• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Table of Contents
 Introduction
 Definition of rural countries
 Diversity of population growth...
 Differential population perfor...
 Recent trends in African ferti...
 Malthus vs. Boserup
 Structural adjustment
 Fertility and democracy
 Gender bias in China and south...
 Summary
 Bibliography
 Reference






Group Title: International working paper series - IW92-31
Title: Determinants of a demographic transition in predominantly rural countries
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Permanent Link: http://ufdc.ufl.edu/UF00054808/00001
 Material Information
Title: Determinants of a demographic transition in predominantly rural countries
Series Title: International working paper series
Physical Description: i, 24, 9 p. : ill. ; 28 cm.
Language: English
Creator: Lele, Uma J
Martin, Michael, 1954-
Conference: Expert Group Meeting on Population Growth and Demographic Structure, (1992
Publisher: Food and Resource Economics Dept., Institute of Food and Agricultural Sciences, University of Florida
Place of Publication: Gainesville Fla
Publication Date: [1992]
 Subjects
Subject: Demographic transition -- Developing countries   ( lcsh )
Agriculture -- Economic aspects -- Developing countries   ( lcsh )
Fertility, Human -- Developing countries   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Bibliography: Includes bibliographical references (p. 22-24).
Statement of Responsibility: by Uma Lele and Michael Martin.
General Note: "For the Expert Group Meeting on Population Growth and Demographic Structure organized by the United Nations, Paris, France, November 16-20, 1992."
General Note: "November 1992"--Cover.
Funding: Electronic resources created as part of a prototype UF Institutional Repository and Faculty Papers project by the University of Florida.
 Record Information
Bibliographic ID: UF00054808
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved, Board of Trustees of the University of Florida
Resource Identifier: aleph - 001784452
oclc - 27377019
notis - AJK7834

Table of Contents
    Front Cover
        Front Cover
    Title Page
        Title Page
    Table of Contents
        Page i
    Introduction
        Page 1
        Page 2
        Page 3
    Definition of rural countries
        Page 4
    Diversity of population growth experiences and need for empirical research
        Page 5
        Page 6
    Differential population performance
        Page 7
        Page 8
    Recent trends in African fertility
        Page 9
        Page 10
        Page 11
    Malthus vs. Boserup
        Page 12
        Page 13
        Page 14
    Structural adjustment
        Page 15
        Page 16
    Fertility and democracy
        Page 17
        Page 18
    Gender bias in China and south Asia
        Page 19
    Summary
        Page 20
        Page 21
    Bibliography
        Page 22
        Page 23
        Page 24
    Reference
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
Full Text
7,


IW92-31


DETERMINANTS OF A DEMOGRAPHIC
TRANSITION IN PREDOMINANTLY
RURAL COUNTRIES


By
Uma Lele and Michael Martin



IW92-31 November 1992


INTERNATIONAL WORKING PAPER SERIES









4p -
10

~.


FOOD AND RESOURCE ECONOMICS DEPARTMENT
Institute of Food and Agricultural Sciences
University of Florida
Gainesville, Florida 32611















DETERMINANTS OF A DEMOGRAPHIC TRANSITION
IN PREDOMINANTLY RURAL COUNTRIES

By

Uma Lele and Michael Martin'


For


The Expert Group Meeting
On Population Growth and Demographic Structure
Organized by the United Nations

Paris, France

November 16-20, 1992


















'Uma Lele is Graduate Research Professor in the Food and Resource Economics Department and
Director of International Studies and Programs, and Michael Martin is a Graduate Student at the University
of Florida, Gainesville, Florida 32611, U.S.A.








TABLE OF CONTENTS


Introduction .....................

Definition of Rural Countries ..........

Diversity of Population Growth Experiences
and Need for Empirical Research ......

Differential Population Performance .....

Recent Trends in African Fertility .......

Malthus Vs. Boserup ...............

Structural Adjustment ...............

Fertility and Democracy .............

Gender Bias in China and South Asia ...


Summary ................


List of Tables and Figures


Table 1:


Table

Table

Table


Figure 1:

Figure 2:

Figure 3:

Figure 4:


. . . . . . 1

.......... .... ...... ....4


............. .................. 5

.......... ... ... ..... ...... ... 7

................... ... ... ......9

... ...... ... ...... ..... .. ..... 12

. . . . . . . . 15

. . . . . . . . 17

. . . . . . . . 19


...... 20


Population, GDP and Percapita GNP Growth Rates for
Selected Regions, 1990

Total Number of Poor for Selected Regions, 1985 2000

Population Growth Rates for Selected Countries

Percent of Currently Married Women Who Want No More
Children and Percent Who Wish to Postpone Among Those
Who Want More Selected Sub-Saharan Countries

Fertility by Per Capita GNP

Fertility by Female Life Expectancy

Fertility by Primary Education

Percapita ODA
i











Determinants of A Demographic Transition
in Predominantly Rural Countries'

Uma Lele and Michael Martin2



Introduction

Why focus on predominantly rural countries, which is the charge of this paper? It is

because predominantly rural countries influence population growth and demographic

transition differently than urbanized countries. Following Gary Becker, it is now generally

believed by economists that human fertility and population growth rates are determined

by income and education. Especially as women's access to income and education

increases and with it the value of their time, they substitute quality of children for quantity.

