplementary to marriage (Hauser 67, Davis 68, David 69).
3. "Direct manipulation of family structure itself—planned efforts at deflecting the family's socializing function, reducing the noneconomic utilities of offspring, or introducing nonfamilial distractions and opportunity costs into people's lives"; specifically, through employment of women outside the home (Blake 70); "selective restructuring of the family in relation to the rest of society" (Davis 71).
4. Promotion of "two types of marriage, one of them childless and readily dissolved, and the other licensed for children and designed to be stable:" the former needs to be from 20-40 per cent of the total in order to allow the remainder to choose family size freely (Meier & Meier 72).
5. Encouragement of long-range social trends leading toward lower fertility, e.g., "improved and universal general education, or new roads facilitating communication, or improved agricultural methods, or a new industry that would increase productivity, or other types of innovation that may break the 'cake of custom' and produce social foment" (Hauser 73); and improved status of women (U.N./ ECOSOC74).
6. Efforts to lower death rates even further, particularly infant and child death rates, on the inference that birth rates will follow them down (Revelle 75, Heer & Smith 76).
G. Approaches via Political Channels and Organizations
1. U.S. insistence on "population control as the price of food aid", with highly selective assistance based thereon, and exertion of political pressures on governments or religious groups impeding "solution" of the population problem, including shifts in sovereignty (Ehrlich 77).
2. Re-organization of national and international agencies to deal with the population problem: within the United States, "coordination by a powerful governmental agency, a Federal Department of Population and Environment (DPE) . . . with the power to take whatever steps are necessary to establish a reasonable population size" (Ehrlich 78); within India, creation of "a separate Ministry of Population Control" (Chandrasekhar 79) ; development of an "international specialized agency larger than WHO to operate programs for extending family limitation techniques to the world . . . charged with the responsibility of effecting the transfer to population equilibrium" (Meier 8c Meier 8°).
3. Promotion of zero growth in population, as the ultimate goal needed to be accepted now in order to place intermediate goals of lowered fertility in proper context (Davis 81).
H Augmented Research Efforts
1. More research on social means for achieving necessary fertility goals (Davis 82).
2. Focused research on practical methods of sex determination (Polgar 83).
3. Increased research toward an improved contraceptive technology (NAS 84).
Proposals: Review of the Issues
Here are 29 proposals beyond family planning for dealing with the problem of undue population growth in the developing world. I naturally cannot claim that these are all the proposals made more or less responsibly toward that end, but my guess is that there are not many more and that these proposals are a reasonably good sample of the total list. In any case, these are perhaps the most visible at the present time and the following analysis is limited to them.
Since several of the proposals tend in the same direction, it seems appropriate to review them illustratively against the criteria that any such proposals might be required to meet. What are such criteria? There are at least six :
(1) scientific/medical/ technological readiness,
(2) political viability,
(3) administrative feasibility,
(4) economic capability,
(5) moral/ethical/ philosophical acceptability, and
(6) presumed effectiveness. In other words, the key questions are: is the scientific/medical/ technological base available or likely? will governments approve? can the proposal be administered? can the society afford the proposal? is it morally acceptable? and finally, will it work?
Such criteria and questions have to be considered against some time scale. As indicated at the outset of this paper, I suggest the next decade or two on the double grounds that the future is dim enough atthat point let alone beyond and that in any case it is difficult to develop plans and programs now for a more remote future. National economic plans, for example, are typically limited to five years and then a new one made in accord with the conditions existing at that time. In any case, long-run social goals are normally approached through successive short-run efforts.
Since the population problem in the developing world is particularly serious in its implications for human welfare, such proposals deserve serious consideration indeed. What do the proposals come to, viewed against the indicated criteria? (I use India throughout as the major illustrative case since it is the key example of the problem; disregarding Mainland China, India has a much larger population than all the other countries with population programs combined.)
Two questions are involved :
(1) is the needed technology available? and
(2) are the needed medical or para-medical personnel available or readily trainable to assure medical administration and safety?
With regard to temporary contraception, sterilization, and abortion, the needed technology is not only available now but is being steadily improved and expanded. The IUD (intrauterine device) and the oral pill have been major contraceptive developments of the past decade, and several promising leads are now being followed up — though it cannot be said with much confidence that any of them will eventuate for mass use within the next few years. Improved technologies for sterilization, both male and female, are being worked on; and there has been a recent development in abortion technique, the so-called suction device now being utilized in Eastern Europe and the U.S.S.R.
