1 00:00:00,210 --> 00:00:07,350 Today, I want to concentrate on the role that family planning programmes may or may not have made in the extraordinary 2 00:00:07,350 --> 00:00:13,260 reduction of the birthrate in a number of developing countries where birth rates are previously high, 3 00:00:13,260 --> 00:00:21,090 six, seven, eight children per family now reduced down to three to one point eight, even lower. 4 00:00:21,090 --> 00:00:29,220 The almost equally astonishing effect in other countries where family planning programmes development and has had almost no effect, 5 00:00:29,220 --> 00:00:33,720 and where birth rates are still at the traditional level of six, seven or even eight. 6 00:00:33,720 --> 00:00:39,300 As in some parts of north western Africa. This problem introduces all sorts of issues. 7 00:00:39,300 --> 00:00:49,260 It introduces a big question about the fundamental rationality of fertility and high fertility, both in traditional and in less traditional settings. 8 00:00:49,260 --> 00:00:53,820 What is family planning policy and their failures and successes? Tell us about that. 9 00:00:53,820 --> 00:00:58,620 What does it tell us about. 10 00:00:58,620 --> 00:01:09,480 The whole possibility of influencing these very fundamental human motivations and instincts in terms of reproduction and family, 11 00:01:09,480 --> 00:01:18,480 the motivation for family planning, the government evidence is clear enough concerns about the rate of population growth 12 00:01:18,480 --> 00:01:22,890 unleashed by the demographic transition up to three or even four percent per year. 13 00:01:22,890 --> 00:01:31,560 Population growth at is extreme in in Kenya, in Yemen in the 1970s prompted all sorts of fears amongst governments, 14 00:01:31,560 --> 00:01:36,900 amongst economists, amongst ordinary observers about the adequacy of human resources, 15 00:01:36,900 --> 00:01:45,990 of water, of food, of space, of land, to to cope with populations doubling every 25 years or so, 16 00:01:45,990 --> 00:01:51,480 which, of course, is what is implied with that kind of rate of of population growth. 17 00:01:51,480 --> 00:01:59,370 That kind of consideration was paramount in the astonishing turnaround of population attitudes in China, for example, a very direct, 18 00:01:59,370 --> 00:02:10,400 very straightforward Malthusian concern for food supply, water resources, population density, self-sufficiency and all the rest. 19 00:02:10,400 --> 00:02:11,810 In all the cases, 20 00:02:11,810 --> 00:02:18,890 the concern was more to do with the mismatch between the current and projected rates of the population of working age on the one hand, 21 00:02:18,890 --> 00:02:25,190 and the capacity of the economy as it then was or could be envisaged to be in generating jobs for 22 00:02:25,190 --> 00:02:30,770 those people with the prospect of growing unemployment amongst the young distress and poverty, 23 00:02:30,770 --> 00:02:37,160 possible unrest when when young populations remain unemployed and unmarried for long periods of time. 24 00:02:37,160 --> 00:02:43,130 That was highly instrumental in the case of turning around population attitudes in Mexico in the middle of the 1970s, 25 00:02:43,130 --> 00:02:48,200 for example, a very direct example of that kind. 26 00:02:48,200 --> 00:02:53,270 Curiously enough, while governments were falling into line, as it were, 27 00:02:53,270 --> 00:02:57,080 one after the other in terms of accepting the need for family planning policies, 28 00:02:57,080 --> 00:03:05,870 the need to reduce population growth rates, the need to reduce overall fertility back in the in the 70s and even in the 1960s, 29 00:03:05,870 --> 00:03:13,760 in the 70s and even into the 1980s, there was considerable equivocation amongst economists as to whether rapid population 30 00:03:13,760 --> 00:03:18,860 growth actually was so harmful from the point of view of economic growth. 31 00:03:18,860 --> 00:03:24,320 If you read literature at that time, you will see a number of articles which suggest that population growth, 32 00:03:24,320 --> 00:03:31,970 perhaps not at the highest level, at least at an average sort of level, was not all that damaging to economic growth. 33 00:03:31,970 --> 00:03:39,090 Those views are, I think now in the past, at least for the time being, as far as the economic consensus is concerned, 34 00:03:39,090 --> 00:03:44,420 the more recent economic literature in the 90s and in the last 10 years seems to be 35 00:03:44,420 --> 00:03:50,030 rather more clear that rapid population growth is was harmful to economic growth, 36 00:03:50,030 --> 00:03:54,710 that it was beneficial, indeed necessary to bring rates of population growth down. 37 00:03:54,710 --> 00:04:02,150 How far down is a different matter? So it's interesting that government should have adopted or apparently seen the need for 38 00:04:02,150 --> 00:04:08,090 family planning and seen the need for reduction in fertility reduction of birth rates, 39 00:04:08,090 --> 00:04:12,830 reduction of growth rates for the point of view of their very practical, immediate concerns, 40 00:04:12,830 --> 00:04:23,420 while academic economists were much less clear about the benefits of reductions. 41 00:04:23,420 --> 00:04:30,380 As I mentioned at the beginning, this is something not just of political and policy and practical interest, 42 00:04:30,380 --> 00:04:38,880 but also, I think a considerable scientific interest, because if it is the case that governments can bring birth rates down by by various means, 43 00:04:38,880 --> 00:04:42,200 some some persuasive, some perhaps in some cases more coercive, 44 00:04:42,200 --> 00:04:50,450 then what does that say, for example, for the very widely accepted view or very widely promoted view in the 1970s, 45 00:04:50,450 --> 00:04:54,980 notably by Jacques Cauldwell and other distinguished economists and demographers, 46 00:04:54,980 --> 00:05:00,230 that under traditional circumstances of high fertility was entirely rational. 47 00:05:00,230 --> 00:05:04,760 It is the case that the birth rates and come down even when the level of development 48 00:05:04,760 --> 00:05:08,900 is not very great and doesn't appear to justify rapid reductions in the birth rate, 49 00:05:08,900 --> 00:05:17,450 then what does that say for all literature, all the theory about the economic rationality of high fertility in conditions of traditional society, 50 00:05:17,450 --> 00:05:24,650 where where the population is still mostly agricultural and as a kind of a peasant subsistence economy, 51 00:05:24,650 --> 00:05:28,520 as opposed to living in cities where smaller birth rates are obviously much more 52 00:05:28,520 --> 00:05:36,400 sensible because of the very different kind of economy in which most people live. 53 00:05:36,400 --> 00:05:44,020 That goes hand in hand with with a controversy which still is very current and not really resolved, 54 00:05:44,020 --> 00:05:49,000 that is to say, how far is a reduction in the birth rate in the developing world, 55 00:05:49,000 --> 00:05:59,620 primarily due to two due to the advent of higher levels of education, high levels of participation in the modern economy, 56 00:05:59,620 --> 00:06:07,180 a more secular attitude towards life, all the usual kinds of perfectly understandable and well tested factors affecting 57 00:06:07,180 --> 00:06:10,510 birthrates in developed as well as developing societies on the one hand, 58 00:06:10,510 --> 00:06:16,150 and how far how family planning programmes just accentuated that and accelerated that effect. 59 00:06:16,150 --> 00:06:21,940 Or have they had a more or less independent effect in bringing down birth rates even when development was not very 60 00:06:21,940 --> 00:06:28,690 powerful and would not normally be expected to have brought birth rates down to the extent that they have fallen? 61 00:06:28,690 --> 00:06:34,540 As we'll see, it's quite technically difficult to to separate technically in a numerical fashion, 62 00:06:34,540 --> 00:06:40,060 in a way which is evidence based to show that that one fact or the other is more important. 63 00:06:40,060 --> 00:06:48,370 I'll go on to that in a moment. And there's an interesting other aspect to this to do with ideology. 