Youthquake

The Earth faces a future of rising populations and growing strains on the planet. Whatever else the future holds, significant population increase is inevitable and the current UN forecast of 9.2 billion by 2050 – itself a 40 per cent increase on the 6.7 billion in 2007 – may turn out to be an underestimate. The environmental damage resulting from population increase is already widespread and serious, ranging from climate change to shortages of basic resources such as food and water. By 2050, humanity is likely to require the biological capacity of two Earths. Without action, longages of humans – the prime cause of all shortages of resources – may cause parts of the planet to become uninhabitable, with governments pushed towards coercive population control measures as a regrettable but lesser evil than conflict and suffering.

The planet faces the biggest generation of adolescents and teenagers in its history – a “youthquake” with major social, political and demographic implications, not least the creation of a huge cohort of young urban males who, through frustration and unemployment, even now seek an outlet in violence. They are the engine of future world population growth - tomorrow’s parents already born, and in unprecedented numbers.

Together, these challenges demand a response from governments which recognises the important role of human numbers in policy-making. Every country – not merely those in the developing world – would benefit from a national population policy that takes environmental sustainability into account. In the UK this would cover initiatives to reduce teenage pregnancies – including new guidelines for the media – encouragement for parents to “stop at two” children, resistance to calls for an increase in the birth rate and national recognition that continuous population growth is highly undesirable and, ultimately, impossible. Far from panicking about “baby shortages”, almost every country can welcome fertility rates at or slightly below replacement level.

Crisis point

Humanity is approaching a crisis point with respect to the interlocking issues of population, environment and development. [1]

Why isn’t everyone as scared as we are? [2]

One simply feels convinced that someone – the government or God – will somehow stop it, before it disturbs our comfortable and settled lives… It takes a long time to realise that as far as looking after the future of humankind and the earth is concerned, there is no-one at the controls; but once achieved, the realisation is remarkably disquieting.[3]

The biggest cause of climate change is climate changers: human beings. Deciding to stop at two children, or at least to have one child less, is the simplest, quickest and most significant thing any of us could do to leave a sustainable and habitable planet for our children and grandchildren. [4]

Population: People feel they can’t talk about it – but there is a large unmet need for smaller family size – i.e. it is do-able, amenable to change. Consumption: People can talk about it – but there is no unmet need for reducing consumption! [It’s] more difficult to change. [5]

The current world population projection of 9–10 billion humans at final population stabilisation is a variable, not a “given”. It is a highly optimistic estimate. With widespread and continuing laissez-faire attitudes to reproductive health care (RHC), and hence no universal voluntary access by all couples (especially young people) to birth planning services, the planet may be forced to accommodate even more people, short of a catastrophic increase in death rates. In the shorter timescale of the next 40 years an increase to about 9 billion is only to be expected, because tomorrow’s parents are already born and, even if their fertility is only at replacement level, their sheer numbers will lead to many added births.

The graph above shows the remarkable similarity between the pattern, not the timing, of world population growth and that of the UK. (Issues relating to UK fertility are dealt with in Fertility: UK.). According to the UN Population Fund (UNFPA) and the Population Reference Bureau [6], almost half the world's people are under the age of 25. This includes the largest ever generation of adolescents, a "youthquake" of some 1.2 billion people between the ages of 10 and 19, the vast majority of whom - 87 per cent - live in the developing world. How many youngsters thronging the slums of the world's mega-cities will be able, as they pass puberty and enter the "sexual market-place", to access the sex and relationships education and contraceptive services they need and deserve? This vast group of young upcoming parents causes the sustained demographic momentum we are witnessing today, despite reduced birth rates in the majority of countries. This is also the basis for a vast elderly generation towards the end of this century.

Consumption

What will be the impact of an extra 2.5 billion people on the planet in 2050? The average ecological footprint (the ecological impact of humanity on the Earth) is 2.2 hectares per person, while there are only 1.8 hectares of land available per person to provide natural resources from the planet. On these measures, humans are on the latest (2003) data currently consuming about 25 per cent more natural resources than the Earth can produce.

