Foreign Relations of the United States, 1977–1980, Volume II, Human Rights and Humanitarian Affairs

308. Report by the NSC Ad Hoc Group on Population Policy¹

Washington, January 1978

U.S. INTERNATIONAL POPULATION POLICY SECOND ANNUAL REPORT

EXECUTIVE SUMMARY

This Annual Report, agreed to by the eighteen agencies represented on the NSC Ad Hoc Group on Population Policy, reviews population trends and program developments, broadly and on a country-specific basis, and reaches certain conclusions as to how to achieve better results in coping with this complex problem.

We recognize the adverse effects of current high developing country population growth which results in: possible worldwide food shortages, rising unemployment, frustrated economic development amongst poorer nations, widespread environmental deterioration, overcrowded cities where living conditions for countless millions are worsening, social unrest, and both national and international tensions. Above all, excessive population growth contributes in a major way to the suffering and poverty of countless millions and limits the prospects for a better life for their children.

While the pace of population growth seems to be slackening, it remains too high in too many developing countries, where most couples seem to desire at least four surviving children rather than the one, two, or three that would make population stabilization possible sometime in the next century.

Fortunately, there is mounting international attention to this situation, reflected in the fact that at least three-quarters of the people in the developing world live in countries whose governments have recently adopted population programs related to their economic development plans. There are also increasing amounts of donor assistance from governments, international organizations (especially the United Nations Fund for Population Activities (UNFPA) and the World Bank (IBRD)), as well as from private organizations, prominently including the International Planned Parenthood Federation (IPPF). We strongly support increasing U.S. contributions for the Agency for International Development’s (AID) population programs, which, aside from their intrinsic merit, are likely to encourage other donors to be more generous and receiving nations to apply themselves more vigorously in coping with excessive population growth.

Yet, despite all the progress achieved over the past decade, there is urgent need for a broader and more concerted effort by donors and receiving nations alike to deal with the problem.

In this situation, AID, while extending the availability of family planning services and building on that base, is now tackling the population problem along a broader front, recognizing the relevance of the many factors that bear upon fertility determination. As a result, 1977 witnessed the initiation of multi-year population strategies; the development of comprehensive performance criteria; the extension and support for low-cost and community-based delivery systems, increasingly integrated with health services; intensified research on the determinants of fertility, and more focus on motivation for smaller families. Most of these developments are described in detail in this Report. The Report also spells out how AID’s Fiscal Year 1979 Congressional population funding request for $205.4 million will enable the Agency to accelerate implementation of its broader approach, including continued major emphasis on expanding and improving family planning services and delivery systems.

We continue to believe, based on reports from our Missions in developing nations, that the most successful population programs usually depend on: (1) national leaders being clearly, firmly, and actively committed to promoting broadly based national population programs; (2) rooting family planning in communities (villages) and relating family planning to the economic interests and social development of the community; (3) training paramedics and others to provide general health services, including family planning, in communities (villages) where these people are known and trusted and ensuring that these paramedics provide personalized family planning advice and support; and (4) advancing the legal, social, and economic status of women.

Although U.S. policy requires that our leaders, Ambassadors, and others be knowledgeable on population issues and that they discuss them, as appropriate, in their contacts with key figures in other governments, particularly those in developing nations, this is often overlooked in the press of day-to-day business. Opportunities are thus lost for high-level exchanges, at least on an informal basis, on this fundamental issue.

One of the most effective ways in which we could bring our influence to bear in discussions with developing country leaders would be in encouraging and supporting them to undertake programs for enlisting the support of their own people in community or village programs. Population programs have enjoyed greater success in communities where there are strong local organizations. The stronger the community, the greater the community awareness of the need for action in limiting population growth, and the greater the opportunities for promoting peer pressures within the community for reduced fertility. In this connection, we believe there may be merit in programs of community incentives of the type now being launched in Indonesia which rewards communities most successful in reducing fertility rates commensurate with Government objectives.

