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 Introduction
 Main
 Conclusion
 Notes














Title: Studies in family planning
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 Material Information
Title: Studies in family planning
Abbreviated Title: Stud. fam. plann.
Physical Description: v. : ill. (part fold.), maps (part col.) ; 28 cm.
Language: English
Creator: Population Council
Publisher: Population Council
Place of Publication: New York
Frequency: quarterly[<1997- >]
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 Subjects
Subject: Birth control -- Periodicals   ( lcsh )
Family Planning Services -- Periodicals   ( mesh )
Gezinsplanning   ( gtt )
Régulation des naissances -- Périodiques   ( rvm )
Genre: periodical   ( marcgt )
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Additional Physical Form: Also issued online.
Dates or Sequential Designation: v. 1- July 1963-
Numbering Peculiarities: Vol. 1- called also no. 1-<25>
General Note: Supplements accompany some issues.
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Volume ID: VID00004
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Table of Contents
    Introduction
        Page 1
    Main
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
    Conclusion
        Page 10
        Page 11
        Page 12
    Notes
        Page 13
        Page 14
Full Text













Number Thirty-Eight


BEYOND FAMILY PLANNING


THE following paper reviews various proposals made for dealing with "the popu-
lation 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 popu-
lation 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 oc-
casions, the question is: what is to be
done? There is a certain agreement on
the general objective (i.e., on the desira-
bility of lowering birth rates, though not
on how far how fast), but there is dis-
agreement as to means.
The 1960's have witnessed a sub-
stantial 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 establish-
ment of national family planning pro-
grams, or rough equivalents thereof.
There are now 20 to 25 countries with
efforts along this line, on all three de-
veloping 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-i~-Taf ly-pfilrifnihgthe 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 alhealth meas-
Sure beyond dispute; and since voluntary
it can be justied 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 plan-
ning as a response to a country's popu-
lation 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 popu-
lation 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 suf-
ficient agreement on the magnitude and
consequence of the problem that addi-
tional 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 birth


A PUBLICATION OF


February 1969


rates 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 onsideraion.
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 sug-
gested to this end in recent years; and
second, by reviewing the issues raised by
the suggested approaches.

Proposals:
Beyond Family Planning
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 pro-
posal? 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


THE POPULATION COUNCIL. INC.. 1969


Studies in


Family Planning


THE

POPULATION

COUNCIL







for difficult cases and with family
planning education and services a
central component of the program
aimed particularly at women of low
parity (Taylor & Berelson6).
2. Liberalization of induced abortion
(Davis7, Ehrlich8, Chandrasekhar9).

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 un-
known but believe to ava r
fieldtestingaiter5-l5 yearsof research
work; to be included in water supply
in urban areas and by "other methods"
elsewhere (Ketchello); "addition of
temporary sterilants to water supplies
or staple food" (Ehrlich11).
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,
S"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 re-
versibility allowed only upon govern-
Smental approval; certificates of ap-
proval distributed according to popular
vote on desired population growth for
a country, and saleable on open
market (Shockley'3).
4. Compulsory sterilization of men with
three monore ivg children (Chand-
rasekhar14); requirement of induced
abortion for all illegitimate pregnancies
(Davis15).

C. Intensified Educational Campaigns
1. Inclusion of population materials in
primary and secondary schools systems
(Davis16, Wayland17, Visaria'8): ma-
terials on demographic and physio-
logical aspects, perhaps family plan-
ning and sex education as well;
introduced at the secondary level in
order to reach next waves of public
school teachers throughout the coun-
try.
2. Promotion of national satellite tele-
vision systems for direct informational


effect on population and family plan-
ning as well as for indirect effect on
modernization in general: satellite
broadcasting probably through ground
relays with village receivers (Ehrlich'9,
Meier & Meier20, UNESCO21,
Schramm & Nelson22).

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 con-
traceptive 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 popu-
lation in return for the desired practice.
This usage is sometimes referred to as a
positive"incentivein distinctionito the
"negative incentive inherent in tax ori
welfare penalties for "too many" children
(E below).
1. Payment for the initiation or the
effective practice o contaception:
payment or equivalent (e.g., transistor
radio) for sterilization (Chand-
rasekhar23, Pohlmann24, Samuel25,
Davis26) or for contraception (Simon27,
Enke28, Samuel29).
2. Paymentor periods of non-pregnancy
or non-birth: a bonus for child spacing
or no n-pregnancy young BTitia3i,
Enke32, Spengler33, Leasure34); a sav-
ings certificate plan for twelve-month
periods of non-birth (Balfour35); a
lottery scheme for preventing il-
legitimate births among teenagers in
a small country (Mauldin36); "respQ
sibilityprizes"for eachhive yeargso[
childless marriage or for vasectomy
before the third child, and special
lotteries with tickets available to the
childless (Ehrlich37).


E. Tax and Welfare Benefits and Penal-
ties: 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 (Bhatia3 8,
Samuel39, Davis40) or unless certain
limiting conditions have been met,
like sufficient child spacing, knowledge
of family planning, or level of income
(Titmuss & Abel-Smith41).
2. Withdrawal of children or family
allowances, perhaps after N children
(Bhatia42, Titmuss & Abel-Smith43,
Davis44).
3. Tax on births after the Nth (Bhatia45,
Samuel46, Spengler47).
4. Limitation of governmentally provided
medical treatment, housing, scholar-
ships, loans and subsidies, etc., to
families with fewer than N children
(Bhatia48, Davis49).
5. Reversal of tax benefits, to favor the
unmarried and the parents of fewer
rather than more children (Bhatiaso,
Titmuss & Abel-Smiths5, Samuels2,
Davis53, Ehrlich54, David55).
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
(Fawcett56).
7. Pensions for poor parents with fewer
than N children as social security for
their old age (Samuel57, Ohlins8, Davi-
son59).

F. Shifts in Social and Economic Insti-
tutirons: 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 sub-
stantial fee for marriage licenses
(David60, Davis61); or through direct
bonuses for delayed marriage
(Young62); or through payment of
marriage benefits only to parents of
brides over 21 years of age (Titmuss
& Abel-Smith63); or through a pro-
gram 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
(Davis64); or through a "governmental
'first marriage grant' awarded
each couple in which the age of both
(sic) partners was 25 or more"
(Ehrlich65); or through establishment
of a domestic "national service"
program for all men for the appro-
priate two-year period in order to
develop social services, inculcate mod-


6_


~e~U1-












C~C~-~Q*
J








ern attitudes including family plan-
ning and population control, and at
the same time delay age of marriage
(Berelson, Etzioni66).
2. Promotion or requirement of female
participation in labor force (outside
the home) to provide roles and in-
terests for women alternative or
supplementary to marriage (Hauser67,
Davis68, David69).
3. "Direct manipulation of family struc-
ture itself-planned efforts at de-
flecting 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 (Blake70); "selective restruc-
turing of the family in relation to the rest
of society" (Davis71).
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 & Meier72).
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 agri-
cultural 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" (Hauser73); and im-
proved 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
(Revelle75, Heer & Smith76).

G. Approaches via Political Channels
and Organizations
1. U.S. insistence on "population control
as the price of foo Jd" hJigjy
selective assistance based thereon, and
exertion of political pressures on
governments or religious groups im-
L peding "solution" of the population
problem, including shifts in sovereignty
(Ehrlich77).
2. Re-organization of national and inter-
national agencies to deal with the
population problem: within the United
States, "coordination by a powerful
governmental agency, a Federal De-
partment of Population and Environ-


ment (DPE)... with the power to take
whatever steps are necessary to estab-
lish a reasonable population size"
(Ehrlich78); within India, creation of
"a separate Ministry of Population
Control" (Chandrasekhar79); develop-
ment of an "international specialized
agency larger than WHO to operate
programs for extending family limi-
tation techniques to the world .
charged with the responsibility of
effecting the transfer to population
equilibrium" (Meier & Meier80).
3. Promotion of zero growth in popu-
lation, as the ultimate goal needed to
be accepted now in order to place
intermediate goals of lowered fertility
in proper context (Davis81).