The IUCN/WWF Living Planet Report 2006 [7] warns that, based on what it terms a “moderate” business-as-usual scenario, with demographic growth leading to a population of 9.1 billion people by 2050, relatively slow increases in carbon dioxide emissions, and the continuation of current trends in biological resource consumption, humanity will be using the biological capacity of two Earths in 2050. Given that another habitable planet is not available, might humanity have to suffer the kind of death-dictated control to achieve stabilisation, or reduction by a "population crash" - a massive cull through violence, disease, starvation or natural disasters - which biology dictates for all other species when their numbers exceed the limits of their environment's carrying capacity?

The projected requirement for more than two Earths in 2050 does not take into account the need to raise the world’s least “affluent” out of poverty. In 2007 53 percent of the world’s people - some 3.5 billion - existed on less than $2 per day. For them a rise in living standards along with inevitable increased consumption is absolutely essential. The result, however, will be additional climate change, habitat destruction and the extinction of tens of thousands of plant and animal species. Populations of terrestrial, freshwater and marine species fell by an average 40 per cent between 1970 and 2000, and already a staggering 97 percent of the vertebrate biomass is human flesh plus the flesh of our cows, pigs, sheep and other domestic animals, leaving only three per cent for all wild species [8].

Among industrialised nations, only the USA, the world’s largest economy and the third most populous country after China and India, is experiencing significant growth in human numbers. Its population is expected to climb from 300 million people in 2006 to 420 million in 2050 [6]. Already the “footprint” of an average North American is double that of a European, and seven times that of the average Asian or African. With US consumption rates so high – the USA being already responsible for 25 per cent of world C02 emissions – a massive increase in its population does not bode well for the environment. Population growth, therefore, should not be viewed as a problem to be tackled solely by the developing world. In both developed and developing worlds, the condom, the Pill, and the intrauterine device ought to be seen as symbols of a green lifestyle just as much as the bicycle [9].

Voluntarism, coercion and mortality

Most countries in the densely-populated and over-consuming minority “North” would themselves benefit from adopting a (lower) population policy. Yet many people continue to portray “any quantitative concern for population as necessarily and intrinsically coercive” [10] of poor people. This is not so. Compulsion in reproductive health is wrong-headed, has usually proved counter-productive, and need not be contemplated when so many societies are not yet adequately taking the voluntary measures. Primarily these would remove the many obstacles (see below), usually caused directly or indirectly by the male gender, and so “ensure that any woman on the planet who wants a modern contraceptive method, to be used tonight by herself or her partner, has easy access to it” [9].

Indeed, the continued inadequate resourcing of the voluntary approach is arguably the best way to ensure that many more future governments will be forced through population pressure, as they will then see it, to legislate for coercive birth control, as occurred in China in the early 1980s. Moreover, not offering so many women the choice of available and accessible contraception is by default coercive, effectively causing many compulsory pregnancies worldwide.

Other people distrust this concern with population quantity as inevitably exclusive of other key interventions: social justice - relieving poverty and gender discrimination; education, especially for the empowerment of women; or improving child survival. This emphatically does not need to be true – the approach should be not “either-or” but “both-and”.

In developed countries research has led to an increasingly wide choice of contraceptive methods. Worldwide, however, nearly 350 million couples, more than a third of all couples, still lack access to a full range of family planning services to enable them to space their children or limit the size of their families, and this number is expected to grow by 40 per cent in the next 15 years [11]. Many for cultural and “social security” reasons still want large families, yet large-scale surveys have shown that at least 50 per cent wish to prevent another pregnancy. “Every minute in the world 380 women become pregnant, and of those 190 did not plan to do so” [11]. We are failing to push at the open door marked “contraception”.

It’s also the case that women cannot die from a pregnancy they don’t have. Yet every minute one woman dies through unsafe induced abortion, pregnancy or childbirth, totalling over half a million per annum [12] (estimates vary because the data are hard to collect). The figures suggest that at least 35 per cent of those women are being killed by pregnancies they would have avoided, if they had had the contraceptive choices women in the North take for granted [12].

Abortion

The above figures on unwanted pregnancy suggest a vast unmet need for the provision of contraception and reproductive health services. There is more clear evidence of this in the fact that about 50 million of the roughly 190 million conceptions worldwide each year end in abortions. Up to half of these procedures are clandestine, performed under unsafe conditions, and around 68,000 women die from complications of unsafe abortions each year – almost all in developing countries.