They invest more in fewer children. It is no wonder then that since the Bucharest

Population Conference in 1974, the two most commonly advocated themes in population

policy have been rapid and broad-based economic growth, to influence the demand for

smaller families, and effective family planning to influence the supply of contraceptives

which would control fertility (Ridker). The inverse relationship of fertility with income and

women's literacy and, its positive relationship with infant mortality is by now well

established (see figures 1-3). There are, nevertheless, numerous non-economic factors

which enter into fertility decisions. These are particularly significant in predominantly rural


'A paper prepared for the Expert Group Meeting on Population Growth and Demographic Structure
organized by the United Nations, Paris, France, November 16-20, 1992.

2Uma Lele Is Graduate Research Professor in the Food and Resource Economics Department and
Director of International Studies and Programs, and Michael Martin is a Graduate Student at the University
of Florida, Gainesville. Florida 32611, U.S.A.








countries. Typically, they are low income countries in which non-market activities

dominate. The level of education is limited, particularly for women. Agriculture dominates

in income, employment, savings, investment, food, exports, etc. The rural sector absorbs

the bulk of the population growth. Labor productivity is very low. Whereas nearly a third

of the GNP in a predominantly rural economy originates in agriculture, between half to

three quarters of the population resides in the rural sector. At best, per capital rural

income is typically only a fifth to a third of the urban average.



Women's labor force participation tends to be high in food production, storage,

processing, marketing, water and fuel wood collection. Yet their high labor force

participation is typically not associated with low fertility levels. Predominantly rural

countries tend to lack physical and institutional capital and the trained personnel

necessary to provide quality public services such as clean water, education or health

services. Access to information and factor and product markets tend to be imperfect,

stressing the role for the government in activities which would otherwise be handled by

the market, for example, the supply of contraceptives. The cost of providing such

services, however, tends to be high due to the limited human and institutional

infrastructure.



For analytical purposes, the economic development riddle can be divided into three

independent but interrelated pieces: 1) vigorous overall economic growth involving

income growth in both agricultural and the manufacturing sectors, a la East Asia; 2)

vigorous growth in the food and the agricultural sectors without necessarily a stellar

macro economic performance, a la South Asia; and, 3) investment in the social sectors,

2







with or without a strong macroeconomic performance, 6 la China, Kerala or Sri Lanka.

All three can achieve varying degrees of decline in fertility rates, but the failure on the first

two fronts for any length of time can make investment in the social sectors unsustainable

and result in high levels of fertility as in Africa. The African situation raises the old

Malthusian concerns by now largely rejected by the economic profession, as well as a

variety of non-economic considerations such as tastes and preferences discussed later

in this paper.



The paper reviews the recent empirical evidence to determine the extent to which income,

residence (rural or urban) and women's education determine fertility levels and overall

population growth rates. Macroeconomic and sectoral performance affecting fertility rates

is reviewed first, followed by the micro level behavior of households. The experience of

East and South Asia is explored where population policies and patterns of rural and

overall economic growth have differed widely. Those differences have resulted in quite

different outcomes with regard to the rates of population growth. The paper inevitably

ends up with a treatment of Africa, where demographic transition has not yet occurred.

On the basis of the evidence presented, Malthusian-Boserupean debate about population

growth as a liability or an asset to economic development is explored. The paper

identifies the need for more location specific, quantitative research at the household,

community and regional levels. It illustrates why such research needs to transcend

traditional sectoral and disciplinary boundaries to effectively address the interactions

between demography, agriculture and the environment, and to explore its implications for

policy (see for instance Lele and Stone).








Definition of Rural Countries:

How should one define predominantly rural countries? One way would be to choose an

arbitrary cut off point such as the share of the total population living in rural areas, e.g.

50 percent or more. According to WDR 1992, such a definition leads to inclusion of all

low income countries, excluding China, with a total population of 1.9 billion and 22 million

middle low income countries in Latin America, Africa and the Middle East (with the total

population of 691 million). Exclusion of China, with 46 percent of the total 1.13 billion

people reported to be in rural areas in 1990 (WDR 1992), may however be questioned.