H. Augmented Research Efforts
1. More research on social means for
achieving necessary fertility goals
(Davis82).
2. Focused research on practical methods
of sex determination (Polgar83).
3. Increased research toward an improved
contraceptive technology (NAS84).

Proposals: Review of the Issues
Here are 29 proposals beyond family
planning for dealing with the problem of
undue population growth in the develop-
ing 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 via-
bility, (3) administrative feasibility, (4)
economic capability, (5) moral/ethical/
philosophical acceptability, and (6) pre-
sumed 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 in-
dicated at the outset of this paper, I sug-
gest the next decade or two on the double
grounds that the future is dim enough at


that 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 condi-
tions existing at that time. In any case,
long-run social goals are normally ap-
proached through successive short-run
efforts.
Since the population problem in the de-
veloping 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 illus-
trative 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 popula-
tion programs combined.)

Scientiflc/Medical/Technological
Readiness
Two questions are involved: (1) is the
needed technology available? and (2) are
the needed medical or para-medical per-
sonnel available or readily trainable to
assure medical administration and safety?
With regard to temporary contracep-
tion, 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 contra-
ceptive developments of the past decade,
and several promising leads are now being
followed up85-though it cannot be said
with much confidence that any of them
will eventuate for mass use within the next
few years.86 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.87
However, neither Ehrlich's "temporary
sterilants" nor Ketchel's "fertility control
agent" (B-l) 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 sub-
stance 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 in-
voluntary addition to a water supply
would face far greater difficulties of ac-
ceptance simply on medical grounds than
the far milder proposals with regard to
fluoridation to prevent tooth decay.
Though a substantial technology in fer-
tility control does exist, that does not
mean that it can be automatically applied
where most needed, partly because of
limitations of trained personnel. In gen-
eral, the more the technology requires the
services of medical or para-medical per-
sonnel (or, what is much the same, is per-
ceived as requiring them), the more diffi-
cult 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 commer-
cial ones, though that network is not with-
out limitations in the poorer countries.
Oral contraceptive pills are now distrib-
uted in large numbers without substantial
medical intervention in a number of coun-
tries-sold by pharmacies without pre-
scription-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 consid-
ered in India (see footnote 14), an esti-
mate was made that the policy would
affect about 40 million males: "one thou-
sand 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 sup-
ply 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 re-
quire hospital beds, which are in particu-
larly short supply in most developing
countries. Just as an indication of order of
magnitude, in India, for example, there
are approximately 22 million births an-
nually; to abort five million would require


the equivalent of about 800 physicians,
each doing 25 a day five days a week fifty
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 re-
quire 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 medi-
cally desirable-and para-medical person-
nel 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.

Political Viability
As mentioned earlier, the "population
problem" has been increasingly recog-
nized by national governments and inter-
national agencies over the past decade,
and favorable policies have been increas-
ingly adopted: national family planning
programs in some 20-25 countries, posi-
tive 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 favor-
able policies are not strong enough to sup-
port 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 in-
volved, with political ramifications; na-
tional size is often equated with national
power, from the standpoint of interna-
tional 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 consider-
able reluctance based on both religio-
moral 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 histori-
cally and given the sensitive religious,
military, and political issues involved, but
it does not provide maximum support for
energetic measures directed at the "neces-
sary" 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, popu-
lation measures are not taken in isolation
-which is to say, they are not given over-
riding 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 govern-
ment 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 de-
veloping 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 offi-
cials 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 frame-
work 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) precipi-







tated "a storm of questions in Parlia-
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, politi-
cal 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 mis-
sion,91 by the Small Family Norm Com-
mittee,92 by the Central Family Planning
Council (e.g., with regard to age of mar-
riage, the education and employment of
women, and various social welfare bene-
fits), 93 and in almost every issue of such
publications as Family Planning News,
Centre Calling, and Planned Parenthood
(illustrative recent headings: "Tax to Re-
duce Family Size," "Relief for Bachelors
Urged," "Scholarships for Children,
Family Planning for Parents"). As Samuel
reports, with accompanying documenta-
tion, "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 edu-
cational 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 privi-
leges, though in the nature of the case only
a small proportion of the state's popula-
tion 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 re-
voked before it really went into effect.98
There is a special political problem in
many countries, in that economic con-
straints on fertility often turn out in prac-
tice to be selective on class, racial, or
ethnic grounds, and thus exacerbate po-
litical 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 con-
cludes: "The prospective quantitative
effect of moves in this direction seems
very questionable. The number of un-
employed in India has been rising by ap-
proximately 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 fe-
male employment almost surely would
be."99
Given the present and likely political
climate both within and between coun-
tries, whether programs for lowering
population growth and birth rates are
politically acceptable or not appears to
depend largely upon whether they are per-
ceived as positive or negative: where
"positive" means that they are seen as
promoting other social values as well as
population limitation and where "nega-
tive" means that they are seen as limited
per se. For example, family planning pro-
grams, as noted above, are often rational-
ized 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 pro-
ductivity at the same time that it sub-
tracted from the birth rate; extension of
MCH services to rural areas is clearly de-
sirable in itself, with or without family
planning attached; incorporation of popu-
lation 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 popu-
lation 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 limi-
tation.
It would thus require great political
courage joined to very firm demographic
convictions for a national leader to move
toward an unpopular and severe prescrip-


tion designed to cure his country's popula-
tion 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. Wit-
ness 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 cata-
logue 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 in-
ternational 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 ob-
stacles. 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 popu-
lation growth must be taken mainly by the
countries directly involved: after all, it is
their people and their nation whose pros-
pects are most centrally affected. But in an
interconnected world, with peace and
human welfare at issue, others are prop-
erly concerned from both self-interested
and humanitarian standpoints-other
governments from the developed world,
the international community, private
groups. What of the political considera-
tions in this connection?
A recommendation (G-l) that the
United States exert strong political pres-
sures to effect population control in de-
veloping countries seems more likely to
generate political opposition abroad than
acceptance. It is conceivable that such
measures might be adopted by the Con-
gress, 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 boom-
erang against a population effort than to
advance the effort.
The proposal to create an international
super-agency (G-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 re-
straint on the international front.'02 A
new international agency would find the
road easier only if restricted to the con-
vinced 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.

Administrative Feasibility
Given technical availability and politi-
cal 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 administra-
tion: 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 them-
selves, 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 administra-
tive feasibility of several of the proposals
listed above, if for no other reason simply
because the proponents do not put for-
ward the necessary organizational plans
or details. How are "fertility control
agents" or "sterilants" to be administered
on an involuntary mass basis in the ab-
sence of a central water supply or a food
processing system? How are men with
three or more children to be reliably iden-
tified in a peasant society and impelled to


undergo 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 compul-
sory 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 bene-
fits and penalties, including marriage dis-
incentives, be made to work under similar
conditions?
Such questions are meant only to sug-
gest 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 ad-
dressed 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 direc-
tion. The plan to institutionalize maternal
care in rural areas with family planning
attached (A-l) is currently under study in
several developing countries with regard
to feasibility in administration, personnel,
and costs. The plans for a national tele-
vision system for informational purposes
(C-2) have worked out some of the admin-
istrative problems, though the basic ques-
tion of how to keep a television set work-
ing 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 popu-
lation into the school curriculum (C-1) has
been carried forward to the preparation
of materials and in a few cases beyond
that.103 The plans for incentive programs
sometimes come down to only the theo-
retical proposition that people will do
things for money, in this case refrain from
having children; but in some cases the per-
missible payment is proposed on the basis
of an economic analysis, and in a few
cases an administrative means is also pro-
posed.104 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.l05
Thus the why of population control is
easy, the what is not very hard, but the
how is difficult. We may know that the ex-
tension 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 ques-
tion of how to bring those developments
about. For example, the proposal (F-l) to
organize the young men of India into a
social service program, directed toward
later age at marriage and general moderni-
zation of attitudes, is extremely difficult
from an administrative standpoint even if
it were acceptable politically and finan-
cially: consider the administrative, super-
visory, and instructional problems in the
United States of handling nine to ten mil-
lion young men (the number affected in
India), many of them unwilling partici-
pants easily "hidden" by their families and
associates, in a series of camps away from
home.106 As has been observed, if a coun-
try could administer such a program it
could more easily administer a family
planning program, or perhaps not need
one.
In short, several proposals assume ad-
ministrable workability of a complicated
scheme in a country that cannot now col-
lect 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.