64 00:06:48,370 --> 00:06:55,250 Generally speaking, I think it's fair to say that those in favour of. 65 00:06:55,250 --> 00:07:00,140 The the independent effect of family planning policies on the one hand and the of the 66 00:07:00,140 --> 00:07:03,810 importance of development on the other tend to follow a kind of ideological divide, 67 00:07:03,810 --> 00:07:08,660 a sort of right left divide in terms of broader political sympathies. 68 00:07:08,660 --> 00:07:15,290 And it's interesting that in international forums on family planning policies, 69 00:07:15,290 --> 00:07:21,980 the international conferences of Bucharest in nineteen seventy four in Cairo in 1994 and many others, 70 00:07:21,980 --> 00:07:34,220 there's a clear split between the approval by different governments for family planning programmes on the one hand and an emphasis on development. 71 00:07:34,220 --> 00:07:42,590 The other going very much with a sort of non Marxist Marxist split with in 1974 in particular, 72 00:07:42,590 --> 00:07:47,900 the then communist countries who really strongly opposed the notion that family planning programmes 73 00:07:47,900 --> 00:07:54,410 should be promoted independently in any way of development which they felt was the best contraceptive. 74 00:07:54,410 --> 00:08:00,350 That was a great slogan is only for development is the best contraceptive, not a contraception, as it were. 75 00:08:00,350 --> 00:08:04,130 And this this reflects a rather messy kind of ideological divide. 76 00:08:04,130 --> 00:08:10,790 The obvious one in his remarks and Maltose remarks, as you know, is highly critical of Maltose Marx took the view that, 77 00:08:10,790 --> 00:08:16,910 as we all know, that the problems of poverty, which is what this is really all about, poverty alleviation, 78 00:08:16,910 --> 00:08:25,880 were primarily due to the to the improper distribution of ownership of the means of of production exchange and a distribution, 79 00:08:25,880 --> 00:08:31,610 and that what was required was a political solution to to equalise those entitlements, 80 00:08:31,610 --> 00:08:35,450 equalise those rights, and that would make population problems disappear of their own accord. 81 00:08:35,450 --> 00:08:45,650 There was no need for population policy. Furthermore, that was not even any general law of population of the kind of MALTOSE was very keen to promote. 82 00:08:45,650 --> 00:08:52,100 These controversies dating from the middle of the 19th century, rattle on to the present day and I still very much alive and well, 83 00:08:52,100 --> 00:08:59,600 and you may recall whiffs of it in the recent Human Sciences Symposium, which you may have gone to two or three weeks ago. 84 00:08:59,600 --> 00:09:05,060 So that's still very much alive. But it's complicated in an interesting way. 85 00:09:05,060 --> 00:09:10,310 There's a kind of unholy alliance between the views of Marxists and those who 86 00:09:10,310 --> 00:09:16,550 take a Marxist analysis of these problems on the one hand and the free market. 87 00:09:16,550 --> 00:09:21,740 Right. And the religious right coming together, as it were, from opposite sides of the spectrum, 88 00:09:21,740 --> 00:09:30,050 having gone around the circle to meet each other on the other side. Some free market economists are very keen on the idea that the population growth, 89 00:09:30,050 --> 00:09:36,200 at least in the developed world, is necessary and desirable for for economic growth. 90 00:09:36,200 --> 00:09:44,630 The religious right as well, which may or may not be allied in individuals with the right wing economic views. 91 00:09:44,630 --> 00:09:48,310 Tends to be very strongly opposed to family planning and particularly abortion, 92 00:09:48,310 --> 00:09:55,280 and you can see this very clear in American presidential campaigns at the present time. 93 00:09:55,280 --> 00:10:05,150 And this has an effect on the Third World. One of the most important international donors for family planning programmes worldwide is USAID. 94 00:10:05,150 --> 00:10:09,410 When there is a president in power of the United States who does not approve of abortion, 95 00:10:09,410 --> 00:10:21,620 whose policy is not to support those family planning programmes which include access to abortion, then U.S. aid has cut its funding very considerably. 96 00:10:21,620 --> 00:10:25,940 Under the Bush years, funding was severely cut for precisely that reason. 97 00:10:25,940 --> 00:10:29,700 Under Obama, it's going up again. What will happen after the next election, 98 00:10:29,700 --> 00:10:38,420 I think rather does depend upon upon whether Mr. Obama or Mr. Romney or whoever it is is going to win the election comes to power. 99 00:10:38,420 --> 00:10:42,770 If Obama continues family planning, aid will continue. If it's Romney comes to power, 100 00:10:42,770 --> 00:10:49,910 it seems reasonable to suppose that family planning will be cut with quite a considerable effect upon the family planning budgets of poorer countries, 101 00:10:49,910 --> 00:11:01,720 particularly in Africa. What are these programmes consists of lots of things, a great spectrum of of approaches, 102 00:11:01,720 --> 00:11:08,110 some essentially nudging, others moving in extreme cases towards towards coercion mostly, 103 00:11:08,110 --> 00:11:16,950 of course, simply providing at state expense or a state subsidy for family planning subsidies based on clinics, hospitals. 104 00:11:16,950 --> 00:11:19,440 And more effectively, village based, 105 00:11:19,440 --> 00:11:27,600 a local service delivery going around to meet the people rather than expecting the people to come to the clinic in Bangladesh and elsewhere. 106 00:11:27,600 --> 00:11:33,090 That's a very much more important way of doing things rather than just making things available. 107 00:11:33,090 --> 00:11:39,580 If you will come along to a particular building at a particular time and ask for particular services, that can be particularly difficult, 108 00:11:39,580 --> 00:11:47,970 of course, in traditional societies where being seen by the local community to be attending a clinic or visiting some place which is new, 109 00:11:47,970 --> 00:11:52,500 possibly rather dubious because of its Western associations and all that may be a very difficult 110 00:11:52,500 --> 00:11:58,230 thing to do and a big impediment towards acceptance or taking up anyway of family planning, 111 00:11:58,230 --> 00:12:09,150 social marketing. So call is also important. Social marketing is is essentially subsidising private provision of family planning services, 112 00:12:09,150 --> 00:12:17,550 not not just handing them out in some state clinic or hospital, but subsidising private providers of family planning so that pharmacies, shops, 113 00:12:17,550 --> 00:12:23,250 ordinary suppliers where you buy food and clothing and all the rest can also supply family planning products. 114 00:12:23,250 --> 00:12:31,350 But of course, at a subsidised rate, hence the term social marketing to make sure that people can afford propaganda and publicity is very important, 115 00:12:31,350 --> 00:12:36,600 not just the direct media, but also indirect media at one stage. 116 00:12:36,600 --> 00:12:45,990 Of course, this put a huge premium on literacy as being an important facilitator or its absence an obstacle to family planning knowledge. 117 00:12:45,990 --> 00:12:48,060 Nowadays, less important, 118 00:12:48,060 --> 00:12:54,810 one of the interesting developments nowadays in the in the take up of family planning policy or family planning methods, rather, 119 00:12:54,810 --> 00:13:01,590 in developing countries is a way in which illiterate women are increasingly taking up family found, 120 00:13:01,590 --> 00:13:06,690 though, of course, by definition they can't read about it. This is well documented in India and many other places. 121 00:13:06,690 --> 00:13:14,250 And one of the reasons for this is the universal access nowadays to transistor radios and the fairly universal access to televisions, 122 00:13:14,250 --> 00:13:18,000 not in every poor person's house, of course, but in most of the Third World. 123 00:13:18,000 --> 00:13:23,460 Every village has got televisions, even if every house hasn't got televisions, people are aware of what's going on. 124 00:13:23,460 --> 00:13:30,810 And they're looking at and listening to not just government propaganda, but also programmes, a very different kind of, 125 00:13:30,810 --> 00:13:35,880 many of which have nothing to do with the government, which nonetheless promotes small family norms. 