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Population Connection Volume 48, Issue 1 March 2016

Inside This Issue:


A Country that “spans the world’s demographic spectrum”

„„ The Young Continent: With Fertility Rates Falling More Slowly Than Anywhere Else, Africa Faces a Population Explosion „„ More Countries Want More Babies: An Analysis

President’s Note

Hand-wringers in Japan and Germany, for example, point to fewer workers per retiree (a measure called the “old age dependency ratio”). But they ignore the all-important ratio between workers and youth. A smaller proportion of youth dependents can largely or even entirely offset the rise among those who may age out of the workforce. In 1960, Japan had a total (young and old) of 56 dependents for every 100 working-age people. By 2010, it was virtually unchanged at 57 dependents. In Germany, it went up slightly, from 48 to 52. These are small shifts of no great consequence. Note also that the U.S. dependency ratio improved greatly during this same period, from 67 to 50. Aging doesn’t necessarily equal dependency. The fact is that most older people are in pretty good shape. A sore knee here, modest hearing loss there. Many would prefer to keep working in some capacity. We need to banish the “rectangularization” of age groups, which assumes that 65+ is some sort of mandatory “no work” zone.

glasses, brought productivity of older workers up to the same level as their younger counterparts. And older workers have lower absenteeism and lower turnover. Also, as the head of Germany’s Bundesbank remarked, “The young can run faster, but the old know the shortcuts.” Germany now has 1.4 children per family. Thus, it is already near the bottom of the fertility ladder. Lower fertility and stable, even declining, population does entail some once-and-done adjustments. Fewer elementary schools and more life-care communities. Fewer pediatricians and more gerontologists. These are not wrenching societal shifts. You’d think a world beset with climate change, civil unrest, and species extinction—all linked to increasing human population—wouldn’t need to invent imaginary problems. With yet another billion people added to the planet every dozen years, population growth still ranks at the top of planetary concerns. Let’s cross going gray off that worry list.

Smart employers should follow the example set by Germany’s BMW. Modest changes, such as wooden floors and magnifying

In Remembrance My friend Searle Whitney (1944–2015) cared so deeply about our natural world that he created the Institute for Population Studies in his beloved Berkeley (California). Its mission: “[T]o remove the obstacles that keep population from being seriously and rationally discussed in public discourse, and empower people to determine, reach, and maintain the best population size for their families, regions, and the planet.” This reflects our own mission as well. Searle was a generous, unflagging supporter of Population Connection. His good humor echoed Indra Devi’s insight that “Laughter drives shouting away.” Both gentleman and gentle man, Searle found the strength to respond to a churlish world with grace and conviction. We miss him. Population Connection — March 2016

John Seager

Lora Schraft/Chief Photographer, Hollister Free Lance


eople, it seems, are getting a bit older. Not very exciting, eh? Well, it’s raising alarms. In fact, 56 nations now have policies to raise fertility, four times as many as 40 years ago (see “More Countries Want More Babies” on page 20).

Population Connection Volume 48, Issue 1 March 2016

Board Chair J. Joseph Speidel, MD, MPH Board of Directors Amy Dickson, Duff G. Gillespie, Padgett Kelly, Anna Logan Lawson, Sacheen Nathan, Dara Purvis, Estelle Raboni, Tom Sawyer (Treasurer), Carol Vlassoff, Jo Lynne Whiting (Vice Chair), Hania Zlotnik (Secretary) President and CEO John Seager Editor Marian Starkey Authors Joseph Chamie, Brian Dixon, Rebecca Harrington, Barry Mirkin, John Seager, Marian Starkey, Pamela Wasserman Proofreader Skye Adams Population Connection (ISSN 2331-0529) Population Connection is the national grassroots population organization that educates young people and advocates progressive action to stabilize world population at a level that can be sustained by Earth’s resources. Annual membership ($25) includes a one-year subscription to Population Connection magazine. All contributions, bequests, and gifts are fully taxdeductible in accordance with current laws. Population Connection 2120 L Street, NW, Suite 500 Washington, DC 20037 (202) 332-2200 • (800) 767-1956

Features 8 The Young Continent: With Fertility Rates Falling More Slowly Than Anywhere Else, Africa Faces a Population Explosion By The Economist

20 More Countries Want More Babies: An Analysis

By Joseph Chamie and Barry Mirkin

Departments 2

Editor’s Note


Letters to the Editor


Pop Facts


The President’s Circle


Washington View


Field & Outreach

30 PopEd 32 Cartoon 33

Editorial Excerpts

Cover Photo

A father and son visit the local health post in the Amhara Region, Ethiopia. © SC4CCM/JSI, Courtesy of Photoshare

March 2016 — Population Connection


Editor’s Note

Baby Bust.

Birth Dearth.

Silver Tsunami. These catchy, if not helpful, terms are often used to describe the unprecedented phenomenon of low fertility that Europe and East Asia are experiencing, and that some fear the United States will experience if our country’s fertility rate doesn’t continue to hover around the replacement rate of 2.1 births per woman. It’s true: 83 countries have fertility rates below replacement level. Yet almost all of those 83 countries have populations that are still growing or remaining stable, due to population momentum. Japan’s population is one of the rare few that has begun to shrink—it has been declining for nine years now, with a reported net loss of nearly 300,000 in 2015. Politicians are frantically trying to increase Japanese fertility, suggesting cash bonuses, flexible work arrangements, and more government-run day care programs. But that’s all likely in vain, at least at the macro level, as there is no country in history that has gone to very low fertility and then risen again. Once small families become the norm it is difficult, if not impossible, to encourage couples to have more than one or two kids, on average. Many writers who wish to incite panic and prompt pronatalist policies would leave the story there and let people’s imaginations run wild. What they would be overlooking, however, is that there are more than 100 countries with fertility rates above replacement— mostly in the poorest parts of the world (see Pop Facts on pages 4-5 for a depiction of the data). In about 40 of those countries—almost all in sub-Saharan Africa—women have an


Population Connection — March 2016

average of four or more children. In those countries there is no need to worry about “running out of people” now, or any time this century (which is as far as most population projections go). Japan would have no trouble attracting immigrant workers from other parts of East Asia and elsewhere, but people there don’t want to disrupt their country’s homogeneity (99 percent of people living in Japan are native Japanese). They would rather develop robots to do jobs that Filipino or Indonesian immigrants could do if given the opportunity. Which is their prerogative. But it’s insincere to make people believe that encouraging Japanese women to have more children than they want is the only way to keep the economy from tanking. My first trip overseas was to Japan when I was 13 years old. I’ve returned twice since, and am still in touch with my host family from 22 years ago. I hope to return again someday because I love the food, the landscapes, the kind and generous people, and the incredible sense of order and efficiency (which is often attributed to the aforementioned homogeneity). I don’t begrudge them their cultural preferences. But I do take issue with anyone who tries to guilt women into having additional, unwanted children for the sake of the state’s GDP. There are plenty of ways to manage a transition to low fertility, many of them outlined in the feature articles within. In the meantime, we’re still adding another billion people to the planet every dozen years. That doesn’t sound like a baby bust to me.

