The Greatest Problem We Face!

Transcription

1 The Greatest Problem We Face! The Refrigerator Model for Human Fertility presented by: Milton H. Saier, Ph.D. UCSD, Biology Based on work conducted by: Martha M. Campbell, Ph.D. and Malcolm Potts, PhD University of California, Berkeley

2 GLOBAL POPULATION: >7,300,000,000. Growth: 156 more people every minute! 9,360 more every hour 225,000 every day ~80,000,000 every year!

3 What kind of world do we want in 2050? For how many people? With what kind of life styles? With what standards of living? With what degrees of suffering? With sustainability?

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5 The Face of Poverty

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12 Annalynn on her 9 th Birthday

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15 Exponential Growth in Finite System

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34 Philippines

35 Population/Environment is considered a sensitive subject We re not supposed to say: Successfully combating population growth will allow us to preserve the environment (ecosystems, biological species, our oceans and forests, the atmosphere, etc) for future generations. But, the human population is the one of the two most important components of the current environmental equation.

36 Ergo Since many believe that couples have the number of children they want to have, and since many believe it is difficult to bring down family size without limiting people s freedom, then, although we know that accelerating the decline in family size will help preserve the environment, Population and its relationship to the Environment remain sensitive topics. For many, it is even taboo. Many others prefer not to discuss it openly for fear of conflict. Politicians are particularly afraid because of past emotional reactions.

37 The Human Population: a contentious subject Why? It involves sensitive subjects including sex and traditional catholic values (since the 1350s) concerning birth control and reproduction. Tough ethical questions are rarely examined unemotionally & objectively. Causality is hard to define.

38 There is much disagreement about 2 questions: Is population growth a problem? and What reduces fertility?

39 A progression 1 billion 1800 > a million years 2 billion years 3 billion years 4 billion years 5 billion years 6 billion years 7 billion years

40 800 Ultimate Population Size Under Different Fertility Assumptions : Pakistan 700 Population in millions Replacement Level Fertility Reached by:

41 South Blue Nile Ethiopia 2002 : 72 million 2050: 173 million White Nile Sudan 2002: 38 million 2050: 84 million Today the Nile is dry before it reaches the Mediterranean. Egypt : 2002: 71 million 2050: 127 million Mediterranean Nile An environmental challenge: the Nile Total population dependent on the Nile: 2002: 194 million; projected for 2050: 385 million essentially doubled.

42 Sinhalese and Tamil Youth Bulges major anti-tamil rioting in Colombo, Sri Lanka Sinhalese insurgency 20% critical level Sinhalese Tamil peak Tamil insurgency Gray Fuller. CIA: The Challenge of Ethnic Conflict. Washington, DC 1995.

43 Socioeconomic (SE) paradigm People want many children until changes occur in external conditions that increase the desire to limit childbearing. These include: Education. Economic development (wealth). Assurance children will survive. People make rational decisions about family size based on socioeconomic conditions.

44 Specific problems of the socioeconomic model It does not explain the connection between decision and results. It does not consider human reproductive biology. It has not been successfully predictive.

45 Scientific theories are likely to be correct if they make correct predictions. The current, dominant SE paradigm Did not predict replacement fertility for the poor in many industrialized nations. Does not explain why the use of contraception is equally high among educated and uneducated women where family planning is easy to obtain. Cannot explain why desired family size always declines ahead of actual family size. Does not explain why Iran s fertility fell from 6 to 2 in record time when birth control was promoted.

46 The Demographic Conundrum What alternative theory would more accurately reflect the truth and be correctly predictive? For this we must consider Human Reproductive Biology.

47 Alternative paradigm the Ease model Facts: 1. Countries with easy access to family planning options, backed up with safe abortion, have low or rapidly declining fertility regardless of economic conditions or culture. 2. ALL countries with replacement level TFR or lower have access to a full range of contraception and safe abortion for ALL (including poor) women. 3. Where family planning is easy to get, contraceptive prevalence between groups of different socioeconomic characteristics falls away.