126 00:13:35,880 --> 00:13:39,690 This is best documented amongst the telenovelas of Brazil, 127 00:13:39,690 --> 00:13:48,060 essentially people the world over love soaps and the soaps in the Third World don't like the soaps in England. 128 00:13:48,060 --> 00:13:52,860 Do it themselves primarily to the deeds and misdeeds of the working class in east London. 129 00:13:52,860 --> 00:13:56,910 Like EastEnders, they're much more concerned with promoting. 130 00:13:56,910 --> 00:14:05,670 We're not promoting, but displaying and describing and documenting the exciting antics of glamorous people leading high income lives. 131 00:14:05,670 --> 00:14:10,890 These people, very much to be emulated, live in comfortable surroundings, in nice houses, 132 00:14:10,890 --> 00:14:15,240 have no money worries, and above all, tend not to have more than two children. 133 00:14:15,240 --> 00:14:18,570 And this message, which is not a government funded policy at all, 134 00:14:18,570 --> 00:14:24,240 that merely a consequence of aspiration is broadcast to many, many, many millions of homes. 135 00:14:24,240 --> 00:14:30,390 And this has been shown, especially in Brazil, is a rather careful studies to be influential in spreading small family norms even 136 00:14:30,390 --> 00:14:36,570 before literacy newspapers have reached the more remote parts of the country. 137 00:14:36,570 --> 00:14:43,320 One of the better innovations of recent years is the integration of family planning services with 138 00:14:43,320 --> 00:14:50,040 a much broader policies promoting infant and maternal health and health and education in general, 139 00:14:50,040 --> 00:14:56,550 so-called reproductive health programmes. These have sometimes distracted attention from family planning provision, 140 00:14:56,550 --> 00:15:02,040 but they tend to put it into a more gentle and more broadly acceptable light. 141 00:15:02,040 --> 00:15:09,840 Educating men always important, of course, payments and other material inducements feature from time to time they featured in the 142 00:15:09,840 --> 00:15:15,030 famous or infamous Indian family planning craze of the 1970s for vasectomy camps, 143 00:15:15,030 --> 00:15:20,370 where, if you'll recall, men were offered a transistor radio if they had their tubes tied. 144 00:15:20,370 --> 00:15:26,460 Similar sorts of things happen elsewhere. They are not necessarily ineffective, but they can't be afforded to any important degree. 145 00:15:26,460 --> 00:15:36,930 Of course, other things like changing the law is important in raising the legal age of marriage is one very widely followed pattern. 146 00:15:36,930 --> 00:15:44,400 It may, of course, be ineffective under the Raj. The British regime in India tried to raise the legal age of marriage but did raise 147 00:15:44,400 --> 00:15:48,980 the legal age of marriage back in the 19th century with rather little effect. 148 00:15:48,980 --> 00:15:55,700 After independence, the Indian government has continued with this policy and of course, if you really can raise the legal age of marriage, 149 00:15:55,700 --> 00:16:01,060 if you can enforce that, if you can persuade people to marry later, they'll have a birth later. 150 00:16:01,060 --> 00:16:07,160 And on the whole, they'll have fewer births. And also the health will improve and the financial situation will be better. 151 00:16:07,160 --> 00:16:15,020 We'll have a kind of favourable circle effect upon subsequent reproductive behaviour and other kind of legal change, 152 00:16:15,020 --> 00:16:20,170 which is important is removing previous impediments of family planning. 153 00:16:20,170 --> 00:16:29,260 The French colonies, for example, in Africa and elsewhere, naturally inherited French legislation concerning family planning from the 1920s. 154 00:16:29,260 --> 00:16:38,230 This was highly restrictive of the 1920s, motivated by affairs for the very low level of fertility then prevalent in France. 155 00:16:38,230 --> 00:16:46,270 The dissemination sailele propagandising provision of family planning was made illegal abortion already illegal, 156 00:16:46,270 --> 00:16:49,720 the subject of much more severe penalties than previously was the case. 157 00:16:49,720 --> 00:16:58,510 These were not listed in France itself until 1960 four in the case of family planning in 1976. 158 00:16:58,510 --> 00:17:05,110 I think in the case of abortion, of course, by that time both those things were done in law or no law. 159 00:17:05,110 --> 00:17:10,600 Nonetheless, the law wasn't changed that in some of the African countries of North West Africa. 160 00:17:10,600 --> 00:17:14,620 They were not changed until much later. I think in some of them they haven't been changed yet. 161 00:17:14,620 --> 00:17:23,800 So that kind of legislation has to be removed before a progress can can really accelerate nagging and coercion, coercion in particular. 162 00:17:23,800 --> 00:17:31,010 We're all familiar with from from from the family planning policy in China, to a lesser extent, also in Vietnam. 163 00:17:31,010 --> 00:17:39,020 So lots of different approaches in making up what a family planning programme is. 164 00:17:39,020 --> 00:17:45,290 Here's an example of propaganda from the Indian Family Planning Programme of about 20 years ago. 165 00:17:45,290 --> 00:17:52,010 This is a picture of a double poster stuck up on billboards like a cigarette advert somewhere. 166 00:17:52,010 --> 00:17:55,250 And you can see the contrast on the left hand side. 167 00:17:55,250 --> 00:18:02,270 You have a big family with living in poverty and misery without shoes and proper clothing and all rested on the right. 168 00:18:02,270 --> 00:18:07,250 We have a two child family things all together very much that in every possible respect you 169 00:18:07,250 --> 00:18:13,550 will see the child sexual the bottom with her homework there and also also her things. 170 00:18:13,550 --> 00:18:20,030 You'll also note that the Adoption and Family Planning Programme turns drought into rainfall, 171 00:18:20,030 --> 00:18:26,390 puts leaves on trees, men's holes in roofs and and other desirable things as well. 172 00:18:26,390 --> 00:18:35,300 So it's not exactly a poster. Still, you get the message and this kind of picture has gone off on on hundreds of thousands of billboards 173 00:18:35,300 --> 00:18:43,700 in dozens of countries up and down the developing world with very much the same kind of message. 174 00:18:43,700 --> 00:18:53,300 This, I think, is something which I've already mentioned this this argument between between essentially a rather more left wing approach, 175 00:18:53,300 --> 00:18:59,360 you might say, or some would say more economically informed approach to development is the best contraceptive or as it were, 176 00:18:59,360 --> 00:19:07,220 contraception and contraception, not really necessarily antithetical at all, but nonetheless a difference in emphasis. 177 00:19:07,220 --> 00:19:13,130 Whatever has happened, it's important to realise there's been a huge increase in family planning take up, 178 00:19:13,130 --> 00:19:19,850 which, of course, has gone hand in hand with the tremendous reduction in overall levels of fertility. 179 00:19:19,850 --> 00:19:27,830 Back in the 1970s and 1960s, about 10 percent of the developing world married couples using modern methods of family planning. 180 00:19:27,830 --> 00:19:39,180 Now it's over 60 percent and keeps on increasing. A tremendous turnaround with consequent necessary obvious effects upon the birth rate. 181 00:19:39,180 --> 00:19:46,620 Factors that can affect rapid fertility decline include family planning policies, which I put here at the bottom, 182 00:19:46,620 --> 00:19:50,460 but it's very important to realise that there are lots of other things going on 183 00:19:50,460 --> 00:19:55,080 which which fuelled this debate between development and family planning policies, 184 00:19:55,080 --> 00:20:03,270 which facilitated and important to realise also that it's not just what happens to the economy, what happens to GDP per head, 185 00:20:03,270 --> 00:20:08,310 what happens the proportion of people in different ages attending secondary schools and tertiary education, 186 00:20:08,310 --> 00:20:13,980 what proportion are in the secondary and tertiary sector of the employment as opposed to the primary sector of employment? 