Fertility Convergence

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1 Fertility Convergence Tiloka De-Silva a Silvana Tenreyro a,b a London School of Economics, CfM; b CEP, CEPR July 2015 Abstract A vast literature has sought to explain large cross-country differences in fertility rates. Income, mortality, urbanization, and female labour force participation, among other socioeconomic variables, have been suggested as explanatory factors for the differences. This paper points out that cross-country differences in fertility rates have fallen very rapidly over the past four decades, with most countries converging to a rate just above two children per woman. This absolute convergence took place despite the limited (or absent) absolute convergence in other economic variables. The rapid decline in fertility rates taking place in developing economies stands in sharp contrast with the slow decline experienced earlier by more mature economies. The preferred number of children has also fallen, suggesting a shift to a small-family norm. The convergence to replacement rates will lead to a stable world population, reducing environmental concerns over explosive population growth. In this paper we explore existing explanations and bring in an additional factor influencing fertility rates: the population programs started in the 1960s, which, we argue, have accelerated the global decline in fertility rates over the past four decades. Key words: fertility rates, birth rate, convergence, macro-development, Malthusian growth, population. For helpful conversations we thank Charlie Bean, Robin Burgess, Francesco Caselli, Laura Castillo, Per Krusell, and Elizabeth Murry. The authors declare that they have no relevant or material financial interests that relate to the research described in this paper. 1

2 I Introduction A vast literature in macro-development has tried to explain the determinants of fertility rates. Most studies build on the seminal framework of Becker (1960), Becker and Barro (1988), and Barro and Becker (1989), who illustrate how economic variables can influence fertility choice. 1 This paper brings attention to the rapid convergence in total fertility rates () experienced by most developing countries in the past few decades. 2 The world s average declined from over 5 children per woman in 1960, to 2.5 in This trend is not driven by just a few countries: in 1960, half the countries in the world had a above 5.8 children per woman. By 2013, the median fell to just 2.2 children per woman, almost equal to the world s estimated replacement fertility rate of This rapid convergence has taken place in countries at widely different levels of development (measured as GDP per capita). Indeed, though there is a negative relationship between fertility and development across countries, suggestive of a substitution towards quality over quantity in the classic Barro-Becker framework, the fertility-development relationship has shifted downward and become flatter over time. The downward shift is considerable: today the typical woman has, on average, 2.5 fewer children than the typical woman living in a country at a similar level of development in While fertility rates tend to be higher in rural than in urban areas, increased urbanization does not appear to be the main driver of the recent fertility decline: fertility rates in rural areas have also fallen sharply. Carrying out a straightforward decomposition of the overall fall in fertility into a within-region effect and a urbanization (or between-region) effect, we find that the within-effect accounts for over 85 percent of the decline in fertility, while urbanization accounts for the other 15 percent. Put differently, fertility has declined significantly both in rural and urban areas and only a small fraction (15 percent) of the decline in fertility can be accounted for by urbanization. Another factor often cited as a determinant of fertility is female labour force participation. The cross-country correlation between fertility rrates and female labour force participation, however, is very weak and the share of women in the labour force has not changed much in developing countries over the past few decades. In contrast, infant and child mortality rates are more positively correlated with fertility. The relationship is nonmonotonic: it is positive at low levels of mortality rates, becoming flatter thereafter that is, fertility does not change with mortality once mortality exceeds a (fairly 1 Two recent examples in this literature are Manuelli and Seshadri (2009) and Doepke (2004). 2 is defined as the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates. Throughout the paper, we use fertility, fertility rate, and interchangeably. 2