The majority in the international community has agreed that reproductive choice is a basic human right. But, as the UNFPA rightly says, “without access to relevant information and high-quality services, that right cannot be exercised”. The opponents of international family planning, such as the Bush administration in the US (see box on The global gag rule) thus effectively cause many abortions – although neither they nor their supporters are favour of abortion as a means of family planning. Indeed support for high-quality services in contraception and sterilisation - with the goal that, in the words of the slogan, abortion should be “legal, safe, and rare” – is virtually universal.

Continuing pregnancies

All women would benefit from having realistic choices to enable them to control their fertility, but this applies above all to those having the most dangerous pregnancies – dangerous both for them and for their babies. These are the “four toos”, those pregnancies that occur:

• Too young – just post puberty.
• Too old – before the menopause.
• Too many – more than the family’s resources can provide for.
• Too often: if babies are spaced by less than 18 months, this trebles infant mortality compared with a 36 month interval [11] - as well as risking the mother’s health.

Regardless of concerns for the planet, reproductive health care saves lives, the lives of millions of women and their offspring. It is also highly cost-effective for governments. A USAID study in 1994 showed that for each birth averted, at an outlay of 64 Egyptian pounds, there would be a saving for Egypt of £E1,250 per five-year primary school course – a 20-fold benefit, before even factoring in the savings on health or housing [13].

UNICEF has concluded that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race” (James Grant, UNICEF Annual Report 1992). It is thus something of a paradox that fertility regulation is so often stigmatised as “anti-life”– indeed is widely treated as a taboo subject.

Alleviating poverty

Halving extreme poverty between 1990 and 2005 is the first of the eight Millennium Development Goals (MDGs) set by the UN in 2000. In 2006 the UK’s All Party Parliamentary Group on Population, Development and Reproductive Health examined the impact of population growth on the MDGs and in its report Return of the Population Growth Factor [12] concluded: “The evidence is overwhelming: the MDGs are difficult or impossible to achieve with the current levels of population growth in the least developed countries and regions” – a conclusion in line with most of the arguments advanced in the present report.

As already stated, more than half the world’s population currently struggles to survive on less than $2 a day, with multiple deprivations, bad sanitation and poor health – all the worse for women because of gender inequality and abuse. Population growth increases, yet it is also increased by, poverty - two apparently contradictory statements that are in reality both true.

Poverty is increased by population growth. It is difficult for a resource-poor country with rapid population growth to reduce poverty, even if the economic “cake” is growing, because each slice must continually be divided between ever more individuals. The 0.9 billion increase in population forecast for the 50 poorest countries by 2050 will wipe out gains faster than they can be made, whether in agriculture, healthcare, education or basic literacy. For example, an extra two million teachers are needed in the world each year just to educate the new arrivals [12]

Yet is also undeniable that population growth is increased by poverty. In rural poverty, reduction of family size appears disadvantageous – as the Chinese saying has it, “every mouth has two hands”. The labour of each new child in the family is welcomed, as a form of social security for sickness and old age. High child mortality also tends, unsurprisingly, to reduce interest in birth planning until a relatively high average family size is achieved. This scenario tends to be emphasised by development agencies, which ignore the way population growth perpetuates poverty by increasing the number of individuals to share the resources - notably the basic resources of land and water - available to each family or country. Often NGOs view increasing numbers passively, as a demographic fact that just has to be coped with by development – in effect, “predict and provide” on a global scale.

Since both these statements are true, in combination a vicious circle is created, reinforced by theories that link economic development to reduced family size – notably the demographic transition.

The standard economic demand-side paradigm focuses on increasing per person prosperity. Those who believe that this “demographic transition” is the only way a country lowers its family size maintain that as per capita wealth increases and more citizens, particularly women, are educated, so child survival improves, the perceived costs of children rise and the “social security” advantages of having more children are reduced. Women, it is hoped, then find ways to contracept. Family planning provision, the argument goes, may thus take a back seat until that point.

But what if poverty is not relieved? One might wait then endlessly for the prosperity-induced change in women’s average family size preference that the classical demographic transition model depends upon. Indeed, while waiting, a country’s wealth per capita tends to go down, as shown clearly in Table 1 for just one example, Ethiopia. The vicious circle needs to be broken, primarily by the removal of fertility control barriers to women.