Economic Capability
From the standpoint of economic capa-
bility there are two questions: is the pro-
gram 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 avail-
able and politically and administratively
acceptable, an involuntary fertility con-
trol agent would probably not be prohibi-
tive economically; incorporation of popu-
lation materials into the school curriculum
is not unduly expensive, particularly when
viewed as a long-term investment in popu-
lation limitation; imposition of taxes or
withdrawal of benefits or increased fees







for marriage licenses might even return a
net gain after administrative cost.
But a few proposals are costly in abso-
lute if not relative terms. For example, the
institutionalization of maternal care (A-l)
might cost the order of $500,000,000 for
construction and $200,000,000 for annual
operation in India, or respectively
$25,000,000 and $10,000,000 in a country
of 25 million population107 (although
later estimates are substantially lower).
The plan for a "youth corps" in India
would cost upwards of $450,000,000 a
year if the participants were paid only $50
annually. The plan for pensions to elderly
fathers without sons could cost from $400
million to $1 billion a year, plus adminis-
trative costs.108 The satellite television
system for India would cost $50,000,000
for capital costs only on a restricted proj-
ect,109 with at least another $200,000,000
needed for receiving sets, broadcast ter-
minals, and programming costs if national
coverage is to be secured (depending
largely on distribution of sets); or, by
another estimate, $30-$35,000,000 a year
over 20 years (or $700 million-$440
million in capital outlay and $250 million
in operating costs) in order to cover 84
per cent of the population by means of
nearly 500,000 receiving sets.110 All of
these proposals are intended to have bene-
ficial consequences beyond population
and hence can be justified on multiple
grounds, but they are still expensive in
absolute amounts.
The broad social programs of popular
education, rationalization of agriculture,
and increased industrialization (F-4) al-
ready absorb even larger sums though
they could no doubt utilize even more.
Here, however, the better question is a
different one. Presently less than one per
cent of the total funds devoted to eco-
nomic development in such countries as
India, Pakistan, South Korea, and Turkey
are allocated to family planning programs
-in most cases, much less. Would that
tiny proportion make a greater contribu-
tion to population control, over some
specified period, if given over to education
or industrialization or road-building, for
their indirect effect, rather than utilized
directly for family planning purposes?"1
From what we now know, the answer is
certainly No.
Still other proposals, particularly those
concerned with incentives and benefits,
are more problematic, and unfortunately
no clear directions are apparent. For com-
parative purposes, let us start with the
generally accepted proposition that in the
typical developing country today, one


prevented birth is worth one to two times
the per capital income, on economic
grounds alone. In that case, the typical
family planning program as currently
operated is economically warranted in
some substantial degree.112 The per caput
annual income of the developing coun-
tries under consideration range, say, from
$75 to $500. In similar order of magni-
tude, the typical family planning program
operates annually at about six cents per
caput, and in Taiwan and South Korea,
where the programs are more effective,
"each initial acceptor costs about $5; each
acceptor continuing effective contracep-
tion for a year costs about $7-$10; each
prevented birth costs, say, $20-$30 (at
three years of protection per averted
birth); and each point off the birth rate at
its present level costs about $25,000
per million population."113
This order of cost is not certified in all
other situations, so even the economic
value of family planning programs is not
yet altogether clear114 although most indi-
cations to date are that it is strongly posi-
tive.115 Beyond family planning, the situa-
tion is still less clear. Assuming that some
level of incentive or benefit would have a
demographic impact, what would the level
have to be to cut the birth rate by, say, 20
per cent? We simply do not know: the
necessary experiments on either adminis-
tration or effectiveness have not been
carried out. There is, of course, the possi-
bility that what would be needed could not
be afforded and that what could be
afforded would not be effective.
For guidance, let us review what has
been proposed with respect to incentives.
Again we take the Indian case; and for
comparative purposes, the present budget
of the Indian family planning program is
about $60,000,000 a year, far higher than
in the recent past (only about $11,000,000
in the 1961-1966 Plan) and not yet fully
spent.
On the ground that incentives for vasec-
tomy are better than incentives for con-
traception-easier to administer and
check on a one-time basis and likely to be
more effective in preventing births116-
Pohlman proposes for India a range of
money benefits depending upon parity
and group acceptance: from $7 to a father
of four or more children if half the vil-
lagers in that category enter the program,
up to $40 to a father of three children if 75
per cent accept. If the 50 per cent criterion
were met in both categories throughout
India, the current plan would cost on the
order of $260,000,000 in incentives alone,
omitting administrative costs (based on


these figures: 90 million couples, of whom
about 40 per cent are parity four and
above, and 15 per cent are parity three; or
about 36.0 and 13.5 million respectively;
half of each times $7 and $20 respectively).
The decline in the birth rate would be
slightly over one fourth, perhaps a third,
or of the order of $35-$40 a prevented
birth by a rough estimate.117
Simon proposes an incentive of half the
per capital income "each year to each fer-
tile woman who does not get pregnant."118
Here a special problem arises. In a typical
developing population of 1000, about
25-30 per cent of the married women of
reproductive age (MWRA) give birth each
year: 1000 population means from 145-
165 MWRA, with a birth rate of, say, 40.
Thus, incentives could be paid to about
three-fourths of the women with no effect
on the birth rate-since they would not be
having a child that year under normal cir-
cumstances-so that the cost could be
three to four times larger than "needed"
for any desired result. Even if the incentive
were fully effective, and each one really
did prevent a birth, a cut of ten points in
the Indian birth rate would cost of the
order of $250,000,000 (or 5,000,000 pre-
vented births at $50 each)-and substan-
tially larger if the anyway non-pregnant,
including the non- or semi-fecund, could
not be screened out efficiently. (Compare
this level of incentive with Spengler's sug-
gestion of "rewards to those who prevent
births-say $5-$10 per married couple of
reproductive age each year they avoid
having offspring."119 In the typical case,
the couple could collect for three years and
then, as before, have the child in the
fourth year; or, if an incentive of this size
were effective, the cost would be four
times the indicated level.)
Enke addresses himself to this problem
by suggesting a system of blocked ac-
counts for Indian women who would have
to remain non-pregnant for three to four
years with examinations thrice yearly.120
Here again the cost could be high: about
$100 for three to four years of non-
pregnancy at his proposed rates, or per-
haps $500,000,000 a year to effect a similar
cut in the birth rate (i.e., over 20,000,000
prevented births over four years at $100
each). And on the administrative side, the
plan requires not only a substantial or-
ganization for management and record-
keeping, but also the dubious assumption
that the Indian peasant is sufficiently
future-oriented and trustful of govern-
mental bureaucracy.
Finally, Balfour has suggested an in-
genious scheme for providing national







saving certificates to married women in
the reproductive ages who remain non-
pregnant 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 in-
centive 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 re-
porting and the greater need of super-
vision-which is not only expensive but
difficult administratively.