3 low) threshold. Mortality rates are argued to be a determinant of : given a desired number of children, more births are needed to ensure that the right number of children survives to adulthood. Interestingly, though, surveys reveal that the number of desired children also fell significantly since the 1970s, suggesting that the higher fertility rate in earlier periods was not solely the result of a calculated overshooting needed to meet a desired target: there seems to have been a global shift towards a small-family norm. Lower mortality rates did play a role, we shall argue, in triggering a number of population policies aimed at reducing fertility. It is instructive to contrast the fast convergence witnessed by developing countries in recent decades with the rather slow and secular decline in fertility rates experienced by more mature economies: the fertility decline began as early as the mid-1700 s in some European countries and only reached replacement levels in the early twenthieth century. While declines in mortality rates did not precede the fertility transition in every developed country, it has done so in almost every developing country. The increase in life expectancy, together with the high fertility rates in developing countries, is why population growth rates rose so fast in the postwar period. The fear of a population explosion lent impetus to what effectively became a global family planning program, which we believe was the most likely driver of the acceleration in the global fertility decline. The initiative, propelled in its beginnings by intellectual elites in the United States, Sweden, and some developing countries, most notably India, mobilized international private foundations as well as national governmental and nongovernmental organizations to advocate and enact policies aimed at reducing. By 1976, following the preparation of the World Population Plan of Action at the World Population Conference in Bucharest in 1974, 40 countries, accounting for 58 percent of the world s population and virtually all of the larger developing countries, had explicit policies to reduce fertility rates. Between 1976 and 2013, the number of countries with direct government support for family planning rose to 160. We argue that while socioeconomic factors do play an important role in the worldwide fertility decline, the timing and speed of the decline over the past four decade suggests that the global family planning program played a significat role in accelerating the process. In line with this hypothesis, the data establish a strong positive association between per capita spending on family planning programs and the percent reduction in. Collectively, the global family planning programs provided a policy template for fertility reduction, though there were significant differences in the actual implementation, as the policies had to be tailored to the specific context of highly diverse countries. There were two main 3