Marian Starkey

Letters to the Editor

Send correspo

ndence to marian@popc Letters are also accepted via postal mail. Le tters may be edited for clar ity and length .

The cover of the December 2015 issue of Population Connection states: “Next U.S. president could help tens of thousands of women and girls with the stroke of a pen.” Why should we wait that long? Marian Starkey points out that Population Connection has been pushing President Obama in this direction. We should push even harder and get Obama to sign an executive order that clarifies the Helms amendment now, to save the lives of some of the 47,000 women who die each year from botched abortions. George Webb, Ph.D. Professor Emeritus Department of Molecular Physiology and Biophysics College of Medicine, University of Vermont We agree, and continue to push President Obama to act. We have submitted a petition with some 700,000 signatures urging action and, with allied organizations, continue to make the case. But even if President Obama does act, we need the next occupant of the White House to be fully engaged and committed to ensuring that the policy change is implemented. That’s why we’re working to make sure that every candidate—in both parties—is asked about this topic and pushed to take a stand. —Brian Dixon, VP of Media and Government Relations After the excellent attention given to water in the July 2015 issue of Population Connection, it is sad but important to note the extent to which potable water supplies around the world are being poisoned with arsenic. This topic, reported in the January 2016 issue of Scientific American, is primarily the result of growing populations in India and elsewhere.

Attn: Marian St Population Co


nnection 2120 L St., NW , Ste. 500 Washington, D C 20037

When will our “leaders” get it? When will someone of high political influence have the courage to bring the topic of human overpopulation to the forefront of discussion in a public forum? When will the impacts of human overpopulation become a topic or even a question during the presidential debates? Why is it such a taboo topic of discussion? How can we change that? It is only when our political leaders have the sense that discussion of this topic will not bring an end to their respective candidacies that we will have a chance to make the necessary larger strides towards change. As I have stated in letters to several environmental, conservation, and wildlife organizations, members of the congressional delegation from my home state of Rhode Island, and the Vatican (shortly before Pope Francis succeeded Pope John Paul), climate change and human overpopulation are the two biggest issues of our time. We cannot expect to effectively deal with the impacts of climate change, nor stop fueling that fire, without addressing and resolving the human overpopulation crisis. Keep up the good work and keep pressing for change. Somehow you/we need to find some major political leaders that are willing to start discussing this topic in major public forums, and hopefully it will be the topic of a presidential debate this year. For without it, we will simply continue to monitor the negative impacts with no apparent end in sight. Dave Brunetti Harrisville, Rhode Island

Gale Corson Santa Rosa, California

March 2016 — Population Connection



Population Connection — March 2016

Design by Rebecca Dodelin

March 2016 — Population Connection


Population Connection thanks the 2015 members of our President’s Circle, who provide core support for population stabilization with their cumulative giving of $1,000 or more throughout the year. We are grateful to them for their generosity and dedication! If you don’t see your name here, or would like to update the way we recognize you for your support, please contact Shauna Scherer at or (202) 974-7730. E. Curtis & Eva Lou B. Aanenson Gretchen G. Adams & Robert R. Hoyes Audra Adelberger Mariette Allen Randy Arnold & Patricia Fair Janet Jeppson Asimov Donald Ayer Kent P. Bach Julia Bailey William E. Baird Greg & Kate Bakkum Mary Barkworth Jill Barnes Edwin & Janet Bartholomew Mary L. Bartlett Ralph L. Bass Jr. Eliot Bean Brett & Tanya BeGole Donald Bell Raymond Bellamy David J. Benefiel James R. Bennett Robert Berg & Carol Emerson Eleanor Berry Fred A. Berry Jeanne Berwind Fred Betz Margaret A. Biggar Rex Bigler David & Annie Bingham Diana Bingham Roger W. & Edith R. Binkley Alan Black Amy Blitzer Joseph Blum Thomas Bosserman Thomas & Marilyn Breckenridge Mary M. Brock Doane R. Broggi Christopher Brown & Susan Urquhart-Brown Lester Brown Lois Bueler Lawrence Buell Paul Burtness Nancy A. Busacca Lisa & Trey Calfee Elizabeth & Gerald Caplan Jerry Carle Sally Cartwright William Cascini Gretchen Chambers Pakhi Chaudhuri Dave Chizek Jonathan Claassen Hilary P. Clark Susan Clark Spencer Clevenger Cindy Cobb


Population Connection — March 2016

Clifford & Carolyn Colwell Janet M. Conn Richard Cook Christina Coolidge Phoebe Cowles Walter Crager Andrew Crowley Christine Curtis Allan L. & Kendra Daniel Gene L. & Linda Daniels David Darwin Eugene L. Davis Linda DeLap Edward E. & Julia DeMartini Jeffrey Dennis Paul C. Deutsch Sarah C. Doering Henry C. & Mary McEwen Doll Evelyn H. & Earl Dolven Julian & Katharine Donahue Fay Dresner Donna Duncan Jim & Maggie Dunn J. Christian Edwardsen Stanley Eisenberg Charlotte Elsner George Emmons Herb Engel Steven Engel Thomas W. & Sarah Faulkner Celia A. Felsher Norborn M. Felton Martha F. Ferger Robert H. & Elizabeth Fergus Mary Fleming Finlay Gail Fliesbach Kathie R. Florsheim Charles & Charlotte Fowler Raymond & Maxine Frankel Marie E. Fraser Daniel A. & Karen Ann Friderici Jed Fuhrman E. Marianne Gabel Leslie Gall Brian & Bina Garfield Paul T. Gaughen Don C. Gentry Paul L. & Barbara Gerhardt Duff G. Gillespie P. Roger Gillette James S. Gilliland Pete Glasier David & Alena Goeddel Krishna Gopinathan & Shuva Mukutmoni Reyla Graber Emily L. Grant Thomas & Elizabeth Gratzek Richard Green

Julia A. Gregory Carol D. Guze Elaine G. Hadden Robert Haegele Christina N. Hammond Jessie M. Harris Alexandra Harrison Robert Harrison James E. Haswell Mark J. Hausknecht Robert & Rosemary E. Heil Robert W. Hellwarth Steve Henderson Donald H. Henley Theodore W. & Margie Henning John W. Hering Richard & Beverly Rae Hermsen Louis J. Herskowitz William W. Hildreth John Hirschi Eric & Susan Hirst Jerre A. & Nancy Hitz Liselotte B. Hof Joyce Homan Catherine Houghton John Houston & Katherine Read Linda Howard Cynthia Hubach Robert Huston Jay A. Jacobson Robert H. Janes Max & Rachel Javit Jerry Jedlicka C. Bradford Jeffries Dorothy Jenney G. G. Johnson K. Malcolm Jones Randal E. Jones Henri Pell Junod Jr. Barbara Kaneshige Sally B. Kaplan Richard & Diana Kasper Richard R. Kauffman Ann Peckham Keenan Alexandra Keith Dennis G. & Joanne Keith Vicky & Grant Kemp Susan M. Kennedy Thomas F. King Graydon C. Kingsland Terry Kitson & Paula Sherman Jan & Chen Koch-Weser Jerry A. Kolar Paul V. Konka Hunt & Linda Kooiker Melodee Kornacker George Krumme Matt W. Krummell

