Population, Gender, and Development in Latin America

1. Population, Gender, and Development in Latin America Kimberly Grahling Charles McKittrick Mark Robinson Gary Wu

2. 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

3. The Importance of Population Control LIMITED RESOURCES!

4. The Economics of Population Decrease ISI Export orientation Privatization Inflation Economic enclaves Debt Exchange rates etc. • Fertility and education • GDP Per Capita = GDP / Population

5. The Importance of Population Control

6. Drivers of High Population • Colonial legacy • Religious influence • Lack of access to birth • control • Lack of education • Agrarian economy • Culture of machismo

7. Population Control Participants Latin American governments • % of governments thinking their country’s population was too high in 1999: Source: 1999 World Population Data Sheet, Population Reference Bureau

8. 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

9. Population Control Participants Nongovernmental Organizations (NGOs) - Funded by local and foreign governments • International • U.N. Population Fund • World Health Organization • U.S.-based • International Planned Parenthood Federation • Family Health International • The Population Council • Pathfinder International

10. Population Control Participants Nongovernmental Organizations (NGOs) • Private donors • Ford Foundation • Rockefeller Foundation • Mellon Foundation • MacArthur Foundation • Gates Foundation

11. Population Control Participants U.S. AID Funding in Latin America for health and family planning FY2000 Source: U.S. AID and Population Reference Bureau

12. Population Control Tools • Sterilization • Long-term, low-cost, convenient • Increased access to modern birth control • Reversible • Higher efficacy rates than traditional methods • Family planning education • Most important aspect of population control

13. Results • Measured by Total Fertility Rate (TFR) • U.S. has a TFR of 2.0. • TFR of 2.1 is replacement-level fertility • Latin America’s TFR fell from 5.9 in the 1950’s to 2.9 in 1999. • Population will double in ~38 years • Population control policies have reduced population growth rate in Latin America

14. Results Source: World Population Beyond 6 Billion, Population Reference Bureau

15. Case Studies Successful vs. unsuccessful examples of population control programs Puerto Rico Peru Case Studies of Two Women's Health Projects in Bolivia Gender, Power and Population Change, Population Reference Bureau

16. What are the parameters of success? • Initially sought to compare effective vs. ineffective examples • Traditional Metrics - focus on short term results: • Funds invested to number of client visits, IUDs inserted, pills distributed • Births per thousand - TFR • New Metrics - focus on medium & long term results • Quality of service • Impact on client's health and well-being • Participant internalization of health knowledge and responsibility • How participation has affected health and well-being in the medium and long term. Case Studies of Two Women's Health Projects in Bolivia Gender, Power and Population Change, Population Reference Bureau

17. 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

18. 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

19. 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

20. 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

21. Peru: Family Planning and Good Intentions • Population Control Tool-set • Network of clinics • Access to latest techniques (including female condom and Norplant) • Voluntary sterilization program • (including vasectomies for men and tubal ligations for women) • Three most practiced forms of contraception in Peru: • (1) Abstinence / 'natural methods'; (2) IUD; (3) Tubal ligation • Abortion Illegal - though ~ 300K abortions performed a year • 1 in 3 pregnancies end in abortion • Primary Participants • Peruvian government • U.S. AID Case Studies of Two Women's Health Projects in Bolivia Gender, Power and Population Change, Population Reference Bureau

22. Peru: Family Planning and Good Intentions • Constraints: • Catholic Church: • Moral arguments • Church claims plan ignores declining birth rate; • Blames the poor for the country's economic problems. • Cultural: • Male perception of loss of control over women • Fear of male impotence • Economic • 1/2 of Peru's 23 million people live in poverty Case Studies of Two Women's Health Projects in Bolivia

23. Peru: Family Planning and Good Intentions • 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.

24. 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

25. Positive Results of Population Control Women have fewer children Higher standard of living More opportunities for education and work Economy gains from more productive workers Women gain higher-paying jobs Women achieve higher economic status

26. Positive Results of Population Control Four Key Indicators of Women’s Quality of Life Source: Women in Poverty: A New Global Underclass, Family Health International

27. Conclusions • Humane population control cannot be achieved with only one tool • Education is a key component of economic development • Population control as a development tool is a long- • term undertaking • The most effective population control policies • focus on both genders.

28. The End Questions and Answers Preguntas y Respuestas Perguntas e Respostas

29. Results 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

30. Results Source: World Population Beyond 6 Billion, Population Reference Bureau