48 Time taken to go from 6.0 to 3.5 children in a family Iran

49 Total fertility rate in 1960 and 1990 for selected countries: low socioeconomic level, poor services in 1960 and Total Fertility Rate Pakistan Nigeria Ethiopia

50 Total fertility rate in 1960 and 1990 for selected countries: LOW socioeconomic level, POOR services in 1960 and GOOD services in Total Fertility Rate Colombia Bangladesh Thailand South Korea

51 Is Replacement Level Fertility Possible Without Access to Abortion? Martha M. Campbell, Ph.D. and Kimberly Adams, M.P.H. The Center for Entrepreneurship in International Health and Development (CEIHD, seed ) School of Public Health, University of California, Berkeley Hypothesis What about the anomalies? Some c ountries with high fertility have liberal abortion laws, and some countries with low fertility have restrictive abortion laws. What is going on here? Conclusions We have observed that all countries with 2 or fewer children have widespread, realistic availability of safe abortion for poor women. (We recognize that rich women have access to safe abortion in virtually every country.) We hypothesize that all high fertility countries have constrained access to abortion, and that it is necessary to have relatively unconstrained access to back up imperfect use of family planning, to achieve low fertility. (Access to safe abortion is also critically important for reproductive health, including low maternal mortality.) This graph demonstrates the relationship between countries TFR and their types of abortion laws by degree of restriction, across 170 countries. Zambia (TFR 5.3, law 4) Zambia has a liberal law but with a critical restriction: it requires approval by 3 ObGyn physicians. Few people are able to have legal abortions in Zambia. India (TFR 3, law 4) A liberal abortion law since 1970s, but restrictive in that only university-trained doc tors c an provide this s erv ice, and thos e doc tors don t liv e in mos t of India s million villages, which are home to most of India s low income people. Tajikistan (TFR 4, law 5) We don t k now about this c ountry, or similar situations in Turkmenistan, Uzbekistan, Kyrgystan. Ireland (TFR 1.9, law 1) The law forbids abortion but safe abortion services are widely accessed across the channel in England. Republic of Korea (TFR 1.7, law 2) The law is restrictive but has been interpreted liberally for decades, to make safe abortion available. Singapore (TFR 1.7, law 3) The law permits abortions for health reasons only, but it is interpreted liberally. Mauritius (TFR 1.9, law 1) Abortion is not legal and we don t k now what is going on here. One possibility: a single illegal abortion provider could make the demographic difference in a country of only 1 million people. Myanmar (TFR 2.3, law 1) Abortion is not legal but it is no secret that it is widely practiced in this country. Many procedures are done with unsafe methods. 1. What is stated in the law is less important than how the abortion providers interpret the law. 2. A country is not likely to get to replacement level fertility without access to safe abortions for low income women. Abortion Law I (26% world s population) Abortion Law II (9.9% world s population) Total Fertility Rate (%) Thailand (TFR 1.7, law 2) Abortion law is restric tiv e in language, but safe and low cost abortion services are widely available. Bangladesh(TFR 3, law 1) Abortion is not permitted, but menstrual regulation (vacuum aspiration in the first 8 weeks to bring on a late menstrual period) is a legal part of family planning. Bangladesh has over 10,000 providers of trained manual vacuum aspiration (MVA) services, only 50% of whom are doctors. Sri Lanka (TFR 2.1, law 1) Abortion is not formally legal but clinics provide large numbers of safe menstrual regulation services. Spain (TFR 1.1, law 3) Abortion is permitted for health reasons, but the law is interpreted liberally. Abortion Law III (2.6% world s population) Abortion Law IV (20.7% world s population) Abortion Law V (40.8% world s population) Spain Bulgaria Czech Rep. Italy Romania Slovenia Estonia Germany Greece Hungary Latvia Austria Belarus Bosnia Herzegovina and Lithuania Russian Federation Slovakia Ukraine Japan Portugal Croatia Netherlands Barbados Switzerland Poland Belgium Canada Cuba Sweden Trinidad and Tobago Armenia Denmark France Moldova, Rep. of Finland Luxembourg United Kingdom Singapore Korea, Rep. of Thailand China Yugoslavia Australia Georgia Norway Ireland Malta Mauritius Azerbaijan Korea, Rep. Dem. People's United States Cyprus New Zealand TFYR Macedonia Iceland Sri Lanka Guyana Kazakstan Brazil Suriname Myanmar Albania Turkey Jamaica Uruguay Chile Mongolia Tunisia Viet Nam Argentina Indonesia Lebanon Panama Fiji Israel Bahamas Mexico Bahrain Brunei Darussalam Colombia Dominican Rep. Iran Costa Rica Kuwait Peru Morocco Venezuela Bangladesh India Malaysia Ecuador Kyrgyzstan South Africa El Salvador Egypt Uzbekistan United Arab Emirates Cape Verde Turkmenistan Philippines Belize Algeria Qatar Zimbabwe Libya Syria Tajikistan Samoa Paraguay Vanuatu Honduras Botswana Bolivia Haiti Kenya Nicaragua Nepal Cambodia Papua New Guinea Sudan Swaziland Comoros Lesotho Namibia Jordan Guatemala Solomon Islands Pakistan Central African Rep. Côte d'ivoire Gambia Ghana Nigeria Cameroon Djibouti Iraq Maldives Gabon Madagascar Zambia Guinea Bhutan Mauritania Tanzania Equatorial Guinea Senegal Eritrea Saudi Arabia Benin Guinea-Bissau Lao Rep. People's Dem. Oman Togo Sierra Leone Rwanda Chad Congo Liberia Burundi Mozambique Ethiopia Congo, Dem. Rep. Burkina Faso Mali Malawi Angola Niger Afghanistan Uganda Somalia Yemen I. Permitted only to save the Woman s Life or Prohibited Altogether II. Physical Health III. Mental Health IV. Socioeconomic Grounds V. Without Restriction as to Reason Sources: The State of the World s Children 2000, UNICEF; and the Center for Reproductive Law and Policy, 2000