In sum, the NSC Ad Hoc Group has no reason to recommend any changes in basic U.S. policy on population or on the conclusions reached in last year’s Report.² We do, however, recognize the need for far greater efforts and more innovative approaches along the lines suggested in this Report, if the world is to be spared the devastating consequences of uncontrolled population growth. All nations, rich and poor, have a major stake in the outcome.

Introduction

The NSC Ad Hoc Group on Population Policy, comprising representatives of eighteen U.S. Departments and Agencies, herewith submits its 1977 Annual Report in accordance with the requirements of a NSC Decision Memorandum of May 17, 1977.³

Basic U.S. policy on international population is set forth in NSC documents as well as in the First Annual Report of the Interagency Task Force on International Population Policy of July 1976. The latter Task Force was replaced by the NSC Ad Hoc Group, but since its membership and purposes are identical, the Report submitted herewith can be viewed as the Second Annual Report on the implementation of basic U.S. policy on international population issues.

This Report is divided into the following five main sections, all largely focused on 1977 developments and their implications for the future:

I. General Trends

II. Program Developments in Key Countries

III. Developments in U.S. Population Assistance Programs

IV. Developments in Population Assistance from Other Donors

V. Conclusions

The conclusions of this Report do not alter basic U.S. international population policy as defined in NSC documents, but they do expand on existing policy in addressing a number of issues requiring attention. This Report (especially Section II) is more country-specific than the First Annual Report, drawing on responses to a circular telegram sent to our Embassies in major population growth countries.

This Report, like its predecessor, deals exclusively with the population problems of developing nations. While it is true that all countries, including the United States, face population problems, population growth rates in the developing world are far higher and pose a different range of issues.

We do not re-state the many adverse environmental, social, economic, and security effects of developing country population growth rates. What has been said in last year’s Report remains valid, although we believe greater emphasis needs to be placed on how high population growth rates (1) aggravate unemployment and underemployment (see Section I); and (2) adversely affect the health of women and children, contribute to high mortality rates, especially amongst those under 12 years of age, and limit prospects for a better life for the children of large families.

With regard to (2), excessive population growth contributes in a major way to the suffering, poverty, and early death of countless millions of poor people. To anyone concerned with the human condition, this must be a compelling argument for far more effective measures to alleviate tragedy on such a vast scale. Moreover, high rates of population growth also increase pressures for internal and international migration, creating severe problems in terms of deteriorating conditions of life in burgeoning urban areas of developing countries as well as in terms of relations between countries affected by the current patterns of large international migration.

The United States’ approach to world population issues is based on concern for the well-being of all people, many of whom are now in dire need, and on respect for the rights and responsibilities of each government in determining its policies and programs. We recognize, however, that a sound population policy and program is an important and integral part of the development process for many of these countries.

Population stabilization is not a goal in itself. The real goal is improving conditions of life for vast numbers of people, especially in the poorer nations; and this involves a wide range of measures, broadly distributed, of which family planning must be seen as a basic part.

In the course of his Environment Message to Congress on May 23, 1977, President Carter stated:

“Rapid population growth is a major environmental problem of world dimensions. World population increased from three to four billion in the last 15 years, substantially cancelling out expansion in world food production and economic growth for the same period.

“Without controlling the growth of population, the prospects for enough food, shelter, and other basic needs for all the world’s people are dim. Where existence is already poor and precarious, efforts to obtain the necessities of life often degrade the environment for generations to come.

“It is, of course, up to each nation to determine its own policies, but we are prepared to respond promptly and fully to all requests for assistance in population and health care programs. At my direction, the Department of State and the Agency for International Development stand ready to cooperate through international organizations, through private voluntary organizations, or through direct contacts with other governments.”⁴

I. General Trends

Whereas current mortality and fertility in the developed regions are such that net reproduction rates are close to replacement levels, fertility rates in the developing world remain high. On the other hand, there is evidence that birth rates are beginning to decline in a mounting number of developing countries, overtaking declines in death rates. Based on U.S. Bureau of the Census data, the 1976 rate of growth of developing country population is estimated at about 2.5 percent, if the People’s Republic of China (PRC) (for which no reliable figures are available) is excluded. This is a drop from a high of 2.6 percent estimated for the early 1970’s.

