Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, September 4, 1994 TAG: 9410190003
SECTION: HORIZON PAGE: D1 EDITION: METRO
SOURCE: CHARLES J. HANLEY ASSOCIATED PRESS
DATELINE: CAIRO, EGYPT LENGTH: Long
We sleep in the streets of Bombay, family by threadbare family. We're squatters in African game preserves, evicting the elephants. Here in chockablock Cairo, we even dispossess the dead, setting up house in mausoleums - with electric lights, no less.
Twenty years from now, when there may be 2 billion more human beings to feed, clothe and house, where on Earth will they put us all?
Looking for answers, humanity's representatives will pack Cairo's hotels by the thousands this week for the International Conference on Population and Development.
The chief U.S. delegate, Undersecretary of State Tim Wirth, says governments know what must be done to control the growth of global population, now 5.7 billion.
``There's a huge `unmet need' out there, and it's absolutely imperative that we do everything we can to meet that need, or our children, grandchildren and great-grandchildren will face an untenable situation,'' Wirth said.
The ``unmet need,'' identified via surveys, is an estimated 120 million couples in developing nations who want to limit their family size but are not using contraceptives - because they're unavailable, because of tradition, because of ignorance.
To help reach them, the Clinton administration has increased U.S. foreign aid for family planning to $600 million a year, from $400 million. Other governments are doing likewise. The Cairo conference's proposed ``Program of Action'' calls for still more, a quadrupling of international support to almost $6 billion by the year 2000.
How the world responds may determine whether human population stays below 8 billion or tops 12 billion by the year 2050, U.N. projections show.
The numbers can be startling:
By doubling since the mid-1950s, human population has grown more in just the past two generations than in all of man's previous years on Earth put together.
Despite gains made by aggressive birth-control programs in China and elsewhere, world population, now at 5.7 billion, could explode to 12.5 billion by the middle of the next century.
Africa's population, the planet's fastest-growing, is projected to leap from 700 million to 1.1 billion in the next 16 years.
``Basic resources ... are being depleted and environmental pollution is intensifying, driven by the unprecedented growth in human numbers,'' the world's nations warn in the draft ``Program of Action'' readied for Cairo.
The woman who heads the U.N. Population Fund says the 1990s are a crucial decade because huge numbers of females, babies of the fertile '70s and '80s, will be in their own child-bearing years.
``Actions of today and consistent action over the next 10 years can change the course and level at which populations can stabilize in the whole world,'' Nafis Sadik said in New York.
More than arithmetic
In misty green African highlands not far from where prehistoric man got his start, modern man may be getting a sneak preview of his end.
Ragged and weary Kenyan peasants, swinging hoes, scattering seed, are trying to grow corn along the shoulders of a road, on pitiful, arms-width strips of rocky earth they hope can feed their families.
There's too little good land in Kenya. And too many babies.
``Seven or eight are usual, and some women have been having 15 children,'' reports local nurse Ruth Waihenya.
Waihenya has helped obtain the first regular supplies of contraceptives and family-planning advice for this mountain hamlet. Now the women talk about limiting their babies to three or four.
Multiply Njogu-ini by thousands of dirt-poor villages and hundreds of jam-packed cities across the globe, and you have some sense of the grim - and accelerating - arithmetic facing delegates to this week's conference in Cairo.
But the conference in Cairo will be more than arithmetic.
The Vatican has grabbed headlines with a preconference campaign against abortion, a fringe issue in the Cairo document, and against contraceptives for teen-agers, something closer to the heart of the action blueprint.
But only a few nations are expected to side with the church. The Vatican rejected the final reports of earlier population conferences as well, and governments still went ahead with multibillion-dollar family-planning programs as they saw fit.
Women's concerns
Women's groups, meanwhile, have campaigned to gear down the family-planning bandwagon a notch, to look at whether Third World women's health is being hurt - and their broader interests are being neglected - in the crush of pills, IUDs and implants.
Similar complaints arise across the developing world: Too many inappropriate sterilizations of women; too little attention paid to sexually transmitted diseases; too little done to reduce maternal mortality, including deaths from unsafe abortions.