An assumption of the standard demographic transition model is that in high fertility countries women want the large families they end up having. But much evidence shows this is not so. Almost no women anywhere want the biological maximum of 10 or more. Frequent coitus is the norm, not necessarily higher than in developed countries, so all babies above the number preferred have to be actively prevented. The crucial differences that separate high fertility countries from low fertility countries are:

• a fatalism about children arriving (“it is God’s will”)
• a lack of the understanding - which comes through education and the arrival with it of correct information (see box on Family Planning and Post-It™ notes) - that there is any realistic option that babies might come “through choice not chance” and
• simple lack of access to contraceptives

Many developing countries have reduced their total fertility rate (TFR) - their “average family size” - to close to two – and have done so about as quickly as China, but without the coercion that exists in China. They include Costa Rica, Cuba, Iran, South Korea, Mexico, Morocco, Sri Lanka, Taiwan, Thailand, Tunisia, Vietnam and - surprisingly, perhaps - South India. These low-fertility “success stories” often involve vastly different developing countries or regions but have one factor in common. Their governments recognised the population-poverty connection and took steps to remove the barriers to fertility planning.

Studies of such very different locations which have successfully lowered their TFR show that whatever else applies, including changes in prosperity, the key requirement - which can also be implemented much more quickly - is the removal of barriers to contraception. These barriers are widespread and include simple lack of access to the contraceptive methods themselves, ignorance and misinformation, some of it deliberate - for example, exaggerating the risks of a method. When these barriers are removed, through education and good use of the media, and contraceptives become easy to obtain, education and per capita wealth have virtually no extra impact on the use of contraception or family size. The chances of per-person prosperity increasing are also much improved, since there are fewer persons to share in the country’s wealth. This is the demographic dividend [12].

Iran succeeded in halving its TFR in just eight years, from a family size of 5.2 children in 1988 to 2.6 in 1996. This was through a conscious government decision in 1987, after a census, to reduce the country’s rapid population growth rate in order to aid its development. Iran’s reproductive health success story occurred in part through the removal of obstacles to women choosing to control their fertility, including perceived religious obstacles through Islam, which Iran’s own religious scholars issued edicts or fatwas to refute. A second key factor was ensuring an efficient supply chain of a good range of contraceptives through a countrywide network of “health houses”. Importantly, this was a voluntary “two-child” population policy, yet the rate of decrease in Iran’s TFR was just as fast as that of China, whose “one-child” policy began in 1980. (See Figure 2)

Removing the barriers and offering women choices to control their own fertility, as surveys [12] show is already desired by many, seems in many countries to have kick-started a virtuous spiral of fewer babies, improved survival because of better spacing, more wealth per capita in each family, more acceptance of smaller families and more desire for and use of voluntary birth control. This is a situation in which everybody wins, yet the majority of development NGOs still refuse to acknowledge it.

Thus the old slogan “development is the best contraceptive” is out-of-date – in reality a contraceptive is the best contraceptive. The vicious circle of population growth and poverty can be broken, without coercion. International aid, therefore, needs to include - much more commonly as part of any package - comprehensive, affordable and fully accessible birth planning services, so that ultimately no one who wishes to control their fertility is denied the means to do so. This must include well-targeted provision, along with sex and relationships education, for the young women in the world’s burgeoning slums who comprise the main engine of future world population growth.

AIDS and family planning

Worldwide, over 40 million adults and children are living with HIV/AIDS (2007 estimate). The 20-year action plan agreed by the 179 participating countries at the 1994 International Conference on Population and Development (ICPD) in Cairo promised to increase annual spending on reproductive health care and education to US $17 billion by 2000. This annual sum was intended to include contraception and all relevant care for HIV/AIDS. Donor nations pledged to provide one-third of the total investment, while developing countries promised to provide the rest.

However, while aid levels have increased moderately, donors would still need to triple their giving to meet ICPD goals. No more than about $5-6 billion is currently forthcoming from the international community – and because of the perceived greater urgency and expense of HIV/AIDS services, less than 10 per cent of this sum is available for establishing and maintaining an adequate supply chain of contraceptives for all who wish to use them. HIV/AIDS work, especially in prevention, must of course be fully funded; however, this should be additional to comprehensive resourcing of international family planning. Indeed, the devastation caused by AIDS is a central argument for prevention through good comprehensive “joined-up” reproductive and sexual health care. Over and above the issue of numbers and sustainability, such holistic services should be fully funded in all countries, as a human right and as key interventions for improving the health of women, their partners and their children [9].