However, neither Ehrlich's "temporary sterilants" nor Ketchel's "fertility control agent" (B-1) is now available or on the technological horizon—though that does not mean that the research task ought not to be pursued against a subsequent need, especially since such substances could be administered voluntarily and individually as well as involuntarily and collectively. In the latter case, if administered through the water supply or a similar source, the substance would need to be medically safe and free of side effects for men and women, young and old, well and ill, physiologically normal and physiologically marginal, as well as for animals and perhaps plants. As some people have remarked, such an involuntary addition to a water supply would face far greater difficulties of acceptance simply on medical grounds than the far milder proposals with regard to fluoridation to prevent tooth decay.
Though a substantial technology in fertility control does exist, that does not mean that it can be automatically applied where most needed, partly because of limitations of trained personnel. In general, the more the technology requires the services of medical or para-medical personnel (or, what is much the same, is perceived as requiring them), the more difficult it is to administer in the developing countries. For example, such traditional contraceptives as condoms or foams can be distributed freely through a variety of non-medical channels, including commercial ones, though that network is not without limitations in the poorer countries. Oral contraceptive pills are now distributed in large numbers without substantial medical intervention in a number of countries—sold by pharmacies without prescription—but not with medical sanction; and most qualified medical specialists here and abroad believe that the pills should be given only after proper medical examination and with proper medical follow-up. IUDs were first inserted only by obstetricians, then by medical doctors, and now, in a few situations where female medical personnel are unavailable in sufficient numbers, by specially trained para-medical personnel (notably, on a large scale, in Pakistan).
In the case of sterilization and abortion, the medical requirement becomes more severe. For example, when the policy of compulsory vasectomy of men with three or more children was first being considered in India (see footnote 14), an estimate was made that the policy would affect about 40 million males: "one thousand surgeons or para-surgeons each averaging 20 operations a day for five days a week would take eight years to cope with the existing candidates, and during this time of course a constant supply of new candidates would be coming along" 8 8 —at present birth rates, probably of the order of 3.5 million a year. Large- scale abortion practice, assuming legality and acceptability, might additionally require hospital beds, which are in particularly short supply in most developing countries. Just as an indication of order of magnitude, in India, for example, there are approximately 22 million births annually; to abort five million would requirethe equivalent of about 800 physicians each doing 25 a day five days a week fift weeks a year, which is approximately 10 per cent of the obstetrical/gynecological specialists in India, or perhaps 25 per cent of the female specialists; and about 10 million bed days, which is over half the estimated number of maternity bed days in the country at present.89 However, the newer abortion technique might not require hospitalization—theoretically, the abortion "camp" may be feasible, as was the vasectomy "camp," except perhaps for the greater sensitivities attaching to the status of women, though it is not medically desirable—and para-medical personnel may be acceptable as well. Reportedly, the newer technique does not involve hospitalization in some parts of Eastern Europe and Mainland China.
In short, the technology is available for some but not all current proposals, and the same may be the case for properly trained personnel.
As mentioned earlier, the "population problem" has been increasingly recognized by national governments and international agencies over the past decade, and favorable policies have been increasingly adopted: national family planning programs in some 20-25 countries, positive resolutions and actions within the United Nations family, large programs of support by such developed countries as United States and Sweden, the so-called World Leaders' Statement. There is no reason to think that - that positive trend has run its course.
At the same time, the political picture is by no means unblemished. Some favorable policies are not strong enough to support a vigorous program even where limited to family planning on health grounds; in national politics "population control" can become a handy issue for a determined opposition; internal ethnic balances are sometimes delicately involved, with political ramifications; national size is often equated with national power, from the standpoint of international relations and regional military balances; the motives behind the support and encouragement of population control by the developed countries are sometimes perceived as politically expedient if not neo-colonialist or neo-imperialist ; and on the international front, as represented by the United Nations, there is still considerable reluctance based on both religiomoral and political considerations. In short, elite ambivalence and perceived political liability are not absent even in the favoring countries. That state of affairs may not be surprising looked at historically and given the sensitive religious, military, and political issues involved, but it does not provide maximum support for energetic measures directed at the "necessary" degree of population control.