Moral/Ethical/Philosophical
Acceptability
Beyond political acceptability, is the
proposal considered right and proper-by
the target population, government offi-
cials, professional or intellectual elites, the
outside agencies committed to assistance?
"One reason the policy of seeking to
make voluntary fertility universal is ap-
pealing-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 "stress-
ing 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 col-
lective interests.
Today, most observers would acknowl-
edge 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 infor-
mation, services, and supplies to imple-
ment 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 them-


selves, their children, and their country;
they are restrained by religious doctrine,
even though they may not accept the doc-
trine; 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 sub-
ject 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 state-
ments 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 cam-
paign to limit births in the national inter-
est? 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 de-
sired result? Presumably it lies somewhere
short of compulsory birth limitation en-
forced 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 prob-
lem, 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 pro-
vide temporary contraception as a means
for population control under present cir-
cumstances are reluctant to extend the
practice to sterilization and firmly op-
posed to abortion125-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 en-
cyclical 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 pro-
gram 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 de-
cline 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 them-
selves or the finders) before the practice
calls for a moral restraint? How large an
increase in the regulatory bureaucracy, or


in systematic corruption through incen-
tives, 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 child-
bearing with monetary incentive is war-
ranted before "bribing people not to have
children" becomes contaminating, with
adverse long-run effects on parental re-
sponsibility?127 How much "immorality,"
locally defined as extramarital sex, is
worth importing along with how much
contraceptive practice (assuming the asso-
ciation)? 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 mar-
riage, would it be right to do so in a so-
ciety in which young women have nothing
else to do, and against their will? In coun-
tries, 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 fer-
tility control. In the balance-and this is
a question of great but neglected impor-
tance-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 abor-
tion. Most official doctrine in the emerg-
ing population programs is conservative
-as is only to be expected at the outset of
a great social experiment ot this character.
Guidance on such ethical questions is
needed. As an offer toward further con-
sideration, these propositions are put for-
ward: (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 con-
form";128 correlatively, it would move
toward compulsion only very reluctantly
and as the absolutely last resort; (2) "an
ideal program designed to affect the num-
ber of children people want would help
promote other goals that are worth sup-
porting on their own merits, or at least
not conflict with such goals";129 correla-
tively, it would not indirectly encourage







undesirable outcomes, e.g., bureaucratic
corruption; (3) an ideal program would
not burden the innocent in an attempt to
penalize the guilty-e.g., would not bur-
den the Nth child by denying him a free
education simply because he was the Nth
child of irresponsible parents; (4) an ideal
program would not weigh heavily upon
the already disadvantaged-e.g., by with-
drawing maternal or medical benefits or
free education from large families, which
would tend to further deprive the poor;
(5) an ideal program would be compre-
hensible to those directly affected-i.e.,
it should be capable of being understood
by those involved and hence subject to
their response; (6) an ideal program would
respect present values in family and chil-
dren, which many people may not be will-
ing to bargain away for other values in a
cost-benefit analysis; and (7) an ideal pro-
gram would not rest upon the designation
of population control as the final value
justifying all others; "preoccupation with
population growth should not serve to
justify measures more dangerous or of
higher social cost than population growth
itself."130

Presumed Effectiveness
If proposals are scientifically ready,
politically and morally acceptable, and
administratively and financially feasible,
to what extent will they actually work in
bringing population growth under con-
trol? That is the final question.
Again we do not know the answer.
We are not even sure in the case of family
planning programs, with which we now
have some amount of experience. But as
order of magnitude and as a kind of
measuring rod for other proposals, the
impact of family planning programs, when
conducted with some energy at the rate of
investment indicated above, ranges roughly
as follows: in situations like Singapore,
South Korea, and Taiwan, they have
recruited 20-33 per cent of the married
women of reproductive age as contra-
ceptive acceptors within 3-4 years, and
in difficult situations like India and
Pakistan, from 5-14 per cent of the target
population.131 In other settings, like
Malaysia or Ceylon or Turkey or Kenya
or Tunisia or Morocco, either it is too
early to tell or the program has been
conducted under political or other re-
straints so that it is difficult to say what
an energetic program could have achieved;
as it is, family planning is being introduced
into such situations at a pace politically
acceptable and administratively feasible.
Overall, it appears that a vigorous pro-


gram can extend contraceptive practices
by an economically worthwhile amount
wherever conducted.132
What of the proposals beyond family
planning? How well might they do,
given administrative implementation?
To begin with, the compulsory measures
would probably be quite effective in
lowering fertility. Inevitably in such
schemes, strongly motivated people are
ingenious enough to find ways "to beat
the system"; if they were numerous
enough the system could not be enforced
except under severe political repression.133
Otherwise, if workable, compulsion could
have its effect.
What about the proposals for the
extension of voluntary contraception?
Institutionalizing maternal care in the
rural areas with family planning attached
does promise to be effective over, say,
five to ten years, particularly in its
potential for reaching the younger and
lower parity women. The International
Postpartum Program did have that effect
in the urban areas134, and presumably the
impact would extend to the rural areas
though probably not to the same degree
because of the somewhat greater sophis-
tication and modernization of the cities.
The importance of the particular target
is suggested in this observation: "The
objective in India is to reach not the
500,000,000 people or the 200,000,000
people in the reproductive ages or the
90,000,000 married couples or even the
20-25,000,000 who had a child this year
-but the 5,000,000 women who gave
birth to their first child. And this may be
the only institutionalized means for
reaching them".135 The total program is
costly, but if it could establish family
planning early in the reproductive period
in a country like India, and thus encourage
the spacing of children and not just
stopping, it could have great demographic
value in addition to the medical and
humanitarian contribution.
A liberalized abortion system, again if
workable, could also be effective in
preventing unwanted births, but it would
probably have to be associated with a
contraceptive effort: otherwise there might
be too many abortions for the system as
well as for the individual woman (who
might need three a year to remain without
issue; in Mainland China, where abortion
on demand is available, it is reported that
a woman may have only one a year136).
Free abortion for contraceptive failures
would probably make for a fertility
decline, but how large a one would
depend upon the quality of the contra-


ceptive program. With modern contra-
ception (the IUD and the pill) the failure
rates are quite small, but women who only
marginally tolerate either method, or
both, would be available for abortion.
Free abortion on demand has certainly
lowered fertility in Japan and certain
Eastern European countries,137 and where
medically feasible would do so elsewhere
as well; as a colleague observes, in this
field one should not underestimate the
attraction of a certainty as compared to
a probability. Abortion for illegitimate
pregnancies, whether voluntary (A-2) or
required (B-4), would not have a large
impact on the birth rate in most de-
veloping countries since known illegiti-
macy is small (assuming that the children
of the numerous consensual unions and
other arrangements in Latin America are
not considered "illegitimate").
The educational programs, whether in
the school system or in the mass media,
would almost certainly have an effect
over the years though it will be difficult
for technical reasons to determine the
precise or even approximate degree of
impact. Anything that can be done to
"bring home" the consequences of undue
population growth to family and nation
will help reach the goal of fertility decline,
but in the nature of the case education
alone will have a limited effect if life
circumstances remain stable.
The large question of the effect of the
various incentive and benefit/liability
plans (D and E) simply cannot be an-
swered: we have too little experience to
know much about the conditions under
which financial factors will affect child-
bearing to any substantial degree. Perhaps
everyone has his price for everything;
if so, we do not know what would have to
be paid, directly or indirectly, to bring
people not to bear children.
Such as it is, the evidence from the
pro-natalist side is not encouraging. All
the countries of Europe have family
allowance programs of one kind or
another138, most of them legislated in
the 1930's and 1940's to raise the birth
rate; collectively they have the lowest
birth rate of any continent. The consensus
among demographers appears to be that
such programs cannot be shown to have
effected an upward trend in the birth rate
where tried. A recent review of the effect
of children's allowances upon fertility
concludes:

It would be helpful to be able to state cate-
gorically that children's allowances do or
do not increase the number of births among






families that receive them. Unfortunately,
there is no conclusive evidence one way or
the other.. To argue that the level of births
in the United States or anywhere else de-
pends upon the existence, coverage, and
adequacy of a set of family allowances is
certainly simplistic. Such a conclusion can
and ought to be rejected not only on logical
grounds but also on the basis of the demon-
strated complexity of the factors producing
specific birthrates Recent fertility sta-
tistics show no relation between the existence
or character of a family allowance program
and the level of the birthrate. In specific
low-income agricultural countries with such
programs, fertility is high. In specific high-
income modernized nations with such pro-
grams, fertility is low Whether the less
developed countries have any form of family
or children's allowances appears wholly
unrelated to the level of fertility.139
As in the case of abortion for illegiti-
mate pregnancies, several of the benefit/
liability proposals would affect only a
trivial fraction of people in much of the
developing world: for example, again in
India, programs for governmental em-
ployees who make up perhaps 5 per cent
of the labor force, tax or social security
systems where the rural masses are not
regularly covered, maternity benefits
since so few women are covered, fees for
marriage licenses, control of public
housing which is insignificant, denial of
education benefits to married students
who are trivially few and not now
covered in any case. Such measures are
probably more relevant to the developed
than the developing countries. However,
because the impact of incentive and bene-
fit/liability plans is uncertain and may
become important, the field needs to
become better informed on the pos-
sibilities and limitations, which informa-
tion can only come from experimentation
under realistic circumstances and at real-
istic levels of payment.
A higher age of marriage and a greater
participation of women in the labor force
are generally credited with effecting
fertility declines. In India, average female
age at marriage has risen from about
13 to about 16 in this century, or about
half a year a decade, although the age of
marital consummation has remained
rather steady at 17 years (since most of
the rise is due to the decrease in child
marriages). In a recent Indian conference
on raising age at marriage, the specialists
seemed to differ only on the magnitude of
the fertility decline that would result:
a decline of 30 per cent in the birth rate
in a generation of 28 years if the minimum
female age of marriage were raised to