Future fertility policy: world

Contrary to perceptions, population problems do not just occur “overseas”. The UK, for example, has a greater population density than China. It also followed a remarkably similar growth curve to the rest of the world (see first chart above), only differing by having its exponential growth phase a century earlier than in most developing countries. It has not yet stabilised.

Given increasing resource scarcity, therefore, the central conclusion is that every country would benefit from having an environmentally sustainable population policy. And, as recommended by a Royal Commission as far back as 1949 [17], the UK could and should set a good example.

Continuous population growth must be fully recognised by voters and politicians – through better environmental education – as impossible, both globally and in the UK. One consequence of this is that fertility rates at replacement level or slightly below replacement level can be welcomed by almost every country. Panics about “baby shortages” are misplaced.

What might these principles mean in practice? First, efforts to encourage, voluntarily, small families by education – “stop at two, or have one less” – should be maintained, and should include an environmental justification (which now resonates for people even in developing countries). Fiscal incentives specifically intended to encourage women to have large families should always be opposed. Employment and taxation policies that enable women to combine careers with bringing up small families should be encouraged.

More generally, education and women’s empowerment in the area of reproductive and sexual health and the removal of all obstacles to birth control, together with the services to deliver the means of contraception and safer sex, need to be given the highest priority in all countries. This must include reducing gender discrimination and sexual abuse in its many forms together with removal of the barriers to women’s control over their fertility, many of them caused by men - or by religion. These barriers include the infamous sexual double standard – husbands arguing that a wife who has contraception cannot be trusted not to go with other men while ignoring their own relationships with other women.

As we have seen, if family planning is available it is wanted. Resourcing an effective supply chain for methods of family planning should be made a priority in every country. This applies especially to long-acting methods such as injections, intrauterine devices and implants (discussed below). As pioneered by Marie Stopes International, this supply chain should avoid medical barriers by primarily using so-called “social marketing”, through small shops and pharmacies, with subsidies to bring down the price for the consumer. It should include not only condoms but also over-the-counter provision of emergency pills, the regular Pill and injections.[12]

Sterilisation, for males (vasectomies) as well as females, is another option that must be readily available, as a choice among other methods. The fact that it is not easily reversible poses problems, given the increasing rate of relationship breakdown. Moreover in many countries high child mortality is a factor. If, as is often the case, female sterilisation is the only effective method available it will be used late and not accepted until the family size includes a wide “safety margin”. Experience from the successful countries cited above suggests that if women can select earlier in their lives from the widest possible range of reversible methods – especially the long-acting reversible contraceptives (LARCs) such as IUDs, injectables and implants, all of which are nearly as effective as female sterilisation – they start using effective contraception at a much smaller family size [15].

Education is of paramount importance and must involve the media in providing correct information about methods of contraception and correcting misinformation. For example, there is a widespread myth in Rwanda that to take the Pill will lead to permanent infertility. Moreover it is widely believed everywhere in Africa that contraceptives are “dangerous” and it’s better to be “natural”. Yet the “natural” risk in a woman’s lifetime of dying from pregnancy, including unsafe abortion, is between 1:10 and 1:20 in sub-Saharan Africa whereas it is 1: 30,000 in Sweden, where contraceptives are universally used.

The independent media can play a part by broadcasting information about contraception that is accurate and impartial. TV and radio story-lines need not and should not encourage unplanned pregnancy. Indeed, as the box on soap operas describes, soaps are being successfully used to promote contraception and safer sex, and these success stories need to be replicated in more countries, not least the UK. Where appropriate, this could take place through the development of media-industry guidelines (see below).

Efforts to reduce teenage pregnancies, in particular, should be continued and strengthened. Given that one third of the world is under 20 (the figure is above 50 per cent in many African countries [6]), and given also that an early start to childbearing correlates with larger numbers of children per woman, this is of paramount importance in all countries. Some countries may find it appropriate, after full and democratic consultation, to bring in incentives for parents to have small families. These might include tax allowances, benefits and other social subsidies, such as maternity or paternity leave, which taper off after the second child, but with the proviso that “safety net” arrangements are in force to ensure that children from later births do not suffer.

