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Jump to Chapter 3 Sections:
>> Health, development and aid >> Broad progress, startling changes, persistent quandaries >> Health indicators: advances and obstacles >> Health systems and services >> To review the bidding >> Implications of trends for future directions >> Implications for the philosophy and pursuit of "foreign assistance" >> Notes >> Background paper >> References
Over the past 20 years there have been two main debates among researchers and policymakers about the relationship between fertility and development. The first argues that lower fertility reduces poverty in developing countries. The second claims that targeted population programs can change women’s preference for the number of children they have, increase contraceptive use, and lower fertility. These debates offer lessons for family planning and poverty reduction programs.
As far back as the mid-1980s it was reported that demographic factors such as fertility decline and
population growth play a role in economic development but that good governance, adequate resources, sound economic policies, and lack of corruption are even more important. More recent research suggests that once fertility starts to decline, investments in human and physical capital can help
reduce poverty in countries with good economic and social policies. The conclusion, then, is that
good economic policies do more to reduce poverty than fertility and family planning programs.
Various questions arise when looking to the future of family planning programs in least developed
countries where fertility remains high. First, in 2020 what will be the unmet need for contraception
that cannot or will not be met by market forces? As economies grow and people become more educated in general and better informed about family planning in particular, they recognize the benefits of smaller families. With the uncertainty that AIDS poses in some parts of the world, expectations are that the momentum of fertility declines will continue unabated.
Second, how will the youth bulge (ages 15-20) in developing countries affect fertility preferences
and population growth over the next decades? By 2020 most people in this age cohort will be in mid-adulthood. Relative to their parents, they are from smaller families, are better educated, and have
benefited more from economic growth. Studies indicate that they desire smaller families and will
likely have lower fertility rates than their parents.
As with nearly all measures of progress, countries with intense HIV/AIDS epidemics may experience
very different fertility patterns. The 16 African countries with the highest incidence of HIV/AIDS are projected to see fertility fall by 23-39 percent through 2020, compared with a 21 percent decline for Africa overall. Because HIV/AIDS is more common among people of working age, reducing poverty will be even more difficult in these countries.
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