20140 or a decline of not more than 15
per cent in 10 yearsl41-"seemed to"
since these figures are not necessarily
incompatible. In either case, the decline
is a valuable one. But the effectiveness of
increased age of marriage rests in the
first instance on its being realized; here
are the perhaps not unrepresentative
views of knowledgeable and committed
observers:

. .In the absence of prolonged education
and training, postponing the age of marriage
becomes a formidable problem (Chand-'
rasekhar) 142
. Legislation regarding marriage can
rarely be used as a measure of fertility con-
trol in democratic countries. The marital
pattern will mostly be determined by social
circumstances and philosophies of life and
any measure by government clashing with
them will be regarded as a restriction on
freedom rather than a population policy
(Dandekar) 143

Similarly, an increase in the proportion
of working women-working for pay-
ment outside the home-might have its
demographic effect,144 but could probably
come about only in conjunction with other
broad social trends like education and
industrialization, which themselves would
powerfully affect fertility (just as a
fertility decline would assist importantly
in bringing them about).145 Both com-
pulsory education and restrictions on
child labor would lower the economic
value of children and hence tend toward
fertility decline: The question is, how are
they to be brought about?
Finally, whether research would affect
fertility trends depends of course upon its
nature and outcome, aside from the gen-
eral proposition that "more research"
as a principle can hardly be argued
against. Most observers believe that
under the typical conditions of the de-
veloping society, any improvement in the
contraceptive technology would make an
important difference to the realization of
present fertility goals and might make an
important contribution to turning the
spiral down. Indeed, several believe that
this is the single most important de-
sideratum over the short run. Easy means
for sex determination should have some
effect upon the "need for sons" and thus
cut completed family size to some extent.
Research on the social-economic side
would probably have to take effect
through the kinds of programs discussed
above.
The picture is not particularly en-
couraging. The measures that would


work to sharply cut fertility are politically
and morally unacceptable to the so-
cieties at issue, as with coercion, and in
any case unavailable; or they are difficult
of attainment in any visible future, as
with the broad social trends or shift in
age of marriage. The measures that might
possibly be tried in some settings, like
some version of incentives or benefit/
liability plans, are uncertain of result at
the probable level of operation. Legali-
zation of abortion, where medically
available, would almost certainly have a
measurable effect, but acceptability is
problematic.

Conclusion
Where does this review leave us with
regard to proposals beyond family plan-
ning? Here is my own summary of the
situation.
(1) There is no easy way to population
control. If this review has indicated noth-
ing else, it has shown how many obstacles
stand in the way of a simple solution to the
population problem-or a complicated
one, for that matter. By way of illustrative
capitulation, let us see how the various
proposals seem to fit the several criteria,
in the large (Table 1).146 That is only one
observer's judgment of the present situa-
tion, but whatever appraisal is made of
specific items it would appear that the
overall picture is mixed. There is no easy
way.
(2) Family planning programs do not
compare unfavorably with specific other
proposals-especially when one considers
that any actual operating program is dis-
advantaged when compared with any
competitive ideal policy. (As any practical
administrator knows, when an "ideal"
policy gets translated into action it de-
velops its own set of realistic problems and
loses some of the shine it had as an idea.)
Indeed, on this showing, if family plan-
ning programs did not exist, they would
have to be invented: it would appear that
they would be among the first proposals
to be made and the first programs to be
tried, given their generally acceptable
characteristics.
In fact, when such proposals are made,
it turns out that many of them call for
more family planning not less, but only in
a somewhat different form. In the present
case, of the proposals listed above, at least
a third put forward in effect simply an-
other approach to family planning, often
accepting the existing motivation as to
family size. In any case, family planning
programs are established, have some mo-
mentum, and, importantly, would be use-







ful as the direct instrument through which
other proposals would take effect. So that,
as a major critic acknowledges, "there is
no reason to abandon family-planning
programs."147
What is needed is the energetic and full
implementation of present experience;
this is by no means being done now. Much
more could be done on the informational
side, on encouragement of commercial
channels of contraception, on the use of
para-medical personnel, on logistics and
supply, on the training and supervision of
field workers, on approaches to special
targets ranging from post-partum women
to young men under draft into the armed
forces. If the field did well what it knows
how to do, that in itself would in all likeli-
hood make a measurable difference-and
one competitive in magnitude with other
specific proposals-not to mention the
further impetus of an improved contra-
ceptive technology.
(3) Most of the proposed ideas are not
new; they have been around for some
time. So if they are not in existence, it is
not because they were not known but be-
cause they were not accepted-presum-
ably, for reasons like those reflected in the
above criteria In India, for example,
several of the social measures being pro-
posed have been, it would seem, under
almost constant review by one or another
committee for the past 10-15 years-
withdrawal of maternity benefits, imposi-
tion of a child tax, increase in age of mar-


riage, liberalization of legal abortion, in-
corporation of population and family
planning in the school curriculum.148 In
Mainland China, reportedly, later age of
marriage is common among party mem-
bers,149 and in Singapore a 1968 law re-
stricts maternity privileges beyond the
third child for employed women and
makes public housing available to child-
less couples.150 As for general social de-
velopment-compulsory education, in-
dustrialization, improved medical care,
etc.-that is in process everywhere, though
of course more can always be done (but
not very quickly). So it is not correct to
imply that it is only new ideas that are
needed; many ideas are there, but their
political, economic, or administrative
feasibility is problematic.
(4) The proposals themselves are not
generally approved by this set of propos-
ers, taken together. All of them are dis-
satisfied to some degree with present
family planning efforts, but that does not
mean that they agree with one another's
schemes to do better. Thus, Ohlin believes
that "the demographic significance of such
measures (maternity benefits and tax de-
ductions for children) would be limited.
By and large those who now benefit from
such arrangements in the developing
countries are groups which are already
involved in the process of social trans-
formation" and that "changes in marital
institutions and norms are fairly slow and
could not in any circumstances reduce


fertility sufficiently by itself when mor-
tality falls to the levels already attained in
the developing world."151 Ketchel op-
poses several "possible alternatives to
fertility control agents":

Financial pressures against large families
would probably be effective only in developed
countries in which there are large numbers
of middle-class people. In underdeveloped
countries practically no financial induce-
ments to have children now exist to be re-
versed, and the imposition of further taxes
upon the many poor people would depress
their living standards even further. In
order to be effective, economic pressures
would probably have to be severe enough
to be quite painful, and when they reached
a level of painfulness at which they were
effective, they would probably seriously
affect the welfare of the children who were
born in spite of the pressures. The same
objection applies to the use of financial
rewards to induce people not to have children
because such programs would make the
families with children the poorer families...
The age at which people marry is largely
determined by slowly changing cultural and
economic factors, and could probably be
changed quickly in a population only by
rather drastic measures (in which) an in-
ordinately severe punishment for violators
would be required. Statutory regulations
of family size would be unenforceable unless
the punishment for exceeding the limit was
so harsh that it would cause harm to the
lives of the existing children and their
parents. Such possible procedures as vas-
ectomizing the father or implanting long-


TABLE 1. Illustrative Appraisal of Proposals by Criteria


A. Extension of
Voluntary
Fertility Control


B. Establishment of
Involuntary
Fertility Control
C. Intensified Educa-
tional Campaigns
D. Incentive Programs

E. Tax and Welfare
Benefits and Penalties
F. Shifts in Social
and Economic
Institutions

G. Political Channels
and Organizations
H. Augmented Research
Efforts


Scientific
Readiness
High



Low


High

High

High

High


High

Moderate


Political
Viability
High on
maternal
care, moder-
ate to low on
abortion
Low


Moderate
to high
Moderately
low
Moderately
low
Generally
high, but low
on some
specifics
Low

