Population and the World Bank: Excessive population growth can threaten economic progress--what is the World Bank doing to help LDCs ?
Author:
Sundaram Sankaran
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The World Bank Group regards excessive population growth as the greatest single obstacle to economic and social advance in the underdeveloped world. What is the Bank doing to help limit this growth?

This paper reviews the population policy in developed countries. The paper highlights that despite the weakness of population concerns in most developed countries compared with less-developed countries, most of the former have taken certain actions that affect, or are thought to affect, demographic events. These actions include such measures as appointing official commissions to study the country’s demographic situation and advise the government what to do; providing birth control services as part of the public health system; and so on. This paper also summarizes the conclusions drawn by Dr. Berelson from the 25 country reports.

Abstract

This paper reviews the population policy in developed countries. The paper highlights that despite the weakness of population concerns in most developed countries compared with less-developed countries, most of the former have taken certain actions that affect, or are thought to affect, demographic events. These actions include such measures as appointing official commissions to study the country’s demographic situation and advise the government what to do; providing birth control services as part of the public health system; and so on. This paper also summarizes the conclusions drawn by Dr. Berelson from the 25 country reports.

Sundaram Sankaran

The first requisite of any successful development project is political will on the part of the developing countries. Outside agencies, bilateral and multilateral, can and should help with money, men, and guidelines. But the basic political and economic decisions must be taken by the developing countries themselves. After all, they are the major partners in the endeavor, providing more than 75 per cent of the material and human resources for economic development.

The need for political commitment to plan population growth and distribution is even more critical to the success of population programs. It is, unfortunately, even more difficult since population planning goes beyond the realm of pure economics, often touching particularly sensitive areas of religion, caste, race, morality, and politics. In a number of developing countries the effectiveness of policymakers is impaired by fears that ethnic and linguistic balances within a country will be upset by population control. Such concerns may be unfounded but they are there.

A racialist plot?

In addition, some critics have characterized the white Western world’s assistance in family planning efforts among the nonwhite developing nations as a racialist plot to keep the whites in ascendance. This is incorrect: in the world’s population, nonwhites massively outnumber whites—they always have and always will. No conceivable degree of family planning could alter this simple statistical truth. It is, in any case, the developing countries themselves, not the affluent whites in Europe and North America, who will suffer as a result of excessive population growth. In many poor countries, any increases in national income are already often consumed in meeting the larger requirements for food and other essentials of a growing population. Such countries frequently suffer acute problems of unemployment and inequality in the distribution of income which can also be eased by reductions in fertility.

Mrs. Indira Gandhi, Prime Minister of India, has succinctly put the problem in perspective: “To plan when population growth is unchecked is like building a house when the ground is constantly flooded. Family planning is an essential part of our strategy of enlarging welfare. Greater welfare is in fact the only reason for family planning, and we need it, not because we are against more children, but because we want every child to have the best opportunity possible in life.”

No substitute for aid

A solution to the population problem is, of course, in no way a substitute for the more traditional forms of development assistance—support for infrastructure, agriculture, industry, education—nor for technical progress. It should not be considered an excuse for providing inadequate amounts of aid—the developing countries urgently need investment capital for a wide range of productive projects of high economic priority. However, as the World Bank has repeatedly emphasized, it would be a mistake to allow these projects to fail just because they are finally overwhelmed by a tidal wave of population. Fortunately, family planning is becoming increasingly accepted by both governments and ordinary people as the only rational and humane way of dealing with a problem that might lead to mass starvation and chaos. The Bank indeed considers an effective population planning policy to be a necessary complement to attempts to improve the standard of living in the developing countries. In 1969, it established a Population Projects Department and also introduced a five-year plan to expand assistance to developing countries. This Department has since the middle of 1972 become the Population and Nutrition Projects Department and is concerned with both family size and welfare.

A gentle reminder

The Bank does not make the adoption of population planning a condition of its lending to individual countries. What the Bank does do is remind those of its borrowers facing a population problem of the threat to their economic progress posed by unduly rapid population growth. The Bank’s economic reports on individual countries increasingly discuss what is or is not being done in this area, putting the population question in the context of the country’s overall economic situation, its choice of priorities, and the appropriate use of resources.