Activists have pushed through ``reproductive health'' planks in the Cairo document, telling the world in effect to care less about fertility numbers and more about women's health.
The draft document goes beyond that, too, to describe women's ``empowerment'' as key to population control. Only when they get educational and job opportunities in countries like Egypt will young women stop seeing motherhood as their sole road to status and security, feminists say.
In a provocative article last March, World Bank economist Lant Pritchett scoffed at family-planning crusaders:
``Reducing the demand for children - for instance, by giving girls more education - is vastly more important to reducing fertility than providing more contraceptives.''
If battle lines are forming, the family planners have an edge. Although the Cairo document bulges with rhetoric on behalf of women's status, spending targets are set only for family-planning programs.
``First things first, and that's family planning,'' concluded a U.S. aid official.
Egypt's population minister, Meher Mahran, sounds just as single-minded.
``The carrying capacity of the globe has been surpassed already,'' he said. ``There is no possibility at this point of postponing, or adding new ideas.''
The most compelling argument may lie in the U.N. projections.
Depending on whether fertility levels fall quickly, the world just 20 years from now will have to support either 7.2 billion people or 7.9 billion. The difference equals the current population of all Africa.
A glimmer of hope
Some specialists, seeing what can be done in places like Kenya, are hopeful.
Just a decade ago, Kenya led the world in human fertility. The average woman was bearing eight children. Then the national government, with U.S. and other aid money, began a crash program.
Health workers were trained in contraceptive methods. Trucks took to Kenya's roads carrying boxes of contraceptives to distant clinics. Family-planning agents went door to door. Today, $2 million in U.S. aid is spent each year just on condoms for Kenyans.
Dramatic changes followed: The proportion of married women using contraceptives - the pill, injections, condoms, intrauterine devices - has doubled to 33 percent, and the fertility rate has dropped from 8 to 5.4 children per woman.
Kenya, a nation of 27 million people headed for 45 million by the year 2010, is an exception in Africa. Over the horizon in Uganda, Malawi, Mali, the fertility rate remains over 7, and fewer than one in 10 women use contraceptives.
The reasons are many: Lower education levels, uninterested governments, higher rates of infant mortality, a subconscious spur to the birth rate.
``You can't do this sort of thing when your country is in turmoil, suffering from political instability, from drought and famine,'' said S.B.A. Bullutt, director of Kenya's National Council for Population and Development.
A long way to go
Surveys suggest an additional one-third of Kenyan women want to limit family size, but are not using contraceptives. Getting services to them will require more aid money and greater efforts to overcome male resistance and cultural and religious taboos.
This ``unmet need'' may be most pressing among Kenyans under age 18, who are barred from receiving contraception services.
Illegal abortions are becoming commonplace among teen-agers in the slums of Nairobi, Kenya's capital, said sociologist Shanyisa Khasiani.
``We're burying our heads in the sand,'' she said.
The population council wants to lower the age for contraception services to 15. ``That would make a significant difference in the fertility rate,'' the council's Joseph Ndambuki said.
But the government is wary of the Roman Catholic Church, a powerful local force that opposes even current family-planning programs.
If all ``unmet needs'' were met, the Kenyan fertility rate still would probably drop no lower than about 4 children per woman, a long way from the ultimate goal of 2 per couple, after which a population eventually stabilizes.
To get there, Kenya - and dozens of other developing nations - must undergo a revolution in education, and in giving women greater economic roles and security, and more say over reproduction.
Lessons and warnings
A sweet smile crinkled Khuki Bibi's golden face as she wished away half her children.
``I should have had just two,'' the 70-year-old midwife of Dhi Ghi, Bangladesh, announced, jabbing a pair of fingers out from beneath the folds of her blue sari.
Besides her own four, the old widow has tended to countless other births in Dhi Ghi's watery rice lands, babies who added to a population - 117 million and counting - that makes little Bangladesh, the size of Wisconsin, the most densely packed nation on Earth.
Now, sitting in a busy clinic, Khuki Bibi watches her 25-year-old daughter get contraceptive pills, and regrets that family planning took so long to come here. As she explains, ``Living is better for a small family.''