About four-fifths of the developing country population lives in the 13 most populous countries, i.e., those whose 1975 population exceeded 35 million. This includes, in order of size: China, India, Indonesia, Brazil, Bangladesh, Pakistan, Nigeria, Mexico, Vietnam, the Philippines, Thailand, Turkey, and Egypt.⁵ Accordingly, these 13 countries have a disproportionately large impact on average demographic trends among the developing countries. Ten of the 13 (excluding Brazil, Nigeria, and Turkey) have adopted population policies and programs to reduce fertility in the interest of national development, as well as family health and welfare.

Some successes . . . The most intensive effort in reducing excessive population growth is probably occurring in the People’s Republic of China. According to a public report from Peking, the rate of the country’s population growth has been declining yearly since 1965. Although considerable data have been reported by PRC officials, local and provincial, there is no information upon which to base nation-wide estimates of the birth rate or to gauge the means whereby success in reducing fertility is being achieved.

Considerable progress has been recorded in two other Asian countries among the 13, namely, Indonesia and Thailand. The latter’s population growth rate is estimated to have declined from 3.1 percent at the start of the Third Five-Year Plan in 1971 to 2.5 percent in 1976. Progress has been made in the Philippines, although organizational and administrative problems have impeded the program’s potential. Vietnam’s—by all indications—vigorous birth control program is still too new to have produced significant nation-wide results.

There have also been encouraging developments in Mexico, Brazil, and Peru, reflecting Latin America’s increasing acceptance of population policy as a legitimate component of comprehensive national development plans. In Mexico, new organizational arrangements and program initiatives in family planning are evidence of the serious attention which the Government is now giving to the issue. Brazil, with a population policy primarily directed toward family welfare needs, has made slow but concrete progress with a decision to provide public family planning services to women at “high risk” who cannot afford to pay for them. In Peru, a Presidential decree, issued in August 1976, established a population policy based on the dual concepts of individual freedom of choice and procreative responsibility to the state.

Continued progress in reducing traditionally high fertility levels was recorded in a number of less populous developing countries. The most sizeable reductions in the birth rates over the past decade or so occurred in rapidly modernizing Singapore, Hong Kong, Taiwan, the Republic of Korea, as well as in Costa Rica, Colombia, Panama, the Dominican Republic, Sri Lanka, and ten or so island-nations of one million population or less.

Finally, on the positive side, special mention should be made of the increasing contribution to population programs being made by the UN system, notably the UNFPA and the World Bank. These are discussed in Section III below.

. . . and disappointments. Family planning programs have run into difficulties in a number of countries, particularly in the South Asian region of India, Bangladesh, and Pakistan—three countries whose aggregate population surpasses that of Latin America and Africa combined. For example, there has been a slowdown in India’s family planning program which reflects public (and the new Government’s) reaction to the compulsion in sterilization activities in some areas, carried out in the last year of the Gandhi Administration. Lack of progress in certain countries (discussed in Section II below) may relate in large degree to such basic factors as male-dominated rural societies, the weakness of village organization and lack of community participation, difficulties in program management, organization and administration, and the relatively low level of government commitment.

In Bolivia, active Government opposition to birth control continued, resulting in serious constraints on all family planning activities. The 1976 census showed a total population of one million less than had been previously estimated.

Forward movement in the establishment of family planning programs in Africa has been slow. Government programs do exist in a few countries, e.g., Kenya, Ghana, Tanzania, and Zaire, but their results have not been significant, although there are signs of improvement. However, most governments in sub-Saharan Africa do not provide family planning services in regularized national programs. A growing number do permit, and even support, the activities of private family planning associations. Family planning in Nigeria is largely provided by private institutions such as hospitals and the Family Planning Council, although the Government, through its newly created National Population Council, has begun to subsidize these activities. Togo recently joined the one or two other Francophone countries in this region which have established national family planning programs. There is widespread tradition in Africa favoring child spacing, and family planning is increasingly perceived as an important public health measure. In many African countries, the extension of health programs into rural areas, organized attempts by rural women to promote their own interests, increased school attendance, and other manifestations of social progress can be viewed as foundations on which to base future African family planning programs.