Peter Kunstadter George & Elisabeth Kurz Keith Kusunis William E. Lafranchi Paul Lampert Jim Lampl Kenneth L. & Priscilla W. Laws Thomas & Anna Logan Lawson Edward & Kathryn Lee David Lehnherr Kurt Leuthold James & Susan Lindsay Arthur D. Lipson & Rochelle S. Kaplan Peter Livingston Peter B. Lucas Perry J. Luke Elizabeth Luster Cynthia A. Mahoney William Marks George & Sheila Marshall Wayne Martinson David T. Massey Christopher & Catherine Mathews Rick & Linda Maxson Richard McCabe James L. McClelland & Heidi Feldman Rick & Shirley McDonald Gregory B. McKenna Rajalaxmi McKenna John Mesching Jeff Messerschmidt Dennis L. Meyer Lincoln C. & JoAnne P. Miller Michael F. Miller Joyce A. Milligan Douglas Mittelstaedt Russell Moffett Sandra J. Moss Denny Mullen Anna S. Murphy William T. Naftel Sherrie Nagin John & Shirley Nash Sacheen Nathan Jeffrey Nelson Lyle E. Nelson Alice P. Neuhauser & Thomas R. Conroy Kathy & Alvin Neumann Linda Nicholes David R. Nichols Margery A. Nicolson Michael Niebling Steven Nierlich & Tienne Lee Heidi Nitze Austin & Martha Nobunaga Robert Z. & Nita Norman Harold Oaklander William Oettmeier Roman Oliynyk & Maureen Hackett Gilman Ordway George W. Orr Julie Osborne David Owen Kathleen Owens & Morse J. Wilkenfeld Carl Pacini William & Carol Palladini Michael L. & Ann Parker Georgene Pasarell Mary Pearlman Joan & Garald Pease Fredric W. & Mary L. Pement

Donald F. Petersen John Petro & Jane Clayton Bob Pettapiece Frank A. & Judy C.M. Pezzanite Mary C. Phinney Richard Pillmore Joseph G. Pittman Paul Popenoe Jr. Stuart E. Porteous Ken Powell Felix Prael & Carol Plantamura Martin Prince Warren Pruess Jerry Radinoff & Paula Siegel Joelle Raichle Judith E. Randal Ralph A. & Arlene F. Reed Thomas Reifsnyder Ann F. Rhoads Brenda Richardson Marie W. Ridder Arthur & Jane Riggs Susan E. Rittenhouse Rob Robinson Larry & Alice Rodgers Sylvia Rose William Rosen Paul W. Rosenberger Bob Rowen Donald Royer Milton H. & Jeanne W. Saier Mo & Carole S. Salman Richard Schablowsky Stephanie & Brian Schaffhausen Michael Scher Henry S. Scherer Jr. Robert & Beth Schlechter Ray & Betty Schofield Peter Seidel Patricia Serrurier Richard Shanteau Jamie Shaw & Christopher Cope Timothy C. Sherck James M. Shultz Nancy M. Shurtleff Linda Siecke Ruth L. Siteman Jeffery Sliter Emil Slowinski Ross A. Smith Susan M. Sogard Laura Somerville Zig Sondelski Pete C. Sparks Richard Speizman & Faith Horowitz Stuart & Shirley Speyer Paul G. Spink Fred Jr. & Alice Stanback David Starr Norton Starr Theodore L. Steck & Yvonne Lange Willliam P. & Diane Steen Bruce Steiner Sybil Stoller Philippa Strahm Martin Strain John R. Stuelpnagel Edwin Sved Bill Swanson Susan H. Talbot Helen Taplin

Lawrence Tarone Thomas Tarpey & Carolyn King Sheri Tepper Kay Thornton John & Anna Marie Thron Howard Tidwell William Towle Don M. Triplehorn Helen Tryon Jonathan Ungar Thomas VanZandt Dave & Christine Vernier Ralph & Ianita Wagner Irene & Robert Wakeland Brooke Walker Margaret Wallace William Warburton John Weeden David Welden Kevin J. Whaley Peter Wheeler & Elizabeth Munro Jo Lynne Whiting Wayne G. Whitmore Jeffrey & Nancy Wilde Alan Wilkinson Michael & Mary Louise Williams Michael Williamson Theodore W. & Gertrude K. Winsberg Anna L. Wooldridge Roger & Ann Marie Worthington Anthony Wright S. Paul Wright Caryn Wunderlich John Zapp Foundations Anna Paulina Foundation Bluestone Foundation Educational Foundation of America Erik E. & Edith H. Bergstrom Foundation McBride Family & Aspen Business Center Foundation McCullough Foundation Michael and Ina Korek Foundation Nina Abrams Fund Philip Birnbaum Foundation Inc. Ranae DeSantis Foundation Sarah Beth Coyote Foundation Shenandoah Foundation The Furnessville Foundation The Gladys & Ralph Lazarus Foundation The Haddock Family Foundation The Laney Thornton Foundation The Louis and Harold Price Foundation The Mike and Corky Hale Stoller Foundation The Moses Feldman Family Foundation The Suwinski Family Foundation

March 2016 — Population Connection



ith Fertility Rates Falling More Slowly Than Anywhere Else, Africa

Faces a Population Explosion Originally published by The Economist

A newborn at a regional hospital in Hawassa, Ethiopia. Š Nicole M. Melancon, Courtesy of Photoshare


Population Connection — March 2016


Young Continent

March 2016 — Population Connection


Left: A mother and son in Ethiopia with the Health Extension Worker who helps them to follow beneficial health, nutrition, and household practices. © SPRING Project, Courtesy of Photoshare Opposite: A mother of nine children waits at a Project Mercy “lie and wait home” in rural Ethiopia for her teenage daughter to give birth. According to Project Mercy, “lie and wait homes” are for women who experience complicated pregnancies or are late in their pregnancies. The homes are situated close to the hospital and offer the women lodging and meals. A midwife lives near the homes in order to provide regular checkups and to arrange quick access for medical care when needed. © Nicole M. Melancon, Courtesy of Photoshare


n a trolley in a government clinic in rural Ethiopia lies Debalke Jemberu. As a medic and a nurse winkle the sperm-carrying tubes out of his testicles, he explains why he decided to have a vasectomy. He is a farmer, growing wheat, sorghum, and a local staple grain called teff. But his plot is barely a quarter of a hectare. He already has four children, and has often struggled to provide for them. “I couldn’t feed more children,” he says. The medic, who has six more vasectomies to perform that day, interrupts to say he is finished. Mr. Jemberu pulls up

10 Population Connection — March 2016

his trousers, pops on his woolly hat, and continues. His parents had seven children, but they had eight hectares to farm. That plot has been shared among his siblings, and diminished by sales and land reforms. At the same time, he complains, the cost of living has gone up. Seven children would be far too big a family these days. Mr. Jemberu’s daughter, who is 25, is still single (he married at 19). He is happy for her to concentrate on her studies for a few more years before starting a family. And when she does, he thinks two children would be plenty. In the meantime,

he says, he will tell his fellow villagers how quick and painless the vasectomy has been. In the minds of many Westerners, Ethiopia is a teeming place with an everincreasing number of mouths to feed. That is indeed the case in some parts of the country: in the arid south and east, for instance, communities of pastoralists, some of them nomadic, still tend to have big families. Six or seven children remains the norm. But in Addis Ababa, the capital, the average is slightly less than two children per woman, just as it is in most rich countries.