China's rural population exceeds the entire population of Sub-Saharan Africa. Moreover,

the Chinese experience raises important policy issues for other developing countries. Its

population growth has dropped to only 1.3 percent in 1985 compared to 2.2 in 1965. On

the other hand, Africa and the Middle East explain the wide range of population

projections by the World Bank until 2160. Their likely future population growth rates

remain a matter of conjecture, and account for between 85 to 90 percent of the difference

between the base case and alternative (higher) scenarios of population growth. The

share of Sub-Saharan Africa alone is estimated to be nearly two thirds of the differences

from the base case. The projections assume a rapid, continent-wide demographic

transition in Africa, lagging Asia's transition by only a few decades. But whether such a

decline will be induced by a deliberate policy or be a by-product of economic

development is not made clear. This is a matter of particular interest. The World Bank's

assessment of economic growth prospects for Africa remain pessimistic. On the other

hand, some of the Bank's most influential analysts have accepted the "revisionist view"

which holds that rapid population growth is not an obstacle to economic development

except under some special circumstances (Birdsall). A major new research project on

4








population growth is likely to throw considerable light on fertility behavior in Africa

(Ainsworth). Concerns from other noneconomic disciplines need nevertheless to become

an integral part of the World Bank's research on determinants of fertility in Africa.



A justification for the World Bank's position and that of the prestigious National Research

Council of the National Academy of Sciences on population is based on the fact that

Total Fertility Rates (TFRs) and population growth rates have declined in all parts of the

world except Africa. But TFRs have remained virtually unaltered at over six live births per

woman in Africa (WDR, 1992). There is some recent evidence of decline in fertility in a

few countries, e.g. Kenya.



The AIDS epidemic is projected to reduce Africa's population growth rate by one half

percent to one percent in the early 21st century (WDR 1992). Yet, TFRs in Africa remain

higher than in other parts of the world even with similar levels of per capital income (Figure

1). It should be noted, however, that relationships of TFRs with life expectancy and female

education follow standard inverse patterns (Figures 2 and 3). Yet,recent empirical

evidence on fertility behavior in some African countries reviewed later offers results

contrary to those normally expected, i.e. increased income and women's increased

access to primary education seems to be associated with higher fertility rates.



Diversity of Population Growth Experiences and Need for Empirical Research:

As the preceding discussion illustrates, there is great diversity among continents,

individual countries and indeed even among regions within single countries (e.g. China,

Kerala vs. the rest of India, or more recently the central province vs. the rest of Kenya).

5







This diversity makes generalizations difficult. Not only do countries differ widely in the size

of populations (e.g. China vs. Chad), but also in population densities, development of

physical, human and institutional capital, social norms as regards family size, the extent

to which joint or nuclear families prevail, (the incidence of polygamy is still pervasive in

Africa), the extent of settled or nomadic populations (in the latter case population growth

rates are significantly lower), the extent to which female children are undervalued relative

to male children as, for instance, in China and India, the nature of religious beliefs, most

notably the role of Islam in reducing female labor force participation, and the differences

in the levels of technologies and factor productivity. For example, value added of labor

per hectare on a typical smallholder farm in Africa is about 85 percent (implying little or

no use of capital) compared to 45 percent in India (despite India's labor abundance)

reflecting the use of higher level of technology in Indian agriculture, i.e. animal draft

power, chemical fertilizers, etc. (Delgado and Ranade).



Undercapitalization has resulted in high labor intensity per unit of land in African

agriculture. However, low population densities, fragmented labor markets and acute

seasonality of rainfed agriculture also cause labor shortages. Clearly, increasing labor

productivity, especially of women that have the primary responsibility for food production

is an important impetus for of reducing fertility. Yet, following the Asian model, much of

the agricultural technology generation in Africa has focused on increasing land rather than

labor productivity. Such new technology frequently generates considerable additional

demand for labor (eg. in weeding, harvesting, storage, etc.) accentuating rather than

alleviating labor bottlenecks and perhaps creating a justification for larger families.








The labor requirements of households increase considerably when collection of water

(much less easily accessible in rural Africa than in rural Asia or rural Latin America), and

fuel wood (much more extensively used in rural Africa than in rural Asia) are taken into

account. Sheer survival calls for considerably more arduous labor and children constitute

an important part of the rural labor force as transporters of water, gatherers of fuel wood

and guardians of cattle and younger siblings. The cost of rearing children is relatively low

where access to primary and secondary education is limited, although considerable

strides have been made in the expansion of social services in Africa.



These various factors together affect rates of growth of population and per capital income.

Yet the relative importance of cultural, technological, infrastructural, institutional and

economic factors in rapid population growth is a highly debated issue. Also debated is

whether rapid population growth and increased population densities are an asset or a

liability for economic development, including in particular the effects of population growth

rates on investment, factor productivity and ultimately on economic growth, debates to

which we return later.



Differential Population Performance:

Table 1 shows the rates of population and GDP growth in the three continents in the

1960s, 1970s and 1980s. GDP growth rates were higher and population growth rates

lower in East Asia leading to the highest rates of per capital GNP growth, followed by

South Asia and Sub-Saharan Africa.



