Biomedical subjects
Publications and source records attributed to W P Mauldin.
New data show that national family planning programmes have made impressive progress in the last 25 years. Fertility rates have been reduced dramatically, but during the current decade even greater achievements will be called for.
The chief results to emerge in this preliminary analysis are as follows: Stronger programmes are stronger on every score. Their overall superiority in the total score is not due to exceptional stress on any one feature, but rather to a substantial advantage score by score, across all 4 dimensions of effort. A further difference is that stronger programmes have more consistent values across the various scores, quite apart from their levels, whereas weaker programmes are erratic, displaying much greater variability around their own mean score than do the stronger programmes. The profiles themselves (apart from levels) have not changed from 1982 to 1989. Stronger programmes in 1989 show the same score patterns as did the smaller number of stronger programmes in 1982. This also holds true for weaker programmes: the profile of the weaker programmes in 1982 was duplicated in 1989, even though countries left that category and moved into the stronger group. The 19 countries that shifted to the higher category conformed to the profile of weaker countries in 1982 (though at a slightly higher level); but conformed to the profile of stronger countries in 1989 (though at a slightly lower level). Thus it is likely that maturing programmes tend to follow a special pattern of improvement: They improve differentially across the 30 scores. The prevalence of contraceptive use is closely associated with programme effort, but some programme features count more than others. The availability scores for contraceptive methods count most, and service and service-related efforts come next.(ABSTRACT TRUNCATED AT 250 WORDS)
By the mid-1960s, countries that accounted for 66% of the population of developing countries had adopted policies designed to reduce their rates of population growth; by 1986, the corresponding figure had reached 78%. In the developing regions as a whole, fertility has fallen by more than 30% since 1950. Contraceptive use has risen sharply, and there has been more than 10-fold increase in the number of couples in developing countries who use contraceptives. There is a very strong association between use of contraception and fertility in developing countries. Social and economic modernization is also taking place, although quite unevenly in the developing regions, so that the relationship of modernization is fertility is not very easy to demonstrate. In general, the experience of the developing countries suggest that a strong family- planning program effort can, and does, lead to a more rapid fertility decline than would be likely based only on socioeconomic variables. The effectiveness of family-planning programs can be enhanced by increasing the range of choice of contraceptive methods offered. However, it is difficult to disentangle the various factors that contribute to the effectiveness of family-planning programs. The public sector is the main supplier of family-planning services in most developing countries, and there is no clear trend towards the reliance on the private sector.
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Since 1965 there have been substantial declines in the crude birth rates of many countries in the developing world, particularly the largest countries. This auspicious trend is shown clearly in an analysis of population figures for the last 25 years, despite the fact that there are deficiencies in the data. In 1950 the average crude birth rate for developing countries was 42 per thousand per year. Over the next 15 years, declines in the crude birth rate were limited to a relatively few, and for the most part small, countries. After 1965, however, for the 13 developing countries with a population numbering 35 million and over, there have been declines in the crude birth rate averaging 13 percent, with declines of over 12 percent in 9 of them. The effects of a number of sociodemographic factors on crude birth rates are examined, and the analysis shows that increases in the age at marriage and decreases in marital fertility were the principal factors affecting declines since 1965.
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During the past 25 years, the world's population increased by 60 percent to 4 billion people. The period witnessed a momentous decline in mortality, which will probably continue in the developed countries. Fertility has fallen dramatically in the developed countries to quite low levels. In the developing countries, where the bulk of the world's population is concentrated, fertility is still high, although it has begun to decline in some countries. Reductions in fertility have been dramatic in Asia and the Pacific; substantial in Central and South America; and hardly noticeable in Africa. Increasingly, population policies will be considered as an integral part of social and economic development; and family planning will receive increasing attention as a human right, as an element of improved maternal and child health, and also as a means of moderating high rates of population growth.
Today, 34 developing countries have policies and programs to lower fertility, and an additional 32 countries provide family planning services for health and humanitarian reasons. Specific causal relationships and linkages between social and economic development, family planning programs, and fertility levels and changes remain mostly unclear at this point. Based on percent acceptors, percent users, and changes in fertility rates (the most commonly used measures to evaluate family planning program accomplishments), however, the performance of programs on the whole has been moderately encouraging.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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According to a set of 30 indices that assess the strength of large-scale family planning programs in developing countries, a strong upward shift in effort scores occurred between 1982 and 1989. During that period, many countries established or augmented their family planning programs, and effort scores improved in all developing regions and in all four dimensions of effort--policies and stage-setting activities, service and service-related activities, record keeping and evaluation, and availability of contraceptive methods. By region, the sharpest improvement was not in East Asia, where levels were already high, but in sub-Saharan Africa, where the movement was clearly upward, from a low base. Earlier associations between program effort and fertility declines are reaffirmed, additive to the contribution of socioeconomic improvements. In order to compute scores ranging from zero to 30 for each of the 30 indices, a detailed questionnaire was sent to 4-6 respondents in each of 103 developing countries having more than one million population. Respondents included program staff, donor agency personnel, local observers, and knowledgeable foreigners. The scores indicate that developing countries are continuing to move toward more favorable policy positions and stronger implementation of action programs, with consequent fertility effects. For the fertility decline to match the medium population projections of the United Nations, however, a substantial enlargement in the number of contraceptive users is necessary, not only to compensate for the enlarging base of couples, but also to increase the proportion who use contraceptives.
The government of Bangladesh and the World Bank commissioned a Compensation Payments Study, carried out in 1987, to assess the merits and demerits of payments for sterilizations to clients, medical personnel, and intermediaries who motivate and refer clients. The study conclusively shows that the decision of Bangladeshi men and women to undergo sterilization is a considered and voluntary act, taken in knowledge of the nature and implications of the procedure, and in knowledge of alternative methods of regulating fertility. There is a high degree of client satisfaction among those who have been sterilized, although among clients who had fewer than three children, 25 percent expressed regret that they had been sterilized. Money may be a contributing factor to the decision to become sterilized in a large majority of cases, but a dominant motive for only a very small minority. Payments to referrers have fostered a large number of unofficial, self-employed agents--particularly men who recruit vasectomy cases. These agents provide information about the procedures for being sterilized, particularly to the poor. They also concentrate on sterilizations to the exclusion of other methods, and are prone to minimize the disadvantages and exaggerate the attractions of sterilization.
In response to concerns about the adverse consequences of rapid population growth, family planning programs have been implemented in many developing countries. The aim of the present study is to assess the impact of this programmatic approach on long-range population growth. The result of a new and hypothetical population projection indicates that in the absence of family planning programs the population of the developing world could be expected to reach 14.6 billion in the year 2100 instead of the 10 billion that is currently projected by the World Bank. Despite the apparent success of existing interventions, fertility control is far from complete, as many women continue to bear unwanted births. To assess the impact of this unintended childbearing a second hypothetical projection is made. With perfect implementation of reproductive preferences, the population size of the developing world in 2100 would be reduced by an estimated 2.2 billion below the current projection. Further strengthening of family planning programs and improvements in birth control technology are therefore likely to provide important demographic benefits.