March 2016 — Population Connection 11

This page: An adolescent girl waits in a Project Mercy “lie and wait home” in rural Ethiopia to give birth to her first child. © Nicole M. Melancon, Courtesy of Photoshare Opposite: A health extension worker at the Saadamoo Health Post in the Oromia Region of Ethiopia explains the materials she uses to talk with couples about family planning. © Sarah V. Harlan/JHU•CCP, Courtesy of Photoshare

In other words, Ethiopia spans the world’s demographic spectrum. Some parts have populations growing as fast as anywhere on the planet; others have already been through a “demographic transition,” in which the population stabilizes or even shrinks as people grow richer and have fewer children. Most of the country, however, is like the highland region where Mr. Jemberu lives, in 12 Population Connection — March 2016

which the typical woman has more than two children, but the downward trend is clear. The shift has been rapid and dramatic. In the early 1990s the average Ethiopian woman had seven children and the country’s population was growing by 3.5 percent a year. Women now have 4.1 children on average and population

growth has slowed to 2.5 percent. By 2050, the UN reckons, growth will have slowed further, to 1.3 percent; by 2100 the population will actually be contracting slightly. By then, however, there will be 243 million Ethiopians, up from 100 million now and 18 million in 1950. Most other countries’ demographic transitions have gone much further.

Globally, the average woman now has 2.5 children, half as many as in 1960-65 and not much above the 2.1 at which the world population will stabilize. (This “replacement rate” is a little higher than two because some girls die before their childbearing years and fewer girls are born than boys.) The fertility rate is below replacement in most rich countries, and in plenty of developing ones. In

Colombia it is 1.9, just as it is in America and Britain. In Iran it is 1.8 and in China 1.6. The UN calculates that 46 percent of the world’s population lives in countries where the fertility rate is below the replacement rate. How quickly Ethiopia and other African countries follow this example has implications not just for those countries but

for the whole world. It is the most pressing question for demographers, since it will determine how fast the global population grows in the coming decades and how soon it might stabilize. That, in turn, has repercussions for efforts to eliminate poverty, curb global warming, and manage international migration.

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Alarmingly, population growth in Africa is not slowing as quickly as demographers had expected. In 2004 the UN predicted that the continent’s population would grow from a little over 900 million at the time, to about 2.3 billion in 2100. At the same time it put the world’s total population in 2100 at 9.1 billion, up from 7.3 billion today. But the UN’s latest estimates, published earlier this year, have global population in 2100 at 11.2 billion—and Africa is where almost all the newly added people will be. The UN now thinks that by 2100 the continent will be home to 4.4 billion people, an increase of more than 2 billion compared with its previous estimate. If the new projections are right, geopolitics will be turned upside-down. By the end of this century, Africa will be home to 39 percent of the world’s population, almost as much as Asia, and four times the share of North America and Europe

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put together. At present only one of the world’s ten most populous countries is in Africa: Nigeria. In 2100, the UN believes, five will be: Nigeria, Congo, Tanzania, Ethiopia, and Niger. Although much could change in the next 85 years, none of those countries is a byword for stability or prosperity. A quadrupling of their population is unlikely to improve matters. If nothing else, the number of Africans seeking a better life in Europe and other richer places is likely to increase several times over. What is more, Africa’s unexpected fecundity will change the shape of the world’s population. The declining birth rate elsewhere has brought the world to the verge of what Hans Rosling, a Swedish demographer, calls “peak child.” In 1950 the world had some 850 million people aged 14 or under. By 1975 that number had almost doubled, to 1.5 billion. This

year it was a little over 1.9 billion—but it has almost stopped growing. It is expected to continue to climb only very slightly in the coming years, reaching 2 billion in 2024, but never exceeding 2.1 billion. Thanks to the continued growth of Africa’s population, however, the peak will be more of a plateau. High birth rates in Africa and low ones elsewhere will more or less balance out. Africans will make up a bigger and bigger share of the world’s young people: by 2100, they will account for 48 percent of those aged 14 and under. Moreover, the world’s population will continue to grow despite the levelling off in the number of children. Up until now population has resembled a pyramid in structure, with children outnumbering young adults, young adults outnumbering the middle-aged, and the middle-aged

Opposite: Children who live in a model village sponsored by Save the Children in rural Bahir Dar, Ethiopia. © 2014 Nicole M. Melancon, Courtesy of Photoshare. Above: Women receive community family planning services at Enchni Health Center in Ethiopia. © Wallace Mawire/ Freelance Photographer, Courtesy of Photoshare

outnumbering the elderly. People now in their 60s, for instance, come from a generation that was less than half as big as the current cohort of children. As today’s children age, they will make the upper echelons of the pyramid wider. But the lower ones will remain the same size, thanks to peak child, so the pyramid will come to look more like a dome. Were it not for continued growth in Africa, the pyramid might even have inverted, leaving more old people in the world than young ones.

African exceptionalism

The revision of population predictions for Africa partly reflects the fact that HIV/AIDS has not proved quite as

catastrophic for the continent as seemed likely ten years ago. Mainly, however, it stems from the startling persistence in Africa of very big families. Women in the region still have more babies, on average, than those in Asia and Latin America did in the 1980s. The human population only began to grow quickly and steadily in the 19th century. Before then women had lots of children—perhaps about seven each on average—but most died before adulthood. As health care improved over the past 200 years or so, far more of these children survived and went on to have children of their own; hence the explosion in the world’s population. As people

have become richer, however, they have also begun to have fewer children; hence the recent decline in the growth rate. The tendency for societies to have fewer children as they become richer appears to be universal. It holds good across races, religions, and ethnicities. Thus the fertility rate is the same (2.3) in Azerbaijan (which is largely Muslim), Mexico (largely Christian), Myanmar (largely Buddhist), and Nepal (largely Hindu). By the same token, many countries that remain relatively rural—Bangladesh, India, and Vietnam, for example—have nonetheless seen sharp falls in fertility, albeit not quite to the levels of heavily urbanized ones, such as Brazil. March 2016 — Population Connection 15