One-child population policies should be the last resort, limited to emergencies such as so-called “demographic entrapment” where the environment of a region is so damaged as to approach being uninhabitable:

• They are unnecessary in most countries, given the successful outcomes in countries such as Thailand, Iran and Sri Lanka (see above) where two-child policies have been properly applied through education and high-quality fertility regulation services.
• They are liable to be neglectful of the human rights of some women, and of additional children who arrive despite the policy.
• They are counter-productive whenever coercion is alleged – even if in reality it is absent or uncommon.
• They are also prone to exacerbate gender imbalance, specifically an excess of young men. Given ever-increasing youth unemployment, one worrying consequence is that there may be few outlets for the testosterone-fuelled frustration of young males aside from violence.
• In the long term one-child policies will not be necessary, since after a population has stabilised and reduced to an environmentally sustainable level, a TFR of just above two would maintain this level.

Fertility policies and recommendations checklist

• Every country would benefit from an environmentally sustainable population policy.
• Fertility rates at or slightly below replacement level should be welcomed.
• Efforts to encourage, voluntarily, small families by education and through the media – “stop at two or have one less” – should be maintained and promoted.
• Fiscal incentives to encourage women to have large families should be opposed.
• Women’s empowerment in reproductive and sexual health should be given the highest priority.
• New guidelines should be developed for the portrayal of sex and fertility issues by broadcasters, print media and internet service providers.
• Obstacles to birth control should be removed, contraception and safer sex services prioritised.
• Challenges of the global youthquake should be recognised, with a special emphasis on preventing teenage pregnancies, in the UK and worldwide, and particularly in the slums of the planet’s new mega-cities.

References

1. Statement from the Science Summit on world population, New Delhi, 1993, signed by representatives of 60 of the world’s academies of science. Population – the complex reality, Ed: Graham-Smith, the Roya l Society, London, 1994.
2. First chapter title, and contained statement, in The Population Explosion, Ehrlich & Ehrlich, Arrow Books, 1990.
3. John Davoll, Lecture to the Conservation Society, 1970.
4. John Guillebaud in OPT Press release quoted in “The Guardian” http://society.guardian.co.uk/societyguardian/story/0,,1817797,00.html, 12 July 2006.
5. Martha Campbell, Annual Meeting of Population and Sustainability Network, 2005
6. World Population Data Sheet 2006, http://www.prb.org/pdf06/06WorldDataSheet.pdf
7. IUCN/WWF Living Planet Report 2006 http://www.footprintnetwork.org/newsletters/gfn_blast_0610.html
8. Mathis Wackernagel 2005 In:“The Ecological Footprint”. Bullfrog Films, Northcutt Productions, GFN, 3270 Lakeshore Avenue CA 94610.
9. Guillebaud J. A Statement for the World Summit on Sustainable Development (rev 2007): “Population, the factor being forgotten or denied?”
10. British Medical Journal, pp 931-34, 977-997. Overpopulation, Overconsumption: Special issue (to mark the arrival of the 6,000 millionth human) 9 October 1999.
11. State of the World Population, 2004/5/6/7. http://www.unfpa.org
12. Return of the Population Growth Factor” 2007. Report of Hearings by the All Party Parliamentary Group on Population, Development and Reproductive Health, downloadable from http://www.appg-popdevrh.org.uk.
13. Guillebaud J. Correspondence on “After Cairo”, British Journal of Obstetrics and Gynaecology 1996;103: 91-96.
14. Campbell M. Consumer behaviour and contraceptive decisions: resolving a decades-long puzzle. Journal of Family Planning & Reproductive Health Care 2006; 32(4): 241-244.
15. Guillebaud J. Post-it Notes and family planning. South African Journal of Obstetrics and Gynaecology 2007; 72-73.
16. Caldwell JC. The globalization of fertility behavior. In: Bulatao R, Casterline J (eds), Global Fertility Transition. New York, NY:Population Council, 2001: 93–115.
17. Royal Commission on Population. Cmd.7695.London: HMSO, 1949. http://www.bopcris.ac.uk/bopall/ref9680.html

See other briefings on this website for policies on Migration and Ageing and unemployment.