Table 2 also shows the number of people living in poverty (ie. with per capital incomes

7








less than one dollar per day) in the three continents and their projected numbers if

present economic trends continue. South Asia and Africa are the regions where the bulk

of poverty will remain concentrated. Furthermore much of this poverty is concentrated in

the rural areas and that is where the problem of rapid population growth will remain. Of

the 1.13 billion living in poverty in 1990, nearly 750 million live in Asia and well over half

a billion in South Asia alone. By the year 2000, the number of poor in East Asia is

expected to decline from 169 million to 73 million, and in South Asia to 511 million, down

from 562 million. In Sub-Saharan Africa, the number is expected to increase from 216

million to 304 million.



The Malthusian concern of population growth outstripping the rate of growth of food

production has been virtually abandoned except perhaps in Africa, although it had much

validity in East and South Asia until the mid 1960s, i.e. until technological change in the

agricultural sector increased return to land and labor and accelerated the rate of growth

of food production above the rate of population growth. The Green Revolution eliminated

recurrent food shortages and, by keeping food prices and wage costs low, provided a

boost to overall economic growth. Per capital income has been higher in each successive

decade in South Asia. Yet South Asian countries have experienced slow growth of

employment in the manufacturing sector and slow overall economic growth due to

protective industrialization policy. But in East Asia, the effects of favorable performance

in food production have been further reinforced by favorable macroeconomic policies

which have ascribed high priority to export orientation, leading to a rapid growth in

employment in the manufacturing, as well as, the agricultural sector. Such personal

income growth has been combined with substantial expansion of public investment in the

8







social sectors leading to female access to primary education in Indonesia exceeding 100

percent" in 1985 compared to 67 percent for India and only 46 percent for Bangladesh

(WDR 1992). An even more certain determinant of fertility reduction, namely women's

access to secondary education, stood at 23 percent in Indonesia compared to 22 percent

in India, only 9 percent in Bangladesh and 7 percent in Senegal. But female literacy rates

provide an even more favorable picture in Indonesia. They had been brought down to

32 percent in Indonesia compared to 66 percent in India, although in the early 1960s

Indonesia's female access to education was 57 percent compared to India's 65 percent.



The examples of Sri Lanka and the Kerala state in India that have also brought down

fertility rates considerably show that investment in the social sectors and the spread of

primary education can result in sharp reduction in fertility rates at low levels of per capital

income. Similar differences in economic and social sector strategies explain why India

has done better than Bangladesh or Senegal (Table 3). Indeed, fertility rates in Indonesia

and India, with per capital incomes of $ 520 and $ 350 respectively in 1990 were

comparable to those in Mexico, Brazil and Colombia. The latter three had per capital

incomes three to six times higher but their income distribution is more skewed, with

significant incidence of poverty.



Recent Trends in African Fertility:

Demographic and health surveys in eleven countries in Africa show that while Total fertility

Rates (TFRs) are very high in Africa, nearly in every country they are significantly lower


The figure exceeds 100 percent because it is based on an age cohort of primary school children, but
people outside that cohort enrolled in school.








in urban than in rural areas, perhaps due to a higher concentration of women with

secondary and higher levels of education in urban areas. Differences in fertility with only

primary schooling are, however, smaller and sometimes in the opposite direction than

those expected (1984 WDR, and Cochrane 1979, 1988) leading to a concern that the

spread of primary schooling could result in increased fertility rates.



Use of contraception is strongly and positively related to the level of education. Recent

survey data suggest that between four to 49 percent of married, nonpregnant women

would like to stop child bearing, suggesting that policies that improve the access to

contraceptives and encourage their use are likely to result in a substantial decline in

fertility (Table 4).



Although lack of contraceptives is a problem in many African countries the primary reason

for high fertility and low contraceptive use appear to be continued high demand for

children (van de Walle and Foster 1990). The ideal family size on recent surveys remains

at six to nine children per woman. This suggests that large scale expansion of family

planning programs is unlikely to have much effect on fertility rates in Africa (Ainsworth).

Indigenous culture clearly plays a role in the determination of family size, but low levels

of education of women, and high child mortality also play a part. The recent increase in

malaria and AIDs has resulted in increase in mortality rates (by year 2000 mortality of

children under five is expected to increase by a fifth to 43 percent in ten severely affected

countries (Ainsworth)), and this should be expected to keep fertility rates high.



Micro studies of fertility behavior show substantial differences among African countries.

10








For instance despite higher per capital income and higher level of urbanization fertility is

higher in C6te d'lvoire than in Ghana, and appears not to have changed in recent years.

Child mortality is very high in both countries. Women's education is strongly related to

fertility decline in both countries and secondary education brings it down more

substantially, but women's education is highly limited in both countries. Only 62 percent

of the female population attends primary schools in C6te d'lvoire and 67 percent in

Ghana'. The rates are even lower for secondary schools, namely 20 percent and 39

percent respectively.