There seems to be just a handful of prerequisites for a falling fertility rate: a modicum of stability and physical security, some education (especially for women), and wide access to contraception. The faster these conditions are met, the faster birth rates come down. The only places where women continue to churn out babies are dirt-poor and unstable countries such as Afghanistan, Congo, East Timor, and Niger. Counterintuitively, war, famine, and other disasters tend to boost population in the long run, by keeping fertility rates high. It is only when parents are confident that their children will survive that they risk having fewer of them. Sub-Saharan Africa, sadly, is very poor and unstable, which helps explain why its demographic transition seems to be proceeding more slowly than that of other parts of the world and to have stalled or not yet started in several countries. But even relative to their levels of income, health, and education, the countries of sub-Saharan Africa have high fertility rates. That has prompted some scholars to posit cultural explanations. One theory is that African men want big families to enhance their status; another that communal land-holding makes them economically beneficial, since resources are shared according to family size. Without dismissing these arguments, John Bongaarts of the Population Council, an international non-profit group, suggests a third: relatively low use of modern contraception. In many places, after all, vigorous campaigns to disseminate contraceptives and discourage big families have contributed to sudden and deep falls in fertility. Such a drive in the 1970s in Matlab, a district in Bangladesh, saw the share of women

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using contraceptives increase six-fold in 18 months. The African countries that have seen big falls in fertility are those, such as Burundi, Ethiopia, and Senegal, with similar campaigns. In Ethiopia the fertility rate has fallen by about 0.15 a year for the past decade—blisteringly fast by demographic standards. That is probably thanks in large part to the nationwide network of 38,000 “health extension workers”—one for every 2,500 people. Their job is to pay regular visits to each household within their locality and provide coaching on public health, from immunizations to hygiene. One of the 16 subjects in which they drill every Ethiopian is family planning. It is through a health extension worker that Mr. Jemberu learned that he could receive a vasectomy free of charge, courtesy of Marie Stopes International, a British charity. Around 100 meters from where he is having the snip, five health extension workers have gathered 50 women for a traditional coffee morning. As one of the workers grinds coffee beans using an improvised pestle and mortar, two doctors explain the different methods of contraception that the government can provide to local women. One holds up a display board with a condom, an intrauterine device, a dose of an injectable contraceptive, a packet of pills, and a contraceptive implant. The other removes these displays one by one and passes them around, along with big chunks of bread and small cups of strong black coffee. Embarrassed women in the audience mutter questions into their shawls, while shushing fussy babies. The discussion is not limited to technicalities: there is much talk about the desirability of small families and how expensive big

ones can be. The same message is echoed in public service announcements on Ethiopian radio and television. Though the government is the main force behind this family planning drive, it welcomes help from Western donors and charities. Marie Stopes, for instance, pays for ten mobile teams that travel between rural clinics performing vasectomies and tubal ligations, the female equivalent. It also runs 31 facilities in cities, where in addition to contraceptives and obstetric care, women can obtain abortions. Then there is its BlueStar scheme, whereby it has accredited 207 private clinics to signal that they provide reliable and affordable maternal health care. Yohannes Abate, who runs one such clinic in Bahir Dar, a lakeside city in the center of the country, says that when he first set up shop in 2003, people hardly knew what contraception was and almost never asked for it. Now providing it accounts for 10 percent of his business. The patients in the waiting area speak freely of the expense of raising children; most say two or three is plenty. “I want to be able to afford to look after them,” says Zewdo Yetimwork, a university lecturer who has come for a postnatal check-up for his month-old daughter. Behind him a cardboard cutout of a sleek and smiling urban couple advertises Sensations, a local brand of condom (“Make your life Sensational”). The UN reckons that the share of Ethiopian women aged 15-49 who use some form of contraception has risen from 6 percent in 2000 to 40 percent last year. The government hopes to get the “prevalence rate” to 66 percent. It is pushing longer-lasting and permanent forms of contraception in particular.

A health provider shows a poster that she uses to counsel women on their family planning options at a health center in Holeta in the Oromia Region of Ethiopia. © Sarah V. Harlan/JHU•CCP, Courtesy of Photoshare

March 2016 — Population Connection 17

18 Population Connection — March 2016

Since 2007 it has allowed health extension workers to administer injectable contraceptives, which typically last for three months. Since 2009 it has allowed them to insert contraceptive implants, which last for several years. Women prefer these methods, say the health extension workers in Mertule Mariam, not only because they involve less hassle, but also because they are more discreet. There are no pills or condoms for nosey relatives or neighbors to discover. For the prevalence rate to keep rising, however, contraceptives must be omnipresent and cheap. Western donors have offered support here, too. At a conference in London in 2012, a group of them agreed to devote $2.6 billion to it. The Gates Foundation, the world’s biggest

philanthropic organization, promised to spend $140 million a year. Since then, it claims, 24 million women have gained access to contraceptives in the countries the group is targeting. It has also helped several African governments to build strong supply chains so that clinics in remote areas never run out, and brought together a consortium of aid agencies that has promised to buy contraceptives in large quantities if their manufacturers lower the price. That has helped reduce the cost of contraceptive implants from about $24 a dose to about $8, says Lester Coutinho, who runs the charity’s family planning efforts. Alas, there is lots more to do. The UN estimates that there are still 216

million married women* in the world who would like access to modern methods of contraception, but do not have it. The Copenhagen Consensus, a group of academics which rates development policies, reckons it would cost $3.6 billion a year to provide what they need. The benefits, in terms of the diminished need for infrastructure and social spending, reduced pollution, and so on, would be $432 billion a year—120 times more. That is the second-most productive investment the project has identified, after liberalizing trade, out of a welter of different development goals. Better yet, it helps with all the others.

* The estimate of unmet need for women of all marital statuses is 225 million.

Opposite: A mother who gave birth to her baby nine days earlier rests inside her hut in Mosebo Village, Ethiopia. © Nicole M. Melancon, Courtesy of Photoshare

This page: Women receive community family planning services at Enchni Health Center, a referral center near Addis Ababa, Ethiopia. © Wallace Mawire/Freelance Photographer, Courtesy of Photoshare

March 2016 — Population Connection 19

More Countries Want More Babies An Analysis

By Joseph Chamie and Barry Mirkin Originally published by Inter Press Service Joseph Chamie is former director of the United Nations Population Division and Barry Mirkin is former chief of the Population Policy Section of the United Nations Population Division. Photo: An Italian mother and her baby in Rome Š Angelo Cordeschi |

20 Population Connection — March 2016

March 2016 — Population Connection 21


oncerned with the consequences of demographic decline and population aging, especially with respect to economic growth, national defense, and pensions and health care for the elderly, a growing number of governments are seeking to raise birth rates. Whereas nearly 40 years ago 13 countries had policies to raise fertility, today the number has increased four-fold to 56, representing more than one-third of the world’s population. The most recent and largest addition to this pronatalist group of countries, which includes Australia, France, Germany, Iran, Israel, Italy, Japan, Russia, South Korea, Spain, and Turkey, is China. The Chinese government announced that it will change its controversial one-child policy to a two-child policy per couple in order to balance population development

and address the challenge of an aging population.

elderly is expected to double again and reach one-third by around midcentury.

