At this time, private research efforts to discover new contraceptives are threatened. Drug companies, particularly in the US, have reduced their interest in contraceptive development due to concern over the rising cost of product liability insurance, the cost of lawsuits in defense of liability claims, and the fear of extremely high awards by juries in product liability cases. The current form of private-public collaboration, now threatened by the liability crisis, works under a few simple principles of agreement. Private industry agrees to supply its patented chemical compounds for assessment as contraceptive agents, to be willing to enter into negotiations with public sector organizations to develop the contraceptive drugs if initial tests warrant it, and to release compounds to another company if the patent-holder declines to proceed with contraceptive development. The public-sector program agrees to fund the studies, keep the industry informed, and maintain confidentiality. When the technology is discovered by the public sector and is of potential interest to private industry, the collaboration involves other issues. The public agency agrees to supply manufacturing know-how and all biological and clinical information, to license under applicable patents, and to permit cross reference to regulatory agency filings. Private industry agrees to use its best efforts to bring the product to market, to manufacture the product at reduced cost for public sector use, or to provide know-how for others to do so. It also agrees to assume product liability and to grant the public sector agency licenses to any patented improvement in its product. Contraceptive research both within and outside the US is feeling the effects of the US litigious atmosphere. Companies from abroad now wish to steer clear of contraceptive research, even though these companies would be prepared to meet the requirements of the Food and Drug Administration. Contraceptives, considered to be high risk targets for lawsuits, are receiving little of the research budgets of pharmaceutical companies. Opposition anti-abortion forces also has had an effect. When the Population Council received new drug approval for the Copper-T-200, it was the 1st time the FDA had issued approval to a noncommercial sponsor. This unprecedented event established a new phase in the cooperative efforts between industry and the nonprofit sector to develop contraceptive products. It showed that given adequate funding, nonprofit agencies can carry out full product development, including the initial regulatory agency clearances.
Private initiatives in developing countries have been successful in increasing women's desire for family planning by enabling them to earn more income. These approaches have incorporated a woman-to-woman strategy in which women train others not only in how to earn an income from producing and marketing products, but also in the skills needed to establish and manage their own organizations. Private voluntary organizations play an especially crucial role in training project managers. The Center for Development and Population Activities, for example, has held 19 Women in Management workshops and channels funds and technical assistance for projects in health, family planning, nutrition, and income generation. Women who move from managerial to policymaking positions are most able to help other women raise their political, social, and economic status.
Private medical practitioners, including physicians, midwives, traditional practitioners, and pharmacists, are important sources of services and information about contraceptive methods. In many developing countries, private practitioners anticipated government policy and were the 1st to provide family planning services. They are the principal source of information and services for the middle and upper classes. Many people have more trust in private practitioners than government institutions. From the viewpoint of national investment, it is sometimes more cost effective to use existing private outlets than to create a new infrastructure of government family planning clinics. In several countries, private doctors have contracted with the government to insert IUDs and provide sterilizations. The role of private practitioners in the provision of family planning services can be developed much further, however. Restrictive laws can be eliminated or modified. The philosophy that private physicians complement but do not compete with government services should be promoted. Fuller use of the skills and resources of private health care providers is especially important in developing countries where there is an unmet need for contraception.
Application of commercial marketing techniques has not only increased awareness, acceptability, and use of modern contraceptives in developing countries, but also overcome logistic problems in service delivery. The ability of contraceptive social marketing to reach large numbers and to treat contraceptives as common consumer products has helped to diminish social and religious constraints associated with family planning. Each contraceptive social marketing program is built around a theme tailored to meet specific cultural, social, and management requirements. The primary target populations are those who cannot afford regular commercial products and those who are not adequately reached by government programs. In countries such as Sri Lanka and Jamaica, profit is not a primary sales objective and retail prices are highly subsidized to make products affordable to low-income people. In contrast, the Colombian and Thai programs use contraceptive social marketing to help offset the operating costs of rural community-based programs and seek profits. The most impressive contraceptive social marketing sales performances have been recorded in Bangladesh, Colombia, Egypt, and Jamaica. The main reason contraceptive social marketing is more cost-efficient than other modes of contraceptive distribution is that the cost of product delivery is assumed by the commercial system. Although there has been some interest in making these programs self-sufficient financially, this step has tended to undermine the purpose of serving lower income groups.