Population and development. While the pace of population growth appears to be slackening, it remains excessive in too many developing nations, substantially offsetting economic gains and reducing prospects for significant improvements in levels of living. In the poorest developing countries, the average gain in gross domestic product (GDP) between 1970 and 1975 (in 1970 prices) was a meager one dollar per person per year. This group of low-income, non-oil exporting developing countries with per capita GDP in 1970 of less than $200, contains over one billion people, or nearly 60 percent of the developing country population, excluding China.

In view of the growing focus on basic needs of the poorest strata in less developed countries, population trends are assuming greater importance in national developmental policies and plans. In earlier decades, the primary objective of development was to promote the growth of aggregate product. On the premise that the benefits would eventually trickle down to the masses, income distribution was of secondary concern. Excessive population growth impedes the attainment of both objectives. Particularly, it thwarts efforts to distribute the benefits of growth to all segments of the population.

A principal mechanism for moderating internal imbalances in income distribution is productive employment. Yet, in the next 25 years, working age populations of all developing countries (excluding China) will more than double, with the potential of increasing mass unemployment/underemployment. Actual deterioration in the employment situation would act to deepen the maldistribution of wealth, as well as intensify social unrest and political tensions.

On the other hand, many developing countries are giving increased attention to social development, notably in health, education, and greater involvement of women in development and in decision-making processes. These programs are expected—in interaction with other components of development—to have a long-term, favorable effect on moderating high fertility, as long as they are adequately extended to rural areas and urban slums.

A list of social and economic pre-conditions for declining fertility does not imply that we know what combination of conditions triggers a sustained fertility decline or that significant declines in fertility cannot be initiated under conditions of illiteracy and high mortality. (A good example of the latter, perhaps, are recent declines in fertility on Java and Bali, Indonesia.) If we assume, however, that voluntary family planning requires:

—a conscious choice on the part of the couple (a decision preceded by a weighing of economic, social, and psychological advantages and disadvantages of another child);

—knowledge and effective use, as well as availability, of acceptable means of contraception or birth control;

then, education, adequate health conditions, rising income and expanding consumer goods and services, acceptability and availability of alternative occupations for women, etc., generate and promote both conditions.

Population and food. Between 1960 and 1975, food production in the developing market economies, as a whole, expanded at the unprecedented rate of 2.8 percent per year. However, since 1960, population and income growth in the developing countries have increased the demand for food by about 3.5 percent per year. Despite the return of overall food production to the previous high growth trend of 2.8 percent, after the lull of 1972 to 1974, population growth has held average per capita increases in food production over the 1960 to 1975 period to about 0.3 percent per year. This leaves relatively little room to reduce malnutrition, particularly when the increased per capita consumption by the more affluent in these countries is taken into account. For the poorest group of developing countries, the average annual increase in food production has been only 2.3 percent over the past 15 years, somewhat less than their average increase in population. Per capita consumption has not increased at all, and in Africa, it has decreased by 10 percent.

About half of the present and expected future deficits are in higher income LDC’s, including a few countries without foreign exchange constraints, able to import commercially sufficient food to meet expected domestic demand. A number of other developing countries usually can do so provided they can continue to have increasing access to OECD markets for their export products.

The more intractable part of the food problem is the expanding deficit in developing countries with a GNP of less than $300 per capita. During the period 1971–1975, their annual food production increased by only 1.8 percent per year. This is well below their annual population growth of 2.4 percent. While recent harvests have improved, long-range prospects show many developing countries becoming increasingly dependent on food imports. If these deficits are to be even partially satisfied by imports, many developing nations will be forced deeper into debt, limiting their ability to finance economic development efforts, including the increase of food production.

