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The Rich, the Poor and the Pregnant

WAY back in 1974, when the New Internationalist ran its first cover story on world population, it was generally agreed that rapid population growth was one of the greatest threats to the global environment and one of the main causes of world poverty.

The New Internationalist opposed that view and opposes it still. Drawing heavily on the wisdom of colleagues like Pierre Pradervand and Tarzie Vittachi - people who refused to be thrown off balance by the talk of population 'explosions', 'time­bombs', and 'juggernauts' - we presented to our readers what we still believe is a saner view of a major world issue.

Since that time, the New Internationalist has been frequently attacked for being ,opposed 'to family planning'. So let us state our position bluntly. We are strongly in favour of family planning - and faintly suspicious of the family planning lobby.

First of all, the issue is not world population - it is their population. It is about the fact that black and brown skinned people have twice as many babies as we do and account for 90 per cent of world population growth. In twenty years from now, Asia alone will hold 6 out of every 10 people in the world.

There may be many reasons for worrying about this, but the environment isn't one of them. As the article on page 14 points out, the average person born in the industrialised world will consume and pollute approximately 30 times as much in his or her lifetime as the average person born into Africa, Asia or Latin America. According to the faithful pocket calculator, that means the rich world's 16 million babies a year are four times more of an environmental worry than the poor world's 119 million a year.

So the cause for concern must be poverty. They are poor because they have too many children. Their economic growth is being wiped out because it has to be divided amongst ever more people. Lyndon Johnson once said that a dollar invested in family planning does more to alleviate poverty than a hundred dollars in any other kind of aid. And it did for , the family planning lobby what picking up a beagle by the ears did for the ASPCA,

Space for Health

Oh to be a fund-raiser, now that pills are here - persuading the rich that they are making a big contribution to the alleviation of poverty and at the same time allaying their own fears about the rising black and brown tide which laps around the shores of white affluence.

For many of the family planning charities in the rich world, it was the sales pitch of the century - combining concern for the persistence of their poverty with concern f or the preservation of our wealth.

Such an approach begins by absolving the rich and blaming the poor - and ends by substituting condoms for justice. And it is founded in a convenient misunder­standing of the relationships between population growth and economic well­being.

Millions of people in the developing world want large families. Where there are no old-age pensions, no medical services, and no unemployment pay, children are the main source of economic security. Where the task of fetching wood and water and tending animals takes up to twelve hours a day, children are an asset in the family's struggle for survival. Where infant mortality rates are high, many children are necessary to ensure the survival of some.

Preaching small families to people who need more children is not only insensitive; it is also ineffective. 'Unless at least a latent motivation towards smaller families exists,' says University of Michigan expert Ronald Freedman, 'providing the means and the services will have little effect.'

Several hundred new population studies published in recent years have played the spotlight on the various factors which lead men and women to want fewer children. Chief amongst them are better health and lower infant mortality; rising incomes and greater economic security; the spread of education and the emancipation of women. Such changes do not depend for their justification on their contribution towards lowering the rate of population growth. They are the aim and the measure of development itself.

And it was after living standards began to rise for the majority of people - and before the advent of cheap, safe, and effective contraceptives - that population growth rates plummeted in today's industrialised countries.

If and when rising living standards provide the motivation for smaller families, then family planning can provide the means. But family planning itself needs to be seen not as an independent venture motivated by concern for the problems of population growth, but as an integral part of improved health services motivated by concern for the problems of people's lives.

There are many commonsense reasons for merging family planning with health services - it helps to avoid duplicating personnel and administration where resources are scarce; it helps in the many cases where contraceptives themselves have adverse effects on health; it helps that there is a relationship of trust between people and their health workers. But most important of all, family planning is one of the numbers in the code which releases the combination lock of community health.

Perhaps because it has long been considered a 'woman's problem', this link between family planning and health has only been given priority, not money. Yet the contribution which family planning could make to health is so great that the expenditure it requires would be amply justified even if population growth itself were not a problem.

Every year in Africa and Asia alone, half a million women die from pregnancy, childbirth and after-birth effects - leaving behind over 1 million motherless children. In Latin America, illegal abortion is now the number one killer of women between the ages of 15 and 39. World wide, 25 million women a year suffer serious illness or complications during pregnancy and childbirth. Fifteen million of the 125 million babies born every year will not reach their first birthday. And these deaths are just the tragic tip of an ice­berg of illness which affects every other aspect of the struggle for economic development.

Nutritionists like Professor Derrick Jeliffe call it the 'maternal depletion syndrome'. Village women in Bangladesh call it 'shutika'. But both are talking about the same thing - the fact that being pregnant, giving birth and breast feeding are exhausting processes for a woman's body. And it takes time to recover. If the recovery time is too short, then health pays the price. Infants are more likely to be malnourished. Mothers suffer from anaemia, toxaemia and plain exhaustion. Babies are prone to low birth weights - carrying with it 20 times the risk of death in infancy. And often the next youngest child suffers as well: 'kwashiorkor', the wasting disease of malnutrition whose symptoms are known throughout the developing world; is a Ghanaian word meaning 'the illness of a baby deposed from the breast too soon'.

The age of the mother, as well as the frequency of birth, is also a strand in the web which links family planning to health. Outside the age band 20-35, there is a higher incidence of unwanted pregnancy, a higher risk to the mother, and a higher rate of mortality among the infants born. And roughly one-third of all births in the world are to mothers younger than 20 or older than 35.

The womenwho are at thesharp end of this 'depletion syndrome' know better than anybody else how it affects their own and their family's health. And it is not just the lack of family planning which prevents them from taking their own fertility and their own health into their own hands. It is often the fact that they live in societies where men take the decisions and women take the consequences.

The availability and acceptability of family planning, by both men and women, could be crucial in reducing this heavy toll on human health. But above all, family planning needs to be, and be seen to be, a service which improves people's health and increases their power over their own lives, and not an imposition which is insensitive to their circumstances and contemptuous of their rights.

An improved quality of life for poor people is the aim of development. When achieved, it is normally reflected in a desire for smaller families and a reduced rate of population growth. Similarly, family planning is an essential part of improved health services. And when available, it also reduces family size, where the motivation exists, and leads again to a lower rate of population growth.

It is the weaving together of these two strands which leads the New International­ist to conclude, just as we did in our first cover story six years ago, that the sane view of the population issue can be summed up in one sentence: 'Look after the people and the population will look after itself'.

The Domino Theory