4 elements common to all programs: 3 1) promoting an increase in contraceptive supply and information (preferences and take up rates for different contraceptives varied significantly across countries and over time); and 2) creating public campaigns aimed at reversing pro-natalist attitudes and establishing a new small-family norm. Indeed, mdedia campaigns appeared to have been critical in complementing contraceptive provision, as the initial phase of the program, focused mostly on contraception methods, did not appear to be suffi cient to change fertility rates. During the 1970s, slogans proliferated in different media outlets (TV, radio, magazines), street posters, brochures, and billboards, all conveying a similar message regarding the benefits of small families. While urban areas were easier to serve through the existing transport and communication infrastructure, most countries formed mobile teams to reach residents living in remote rural areas indeed, some countries, like South Korea, focused their efforts particularly on rural areas. Not surprisingly, then, fertility rates fell also outside urban centers. Though religious groups were generally opposed to birth control policies, the family planning programs expanded in Buddhist, Christian, and Muslim countries alike. Remarkably, fertility reduction programs took place under both democratic and autocratic regimes, whether oriented to the political left or right (e.g. Chile under both Allende and Pinochet), and with or without strong government support (in some countries, like Brazil, family planning programs were initiated and almost exclusively run by nonprofit, nongovernmental organizations, while in others, like Singapore or India, the government was fully involved). The absolute convergence to a global fertility rate close to replacement rates will lead to a constant population level, reducing environmental concerns over explosive population growth. To the extent that lower fertility rates are associated with higher levels of capital per capita (through lower capital dilution) and higher investment in human capital, particularly for women (Goldin and Katz 2002), the trends bode well for development and living standards in the poorest regions of the world. 4 The rest of the paper is organized as follows. Section II studies the time-series and cross-sectional evidence on fertility rates since Section III revisits the evidence relating fertility to key covariates. Section IV discusses in detail the global population program and its effects on fertility reduction. Section V presents concluding remarks. 3 Other measures put in place, although not uniformly in all countries, were increases in the legal age of marriage (e.g., Egypt and Tunisia), tax incentives (e.g., tax exceptions for families of up to three children in Korea), promotion of domestic contraceptive production, establishment of family planning clinics, post-partum follow-up programs, legalization of abortion, maternity leave and allocation of public apartments and school choice for families of up to two or three children (e.g., Singapore), etc. Different countries opted for different specific policies, adjusted to the domestic context. 4 Insofar as the U.S. experience can be of guidance, the diffusion of contraception and the decline of fertility and postponement of childbearing could increase female empowerment in developing countries through higher levels of investment in human capital (Goldin and Katz 2002). 4

5 II Fertility across Time and Space Since the 1960s, the world s has steadily declined, more than halving over the five decades that we analyze. This decline has been experienced by most countries in the world and is not skewed by the experience of a few countries, particularly China s one-child policy. Using the World Bank s World Development Indicators (WDI), Figure 1 illustrates these developments by plotting the histograms for the start of each decade; the bars show the fraction of countries for each interval. (The figure shows 2013 rather than 2010 to report the latest information.) As the figure illustrates, there is a clear change in the shape of the distribution of fertility over time. In 1960, nearly half the countries in the world had a fertility rate between 6 and 8, with the median rate in the distribution equal to 5.8. In 2013, the largest mass of countries is concentrated around 2, with the median equal to 2.2. The skewness changed from highly negative to highly positive over the period. FIGURE 1 Fertility histograms over time Fraction Fraction Fraction Fraction Fraction Fraction Notes: The figure shows fertility histograms at the beginning of each decade. (2013 is used rather than 2010 to report the latest information). The data comes from the World Bank s WDI database. 5