Many views of the world food situation focus on immutable forces or circumstances (such as the limited surface of the earth, changed climatic patterns, or the fixed nature of consumption patterns) which are thought to be beyond control. However, much of what has happened in the development of the world food situation can be traced to government policies and basic human conditions (such as income distribution and poverty), and suggests that governmental and individual choices will continue to be critical in the future. The world food situation can be changed to the extent that governments and individuals see needs for change and are willing to modify those policies and conditions that influence food production and consumption.

Increasing food production in the developing countries will require improvements in basic agricultural technology and infrastructure, favorable policies, and better resource management. There is, however, no practical solution to long-term food production problems that does not prominently include accelerated declines in population growth rates.

Longer-term demographic prospects. There are some hopeful signs, but intensified action in policies and programs aimed at encouraging small families and providing the means of achieving them is required. Progress has been made in reducing fertility, but the gains are still too localized and some are too fragile. Changes in governments can upset programs’ efficiency. Much greater efforts will be required (1) to institutionalize small family norms (through reduction of poverty, expanded educational opportunities and health services for the masses, and improvements in legal, social, and economic status of women, including greater participation of women in making decisions as to family size), as well as (2) to raise the coverage and quality of family planning services. All of these measures are necessary if past gains in reducing fertility are to be solidified and future reductions accelerated.

World Bank President McNamara observed in his recent speech (MIT, May 1977)⁶ that, if, through some extraordinary concentration of effort, the worldwide fertility rate would decline to the replacement level (NRR=1) by the end of this century, world population would ultimately cease to grow at about 8 billion. Delaying this fertility transition another 20 years would eventually produce a stable population of 11 billion. Thus, for every decade of delay in achieving replacement-level fertility rates, the ultimate size of world population will increase by some 15 percent.⁷

[Omitted here are Section II: Program Developments in Key Countries; Section III: Developments in U.S. Population Assistance Programs; and Section IV: Developments in Population Assistance from Other Donors.]

V. Conclusions

A. Overall Strategy.

The Ad Hoc Group endorses U.S. strategy in dealing with international population issues as set forth in Section II of last year’s Report.

We continue to believe, based on reports from our Missions in developing nations, that the most successful population programs usually depend on: (1) national leaders being clearly, firmly, and actively committed to promoting broadly based national population programs; (2) rooting family planning in communities (villages) and relating family planning to the economic interests and social development of the community; (3) training paramedics and others to provide primary health services, including family planning, in communities (villages) where these people are known and trusted and ensuring that these paramedics provide personalized family planning advice and support; and (4) advancing the legal, social, and economic status of women.

Although U.S. policy requires that our leaders, Ambassadors, and others be knowledgeable on population issues and that they discuss them, as appropriate, in their contacts with key figures in other governments, particularly those in developing nations, this is often overlooked in the press of day-to-day business. Opportunities are thus lost for high-level exchanges, at least on an informal basis, on an issue widely seen by developing country leaders as the most fundamental one their nations face.

It is not a matter of our lecturing them or they us, but of learning from each other and discovering ways in which we can be of greatest mutual help in carrying out successful programs of development, including adequate attention to demographic issues.

These discussions should not focus exclusively on the adverse effects of high population growth rates on economic development. Our concerns relate in a major way to how high birth rates impair the health of mothers and children and limit prospects for a better life for children now, and for generations to come. This broadly relates to human rights and meeting basic human needs.

B. Strengthening Community Organizations.

Population programs have enjoyed greater success in communities where there are strong local organizations. The stronger the community, the greater the community awareness of the need for action in limiting population growth, and the greater the opportunities for promoting peer pressures within the community for reduced fertility.

Strengthening community organizations serves many purposes, including the achievement of demographic goals. Stronger village or community organization involves enlisting the support of people in self-help programs, and engendering a stronger sense of participation on the part of individuals in the communities in which they dwell. This will not occur spontaneously. Above all, it requires that national governments take the lead in strengthening local organizations, and in providing direction and assistance for mutually supportive programs at the village level whether these programs are in education, health, family planning, nutrition, or rural development, and include cooperatives or other means to expand the income of local communities.