The question of political acceptability of such proposals becomes in effect two questions: what is presumably acceptable within the present situation? and what might be done to enlarge the sphere of acceptability (as, for example, in proposals G-1 and G-2)?
In the nature of the political case, population measures are not taken in isolation —which is to say, they are not given overriding claim upon the nation's attention and resources even though they have been given special authority in a few countries. They must thus compete in the political arena with other claims and values, and that kind of competition accords with the political bases of an open society.
Any social policy adopted by government rests on some minimum consensus upon goals and means. They need not be the ultimate goals or the final means; as noted above, the socio-economic plans of developing countries are typically five-year plans, not 20- or 40- or 100-year plans. Indeed, an ultimate goal of population policy—that is, zero growth—need not be agreed upon or even considered by officials who can agree upon the immediate goal of lowering growth by a specified amount or by "as much as possible" within a period of years. And since there are always goals beyond goals, one does not even need to know what the ultimate goal is, only the direction in which it will be found (which is usually more likely of agreement). Would the insistence now on the acknowledgment of an ultimate goal of zero growth advance the effort or change its direction?
The means to such ends need not be final either. Indeed, at least at the outset of a somewhat controversial program, the means probably must fit within the framework of existing values, elite or mass, and preferably both—for example, a family planning program for maternal and child health and for preventing unwanted births even though the resultant growth rate may still remain "too high" by ultimate standards.
Specifically, against this background, how politically acceptable do some of the proposals appear to be? To start with, the proposal of involuntary controls in India in 1967 (B-4) precipitated "a storm of questions in Parli ment,"90 was withdrawn, and resulted in a high-level personnel shift within the family planning organization. No other country has seriously entertained the idea. Leaving aside other considerations, political instability in many countries would make implementation virtually impossible.
Social measures designed to affect the birth rate indirectly—e.g., tax benefits, social security arrangements, etc.—have been proposed from time to time. In India, there have been several such proposals:
for example, by the United Nations mission, 91 by the Small Family Norm Committee, 92 by the Central Family Planning Council (e.g., with regard to age of marriage, the education and employment of women, and various social welfare benefits), 93 and in almost every issue of such publications as Family Planning News, Centre Calling, and Planned Parenthood
(illustrative recent headings: "Tax to Reduce Family Size," "Relief for Bachelors Urged," "Scholarships for Children, Family Planning for Parents").
As Samuel reports, with accompanying documentation, "the desirability of imposing a tax on births of fourth or higher order has been afloat for some time. However, time and again, the suggestion has been rejected by the Government of India."94 In some cases, action has been taken by either the Central Government (e.g., income tax "deductions for dependent children are given for the first and second child only"95) or certain states (e.g., "Maharashtra and Uttar Pradesh have decided to grant educational concessions and benefits only to those children whose parents restrict the size of their families .
•"96 and the former state is reportedly beginning to penalize families with more than three children by withholding maternity leave, educational benefits, and housing privileges, though in the nature of the case only a small proportion of the state's population is affected by these disincentives97). As an indication of political sensitivity, an order withdrawing maternity leave for non-industrial women employees with three or more living children—at best a tiny number of educated women—was revoked before it really went into effect.98 There is a special political problem in many countries, in that economic constraints on fertility often turn out in practice to be selective on class, racial, or ethnic grounds, and thus exacerbate political tensions.
As another example, promoting female participation in the labor force runs up against the political problem that such employment would be competitive with men in situations of already high male un and under-employment. One inquiry concludes: "The prospective quantitative effect of moves in this direction seems very questionable. The number of unemployed in India has been rising by approximately 50 per cent every five years, and this is a well-known and very hot political issue. The government can hardly be blamed for being reluctant to promote female employment at the expense of male employment, which the great bulk of female employment almost surely would be."99
Given the present and likely political climate both within and between countries, whether programs for lowering population growth and birth rates are politically acceptable or not appears to depend largely upon whether they are perceived as positive or negative: where "positive" means that they are seen as promoting other social values as well as population limitation and where "negative" means that they are seen as limited per se.