Income seems to have opposite effects in the two countries, in C6te d'lvoire it is positively

related to fertility and negatively in Ghana (Kofi Benefo and T. Paul Schultz will cite as

forthcoming). Urbanization seems to have only a limited effect in Ghana but seems to

contribute to a fertility decline in C6te d'lvoire. Women's education is thus the most

important determinant of fertility decline, other things being equal (Benefo and Schultz).



Even among high fertility rate countries differences among socioeconomic classes lead

to a conclusion that high demand for children might well be a result of high rates of

mortality and low levels of schooling of female children (Cochrane and Farid). Yet

empirical support for the decline in fertility associated with decline in child mortality is

weak in Africa. Frank and McNicoll argue that fertility rates in Kenya in particular and

Africa in general may be reduced more quickly by directing attention to women most likely

to be interested in ceasing childbearing (e.g., women who already have several children



4The data are from the years 1985 for C6te d'lvoire and 1987 for Ghana.

11







or adolescents whose early pregnancies increasingly conflict with education) rather than

spreading program attention over all child bearing families. They lament that economic

and demographic models do not take into account the impact of local government

organizations, delivery systems, land tenure institutions or ethnic factors that influence

women's security and child bearing decisions.



Malthus Vs. Boserup:

The impetus for an active family planning program in India and China, discussed below,

has been prompted by high population densities and exploitation of already quite marginal

lands, with extensive landlessness. Boserup, on the other hand has argued, particularly

in the case of Africa where population densities have been generally low until recently,

that population growth and increased densities can stimulate intensification of agriculture

by inducing technological change made possible by changes in relative factor proportions

as well as by the development of factor and product markets, specialization and

development of property rights, all in turn leading to greater investment in land. Lele and

Stone have shown, however, that there is no universal guarantee of such outcomes.

Rather they are determined by the nature of public policy. For example, where land

access is restricted to a privileged few and price, technology and infrastructural

investments by the public sector discriminate against small farm production as in Malawi

policies can result in involution much as Gertz observed in Java in the 1950s. In contrast,

more egalitarian and pro-active agricultural policies such as those pursued in Kenya can

result in rapid intensification of agriculture through shift to high value crops and increased

yields per ha.








Kenya's agricultural success notwithstanding, there is growing evidence in Kenya and

other parts of Africa of stagnation or decline in per hectare yields of major crops, caused

by increased population pressure on the land, a reduction in the bush fallow, absence of

crop rotation and widespread migration of populations to the poorer lands (Lele and

Stone). According to various recent international assessments (e.g. WDR 1992),

prospects for economic growth are by far the least promising in Africa due to a

combination of a rapidly growing population and an ineffective public policy.



Whether Boserup or Malthus prove right in the long run in Africa depends on the quality

of public policy that is in turn influenced by a variety of external factors. For example,

the world food situation has changed considerably relative to that which Asian countries

faced in the mid 1960s. The depletion of US food surpluses by the end of the 1960s

followed by a severe drought in 1973 resulted in a sharp rise in world food prices

adversely affecting large food importers in South and East Asia (e.g. China, India and

Indonesia). The increased food import dependence was an impetus for Asian policy

makers to increase domestic food production. Concern about domestic political stability

also weighed heavily in Asia.



In contrast, African countries are small importers. Even with a doubling share of world

cereal imports they stood at only 12% in 1990. Moveover, the world food situation is now

considerably more favorable with virtually all industrial countries having become major

surplus producers. High levels of per capital aid have been easier to mobilize for small

African countries (see Figure 5). There has been less impetus to get African agriculture

in order. Technological breakthroughs have also been harder to achieve in rain-fed

13








African agriculture in contrast to the irrigated agriculture of Asia, with the result that

increased population pressure has frequently had disastrous effects. The growing

concerns about environmental sustainability has caused erosion of the traditional

approach to intensify agriculture through the increased use of modern inputs. Because

external dependence is much greater these concerns have had the inadvertent effect of

keeping fertilizer consumption low in African agriculture.



Yet, the growing environmental concerns may well affect the world's ability to feed a

growing population, even though virtually every recent global study has concluded that

the world has the necessary physical resources to feed a much larger population

(Srinivasan). However, these studies do not factor in the economics of increasing food

production. Changes in input prices which more correctly reflect the true environmental

costs could increase the cost of food production considerably, thereby rendering it less

profitable in developing countries than it has been in the last two decades. Yet the world

food prices continue to decline following a virtually autonomous technical change in

agriculture in industrial countries.



The emphasis on structural adjustment since the early 1980s has shifted the attention

away from these micro level realities to macroeconomic policy reforms. Investment rates,

including especially public investments in irrigation have dropped throughout the

developing world, and growth of fertilizer use is expected to decelerate in a situation of

devaluations, reductions in fertilizer subsidies and crowding out of the private sector

access to institutional credit (Lele, 1992).







In summary, prospects for rapid increase in per capital food availability are believed to be

less promising in the next two decades than they did in Asia in the 1960s and 1970s.

