Chapter 6

Population Policies in Developing Countries

Knowing is not enough; we must apply.

Willing is not enough; we must do.
Johann Wolfgang von Goethe (1749–1832)
German writer and polymath

This chapter covers the broader population policies that were designed and
implemented in developing countries during the period from 1974 until today. The
heyday of these more comprehensive policies was in the 1980s and 1990s.
After the 1974 Bucharest Conference, developing countries continued to address
high levels of mortality and especially fertility (Chap. 4 describes the initial efforts
in these areas). To cope with high levels of fertility, most developing countries
implemented family planning programs. Fertility levels started to decline, although
induced abortion also played a role. However, traditional family planning programs
changed after the 1994 International Conference on Population and Development
(ICPD). The policy goal shifted to the implementation of the Cairo agenda, which
put more emphasis on reproductive rights and helped address a range of new issues,
including excision or female genital mutilation (FGM).
At the same time, population policies were gradually broadened to address, in
addition to mortality and fertility, other components of demographic growth and their
socioeconomic determinants. Population policies benefited from larger socioeco-
nomic and gender-related interventions, including endeavors to foster female educa-
tion. These gender-related interventions usually bring indirect effects on mortality
and particularly fertility. Policies also tackled urbanization patterns, as well as inter-
nal and international migration flows, e.g., through internal resettlement programs as
was the case in the Indonesian transmigration program. The impact of rapid popula-
tion growth on the environment affected some countries, like Haiti. In the mid-1980s,
countries also had to address the threat of the HIV/AIDS epidemic, in addition to
issues that had been traditionally encompassed by the population policies.
The chapter first analyzes how family planning programs spread to developing
countries, the role of abortion in the reduction of fertility (with a focus on Vietnam),

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130 6 Population Policies in Developing Countries

and the adoption of the broader agenda of reproductive rights that superseded the
implementation of the somewhat narrower family planning programs (as illustrated
by the example of excision). Then, the chapter turns to the process of designing more
comprehensive population policies, which targeted, in addition to mortality and fertil-
ity trends, the other components of demographic growth and their socioeconomic
determinants, as was done in Mexico. At around the same time, gender and education
issues also received more attention. Thereafter, the chapter reviews the policies of
urbanization and internal and international migration (using the situation of Indonesia),
as well as the emerging concerns regarding the relationship between population
growth and the environment (with a focus on Haiti). Finally, the chapter covers the
policies on HIV/AIDS that have been adopted since the mid-1980s.

Family Planning Spreads Around the World

After World War II, a few countries established family planning programs,
with Japan and India among the precursors, followed later by Egypt and other
countries. Subsequently, other countries, mostly in South and East Asia, also
launched family planning programs (see Chap. 4). However, the outcomes of
these endeavors were rather mediocre, especially in some of the 18 big countries
(as defined in Chap. 2), for instance in Pakistan. At the time, these failures cast
doubt on the ability of family planning programs to bring about fertility declines
and questions were raised about the strategies to implement efficient family plan-
ning programs (Sinding 2007: 4).
In contrast, the two decades after the 1974 Bucharest Conference were dubbed
the “golden era of family planning”. In the 1970s and the 1980s, many more
countries, mostly in Asia but also in Latin America and the Caribbean, designed and
implemented family planning programs. This ushered a global family planning
revolution that spread across the developing world and reached almost all corners of
the globe, with the exception of the least developed countries (LDCs).
The agreement reached at the 1974 Bucharest Conference made this revolution
possible. Dr. Karan Singh, the head of the Indian delegation in Bucharest, made the
provocative statement that “development is the best contraceptive”, which created a
sensation. It seemed to espouse the views of those who insisted “that rapid popula-
tion growth was a red herring invented by the Western powers to keep developing
countries’ populations under control” (Sinding 2007: 6).1 Nevertheless, the confer-
ence concluded with a World Population Plan of Action (WPPA), which called for
a mix of family planning and other development investments (Sinding 2007: 6–7).
As Sinding summed it up: “despite the intense … debates of the Bucharest era, the
vast majority of countries adopted population or family planning policies during the

1
Dr. Singh explained later that “when he called development the best contraceptive, he had not
considered it to be the only contraceptive.” In 1992, he coined the new phrase: “Contraception is
the best development”; see Visaria and Chari (1998): 69.
Chapter 7
Population Policies in Developed Countries

The golden rule is that there is no golden rule.

