(September 2004) Ten years ago this summer, representatives from 179 countries, scores of international agencies, and about 1,200 nongovernmental organizations met in Cairo for the United Nations-sponsored International Conference on Population and Development (ICPD), a landmark event in world population and health.
ICPD hammered out ambitious global goals in five areas: family planning, reproductive health, infant mortality, female education, and life expectancy. As we near the 10th anniversary of ICPD, let us celebrate the progress many parts of the world have made toward these goals:
- Modern contraceptive prevalence—the proportion of reproductive-age women using modern contraceptive methods—is substantially up in most developing countries.
- Infant mortality rates in most developing countries have fallen.
- Girls worldwide have made striking gains in primary school enrollments.
- Life expectancy has increased in many areas.
Such progress (which was already underway at the time of the Cairo conference) does not happen by itself. Socioeconomic development and hard-won advances in women’s rights and equality have been crucial factors. Family planning programs and maternal and child health initiatives have also enabled millions of couples to choose the number and spacing of their children and to improve their families’ health.
In addition, international financial support and technical assistance, private foundation investments, and new priorities by national governments—although in most cases less than the amounts pledged in Cairo—have been essential to the global gains in health and development that ICPD first targeted.
The Demographic Divide Still Persists
These improvements in developing countries have also driven two related population trends that distinguish the past 40 years from most of the 20th century:
- Fertility rates have been declining in nearly all countries.
- In more than one-third of all countries—containing 43 percent of the world’s people—women now bear two or fewer children on average. If sustained, these reduced levels of fertility would cause population in those countries to eventually stabilize or even decline.
Meanwhile, a third related trend has taken strong hold in the world’s developed countries:
- In Japan and throughout much of Europe, fertility rates have fallen to levels far below those required to maintain a constant population, and these very low rates have persisted.
These demographic changes since the Cairo conference have narrowed the differences between the world’s countries in some key population and health indicators. But the “Demographic Divide” (the gap between fertility rates in developed and developing countries) remains enormous.
For example, while women in Niger have an average of 8 children in their lifetimes, Bulgaria’s women have an average of only 1.2 children. (Not surprisingly, Niger’s population is projected to jump by 327 percent by 2050, while Bulgaria’s is projected to decline by 38 percent.)
And, while one in 16 mothers dies in childbirth in sub-Saharan Africa, only one in 2,800 dies in industrialized countries. A glance at PRB’s 2004 World Population Data Sheet reveals many other stark disparities across this divide.
The Advocacy Divide: Two Halves That Don’t Make a Whole
But a very different divide—this one between two different kinds of advocates instead of between countries—today threatens even the progress we have made in diminishing the Demographic Divide. These two sides make up what I call the Advocacy Divide:
- The Implosionists. The Implosionists argue that widespread falling fertility rates are more important than all other demographic trends. These analysts and organizations predict that the unprecedented challenges that declining fertility poses for Europe and Japan—challenges from aging populations, shrinking workforces, immigration pressures, inadequate aggregate demand for goods and services, and intergenerational conflict—also lurk for those developing countries where average family size is below two children. And the Implosionists warn that such problems will eventually spread to countries whose current fertility rates are still high but declining.
The Implosionists contend that the world population explosion is a thing of the past. Instead, they argue, governments, international organizations, and researchers must focus on how to cope with a future of universally declining fertility rates and stagnant or declining population sizes.
- The Explosionists. On the other side of the advocacy divide are the Explosionists, who focus on the substantial population growth yet to come in most developing countries. Even those developing countries with relatively low fertility rates, say the Explosionists, still have large numbers of children and youth that will swell the childbearing ranks for years to come. They also stress that many millions of women still have inadequate access to modern contraceptives and reproductive health services—and that many countries still have high female death rates associated with pregnancy and childbirth.