6 Key summary measures are reported in Table 1, showing the evolution of the world s, together with the median and the range. As the Table shows, the median has fallen dramatically, with the median woman now giving birth to 2.2 children, down from a 5.8 median in TABLE 1 Fertility summary statistics Year Mean Median Min Max Notes: The table reports summary statistics of the total fertility rate at the start of each decade. The mean fertility rate is the "World" fertility rate available from the WDI, while the median, minimum and maximum are calculated using crosscountry fertility rates for each year. This decline in fertility rates has taken place across most regions in the world, as shown in Figure 2, which depicts the average across broadly defined regions over time. As the figure illustrates, between 1960 and 2015, large declines in took place in Latin America and the Caribbean, South Asia, and the Middle East and North Africa. Interestingly, while the global average continues to decline, fertility rates have been increasing slightly in North America, which reached its lowest in the 1980s, and Europe and Central Asia, which bottomed up in the 1990s. This also suggests a slight convergence to 2 taking place in regions where the was below 2. 6

7 FIGURE 2 Fertility trends across regions Total Fertility Rate Year North America East Asia and Pacific Middle East and North Africa Sub Saharan Africa Europe and Central Asia Latin America and Caribbean South Asia Notes: This figure plots the trends in fertility trends by region, as defined by the World Bank, between 1960 and The data comes from the WDI database. As shown in Table 2, fertility rates in East Asia and the Pacific fell from 5.4 to 1.81 over the period from 1960 to 2013 (a 66 percent reduction), while Latin America and the Caribbean went from an average of 5.98 in 1960 to 2.16 in 2013 (a 64 percent decline). The Middle East and North Africa s fell from 6.87 to 2.83, the largest absolute decline in fertility from among all world regions, while South Asia s fell from 6.02 in 1960 to 2.56 in While absolute declines in fertility were not as large in North America or Europe and Central Asia, the percentage declines in both regions have been significant nearly 50 percent in North America and close to 40 percent in Europe and Central Asia. Convergence in Sub-Saharan Africa has been slower, as this region recorded the lowest percentage decline in fertility over all 53 years. However, since the 1980s, fell from 6.7 to 5, whic represents a sizeable decline. 5 Within this region, South Africa has already reached a of 2.4, and Mauritius in 2013 reported the lowest African, The replacement fertility rate for Sub-Saharan Africa is also much higher than for the rest of the world: it is 2.52 as opposed to the world average of (See Table A4 in the Appendix for replacement fertility rates by country.) 7

8 TABLE 2 Fertility decline from Region Absolute decline in Percentage decline in North America Europe and Central Asia East Asia and the Pacific Latin America and Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Notes: This table reports the absolute and percentage decline in over the period by region. Fertility declines are calculated using data from the WDI database and the regions are as defined by the World Bank. III Determinants of Fertility Rates In this section, we study the covariation of fertility rates with the main variables emphasized in the literature. The data are taken from the World Bank s WDI database unless otherwise noted. A Fertility and Income Several empirical studies have documented a negative relationship between fertility rates and income. While the relationship between fertility rates and income is indeed negative in the cross-section of countries, the main fact that this paper wishes to emphasize is that the relationship has shifted downward and become flatter over time. This development is illustrated in Figure 3, which shows the relationship between and real GDP per capita both in 1960 and in The figure also shows a fitted polynomial line. The downward shift has been, on average, around 2.5 children per woman, meaning that today a woman has 2.5 children less than a woman living in a country at the same level of development had in