High


Administrative
Feasibility
Uncertain in
near future


Low


High

Low

Low

Low


Low

Moderate
to high


Economic
Capability
Maternal care
too costly
for local bud-
get, abortion
feasible
High


Probably high

Low to
moderate
Low to
moderate
Generally
low


Moderate

High


Ethical
Acceptability
High for
maternal
care, low for
abortion

Low


Generally
high
Low to high

Low to
moderate
Generally
high, but
uneven

Moderately
low
High


Presumed
Effectiveness
Moderately
high


Moderate

Uncertain

Uncertain

High, over
long run


Uncertain

Uncertain


Family Planning Generally Moderate to Moderate High Generally Moderately
Programs high, but high to high high, but high
could use uneven on
improved religious
technology grounds






acting contraceptives in the mother would
require a direct physical assault by a govern-
ment agent on the body of an individual.152
Meier argues against the tax on children
on both humanitarian and political
grounds.153 To the U. N. Advisory Mis-
sion to India, "it is realized that no major
demographic effects can be expected from
measures of this kind (maternity benefits),
particularly as only a small proportion of
families are covered but they could
contribute, together with the family plan-
ning programme, to a general change in
the social climate relating to child-
bearing."154 Earlier, in supporting a
family planning effort in India, Davis
noted that "the reaction to the Sarda Act
(the Child Marriage Restraint Act of
1929) prohibiting female marriage (below
14) shows the difficulty of trying to regu-
late the age of marriage by direct legisla-
tion."155 Myrdal warns against cash pay-
ments to parents in this connection, as a
redistributional reform, and supports
social awards to the children in kind.156
Kirk believes that "it might prove to be
the height of folly to undermine the exist-
ing family structure, which continues to be
a crucial institution for stability and so-
cialization in an increasingly mobile and
revolutionary society."157 Raulet believes
that "Davis' main observation... that al-
ternatives to the present stress on famil-
ism will ultimately be required... obvi-
ously makes no sense for most less
developed countries today ... Aside from
the repressive tone of some of (the pro-
posed) measures, the most striking thing
about these proposals is the impracticality
of implementing them. The applica-
tion of social security measures and nega-
tive economic sanctions are so far
beyond the present economic capacities of
these countries, and would raise such dif-
ficult administrative and economic prob-
lems, that they are probably not worth
serious mention."158 Finally, Ehrlich is
contemptuous of the professors whose
"idea of 'action' is to form a committee or
to urge 'more research.' Both courses are
actually substitutes for action. Neither
will do much good in the crisis we face
now. We've got lots of committees, and
decades ago enough research had been
done at least to outline the problem and
make clear many of the steps necessary to
solve it. Unless those steps are taken, re-
search initiated today will be terminated
not by success but by the problem under
investigation."159
(5) In a rough way, there appears to be
a progression in national efforts to deal
with the problem of population control.


The first step is the theoretical recognition
that population growth may have some-
thing to do with the prospects for eco-
nomic development. Then, typically,
comes an expert mission from abroad to
do a survey and make a report to the gov-
ernment, as has occurred in India,
Pakistan, South Korea, Turkey, Iran,
Tunisia, Morocco, and Kenya among
others. The first action program is in
family planning, and most of the efforts
are still there. Beyond that, it apparently
takes (1) some degree of discouragement
over progress combined with (2) some
heightened awareness of the seriousness of
the problem to move the effort forward.
To date those conditions have been most
prominently present in India-and that is
the country that has gone farthest in the
use of incentives and in at least considera-
tion of further steps along the lines men-
tioned above. It may be that in this respect
the Indian experience is a harbinger of the
international population scene. It is only
natural that on matters of such sensitivity,
governments try "softer" measures before
"harder" ones; and only natural, too, that
they move gradually from one position to
the next to realize their goals. Indeed,
some proposals require prior or simul-
taneous developments, often of a substan-
tial nature: for example a loan system
tied to age of brides may require a good
system of vital registration for purpose of
verification, instruction in population in
the schools requires some degree of com-
pulsory education, tying family planning
to health programs requires a medical
infrastructure.
Finally, it is also worth noting that more
extreme or controversial proposals tend
to legitimate more moderate advances, by
shifting the boundaries of discourse.
(6) Proposals need to be specified-
proposals both for action schemes and for
further research. It is perhaps too much to
ask advocates to spell out all the adminis-
trative details of how their plan is to
operate in the face of the kinds of ob-
stacles and difficulties discussed above, or
even get permission to operate: the situa-
tions, settings, opportunities, and person-
alities are too diverse for that. But it does
seem proper to ask for the fullest possible
specification of actual plans, under realis-
tic conditions, in order to test out their
feasibility and likely effectiveness. The
advocates of further research similarly
ought to spell out not only what would be
studied and how, but also how the results
might be applied in action programs to
affect fertility. Social research is not al-
ways readily translated into action, espe-


cially into administrative action; and the
thrust of research is toward refinement,
subtlety, precision, and qualification
whereas the administrator must act in the
large. Short of such specification, the field
remains confronted with potentially good
ideas like "raise the age of marriage" or
"use incentives" or "substitute pension
systems for male children" without being
able to move very far toward imple-
mentation.
(7) Just as there is no easy way, there is
no single way. Since population control
will at best be difficult, it follows that
every acceptable step be taken that
promises some measure of impact. The
most likely prospect is that population
control, to the degree realized, will be the
result of a combination of various efforts
-economic, legal, social, medical-each
of which has some effect but not an imme-
diately overwhelming one.o60 According-
ly, it is incumbent upon the professional
fields concerned to look hard at various
approaches, including family planning
itself, in order to screen out what is poten-
tially useful for application. In doing so,
on an anyway difficult problem, it may be
the path of wisdom to move with the
"natural" progression. Some important
proposals seem reasonably likely of adop-
tion-institutionalization of maternal
care, population study in the schools, the
TV satellite system for informational
purposes, a better contraceptive technol-
ogy, perhaps even liberalization of abor-
tion in some settings-and we need to
know not only how effective such efforts
will be but, beyond them, how large a
money incentive needs to be to effect a
given amount of fertility control and how
effective those indirect social measures are
that are decently possible of realization. It
may be that some of these measures would
be both feasible and effective-many ob-
servers 15 years ago thought that family
planning programs were neither-and a
genuine effort needs to be made in the
next years, wherever feasible, to do the
needed experimentation and demonstra-
tion. The "heavy" measures-involuntary
means and political pressures-may be
put aside for the time being, if not
forever.
(8) In the last analysis, what will be
scientifically available, politically accept-
able, administratively feasible, economi-
cally justifiable, and morally tolerated de-
pends upon people's perceptions of conse-
quences. If "the population problem" is
considered relatively unimportant or only
moderately important, that judgment will
not support much investment of effort. If








it is considered urgent, much more can
and will be done. The fact is that despite
the large forward strides taken in inter-
national recognition of the problem in the
1960's, there still does not exist the in-
formed, firm, and constant conviction in
high circles that this is a matter with truly
great ramifications for human welfare.161
Such convictions must be based on sound
knowledge. Here it would appear that the
demographers and economists have not
sufficiently made their case to the world
elite-or that, if made, the case has not
sufficiently been brought to their attention
or credited by them. Population pressures
are not sharply visible on a day-to-day or
even year-to-year basis nor, short of major
famine, do they lend themselves to dra-
matic recognition by event. Moreover, the
warnings of demographers are often dis-
missed, albeit unfairly and wrongly, on
their record of past forecasts:162 after all,
it was only a generation ago that a declin-
ing population was being warned about in
the West. It is asking government leaders
to take very substantial steps indeed when
population control is the issue-substan-
tial for their people as well as for their own
political careers-and hence the case must
be not only substantial but virtually in-
controvertible. Accordingly, the scientific
base must be carefully prepared (and per-
haps with some sense of humility about
the ease of predicting great events, on
which the record is not without blemishes).
Excluding social repression and mindful
of maximizing human freedom, greater
measures to meet the problem must rely
on heightened awareness of what is at
stake, by leaders and masses alike.