This makes it all the more important and yet all the more difficult to reduce the rates of

population growth in a situation of growing poverty.



Structural Adjustment:

The impact of structural adjustment on the social sectors is a matter of interest. A major

IMF study of government expenditures covering the 1975-1986 period concludes that

there has been a general upward shift toward higher educational spending in all regions

of the developing world, eight to fifteen percent higher than levels predicted in relation to

the structure of the economies and growth rates of GNP (Heller and Diamond). While

gains in women's education have been more significant than average throughout the

world, major variations exist among the lowest income countries (e.g., Kenya, Lesotho,

Togo and Zaire are above the predicted level but Sudan, Cameroon and Tanzania are

below).



The same IMF study finds that foreign debt is a major constraint on education

expenditures. Furthermore, none of the demand factors (such as the size of dependent

population, birth and population growth rates and poor access to clean water) have a

significant influence on the share of health expenditures in GDP. Rather health

expenditures too are most significantly and negatively related to the size of the foreign

debt.



The higher cost of providing services in rural areas tends to raise the share of

15








expenditures. This may explain why the share of actual health expenditures to GDP ratios

were higher than those predicted for Africa with its greater share of rural populations

compared to Asia.



In a recent study, Sahn concludes that there is no conclusive evidence to suggest that

countries reduce government expenditures either in real terms or as a percent of GDP as

a consequence of receiving adjustment loans. In those countries where compression in

government spending is noted in the 1980s, it preceded the beginning of adjustment

programs. That, however, is little consolation since the interest is in knowing about the

impact of adjustment (rather than of loan conditionality) on the access to social services.

Sahn concludes that real spending on a per capital basis has declined. Precisely how a

contraction in those expenditures has affected services is not known. It depends on:

whether the balance of investment and recurrent expenditures has become more or less

appropriate, within recurrent expenditures; whether the resources for operating expenses

--that tend to be the most constrained in the least developed countries-- improved or

worsened; whether the quality of public services deteriorated; or whether expenditure cuts

resulted in the marginal activities being eliminated.



The increased emphasis on cost recovery has been justified on grounds that subsidized

services do not benefit the most deserving and result in rationing of supply by

constraining the budgetary resources allocated to those activities (Jimenez). There is little

empirical evidence yet to indicate the actual increase in cost recovery in the social

sectors, and whether it has resulted in expanded services. It is likely that the poor would

be unable to pay for such services. If they did not benefit before the reforms were

16







introduced, they would not benefit from expansion of market based services either,

particularly in the rural areas. Subsidies targeted specifically for the poor are clearly

essential. More empirical research is needed on the quantity and the quality of social

services than exists currently.



Fertility and Democracy:

The much faster decline in fertility rates in China than India raise additional policy issues

especially in the context of the contemporary interest in the exercise of democracy. In

both countries economic and social incentives to reduce fertility have been combined with

exercise of compulsion, albeit more consistently in China than India, e.g. the one-child

policy in China and the temporary use of forced sterilizations following the declaration

of emergency in the early 1970s in India. India was unable to enforce compulsion on a

sustained basis however. The unpopularity of sterilizations and the ensuing loss of

election by Mrs. Gandhi set back the political will to actively promote family planning

programs in India even where market demand for such services now outstrips supply.



China's better performance is a result of more effective economic incentives as well as

stronger enforcement of compulsion. Through a revolution, China redistributed assets

and ensured a much more broad-based access of households to productive services in

the agricultural sector than India could manage through democratic means. China's

policy of personal responsibility in agricultural production since the early 1980s

accelerated and diversified agricultural production. China also greatly increased women's

access to education and health services and expanded their labor force participation.

Three quarters of women in China had access to contraceptives in 1985 compared to 45

17







percent in India in 1988, the latest years for which data are available. Contraceptives are

virtually totally unavailable in rural areas of India according to some latest study. This is

in no small measure due to an excessive emphasis on sterilizations aimed at women at

the end of their child bearing stage as the means of controlling population growth.



The enforcement of the policy of universal primary school attendance has similarly been

constrained in India by a general recognition that the opportunity cost of children's (and

especially the girl's) time, is higher for poor households who rely on their income than the

discounted future return to education. Compulsory schooling may boomerang at the ballot

box although the discounted long run social return to such education may well be

considerably higher. Not only will spread of primary and secondary education increase

labor productivity and future streams of household income. It will result in reduced fertility

rates and increased quality of child care. Moreover, the spread of primary education will

curtail the widespread practice of the employment of child labor. Recent data show that,

although female primary school attendance increased by 20 percent in India in the late

seventies and early eighties, it began to decline in 1988 (WDR's 1965-92). More alarming

is the fall in female labor force participation rate from 27 percent in 1965 to 20 percent in

1990, whereas female labor participation in other developing countries has increased.

Regarding freedom of household choice and high social costs of female illiteracy, India

and other developing countries facing these dilemmas clearly need to assert the more

pro-active role of the state in the enforcement of primary and secondary education, in

much the same way that it was done in the now industrialized democracies.