Thailand's pilot Community-based Incentives Program in the northeast illustrates the high level of contraceptive prevalence that can be achieved when entire communities profit from economic incentives. This particular community incentives program began in 1983 with funding from the Special Projects Fund of the Population Crisis Committee under the auspices of Thailand's largest nongovernmental organization, the Population and Community Development Association (PDA). PDA, with its long and impressive record as a grassroots family planning service network, had almost a decade of experience in creating demand for family planning by offering income generating incentives to individuals. Through the community incentives program, PDA used the grant from abroad to establish loan funds of about $2000 in each of 6 villages. The loan funds grew in size as the overall contraceptive prevalence rate in the villages increased. Loans between $80 and $200 were made available to villagers for income-generating activities, mostly to buy fertilizer, rent tractors, or hire workers for planting and harvesting the local crops. Elected villagers administered the funds and reviewed loan applications with assistance from PDA. By the end of 2 years, loans totaling $72,000 had been granted in the 6 villages, and 75% of all village households had received at least 1 loan. Repayment was nearly 100% on schedule with no defaults. The 6 loan funds are still operating in 1986 but without outside assistance. Contraceptive practice increased from 46% to 75% of all married women aged 15-44 in the 6 villages between 1983-85. In a comparative study of 3 villages in which no loan fund operated, contraceptive prevalence increased from 51% to only 57%. In the Thai experience, the private PDA appears to have several advantages over the central government in implementing a community incentives approach: because PDA works closely with community members, it is able to determine community needs, involve the community in decisionmaking, and create the foundation for community self-management; it is able to provide close supervision to assure that performance is rewarded; and it may be perceived as a more credible source of rewards than a government that is removed from the people. Community incentives programs work because family planning and economic development reinforce each other to increase per capita income.
Private support for the development of family planning programs continues to grow and now includes industries that provide family planning services, commercial outlets that distribute contraceptives, community groups that help to build demand, private medical practitioners who include contraception as a part of health care, organizations that provide technical and financial assistance to developing country programs, pharmaceutical firms, and foundations that underwrite contraceptive research. Although the mix of private and public programs differs from country to country, these 2 family planning programs complement each other and often work in close partnership. The private sector has the advantages of being able to pioneer innovative programs the public sector is unwilling or unable to pursue, to bring foreign financial and technical assistance to developing countries without political implications, and to achieve financially self-sustaining family planning efforts that are linked to other development efforts. In many countries, the private sector has been instrumental in developing a national family planning program and in eliminating barriers to family planning in countries with restrictive laws and policies. The private sector has been especially important in pioneering grassroots programs that improve the status of women through education, health care, training, and economic opportunity.
Many firms throughout Japan and around the world have come to realize that family planning is good for employee morale and company profits. Japanese and Indian efforts prove that family planning programs not only bring welfare benefits to workers, but commercial advantages to businesses. Because workers' family welfare is closely linked to labor welfare and productivity, the trade union movement has started to become active in promoting family planning activities. Factory-based family planning programs have often cut pregnancy rates in half. Godrej Enterprises of India started promoting family planning in 1957; it provides a model of how family planning has been incorporated into a comprehensive employee welfare system in a factory complex on the outskirts of Bombay, where about 1/2 the workers live in high-rise apartments in the company township of Pirojsha Nagar. Similar programs are presented in India, Thailand, Indonesia, Jamaica, Guatemala, Colombia, Korea, and Turkey. Limiting family size enriches workers' lives and improves the quality of the workforce. The International Labor Organization, through its Workers' Education Program on Population, has played an important role in stimulating industrial sector interest in family planning throughout the world.