The Explosionists contend that the global population explosion is a continuing fact. Urban and coastal population concentrations and the spread of Western consumption patterns, they argue, will continue to degrade the environment and exacerbate global warming. The Explosionists also warn that burgeoning numbers of youth in developing countries will prompt humanitarian crises, wars, and other conflicts. Their solution to these problems? Governments and international organizations should extend their investments in family planning, reproductive and child health, and gender equality while we still can forestall environmental and human disaster.
The differences between these two positions, however, are more than interpretation, opinion, or prescription. Instead, they are akin to a culture war, with the two sides often arguing and sometimes even shouting past each other. And like the larger culture wars in American society and elsewhere, the advocacy divide has implications for policymaking.
Listening exclusively to the Implosionists, you might well miss these three important facts about our world:
- Population growth will continue for decades to come.
- Such growth will bring profound challenges.
- Continuing large national and international investments will be required to slow this growth.
Listening only to the Explosionists, you might well miss three other important facts:
- Fertility rates worldwide have declined more quickly—and the well-being of women and children has improved more broadly—in recent decades than in perhaps any other period in human history.
- If recent trends continue, the world’s population will stop growing well before the end of the century.
- The looming challenges of population decline are profound, unprecedented, and badly understood.
Who can hold these six facts in one’s head at the same time? What member of either camp, when expounding its views, acknowledges the other’s portion of the truth? Judging from much of what I read and hear, thinking beyond the self-imposed boxes of either the Implosionists or the Explosionists must be a difficult challenge!
The Risk in the Current Debate
The emergence of two opposing positions on the future of the world’s population was predictable in retrospect. Geographic perspectives, political orientations, and organizational interests naturally run in one of these directions or the other.
But while the advocacy divide is understandable, it is also risky. Some of the Implosionists and some of the Explosionists espouse extreme positions that are each slowing the health gains of developing countries—a trend that delays closing the demographic divide.
For example, when the Implosionists stress the challenges of declining fertility, they are (however implicitly or unintentionally) diverting donors’ and policymakers’ attention from the investments still required in the next 50 years to improve health and lower fertility in less developed countries. How can we build on the progress already made without continuing the investments that have fueled that progress? But the Implosionists’ conviction that the world has turned the demographic corner discourages these investments. And deferring those investments will, ironically, delay addressing declining fertility.
Similarly, when the Explosionists deny or underplay the extraordinary achievements of the last 40 years in family planning, maternal and child health, and gender equality, they are also in effect discouraging further investment in these areas. After all, if nothing works—if global population continues to explode after all that has been done—then why continue to throw good money after bad? The Explosionists’ pessimism, which often culminates in despair and anger, has become self-fulfilling.
Neither position is anywhere near a complete guide to policy toward population and reproductive health issues. Yet both positions now affect such policy. The Implosionists and the Explosionists have unwittingly combined to cast doubt among governments, international donor organizations, and foundations about the importance of population and reproductive health investments in developing countries. Such investments are still of great moment—but they are not receiving high priority today in many policymaking quarters.
How ICPD Still Points the Way
The true spirit of the Cairo conference—promoting gender equality and enabling women and couples to have greater opportunities and choices—is the way out of the dead-end of the advocacy divide. Policymakers need to be reminded that the ICPD Programme of Action goes a long way toward addressing challenges related to both high fertility and low fertility. For example:
- Women in many low-fertility countries often must choose work over having children, a decision prompted by inadequate child care and work environments that are not yet family-friendly. Government policies in the spirit of ICPD could broaden these women’s options and thereby induce higher fertility rates—a process already occurring, for example, in France and Sweden.
- And many women in developing countries lack schooling, employment opportunities, access to modern contraceptives, and empowerment within their own families. Government policies in the spirit of the ICPD could improve these conditions, which would reduce high fertility rates in the developing world.
A rededication to the goals of ICPD—as well as recognition of the legitimate points on both sides of the advocacy divide—might well carry us over the demographic divide and through the dual challenges of population growth and population decline. In subsequent essays, I will take up the nature of these challenges and the important role of the Population Reference Bureau in meeting them.
William P. Butz is president of PRB.