While it is true that broad, multi-purpose programs may suffer from organizational complexity, this could be offset to some extent by greater reliance on community organizations for the execution of policies and programs established by the central government. In fact, central governments might be well advised to enlist community organizations in discussing policies and programs at a formative stage in order to ensure that the policies and programs reflect local realities and enlist community interest and support from the outset.

C. Laws and Regulations; Incentives and Disincentives.

Population programs must be supported by laws and regulations to refine, coordinate, finance, and implement the determined policy. From the viewpoints of both donor and recipient countries, legal reform is often essential, lest population assistance be negated by outdated laws. Ironically, many developing countries have retained antiquated population-related laws which they inherited from former colonial powers, and which those powers have by now discarded as being incompatible with human rights.

Although a good start has been made through the establishment of over 30 Law and Population Projects in developing countries (most funded by UNFPA) to review population-related laws and recommend legal reforms, there is need both to expand the network and to encourage the actual implementation of proposed legal reforms.

One of the most important laws affecting population is the regulation of the legal age of marriage. Most informed observers believe that Sri Lanka’s success in moderating fertility rates is related in an important degree to the relatively high age for women at first marriage.

It is a regrettable fact that few developing countries today have adequate systems for registering births, deaths, and other vital events. Not only does the dearth of such data have an adverse impact on the application of their laws affecting population, but it also makes it difficult, quantitatively, to assess the cost-effectiveness of population programs and to measure and thus give greater support to those socio-economic factors which have the greatest impact on moderating fertility rates.

The World Population Plan of Action (paragraph 14(f)) states that it is the basic right of all couples and individuals “to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so.” The key words here are “freely and responsibly.” The Plan is explicit in specifying that “the responsibility of couples and individuals in the exercise of this right takes into account the needs of their living and future children, and their responsibilities towards the community.” The Plan therefore recommends that a couple or individual limit the number of children if: (a) they are unable to provide adequately for the needs of their living and future children; or (b) the community cannot afford a population growth rate which would jeopardize its ability to provide adequate food, housing, education, health care, and job opportunities for all its citizenry.⁸

It has been essentially against this background that some of the most densely populated countries have applied or are now considering applying a range of incentives or disincentives to motivate people to have smaller families. Incentives have usually taken the form of inducements or rewards for those accepting sterilization. Disincentives have usually taken the form of administrative measures which have the effect of penalizing those with large families.

Incentives and disincentives have been effectively used, but they sometimes lend themselves to abuse. AID funds are not involved in the direct payment of incentives or disincentives.

Several countries are now launching, or are considering launching, programs of community incentives. For example, Indonesia has recently started a program, with World Bank support, of rewarding those villages (within certain designated districts) most successful in lowering fertility rates. Ideally, the rewards would take the form of providing prize-winning villages or communities with whatever the residents of those villages had collectively decided in advance they most wanted, meanwhile having that potential prize kept constantly before public attention.

This type of incentive has particular merit both in terms of increasing flows of assistance to villages and in terms of stimulating motivation, including peer pressures, for lowering birth rates. Although less subject to abuse than individual incentives, community incentives will require careful administration to be equitable and effective.

D. Population and Food Assistance.

As brought out in Section I of this Report, we recognize the likelihood of a growing gap between food and population in certain parts of the world, and therefore the need for actions, additional to those currently being taken, to increase food production and to lower population growth rates. The United States has a particular responsibility to support efforts to maintain a viable balance between food and population. We are the largest food exporter of the world and by far the largest supplier of food assistance, currently providing twelve times as much food aid as population assistance. Clearly, it is in our interest as a major food and population assistance donor to help ensure that (1) our food aid meets the critical nutritional needs of people in the most seriously affected countries; (2) food aid has maximum developmental impact; (3) it stimulates receiving countries to increase their own food production; and (4) our food aid and population program policies are mutually supportive.