George Bernard Shaw (1856–1950)
Irish playwright

Developed countries have completed their demographic transition process, and

many of these countries must now deal with post-transitional imbalances. They are
facing three main issues: sub-replacement fertility, population aging, and immigra-
tion. The proposed remedies have taken the shape of policies addressing each of
these issues specifically. First, some countries have designed and implemented poli-
cies to raise fertility. These policies have occasionally obtained modest results, but
generally have failed to change fertility levels significantly. Second, countries have
tried to address population aging by taking some programmed initiatives, for
instance through the provision of specific care for the elderly. However, interven-
tions in this area have been less well defined and, so far, not very conclusive either.
Finally, several countries have attracted immigrants whilst others have tried to curb
immigration flows. Immigration policies have been shaped by the specific economic
and political context of receiving countries.
Issues of sub-replacement fertility, population aging, and immigration are quite
difficult to address. Yet policy responses to these challenges will have important con-
sequences for the sustainability of the socioeconomic achievements of developed
countries. In developing countries, population policies are more narrowly defined
(e.g., reduction of mortality or fertility) and aimed at a few key interventions (e.g.,
immunization or family planning programs). The situation is quite different in indus-
trialized countries, which have more complex social systems that are difficult to adjust
in order to fit new policy orientations. Policies in developed countries need to be
translated into an array of social and economic regulations and programs. These regu-
lations must be first properly identified and thereafter orderly implemented by multi-
ple institutions and agencies. Consequently, population policy interventions in
industrialized countries have been more indirect and implicit than direct and explicit.

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172 7 Population Policies in Developed Countries

Sound policies call for an awareness of the issues at stake, as well as a large con-
sensus on the different actions to be taken. Since population challenges in developed
countries, especially immigration trends, ultimately concern the national identity, they
have the potential to trigger political passions. Moreover, industrialized countries
often harbor numerous lobbying groups and generally have vocal public opinions. In
this context, the public debate on future policy orientations has been difficult and has
often brought about a polarization of the public opinion, because of misleading or
slanted information, or even sheer ignorance. Therefore, it should be no surprise that
leaders and the public alike have at times turned a blind eye to the pressing issues at
hand. Sound policies also require good data that are not always readily available,
especially in the area of international migration. Finally, implementation of policies
necessitates strong political will, adequate institutional settings, good coordination
among various sectors, and effective monitoring and evaluation mechanisms.
This chapter first covers the three main demographic issues that industrialized
countries must address. It examines the main problems related to sub-replacement
fertility and reviews examples of interventions that have been implemented in
France and other countries (e.g., in Asia). The second section analyzes the issues of
population aging and its foreseeable consequences, for example, on public finances
and fiscal space. The next section covers immigration policies and their effects as
well as the economic impact of the migratory transition (this is illustrated with the
example of the United States). Then the chapter turns to the various issues pertain-
ing to population policy design, implementation, and monitoring and evaluation. It
addresses the nature of population policies vs. socioeconomic regulations, and
discusses the institutional settings needed to design, implement, and monitor and
evaluate population policies. The chapter also analyzes family policies, including a
comparison of Italy and Sweden. It concludes with the difficulties encountered to
reach a policy consensus; this is illustrated with a discussion of the views expressed
by the Roman Catholic Church on modern contraception.

Sub-replacement Fertility

Sub-replacement fertility is defined by levels of fertility that are not sufficient to

enable the replacement of generations, i.e., when the total fertility rate (TFR) is
below 2.1 children per woman on average. The replacement level of fertility is
determined by the number of children that are needed to replace women by girls that
themselves will reach the mean age at childbearing. The figure of 2.1 children,
although somewhat arbitrary because it is linked to the mortality conditions of the
moment, will be used in this analysis.
Most countries listed as developed, i.e., the US, Canada, Europe, Japan, and
Australia,1 are characterized by TFRs that are lower and sometimes much lower
than those needed to replace generations. However, three European countries,

1
In 2010, industrialized countries taken together represented 17.9% of the world population,
against 32.1% in 1950, according to the UN Population Division.