For example, family planning programs, as noted above, are often rationalized as contributing both to maternal and child health and to the effective freedom of the individual family; a large-scale television network would contribute to other informational goals (though it is also politically suspect as providing too much power to the government in office); promotion of female participation in the labor force would add to economic productivity at the same time that it subtracted from the birth rate; extension of MCH services to rural areas is clearly desirable in itself, with or without family planning attached; incorporation of population material in school systems can be justified on educational grounds as well as population ones; a pension for the elderly would have social welfare benefits as well as indirect impact upon the large family as a social security system; contraceptive programs in Latin America are promoted by the medical community as a medical and humanitarian answer not to the population problem but to the extensive illegal and dangerous practice of abortion. On the other hand, imposing tax liabilities or withdrawing benefits after the Nth child, not to mention involuntary measures, can be attacked as a punitive means whose only purpose is that of population limitation.
It would thus require great political courage joined to very firm demographic convictions for a national leader to move toward an unpopular and severe prescription designed to cure his country's population ills. Indeed, it is difficult to envisage such a political move in an open society where a political opposition could present a counter view and perhaps prevail. Witness the views of two strong advocates of additional measures beyond family planning:
A realistic proposal for a government policy of lowering the birth rate reads like a catalogue of horrors. . . No government will institute such hardship simply for the purpose of controlling population growth.100
If a perfected control agent were available now, I am certain that it would not be utilized in any democratic country, for no population would be likely to vote to have such agents used on itself. This means that the effects of overpopulation are not yet acute enough for people to accept an unpleasant alternative.101
The political problem of population control, like many political matters of consequence, is a matter of timing: in the 1950's nothing much could be done but in the 1960's a number of countries and international agencies moved at least as far as family planning programs. Political accommodation is typically a matter of several small steps with an occasional large one; and in this case it rests upon the seriousness with which the population problem is viewed. That is growing, hence political acceptability of added measures may also grow. Regardless of what the future may bring in this regard, several social measures like those in the list of proposals have been made from time to time and have encountered political obstacles. At least for the time being, such obstacles are real and must be taken into account in any realistic proposal.
The governmental decisions about measures taken to deal with undue population growth must be taken mainly by the countries directly involved: after all, it is their people and their nation whose prospects are most centrally affected. But in an interconnected world, with peace and human welfare at issue, others are properly concerned from both self-interested and humanitarian standpoints—other governments from the developed world, the international community, private groups. What of the political considerations in this connection?
A recommendation (G-1) that the United States exert strong political pressures to effect population control in developing countries seems more likely to generate political opposition abroad than acceptance. It is conceivable that such measures might be adopted by the Congress, though if so certainly against the advice of the executive agencies, but it is hardly conceivable that they would be agreed to by the proposed recipients. Such a policy is probably more likely to boomerang against a population effort than to advance the effort.
The proposal to create an international super-agency (0-2) seems more likely of success, but not without difficulty. WHO, UNICEF, and UNESCO have moved some distance toward family planning, if not population control, but only slowly and against considerable political restraint on the international front."
A new international agency would find the road easier only if restricted to the convinced countries. Certainly the present international organizations at interest would not be expected to abdicate in its favor. If it could be brought into being and given a strong charter for action, then almost by definition the international political climate would be such as to favor action by the present agencies, and then efficiency and not political acceptability would be the issue.
Given technical availability and political acceptability, what can actually be done in the field? This is where several "good ideas" run into difficulties in the developing world, in the translation of a theoretical probability into a practical program.
One of the underdeveloped elements of an underdeveloped country is administration: in most such countries there is not only a limited medical infrastructure but also a limited administrative apparatus to be applied to any program. Policies that look good on paper are difficult to put into practice—and that has been true in the case of family planning efforts themselves, where the simple organizational and logistic problems of delivering service and supplies have by no means been solved in several large countries after some years of trying. Again, this is one of the realities that must be dealt with in any proposals for action.
It is difficult to estimate the administrative feasibility of several of the proposals listed above, if for no other reason simply because the proponents do not put forward the necessary organizational plans or details.
How are "fertility control agents" or "sterilants" to be administered on an involuntary mass basis in the absence of a central water supply or a food processing system? How are men with three or more children to be reliably identified in a peasant society and impelled toundergo sterilization against their will; and what is to be done if they decline, or if the fourth child is born? What is to be done with parents who evade the compulsory programs, or with the children born in consequence? How can an incentive system be honestly run in the absence of an organized network of offices positioned and staffed to carry out the regulatory activity? How can a system of social benefits and penalties, including marriage disincentives, be made to work under similar conditions?