Despite government policy enacted in 1964 to reduce fertility in order to hasten socioeconomic progress, population pressures continue to impair development in Tunisia. The birth rate fell 20% over the last 2 decades, but this accomplishment has been outweighed by a 50% decline in mortality rates. As a result, the rate of natural population increase has remained relatively constant at 2.5%/year. The initial decline in fertility that followed introduction of the national family planning program appears to have reached a plateau, explained in part by the resurgence of conservatism and religious fundamentalism and the consequent emphasis on women's childbearing roles. Unemployment in rural areas has led to widespread migration and unemployment is as high as 20% in the nonagricultural sector. Many young Tunisians lack adequate educational preparation to enter the labor force; in 1982, 27% of new job entrants could not read or write. The government's plan to decentralize development to stabilize population and achieve equilibrium between regions has been thwarted by the pace of population growth and limited resources. The rural regions where population is increasing the fastest are also the most difficult to reach with family planning programs. On the other hand, there have been some successes in this area when services have been adapted to the lifestyle and traditions of those in these isolated rural villages.
Between the end of Sahel's 1968-73 drought and the early 1980s, the production of the drought-resistant sorghum and millet was increasing at about 1% a year, but simultaneously the population was growing by about 2.5% a year. A 1982 UN study of the developing world's carrying capacity found that given the current low levels of agricultural technology used, about half the Sahelian countries could not be expected to feed themselves. The Sahel's demographic picture is complicated by the way different populations fill the various rainfall zones. The Sahelo-Saharan zone, the land of the nomad herders, can support a human density of only 0.3 people per square kilometer, but the density is actually 2 per square kilometer. The zone to the south, where herders and settled farmers mix, can support 15 people per square kilometer, yet it actually supports 20. the Sudano-Guinean zone at the far south may be able to support a larger population, but it has not been settled in part becuase it has spawned the tsetse fly and black fly. The region's rapidly growing population requires increased food production, yet the Sahelian countries have opted to encourage the cultivation of cash crops, especially cotton and peanuts, at the expense of food crops. Governments now are caught in the trap of depending on commodities, which are delcining in price, to pay rising debts. Extension advice, fertilizer, equipment, and marketing services are in short supply. In response to urban population pressure, Sahelian governments have kept food prices artificially low. With cities growing at an average annual rate of between 4-9%, national leaders fear social disruption and political instability if basic food needs at low prices are not met in the large cities. This policy inadvertently discourages food production. Meanwhile, the food situation for the region as a whole deteriorates to a calamity situation. The pressures of population growth and the emphasis on cash crops have forced families to try to expand grain production by cultivating marginal lands. They also have begun to ignore the fallowing technique, which should be used to allow land time to recover between crops. The need to expand land under cultivation has led to the rapid cutting of trees, trees which once acted to hold soil together and coax rainfall into the ground to raise the water table. Most of the Sahelian nations are now among the worst disaster-afflicted nations in the world. In addition to desertification, the Sahel's climate may be getting drier. Governments may have to take radical steps to change their cropping strategies and to move large numbers of people.
This article presents an overview of stresses facing Indian society, including population pressures on land and agriculture, topsoil erosion, deforestation, flooding, unemployment, urban slums, and political unrest. Over 60% of India's arable land is estimated to suffer from environmental degradation. This has been caused both by a rapidly growing poor population seeking subsistence and by the misappropriation of natural resources by the wealthy for luxury consumption. Although deforestation is officially cited at 0.37 million acres/year, more sensitive estimates put it at 2.5 million acres/year. Deforestation and massive soil erosion have further created silting, flooding, and pollution in the plains areas of the country. Moreover, the urban population of India is expected to double in the next 15 years to reach a level of 350-400 million. At present, 20-33% of the urban population lives in slums without basic facilities. The employment crisis precipitated by increasing urbanization and migration is expected to be a major problem in the decades ahead. By the year 2000, 7.5 million people will enter the labor force annually. Demographic tension has been a major factor in recent political unrest. Language differences, inequitable access to resources, and the lack of job opportunities have been central issues in these conflicts. Unless more effective means can be found to cope simultaneously with the need to speed up development and meet the needs of a rapidly expanding population, the social and environmental fabric of India is in danger of further erosion.