What is beyond family planning? Even
if most of the specific plans are not par-
ticularly new, that in itself does not mean
that they are to be disregarded. The ques-
tions are: which can be effected, given
such criteria? how can they be imple-
mented? what will be the outcome?
This paper is an effort to promote the
discourse across the professional fields
concerned with this important issue.
Given the recent stress on family planning
programs as the "means of choice" in
dealing with the problem, it is natural and
desirable that counter positions should be
put forward and reviewed. But that does
not in itself settle the critical questions.
What can we do now to advance the mat-
ter? Beyond family planning, what?


FOOTNOTES
1. As one example, see "Declaration on
Population: The World Leaders' State-
ment", signed by 30 heads of state, in
Studies in Family Planning, no. 26, Janu-
ary 1968.
2. For example, see Kingsley Davis, "Popula-
tion Policy: Will Current Programs Suc-
ceed?", Science, vol. 158, 10 November
1967, p. 730-739; Robert G. Potter, Ron-
ald Freedman, and L. P. Chow, "Taiwan's
Family Planning Program", Science, vol.
160, 24 May 1968, p. 848-853; and Frank
W. Notestein, "Population Growth and
Its Control", MS prepared for American
Assembly meeting on World Hunger, Fall
1968.
3. See, for example, the section on "Goals" in
Davis, op. cit., p. 731-733, and the 1968
presidential address to the Population As-
sociation of America, "Should the United
States Start a Campaign for Fewer Births?",
by Ansley J. Coale.
4. For current targets of some national family
planning programs, see table 8, p. 39, and
accompanying text in Bernard Berelson,
"National Family Planning Programs:
Where We Stand", prepared for University
of Michigan Sesquicentennial Celebration,
November 1967, which concludes: "By and
large, developing countries are now aiming
at the birth rates of Western Europe 75
years ago or the United States 50 years
ago."
5. For a first effort to outline the matter, see
point 12, p. 46-51, in Berelson, op. cit.
6. Howard C. Taylor Jr. & Bernard Berelson,
"Maternity Care and Family Planning as a
World Program", American Journal of
Obstetrics and Gynecology, vol. 100, 1968,
p. 885-893.
7. Davis, op. cit., p. 732, 738.
8. Paul R. Ehrlich, The Population Bomb,
Ballantine Books, 1968, p. 139.
9. S. Chandrasekhar, "Should We Legalize
Abortion in India?", Population Review,
10, 1966, 17-22.
10. Melvin M. Ketchel, "Fertility Control
Agents as a Possible Solution to the World
Population Problem", Perspectives in Bi-
ology and Medicine, vol. 11, 1968, p. 687-
703. See also his "Should Birth Control Be
Mandatory?", in Medical World News, 18
October 1968, p. 66-71.
11. Ehrlich, op. cit., p. 135-36. The author ap-
pears to dismiss the scheme as unworkable
on page 136 though two pages later he
advocates "ample funds" to "promote in-
tensive investigation of new techniques of
birth control, possibly leading to the de-
velopment of mass sterilizing agents such
as were discussed above".
12. Kenneth E. Boulding, The Meaning of the
Twentieth Century: The Great Transition,
Harper & Row, p. 135-36. For the record,
I note a statement that appeared too late
for consideration but does argue for "mu-
tual coercion, mutually agreed upon by the
majority of the people affected": Garrett
Hardin, "The Tragedy of the Commons",
Science, 162, 13 December 1968, p. 1247.
13. William B. Shockley, in lecture at Mc-
Master University, Hamilton, Ontario, re-
ported in New York Post, 12 December
1967.
14. Sripati Chandrasekhar, as reported in The
New York Times, 24 July 1967. Just as this


paper was being completed, the same
author "proposed that every married
couple in India deny themselves sexual
intercourse for a year Abstinence for a
year would do enormous good to the indi-
vidual and the country" (as reported in
The New York Times, 21 October 1968).
The reader may wish to consider this the
30th proposal and test it against the criteria
that follow.
15. Davis, op. cit., p. 738.
16. Davis, op. cit., p. 738.
17. Sloan Wayland, "Family Planning and the
School Curriculum", in Bernard Berelson
et al., eds., Family Planning and Population
Programs, University of Chicago Press,
1966, p. 353-62; his "Population Educa-
tion, Family Planning and the School
Curriculum", MS prepared for collection
of readings edited by John Ross and John
Friesen, Family Planning Programs: Ad-
ministration, Education, Evaluation, forth-
coming 1969; and two manuals prepared
under his direction: Teaching Population
Dynamics: An Instructional Unit for Sec-
ondary School Students and Critical Stages
in Reproduction: Instruction Materials in
General Science and Biology, both Teachers
College, Columbia University, 1965.
18. Pravin Visaria, "Population Assumptions
and Policy", Economic Weekly, 8 August
1964, p. 1343.
19. Ehrlich, op. cit., p. 162.
20. Richard L. Meier & Gitta Meier, "New
Directions, A Population Policy for the
Future", University of Michigan, revised
MS, October 1967, p. 11.
21. UNESCO Expert Mission, Preparatory
Study of a Pilot Project in the Use of
Satellite Communication for National De-
velopment Purposes in India, 5 February
1968, especially the section on "The Popu-
lation Problem", p. 13-14, paras. 61-66.
22. Wilbur Schramm & Lyle Nelson, Com-
munication Satellites for Education and De-
velopment-The Case of India. Stanford
Research Institute, July 1968: "Family
Planning", p. 63-66.
23. Sripati Chandrasekhar, as reported in The
New York Times, 19 July 1967. Here again
I note for the record a very recent "Pro-
posal for a Family Planning Bond", by
Ronald J. Ridker, USAID-India, July
1968. This memorandum is a comprehen-
sive and quite detailed review of the issues
involved in providing 20-year bonds for
couples sterilized after the second or third
child. Along this same line, see another late
suggestion of a bond linked both to age of
marriage and to number of children, in
Approaches to the Human Fertility Problem,
prepared by The Carolina Population Cen-
ter for the United Nations Advisory Com-
mittee on the Application of Science and
Technology to Development, October 1968,
p. 68.
24. Edward Pohlman, "Incentives for 'Non-
Maternity' Cannot 'Compete' with Incen-
tives for Vasectomy", Central Family
Planning Institute, India, MS 1967?
25. T. J. Samuel, "The Strengthening of the
Motivation for Family Limitation in
India", The Journal of Family Welfare,
vol. 13, 1966, p. 11-12.
26. Davis, op. cit., p. 738.
27. Julian Simon, "Money Incentives to Re-
duce Birth Rates in Low-Income Coun-