Such questions are meant only to suggest the kinds of considerations that must be taken into account if proposals are to be translated into program. They are difficult but perhaps not insurmountable: somewhat similar problems have been addressed in the development of family planning programs themselves, as with the availability of medical and para-medical personnel. But it would seem desirable that every responsible proposal address itself to such administrative problems in the attempt to convert a proposal into a workable plan.
Some proposals do move in that direction. The plan to institutionalize maternal care in rural areas with family planning attached (A-1) is currently under study in several developing countries with regard to feasibility in administration, personnel, and costs. The plans for a national television system for informational purposes (C-2) have worked out some of the administrative problems, though the basic question of how to keep a television set working in a non-electrified area of a non- mechanical rural culture is not addressed and is not easy (as in the parallel case of keeping vehicles in working order under such conditions). The plan to build population into the school curriculum (C-1) has been carried forward to the preparation of materials and in a few cases beyond that."03 The plans for incentive programs sometimes come down to only the theoretical proposition that people will do things for money, in this case refrain from having children; but in some cases the permissible payment is proposed on the basis of an economic analysis, and in a few cases an administrative means is also proposed.'" The plan for wedding loans tied to the bride's age appreciates that a birth registration system might be needed in order to control against misreporting of age.' °
Thus the why of population control is easy, the what is not very hard, but the how is difficult. We may know that the extension of popular education or the in-crease of women in the labor force or a later age of marriage would all contribute to population control in a significant way. But there remains the administrative question of how to bring those developments about. For example, the proposal (F-1) to organize the young men of India into a social service program, directed toward later age at marriage and general modernization of attitudes, is extremely difficult from an administrative standpoint even if it were acceptable politically and financially: consider the administrative, supervisory, and instructional problems in the United States of handling nine to ten million young men (the number affected in India), many of them unwilling participants easily "hidden" by their families and associates, in a series of camps away from home.106 As has been observed, if a country could administer such a program it could more easily administer a family planning program, or perhaps not need one.
In short, several proposals assume administrable workability of a complicated scheme in a country that cannot now collect its own vital statistics in a reliable manner. Moreover, there is a near limit to how much administrative burden can be carried by the typical developing country at need: it cannot carry very many large- scale developmental efforts at the same time, either within the population field or overall. For population is not the only effort: agriculture, industry, education, health, communications, the military—all are important claimants. And within the field of population, a country that finds it difficult to organize and run a family planning program will find it still harder to add other programs along with that one. So difficult administrative choices must be made.
From the standpoint of economic capability there are two questions: is the program worthwhile when measured against the criterion of economic return? and can it be afforded from present budgets even if worthwhile?
Most of the proposals probably pass the second screen: if scientifically available and politically and administratively acceptable, an involuntary fertility control agent would probably not be prohibitive economically; incorporation. of population materials into the school curriculum is not unduly expensive, particularly when viewed as a long-term investment in population limitation; imposition of taxes or withdrawal of benefits or increased fees
saving certificates to married women in the reproductive ages who remain nonpregnant for three, four, five, or more years at the rate of about $3–$4 a year.121 He estimates that this plan in action would cost about $200 per year per thousand population, which comes to about $100,000,000 for all India.
But these are only speculations: to date we simply do not know whether incentives will lower a birth rate or rather, how large they would have to be in order to do so. These illustrations show only that an incentive program could be expensive. In any case, incentive systems would require a good amount of supervision and record- keeping; and presumably the higher the incentive (and hence the greater the chance of impact), the greater the risk of false reporting and the greater need of supervision—which is not only expensive but difficult administratively.
Beyond political acceptability, is the proposal considered right and proper—by the target population, government officials, professional or intellectual elites, the outside agencies committed to assistance?
"One reason the policy of seeking to make voluntary fertility universal is appealing—whether adequate or not—is that it is a natural extension of traditional democratic values: of providing each individual with the information he needs to make wise choices, and allowing the greatest freedom for each to work out his own destiny. The underlying rationale is that if every individual knowledgeably pursues his self-interest, the social interest will best be served."122 But what if "stressing the right of parents to have the number of children they want . . . evades the basic question of population policy, which is how to give societies the number of children they need?"123 Thus the issue rests at the center of political philosophy: how best to reconcile individual and collective interests.