Population pressures in China have led to challenges to the country's natural resource capacity, pollution and environmental damage, retardation of economic development, and strains on the government's capacity to improve living conditions. The population's young age structure has implications for the educational system, employment, and the housing supply. To achieve economic development and raise living standards, China must both educate its population and provide meaningful jobs for an expanding labor force. At present, there is a shortage of scientific and technologic personnel and a surplus of agricultural labor. Environmental problems include topsoil erosion, desertification, water shortages, deforestation, and air pollution. Economic development has been hindered by shortages of capital investment funds. Moreover, gains in gross national product per capita have been undercut by population growth. Because of limited resources and pressures on the economy and environment, family planning is a necessity. Population growth was reduced from 2.6% in 1970 to 1.154% in 1983; 124 million of the 180 million women of childbearing age now practice family planning and 21% of Chinese couples with children have only 1 child. China's family planning policy is viewed as an integral part of the effort to raise living standards in the country. However, even if fertility drops to 1.7 children/woman, as the Government hopes, China's population will continue to grow until 2035. Despite all these difficulties, China is in a good position to achieve the goals of economic development. The country has the economic and material base required, and the socialist system has resulted in strong unity and a national will to raise the standard of living for all.
High population growth rates in Turkey have exacerbated problems in the areas of employment, education, housing, and medical care. Rural unemployment has caused widespread migration to major cities, resulting in a deterioration of living conditions in these centers and increasing the demand for municipal services. Since 1940 population increases have consumed most of the rise in national income and hindered economic development. Employment opportunities have not kept pace with the excess supply of labor caused by population growth, especially in the modern industrial sector. Despite overall progress in increasing literacy, educational imbalances persist between regions, rural and urban areas, and males and females. Women with at least a primary school education have an average of 2.5 children compared with 5.2 children among illiterate women. Historically, large families have been encouraged by the Turkish government. From 1927-80, Turkey's population increased 350% to 45 million and is expected to reach 65-70 million by the year 2000. 38% of the population is currently under the age of 15 years, a fact that has implications for future population trends and economic development. The 1965 Population Planning Law gave responsibility for carrying out the country's family planning services to the Ministry of Health and Social Welfare. A 1983 law legalized abortion, which had been a major cause of maternal mortality, up to 10 weeks or longer if there is a risk to the infant or mother. 1600 physicians and 6800 other health personnel have been trained to provide contraceptive services. By 1981, 4 million people had been educated in family planning and maternal-child health. As a result of all these measures, a marked decrease in fertility has been noted since 1965.
This discussion of population and internal unrest in Latin America covers the following: pressures on land and agriculture; economic frustrations; the youth and radicalism; rising social tensions; and political instability. At current growth rates Latin Americas population is projected to increases between 1981 2001 by 225 million people. This staggering population growth is likely to have serious political economic social strategic and other implications. The strong opposition to family planning which came principally from nationlists the military and the church during the 1960s has changed to general support for voluntary family planning programs in much of Latin America. Too rapid population growth now is viewed widely as aggravating the problems of development and putting severe strains on services and facilities. The wish to limit family size is particularly strong among women. Most of Latin Americas untapped land is unusable either so steeply mountainous densely tropical or barren of topsoil that it cannot support life at even the most meager level of subsistence. Food production in most of Latin America has not kept pace with population growth. Since most new agricultural production is oriented toward exports rather than home consumption conditions for most rural populations are worsening. Economic dilemmas facing Latin America include widespread poverty the worlds highest per capita debt unemployment and underemployment that may reach between 40-50% of the workforce negative economic growth rates over the past 5 years immense income inequalities declining terms of trade extensive capital flight little new investment or foreign assistance increased protectionism on the part of those countriews with whom Latin America must trade rising prices for the goods Latin America must import and (in some countries) devastation of the economic infrastrucutre by guerrilla forces. The unprecedent flow from the countryside has made Latin America the worlds 3rd most highly urbanized region. Over 65% of its population reside in cities particularly capital cities. Social services are breaking down in all Latin American capitals to the extent that over half the inhabitants lack water or sewage facilities. There is mixed evidence on the relationship between youth and radicalism yet it is clear that in Latin America most of the generation of university-trained young people are Marxists. As many as 45% of college-aged people are activists. The implications of this disaffected group coming to power are enormous particularly since the generation currently under 15 is likely to be even more embittered and radical. Tension frustration and violence in society all are likely to have a political impact. In sum a close but indirect relationship exists between unchecked population growth spiraling socioeconomic problems and the potential for political breakdown destabilization and internal unrest in Latin America.