9 FIGURE 3 The Fertility-Income Relation in 1960 and RWA KEN NER HNDDOM DZA MDG SYR CIV NER ZWE OMN NIC PHL VCT CRI MWI BDI SEN ZMB PAK BGDBWA MRT GHA SDNSSF BOL GTM BFA T GO MLI COL PER ECU MEX BENPNG LBR NGA PRY BLZ FJI VEN TCD TCD BRATUR BDI NPL SAS ZAR CHN LSO IND SLE MYS KOR ZAF ZAR CAF COG PAN LCN IDN LMC UGA NGA GMB LKA MICUMC AGO BFACMR GUYZMB CHL MWI EAS SGP MOZ TZA TTO GNB SSF WLD ERI LBR GINAFGBENSENCIV COG SLE ETHT GOCOM MRTCMR GNQ PRI MDG CAF RWAKEN SDN GAB BRB BHS ISL LIC YEMSTP GAB GHA SLBWBG IRQ WSM TJK PNG GTMT ON ISR CAN NAC ZWE USA DJI AUS HTI BOL VUT KGZ PAK FSM SWZ JORPRT KIRHND ARG NLD KHM LAOLSO PHL EGY URY NAM LMC PRY DZA ESP ECSHIC ISR FIN FRA GBR NOR SAS MAR DNK GRC ITA AUT IND GUY NIC BWA MNG ECU FJI BLZMEA DOM KAZ BEL SAU NPL BGDUZB IDN BTN LKACPV MIC SLV TKM TUN PER JPN SWELUX IRN MDV ZAF LBY VEN PAN WLD SYC KSV COL SURLCN GRD URY MEX AZE VCT TUR BHR VNM ARMCHN ALBLCA MNE BRA CRI EAS MYS ATG GEO UMC FRA CHL TTO AREAUS MDA BLR ECS BEL FIN UKR THA MKD ROM LBNHRV BIH SRB BGRMUS LVA LTU EST POL HUN CZECYP LUX PRT DEU CHE SVK SVN BHS BRN NZLGBR SWE IRLISL RUS NLD NAC USANOR PRI HIC CAN MLT JPN KOR ESP ITA DNKQAT GRC AUT HKG SGPMAC Log(GDP per capita) 1960 lowess ln_gdp lowess ln_gdp 2013 Notes: The figure shows the scatter plots and lowess smoothed relationship between fertility and log of per capita GDP (in constant 2005 US$) in 1960 and The data is from the WDI database. A significant amount of theoretical work has been devoted to generate a negative relationship between fertility rates and income. See for example Jones, Schoonbroodt, and Tertilt (2011), who study the theoretical conditions under which economic models can yield the negative relation observed in the data, and Manuelli and Sheshadri (2009), who seek to explain differences in fertility rates across countries with productivity and tax differences. But given the recent declines in fertility rates, the real challenge seems to be how to explain why countries with markedly different income levels are converging to very similar. In Section IV we come back to this challenge and argue that the population programs started in the 1960s provide an explanation for the decline. B Fertility and Urbanization We now investigate whether increased urbanization can account for the decline in fertility rates. Rural areas have historically had much higher fertility rates than urban ones. Arguably, in rural areas, children can be a significant input in agricultural production. Moreover, despite the fact that parents can earn higher average wages in urban areas, it can cost more to raise children there, as the costs of 9

10 housing and (typically compulsory) education are higher. 6 The negative relationship is illustrated in Figure 4, which plots the proportion of population living in urban areas against for all countries (again, using data from the WDI). FIGURE 4 Fertility and Urbanization RWA KEN AFGW SOM HND SM CIV MDV DOM DZA SYR JOR BDI MDG AGO BGDCPV SEN MAR BTNSDN UGA NER YEM MWI TZA ETH MRT SSD ERI KHM VUT ZWE COM ZMB PAK GHAIRN MNG TUN BWA SWZ MOZ MLI SLV HTI GTM BOL TMP EGY DJI NPL PNG BFA SLB TCD BEN VNM NGA LBR LSO LAO TGO KIR OMN TONLBY PHL CRI NIC LCA FSM VCT SAU BHR GIN STP FJI UZB ARE THA ZAR IRQ GMB GNB MMR TUR PRY MEX BRA CMR IDN CHN SLE NAMYS KOR MUS ECU KWT GRDCOL PER ALB TKM ZAF SURBLZ QAT VEN TJK NCL BRN IND CAFCOG GNQ GUYPAN GUM LKA LBNAZE CHL TTO J KGZ AM PYF VIR HKG GAB BRB KAZ ABW MAC ATG PRK PRI ARM BHS BIH CUB NZL MNEMKD MDACYP IRL CAN ISR ISL USA SVK PRT AUS MLT GEO POL NLDARG BLR NORFRA URY HRV ROM BGR LTUCHE DEU DNK GBR SVN RUS FIN ESP CHI AUT UKR HUN GRC ITA BEL LVA EST CZE J PNSWE RWA KEN AFG CIV BDI MNG MWI AGO ZMB UGA IRQ TZA SSDBEN ETH MDV YEM MDGSEN ZWE DZA HND SYR LBY JOR NER BFA BTN BGDCPV SLB SWZ MLI SDN SOM NIC MOZ BWA ERI MRT VNM PAK LBR GHA KHM NGASTP COM WTGO SM OMN TCDSLEMAR BOL DJI IRN TUN NPL LSO LAO PNG TMP GNB GIN GMB CMR KIR COG CAF SLV IDN CHN IND HTI MMR LCA ZARGTM UZB TJK SAU KWT FSM VUTNAM DOM THA GNQPRY EGY TKM MEX QAT ARE VCT PHL ECUBLZ PER BHR TON TUR J AM SUR ZAF COL BRN