Today, most observers would acknowledge that having a child is theoretically a free choice of the individual couple—but only theoretical in that the freedom is principled and legal. For many couples, particularly among the poor of the world, it is not effectively free in the sense that the individual couple does not have the information, services, and supplies to implement a free wish in this regard. Such couples are restrained by ignorance, not only of contraceptive practice but of the consequences of high fertility for themselves, their children, and their country; they are restrained by religious doctrine, even though they may not accept the doctrine; they are restrained legally, as with people who would abort a pregnancy if that action were open to them; they are restrained culturally, as with women subject to the subordination that reserves for them only the child-bearing and child- rearing role. Hence effective freedom in child-bearing is by no means realized in the world today, as recent policy statements have remarked. 124
Where does effective freedom lie? With the free provision of information and services for voluntary fertility limitation? With that plus a heavy propaganda campaign to limit births in the national interest? With that plus an incentive system of small payments? large payments? finders fees? With that plus a program of social benefits and penalties geared to the desired result? Presumably it lies somewhere short of compulsory birth limitation enforced by the state.
One's answer may depend not only on his own ethical philosophy but also upon the seriousness with which he views the population problem: the worse the problem, the more one is willing to "give up" in ethical position in order to attain "a solution." As usual, the important and hard ethical questions are those involving a conflict of values. In some countries, for example, people who are willing to provide temporary contraception as a means for population control under present circumstances are reluctant to extend the practice to sterilization and firmly opposed to abortion 125—though again the wheel of history seems to be moving the world across that range under the pressure of population growth. But in some groups, notably religious groups, morality in this connection is absolute and no compromise with social need is to be tolerated, as for example in the case of Pope Paul's encyclical of July 1968.
How much in ethical values should a society be willing to forego for the solution of a great social problem? Suppose a program for population control resulted in many more abortions in a society where abortion is not only morally repugnant but also widely unavailable by acceptable medical standards: how much fertility decline would be "worth" the result? What of infanticide under the same conditions? How many innocent or unknowing men may be vasectomized for a fee (for themselves or the finders) before the practice calls for a moral restraint? How large an increase in the regulatory bureaucracy, orin systematic corruption through incentives, or in differential effect by social class to the disadvantage of the poor, 126 is worth how much decrease in the birth rate? How much association of childbearing with monetary incentive is warranted before "bribing people not to have children" becomes contaminating, with adverse long-run effects on parental responsibility?
127 How much "immorality," locally defined as extramarital sex, is worth importing along with how much contraceptive practice (assuming the association)? How much withholding of food aid is ethical, judged against how much performance in fertility decline? If it were possible to legislate a later age of marriage, would it be right to do so in a society in which young women have nothing else to do, and against their will? In countries, like our own, where urbanization is a serious population problem, is it right to tell people where to live, or to impose heavy economic constraints that in effect "force" the desired migration? Is it right to withdraw educational benefits from the children in "too large" families?—which is not only repressive from the standpoint of free education but in the long run would be unfortunate from the standpoint of fertility control.
In the balance—and this is a question of great but neglected importance—what weight should be given to the opportunities of the next generations as against the ignorance, the prejudices, or the preferences of the present one?
These are not light questions, nor easy ones to answer. And they have not been seriously analyzed and ventilated, beyond the traditional religious concern about the acceptability of contraception and abortion. Most official doctrine in the emerging population programs is conservative —as is only to be expected at the outset of a great social experiment of this character.
Guidance on such ethical questions is needed. As an offer toward further consideration, these propositions are put forward: (1) "an ideal policy would permit a maximum of individual freedom and diversity. It would not prescribe a precise number of children for each category of married couple, nor lay down a universal norm to which all couples should conform" ;128 correlatively, it would move toward compulsion only very reluctantly and as the absolutely last resort; (2) "an ideal program designed to affect the number of children people want would help promote other goals that are worth supporting on their own merits, or at least not conflict with such goals";129 correlatively, it would not indirectly encourage
it goes on i will post pages 10-16 soon. and i skipped page 7