The emphasis to be placed in national policy on methods of population planning is the responsibility of governments. The acceptance of family planning and the choice of methods is the right of individuals. The Bank is not attempting to dictate detailed policies or to promote particular methods; it recognizes that this is a field where individual, social, or national attitudes cannot be expected to change overnight—even when the will to change is present. But as an international development agency, the Bank gives priority to this problem and stands ready to provide technical and financial assistance to governments that wish to stabilize their rate of population growth.

No overnight success

Any development scholar wishing to pass judgment on the performance of a developing country in population planning should be conscious of the size of the problem, its complexities and sensitivities involving difficult ethical, political, and social issues. As the World Bank President, Robert S. McNamara, said “there are dozens of countries plagued with the problem—each of them different, each of them possessing their own particular set of social and cultural traditions. There are thousands of clinical facilities to be established; hundreds of thousands of staff workers to be recruited, trained and organized in the administration of the vast national programs; hundreds of millions of families to be informed and served; and well over one billion births to be averted in the developing world alone, if, for example, by the year 2000 the present birth rate of 40 per 1,000 population were to be reduced to 20 per 1,000. What we must understand is that even if an average family size of two children per couple is achieved, the population will continue to grow for an additional 65 or 70 years and the ultimate stabilization level will be far greater than at the time the two-per-couple rate is achieved.”

In our anxiety to attract greater financial commitment for population planning programs, we should not overstate their prospects for success or minimize the magnitude of the problem. No instant success story is around the corner. Much of the disillusionment about foreign aid can be attributed to failure to realize exagerated expectations about winning friends, getting hold of markets, and repeating the German and Japanese “miracles.” The enormous growth in the literature on the “birth” and “death” of the “Green Revolution”—all in a span of about six years—once again underlines the dangers of generating overoptimism.

The World Bank’s Sector Working Paper on Population Planning (1972) underlines the preconditions for reducing fertility: “In the long run, fertility reduction can be achieved only with the right combination of social and economic development, cultural and political attitudes, and easy availability of contraceptive facilities. No one yet knows the required mix, which probably differs from country to country. However, the limited experience available has already shown that if an adequate service can be provided, including public information and a variety of acceptable methods, the results will be demographically significant even if inadequate to achieve the desired reduction in fertility.”

More than money

The Bank Group’s assistance to member countries in the field of population planning is more extensive than the volume of its lending operations. This is because, in a number of cases, a lack of foreign exchange is not the principal constraint on effective implementation of population policies. Often, the country’s greatest requirement, and the Bank’s most useful contribution, is not finance but technical assistance in any or all of its many forms.

According to the Bank’s Sector Working Paper, “one of these is education, in the most strategic sense. In many countries, the general implications of population growth in terms of development may be known by the professional and political elite, but understanding may not be sufficiently widespread to support decisive policies or action. In these cases, the Bank can often help governments through its capability for fact-finding and analysis. It can do so effectively, of course, only at the Government’s invitation or, at least, with its acquiescence. Given one or the other, however, the Bank’s help in collecting, organizing, and analyzing facts about a country’s demographic position and its meaning in terms of development can sometimes be crucial.”

However, in financial terms alone, the Bank and the International Development Agency have since 1969 provided $65.7 million for population projects (described below) in seven countries.

India

India’s population of 560 million is growing at the rate of about 12 million a year. This rapid increase has diminished the country’s efforts to raise living standards. In the 1960s, for instance, as much as 60 per cent of the increase in national income has been absorbed by growing population.

India proclaimed an official population policy in 1961. In 1965 it launched a concerted effort to expand the country’s family planning program. Since then an administrative machinery of more than 80,000 persons has been set up; a mass information campaign launched; a system of centralized service for groups of villages has been introduced; and postpartum programs have been initiated in selected large hospitals in several cities. The number of new acceptors of birth-control measures increased from 2.4 million in 1966/67 to 3.8 million 1970/71 and, at present, about 11 per cent of the 98 million couples in the reproductive ages of 15 to 44 are estimated to be using contraception. However, a more effective family planning program is required if the Government’s objective of reducing the birth rate to 25 per 1,000—and the population growth rate to 1.5 per cent—by 1980, is to be met.

