Population Control Policies and Fertility Convergence

Rapid population growth in developing countries in the middle of the 20th century led to fears of a population explosion and motivated the inception of what effectively became a global population-control program. The initiative, propelled in its beginnings by intellectual elites in the United States, Sweden, and some developing countries, mobilized resources to enact policies aimed at reducing fertility by widening contraception provision and changing family-size norms. In the following five decades, fertility rates fell dramatically, with a majority of countries converging to a fertility rate just above two children per woman, despite large cross-country differences in economic variables such as GDP per capita, education levels, urbanization, and female labor force participation. The fast decline in fertility rates in developing economies stands in sharp contrast with the gradual decline experienced earlier by more mature economies. In this paper, we argue that population-control policies likely played a central role in the global decline in fertility rates in recent decades and can explain some patterns of that fertility decline that are not well accounted for by other socioeconomic factors.

The effects of China's universal two-child policy

In October, 2015, China's one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include: a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. All of these effects should improve health outcomes. Effects of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime, more sound policy actions are needed to meet the social, health, and care needs of the elderly population.

Nitrogen, phosphorus, carbon and population

Population growth makes food production increase necessary; economic growth increases demand for animal products and livestock feed. As further increase of the cropland area is ecologically undesirable, it is necessary to increase crop yields; this requires, inter alia, more nitrogen and phosphorus fertiliser despite the environmental problems which this will exacerbate. It is probable that a satisfactory food supply and an environmentally benign agriculture worldwide cannot be achieved without reducing population to approximately three billion. The reduction could be achieved by 2200 if the total fertility rate--currently 2.5--declined to 1.5 as a world average by 2050, and remained at that level until 2200, but the probability of such a global fertility trajectory is close to zero. It will also be necessary to replace fossil energy by nuclear and renewable energy in order to stabilise atmospheric carbon dioxide concentration, but the phase-out cannot be completed until the 22nd century, when the atmospheric concentration will be approximately 50% above the 2015 level of 400 ppm.

Antisperm contraceptive vaccines: where we are and where we are going?

This is a review of current status and future perspectives on the development of antisperm contraceptive vaccines (CV) and immunocontraceptives. The development of antisperm CV is an exciting proposition. There is a strong rationale and recent data indicating that this proposition can translate into reality. The search for novel sperm-specific antigens/genes, that can be used for CV, continues using various recent developing technologies. Various approaches of proteomics, genomics, reproductive biology, mucosal immunity and vaccinology and several novel technologies such as gene knockout technology, phage display technology, antibody engineering, differential display technique, subtractive hybridization, and hybridoma technology are being used to delineate sperm-specific antigens and construct CV. Various sperm antigens/genes have been delineated, cloned, and sequenced from various laboratories. Vaccination with these sperm antigens (recombinant/synthetic peptide/DNA) causes a reversible contraceptive effect in females and males of various animal species, by inducing a systemic and local antisperm antibody response. The efficacy is enhanced by combination vaccination, including peptides based on various sperm antigens. Several human novel scFv antibodies with unique complementarity-determining regions (CDRs), that react with specific well-defined fertility-related sperm antigens, have been synthesized. These human infertility-related antibodies may find application in the development of novel immunocontraceptives. Besides finding the novel sperm antigens, the present and future focus is on enhancing the immunogenicity, bioefficacy, and on obliterating the inter-individual variability of the immune response, and proceeding for primate and human clinical trials. Multi-epitope vaccines combining sperm proteins involved in various steps of fertilization cascade have been found to enhance the immunogenicity and bioefficacy of the contraceptive effect. The in vitro synthesis of infertility-related human scFv antibodies may provide unique once-a-month immunocontraceptives, the first of its kind, for human use. The multi-epitope CV and preformed engineered human antibodies of defined specificity may obliterate the concern related to inter-individual variability of the immune response.