GUY GAB BRA LBN GRD CRI PAN VEN ALB MYS KGZ PYF VIR LKA FJI KOR AZE NCL PRK CHL TTO KAZ CUB GUM ATG MUS IRL BHS ISR HKG BIH BRB PRT ARM MNEROM MKD ARG MDA CYP ABW PRI NZL URY BLR GEO ESP ISL SVN NLD HRVPOL BGR GRC UKR HUN LVA RUS CZE J USA PN GBR AUS SVKLTU ITA EST AUT NOR CHI CHE FRA DEU CAN BEL FIN DNKMLTMAC SWE YEM RWA OMN BDI MWI NER UGA KEN BFA TGOSEN CIV ETH AFG LBY MLI TCD AGO ERI TZA NGA MDV COM SOM BEN SLEZMB SSD DZA MOZ SWZ SDN LBR BTN SLB GNB CPV MRT CMR LAO BGD MDG ZWE GIN ZAR SYR JOR SAU PAK STP HTI GMB GHA HND IRQ BWAW NAM FSM IRN GTMCOG NIC GNQ CAF MNG DJI NPL KHM LSO PNG VUT TJK MAR BLZ TON GAB QAT EGY BOL TUN VNM SLV TMP MMR IDN IND KIR PHL UZB PRY ECU ZAF TUR DOM PER AREKWT TKM LCA MEX BHR GRD VCT KGZ BRA THA GUY PANCOLLBN VEN TTOLKA ALB FJI MYS J AM PYF BRN SUR CRI AZE IRL NCL ARG CHN MUS KAZ KOR BHS ISR URY MNE MDA ROMMKDARM CHL ATG BIH BRB PRTGEO BLR POL CYP SVN SVK PRKPRI VIR GUM ABW HRVBGR GRC ISL LTU UKR HUN LVA CUB EST ESP RUS CZE GBR AUS HKG CHE NLD ITAJPN NOR FIN FRA USA NZL CHI AUTCAN SWE DNK MLT DEU BEL MAC YEM NER AFG RWA BDI ETH BFAAGO SOM UGA MWI TCDZAR SSD MLI OMN ERI GNB GINBEN TZA MOZ ZMB SLB KENMDV SDN TGO SEN LBR LAOMDG NGA SLE CMR DJI KHM SWZ PAKGMB CIV GNQ CAF MRT BTN TMPHTI COM GHA GTM IRQSAU NPL STP SYR COGGAB LSO W NAM ZWEHND CPV JOR PNG VUT TJK BGD TON FSM KIRBWADZA NIC BOL IRN LBY EGY TKM BLZ PRY ARE IND MAR SLVMNG VNM GRD UZB PHL MMR KGZ ZAF PER DOM IDN FJIMYS ECU PAN TUN VEN BHR QAT LCA ALB CRI PYFBRN TUR MEX VCT J AM NCL COL CHN BRAARG TTOLKAGUY AZE KAZSUR LBN VIR THA MUS MDAMKD MNE POL URY GEOCYP ARM CHL ISR GUM BHS ATG ABW BRB BIHPRT ROM SVK IRL PRK ISL HRV HUN BLR BGR EST CHE CUB USA CZE NZL KOR FIN SWE KWT UKR LTU NOR RUS FRA CANMLT AUT DNK AUS ITADEU NLDJ GBR SVN LVA PRI CHI GRC ESP PN BEL MAC HKG NER AFG BDI TCD SOM UGA TMP BFAMLI AGO ZAR MWI ETH RWA SSD ERI YEM NGA TZA MDG MOZ GIN ZMB GNB BEN LBR COMCIV CMR GMB CAFMRT KEN SDN SLE GNQ TGO SEN COG PNG SLB GHA GTM STP IRQ PAK DJI NPL LSO VUT W LAO FSM GAB SWZ TON SM ZWE HTI KHM TJK NAM KIR HND SYRBOL BTN IND MDVEGYBWA CPV OMN SAU BLZ PHL JOR PRY BGD NIC MMR IDNMAR SLV GUY ZAF ECU DOM MYSPER LBY KGZ UZB LKA DZA MNG TUN IRN TUR SUR MEX ARE BRA TTO VNM GRD TKM FJI BHR VCT COL LBN ARG THA BRB MUS AZE J AM PAN VEN ISR QAT KWT LCA ATGALB CHNMDA MNE CHL URY BIH GEO PRT HRV ARMCUB ROM KAZ CRI NCL GUM PYF BRN ABWMKD IRL PRK CYP NOR FRA BHS POL HUN BGR BLRKOR AUS AUT LTU NZL ISL FIN SVK GRC RUS J PN MLT BEL SVN ITA LVA EST DEU CHE GBR CAN SWE DNK UKRESP NLD USAVIR PRI CHI CZE HKG MAC NER MLI SOM BDITCD UGA ZAR AGO NGAGMB MWIBFA SSD TZA ETH ERI AFG TMP COM MOZ ZMB GIN TGO BEN SEN GNB CIV MRT COG RWA LBR KENSDN MDG SLE GNQCMR W YEM CAF SLB SM PNGTON TJK STP SWZZWE GTM GHA IRQ GAB FSM VUT KHM LSOKGZ LAO PAK KIRHND HTI SYR BOL DJI GUY DZA IND EGY PHL NAM BWA NIC BGD BTN MDV MAR JOR BLZ NPL IDN CPV SLV TUN MNG DOM TTO VNM MMR GRD UZBTKM FJI KAZ PRY OMN ISR LKA J AM ECU ZAF PANPER LBY SAU CHN IRN TUR MEXVEN LCABRB VCT AZE BRA BHR THA ROM ALB MKD HRV MNECRIARE URY BIHMDA ARMMYS COL KWT ATG SUR ARG GEO FRA MUS POL PRT CYP EST HUN BGR BLR CUB KOR LBN CHL AUS SVN IRL LVA CHE DEU FIN BEL SVK LTU ITA UKR CZE RUS BRN NOR USA GBR ESP BHS DNK J ISL MLT PN QAT GRC SWE NZL CHIABW PYF NCL GUM PRK AUT CAN NLD PRI VIR HKG MAC % urban population % urban population % urban population Notes: The figure shows the scatter plots and smoothed polynomial relationship between fertility and urbanization at the start of each decade. Urbanization is measured as the proportion of the population living in urban areas. Data comes from the WDI database. Interestingly, though on average rural areas have higher, the urbanization process alone cannot account for the sharp decline in fertility rates observed over the past five decades. Rather, it appears that fertility rates fell rapidly both in urban and rural areas. We are able to quantitatively explore this issue and assess the contribution of urbanization using data from rural and urban areas obtained from the Demographic and Health Surveys (DHS). We decompose the fall in fertility rates into a within-region effect (corresponding to the decline in fertility within rural areas or urban areas) and a between-region effect (urbanization), corresponding to the decline in fertility rates due to the change in a country s urban population share. 6 This idea is presented in Becker (1960) as farmers having a comparative advantage in producing both children and food, though this advantage is smaller for higher quality of childrearing. Caldwell s net wealth flow theory (1976) also supports the view that wealth flows from children to parents in primitive agricultural societies, whereas the direction of flows reverses as society modernises and costs of raising children go up. 10