This article describes the impact of rapid population growth and high fertility on the lives of rural families in West Africa. Population pressures have exacerbated environmental problems and made daily activities such as food production, child care, and access to water and firewood more difficult. Crowded, impoverished homes lead young people to enter into early marriages and childbearing. The lack of fertility control results in premature weaning, close child spacing, and malnutrition. Population problems further contribute to economic problems and social dislocation; symptomatic of the breakdown of the family system is the rapid increase in premarital adolescent pregnancies. Growing need for firewood has led to deforestation, which in turn has resulted in soil erosion, declining soil fertility, and poor harvests. Although women in West Africa express a desire for access to the basic necessities of life (clean water, an adequate food supply, money for children's school fees), they generally fail to perceive the connection between population pressure and decreased food production, inadequate income, and physical exhaustion. Solutions to the problem of overpopulation cannot be imposed from the outside; they must be part of the framework of African women's lives and thoughts. It is necessary to pay attention to desires of these women and their thoughts about how changes can be achieved. If problems are approached from the perspective of those most affected, connections will eventually be discovered between food production, income, family planning, and family health.
The "Alliance for Progress," an inter-American program of economic assistance launched in 1961, was doomed to failure because th subject of family planning was deemed to be too politically dangerous to be discussed by Latin American governments in an international forum and was omitted. It was fortunate that during the 1960s a number of Latin American governments began to act on the recommendations of private groups who were calling attention to the fact that population growth was outpacing the provision of food, sanitation facilities, housing, and, particularly, employment opportunities. A few governments accepted the necessity of including contraceptive services in their maternal/child health care programs. Chile and Colombia, leaders among these countries, have since experienced significant drops in birthrates. There is ample evidence to suggest that this has been a major factor in the favorable declines in their infant mortality rates. By the 1970s a significant number of countries supported family planning programs. Currently, the Cuban and Mexican programs are among the most successful, as are those of Barbados, the Netherlands Antilles, and other islands of the Caribbean region. A few governments are still swayed by pronatalist forces, and where family planning services are provided only on a private scale, which is necessarily limited, birthrate declines are not as successful. Current projections indicate a moderate decline in the rate of population growth after 1980, but the number of people added each year will continue to increase. By the year 2000, Latin America will be faced with a total population of 562 million. A UN study shows that severe undernutrition affects from 3% to over 40% of Latin American children under 5 years of age, yet by 2000 almost 200 million more people will have to be fed. Latin America is already being forced to import food. The World Health Organization (WHO) promotes "Health for All by the Year 2000," but a campaign for good health cannot succeed until family planning services are adequate and easily available. All governments must realize how important family planning is to the promotion of family health. The decline in fertility over the next 20 years will be greatest in countries that have government supported family planning programs, particularly long established programs. Even in those countries, government efforts are still insufficient, and unwanted children are born. Family planning education and services are not being made available to all who need them.
