Population Programs

What’s the big idea? There were twin notions on the history of development and population that (a) the rapid growth of population was a major obstacle to economic development and (b) that the expansion of modern conception would, in and of itself as an independent causal factor, reduce population growth as women were having many more children than they wanted. I only ever had one important paper in this field and it was an argument that roughly women were having the total number of children they wanted and that “excess fertility” and “unmet need” were not in fact keys to reduction in population growth. This is not to say that expansion of access to modern conception would have a number of positive benefits–including expanding women’s rights and freedom as an intrinsic good as well as health and other benefits from greater control over spacing and timing of births. But “family planning” programs focused on expanding supply of contraception per se, on the premise this would ease demographic pressures both (a) would not work unless and until “desired fertility” fell and (b) ran the very real (and realized) risk of violating women’s rights in order to achieve the population targets as happened in China and India. This was part of the dramatic shift at the 1994 Cairo International Conference on Population and Development to a “reproductive health” approach that explicitly rejected family planning/access to contraception programs driven by demographic concerns and targets.

Desired Fertility and the Impact of Population Policies.” Population and Development Review, vol. 20 no.1, March 1994. Given the content and timing (which was not coincidental), this was perhaps the most controversial and high stakes paper I ever published. The Population and Development Review was a publication of the Population Council and I suspect the editor, the wonderful Hungarian demographer/economist Paul Demeny, came under considerable pressure–I received and had to address comments from five referee reports.

The Impact of Population Policies:  Reply.Population and Development Review, vol. 20 no. 3, September 1994. The original article elicited a number of comments that PDR published and I published this Reply. From the vantage of years, I am not sure I should have responded so strongly, but on the other hand, it is, for better or worse, my natural style to fight fire with more fire.

Two methodological notes on the above paper.

First, if you want an example where “correlation is not causation” was in fact deeply confused and used erroneously in real-world policy making I think this is a prime example. For decades the family planning advocates pointed to the high correlation between actual fertility and contraceptive use as if that represented a causal mechanism running from contraceptive supply to reduced fertility as opposed to a causal relationship running from desired to limit fertility to contraceptive use.

Second, in an era in which people are concerned, rightly, with a “replication crisis” of published results that are fragile, the basic findings of this paper about the relationship between desired and actual fertility were based on using data from DHS surveys (which, given the primitive times of the early 1990s, I had to enter by hand from actual hard copy DHS reports). There have subsequently been as many (or more) DHS reports completed as I had access to when I wrote the paper and the basic results replicate almost exactly in the aggregate (but with some emerging differences in Sub-Saharan Africa). Getting the descriptive facts (including basic correlations and regression results, which are just summary statistics of data too) right matters.

No Need for Unmet Need” This is a very rough, never published, paper based on a presentation at Johns Hopkins school of public health in 1996 arguing that the advocacy concept of “unmet need” was empirically illegitimate–and ultimately not useful. I include this in part because it is a great illustration of a common intellectual danger in development, which is to, for purposes of mobilizing effort and advocacy, to characterize something as a “need” but which then frames the actual program design such that, in a top-down way, since what is being supplied is a “need” (and not a wish, or desire, or demand, or preference–each of which interact in complex ways with other priorities in individual and household decision making) then one doesn’t actually have to listen to people, the intended “beneficiaries” about what they actually want. I argue that, for a very long time in the field of family planning there was a large advocacy program arguing that women “needed” modern contraception but that the actually literature on implementation of vertical family planning programs was full of concerns about the lack of uptake. This was, in part, because the clinics were interested in the “need” to reduce population and so were looking at methods that were cost-effective in reducing total fertility (and sterilization was cost-effective at that specific target) whereas women had a much broader array of concerns–such as how to space births–but what women wanted was not part of the demographic driven advocacy. So the idea of “unmet need” was itself counter-productive. These themes of the top-down, technocratic, supply driven approaches to meet “need”–which I also saw in other domains like rural water supply, sanitation, basic education, health–but which actually ignored the realities of people’s lives and their complex choice and precluded effective feedback from “beneficiaries” became a central part of my thinking about development, see for instance “Solutions when ‘the solution’ is the problem.”

Swimming, Smoking, Solving. This is a presentation I gave at the Population Association of America meetings in 2008 as part of a panel on Matthew Connelly’s new book Fatal Misconceptionwhich, as you might imagine, was hotly controversial at the PAA. In it, I speculate on how and why–in a positive sense–social movements around certain issues, such as the “expand family planning to defuse the population bomb”–are successful or not. I discuss how the intellectual traction of various elements of support and opposition to this movement had shifted over time (the metatphor of the title is “swimming with the tide” of dominant ideas versus “what are you smoking? of new, aberrant ideas)”. In particular, I pointed out that in its origins in the early to mid-20th century this movement had supported by a powerful “eugenics” movement and the “sexualityism” and “feminist” movements were weak (the former illegal), but by 1994 in Cairo the feminists could basically eject the “population bomb” demographers from the core of a movement the demographers thought was their movement, and that by 2008 the “sexualityism” might be the most powerful of all the supports for contraception. I have never written any of this into a paper, but a big problem is that everyone who wants to “change the world” wants a usable “theory of change” but part of the success of nearly all successful movements is creating a mostly false myth of why they succeeded.

Why Demographic Suicide? The Puzzles of European Fertility.” 2013. Population and Development Review. (with Martina Viarengo). This was part of a volume in tribute to Paul Demeny. There are two parts of this paper I would like to pursue. First, standard economics (e.g. Becker) of low fertility for rich people (which is of course a historical inversion) is that demand increases for “quality adjusted” children–but this cannot explain rising childlessness as one cannot “quality adjust” zero children. Second, why isn’t very low fertility seen as a major challenge for evolutionary psychology? That is, if my theory of human behavior is that people do things because evolution has programmed us with certain impulses then certainly far and away the most important of those impulses must be to have children–which is precisely what the people of the West (and Japan and globally) have stopped doing.

Autonomous Reform vs Global Isomorphism: Explaining Iran’s Success in Reducing Fertility.  (with Masoomeh Khandan). In 2017 I returned to the issue of family planning programs with a completely different lens. I was interested, via my work on state capability, in the idea of global isomorphism (these are the pressures that the international system brings to bear on countries to adopt certain reforms not because these reforms particularly speak to local concerns or even would be effective but because it is the “done thing” (this draws on work sociologists like DiMaggio and Powell and John Meyers)). Most countries that are immune to the vectors of global isomorphism are basket cases (e.g. North Korea, (pre-reform) Myammar, etc.) but Iran is an interesting case of a country that has self-consciously cut itself off (and at times been cut off via sanctions) from international influences and yet has undertaken a number of interesting and successful reforms (said without any defense of the regime’s overall record). One of the most interesting of those is that the most rapid reduction in fertility from high to low levels in history was Iran’s reduction in the 1990s–driven by an explicitly Islamic political regime.

CID Faculty Working Paper No. 338

Masoomeh Khandan and Lant Pritchett