Falling fertility and increase in use of contraception in Zimbabwe

Zimbabwe does not feature much on the current debate of fertility transition in sub-Saharan Africa. This article is trying to fill this gap by analysing the ZDHS data. The total fertility rate of Zimbabwe was close to 7 births during independence in 1980. However, it has declined to 3.8 in 2006. This does not only show that fertility in Zimbabwe has been declining over the years, but it is one of the lowest in the region. The fertility trend observed is mainly explained by use of contraception. The contraceptive prevalence rate was 60 percent in 2006. It is noted that the contraceptive uptake has continued to increase even during the years when Zimbabwe was going through serious political, economic, social and health challenges. This is because the groundwork done on the family planning programme soon after independence put a solid foundation in motivating women to use contraception.

The Dilemma of Past Success: Insiders' Views on the Future of the International Family Planning Movement

Many observers believe that the international family planning movement has played a significant role in reducing fertility levels and slowing population growth in the developing world. Yet the perceived success of family planning programs recently has led some researchers to formulate questions about their relevance and future place on the development policy agenda. Within a framework derived from the sociological literature on social movements, we use interviews and focus-group discussions with insiders in the field of population studies to examine current perspectives on the status and future of the family planning movement, factors contributing to its declining international visibility, and possible responses from the family planning field. Informants cited four possible courses of action for the movement: (1) forming strategic alliances with other movements, specifically HIV/AIDS prevention; (2) redefining the family planning message to mobilize and strengthen support; (3) improving service delivery to broaden public acceptance and contraceptive method use; and (4) nurturing new leadership. The future course of the movement--whether it be one of cooptation by overlapping movements or revitalization--requires waiting until its full history can be written.

Intractable limits to a sustainable human population

The pressing need for a much smaller world population arises for two reasons. Humans are emitting about two and a half times as much carbon as the maximum permissible to achieve stabilisation of carbon in the atmosphere. Today's six billion humans, in striving to enjoy at least a basic quality of life, are damaging many vital ecological systems and causing a major extinction of other forms of life. Within the next half century, a new and compelling reason for a smaller human population is likely to arise through the fact that we cannot be at all sure that a suitable replacement to fossil fuel energy is going to be found. Analysis of all these aspects indicates the need for a world population of about 2000 million (2 billion).

Rethinking the “early” decline of marital fertility in the united states

In this article, I rely on new estimates of nineteenth-century mortality and the Integrated Public Use Microdata Series to construct new estimates of white fertility in the nineteenth-century United States. Unlike previous estimates that showed a long-term decline in overall fertility beginning at or before the turn of the nineteenth century, the new estimates suggest that U.S. fertility did not begin its secular decline until circa 1840. Moreover, new estimates of white marital fertility, based on “own-children” methods, suggest that the decline in marital fertility did not begin in the nation as a whole until after the Civil War (1861–1865).

Is low fertility a twenty-first-century demographic crisis?

Nearly half of the world's population in 2000 lived in countries with fertility rates at or below replacement level, and nearly all countries will reach low fertility levels in the next two decades. Concerns about low fertility, fertility that is well below replacement, are widespread. But there are both persistent rationales for having children and institutional adjustments that can make the widespread intentions for two children attainable, even in increasingly individualistic and egalitarian societies.

Current advances in antifertility vaccines for fertility control and noncontraceptive applications

The search for effective antifertility vaccines has been actively pursued for decades in clinical applications as contraceptives or in the treatment of hormone-dependent conditions. More recently, innovations have seen immunocontraception being employed successfully in veterinary and farming applications, as well as in population control of a number of different wildlife species. Although the basic principle behind these vaccines is the same, design considerations and criteria for commercialization are very different. This review will examine current advances in this field and evaluate the future scope of antifertility vaccines.

[Long-term trends of the demographic aging in Germany]

At the beginning of the 21st century, Germany is experiencing the highest demographic aging after Japan. The aging process was first initiated by the increase of life expectancy, especially at the age above 60 years which caused an increase in the number of old people. During the next phase (1970-2000) the aging process was additionally affected by decreasing birth rates. Since the end of the 1960s the total fertility rate in Germany has been below the replacement level. As a consequence the number of children is decreasing and the number of old people has been increasing for 30 years. Various population projections published by the Institute for Population Research and Social Policy (IBS) demonstrate that the aging process will intensify during the next 50 years: the number of the oldest old population will triple, and the dependancy ratio will at least double. This process cannot be stopped or considerably diminished by an increasing number of young immigrants. After 2050 the cohorts born after the second world war (the baby boom cohorts) will be dead. But the decreasing number of old people beyond 2050 will not automatically lead to a lower dependancy ratio, because the age group 0-20 is diminishing continuously. Only a rise of the total fertility rate to the replacement level of 2.1 children per women could stop the aging process effectively in the long run (i.e., after two generations or after 60 years, respectively). In this case, the dependancy ratio will not double or triple but increase by a factor of 1.5.