187 00:20:13,980 --> 00:20:23,250 It also matters very much, it seems, what the predisposing pre-existing factors are in terms of in terms of the culture of the country, 188 00:20:23,250 --> 00:20:26,370 in terms of the equality between the sexes, 189 00:20:26,370 --> 00:20:33,840 in terms of the kind of religion which is predominant in the country, the extent to which the country is regionally divided or unified, 190 00:20:33,840 --> 00:20:39,900 the extent to which the country is divided by into, say, 14 different tribal groupings like in Kenya, 191 00:20:39,900 --> 00:20:45,780 generally regarded as being an impediment to adoption of family planning or is reasonably uniform, 192 00:20:45,780 --> 00:20:54,280 like Botswana, where there's essentially only one major ethnic group not counting the miserable and marginalised bushmen. 193 00:20:54,280 --> 00:21:04,210 In terms of in terms of religious background, it's often claimed that those countries with a strong Buddhist heritage like Sri Lanka, 194 00:21:04,210 --> 00:21:12,010 like Thailand, are like the southern part of India, for example, tend to be much more receptive to family planning. 195 00:21:12,010 --> 00:21:19,330 They tend to have no specific objections to it on religious grounds or or on broader cultural intellectual grounds, 196 00:21:19,330 --> 00:21:27,670 and tend to welcome it as being part of what is often claimed to be the favourable Buddhist attitude towards enlightenment, 197 00:21:27,670 --> 00:21:31,480 unquote, which doesn't just mean enlightenment in relation to the scriptures, 198 00:21:31,480 --> 00:21:38,950 but also appears to embrace a rather wider, open minded outlook to try new ideas from outside. 199 00:21:38,950 --> 00:21:43,930 And indeed, it's the case that birth rates in the countries I mentioned in Sri Lanka, in Thailand, 200 00:21:43,930 --> 00:21:50,980 in the southern states of India, especially Kerala, have gone down much faster than elsewhere. 201 00:21:50,980 --> 00:21:55,210 There are other reasons for that, obviously, but it certainly isn't economic development. 202 00:21:55,210 --> 00:21:59,830 There are no more developed than anywhere else in terms of Kerala, less so. 203 00:21:59,830 --> 00:22:05,440 Islam is often thought to be an impediment. And there are there are reasons for doing that, for thinking this, 204 00:22:05,440 --> 00:22:13,870 not because there's any objections specific to Islam against particular methods of family planning, unlike the Roman Catholic Church. 205 00:22:13,870 --> 00:22:18,520 Impossible to say exactly what the Islamic view about about family planning is, 206 00:22:18,520 --> 00:22:24,490 because it's diverse and absurd for me to pretend to be an Islamic scholar, which I'm certainly not. 207 00:22:24,490 --> 00:22:29,620 Nonetheless, it seems to be widely understood that in Islam there is no central authority, 208 00:22:29,620 --> 00:22:36,580 no single central authority laying down the law on family planning or birth control or other matters. 209 00:22:36,580 --> 00:22:39,850 But there is a consensus of the faithful, motivated and informed, 210 00:22:39,850 --> 00:22:48,370 particularly by two or three particular respected centres of Islamic scholarship in Cairo, in Jerusalem and elsewhere. 211 00:22:48,370 --> 00:22:53,770 The the consensus there appears to be that there is no specific objection to family planning in Islam, 212 00:22:53,770 --> 00:22:57,700 and a number of passages in the Koran can be interpreted rather clearly. 213 00:22:57,700 --> 00:23:02,410 It seems as enjoining families, particularly in joining husbands, 214 00:23:02,410 --> 00:23:07,600 not to burden the wives of too many children, not to burden the family with too many children, 215 00:23:07,600 --> 00:23:12,160 but to pay attention to protecting the wife's health and also to protecting the 216 00:23:12,160 --> 00:23:17,680 economic standing of the of the family are not impoverished by too large a family size. 217 00:23:17,680 --> 00:23:23,860 So the notion that Islam is is inherently at is perhaps not justified. 218 00:23:23,860 --> 00:23:31,930 Where there does seem to be a religious effect is not so much in any specific injunction's of a pro or anti contraception kind, 219 00:23:31,930 --> 00:23:40,190 but rather in the rather numerous prescriptions concerning the position of women insofar as those help to keep women secluded at home, 220 00:23:40,190 --> 00:23:46,180 not in the workforce, in the private realm or not in the public realm, not educated rather than educated. 221 00:23:46,180 --> 00:23:54,370 That will have an indirect effect upon upon family planning and also may have an effect upon upon economic development as a whole. 222 00:23:54,370 --> 00:23:59,050 And of course, if you are living in a traditional society where levels of education, 223 00:23:59,050 --> 00:24:03,070 particularly of women, are relatively low, certainly a modern education, 224 00:24:03,070 --> 00:24:10,330 then you will tend to regard innovations like family planning as being something of Western and threatening to Islam, 225 00:24:10,330 --> 00:24:15,540 even when they are not inherently anti-Islamic at all. 226 00:24:15,540 --> 00:24:20,040 Some of these differences are very apparent in the contrast between north and south India, 227 00:24:20,040 --> 00:24:25,830 where the variation in birthrates at the present time between the states of south India, 228 00:24:25,830 --> 00:24:31,740 not particularly rich compared with those in the north of your or three, 229 00:24:31,740 --> 00:24:41,730 comparing Kerala with the TFR of one point six, one point seven with Bihar or decide whether TFR is over for. 230 00:24:41,730 --> 00:24:46,380 Autocratic government tends to have an effect, generally speaking, autocratic governments are in favour of more population. 231 00:24:46,380 --> 00:24:56,220 It's the old mercantilist approach. Perfectly understandable. The other factors I don't need to dwell on, they're pretty self-evident. 232 00:24:56,220 --> 00:25:00,730 One curiosity here. I like to draw attention to actually occur to me the other day. 233 00:25:00,730 --> 00:25:05,250 That is to say that that of all the countries in the developing developed well, 234 00:25:05,250 --> 00:25:10,410 the only one which features in the top 10 of the projected future population increase in the world, 235 00:25:10,410 --> 00:25:16,200 which are the ones on the right from the right, well, is the US. 236 00:25:16,200 --> 00:25:22,950 Once upon a time, there was quite some interest in the US in the notion of zero population growth, 237 00:25:22,950 --> 00:25:31,700 in the notion that there might be limits to the appropriate level of population growth, which the US might might think to experience in the future. 238 00:25:31,700 --> 00:25:39,130 And there was a congressional committee on that in the 1970s and quite a movement towards moderating U.S. population growth. 239 00:25:39,130 --> 00:25:46,290 All that, for the time being, seems to be seriously in eclipse. The US population exceeded 300 million a couple of years ago. 240 00:25:46,290 --> 00:25:51,960 It's going to be at 440 million by mid century, probably half a billion by the end of the century. 241 00:25:51,960 --> 00:26:02,650 And as you see, it's still in the world's top 10. So in that respect is another example, I suppose, of American exceptionalism. 242 00:26:02,650 --> 00:26:05,260 Is all this going against the grain? 243 00:26:05,260 --> 00:26:13,570 After all, what happened, what is happening to all that vast and very persuasive literature from the 1960s and 1970s, 244 00:26:13,570 --> 00:26:15,610 particularly from Jack Caldwell and also from Mede, 245 00:26:15,610 --> 00:26:24,450 came numbers of others apparently showing that there was a lot of rationality in the high fertility of. 246 00:26:24,450 --> 00:26:30,120 In traditional societies, and this was magnified rather than reduced, at least for the time being, 247 00:26:30,120 --> 00:26:36,750 by the advent of the modern sector in those countries and also magnified by the reduction in the death rate. 248 00:26:36,750 --> 00:26:45,930 After all, in the past, as I'm sure you will appreciate, the actual effective surviving family size of children who made it to be young adults the 249 00:26:45,930 --> 00:26:49,500 same age as their parents were when their parents gave birth and could not have been. 250 00:26:49,500 --> 00:26:54,600 On the whole, much more than two know how many were born four or five, six, seven, eight. 