Three specific aspects of the Food for Peace program help to further the goals enumerated in the first paragraph of this Section. Title II⁹ food commodities are provided through private U.S. organizations like CARE and Church World Service and the UN World Food Program, which run their supplemental feeding activities in the context of nutrition and health education as well as agricultural extension programs. Particularly where these food and education programs are directed at pregnant or breastfeeding mothers and young children, family planning information should be included along with nutrition education. The passage of Title III of the Agricultural Trade Development and Assistance Act (P.L. 480) furthers goal (2).¹⁰ Title III permits the President to forgive Food for Peace loans to those countries who have used funds generated by the sales of U.S. food commodities for development purposes including voluntary family planning. Finally, with regard to goal (4), our records show that there has been a family planning component to several Food for Work projects (e.g., in India, Egypt, and Peru); and consideration, as recommended in the Interagency Task Force’s First Annual Report to the President, should be given to expanding this approach wherever feasible.

We conclude that, where food production and population are clearly out of balance, the leaders of countries requesting U.S. food assistance should be reminded at an appropriately high level of: (1) longer-term anticipated worldwide food shortages, citing FAO and other data in that connection, including increased commercial demand; and (2) Congressional requirements that our assistance be increasingly concentrated on countries that make effective use of such assistance, including their performance in improving agricultural output and nutrition and reducing population growth. Such an intervention should be made by Ambassadors in a way that would be most likely to produce effect without causing offense.

This would also provide a useful opportunity to review what the particular country is doing to ease the food-population problem and, where required, to stimulate greater attention to the food-population linkage and programs related thereto. It would have the further advantage of bringing to the attention of receiving countries the seriousness we attach to the longer-range food-population issue and the urgent need to take timely action.

E. AID Population Programs.

Despite all the progress achieved over the past decade with AID assistance in introducing and expanding developing country family planning programs, population growth rates remain excessively high, with most couples in the developing world desiring a completed family size of four or more children.

AID’s population assistance has focused strongly on extending family planning services. While building on that base, the Agency is now tackling the population problem along a broader front, recognizing the importance of the many factors that bear upon fertility determination.

As described in earlier sections of this Report, it is this broadening of approach that motivated many of the principal developments in AID’s population programs and organization in 1977.

The 1979 request for $216.4 million will enable the Agency to accelerate implementation of this broader approach so that, in addition to continued attention to the supply of family planning services, it will undertake:

(1) Development of comprehensive country population strategies and of better means to evaluate the effectiveness of population programs.

(2) Expanding integrated health services, including family planning, at low cost with maximum outreach.

(3) Improved motivation programs, especially on a personalized basis.

(4) Research which increases understanding on the determinants of fertility, particularly in key countries receiving our assistance.

(5) Improved demographic data collection, including recognition of the need for better vital registration systems.

(6) Greater attention to sound administration and logistics management.

In addition to the above points of program emphasis, AID will accelerate its efforts to enhance population programs by interrelating them to other components of development assistance which now affect population growth or which can broaden the delivery of family planning services.

AID’s internal reorganization takes the foregoing into account, as does Section 104(d) of the Foreign Assistance Act,¹¹ enacted last year, which requires that all appropriate development assistance programs be developed with a view to “building motivation” for smaller families.

AID is also ensuring that service delivery programs will be organized increasingly around low-cost village and community-based systems, including training of paramedics and auxiliaries in family planning techniques, distribution, and ways to motivate people to practice contraception and otherwise to lower fertility rates.

Since the need and demand for voluntary sterilization is widespread, AID will be training doctors in new surgical techniques so that medically safe, voluntary sterilization programs can be undertaken by governments and private agencies. Also, in response to mounting requests, AID will be increasing support for developing country voluntary sterilization programs through improved biomedical research, chemical testing, training, equipment, and related services.

Continued research, carried out in the U.S. or in developing country institutions, whenever feasible, to create simple, but effective, diagnostic procedures and contraceptive techniques, is needed to improve the quality of health and family planning services. Clinical testing of research results will be done in developing countries to be sure that the new or modified methods are adapted to country-specific circumstances. Research and tests of improved IUD’s, better male and female sterilization procedures, and an early, simple, and accurate pregnancy test are among the problems to be pursued.