52 Observations All countries with 2 or fewer children/woman have widespread, realistic availability of safe abortion for poor women. (Rich women have access to safe abortion in virtually every country.) All high fertility countries have constrained access to abortion; Access to safe abortion is also critical for reproductive health, including low maternal mortality. The graph demonstrates the relationship between countries TFR and their types of abortion laws by degree of restriction, across 170 countries.

53 What about the anomalies? Some countries with high fertility have liberal abortion laws, and some countries with low fertility have restrictive abortion laws. What is going on here? Zambia (TFR 5.3, law 4) Zambia has a liberal law but with a critical restriction: it requires approval by 3 ObGyn physicians. Few people are able to have legal abortions in Zambia. India (TFR 3, law 4) A liberal abortion law since 1970s, but restrictive in that only university-trained doctors can provide this service, and those doctors don t live in most of India s million villages, which are home to most of India s low income people. Ireland (TFR 1.9, law 1) The law forbids abortion, but safe abortion services are widely accessed across the channel in England. Republic of Korea (TFR 1.7, law 2) The law is restrictive but has been interpreted liberally for decades, to make safe abortion available. Singapore (TFR 1.7, law 3) The law permits abortions for health reasons only, but it is interpreted liberally. Myanmar (TFR 2.3, law 1) Abortion is not legal but it is no secret that it is widely practiced in this country. Many procedures are done with unsafe methods. Thailand (TFR 1.7, law 2) Abortion law is restrictive in language, but safe and low cost abortion services are widely available. Bangladesh (TFR 3, law 1) Abortion is not permitted, but menstrual regulation (vacuum aspiration in the first 8 weeks to bring on a late menstrual period) is a legal part of family planning. Bangladesh has over 10,000 providers of trained manual vacuum aspiration (MVA) services, only 50% of whom are doctors. Sri Lanka (TFR 2.1, law 1) Abortion is not formally legal but clinics provide large numbers of safe menstrual regulation services. Spain (TFR 1.1, law 3) Abortion is permitted for health reasons, but the law is interpreted liberally.