Are births underreported in rural China? Manipulation of statistical records in response to China's population policies

Under the current family planning policy in China, the criterion for evaluating all parties involved in the birth planning system provides an incentive for everyone to see that the policy is met, either in reality through strict enforcement of family planning regulations, or statistically through manipulation of statistical records. We investigate underreporting of births in four rural counties of northern China, using data from a 1992 sample survey featuring a reproductive history. To clarify the mechanisms of underreporting, we focus on the ways in which reporting errors may affect the distribution of first births by time since marriage. The results of our investigation suggest that in three of the four counties, first-birth intervals are lengthened by underreporting of girl babies and by replacing them with second births reported as first births.

Carrots and sticks: fertility effects of China's population policies

For 20 years following 1949, average total fertility per woman in China hovered just above six children. The year 1970 marked the beginning of persistent fertility declines. By 1980, the rate had dropped to 2.75, and since 1992 it has remained under 2. While some of this transition can be accounted for by broad socioeconomic developments, the extent to which it is attributable to China's unique population policies remains controversial. This paper analyzes household data from the 1992 Household Economy and Fertility Survey (HEFS) to provide the first direct microeconomic empirical evidence on the efficacy of these policies.

The importance of human ecology at the threshold of the next millennium: how can population growth be stopped?

Ecology is defined as the set of complex interactions between the biotic and abiotic environments. Human ecology concerns principally the population ecology "only" of Homo sapiens, but it also includes all aspects of global ecology because humans are the most important species. Human demography is characterized by a recent decline in mortality and fertility rates. These demographic transitions have largely been completed in industrialized countries, but not in the 140 developing countries. Approximately 100 countries are following the same demographic pattern as industrialized countries, however with a time delay of several generations. China has effectively reduced its population increase by means that would be unacceptable in Western democracies. Some 44 developing countries still show increasing population growth and no detectable demographic transition in birth rate. Thus one part of the world shows limited (and, in the long run, shrinking) population growth, and another continues with a strong increase. All populations are limited in their development by their sustainability by their environment, for example, food and energy resources, and the extent of pollution which the use of these resources produces. It is argued that in the case of human population the limits of sustainability have already been reached with the 6 billion humans alive today, since at least 20% of these suffer from hunger, natural resources are overexploited, and biodiversity is threatened. In the coming 200 years it is more likely that the total population will substantially oscillate rather than approach the predicted 12 billion. The most important goal of human ecology should therefore be to slow population growth as far as possible.

Barriers to uptake and use of modern methods of contraception in developing countries

As the next millennium approaches, the current world population of 5.9 billion will continue to increase by 81 million per year -- 93% of which will come from the developing countries. Poor uptake and utilisation of various modern methods of contraception in the developing countries is mainly responsible. In this article, we identify various barriers responsible for the low prevalence of contraceptive uptake in these countries and suggest how these barriers may be eliminated. We conclude that by increasing contraceptive availability and utilisation, population explosion can be significantly controlled.

Whither the global population problem

Growth of the human population has been underway for thousands of years and was never a problem until recently. It is now expanding exponentially, and today global population stands at nearly 6 billion with 97 million being added each year. Currently, overpopulation has led to serious social and environmental problems such as poverty, overcrowded slums, crime, terrorism, pollution of air and water, and depletion of the protective ozone layer. Warnings were sounded, but few listened. The enthusiasm once generated for solving the problem of too many people was short-lived. The press with puzzling abrogation of its responsibility to the public managed to allay all fears of population overgrowth. Two U.S. presidents welcomed such growth as a stimulus to economic development. Although modern contraceptives are safe, effective, and widely available, more are badly needed, but none are in the pipeline. Research is being hampered by hostile attitudes and by the high cost in time and money of bringing a new contraceptive to an uncertain market with the added threat of litigation. At the present rate of growth, the population will double in the next century. This is believed to be beyond the carrying capacity of our planet. Corrective measures by man or nature need to be undertaken.