11 In formulas, the overall fertility rate equals the weighted average of urban and rural fertility rates: F t = λ R,t F R,t + λ U,t F U,t where λ R,t is the proportion of the country s population living in rural areas in period t, λ U,t = 1 λ R,t, and F R,t and F U,t are the rural and urban fertility rates at time t, respectively. With some algebra, the change in overall fertility between time 0 and time t can be exactly decomposed as: F t = F t F 0 = ( λ R,t FR λ U,t FU ) } {{ } Urbanization (between effect) + ( λ R F R,t + λ U F U,t ) } {{ } W ithin-effect where 0 and t correspond to the start and end of the period, respectively; and the terms denoted with a bar are the time averages: x j = x j,t + x j,o, j = R, U; x = λ, F. 2 We perform this decomposition for 63 developing countries in which the DHS was carried out. 7 Surprisingly, wit an average contribution of about 15 percent, the results indicate that the urbanization process has not contributed very much to the overall fall in fertility rates (see Figure 5). The contribution of urbanization does not vary significantly with a country s fertility or urbanization rates. This result suggests that while urbanization is indeed negatively correlated with fertility rates, there are other forces at work driving down fertility in both rural and urban areas around the worl. 7 It should be noted that since the DHS are carried out in different years and at different intervals in different countries, the period over which the changes are computed is not the same for every country. More details of the data are available in Table A3 in the Appendix. 11

12 FIGURE 5 Decomposition of the Decline in Fertility Rates Europe, Middle East, North Africa Latin America and Caribbean Albania Armenia Egypt Jordan Moldova Morocco Ukraine Yemen Bolivia Brazil Colombia Dominican Rep. Ecuador El Salvador Guatemala Haiti Honduras Nicaragua Paraguay Peru Within effect Urbanization effect Within effect Urbanization effect Asia Sub Saharan Africa Azerbaijan Bangladesh Cambodia India Indonesia Kazakhstan Kyrgyzstan Nepal Pakistan Philippines Turkey Vietnam Benin Burkina Faso Burundi Cameroon Chad Comoros Congo Democratic Republic Cote d'ivoire Eritrea Ethiopia Ghana Guinea Kenya Lesotho Liberia Madagascar Malawi Mali Mozambique Namibia Niger Nigeria Rw anda Senegal Sierra Leone Tanzania Togo Uganda Zambia Zimbabwe Within effect Urbanization effect Within effect Urbanization effect Notes: The figure plots the decomposition of the overall fall in fertility by the urbanization effect and the within-region effect. The data on urban and rural fertility is taken from the Demographic and Health Survey database and covers 63 developing countries over different time periods. The data on proportion of population living in urban areas for the corresponding years is taken from the World Development Indicators database. (See Table A3 in the Appendix for more details.) C Fertility and Female Labour Force Participation We now explore the relationship between fertility and female labour force participation, the latter is often viewed as a key covariate in fertility choice. 8 The relationship is plotted in Figure 6, which shows the cross-country data in different decades, together with a fitted line. The data on female labour force 8 A key premise underlying economic models of fertility since Becker (1960) is that childbearing is a time-consuming activity, an assumption that mediates the theoretical relation between fertility rates and income. Some models explicitly or implicitly assume that mothers have a comparative advantage in childbearing (e.g., Mincer 1963; Becker 1965). In these models, as the value of female time in the market increases, the opportunity cost of having children also increases; this tends to reduce the demand for children (substitution effect) and can indeed offset increases in the demand for children stemming from higher income (income effect). 12