251 00:26:54,600 --> 00:27:00,210 Only about two or so would survive to to to say age 35 or something of that kind. 252 00:27:00,210 --> 00:27:05,040 Well, that's not the case. Then, of course, the world population would have exploded hundreds of years ago. 253 00:27:05,040 --> 00:27:14,860 And it hasn't. People did not in the past benefit from large private armies of adult children to act as their workforce, 254 00:27:14,860 --> 00:27:19,630 their private army, their Social Security or. 255 00:27:19,630 --> 00:27:28,540 But and that is often forgotten, but the analysts in the 1970s felt that even even though there was now a large number of surviving children, 256 00:27:28,540 --> 00:27:34,930 this is not so much putting pressure upon family resources on available land available to each family, 257 00:27:34,930 --> 00:27:41,680 but rather it was a benefit for all the reasons which I put here, particularly wealth flows. 258 00:27:41,680 --> 00:27:49,690 The view being that wealth in traditional societies have flowed, flowed on the whole from children to parents, rather than from parents to children, 259 00:27:49,690 --> 00:27:58,820 which is the dismal experience of all adults in countries like the UK at the present time and has been for quite a long time. 260 00:27:58,820 --> 00:28:03,890 Likewise, the importance of old support in countries without without a welfare state, 261 00:28:03,890 --> 00:28:10,670 without much civil society and where kinship links are much more important than they are in 262 00:28:10,670 --> 00:28:14,240 the rest of the world and much more important than they ever have been in the Western world, 263 00:28:14,240 --> 00:28:20,090 at least in terms of recorded history. All these things are entirely plausible. 264 00:28:20,090 --> 00:28:24,800 They don't, at the end of the day, seem to have, as it were, carried the day, 265 00:28:24,800 --> 00:28:33,650 even though the values underpinning high fertility are in many cases very strong and deeply embedded in culture, 266 00:28:33,650 --> 00:28:40,580 as those of you who've studied anthropology were very well aware. 267 00:28:40,580 --> 00:28:42,310 Here are some examples. 268 00:28:42,310 --> 00:28:52,400 There are many, many examples, and all I can do is pull out a couple to to to emphasise or provide evidence for for these favourable points of view. 269 00:28:52,400 --> 00:28:58,550 This is the division of rural labour, and I call it Xiahe. I should call it the Democratic Republic of the Congo. 270 00:28:58,550 --> 00:29:04,970 It keeps changing its name. Originally Belgian Congo, then Zaire, then Democratic Republic of the Congo. 271 00:29:04,970 --> 00:29:06,320 Next week, who knows? 272 00:29:06,320 --> 00:29:14,300 But anyway, a very large country in Central Africa, you can see that the division of labour, essentially, that women do the work. 273 00:29:14,300 --> 00:29:17,180 Adult women score 100 days of ploughing. 274 00:29:17,180 --> 00:29:27,800 Even men in this extreme example only score 15, looking after banana trees and other horrible tasks to land girls to do a bit. 275 00:29:27,800 --> 00:29:35,960 Boys do rather little. Even old women do quite, quite a lot of light work in the fields compared with old men. 276 00:29:35,960 --> 00:29:43,730 This is an extreme example that I presented to us as part of the evidence which reinforced the entirely 277 00:29:43,730 --> 00:29:49,430 understandable arguments for the rationality of the continuation of high fertility in this case, 278 00:29:49,430 --> 00:29:59,510 particularly of girls. Quite the reverse of what happens in many Asian countries, of course, and would not happen so much in a Muslim country. 279 00:29:59,510 --> 00:30:08,720 And of family support. Here are some examples of patterns of family support in Thailand as recently as 1996 at a time, 280 00:30:08,720 --> 00:30:13,220 incidentally, when the Thai birthrate was already in freefall. 281 00:30:13,220 --> 00:30:20,730 Even so, parents with children, a very high proportion daily contact, 282 00:30:20,730 --> 00:30:29,750 a very high proportion of parents receiving support of various kinds food, clothes, money from children, a majority doing that. 283 00:30:29,750 --> 00:30:41,810 Even so, the birth rate went down. What the result of all this has been a complete turnaround in my lifetime, indeed in my career, 284 00:30:41,810 --> 00:30:46,900 in the pattern of acceptance of family planning policy in different countries. 285 00:30:46,900 --> 00:30:56,230 When I started standing up here lecturing miserable students about family planning policies about 30 years ago, 286 00:30:56,230 --> 00:31:00,220 it was it was then possible to point to rather small number of countries which are 287 00:31:00,220 --> 00:31:05,080 unequivocally adopted family planning programmes and where those programmes appeared to be, 288 00:31:05,080 --> 00:31:09,370 if not effective, then least associated with some reduction in the birthrate. 289 00:31:09,370 --> 00:31:12,100 Now it's totally different. It's a complete turnaround. 290 00:31:12,100 --> 00:31:19,030 Now, instead of producing, as I did then, rather short list of countries which did adopt family planning programmes, 291 00:31:19,030 --> 00:31:28,570 mostly other developed ones, small islands, countries strongly influenced by the West, Thailand, Singapore, Costa Rica and Taiwan and so on. 292 00:31:28,570 --> 00:31:38,260 Now it's the unbelievers, as it were, those who not accept your family planning policies, which are still which are now making this very short list. 293 00:31:38,260 --> 00:31:45,430 This is as of 2009. And these are countries which still have a policy either not to intervene in their birth rate, 294 00:31:45,430 --> 00:31:53,180 having got a very high birth rate, or want to maintain it, or even in some cases were needless ones to increase it. 295 00:31:53,180 --> 00:31:59,350 As you can see here, that they're not all that new in Africa that's been in Brunei's, not in Africa. 296 00:31:59,350 --> 00:32:07,330 That's I should put that somewhere else. It's in Asia, but I good Sierra Leone gobble. 297 00:32:07,330 --> 00:32:11,950 Gobble is the only one that governs, the only one which actually wants to its birth rate up. 298 00:32:11,950 --> 00:32:17,470 The rest have high birthrates. We don't want to reduce Libya up 2009. 299 00:32:17,470 --> 00:32:21,790 God knows what the policy is going to emerge in Libya after removal of Mr. Gadhafi. 300 00:32:21,790 --> 00:32:30,430 Mr. Gadhafi, predictably, was was a person out in favour of more people, which frankly, in a country the size of Libya is not unreasonable, 301 00:32:30,430 --> 00:32:39,400 even though most of it is sand, the Middle East, Israel's poor nations, for reasons which we've well understood and don't be elaborating Kuwait. 302 00:32:39,400 --> 00:32:43,270 Likewise, Oman until 2005 now changed his mind is now. 303 00:32:43,270 --> 00:32:49,830 It now has a family planning policy. Saudi Arabia at least wants to maintain its birthrate, which was relentless, isn't it? 304 00:32:49,830 --> 00:32:56,140 Not notice any longer. And whatever its policy, the birth rate in Saudi Arabia is going down as it is in Kuwait, 305 00:32:56,140 --> 00:33:02,560 as it is in Oman, a few in Latin America, a few in Asia and the Pacific in Afghanistan. 306 00:33:02,560 --> 00:33:07,090 Heaven knows what the policy is going to be if a real government ever emerges. 307 00:33:07,090 --> 00:33:10,870 Mongolia is the only really ponytail's country that Mongolia, as you know, 308 00:33:10,870 --> 00:33:16,540 gigantically large country with a tiny population is not obviously irrational. 309 00:33:16,540 --> 00:33:19,060 To want to have rather more people in their president presently have, 310 00:33:19,060 --> 00:33:25,630 even at a cost of some damage to the Eastern Shore, although in fact, in Mongolia the birthrate is really quite low. 311 00:33:25,630 --> 00:33:31,540 It's about two and a half. So it's not going to make very much difference to to economic progress. 312 00:33:31,540 --> 00:33:40,200 This is an example of the change of mind here, a very good graph as viewed from here. 313 00:33:40,200 --> 00:33:48,580 The the black areas in 1976 and 2005 are the ones where the birth rate was thought to be too low and needs to be increased. 314 00:33:48,580 --> 00:33:51,760 As you can see that they've diminished to almost nothing. 