Population, Gender, and
Development in
Latin America
Kimberly Grahling
Charles McKittrick
Mark Robinson
Gary Wu
Agenda
• Why is population control so important and what other
issues influence growth?
• What Latin American countries are doing to control
population growth and the results are they seeing
• Puerto Rico and Peru
• Desired long-term results and our conclusions
The Importance of Population
Control
LIMITED RESOURCES!
The Economics of Population
• Fertility and education
• GDP Per Capita =
ISI
Export orientation
Privatization
Inflation
Economic enclaves
Debt
Exchange rates
etc.
GDP / Population
Decrease
The Importance of Population
Control
1997 GNP Per Capita and 1999 Total Fertility Rate
6.0
28,130
25,000
5.0
20,000
4.0
15,000
2.9
10,000
3.3
13,890
2.9
2.0
5,170
5,000
1.4
3,950 3,130
3.0
2.7
2.8
2.8
2.0
4,430
2,450 1.0
Total Fertility Rate (TFR)
5.4
660
ia
As
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1997 GNP Per Capita (US$)
30,000
GNP Per Capita
(US$), 1997
Total Fertility
Rate
Drivers of High Population
• Colonial legacy
• Religious influence
• Lack of access to birth
control
• Lack of education
• Agrarian economy
• Culture of machismo
Population Control
Participants
Latin American governments
• % of governments thinking their country’s
population was too high in 1999:
Central America
Caribbean
South America
88%
47%
15%
Source: 1999 World Population Data Sheet, Population Reference Bureau
Population Control
Participants
Foreign governments
• Spend $2 billion/year subsidizing family planning
worldwide.
• Largest contributors:
–
–
–
–
–
United States through U.S. AID
Netherlands
Germany
United Kingdom
Japan
Source: United Nations and New York Times
Population Control
Participants
Nongovernmental Organizations
(NGOs) - Funded by local and foreign
governments
• International
– U.N. Population Fund
– World Health Organization
• U.S.-based
–
–
–
–
International Planned Parenthood Federation
Family Health International
The Population Council
Pathfinder International
Population Control
Participants
Nongovernmental Organizations (NGOs)
• Private donors
–
–
–
–
–
Ford Foundation
Rockefeller Foundation
Mellon Foundation
MacArthur Foundation
Gates Foundation
Population Control
Participants
U.S. AID Funding in Latin America for
health and family planning FY2000
Funding
Country
($000)
Haiti
$ 22,300
Peru
$ 13,500
Bolivia
$ 13,000
El Salvador $ 7,145
Guatemala $ 6,000
Honduras
$ 4,318
Nicaragua $ 4,000
Brazil
$ 2,900
Paraguay
$ 2,000
Jamaica
$ 1,450
TFR
4.8
3.5
4.2
3.6
5.1
4.4
3.9
2.3
4.4
2.8
Source: U.S. AID and Population
Reference Bureau
Population Control Tools
• Sterilization
• Long-term, low-cost, convenient
• Increased access to modern birth
control
• Reversible
• Higher efficacy rates than traditional methods
• Family planning education
• Most important aspect of population control
Results
• Measured by Total Fertility Rate
(TFR)
• U.S. has a TFR of 2.0.
• TFR of 2.1 is replacement-level fertility
• Latin America’s TFR fell from 5.9 in
the 1950’s to 2.9 in 1999.
• Population will double in ~38 years
• Population control policies have
reduced population growth rate in
Latin America
Results
Source: World Population Beyond 6 Billion, Population Reference Bureau
Case Studies
Successful vs. unsuccessful examples of population
control programs
Puerto Rico
Peru
Case Studies of Two Women's Health Projects in Bolivia
Gender, Power and Population Change, Population Reference Bureau
What are the parameters of success?
Initially sought to compare effective vs. ineffective examples
Traditional Metrics - focus on short term results:
• Funds invested to number of client visits, IUDs inserted, pills
distributed
• Births per thousand - TFR
New Metrics - focus on medium & long term results
• Quality of service
• Impact on client's health and well-being
• Participant internalization of health knowledge and responsibility
• How participation has affected health and well-being in the medium
and long term.
Case Studies of Two Women's Health Projects in Bolivia
Gender, Power and Population Change, Population Reference Bureau
Puerto Rico: Effective results ...
Low Cost - high efficiency - Immediate results
• Population control expenditures 100% more effective in raising
per capita income than expenditures in accelerating
conventional economic growth (General Electric Tempo Research Center)
• $5 of birth control = $100 of economic development
(Lyndon Johnson's '65 speech to UN)
• Every prevented birth worth 2.6 times per capita output…
births prevented in Puerto Rico ('68) = $3,600 per birth
• Study suggested that improved management efficiency and
more permanent birth control might result in over $12.5M gain
for Puerto Rico
Puerto Rico: Effective results…but at what cost?
