Amartya Sen on Population: Delusion and Reality

Family Planning

Even those who do not advocate legal or economic coercion sometimes suggest a variant of the "override" approach—the view, which has been getting increasing support, that the highest priority should be given simply to family planning, even if this means diverting resources from education and health care as well as other activities associated with development. We often hear claims that enormous declines in birth rates have been accomplished through making family planning services available, without waiting for improvements in education and health care.

The experience of Bangladesh is sometimes cited as an example of such success. Indeed, even though the female literacy rate in Bangladesh is only around 22 percent and life expectancy at birth no higher than 55 years, fertility rates have been substantially reduced there through the greater availability of family planning services, including counseling.(36) We have to examine carefully what lessons can, in fact, be drawn from this evidence.

First, it is certainly significant that Bangladesh has been able to cut its fertility rate from 7.0 to 4.5 during the short period between 1975 and 1990, an achievement that discredits the view that people will not voluntarily embrace family planning in the poorest countries. But we have to ask further whether family planning efforts may themselves be sufficient to make fertility come down to really low levels, without providing for female education and the other features of a fuller collaborative approach. The fertility rate of 4.5 in Bangladesh is still quite high—considerably higher than even India's average rate of 3.6. To begin stabilizing the population, the fertility rates would have to come down closer to the "replacement level" of 2.0, as has happened in Kerala and Tamil Nadu, and in many other places outside the Indian subcontinent. Female education and the other social developments connected with lowering the birth rate would still be much needed.

Contrasts between the records of Indian states offer some substantial lessons here. While Kerala, and to a smaller extent Tamil Nadu, have surged ahead in achieving radically reduced fertility rates, other states in India in the so-called "northern heartland" (such as Uttar Pradesh, Bihar, Madhya Pradesh, and Rajasthan), have very low levels of education, especially female education, and of general health care (often combined with pressure on the poor to accept birth control measures, including sterilization, as a qualifying condition for medical attention and other public services). These states all have high fertility rates—between 4.4 and 5.1. The regional contrasts within India strongly argue for the collaborative approach, including active and educated participation of women.

The threat of an impending population crisis tempts many international observers to suggest that priority be given to family planning arrangements in the third world countries over other commitments such as education and health care, a redirection of public efforts that is often recommended by policy-makers and at international conferences. Not only will this shift have negative effects on people's well-being and reduce their freedoms, it can also be self-defeating if the goal is to stabilize population.

The appeal of such slogans as "family planning first" rests partly on misconceptions about what is needed to reduce fertility rates, but also on mistaken beliefs about the excessive costs of social development, including education and health care. As has been discussed, both these activities are highly labor intensive, and thus relatively inexpensive even in very poor economies. In fact, Kerala, India's star performer in expanding education and reducing both death rates and birth rates, is among the poorer Indian states. Its domestically produced income is quite low—lower indeed in per capita terms than even the Indian average—even if this is somewhat deceptive, for the greatest expansion of Kerala's earnings derives from citizens who work outside the state. Kerala's ability to finance adequately both educational expansion and health coverage depends on both activities being labor-intensive; they can be made available even in a low-income economy when there is the political will to use them. Despite its economic backwardness, an issue which Kerala will undoubtedly have to address before long (perhaps by reducing bureaucratic controls over agriculture and industry, which have stagnated), its level of social development has been remarkable, and that has turned out to be crucial in reducing fertility rates. Kerala's fertility rate of 1.8 not only compares well with China's 2.0, but also with the US's and Sweden's 2.1, Canada's 1.9, and Britain's and France's 1.8.

The population problem is serious, certainly, but neither because of "the proportion between the natural increase of population and food" nor because of some mpending apocalypse. There are reasons for worry about the long-term effects of population growth on the environment; and there are strong reasons for concern about the adverse effects of high birth rates on the quality of life, especially of women. With greater opportunities for education (especially female education), reduction of mortality rates (especially of children), improvement in economic security (especially in old age), and greater participation of women in employment and in political action, fast reductions in birth rates can be expected to result through the decisions and actions of those whose lives depend on them.

This is happening right now in many parts of the world, and the result has been a considerable slowing down of world population growth. The best way of dealing with the population problem is to help to spread these processes elsewhere. In contrast, the emergency mentality based on false beliefs in imminent cataclysms leads to breathless responses that are deeply counterproductive, preventing the development of rational and sustainable family planning. Coercive policies of forced birth control involve terrible social sacrifices, and there is little evidence that they are more effective in reducing birth rates than serious programs of collaborative action.