Assuming a slight increase in its current fertility level, China’s population of 1.38 billion is projected—according to the UN medium variant—to peak by 2030 at 1.42 billion and then decline to 1 billion by the end of the century. However, if fertility were to remain constant at its current level, China’s population would soon begin declining, reaching around 0.8 billion by the year 2100. If fertility were to instantly reach the replacement level, an unlikely event, China’s population would grow to 1.5 billion by midcentury.

Similar to China, 82 other countries— accounting for almost half of the world’s population—are experiencing fertility rates below the replacement level of about two births per woman. As a result, the populations of 48 of those countries, including Germany, Japan, Russia, and South Korea, are projected to be smaller and older by midcentury, even assuming modest gains in birth rates. If fertility rates were to remain constant at their current levels, the declines and aging would be even more pronounced than currently expected.

China’s population age structure is also becoming older than any time in the past. Whereas in 1950 less than five percent of the Chinese were aged 65 years or older, today the proportion has doubled to 10 percent. By 2035 China’s proportion

In an attempt to counter those two major demographic trends, many governments have adopted a variety of policies to raise birth rates. At one extreme are draconian measures such as prohibiting contraception, sterilization, abortion,

China, Popula&on Projec&ons, 2015-2100 Medium variant 1,600,000

Constant fer1lity

Instant replacement 1,490,256

popula&on, in thousands

1,400,000 1,200,000




800,000 600,000 400,000 200,000 0

2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065 2070 2075 2080 2085 2090 2095 2100

22 Population Connection — March 2016

and the education and employment of women. As those measures violate basic human rights, few governments are prepared to take such drastic steps to raise fertility. Moreover, such measures have undesirable demographic consequences, including higher levels of unintended pregnancy, illegal abortion, and maternal mortality. Some governments are promoting marriage,childbearing,and parenting through public relations campaigns, incentives, and preferences. Such programs highlight the vital role of motherhood and its valuable contribution to the welfare and growth of the country. Australia and South Korea, for example, are among those making appeals to women to have one more child. Also, Iran is considering legislation that would encourage businesses to prioritize the hiring of men with children.

couples, especially mothers. In addition to extended maternity leave as well as paternity leave, other measures include part-time work, flexible working hours, working at home, and family-friendly workplaces, including nurseries, as well as pre-school and after-school care facilities. However, the costs of family-friendly policies are not insignificant. For example, with fertility at two children per

woman, France’s extensive scheme of family benefits is estimated to cost four percent of gross domestic product, one of the highest percentages in the European Union. Some governments are also looking to selective immigration to maintain the size of their workforce and slow down the pace of population aging. However, a recent United Nations study concluded that international migration at current

Perhaps the most common pronatalist policies aim to reduce parents’ considerable financial costs for childbearing and child rearing. Those policies include cash bonuses at the time of a child’s birth and/or recurrent cash supplements for dependent children. In Turkey, for example, parents are entitled to 300 Turkish lira (108 dollars) for the birth of their first child, 400 Turkish lira (144 dollars) for the second, and 600 Turkish lira (215 dollars) for the fourth and any subsequent children. One consequence of this legislation, however, has been the need for the provision of government financial assistance to large, needy families. Additional policies, especially popular among many Western countries, focus on making employment and family responsibilities “compatible” for working

March 2016 — Population Connection 23

“…the populations of 48 … countries, including Germany, Japan, Russia, and South Korea, are projected to be smaller and older by midcentury, even assuming modest gains in birth rates.”

Mother and child in Busan, South Korea. © Steve Squires, Flickr

24 Population Connection — March 2016

levels would be unable to compensate fully for the expected population decline. Between 2015 and 2050, the excess of deaths over births in Europe is projected to be 63 million, whereas the net number of international migrants to Europe is projected at 31 million, implying an overall shrinking of Europe’s population by about 32 million. In addition, the financial costs, social integration, and cultural impact of immigration have come to the political forefront in recent months. A growing tide of refugees and economic migrants—mainly from Syria, Afghanistan, Eritrea, Iraq, Nigeria, and Pakistan, estimated at over 800,000—have arrived on the shores of the European Union since the beginning of 2015 to escape war, repression, discrimination, and unemployment. As part of its response, the EU is considering a plan to offer aid money and visas to African countries that agree to take back thousands of their citizens who are unlawfully residing within its borders. Also aiming to stem the record inflows of refugees, various EU members have put up fences, imposed border controls, and tightened asylum rules. Other countries that are averse to encouraging immigration, such as Japan and South Korea, have instead opted to boost labor productivity as a means of compensating for a shrinking labor force. Those governments are also reviewing legislation to encourage more women to join and remain in the labor force by offering them family-friendly work environments, improved career mobility, and promotions to management and senior positions. While family-oriented measures may encourage some women to have children, those policies are costly and their overall effect on fertility is weak or unclear. The many forces pushing fertility to low levels are simply too powerful for governments to overcome with dictates, financial incentives, and public relations campaigns.

March 2016 — Population Connection 25

Washington View

FY 2016 Budget Finally Passes; Senators Condemn the Helms Amendment By Brian Dixon

Congress Finally Acts on Funding

Just before leaving Washington for the holiday break, congressional leaders released—and both houses passed—a final 2016 funding package. Nearly four months late. There’s a lot to be happy about in the bill. We, with the steadfast support of our champions on Capitol Hill, largely protected funding for family planning programs in the developing world. House GOP leaders called for slashing funds for our bilateral efforts by 25 percent. They called for reinstating the odious Global Gag Rule that disqualifies the most effective, experienced, and respected providers around the world from receiving aid. They demanded a provision barring any aid to the United Nations Population Fund (UNFPA) for its work in some 150 countries— including in some of the most unstable and dangerous places for women in the world. They failed on every count. On the domestic front, those same Republicans proposed eliminating the sole program—Title X (ten)—dedicated to providing low-income American women with affordable family planning

26 Population Connection — March 2016

and contraceptive services. We defeated them. They also failed in their effort to prevent Planned Parenthood clinics across the country from being reimbursed for the care they provide to women receiving Medicaid. Finally, they were stymied in their effort to include a provision to allow bosses and health plans to deny coverage for birth control if they have a “moral” objection to it and to allow hospitals and other health care providers to refuse to provide abortions even when necessary to save a woman’s life. Sadly, they were successful in cutting funding to UNFPA by $2.5 million, from $35 million to $32.5 million. That may not sound like much, but it will leave more than 200,000 women in the developing world without access to reproductive health care and contraceptives this year. In a shameless display, those GOP leaders are publicly gloating over this victory. UNFPA is providing critical care to women facing the most horrific circumstances: refugees fleeing violence in Syria,

South Sudan, and Nigeria. Denying those women access to safe delivery services and contraceptives is a travesty, not a victory. Outrage, not celebration, is the proper response.

Sen. Blumenthal Calls for Complete Care for Yazidi Victims of ISIL

The Senate passed a resolution condemning sexual violence perpetrated by terrorists against Yazidi girls and women in Iraq. Sen. Richard Blumenthal (D-CT) made an impassioned plea on the floor of the Senate to ensure that victims who are made pregnant as a result have access to the full range of care they need—including safe abortion. Sadly, a flawed interpretation of a longstanding U.S. law—known as the Helms amendment—is preventing safe abortion care from being included in our assistance to these girls and women. Blumenthal led 28 senators in urging President Obama to act to clarify that the law allows for safe abortion services for victims of rape and incest and for women whose lives are threatened by pregnancy.