Gender Bias in China and South Asia

Whereas the supply of contraceptives may affect the motivation to plan families, the

absence of a democratic environment at the household level also has effects on infant

and child mortality. Both India and China are notorious for their discrimination against

female children. Over 50 million females are estimated to be missing in China and India

(Coale).



South Asia has fewer females to males in the total population (Visaria) due to

discrimination against female children and their consequent excessive mortality (see for

instance D'Souza and Chen, Wyon and Gordon, Levinson). Such differences are more

pronounced in North than South India (Dyson and Moore). Moreover, whereas such

discrimination should be expected to prevail in the rural areas, recent evidence suggests

that increase in incomes, access to education including particularly women's access to

education, and indeed even the general decline in fertility rates caused by overall

economic growth has not eliminated discrimination against female children.



Girls in families with one or more surviving daughters are more likely to suffer

discrimination. In the Punjab, girls face 2.36 times higher mortality than their male

siblings. Expenditures on medical care are 2.34 times higher on boys before the age of

two, as compared to girls. Boys also benefit from higher quality nutrition, better clothing

etc (Das Gupta).



A strong preference for male children is accentuated by the reduction in the size of the

family, and this has been noted in China (Arnold and iu). Sten Johanssen and Ola

19








Nygren estimate the excess female infant deaths in China to be about 39,000 per year or

about 4 per 1,000 live born births. They attribute the phenomenon of the so-called

missing females to under-reporting of girls, differential abortion and female infanticide.



Summary

The main characteristic shared by predominantly rural countries is the low level of per

capital income. Other social and economic conditions vary substantially, however,

highlighting the need for location specific population research. Availing contraceptives to

women has little impact if cultural or institutional constraints adversely influence economic

incentives to bear children.



Due to its massive poverty in global terms, the biggest challenge of population growth is

in Africa and South Asia. With respect to Africa, aspects and assumptions pertaining to

the Boserup hypothesis merit critical examination to determine the extent to which

population growth can actually assist economic development. The same conditions that

averted a Malthusian crisis in Europe and more recently in Asia do not prevail in much

of Africa. Promoting universal female education, health care, contraceptive materials and

training is clearly critical. Agricultural research, extension, credit and labor productivity

are also critical to increase agricultural productivity, income and thereby to lower fertility

rates. International aid is important but past aid efforts focussing simplistically both on

integrated rural development and structural adjustment without an economic development

strategy have had a very limited impact (Lele, 1991). More aid to Africa without assessing

its impact and implications for the future is therefore not a solution. Reduction of implicit

domestic taxation of agriculture and intersectoral redistribution between agriculture and

20







industry attempted through structural adjustment is essential, but has not occurred in

many African countries and in any case is not sufficient. It cannot generate sufficient

revenue to alleviate the poverty that contributes to high fertility rates. The evidence from

IMF studies indicates that large foreign debts and budget cuts have threatened essential

social services. Predominantly rural countries also face higher per unit costs of delivering

social services, given their poor infrastructures and the wide geographical dispersion of

their populations.



In South Asia, female fertility rates have not declined as much as they could because, with

the exception of Sri Lanka and Kerala in India, South Asia has not given the priority to

investment in education and the social sectors that it deserves, including especially the

focus on women. The often fatal discrimination of female infants in China and South Asia

has been well recognized. Yet surprisingly little attempt has been made by the countries'

policy makers and social and religious leaders to deal with the problem. There is a need

to encourage public discussion and massive public education of men and women within

the countries involved on an issue in which male national leaders must clearly take the

lead. International agencies should assist their counterparts in countries where female

infanticide occurs and offer support for whatever policy initiatives that diminish the

problem.







BIBLIOGRAPHY


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Becker, Gary S., 1981, A Treatise on the Family, Cambridge, Massachusetts: Harvard
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Benefo, Kofi and T. Paul Schulltz, 1992, Fertility and Mortality in C6te d'lvoire and
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1981, Population and Technical Change: A Study of Long Term Trends, Chicago:
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Table 1


Population, GDP and Percapita GNP Growth Rates
for Selected Regions, 1990


Region'


Sub-Saharan Africa4

East Asia

South Asia

Europe, Middle East
& North Africa

Latin America &
the Caribbean


1965-73

2.6

2.6

2.4

1.8


2.6


Population

1973-80 1980-89

2.7 3.2

1.7 1.6

2.4 2.3

2.0 2.0


1965-73

4.8

8.1

3.6

7.7


6.5


GDP

1973-80 1980-89

3.2 2.1

6.6 7.9

4.2 5.1

3.9 2.9


Per Capita GNP

1965-73 1973-80 1980-89

1.7 0.6 12

5.2 4.7 63

1.2 1.9 29

1.8


'Source: World Development Report, 1991.