In June 1972, IDA joined Sweden in providing jointly $31.8 million for a research-oriented population planning project in selected areas of Uttar Pradesh and Mysore States. The IDA credit of $21.2 million is the largest in the population planning field which the Bank Group has so far made. It is also unique in content—an experimental effort to determine what needs to be done to improve India’s national program to reduce fertility. Its central core will be the development of a management-information and evaluation system to generate answers to operational questions; undertake research on demand aspects; and recommend new approaches. This will be done in two population centers—in Lucknow and Bangalore—which will be set up with the support of Indian technical assistance also financed from this credit.

The project includes financing some 1,500 buildings—mostly rural health centers for field-level personnel—but including training schools for assistant nurse-midwives and family planning workers, urban maternity homes and family planning clinics, maternity-sterilization wards, and administrative buildings. Mobile teams for education and provision of family planning services are also part of this project.

Indonesia

In March 1972, IDA joined the United Nations Fund for Population Activities (UNFPA) in financing a project designed to expand the Indonesian Government’s family planning program and broaden the range of its activities. IDA is providing $13.2 million and the UNFPA is committing an equivalent amount, in the form of a grant, to support the project.

With a population of 121 million, growing at an annual rate of 2.6 per cent, Indonesia ranks fifth among the world’s most heavily populated countries. Nearly two thirds of this population lives on Java and Bali, which have average densities of about 1,490 persons a square mile. The Indonesian Government is giving strong support to a national family planning program—of which the IDA-supported project is a part—but a much greater acceptance of family planning is needed before any significant effect on the current birth rate of 48 per 1,000 persons can be expected. The current level of new family planning acceptors in Indonesia is about 270,000 a year and it is hoped that the project will increase this to 1.6 million by 1975. Without the project, this level might only reach around 500,000.

The project being supported by IDA is a comprehensive project providing support—as in other Bank and IDA population projects—for physical facilities and technical assistance in East Java, Bali, and Djakarta. However, activities directly affecting family planning performance—training, motivation, evaluation, research, and population education—are also being supported and these will benefit the entire national program.

The project calls for the construction, equipping, and staffing of 10 schools to train nurse-midwives and auxiliaries, 6 provincial training centers for in-service family planning training, and about 250 rural and 30 urban maternal, child health, and family planning centers. In East Java, about 40 additional small rural centers will be built to serve a demonstration field postpartum program.

Iran

The Government of Iran is greatly expanding its national family planning program during the Fifth Plan period (1973-77) with the objective of reducing population growth below its current 3 per cent annual increase. A $16.5 million Bank loan will assist this effort by extending family planning activities to small towns and rural areas, providing training facilities, and exploring means of improving the management and administration of the program.

About 60 per cent of Iran’s 31 million people now live in rural areas where incomes are much lower than in towns. During the Fifth Plan, the Government plans to accelerate agricultural development to lessen the income gap. However, only a quarter of the land area is suited to agriculture and, because of the scarcity of irrigation water, agriculture cannot provide higher incomes and gainful employment for all those now living in rural areas, let alone an increased number.

The Government also intends to slow down the growth rate of the rural population and the agricultural work force by further urbanization. However, unless fertility is reduced, the rapid growth of population will severely strain the Government’s capacity to provide social infrastructure and industrial economic opportunities in both rural and urban areas.

The Bank project includes the construction, equipping, and furnishing of 78 health centers to be located in the administrative centers of rural counties. The health centers will provide, in one physical complex, preventive and curative health services, including maternal and child health, and family planning clinics.

An important part of the project will be the construction and equipping of nine regional family planning training centers and seven multipurpose training schools. The centers will provide training in family planning for a larger number of Health Corps women, as well as in-service training of medical and paramedical staff involved in the national program. The schools will provide improved training for assistant nurse/midwives.

Jamaica

The World Bank’s first loan for slowing down the growth rate of population was made in 1970 in Jamaica. The $2 million loan is financing a project designed to inform women about family planning during the postpartum period. After their babies are born, mothers are especially receptive to family planning information, which can be given directly in the delivery hospitals themselves. The same approach, through creation of maternity centers, is being adopted for rural areas.