Abortion policy and practice in Greece

Despite its illegality until recently, abortion is estimated to have been responsible for almost half of the sharp postwar decline in the Greek birth rate. This article examines abortion as a part of a Greek contraceptive culture which has taken shape during the postwar period both in response, and in resistance to, a variety of macro- and micropolitical institutions and forces. During much of this period, pronatalist policies and discourses of both state and church combined to foreclose most medical contraceptive alternatives. In contrast, illegal abortion was a relatively safe, medicalized procedure widely practiced by doctors. Even after being legalized in 1980, female medical contraceptive methods continue to be rejected by the great majority of Greek women, and abortion and male methods of birth control remain the principal means of controlling fertility. The article focuses on the specific abortion practices and meanings of three generations of married women living in the city of Rhodes, capital of the Dodecanese Province of Greece's Eastern Aegean, and explores the ways in which they have been shaped by, and reflect, local cultural understandings of the body, health, sexuality, morality, motherhood and childhood, as well as micropolitical relations within the family.

Abortion in Turkey: a matter of state, family or individual decision

This paper gives a historical, international and cultural outlook on the debate related to the 1982 legalization of abortion in the modern democratic republic of Turkey. A belief that the country is under-populated and subsequent pro-natalist concerns of the turn of the century seem to have strongly influenced the legal prohibition of abortion. The paper first discusses the widespread social practice and the permissive attitudes towards abortion in the late Ottoman Empire and in contemporary Turkey. The contrast between the above social situation and until recently the strict, non-permissive religious and secular attitudes are presented with a discussion of the effects of the westernization and secularization processes in the late Ottoman Empire. Moral concerns and judgements regarding abortion seem to have penetrated Ottoman society as part of the above processes beginning in the nineteenth century. The present day official religious interpretations seem to conform with the more conservative Islamic schools of thought rather than the more liberal Islamic interpretations. Furthermore, the 1982 laws which legalize abortion until the eight week of pregnancy consider family planning to be a family issue and bring the restriction of making married women have their husband's permission before preceding with abortion. As such, the present legal platform opens to question the rationales and population control motives behind the law and the importance of who it is that can make the decision to proceed with abortion. Thus, in the last 70 years a historical and ideological progression can be discerned in the line of assuming first the state and then the family to have decision making legitimacy as regards reproductive choices. Today, the platform of radical discussion has shifted to evaluating the importance of individual women in making this reproductive choice. In this context, in conclusion, the paper discussed the rationale and the logic behind and the implications for gender power structures of the existing legal situation in Turkey.

Direct and judgmental measures of family planning program inputs

This report compares two different approaches to measuring the strength of family planning programs in Bangladesh and Kenya. The first approach, the judgmental approach, has been used in a number of studies during the past two decades; scores on the characteristics of family planning programs are derived from the responses knowledgeable persons give to a series of questions. The second approach is to obtain direct measures of each item being considered. In Bangladesh, the total score varied trivially between the direct and the judgmental approaches. In Kenya, the total direct score was substantially higher than the judgmental score. The primary advantage of the judgmental approach is that comparative scores can be obtained for a larger number of countries for the same time period at a much lower cost than would be required by the direct approach.

Determinants of induced abortion and their policy implications in four counties in north China

A retrospective survey conducted in four counties in North China in 1991-92 shows that the probability of aborting a pregnancy is strongly related to parity. No induced abortions are found prior to the first live birth, and almost universal abortion is shown after the second. Women had a high risk of undergoing abortion after their first live birth because most (82 percent) had become pregnant again without meeting official requirements for late second births with long spacing between births. The likelihood that a pregnancy will be aborted is strongly determined by official family planning policy and regulations. Individual and household socioeconomic status plays a relatively insignificant role. Great variation in the prevalence of induced abortion exists at the county and village levels. In recent years, the incidence of induced abortion has increased among women with one living child. Even a two-child policy, with late childbearing and spacing, can have high social and health costs in a country where childbearing is universal and begins relatively early.