Southwest Asia, which support 1/3 of the world's population, is acutely aware of the consequences of rapid and excessive population growth. No other region has consciously devoted so much of its resources to stemming excessive population growth. India, with a population of 684 million, formulated a policy of population limitation in the 1950s. The 1980 government rededicated itself to voluntary family planning and rebuilt the broad coalition of an excellent infrastructure of government institutions, voluntary organizations, and international agencies. Government support for family planning clinics began in Bangladesh in the 1960s. A strong institutional structure has been established under the supervision of the National Population Council. Innovative approaches to family planning service delivery have been initiated by an admirable array of institutions. Pakistan's Population Welfare Plan provides substantial funds and an administrative structure to make maternal/child helath care and family planning services available in rural areas. Another welfare program encourages smaller families through projects to enhance the status of women by improving literacy, establishing rural industries, and advocating late marriage. Nepal has had to struggle with a poor administrative structure, grossly insufficient medical services, and an inadequate database for policy formulation. Family planning services are now a component of the overall health program. The family planning services of the pioneer Afghan Family Guidance Association, established in 1968, have been incorported into the national maternal/child health program. The present government of Iran views foreign assistance as an unacceptable form of persuasion and has phased out all international funded family planning programs. Sri Lanka is the only country in the region to have made the demographic transition to fertility decline. An impressive health infrastructure delivers family planning services at every level using medical and paramedical professionals, a large scale retail sale of contraceptive, wide media coverage, and cash incentives for sterilization. Throughtout Southwest Asia the major problem encountered by policymakers has been the strong political sensitivity of population programs. Southwest Asis has produced several innovative ideas in the field of population programs. International assistance has played an important role in the development of the region's national family planning programs.
The people of East and Southeast Asia, despite societal differences and varied economic successes, share 1 cultural value, i.e., the love of children and the importance of family. The small family norms espoused by family planning programs, the goal in some nations of 1- or 2-child families, the concept that 2 children are enough regardless of their sex -- all these ideas contradict the basic cultural appreciation for children in most countries and the preference for sons in many. Yet, demographic realities give Asia no alternative. It is necessary to work against cultural values to increase the opportunities for individuals, their families, their countries, and the region as a whole. All the countries of this region have had family planning programs since at least the 1970s, and some have been very successful. It may be well into the 21st century before the populations of most East and Southeast countries stabilize. Stabilization will take longer for those countries which are without successful family planning policies and programs. Each national family planning program requires the full and positive political and financial commitment of its government. Programs also need the freedom to try all new approaches. The appropriateness and acceptability of a particular mehtod should be decided by program managers and personnel in consultation with potential users, rather than by politicians. Future family planning programs will need to be even more innovative. Family planning service delivery must be brought closer to the client so it will be available in all communities and work places and at all potential public and private places. Other basic services such as nutrition, income-generating schemes, and general and maternal/child health must be integrated into the programs. The responsibility for managing programs must be assumed by the community in order to create a very strong and broad base of national commitment.
All governments of the Arab world are aware of the population issue, and there has been increasing interest in policies designed to bring about a lower rate of natural increase and older population age structure. Overpopulation is believed to be a major obstacle to economic development. The population activities of the Arab countries can be divided into 3 categories: national policy to reduce population growth; nongovernmental efforts to reduce population growth; and countries with pronatalist policies. The countries with a national policy to reduce population growth include Egypt, Tunisia, and Morocco. All suffer severe problems of high density, young age structure, and lack of balance between the population and the economy. In these countries an active national family planning program operates alongside many active nongovernmental family planning associations. Reduction of the growth rate is regarded as urgent, and emigration is encouraged. In egypt contraceptives are readily available through commerical outlets, and village level social and economic activities are promoted in conjunction with family planning services. Tunisia is the only country to offer voluntary sterilization and 1st trimester abortion on request. Morocco includes family planning in its health and welfare services and there is an active voluntary family planning association. Countries in the group who have made nongovernmental efforts to reduce population growth include Algeria, Bahrain, Iarq, Jordan, Lebanon, Sudan, Syria, and Democratic Yemen. all have major population problems and generally support reduced growth rated but as yet have no national family planning. In this group the highest rate of population increase is in Syria, 3.8% a year; the highest total fertility rate is in Bahrain with almost 8 children per women. Saudi Arabia, Kewait, Qwatar, Libya, and Oman have pronatalist policies. Methods of contraception are available in the private sector. The outstanding feature of these oil rich countries is their high per capita gross national product. A 1981 estimate showed Qatar's at US$27,790, to be the highest in the world. Generally, all the governments of the Arab world have become aware of population issues and of the population pressures within their own borders.