The collection and analysis of fertility and other demographic data are essential tools for the design of better family planning services and the assessment of a country’s population program. Trained, objective analysts and designers of data collection systems are needed to evaluate program progress against demographic goals. AID plans to continue support to a number of data collection and evaluation programs which are producing useful statistical materials and are training developing country personnel to carry out these tasks in the future.

AID will continue to give priority attention to those large, populous developing countries which contribute most to the growth of the world population. About half of our bilateral population assistance now goes to Indonesia, Bangladesh, Pakistan, Thailand, and the Philippines. Moreover, during the past year, two additional populous countries, for the first time, received indirect U.S. assistance through private voluntary organizations. We do not believe, in priority cases like this, that the fact that they are “graduate countries” (with per capita income above the ceiling for AID assistance) should stand in the way of receiving at least indirect population assistance, where such help is needed and requested, particularly in light of the President’s commitment in his Environment Message (quoted above) to be responsive to all requests for assistance in this area.

Over the next decade, AID looks to the steady growth of more effective family planning programs, sustained and more equitable economic and social development, and the deliberate introduction of a concern for reduced birth rates into developing country development programs. If adequately supported by the U.S., international, private, and other bilateral donors, a concerted effort can accelerate the reduction in developing country population growth rates and lead to an improvement of the quality of life for the world’s poor majority.

1. Source: National Archives, RG 59, Central Foreign Policy File, P780054–1154. No classification marking. Sent under cover of a March 15 memorandum from Tarnoff to Brzezinski. Forwarded to all diplomatic and consular posts as Airgram A–1345, April 5. (National Archives, RG 59, Central Foreign Policy File, P780052–1723)
2. See Foreign Relations, 1969–1976, volume E–14, Part 1, Documents on the United Nations, 1973–1976, Document 125.
3. See Document 282.
4. See footnote 4, Document 284.
5. The “key 13 countries” mentioned elsewhere in this Report, and in last year’s Report, include 11 of the 13 developing countries listed in this paragraph. [Footnote in the original.]
6. According to a May 2, 1977, editorial in The Christian Science Monitor, McNamara spoke at the Massachusetts Institute of Technology (MIT) the last weekend of April, exploring the connection between population control and the status of women. (“Wives’ clubs and population warnings,” p. 36) See also David R. Francis, “Social justice and economic progress. . .,” The Christian Science Monitor, May 2, 1977, p. 11.
7. The above population projections, developed by Tomas Frejka of the Population Council, are not intended to predict the actual situation but are meant to illustrate the enormous potential for growth built into the current age structure of much of the world’s population. It is not inconceivable, for example, that, at some point in history, average family size in countries, regions, and the world may consist of fewer than two children (i.e., that fertility may stabilize at a level below replacement of the parental generation). A sustained fertility level below replacement, however, would eventually lead to a decline in the absolute size of the population. This, to our knowledge, is not an objective of any governmental population policy and, hence, is not used—even for illustrative purposes—in this Report. [Footnote in the original.]
8. See footnote 6, Document 284.
9. Title II of Public Law 480 provides for the donation of U.S. agricultural commodities to private voluntary organizations and international organizations for use in foreign humanitarian feeding programs.
10. See footnote 31, Document 245.
11. Congress, in the 1973 Foreign Assistance Act (P.L. 93–189; 87 Stat. 715), amended the Foreign Assistance Act of 1961 (P.L. 87–195; 75 Stat. 424) to include Section 104, which outlined U.S. assistance activities in the areas of health and population. The International Development and Food Assistance Act of 1978 (P.L. 95–88; 91 Stat. 537), further amended the Act by adding Section 104 (d), specifying the integration of assistance programs with population planning efforts. Public Law 95–88 additionally authorized $167 million for population programs. See Congress and the Nation, Volume V, 1977–1980, pp. 37–38.