• By 1968 ~34% of women of child bearing age had been
sterilized - 2/3s of whom were still in their early twenties
• Lowest natural population increases in Latin America:
19.1/thousand vs. 29/thousand
Year
1947-48
1948
1953-54
1965
1968
Age
15 +
n/a
20 +
20-49
20-49
Percent Sterilized
6.6
6.9
16.5
34
35.3
Puerto Rico: Context and players
Primary participants:
• Puerto Rican government
• NGOs
• Foreign governments
• Private donors to NGOs (with linked economic interests)
Population Control Policies:
• Sterilization
• IUD & the Pill
Sterilization
1) Underdeveloped health-care services
2) Abortion difficult to obtain (2 year prison term)
3) Non-prescription use of the pill
4) IUD's expensive and poorly distributed
5) Sterilization is free
Rationalization:
• Demand Statistics
6) Reimburse $50 and 90% of hospital cost
7) Sterilization post partum - consent is obtained during labor
Peru: Family Planning and Good Intentions
Fujimori places family planning at forefront of national agenda (4/95)
• Method for reducing poverty in Peru.
• Goal: state to prevent the birth of 500,000 Peruvians by 2000
• Population control linked to shift in market-oriented economic
policies
Good intentions
• 1st step in reducing poverty  decrease size of low income families
• Accessible family planning for all classes
Peru: Family Planning and Good Intentions
Population Control Tool-set
• Network of clinics
• Access to latest techniques (including female condom and Norplant)
• Voluntary sterilization program
•
(including vasectomies for men and tubal ligations for women)
• Three most practiced forms of contraception in Peru:
(1) Abstinence / 'natural methods'; (2) IUD; (3) Tubal ligation
• Abortion Illegal - though ~ 300K abortions performed a year
• 1 in 3 pregnancies end in abortion
Primary Participants
•
Peruvian government
•
U.S. AID
Case Studies of Two Women's Health Projects in Bolivia
Gender, Power and Population Change, Population Reference Bureau
Peru: Family Planning and Good Intentions
Constraints:
• Catholic Church:
• Moral arguments
• Church claims plan ignores declining birth rate;
• Blames the poor for the country's economic problems.
• Cultural:
• Male perception of loss of control over women
• Fear of male impotence
Economic
• 1/2 of Peru's 23 million people live in poverty
Case Studies of Two Women's Health Projects in Bolivia
Peru: Family Planning and Good Intentions
Results & Pitfalls
Year
1995
1996
1997
Female
Sterilizations
10,000
30,000
110,000
Male
Sterilizations
n/a
n/a
10,000
• '97 sterilization's result in 26,000 fewer births in '98
• Quotas motivate State health-care workers to take advantage
of rural poor women
• Promotions and cash incentives stimulate hurried, low quality
care
• Going rate: two dresses and a t-shirt.
Future Trends: An Alternative Viewpoint
Population control guided by improving human welfare instead of
reducing overcrowding
•
Invest in the conditions that facilitate use of programs in addition to
the programs themselves.
Integrated approaches to service delivery
•
Emphasis on continued education and growth
•
Focus on interpersonal relationships
New Paradigm:
•
Health more complex than medical service and necessarily linked to
education, human rights, personal empowerment
•
Transforms relationship between clinician and patient so delivery more
effective
Positive Results of Population Control
Higher standard of living
Economy gains from
more productive workers
Women achieve higher
economic status
Women have fewer children
More opportunities for
education and work
Women gain higherpaying jobs
Positive Results of Population Control
Four Key Indicators of
Women’s Quality of Life
Region
Latin America and
the Caribbean
Women Aged
15-44 Using
Girls Enrolled in
Modern
Primary School Contraception
1970
1990
1970
1990
89%
103%
39%
52%
Life
Expectancy
(years)
1970
1990
64
70
Fertility
1970 1990
5.0
3.2
Source: Women in Poverty: A New Global Underclass, Family Health International
Conclusions
• Humane population control cannot be achieved
with only one tool
• Education is a key component of economic development
• Population control as a development tool is a longterm undertaking
• The most effective population control policies
focus on both genders.
The End
Questions and
Answers
Preguntas y
Respuestas
Perguntas e
Respostas
Results
Costs and Benefits of One Additional Year
of Schooling For 1,000 women in
Pakistan (estimated):
Costs
Benefits
•Schooling costs for 1,000 women =
$30K
•Increase in wages = 20%
•Child deaths averted = 60
•Alternative health intervention to save 60 lives = $48K
•Total births averted = 500
•Alternative family planning costs per 500 births averted
= $33K
•Total maternal deaths averted = 3
•Alternative costs per 3 averted maternal deaths = $7.5K
Results
Source: World Population Beyond 6 Billion, Population Reference Bureau
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Monetary - Babson College