Too late for Khuki Bibi. But perhaps not for Bangladesh.
To the surprise of experts, this poor and backward land's family-planning offensive has won significant ground.
The fertility rate - the number of children born to the average woman - has plunged from 7 in the 1970s to about 4 today. And it was done against the grain of demographic theory, which holds that such dramatic declines come only when a country's economy is developing successfully.
But four children are still twice what the planners want, and the inescapable calculus of human breeding still points toward crisis for Bangladesh in the 21st century.
``I have been frank on this,'' says the health minister, Yousuf Ibne Kamal. If Bangladesh doesn't sharply reduce its birth rate still further, ``it will be a nightmare, simply a disaster.''
The Bangladesh delegation can offer the International Conference on Population and Development both lessons and warnings to others.
Lesson No. 1: Family planners must get out and knock on doors.
Bangladesh's 36,000 female ``fertility workers,'' who walk door to door in the villages, informing, advising, supplying free contraceptives, deserve chief credit for the progress thus far.
Their personal approach broke through Islamic Bangladesh's traditional ``purdah,'' women's seclusion in the household.
The field workers - from both government and private organizations - are backed up by 130,000 pharmacies and other retail outlets that sell subsidized pills and condoms.
But these programs are expensive, costing more than $100 million a year, mostly underwritten by U.S. and other foreign aid. And the campaign has stumbled through tactical problems.
In the early 1980s, its emphasis on female sterilization - with small payments made to impoverished women who submitted to surgery - came under fire as crude and subtly coercive.
The focus switched to pills, but they proved costly and the supply was easily disrupted in a land of slow roads and sudden floods. Family-planning strategists began pushing longer-term contraceptives - injectable and implantable hormones.
In the shadows, another problem grew: Family-planning workers moonlighting as abortionists. The number of abortions, which are illegal in Bangladesh except to save a mother's life, can only be estimated, but one authoritative estimate puts it at close to 1 million a year.
Despite these failures, family planning has run up impressive numbers.
In 1975, only 8 percent of Bangladeshi women reported using contraceptives; now 45 percent do. Population growth in the 1970s was 3 percent a year; it has dropped to 2.3 percent.
But Bangladesh may be just as much a ``macro'' story - of economic forces - as a ``micro'' story of village-level campaigns.
Poor farmers, worldwide, generally have large families. But economists suggest that landlessness and overwhelming poverty may finally be grinding down the fertility rate in Bangladesh.
In the village of Nabagram, as women listened to a lecture by a family-planning worker, farmer Anil Kumar, 25, who has two children and wants no more, told his story to a visitor.
Kumar got a mere quarter-acre when his father's rice land was divided among three sons and two daughters.
``Now what can I leave my two sons? There's less and less farmland for more and more people,'' he said.
In just two generations, in fact, Bangladesh's population density has almost tripled, to 2,300 per square mile.
Kumar's wife, Rongu, knows the answer. ``I want my sons to be educated,'' she said from behind her veil. ``Then they can find jobs.''
And the village girls? ``They should be educated, too,'' she said. The female literacy rate is just 22 percent in Bangladesh, half the male rate.
Answers abound, but they're costly: More education, especially of females so women have roles beyond child-bearing; diversified economic development to relieve pressure on farmland; expansion of family-planning services.
Sandra Kabir, whose Bangladesh Women's Health Coalition operates private contraception programs and clinics, is among those who dismiss the government's official optimism that it will hit its target fertility rate - 2.2 children per woman - by 2005.
``They can continue to lower the rate,'' she said. ``But it's all linked to improving people's living standards, economic opportunities, educational opportunities.''
The road from four babies to two leads through the Cairo conference, where 190 delegations will debate a document calling for urgent help for the economies of the world's Bangladeshes.
If Bangladesh hits its two-baby target soon, its population may top out at a huge - but stable - 200 million in mid-21st century.
If not, Anil Kumar's little quarter-acre may be fondly remembered by his grandchildren as a Garden of Eden.
by CNB