315 00:33:51,760 --> 00:33:57,910 The the pale areas with the little dots were the ones the then high birth rate was reckoned with satisfactory. 316 00:33:57,910 --> 00:34:03,460 With no intervention. They have now diminished to a small number down that central corridor. 317 00:34:03,460 --> 00:34:07,120 As you can see, most now regard their birth rates as being too high. 318 00:34:07,120 --> 00:34:14,770 And of course, Africa is as well the international laggard in terms of family planning programmes. 319 00:34:14,770 --> 00:34:20,620 These are some people who people, countries which have changed their minds rather radically over the years. 320 00:34:20,620 --> 00:34:31,680 I won't dwell on this or talk about them a bit more in a moment. A few examples might be instructive, at risk of overloading you with detail, 321 00:34:31,680 --> 00:34:36,540 the Indian Family Planning Programme was the first in the developing world of independent country. 322 00:34:36,540 --> 00:34:43,560 It had been thought about a lot in the time of the Raj, but but in the time of British Dominion of India, 323 00:34:43,560 --> 00:34:47,460 it was thought to be really politically impossible to try to introduce a policy 324 00:34:47,460 --> 00:34:53,070 of of family planning to bring population growth rates more under control, 325 00:34:53,070 --> 00:34:55,710 even though it seemed very obvious that it was desirable. 326 00:34:55,710 --> 00:35:01,560 Even though many Indians themselves felt that it was desirable, nothing was done, couldn't really be done. 327 00:35:01,560 --> 00:35:10,350 But as soon as it was independent, Review of Independence and Family Planning Programme began in 1952, typically, 328 00:35:10,350 --> 00:35:20,130 as in family planning programmes at that time, rather ineffectual, very much top down, very bureaucratic, inconsistent, changing. 329 00:35:20,130 --> 00:35:27,700 As one minister was replaced by a different minister. The very first minister was a Christian who believed in Gandhian approaches to family planning, 330 00:35:27,700 --> 00:35:34,170 and therefore it was not a very vigorous proponent of artificial methods of birth control. 331 00:35:34,170 --> 00:35:40,590 Things started to heat up, but essentially the Indian policy has been characterised by a succession of crazies. 332 00:35:40,590 --> 00:35:45,570 In the 1960s, it was all IUDs, which initially had some success. 333 00:35:45,570 --> 00:35:52,380 And then then that that that weakened a bit. By the 1970s, it was sterilisation, particularly vasectomies, 334 00:35:52,380 --> 00:35:59,250 male sterilisation with the development of discectomy camps where where mass was actually carried out, 335 00:35:59,250 --> 00:36:06,000 where the famous bribe or inducement of the transistor radio was on offer, which we've all heard about. 336 00:36:06,000 --> 00:36:14,940 A big boost to family planning of a eventually counterproductive kind happened during the national emergency in nineteen seventy five. 337 00:36:14,940 --> 00:36:20,460 Mrs Gandhi, the Congress party of Prime Minister of India at the time declared a national emergency. 338 00:36:20,460 --> 00:36:25,200 Nothing to do with family planning. It was a consequence of a major rail strike, which, as you felt, 339 00:36:25,200 --> 00:36:29,490 was threatening to bring India to its knees, suspended the constitution declared the emergency. 340 00:36:29,490 --> 00:36:32,940 Her son, Sanjay, a great enthusiast, a family planning policy, 341 00:36:32,940 --> 00:36:39,720 seise the opportunity of these new powers which have been given to government irrespective of parliament, 342 00:36:39,720 --> 00:36:48,750 to introduce a much more vigorous family planning policy involving much more incentives for sterilisation, 343 00:36:48,750 --> 00:36:52,980 trying to persuade regional governments to persuade all their employees and lots 344 00:36:52,980 --> 00:36:57,690 and lots of public employees in India to adopt family planning programmes whereby, 345 00:36:57,690 --> 00:37:02,160 for example, promotion will be made dependent upon adopting family planning policies. 346 00:37:02,160 --> 00:37:06,600 Promotion will be denied to those who had more than, say, three children. 347 00:37:06,600 --> 00:37:13,050 Quotas were assigned to public employees to recruit other people to to to adopt family planning. 348 00:37:13,050 --> 00:37:18,870 Imagine being persuaded to a number of your children by the chef of selling railway tickets. 349 00:37:18,870 --> 00:37:21,240 A very, very interesting. 350 00:37:21,240 --> 00:37:30,050 So there are lots of nudging, lots of encouragement, lots of cajoling, lots of bullying and eventually some coercion, particularly Muslims. 351 00:37:30,050 --> 00:37:31,920 A minority in India, of course, 352 00:37:31,920 --> 00:37:39,000 being being corralled into family planning camps and given forced sterilisations in some cases creates a major scandal. 353 00:37:39,000 --> 00:37:44,610 So essentially one party for that party for lots of other reasons why Mrs Gandhi had to call an election. 354 00:37:44,610 --> 00:37:50,940 She lost it. The the nationalist Janta Party, one family planning policy was not abolished. 355 00:37:50,940 --> 00:37:55,890 It was put on the back burner for some time and is now essentially come back into fashion. 356 00:37:55,890 --> 00:38:00,630 It's now a very active, more active perhaps than ever before. 357 00:38:00,630 --> 00:38:08,010 The national population policy of 2000 has got this target of two point one TFR by by two years ago, alas, not achieved. 358 00:38:08,010 --> 00:38:11,340 It is down to two point five. But there is enormous regional variation. 359 00:38:11,340 --> 00:38:19,060 As I mentioned that last week, we haven't yet got 50 percent use of family planning by families in India. 360 00:38:19,060 --> 00:38:26,460 It's just under that. One of the downsides of that is it's very, very much still a sterilisation. 361 00:38:26,460 --> 00:38:32,430 85 percent of couples who are protected by family planning policy of any kind are sterilised, 362 00:38:32,430 --> 00:38:38,520 mostly women as women sterilised if commercialisation is new is a new craze. 363 00:38:38,520 --> 00:38:44,130 Except in the South, marriage is still quite early. Almost no one is remains unmarried. 364 00:38:44,130 --> 00:38:49,060 And this is unlike those countries where family planning has really made a big progress here. 365 00:38:49,060 --> 00:39:03,700 Just a reminder of the enormous variation of. Family planning, acceptance and TFR in different parts of India and these parts of India being more. 366 00:39:03,700 --> 00:39:08,170 Almost every every way except economic development, more favourable to family planning, 367 00:39:08,170 --> 00:39:13,000 much more cultural gender, gender equality here, a much higher level of education, 368 00:39:13,000 --> 00:39:22,420 much later marriage, much lower levels of mortality up here, high mortality, high fertility, much more poverty, much bigger population as well. 369 00:39:22,420 --> 00:39:32,920 China I mustn't dwell on because it's it's so, so much to say and also I think it's very well known to some people in this room. 370 00:39:32,920 --> 00:39:39,310 What's interesting in China is the same kind of thing that's interesting in Iran, that is to say, 371 00:39:39,310 --> 00:39:47,560 a complete volte face in policy, apparently directly contradictory to what ideology would expect. 372 00:39:47,560 --> 00:39:50,740 China, of course, is only 49. Is that a communist government? 373 00:39:50,740 --> 00:39:58,120 A communist governments are, as we're supposed not to believe in Malthusian analysis of the causes of poverty, 374 00:39:58,120 --> 00:40:01,570 not to feel that any need for family planning policies, 375 00:40:01,570 --> 00:40:08,410 but rather to regard the population something which can simply managed like everything else in the economy and which will solve itself. 376 00:40:08,410 --> 00:40:13,560 Because the central problem of poverty is not population, as Marx said, 377 00:40:13,560 --> 00:40:21,480 but that is the ownership of property and and distribution and all the rest of it. 378 00:40:21,480 --> 00:40:28,260 Nonetheless, despite what ought to be a almost religious adherence to Marxist principles in 379 00:40:28,260 --> 00:40:32,220 terms of avoiding family planning policy and adopting a Malthusian rhetoric, 380 00:40:32,220 --> 00:40:39,690 nonetheless, that's exactly what China has done. The pronouncements on the need for family planning, 381 00:40:39,690 --> 00:40:48,990 the need to reduce population size and population growth since the 1970s in official Chinese 382 00:40:48,990 --> 00:40:54,480 publications would even make the most hardened Malthusian society pink with embarrassment. 