tries: A Proposal to Determine the Effect
Experimentally"; "The Role of Bonuses
and Persuasive Propaganda in the Reduc-
tion of Birth Rates"; and "Family Planning
Prospects in Less-Developed Countries,
and a Cost-Benefit Analysis of Various
Alternatives", University of Illinois, MSS
1966-1968?
28. Stephen Enke, "Government Bonuses for
Smaller Families", Population Review, vol.
4, 1960, p. 47-54.
29. Samuel, op. cit., p. 12.
30. Michael Young, in "The Behavioral Sci-
ences and Family Planning Programs: Re-
port on a Conference", Studies in Family
Planning, no. 23, October 1967, p. 10.
31. Dipak Bhatia, "Government of India Small
Family Norm Committee Questionnaire",
Indian Journal of Medical Education, vol. 6,
October 1967, p. 189. As the title indicates,
this is not a proposal as such but a ques-
tionnaire soliciting opinions on various
ideas put forward to promote "the small
family norm".
32. Stephen Enke, "The Gains to India from
Population Control", The Review of Eco-
nomics and Statistics, May 1960, p. 179-
180.
33. Joseph J. Spengler, "Agricultural Develop-
ment is Not Enough", MS prepared for
Conference on World Population Prob-
lems, Indiana University, May 1967, p.
29-30.
34. J. William Leasure, "Some Economic Bene-
fits of Birth Prevention", Milbank Memorial
Fund Quarterly, 45, 1967, p. 417-25.
35. Marshall C. Balfour, "A Scheme for Re-
warding Successful Family Planners",
Memorandum, The Population Council,
June 1962.
36. W. Parker Mauldin, "Prevention of Il-
legitimate Births: A Bonus Scheme", Mem-
orandum, The Population Council, August
1967.
37. Ehrlich, op. cit., p. 138.
38. Bhatia, op. cit., p. 188.
39. Samuel, op. cit., p. 14.
40. Davis, op. cit., p. 738.
41. Richard M. Titmuss & Brian Abel-Smith,
Social Policies and Population Growth in
Mauritius, Methuen, 1960, p. 130-31.
42. Bhatia, op. cit., p. 189.
43. Titmuss & Abel-Smith, op. cit., p. 131-36.
44. Davis, op. cit., p. 739.
45. Bhatia, op. cit., p. 189-90.
46. Samuel, op. cit., p. 12-14.
47. Spengler, op. cit., p. 30.
48. Bhatia, op. cit., p. 190.
49. Davis, op. cit., p. 738.
50. Bhatia, op. cit., p. 190.
51. Titmuss & Abel-Smith, op. cit., p. 137.
52. Samuel, op. cit., p. 12-14.
53. Davis, op. cit., p. 738.
54. Ehrlich, op. cit., p. 136-37.
55. A. S. David, National Development, Popula-
tion and Family Planning in Nepal, June-
July 1968, p. 53-54.
56. James Fawcett, personal communication,
September 1968.
57. Samuel, op. cit., p. 12.
58. Goran Ohlin, Population Control and Eco-
nomic Development, Development Centre
of the Organization for Economic Co-
operation and Development, 1967, p. 104.
59. W. Phillips Davison, personal communica-
tion, 4 October 1968. Davison suggests a
good pension (perhaps $400 a year) for men
aged 60, married for at least 20 years, with
no sons.


60. David, op. cit., p. 53.
61. Davis, op. cit., p. 738.
62. Young, op. cit., p. 10.
63. Titmuss & Abel-Smith, op. cit., p. 130.
64. Kingsley Davis, personal communication,
7 October 1968.
65. Ehrlich, op. cit., p. 138.
66. Bernard Berelson, Amitai Etzioni, brief
formulations, 1962, 1967.
67. Philip M. Hauser, in "The Behavioral Sci-
ences and Family Planning Programs: Re-
port on a Conference", Studies in Family
Planning, no. 23, October 1967, p. 9.
68. Davis, op. cit., p. 738.
69. David, op. cit., p. 54.
70. Judith Blake, "Demographic Science and
the Redirection of Population Policy", in
Mindel C. Sheps & Jeanne Clare Ridley,
eds., Public Health and Population Change:
Current Research Issues, University of
Pittsburgh Press, 1965, p. 62.
71. Davis, op. cit., p. 737.
72. Meier & Meier, op. cit., p. 9. For the initial
formulation of the proposal, see Richard L.
Meier, Modern Science and the Human Fer-
tility Problem, Wiley, 1959, chapter 7, esp.
p. 171 ff.
73. Philip M. Hauser, "'Family Planning and
Population Programs': A Book Review
Article", Demography, vol. 4, 1967, p. 412.
74. United Nations Economic and Social
Council. Commission on the Status of
Women. "Family Planning and the Status
of Women: Interim Report of the Secre-
tary-General", 30 January 1968, esp. p.
17 ff.
75. Roger Revelle, as quoted in "Too Many
Born? Too Many Die. So Says Roger
Revelle", by Milton Viorst, Horizon, Sum-
mer 1968, p. 35.
76. David M. Heer & Dean O. Smith, "Mor-
tality Level and Desired Family Size",
paper prepared for presentation at Popula-
tion Association of America meeting, April
1967. See also David A. May and David M.
Heer, "Son Survivorship Motivation and
Family Size in India: A Computer Simula-
tion", Population Studies, 22, 1968, p. 199-
210.
77. Ehrlich, op. cit., p. 161-66, passim. The
author makes the same point in his article,
"Paying the Piper", New Scientist, 14
December 1967, p. 655: "Refuse all foreign
aid to any country with an increasing popu-
lation which we believe is not making a
maximum effort to limit its population ...
The United States should use its power and
prestige to bring extreme diplomatic and/or
economic pressure on any country or or-
ganization [the Roman Catholic Church?]
impeding a solution to the world's most
pressing problem."
78. Ehrlich, op. cit., p. 138. In the earlier
article cited just above, he calls for a
"Federal Population Commission with a
large budget for propaganda", presumably
limited to the United States (p. 655).
79. S. Chandrasekhar, "India's Population:
Fact, Problem and Policy", in S. Chand-
rasekhar, ed., Asia's Population Problems,
Allen & Unwin, 1967, p. 96, citing a Julian
Huxley suggestion of 1961.
80. Meier & Meier, op. cit., p. 5.
81. Davis, op. cit., p. 731-33.
82. Davis, op. cit., p. 738, 739.
83. Steven Polgar, in "The Behavioral Sciences
and Family Planning Programs: Report on
a Conference", Studies in Family Planning,


no. 23, October 1967, p. 10. See also the
recent suggestion of research on "the pos-
sibilities for artificially decreasing libido",
in Approaches to the Human Fertility Prob-
lem, op. cit., p. 73.
84. National Academy of Sciences, Committee
on Science and Public Policy, The Growth
of World Population, 1963, p. 5, 28-36.
This recommendation has of course been
made on several occasions by several
people: "we need a better contraceptive".
For an imaginative account of the impact
of biological developments, see Paul C.
Berry, Origins of Positive Population Con-
trol, 1970-2000, Working Paper, Appen-
dix to The Next Thirty-Four Years: A Con-
text for Speculation, Hudson Institute,
February 1966.
85. For example, see Sheldon J. Segal, "Bio-
logical Aspects of Fertility Regulation",
MS prepared for University of Michigan
Sesquicentennial Celebration, November
1967.
86. In passing it is worth noting that such ex-
pectations are not particularly reliable. For
example, in 1952-1953 a Working Group
on Fertility Control was organized by the
Conservation Foundation to review the
most promising "leads to physiologic con-
trol of fertility", based on a survey con-
ducted by Dr. Paul S. Henshaw and
Kingsley Davis. The Group did identify a
lead that became the oral contraceptive
(already then under investigation) but did
not mention the intrauterine device. The
Group was specifically searching for better
ways to control fertility because of the
population problem in the developing
world, and considered the contraceptive ap-
proach essential to that end: "It thus ap-
pears imperative that an attempt be made
to bring down fertility in overpopulated
regions without waiting for a remote,
hoped-for transformation of the entire
society It seems plausible that accept-
able birth control techniques might be
found, and that the application of science
to developing such techniques for peasant
regions might yield revolutionary results."
(The Physiological Approach to Fertility
Control, Report of the Working Group on
Fertility Control, The Conservation Foun-
dation, April 1953, p. 69.)
87. Z. Dvorak, V. Trka, and R. Vasicek,
"Termination of Pregnancy by Vacuum
Aspiration", Lancet, vol. 2, 11 November
1967, p. 997-98; and D. Kerslake and D.
Casey, "Abortion Induced by Means of the
Uterine Aspirator", Obstetrics and Gyne-
cology, vol. 30, July 1967, p. 35-45.
88. A. S. Parkes, "Can India Do It?", New
Scientist, vol. 35, July 1967, p. 186.
89. These are only illustrative magnitudes.
Actually, the five million does not really
represent 5/22nd of the birth rate since an
aborted woman could again become preg-
nant within a period of months, whereas a
newly pregnant woman would not normally
become so for over a year. Thus it may be
that abortion needs to be combined with
contraceptive practice and used mainly for
contraceptive failures or "accidents" in
order to be fully effective as a means of
fertility limitation in the developing coun-
tries.
90. Report in The New York Times, November
17, 1967. The then-Minister had earlier
suggested a substantial bonus (100 rupees)




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