The Bank loan is helping to finance the improvement and expansion of the Victoria Jubilee Hospital in Kingston, where nearly a quarter of all Jamaican babies are born. A new 150-bed wing, including a delivery suite with 33 labor and delivery units and space for midwifery training, is being built and equipped. The project also includes the construction and equipping of ten rural maternity centers—each with an initial capacity of 4 to 8 beds—in certain selected locations all over Jamaica. Provision is made for designing training programs for family planning personnel and for an annual evaluation of the national program’s effectiveness.

Malaysia

Malaysia has a population of about 11 million, of which some 9.3 million are in West Malaysia, where a population control project is being supported jointly by the World Bank and UNFPA. The $14.5 million project aims at expanding family planning services into rural areas and improving the effectiveness of maternal and child health services and the National Family Planning Board (NFPB).

Until now, NFPB’s activities have been concentrated in urban areas where less than one third of the population lives. And although the population growth rate has dropped from 3 per cent to about 2.5 per cent in the last decade and a half, progress will be much slower unless the family planning program is expanded and improved.

The project is expected to reduce the population growth rate from its present level to 1.5 per cent by 1985, thereby increasing per capita income growth and savings, reducing unemployment, and helping to make the distribution of income more equitable. In addition to strengthening administration and extending family planning services through the provision of health facilities and basic training of paramedical personnel, the project includes financial and technical assistance for in-service training of existing medical and paramedical personnel; a pilot program in applied nutrition; health education in rural areas; introducing population education in schools; and broadening research and evaluation, in particular through a management study.

Trinidad and Tobago

The population of Trinidad and Tobago has doubled twice since 1900 and had reached more than one million by 1969. This demographic trend has been reflected in unemployment and underemployment and, in recent years, in emigration. In response to these problems, the Government initiated in 1967 a national policy of family planning.

A Bank loan of $3 million, made in 1971, is assisting a project designed to promote the effectiveness of the Government’s population program. It provides for the design, construction, and equipping of a new maternity hospital with teaching facilities at Mount Hope; seven new health centers providing family planning and maternal and child health services; and a family planning clinic attached to the San Fernando Hospital.

In addition to new facilities, the loan also provides technical assistance designed to strengthen administrative and training procedures and to provide continuing evaluation of the program. Another important feature is the introduction of family-life education in schools to familiarize young people with concepts in population and encourage the idea of the small family.

The project is expected to reduce the birth rate from 27 per 1,000 in 1969 to 15.5 in 1980.

Tunisia

Tunisia’s population has been growing at an annual rate of 2.8 per cent in recent years—impeding economic progress, aggravating unemployment, and creating other social problems. The Government, recognizing these difficulties, initiated a family planning program in 1966. One project—now being helped by an IDA credit of $4.8 million—is expected to triple the number of Tunisian women receiving family planning services.

The project consists of the establishment of 4 maternity hospitals, 2 rural maternity centers, and 29 maternal and child health centers where specially trained personnel will provide the full range of family planning services. The paramedical school in Tunis is being extended and will include a postgraduate section. The provision of family planning services in close association with that of health services for mothers and children is important to the success of the program.

Another key aspect of the project is its financing of technical assistance for management and personnel training and in evaluation of the program. Although this assistance represents a small percentage of total project cost, it is expected to play a crucial role in helping the Tunisian authorities adopt a system which will ensure optimum use of family planning services.

Increasing support

Within five years, the number of projects supported by the Bank and IDA in the population planning field is expected to increase to about 30. In many of these, the Bank will work closely with other external donors as it has in several of the ongoing projects—e.g., in India, Indonesia, and Malaysia—which are being funded in association with interested donors.

The Bank’s objectives are to help develop viable family planning organizations and programs, strengthen information and communication activities, and promote a deeper understanding of the many socioeconomic factors that influence fertility. Work is also going forward to develop specific projects to combat malnutrition, a field in which the Bank is becoming increasingly active.

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Finance & Development, December 1973
Author:
International Monetary Fund. External Relations Dept.