Population, Gender, and Development in Latin America

Population, Gender, andDevelopment in

Latin America

Kimberly GrahlingCharles McKittrick

Mark RobinsonGary Wu

Agenda

• Why is population control so important and what other issues influence growth?

• What Latin American countries are doing to control population growth and the results are they seeing

• Puerto Rico and Peru

• Desired long-term results and our conclusions

The Importance of Population Control

LIMITED RESOURCES!

The Economics of Population• Fertility and education

• GDP Per Capita = GDP / Population

ISIExport orientationPrivatizationInflationEconomic enclavesDebtExchange ratesetc.

Decrease

The Importance of Population Control

Drivers of High Population• Colonial legacy

• Culture of machismo

• Agrarian economy

• Lack of education

• Lack of access to birth control

• Religious influence

Latin American governments• % of governments thinking their country’s

population was too high in 1999:

Source: 1999 World Population Data Sheet, Population Reference Bureau

Central America 88%Caribbean 47%South America 15%

Population Control Participants

Foreign governments• Spend $2 billion/year subsidizing family planning

worldwide.• Largest contributors:

– United States through U.S. AID– Netherlands– Germany– United Kingdom– Japan

Source: United Nations and New York Times


Nongovernmental Organizations (NGOs) - Funded by local and foreign governments

• International– U.N. Population Fund– World Health Organization

• U.S.-based– International Planned Parenthood Federation– Family Health International– The Population Council– Pathfinder International


Nongovernmental Organizations (NGOs)• Private donors

– Ford Foundation– Rockefeller Foundation– Mellon Foundation– MacArthur Foundation– Gates Foundation


U.S. AID Funding in Latin America for health and family planning FY2000

CountryFunding

($000) TFRHaiti 22,300$ 4.8Peru 13,500$ 3.5Bolivia 13,000$ 4.2El Salvador 7,145$ 3.6Guatemala 6,000$ 5.1Honduras 4,318$ 4.4Nicaragua 4,000$ 3.9Brazil 2,900$ 2.3Paraguay 2,000$ 4.4Jamaica 1,450$ 2.8

Source: U.S. AID and Population Reference Bureau


• Sterilization• Long-term, low-cost, convenient

Population Control Tools

• Increased access to modern birth control• Reversible• Higher efficacy rates than traditional methods

• Family planning education• Most important aspect of population control

• Measured by Total Fertility Rate (TFR)• U.S. has a TFR of 2.0.• TFR of 2.1 is replacement-level fertility

• Latin America’s TFR fell from 5.9 in the 1950’s to 2.9 in 1999.

• Population will double in ~38 years

• Population control policies have reduced population growth rate in Latin America

Results

Source: World Population Beyond 6 Billion, Population Reference Bureau

Results

Case StudiesSuccessful vs. unsuccessful examples of population

control programs

Case Studies of Two Women's Health Projects in BoliviaGender, Power and Population Change, Population Reference Bureau

Puerto Rico

Peru

What are the parameters of success?

Initially sought to compare effective vs. ineffective examples

Traditional Metrics - focus on short term results:

• Funds invested to number of client visits, IUDs inserted, pills distributed

• Births per thousand - TFR

New Metrics - focus on medium & long term results

• Quality of service

• Impact on client's health and well-being

• Participant internalization of health knowledge and responsibility

• How participation has affected health and well-being in the medium and long term.


Puerto Rico: Effective results ...

Low Cost - high efficiency - Immediate results

• Population control expenditures 100% more effective in raising per capita income than expenditures in accelerating conventional economic growth (General Electric Tempo Research Center)

• $5 of birth control = $100 of economic development (Lyndon Johnson's '65 speech to UN)

• Every prevented birth worth 2.6 times per capita output…

births prevented in Puerto Rico ('68) = $3,600 per birth

• Study suggested that improved management efficiency and more permanent birth control might result in over $12.5M gain for Puerto Rico

Puerto Rico: Effective results…but at what cost?