Excerpts from Senator Blumenthal’s Speech on the Senate Floor witnessing such. The United States must work to increase access to health care, especially abortion services, and most especially for the Yazidi girls and women who were purposefully impregnated as a tool of terrorism by ISIL.” “Tomorrow is the 42nd anniversary of the Helms amendment. For its entire existence, it has been incorrectly interpreted, and it continues to serve as a critical obstacle in our foreign aid efforts to provide for safe abortions in the case of rape, incest, and life endangerment … preventing our foreign aid funds from being used for that purpose not only denies critical assistance to the Yazidi girls and women but also overly constrains the assistance of this great nation to the victims of terror and horror abroad.” “[I]t remains essential that we recognize the full scope of the post-rape health care needed by survivors of rape, who hideously and gruesomely have been victims of a tool of terrorism by ISIL. Fully countering ISIL’s terror strategy means providing necessary and compassionate care for girls and women who have been victims and who have been shunned by their families. They have been rejected by their communities. They have been victims many times over as a result of these crimes, heinous crimes, committed against them.” “We cannot allow for ISIL to terrorize and disrupt communities, to exert control over women and girls, and in the case of the Yazidis, to impregnate them purposefully and relentlessly. Survivors should not be forced to carry pregnancies to full term simply because access to reproductive health care is not available following their vicious assault. We cannot stand idly by

“As the world’s largest donor of assistance around the world, the United States can and should do better and do more to provide health care that girls and women vitally need when they become vulnerable and, in fact, victims of terror inflicted by these heinous criminal acts.”

March 2016 — Population Connection 27

Field & Outreach

From Lobbying to Grassroots Outreach, Marie Lina Excellent Shines By Rebecca Harrington


n addition to flooding Capitol Hill for a day with committed and wellprepared constituents, our annual Capitol Hill Days (CHD) event is a valuable time for us to form relationships with activists who will continue their advocacy with Population Connection once they return home. When Marie Lina Excellent, one of our CHD 2015 participants, reached out to us about organizing an event on the University of North Carolina (UNC) Chapel Hill campus, we were very pleased and encouraged that we had made a solid connection through our CHD outreach. Marie Lina is a medical doctor, trained in her native Haiti. She is also a public health student at UNC, and serves as co-president of the Public Health Leadership Student Association (PHLSA). She says, “In April 2015, I had the opportunity to attend Population Connection’s Capitol Hill Days. It was such an inspiring event that when I went back to UNC I suggested to a couple of student organizations that a collaborative event with Population Connection would help us bring more awareness about reproductive health and the challenges of foreign policy to campus.” So, in January, we worked with the Public Health Student Leadership Association, the Student Global Health Committee, and Carolina BEBES (a campus organization that supports the Carolina Global Breastfeeding Institute) to organize a screening of the documentary Vessel. While in the Research Triangle area, we also had the opportunity to host a well-attended film screening and discussion of Blessed Fruit of the Womb with several groups at the UNC School of Medicine, and to host a grassroots advocacy training with Partners in Health Engage at Duke University. As always, we were encouraged by the strength and commitment of our supporters in North Carolina, and look forward to our future collaborations with these groups and other volunteers in the state.

28 Population Connection — March 2016

A Closer Look at an Excellent Advocate: Marie Lina From a young age, Marie Lina Excellent was passionate about helping others. As a child, those close to her referred to her as “Attorney Marie Lina” because of her aspiration to become a lawyer, and because she was always defending and standing up for her friends and family. Marie Lina is a Fulbright Scholar from Haiti in her final semester of the master’s program

in Public Health Leadership at the UNC Chapel Hill Gillings School of Global Public Health. She returned to school for her MPH because through her medical work, both in Port-au-Prince and in remote parts of Haiti, she realized that she could have a greater impact by doing public health work with the “larger community.” Her interest in public health was first piqued during epidemiology courses in medical school, and continued to grow through her work as the Director of HIV/AIDS and Community Health Programs at Saint Damien Hospital in Port-au-Prince. It’s hard to focus on HIV prevention without talking about reproductive health, and at Saint Damien’s, Marie Lina also ran a family planning program that provided education and services, along with free contraceptives and condoms. Marie Lina notes that the “beauty” of the program was in its comprehensiveness and its ability to support women who were unable to “negotiate condom use” with their partners. In providing information about all the various methods of contraception and providing a wide variety of supplies,

women were able to choose what option worked best for them. As Marie Lina says, “It’s your health; it’s your body; it’s your life; it’s your choice.” Marie Lina also implemented a strategy to bridge her family planning and HIV prevention work. At first, only two of her staff were allowed to distribute family planning information and supplies. Marie Lina made a change to that policy so that every provider—whether working in the HIV prevention program, the family planning program, or the community health program—had condoms available in his or her office, to avoid “missed opportunities” in promoting sexual and reproductive health to patients. Once each patient’s primary reason for their visit was addressed, they were offered condoms, which led to an uptick in their use among the hospital’s patients. Marie Lina reflects that running the family planning program was “a great experience to learn about the barriers that women face when it comes to family planning—all the taboo and the stigma surrounding it” and that “the benefits of reducing numbers of births—when women want this as an option—is really beneficial.”

Her “wake-up call to strengthen her public health background” came following the 2010 earthquake in Haiti. This event was the catalyst for her transition to becoming a public health professional. While clinical care was obviously essential in the earthquake’s aftermath, public health was the greater issue, because at that time “not one patient, but an entire population was screaming for help.” Around the time of the earthquake, Marie Lina had a dream which caused her to ask herself “Am I going back to school?” In the dream, she was walking through an unfamiliar place and heard a voice telling her that she was in Chapel Hill, North Carolina. She had never heard of Chapel Hill, and when she woke up, she researched the name, and discovered information about UNC. Several years later, she enrolled in UNC’s public health program. She says her subconscious fortune telling was “a wonderful dream that became a wonderful reality.” We feel fortunate to have met Marie Lina, and are grateful that she has dedicated her career to promoting the health of women, men, and children everywhere. We look forward to having her as one of our volunteers for a long time to come!

March 2016 — Population Connection 29

Using Real-World Math to Teach About Global Demographics PopEd

By Pamela Wasserman


hile most population concepts are firmly rooted in K-12 science and social studies curricula, many of PopEd’s lessons also find a place in the math classroom. Understanding birth, death, and fertility rates, growth patterns, probabilities, and projections are all part of “real-world math”—using relevant data about the world around us to build students’ foundations in mathematical practices and reasoning. Real-world math has long been a priority for the National Council of Teachers of Mathematics (NCTM) and is now integral to the new Common Core Math Standards. Through math instruction, we can illustrate the different population dynamics of countries and world regions while also building students’ computational skills and understanding of ratios, percentages, logarithmic equations, and modeling. The feature articles in this issue explore the demographic phenomenon of low birth rates in Europe and East Asia. Several of our math-focused activities compare birth and death rates for a variety of countries. In “On the Double,” middle school students explore these rates for ten countries ranging from high growth to no growth to negative growth, and calculate their populations’ doubling time. In “The Stork and the Grim Reaper,” elementary students illustrate birth and death ratios using measuring cups and colored water. The “stork” (representing birth rates) and “grim reaper” (representing death rates) take turns “populating” or “depopulating” the water bowl (representing people). The size of their cups varies depending on the ratios they are depicting. When the stork’s cup is larger than the grim reaper’s, the water level rises; when the grim reaper’s is larger, the water level falls.