Footnotes

1 This paper draws on my lecture arranged by the "Eminent Citizens Committee for Cairo '94" at the United Nations in New York on April 18, 1994, and also on research supported by the National Science Foundation.

2 Paul Ehrlich, The Population Bomb (Ballantine, 1968). More recently Paul Ehrlich and Anne H. Ehrlich have written The Population Explosion (Simon and Schuster, 1990).

3 Garrett Hardin, Living within Limits (Oxford University Press, 1993).

4 Thomas Robert Malthus, Essay on the Principle of Population As It Affects the Future Improvement of Society with Remarks on the Speculation of Mr. Godwin, M. Condorcet, and Other Writers (London: J. Johnson, 1798), Chapter 8; in the Penguin classics edition, An Essay on the Principle of Population)

5 See Simon Kuznets, Modern Economic Growth (Yale University Press, 1966).

6 Note by the Secretary-General of the United Nations to the Preparatory Committee for the International Conference on Population and Development, Third Session, A/Conf.171/PC/5, February 18, 1994, p. 30.

7 Philip Morris Hauser's estimates are presented in the National Academy of Sciences publication Rapid Population Growth: Consequences and Policy Implications, Vol. 1 (Johns Hopkins University Press, 1971). See also Simon Kuznets, Modern Economic Growth, Chapter 2.

8 For an important collection of papers on these and related issues see Sir Francis Graham-Smith, F.R.S., editor, Population—The Complex Reality: A Report of the Population Summit of the World's Scientific Academies, issued by the Royal Society and published in the US by North American Press, Golden, Colorado. See also D. Gale Johnson and Ronald D. Lee, editors, Population Growth and Economic Development, Issues and Evidence (University of Wisconsin Press, 1987).

9 Garrett Hardin, Living within Limits, p. 274.

10 Paul Kennedy, who has discussed important problems in the distinctly "social" aspects of population growth, has pointed out that this debate "has, in one form or another, been with us since then," and "it is even more pertinent today than when Malthus composed his Essay," in Preparing for the Twenty-first Century (Random House, 1993), pp. 5-6.

11 On the importance of "enlightenment" traditions in Condorcet's thinking, see Emma Rothschild, "Condorcet and the Conflict of Values," forthcoming in The Historical Journal.

12 Marie Jean Antoine Nicholas de Caritat Marquis de Condorcet's Esquisse d'un Tableau Historique des Progrès de l'Esprit Humain, Xe Epoque (1795). English translation by June Barraclough, Sketch for a Historical Picture of the Progress of the Human Mind, with an introduction by Stuart Hampshire (Weidenfeld and Nicolson, 1955), pp. 187-192.

13 T.R. Malthus, A Summary View of the Principle of Population (London: John Murray, 1830); in the Penguin classics edition (1982), p. 243; italics added.

14 On practical policies, including criticism of poverty relief and charitable hospitals, advocated for Britain by Malthus and his followers, see William St. Clair, The Godwins and the Shelleys: A Biography of a Family (Norton, 1989).

15 Malthus, Essay on the Principle of Population, Chapter 17; in the Penguin classics edition, An Essay on the Principle of Population, pp. 198-199. Malthus showed some signs of weakening in this belief as he grew older.

16 Gerard Piel, Only One World: Our Own to Make and to Keep (Freeman, 1992).

17 For discussions of these empirical connections, see R.A. Easterlin, editor, Population and Economic Change in Developing Countries (University of Chicago Press, 1980); T.P. Schultz, Economics of Population (Addison-Wesley, 1981); J.C. Caldwell, Theory of Fertility Decline (Academic Press, 1982); E. King and M.A. Hill, editors, Women's Education in Developing Countries (Johns Hopkins University Press, 1992); Nancy Birdsall, "Economic Approaches to Population Growth" in The Handbook of Development Economics, edited by H.B. Chenery and T.N. Srinivasan (Amsterdam: North Holland, 1988); Robert Cassen, et. al., Population and Development: Old Debates, New Conclusions (New Brunswick: Overseas Development Council/Transaction Publishers, 1994).