• By 1968 ~34% of women of child bearing age had been sterilized - 2/3s of whom were still in their early twenties

• Lowest natural population increases in Latin America: 19.1/thousand vs. 29/thousand

Year Age Percent Sterilized1947-48 15 + 6.6

1948 n/a 6.91953-54 20 + 16.5

1965 20-49 341968 20-49 35.3

Puerto Rico: Context and players

Primary participants:

• Puerto Rican government

• NGOs

• Foreign governments

• Private donors to NGOs (with linked economic interests)

Population Control Policies:

• Sterilization

• IUD & the Pill

Rationalization:

• Demand Statistics

Sterilization

1) Underdeveloped health-care services

2) Abortion difficult to obtain (2 year prison term)

3) Non-prescription use of the pill

4) IUD's expensive and poorly distributed

5) Sterilization is free

6) Reimburse $50 and 90% of hospital cost

7) Sterilization post partum - consent is obtained during labor

Peru: Family Planning and Good Intentions

Fujimori places family planning at forefront of national agenda (4/95)

• Method for reducing poverty in Peru.

• Goal: state to prevent the birth of 500,000 Peruvians by 2000

• Population control linked to shift in market-oriented economic policies

Good intentions

• 1st step in reducing poverty decrease size of low income families

• Accessible family planning for all classes



Population Control Tool-set• Network of clinics• Access to latest techniques (including female condom and Norplant)

• Voluntary sterilization program • (including vasectomies for men and tubal ligations for women)

• Three most practiced forms of contraception in Peru:(1) Abstinence / 'natural methods'; (2) IUD; (3) Tubal ligation

• Abortion Illegal - though ~ 300K abortions performed a year• 1 in 3 pregnancies end in abortion

Primary Participants• Peruvian government

• U.S. AID


Case Studies of Two Women's Health Projects in Bolivia

Constraints:• Catholic Church:

• Moral arguments

• Church claims plan ignores declining birth rate;

• Blames the poor for the country's economic problems.• Cultural:

• Male perception of loss of control over women

• Fear of male impotence

Economic

• 1/2 of Peru's 23 million people live in poverty


Results & Pitfalls

• '97 sterilization's result in 26,000 fewer births in '98

• Quotas motivate State health-care workers to take advantage of rural poor women

• Promotions and cash incentives stimulate hurried, low quality care

• Going rate: two dresses and a t-shirt.

YearFemale

SterilizationsMale

Sterilizations1995 10,000 n/a1996 30,000 n/a1997 110,000 10,000

Future Trends: An Alternative Viewpoint

Population control guided by improving human welfare instead of reducing overcrowding

• Invest in the conditions that facilitate use of programs in addition to the programs themselves.

Integrated approaches to service delivery• Emphasis on continued education and growth

• Focus on interpersonal relationships

New Paradigm: • Health more complex than medical service and necessarily linked to

education, human rights, personal empowerment

• Transforms relationship between clinician and patient so delivery more effective

Positive Results of Population Control

Women have fewer children

More opportunities for education and work

Women gain higher-paying jobsWomen achieve higher

economic status

Economy gains from more productive workers

Higher standard of living

Four Key Indicators of Women’s Quality of Life

Region 1970 1990 1970 1990 1970 1990 1970 1990Latin America and the Caribbean 89% 103% 39% 52% 64 70 5.0 3.2

Life Expectancy

(years) FertilityGirls Enrolled in Primary School

Women Aged 15-44 Using

Modern Contraception

Source: Women in Poverty: A New Global Underclass, Family Health International

Positive Results of Population Control

Conclusions• Humane population control cannot be achieved

with only one tool

• Population control as a development tool is a long- term undertaking

• Education is a key component of economic development

• The most effective population control policies focus on both genders.

The End

Questions and Answers

Perguntas e Respostas

Preguntas y Respuestas

Costs and Benefits of One Additional Year of Schooling For 1,000 women in

Pakistan (estimated):Costs•Schooling costs for 1,000 women = $30K

Benefits•Increase in wages = 20%

•Child deaths averted = 60

•Alternative health intervention to save 60 lives = $48K

•Total births averted = 500

•Alternative family planning costs per 500 births averted = $33K

•Total maternal deaths averted = 3

•Alternative costs per 3 averted maternal deaths = $7.5K

Results

Source: World Population Beyond 6 Billion, Population Reference Bureau

Results

Documents

Population, Gender, and Development in Latin America