Country India


South Africa Panama


Birth Rate (births per 1,000 people) 21

Death Rate (deaths per 1,000 people) 7





22 9

Data Source: Population Reference Bureau

30 Population Connection — March 2016

10 15

Stork’s Cup Size

Grim Reaper’s Cup Size

1 cup

1 cup

1 cup 1 cup 1 cup

2/3 cup

1/3 cup 1/2 cup 1/4 cup 1 cup

Towson University (MD) students in an Elementary Math Methods course demonstrate “The Stork and the Grim Reaper” activity.

“On the Double” and “The Stork and the Grim Reaper” are just two of the more than 70 PopEd activities that teach real-world math concepts. To find more, visit our interactive “Find a Lesson” module at

On the Double Procedure:

Explain to students that the larger the difference between a nation’s birth rate and its death rate, the greater (or lesser) the population growth rate. Ask students to look at the chart below and hypothesize which countries will have the highest growth rates and which will lose population at current rates. Now have students determine the rate of annual increase for each country’s population using the following formula: (birth rate-death rate)/10 For example, the world’s current rate of annual increase can be calculated by knowing the birth rate is 20 births/1,000 people and the death rate is 8 deaths/1,000 people. (20-8)/10 = 1.2% (Note: These figures represent the rate of “natural increase” and do not include net migration.) Based on the rate of natural increase, students can now determine each country’s population doubling time with the following formula: 70*/rate of increase = doubling time For example, to calculate the doubling time for the world population at the present rate of increase (1.2%), you would use this formula: 70/1.2 = 58 years For countries that are losing population, the same formula can be used to * Note: 70 is the approximate equivalent of 100 times the natural logarithm of 2, which is used to determine doubling time.

determine how many years it would take that population to decline by half: 70/rate of decrease** = halving time

Why do you think the death rate in the U.S. is higher than in Guatemala? War, disease, famine, poor health care, and age structure can influence death rates. The difference in death rates between Guatemala and the U.S. can be attributed to the U.S. having a larger proportion of elderly citizens.


Which figures differ most among countries, the birth rates or the death rates? How would you explain this? Birth rates vary more because there is more variability in family size. The birth rate is higher when the average family size is larger. For example, Nigeria (with a birth rate of 39/1,000) averages 5.5 children per family while Germany (with a birth rate of 8/1,000) averages 1.5 children per family. Death rates are affected by age distribution, and most countries will eventually show a rise in the overall death rate, in spite of continued decline in mortality at all ages, as declining fertility results in an aging population (and the elderly die at a higher rate).

Are countries like Germany or Bulgaria likely to run out of people? Why or why not? Not likely. Birth and death rates can change each year due to various social and economic factors. Migration changes demographic profiles as well. For example, the recent influx of hundreds of thousands of migrants to Germany from war-torn countries in the Middle East is likely to increase Germany’s population and also bring down the mean age (and therefore the death rate) because migrants tend to be young.

What do you think accounts for variations in death rates among countries?


United States Germany

Guatemala Nigeria Japan India



South Africa China

Birth Rate (births per 1,000 people) 13

Death Rate (deaths per 1,000 people) 8

Annual Natural Increase (%) 0.5







25 8










21 9









Doubling/ Halving Time (in years) 140

233 (halving) 35 28

350 (halving) 50


117 (halving) 58


Data Source: Population Reference Bureau ** Do not make rate of decrease negative. For example, for Germany, divide by 0.3, not -0.3.

March 2016 — Population Connection 31


Cartoonist: Patrick Forde

“Leapfrog! It’s the latest craze among the kids, but experts say it contributes to declining birth rates. Find out why … after the break!”

32 Population Connection — March 2016

Editorial Excerpts

Starting sometime in the next few months, California and Oregon will allow women to get a contraceptive prescription directly from a pharmacist, a move that advocates hope becomes a national model. Texas abortion-rights opponents should take note, considering the great lengths they’ve gone to in recent years to impose harsh restrictions on abortion clinics. Underlying nearly every abortion is an unwanted and unintended pregnancy. If the goal is to curtail abortions, improved access to contraception is the best route to success. Millions of American women have relied on the pill for decades as their principal form of birth control. Does it really make sense to force millions of women to continue undergoing expensive doctors’ visits for something as widely used and routinely dispensed as the pill? U.S. and World Health Organization guidelines say such exams are medically unnecessary. Yet a 2010 medical survey found that 33 to 44 percent of doctors still required pelvic exams before they would write a pill prescription. The cost of doctors’ visits could be a major culprit behind the high correlation between poverty and unintended pregnancies. Each year, 6.6 million American women get pregnant, with about half of those unintended. The closer women are to the poverty level, the higher their rate of unintended pregnancies, according to the U.S. Centers for Disease Control and Prevention. The experiments in Oregon and California are worthwhile and should offer important guidance on the best way forward. —November 25, 2015

Patients seeking birth control pills today typically have to get a prescription from a doctor, but reproductive health advocates have long argued that this process is unnecessary since the pills are safe for a vast majority of women. Now two states are about to allow patients to get them from a pharmacist without seeing a doctor first. Other states should consider similar moves. Laws in California and Oregon will soon allow pharmacists to prescribe pills, patches, and rings after screening patients for possible risk factors like smoking or a history of blood clots. The measures will allow patients to get birth control quickly, without the need to schedule an appointment with a doctor. Pharmacies are more plentiful in many areas than doctors’ offices and clinics, and they often have longer hours, making them a more convenient option. The change could help reduce unintended pregnancies, especially for low-income women who might have trouble traveling to see a doctor or getting time off for an appointment. Oregon’s law takes effect in January, and California’s is likely to start in April. A pharmacy chain is pushing for a similar bill in Nevada, and efforts to introduce one are underway in New Mexico as well. Birth control pills meet the Food and Drug Administration’s criteria for over-the-counter safety, and they are just as safe as many medications that are already sold that way. Only a small minority of women have medical conditions that increase the risks of using birth control pills, and, as studies have shown, women can accurately assess whether the pills would be too risky for them. In the meantime, laws like those in California and Oregon could help many women get the contraceptives they need. —November 28, 2015

March 2016 — Population Connection 33

Population Connection 2120 L Street, NW, Suite 500 Washington, DC 20037


Profile for Marian Starkey

Population Connection  

March 2016, Volume 48, Issue 1

Population Connection  

March 2016, Volume 48, Issue 1


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