Immunization to regulate fertility: biological and cultural frameworks

Deliberate immunization to control fertility differs from that to control disease. Those differences can be discussed within various frameworks, e.g., intent, recipient population, biological bases, and immunological targets. Others include differing perspectives of developers, providers and users, and rights of the state to impose programs of control. Almost all of the differences are grounded in the social, economic, and gendered aspects of societies. The intent of providing a fertility-regulating vaccine is to prevent pregnancy. In theory, men as well as women could receive such vaccines; in reality, most are designed for women. Traditional vaccines are intended to prevent disease and are generally given to susceptible individuals whether male or female, child or adult. The biological bases of contraceptive vaccines are molecules specific to reproduction. The immune response generated by most anti-fertility vaccines is directed toward 'self', one's own cells and molecules. In contrast, the bases of traditional vaccines are materials derived from non-self, disease-causing microorganisms; the immunological targets are those microorganisms or their toxic products. From a developer perspective vaccines that regulate fertility differ little from those that control disease; both prevent a particular condition. Developers cite these advantages to contraceptive vaccines: non-invasive, no serious side-effects, easy to use, reduced patient failure, and long-lasting but naturally reversible. Because anti-fertility vaccines have been tested only in small-scale clinical trials, information on user reactions and experiences is limited. Not surprisingly, the perspectives of women's health advocates and of potential users (mostly women) often differ markedly from those of developers. Women cite as disadvantages the cryptic nature of immunity which leaves one without an obvious signal for the beginning of protection (against pregnancy) and its decline, and the inability to 'turn-off' an immune response. Further, long-acting contraception can complicate alleviation and side-effects, and it leaves women always vulnerable to sexual demands. Most women object to the lack of user control and are especially concerned about the enormous potential for misuse and coercion by population control programs should fertility-regulating vaccines become widely available. Many scholars and government officials subscribe to the following logic: the global environmental crisis is due to over-population which necessitates population control programs; thus pregnancy can be considered a disease subject to state control. But pregnancy is not a disease nor is over-population the single major cause of environmental degradation. However, as governments grapple with the economic, social, and ecological consequences of population growth, draconian measures to control fertility will be ever more tempting.(ABSTRACT TRUNCATED AT 400 WORDS)

Cairo: repackaging population control

Aid agencies, charities, and other nongovernmental organizations once denounced population control programs as racist interference in the third world. Yet, at the United Nations Conference on Population and Development in Cairo last September, these same organizations endorsed very similar ideas. The U.N. can now claim that even its fiercest critics not only have muted their criticism of population control programs but now positively endorse them. Over the last 30 years, population control has been consciously repackaged by the U.S. establishment. The image of population control has changed from being overtly anti-third world to being about giving the people of the third world--especially women--basic rights in family planning. Wrapped up in the language of women's empowerment and environmentalism, the establishment's old arguments about there being too many nonwhite babies in the world, have, unfortunately, won the day.

From birth control to reproductive health

During the 1960s birth control was seen as the only means of curbing the very rapid population growth that resulted from decreased mortality without a parallel decrease in fertility. Birth control was considered such a priority that the means used to achieve it were not always respectful of human rights, and, for the same reason, it did not work as expected. During the 1970s and 1980s, birth control policy was re-evaluated. Concepts such as the need to balance birth control with socioeconomic development, to avoid target-oriented programs that imposed particular contraceptive methods on people, to integrate contraceptive services within a comprehensive women's health care program, and to emphasize the importance of quality of care became accepted. This led to the understanding that a reproductive health care approach was a more efficient way to achieve people's wellbeing and, at the same time, to reduce fertility. The need for greater dialog between women/clients and men/providers is emphasized.

Demographic perspectives on China and India

This paper compares levels and trends of population growth rates, age and sex composition, mortality, and fertility including family planning practices in the world's two most populous countries, China and India. Both countries are undergoing demographic transition but China is nearer than India to achieving a stationary population. Fertility in China has declined below replacement level while in India it is nearly one and a half children per woman above replacement level. Both countries have achieved large reductions in mortality but life expectancy at birth in China is currently about 10 years longer than in India. Both countries have young populations but China will precede India in the aging of population structure during the 21st century.