383 00:40:54,480 --> 00:40:59,220 They are so enthusiastically Malthusian, not citing the need for mothers particularly, 384 00:40:59,220 --> 00:41:13,860 but but expressing a Malthusian sentiments in a way which are a naive year student being slightly rebuked for even by pro population control teachers. 385 00:41:13,860 --> 00:41:22,890 And and so. So it's continued. Important to remember amongst all of this detail that the major reduction in the 386 00:41:22,890 --> 00:41:28,410 birthrate in China took place not during the one child policy starting in 1980, 387 00:41:28,410 --> 00:41:37,110 but in the earlier policy, which I think was the slogan as later longer, fewer later marriage and childbearing, longer birth intervals, 388 00:41:37,110 --> 00:41:40,860 fewer children that was promoted without coercion, 389 00:41:40,860 --> 00:41:45,510 although with lots and lots of nudging and propaganda at a time when the prestige of the regime was very, 390 00:41:45,510 --> 00:41:51,030 very high and were contrary to the cynicism which we normally express towards politicians, 391 00:41:51,030 --> 00:41:55,200 trust in the government of Mao and his successors were very high. 392 00:41:55,200 --> 00:41:58,950 And if if the government wanted something doing, then that was the right thing to do. 393 00:41:58,950 --> 00:42:05,850 The birthrate went down to about two point five from over five, almost six, I think, over a relatively short period of time. 394 00:42:05,850 --> 00:42:12,690 And one child policy has kept it there. And of course, the great problem, the one child policy is, is how to continue it or not to continue it. 395 00:42:12,690 --> 00:42:20,670 Given the birth rate is now below replacement rate and population, momentum of a negative kind is building up with the possibility, 396 00:42:20,670 --> 00:42:29,670 as I say at the bottom, to cite a well-worn slogan that China may become old before it becomes rich. 397 00:42:29,670 --> 00:42:38,940 Policy changes not urgent, thanks to the of the combined effects of development of progress and and family planning policy in that huge country. 398 00:42:38,940 --> 00:42:46,110 We know all about that. I think Vietnam has sort of followed followed suit, and that's well known policy. 399 00:42:46,110 --> 00:42:52,320 But nonetheless, one with with some coercion, particularly if people go on to have three children. 400 00:42:52,320 --> 00:42:58,560 It's one child policy. It's kind of two child policy. Frankly, I'm not sure what is present status is better. 401 00:42:58,560 --> 00:43:07,320 Until a few years ago, this is what it was. And the Vietnamese TFR, for one reason or another, is certainly now quite modest. 402 00:43:07,320 --> 00:43:16,500 Bangladesh is often cited as a particularly strong case for the possibility of family planning programmes to promote low fertility, 403 00:43:16,500 --> 00:43:24,420 even in countries with rather modest levels of development, which Bangladesh certainly has, its infant mortality is still relatively high. 404 00:43:24,420 --> 00:43:30,210 Expectation of life is not very great, although much higher than it used to be illiteracy. 405 00:43:30,210 --> 00:43:38,580 This is these are data is not quite up to date, but they're still not immensely better than these is quite high, especially amongst women. 406 00:43:38,580 --> 00:43:44,790 It's mostly agricultural, mostly Muslim, mostly rural, one of the least urbanised countries in Asia. 407 00:43:44,790 --> 00:43:47,680 And right down at the bottom of the Human Development Index. 408 00:43:47,680 --> 00:43:57,900 Thirty six out of 150 back in 1991, when the family planning programme appeared to be having its success and by no means rich. 409 00:43:57,900 --> 00:44:05,640 Nonetheless, the TFR, which was about seven in 1979, is now down to just over three. 410 00:44:05,640 --> 00:44:14,430 The extent to which the family planning policy is responsible for this is controversial, 411 00:44:14,430 --> 00:44:17,880 but it is possible to evaluate it because of the somewhat experimental nature, 412 00:44:17,880 --> 00:44:25,620 at least at the beginning of the family planning programme and its effectiveness or partial effectiveness, 413 00:44:25,620 --> 00:44:31,410 at least in this apparently unpromising cultural and religious belief that was attributed 414 00:44:31,410 --> 00:44:38,070 to the way in which rather than having a top down programme driven driven by it, 415 00:44:38,070 --> 00:44:43,560 by the government, incentives given by government, exhortations given by clinics, 416 00:44:43,560 --> 00:44:53,940 it was a programme was adopted of trying to deliver family planning services to women in in rural areas by other women, 417 00:44:53,940 --> 00:45:01,830 particularly women who were themselves married with children, of course, Muslim and a reasonably high status. 418 00:45:01,830 --> 00:45:09,780 All of these things are important, not possible in a country of pious Muslim women like Bangladesh to have men going 419 00:45:09,780 --> 00:45:14,220 around promoting family planning or even women who are not themselves married, 420 00:45:14,220 --> 00:45:21,660 don't have children, don't understand. It is important to talk to women in a frank way women can do to women. 421 00:45:21,660 --> 00:45:28,540 And it wasn't a society of men absolutely cannot do whether related or otherwise. 422 00:45:28,540 --> 00:45:35,080 Others have failed, Nigeria's policy started a long time ago, in 1988, it appears to have had no effect. 423 00:45:35,080 --> 00:45:40,990 The Nigerian birthrate is still about six, is gone down a little bit, possibly one child, 424 00:45:40,990 --> 00:45:45,550 but that may be more probably due to development rather than anything else. 425 00:45:45,550 --> 00:45:50,230 It's partly a consequence of weak and unstable government poverty. 426 00:45:50,230 --> 00:45:56,470 It's often claimed of the divided nature of Nigeria, which is a huge country divided into many different tribal groups, 427 00:45:56,470 --> 00:46:02,440 particularly and importantly divided between the north of the country, 428 00:46:02,440 --> 00:46:13,060 almost entirely Muslim House and Fulani and other smaller groupings compared with the South, Yoruba and Ibo and others, 429 00:46:13,060 --> 00:46:19,690 mostly Christian, but by no means all with very different views about about the way the country ought to be run. 430 00:46:19,690 --> 00:46:22,350 Very apparent at the present time. 431 00:46:22,350 --> 00:46:34,320 With the unrest in Nigeria and made worse, by the way, in which the the episodically democratic government in Nigeria is run on provincial basis, 432 00:46:34,320 --> 00:46:40,740 the population of provinces north and south and all their subdivisions determines representation in the parliament. 433 00:46:40,740 --> 00:46:46,910 So the more people you've got, the more power you got and the more resources you can divert to your area rather than anyone else's. 434 00:46:46,910 --> 00:46:56,670 And that is messed up in Nigeria censuses and Nigeria's family planning policy, arguably ever since the 1960s. 435 00:46:56,670 --> 00:47:03,330 Brazil is an interesting case, Brazil, a very important country, the biggest in Latin America, as you know, one where the birth rates are very low. 436 00:47:03,330 --> 00:47:11,790 Her replacement. Sorry, this ferry started off in the TFR about six. 437 00:47:11,790 --> 00:47:17,550 Even by the 1970s. This was deemed too, too much by very many families. 438 00:47:17,550 --> 00:47:24,330 The level of illegal abortion in the absence of a family planning provision was very high in Brazil, with very dire consequences for health, 439 00:47:24,330 --> 00:47:26,820 as it was in most other parts of Latin America, 440 00:47:26,820 --> 00:47:34,050 where abortion in many countries still remains illegal altogether or only accessible to the most extreme circumstances. 