Table 2


Total Number of Poor
for Selected Regions, 1985 2000




Region' (millions by year)

1985 1990 2000


Sub-Saharan Africa 184 216 304

East Asia 182 169 73

South Asia 532 562 511

East Europe, Middle 65 78 93
East & North Africa

Latin America & 87 108 126
the Caribbean


1Source: World Development Report, 1991.







Table 3


Population Growth Rates for Selected Countries'
(% 1990)


Country

Indonesia

India

Bangledesh

Brazil

Colombia

Mexico

Kenya

Senegal


'Source: Population and the World Bank: Implications from Eight Case Studies, World
Bank, 1992.








Table 4


Country

Benin

Botswana

Burundi

Cameroon

Cote d'lvoire

Ghana

Kenya

Lesotho

Liberia

Mali

Mauratania

Nigeria
(Ondo State)


Percent of Currently Married Women Who Want No More Children
and Percent Who Wish to Postpone Among Those Who Want More
Selected Sub-Saharan Countries

Percent Who Percent Who Wish to
Want No More Postpone Among Those
Year/Source Children Who Want More

1982 WFS 8 55

1988 DHS 33 24

1987 DHS 24 76

1978 WFS 8

1980 WFS 4 38

1988 DHS 23 70

1989 DHS 49 68

1977 WFS 14

1986 DHS 17 48

1987 DHS 17 50

1981 WFS 11

1986 DHS 23 58


Senegal 1986 DHS

Sudan 1978 WFS

Togo 1988 DHS

Zimbabwe 1988 DHS

Source: Table 5, Cochrane and Sai, 1990.
Note: Pregnant women excluded.









rtility


by Percapita
Selected Countries


GNP


Lao.PDR
Tanzania Kenya
Madagascar
Nig distan


Cote d'lvoire


Cameroon


Lesotho


Haiti
Bangladesh


Zimbabwe


Paraguay
El Salvador


Peru
Philippines
SDominican Republic
Indonesia


Guyana
Ch iri Lanka


Coomb Jamaica
Colombiai
Thailand


Mexic OBrazil


Panama


Mauritius


1500
Percapita GNP


Social Indicators of Development 1991-92, A World Bank Book, Baltimore:
Johns Hopkins University Press, 1992.


Figure 1


Fe


Malawi


6


India


Algeria


Belize


500


1000


Source:


2000


2500


3000


I- I ,








Fertility


by


Female


Primary Education


40 60
Female Primary


Enrollment


Social Indicators of Development 1991-92, A World Bank Book, Baltimore:
Johns Hopkins University Press, 1992.


Figure 2


Source:


100


120


140





Figure 3


Fertility by
9


nfa


nt M


orta ity


Rwanda

Ethiopia Malawi


Cote d'lvoire & alia
Suurkina
Sudan Madagascar


Cameroon


Mali
Faso & Sierra Leone


Pak Set i


Honduras & Nicaragua
Zimbabwe Haiti

El Salvador
Viet Nam Peru India
Philippines
Mexico Brazil& Indonesia


Colombia
Sri L rk
CubcMvauritius


100


Infant Mortality


(per


1,000 live births


Social Indicators of Development 1991-92, A World Bank Book, Baltimore:
Johns Hopkins University Press, 1992.


C
0
E
0

L
Qa


Kenya


Source:


150


200


I I










Fertility


by


Female


Life Expectancy


Rwanda


Malaw-thiopia

NigejAali
Afghanistan Burundi & Somaliote d'lvoire
Guinea MTanzqnia Congo Kenya
Su aen & ZairGhana


Chad
Nepal


NigFristaameroon & Namibia
Lesotho


Syrian Arab Republic
Jordan


C
c-
0
E
0

L






a-
0.
-F-'
L
U-Q








0
-
0)




H-


India


Peru EYiAc Am
Philippines


Indonesia


Brazil Mexico
Panama & Jamaica
Colombia
Thailaaingri Lanka


Mauritius Cuba


60 70
Female Life Expectancy


Social Indicators of Development 1991-92, A World Bank Book, Baltimore:
Johns Hopkins University Press, 1992.


Figure 4


Guatemala & Nicaragua
Honduras
Papua New Guinea Algeria
Haiti lPai8bwe
Bangladesh & Cambodia Morocco Paraguay & Belize
El Salvador


40


Source:


III










Perca ita


ODA


Mozambique


Tanz


oMala
Lesotho


Mauritai


Hondur
Ethiopi
Keny
Gha~i L~%R ~aU9 Foso
El Salvadideiti
Mauriti
ne aln E~i s

0.60 1.60 3.60 6.40 6.60 7.40 8.20 9.20 9.90 11.40 14.60 16.40 20.00 24.50 25.70 45.90 48.20
Country


Social Indicators of Development 1991-92, A World Bank Book, Baltimore:
Johns Hopkins University Press, 1992.


Figure 5


Some


4-J
0
O_
U 30
L
Q)

20



10



0


Source:




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