18 World Bank, World Development Report 1994 (Oxford University Press, 1994), Table 25, pp. 210-211.

19 World Bank, World Development Report 1994, Table 2.

20 These issues are discussed in my joint book with Jean Drèze, Hunger and Public Action (Oxford University Press, 1989), and the three volumes edited by us, The Political Economy of Hunger (Oxford University Press, 1990), and also in my paper "Economic Regress: Concepts and Features," Proceedings of the World Bank Annual Conference on Development Economics 1993 (World Bank, 1994).

21 This is confirmed by, among other statistics, the food production figures regularly presented by the United Nations Food and Agricultural Organization (see the FAO Quarterly Bulletin of Statistics, and also the FAO Monthly Bulletins).

22 For a more detailed picture and references to data sources, see my "Population and Reasoned Agency: Food, Fertility and Economic Development," in Population, Economic Development, and the Environment, edited by Kerstin Lindahl-Kiessling and Hans Landberg (Oxford University Press, 1994); see also the other contributions in this volume. The data presented here have been slightly updated from later publications of the FAO.

23 On this see my Poverty and Famines (Oxford University Press, 1981).

24 See UNCTAD VIII, Analytical Report by the UNCTAD Secretariat to the Conference (United Nations, 1992), Table V-S, p. 235. The period covered is between 1979-1981 to 1988-1990. These figures and related ones are discussed in greater detail in my paper "Population and Reasoned Agency," cited earlier.

25 World Bank, Price Prospects for Major Primary Commodities, Vol. II (World Bank, March 1993), Annex Tables 6, 12, and 18.

26 Condorcet, Esquisse d'un Tableau Historique des Progrès de l'Esprit Humain; in the 1968 reprint, p. 187.

27 The importance of "local" environmental issues is stressed and particularly explored by Partha Dasgupta in An Inquiry into Well-Being and Destitution (Oxford University Press, 1993).

28 In a forthcoming monograph by Jean Drèze and myself tentatively called "India: Economic Development and Social Opportunities," we discuss the importance of women's political agency in rectifying some of the more serious lapses in Indian economic and social performance—not just pertaining to the deprivation of women themselves.

29 See Jean Drèze and Amartya Sen, Hunger and Public Action (Oxford University Press, 1989), which also investigates the remarkable success of some poor countries in providing widespread educational and health services.

30 World Bank, World Development Report 1994, p. 212; and Sample Registration System: Fertility and Mortality Indicators 1991 (New Delhi: Ministry of Home Affairs, 1993).

31 See the discussions, and the literature cited, in Gita Sen, Adrienne German, and Lincoln Chen, editors, Population Policies Reconsidered: Health, Empowerment, and Rights (Harvard Center for Population and Development Studies/International Women's Health Coalition, 1994).

32 On the actual processes involved, see T.N. Krishnan, "Demographic Transition in Kerala: Facts and Factors," in Economic and Political Weekly, Vol. 11 (1976), and P.N. Mari Bhat and S. I. Rajan, "Demographic Transition in Kerala Revisited," in Economic and Political Weekly, Vol. 25 (1990).

33 See, for example, Robin Jeffrey, "Culture and Governments: How Women Made Kerala Literate," in Pacific Affairs, Vol. 60 (1987).

34 On this see my "More Than 100 Million Women Are Missing," New York Review of Books, December 20, 1990; Ansley J. Coale, "Excess Female Mortality and the Balance of the Sexes: An Estimate of the Number of 'Missing Females'," Population and Development Review, No. 17 (1991); Amartya Sen, "Missing Women," British Medical Journal, No. 304 (March 1992); Stephan Klasen, "'Missing Women' Reconsidered," World Development, forthcoming.

35 Tamil Nadu has benefited from an active and efficient voluntary program of family planning, but these efforts have been helped by favorable social conditions as well, such as a high literacy rate (the second highest among the sixteen major states), a high rate of female participation in work outside the home (the third highest), a relatively low infant mortality rate (the third lowest), and a traditionally higher age of marriage. See also T.V. Antony, "The Family Planning Programme—Lessons from Tamil Nadu's Experience," Indian Journal of Social Science, Volume 5 (1992).

36 World Bank and Population Reference Bureau, Success in a Challenging Environment: Fertility Decline in Bangladesh (World Bank, 1993).

* Tables not included in this text.