A diversified pattern of family planning service delivery currently exists, one that is considerably extended through the development of a wide range of supply and distribution channels. In most areas, nongovernmental organizations have played a crucial role in the development of innovative approaches to making contraceptives widely available. In many nations the provision of contraceptives through the national health system continues to be the backbone of the family planning program. Changes in the approach to health care have helped increase the acccessibility and acceptability of family planning services. 2 factors necessitate a close link between contraceptive and health services: the need for medical skills and facilities in the provision of surgical contraceptive methods, and the importance of medical supervision in the continuing use of other methods. A widely used approach integrates contraceptive delivery with other development programs, community-based distribution (CBD) of contraceptives, and commercial retail sales. The cornerstone of CBD is extensive use of community networks and of trained community residents. An effective project requires efficient resupply and distribution mechanisms, carefully designed supervision systems, and medical back-up facilities. CBD has spread to over 40 countries, most of them in Asia and Latin America. Wider use of existing commercial retail outlets is being followed in more than 30 countries. Self-sufficiency of these projects has not been realized, and considerable subsidization continues to be required to maintain their efficiency. Efforts to increase the availability of contraceptives have been facilitated by the widening range of service providers. Nurses, midwives, traditional birth attendants, and members of the community are being trained to perform many family planning tasks in clinical and nonclinical settings. Many of these advances have been made possible by the liberalization of laws and regulations governing the distribution, provision, and use of birth control methods. The unmet need for contraceptive advice, services, and supplies is still enormous. The greatest challenge to governments and nongovernmental organizations is to find more effective ways of taking family planning to the people while recognizing that the key to success lies in sensitivity to their needs, perceptions, and priorities.
The UN International Conference on Population to be held in Mexico City in August 1984, responding to an unprecedented upsurge of interest in population over the last decade, offers developed and developing countries the opportunity to assess current and likely future population trends, to comment on programs and progress during the past 10 years, and to determine desirable future directions. More developing countries are reporting diminished declining fertility and family size in countries of widely varying ethnic, social, and economic makeup. Although it is likely that the future will bring a steadily declining rate of world population growth, culminating in stability, present trends indicate that it will take more than a century for world population to stabilize. Meanwhile growth continues. The developing world's annual average birthrate from1975-80 was twice as high as the developed world's. Also there are large areas, much of Latin America and most of Africa, where growth rates continue very high. Other areas, such as parts of Asia, do not follow the general declining trend despite trend despite, in some instances, a long history of population programs. Interest in population programs and demand for resources to support them are growing, but the population dimension is sometimes unrecognized in development planning. The experience of the last decade illustrates that population assistance can make a uniquely valuable contribution to national development when it is given in accord with national policies, is appropriate to local conditions and needs, and is delivered where it can make the most impact. Substantial evidence exists that women in the developing world undertand the risks of repeated pregrancy and would like to take steps to reduce them. It is evident that providers of family planning services are not yet sufficiently responsive to women's own perceptions of their needs and that the social and economic conditions which make family planning a reasonable option do not yet exist. Influxes of immigrants, short and long term, legal and illegal, create particular problems for receiving countries. It is important for sending countries to know what effect the absence of their nationals is having on the domestic economy and essential for receiving countries to consider the protection of the human rights of international migrants, including settlers, workers, undocumented migrants, and refugees. It is a particular responsibility of the industrialized nations to make careful use of limited resources and to ensure that their comsumption contributes to the overall balance of the environment. In most developing countries infectious and parasitic disease remains the primary cause of death, particularly among the young. Much of this toll is preventable. The International Conference on Population provides an opportunity to establish in broad terms the conditions and directions of future cooperation.