54 Conclusions 1. What is stated in the law is important, but how the abortion providers interpret or are allowed to interpret the law is also important. 2. A country is not likely to get to replacement level fertility without access to safe abortions for low income women.

55 Percentage Currently Married US Women Method who had an Unplanned Pregnancy (standardized for age, parity, income and intention) Pill 2.9 IUD 6.0 Condom 14.1 Diaphragm 17.2 Spermicides 22.1 Nothing 41.2 Percent pregnant per yr.

56 Why does the paradigm matter? The socioeconomic model has had unintended consequences: Population and environmental issues are met with fear and a feeling of futility. Control of demographic fertility is politically incorrect. Foreign aid for population control is insufficient and spent unproductively; family planning is still hard to get for the poor. Population is viewed as the given in the population/ environment equation, not as a factor amenable to change.

57 What are the barriers to fertility regulation methods? Religions constrain providers Mothers-in-law are in charge. Young brides lack power. Unmarried young females are excluded from services. Prices are too high. Outlets are unreachable. Medical rules make getting contraception difficult. Misinformation about contraception. Gov t services are poor. Advertising isn t allowed. Paramedicals are not activated. Pills are either restricted or not understood. Method choices are limited. Safe abortion is hard for poor women to get.

58 Which of the barriers can be reduced on a large scale by foreign money? Religions constrain providers Mothers-in-law are in charge. Young brides lack power. Unmarried young females are excluded from services. ü Prices are too high. ü Outlets are unreachable. ü Medical rules make getting contraception difficult. ü Misinformation about contraception. Gov ts are weak or uncooperative. ü Advertising isn t allowed. ü Paramedicals are not activated. ü Pills are either restricted or not understood. ü Method choices are limited. ü Safe abortion is hard for poor women to get.

59 We must be courageous in speaking out on the issues that concern us: We must not bend under the weight of spurious arguments invoking culture or traditional values. No value worth the name supports the oppression and enslavement of women. The function of culture and tradition is to provide a framework for human well being. If they are used against us, we will reject them, and move on. We will not allow ourselves to be silenced. Dr. Nafis Sadik, Exec. Director, UNFPA, Under-Secretary of UN, at the United Nations Conference on Women, Beijing, China, September 1995

60 The Refrigerator Model of Fertility

61 Human sex and reproduction do not fit the standard economic model The nature of decision making about family size differs from rational choice in the purchase of a normally marketed good or service. Human sexual intercourse is frequent and usually unrelated to desired reproduction. The decision to have a child is not a positive one of turning childbearing on, but a negative one of turning childbearing off and negative, preventive action must be taken repeatedly, persistently, perfectly.

62 The Refrigerator Model of Fertility #SI = # refrigerators sold, (or # of pregnancies).

63 The Refrigerator Model of Fertility To buy a refrigerator: Call Sears. Send a fridge. If buying a refrigerator is like human reproduction: We must call Sears X times a week and say Do not send a refrigerator. If we fail to call Sears every time we do NOT want a refrigerator - repeatedly, persistently, perfectly -

64 The Refrigerator Model of Fertility there are consequences

65 The Refrigerator Model of Fertility and more consequences!

66 The Refrigerator Model of Fertility girl and boy frigs!

67 Important Questions Answered! 1, What were the main inaccuracies of the socioeconomic (SE) proposal? 2, What is the evidence that human fertility throughout the world is determined by the vailability of contraception and abortion services? 3, Why does the Refrigerator Model of Fertility offer a more valid view of human reproduction? 4, What are the primary goals of the UNFPA?