441 00:47:34,050 --> 00:47:41,130 Until 1985, the government was not interested enough in population, became more so after then. 442 00:47:41,130 --> 00:47:47,700 But because of the opposition, the Roman Catholic hierarchy could not introduce a fully fledged family planning policy, 443 00:47:47,700 --> 00:47:53,940 but instead facilitated is permitted it in a kind of compromise with with the church. 444 00:47:53,940 --> 00:47:56,880 What happened instead is very interesting, 445 00:47:56,880 --> 00:48:06,090 motivated partly by a strong hostility to the very high level of illegal abortion and all the illness and death that followed. 446 00:48:06,090 --> 00:48:16,770 From that, the medical profession started a programme to market a family planning and promote family planning in hospitals and elsewhere. 447 00:48:16,770 --> 00:48:26,760 This Bentham's organisation is a branch of the international Planned Parenthood Federation set up in in in India in 1954 to promote family planning. 448 00:48:26,760 --> 00:48:38,640 Also, the pharmaceutical companies aware that there was an unmet need for family planning, started marketing it to meet private demand and. 449 00:48:38,640 --> 00:48:43,680 The doctors again started to circumvent the law against sterilisation, 450 00:48:43,680 --> 00:48:55,030 tubal ligation by but by providing tubal ligation to women who are in hospital having caesarean sections and as a consequence of all this, 451 00:48:55,030 --> 00:48:58,440 had much, much increased reduction in the birth rate. 452 00:48:58,440 --> 00:49:06,180 The TFR in Brazil is now about one point eight, having been six about 30 years ago. 453 00:49:06,180 --> 00:49:08,850 And this is in the absence of an official family planning policy, 454 00:49:08,850 --> 00:49:15,730 which you might say that that the doctors and the pharmaceutical companies public demand have, as it were, replaced it with with something else. 455 00:49:15,730 --> 00:49:20,400 There are there are downsides to this far too many Caesarian operations. 456 00:49:20,400 --> 00:49:29,070 And there are there are big, rich and poor urban rural differences because of the market based approach to to access to contraception, 457 00:49:29,070 --> 00:49:37,240 because of the public free or subsidised family planning is really not on offer. 458 00:49:37,240 --> 00:49:45,580 I'm sorry, you've got to go. Iran is another example, slightly analogous set of China, Iran, 459 00:49:45,580 --> 00:49:56,140 where the advent of the ayatollahs in 1979 saw the removed total removal of the Shah's programme of 460 00:49:56,140 --> 00:50:03,160 secularist modernisation and its replacement by a theocratic regime strongly opposed to family planning. 461 00:50:03,160 --> 00:50:08,860 Not all Islamic grounds, particularly because it was Western, I think is the underlying objection. 462 00:50:08,860 --> 00:50:13,300 Also, all the women were bundled out of universities, back into the chador, 463 00:50:13,300 --> 00:50:25,720 and women's education came to a full stop after the horrific Iran-Iraq war that the policy became even more prenatal. 464 00:50:25,720 --> 00:50:32,070 As the birth rate went up to about eight, population growth nudged four percent. 465 00:50:32,070 --> 00:50:38,950 The terrible consequences of the war, plus the consequences of this growth which was unleashed, caused a complete turnaround. 466 00:50:38,950 --> 00:50:47,240 In the past. It was it was argued that in order to be strong and confront Great Satan, namely the United States, Iran had to be very numerous. 467 00:50:47,240 --> 00:50:52,810 The ayatollahs then decided that in order to confront Great Satan and promote Iran's interests and the interests of the people, 468 00:50:52,810 --> 00:51:00,520 of course it was necessary for the family planning programme to be to be redeveloped and promoted with great vigour. 469 00:51:00,520 --> 00:51:08,500 And by 1989, just 10 years after the Islamic revolution, the Islamic clergy was actively promoting family financing, 470 00:51:08,500 --> 00:51:12,610 planning in the context of the census around that time, 471 00:51:12,610 --> 00:51:21,130 and also a very important programme of rural rural focus, education and health linked with family planning provision. 472 00:51:21,130 --> 00:51:26,220 Very much the village level, highly effective, going with the grain, of course, Iranian society. 473 00:51:26,220 --> 00:51:33,370 Iran is a very ancient, civilised population. It's had a it's been there for about three thousand years. 474 00:51:33,370 --> 00:51:41,170 It's quite unlike tribal societies elsewhere in the world. So women have felt that it was ripe anyway for family planning acceptance. 475 00:51:41,170 --> 00:51:47,440 This was happening a big time in the cities. In any case, anyway, GFR is now a national level one point. 476 00:51:47,440 --> 00:51:51,790 And even in rural areas, it's down to about rephase. On average, there's some variation. 477 00:51:51,790 --> 00:52:00,940 This is a quite extraordinary achievement and shows the importance of the value, if you like, of the way in which in Islam, 478 00:52:00,940 --> 00:52:07,210 the interests of the nation and the interests of religion are the same because the state is religion and religion is the state. 479 00:52:07,210 --> 00:52:11,230 There's no separation. This is often regarded as being a problem in the West. 480 00:52:11,230 --> 00:52:18,490 In the case of Iran, it's clearly been turned to great advantage at his birth rate going up during 481 00:52:18,490 --> 00:52:26,240 the early period of after the Shah and then going down in a major reduction. 482 00:52:26,240 --> 00:52:37,370 Kenya, progress on hold, I think I talked about the fertility stall in Kenya, a somewhat important to work out why this should be the case. 483 00:52:37,370 --> 00:52:44,390 Some insist that it's a reassertion of the fact that high levels of fertility are, in fact, rational. 484 00:52:44,390 --> 00:52:49,490 And under the circumstances, most people still offer live live in the countryside. 485 00:52:49,490 --> 00:52:58,370 For my part, I think this is deeply unlikely and that postponement of an recuperation may be 486 00:52:58,370 --> 00:53:02,720 important that certainly the reduction of funds devoted to family planning, 487 00:53:02,720 --> 00:53:10,110 partly because of the distraction of AIDS, has been very important and. 488 00:53:10,110 --> 00:53:17,220 Other problems in particular to Africa and especially to Kenya, led this to be the case with the consequence. 489 00:53:17,220 --> 00:53:20,970 There is a measurable increase in unwanted pregnancy in Kenya. 490 00:53:20,970 --> 00:53:28,620 So that, I think, suggests it's not actually a rational response to what was before. 491 00:53:28,620 --> 00:53:35,310 I've exceeded my time rather badly. I'm not going to talk about calculating programme effort except to say that a lot 492 00:53:35,310 --> 00:53:39,720 of attention has been devoted to trying to work out how effective programmes are. 493 00:53:39,720 --> 00:53:43,350 Huge amounts of money being spent on family planning programmes, 494 00:53:43,350 --> 00:53:50,760 a lot of efforts being made by the United Nations and elsewhere to devise statistical ways of testing how far the policy is responsible. 495 00:53:50,760 --> 00:53:53,160 On the one hand, how far development is responsible. 496 00:53:53,160 --> 00:54:02,550 On the other, with very mixed results, sometimes as high as 40 or even 80 percent of fertility decline attributed to policy factors. 497 00:54:02,550 --> 00:54:10,410 More recently, not much more than 20 percent in a recent analysis in Iran and in Bangladesh, for example. 498 00:54:10,410 --> 00:54:18,540 And finally, these things now appear to be, in some cases, moving towards a natural end and towards reversal. 499 00:54:18,540 --> 00:54:24,420 These countries have already reversed their family planning programmes previously very anti-nuclear. 500 00:54:24,420 --> 00:54:30,790 Now, of course, with low birth rates and high ageing Principlist, these countries are about to tap into population decline. 501 00:54:30,790 --> 00:54:40,260 I think we will see a turnaround in family planning policy in all of these over the next 10 or 20 years as family planning policies, 502 00:54:40,260 --> 00:54:49,320 possibly, except in Africa, will finally have done their job insofar as they have done it and can be laid to rest there. 503 00:54:49,320 --> 00:54:54,122 I must stop with apologies for overrunning.