Taiwan's transition from high fertility to below-replacement levels

This article compares the fertility experience of Taiwanese in the eight years since the total fertility rate reached 2.1 with that before fertility reached replacement levels. During the earlier period, two-thirds of the fertility decline resulted from falling marital fertility and one-third from higher age at marriage. The changing age distribution retarded this decline. Since 1983, the further decline to 1.7-1.8 has been entirely the result of the trend toward later marriage. Older age distributions now facilitate the decline. Births postponed by those marrying later make the conventional TFR misleading. Computation based on parity-progression ratios raise TFRs from 1.7 to 2.0, a number less alarming to policymakers. Contraceptive prevalence is at saturation levels in all major populations strata. The "KAP-GAP" has disappeared. What would have happened without Taiwan's effective family planning program is impossible to determine, but clearly, contraceptive services supplied by the program were the major proximate cause of Taiwan's fertility decline.

Using parity-progression ratios to estimate the effect of female sterilization on fertility

In this article, a new methodology that employs parity-progression ratios to estimate the effect of female sterilization on fertility is described, and results using data from Ecuador are compared to those obtained using a previously existing approach that classifies women by marital duration. The methods differ in how they disaggregate marital fertility and in the assumption they make about what the subsequent fertility of sterilized women would have been if they had not been sterilized. The analysis of the Ecuadoran data shows that the estimate of births averted by sterilization has diminished over time, even as sterilization prevalence has been increasing. This situation is attributed to a decline in the fertility of nonsterilized women resulting from increased use of reversible methods of contraception.

From population control to reproductive health: an emerging policy agenda

This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in women's health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and women's empowerment generally.

Abortion in Vietnam: measurements, puzzles, and concerns

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve.

Women and the family of the future

The complexities of current societal trends impose a daunting challenge to providers of maternal child health services. Demographers, anthropologists, sociologists, policy makers, and health care providers struggle to grasp the multiple issues in an effort to create useful strategies for the 21st century. The 1990s have been labeled the decade of women's health. Legislative and policy efforts have focused new and much-needed attention on women as recipients and providers of health care. The realities of mothers in the work force, the epidemic of adolescent pregnancy, the swelling ranks of women and children in poverty, the increasing number of women with acquired immune deficiency syndrome, the new advances in reproductive technology, and the effect of population and immigration trends greatly influence the childbearing client of the future and create enormous pressures for critical problem solving.

How economic development and family planning programs combined to reduce Indonesian fertility

This paper examines the contributions of family planning programs, economic development, and women's status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single "structural" proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.

Caregiving and long-term health care in the People's Republic of China

The growing proportion of frail elderly in the People's Republic of China has necessitated policy of the state toward their long-term care. In this decade, there has been an increase in the amount of data available on the care and needs of Chinese frail elders. This article synthesizes these data and traces the patterns of care of frail elders. It distinguishes between urban and rural patterns, and identifies the increasing role of the family and community in the caregiving of elders. State policy, evident from the data, suggests that the state's role in direct care of elders is minor but that it continues to influence and support eldercare as part of its policy of promoting the one-child per couple policy. This process can be seen in support programs for the childless elder, who symbolizes the expected condition of a large number of future elders under the one-child policy. The article identifies four factors that are influencing the changing patterns of long-term care of elders in China: (1) economic reform programs; (2) the political agenda of the Chinese Communist Party; (3) differences in urban and rural economic conditions; and (4) policy directed at long-term investment in health care technology.

West Indian gender relations, family planning programs and fertility decline

Nearly all West Indian islands initiated marked fertility declines sometime between 1960 and 1970. Family planning programs have not played an important role in these declines. Neither have other variables that conventional social theory tells us should promote reduced family sizes, like education and rising standards of living. The historical experience of Barbados and Antigua, which reached replacement-level fertility in the 1980s, suggests that West Indian fertility declines reflect structural changes in national economies that created job opportunities for women. Family planning programs need to be evaluated with reference to the distinctive health and human rights goals other than fertility transition that they can effectively reach.