13 participation (the proportion of women aged 15+ years who are participating in the labour force) com from estimates by the International Labour Organization (ILO), published in the World Development Indicators and are available from 1980 through to As the plots in Figure 6 show, the relationship is U-shaped rather than negative and seems to be flattening out over time. This result should not be too surprising: in 2013 female labour force participation was highest in Sub-Saharan African countries (at an average rate above 63 percent), higher indeed than in North America, Europe, and Central Asia (regions for which participation rates were between 50 and 60 percent). In contrast, participation rates for women are vert low in South Asia (35 percent), the Middle East, and North Africa (just over 20 percent in 2013), regions with remarkably low. For a given country over time (that is, controlling for country-fixed effects), the relationship appears to be negative, meaning that increases in labour force participation are associated with decreases in fertility rates, though the statistical association is very low (the R-square coeffi cients are below 5 percent.) FIGURE 6 Fertility and Female Labour Force Participation YEM OMN RWA LBY AFG NER JOR CIV DZA BEN ETH TCD COMAGO KEN MWI SAU SYR MDV MLI ZMB SEN BFA BDI IRQ IRN BTNNGA SOM LBR TGO PAK SDN CPV ERI CMR BWA BGD ZAR BLZ GTM HND STP NAM SLB SLE ZWE UGA GNB COG MRT DJI SWZ MNG CAF EGY BOL GNQ GAB GMB GHA GIN MDG HTI LAOMOZ TZA NIC WSM KWT QAT AREMAR NPL TUN TON LSO PNG TJK KHM BHR SLV ECU PER PHL PRY DOM IND LCA MEXZAF FJI BRN IDN TMPTKMMMR VNM UZB VUT LBN VEN TUR BRA COL GUY SUR VCT PYF KGZ ARG CRI PANMYS ALB JAM IRL ISRLKA NCL TTOGUM BHS AZE PRI CHLMUS ARM CHN CUB GRC AUTAUS BRB BLR BGR BIH BEL CYP KOR VIR THA URY PRK MKD KAZ MDA MLTESP NZLFRA CAN HRV POL CZE EST GEO HKGHUN PRT ROM ISL ITA DEU JPN LTU SVK NLD LUXMAC SGPNOR SVN FIN RUS CHE GBRUSA DNK SWE UKRLVA YEM AFG NER BDI OMN SOM MLI TCD AGO ZAR ETH BEN MWI BFAUGA RWA WBG NGA CIV CMR LBR GNB SEN SLE GIN ERI IRQ PAKMRT MDVDJI COM CPV BTN CAFKHM GNQ GAB GMB KEN LAO MDG MOZ JOR SAU SDN TGOZMB TZA GTM COG GHA HND STP SWZ SLB SYR HTI IRN DZALBY WSM TMPNAM BOL TJK ZWE BLZ BGD BWA LSO NPL NIC EGY TON PRY PNG MAR BHRINDECU SLV FJI MYS BRN PER PHL VUT ARE QAT UZB TKM MNG TUN COL CRI MEX VEN ZAFDOM PYF KGZ LBN PAN ARG NCL CHL BRA IDNLCA MMR VNM TUR ALB AZEARM BHSCHN CUB CYP ISR GUM JAM GUY KAZ MLT PRI KWT LKASUR VCTVIR IRL MUS TTO MKD URY BIH BEL AUS BGR CAN BLR AUT FRA HUN HRV CZE GEOMDA FIN LTU BRB ESTISL PRK ITA GRCDEU KOR DNK LVA LUX NLD MAC MNE NZL NOR POL HKG PRT JPN SGP ROMRUS GBR SVN SVK SWE THA ESP CHE UKR USA AFG SOM NER TCD MLI TMP AGO ZAR ETH BFA UGA YEM BDI NGA LBR CMR GIN BENGMB ERI MWI GNB CAF GNQ MRTCOM CIV SEN SLE ZMB MDG RWA WBG SDN TZA MOZ IRQ COG DJI GTM KEN TGO GAB BLZCPVBTN BOL GHA JOR PAK WSMSTP SLB HTI PNG SAU SYR SWZ HND NAM TON LAO OMN PHL LSO DZA BHR BGD BWA KHM NPL EGY PRYTJK ZWE VUT LBYIND MDV QAT NIC FJI MARSURSLV DOM ECU ARGCOL CHL CRI MEX GUY KWT MYS PAN ISR PYF IDN GUM IRNLBN NCL ZAF PER ALBRA BRN KGZ BEL AUT AUS AZE JAM TUN TUR ARE MLT PRI LKA UZB TKM VEN ARMBRB BIH CUB MUS LUXIRL BHS BGR HRV FRAFIN GRC HUNDEU CYP VCT URY MNG CZE EST BLR GEO CAN DNK KAZISL MMR MKD MNE PRK ITA KOR LVA CHN HKG JPN NLD NZL LCA SRB TTO VIR LTU MDA NOR ESP POL SVN SVK PRT GBR RUS CHE SWE MAC ROM USA THAVNM UKR NER SOM MLI NGA TCD AGOZAR GMB ZMB UGA BFA BDI AFG TMP MRTCOM CIVLBRCMR GINGNB SEN BEN COG CAF ERI GNQ MWI MOZ TZA ETH IRQ WSMSDN GAB KEN SLE TGORWA MDG WBG YEM STP DJI GTM SLB TON GHA JOR BOL DZA EGY HND FJI BLZ ISR HTI IND GUY KWT BHRARG DOM CPV ECU KGZ TJK PNG PAK SWZ MAR OMN PHL NAM LSO VUT ZWE SYR LAO SAU BGD ALB BEL BLR ARM AUS AUT AZEBHS BTN BWAKHM LBY BRN COL CRI PYF SLVGUM BRA BRB BIH CUB HRV BGR CHL FRA IDN IRN IRL JAM KAZ MYS MEX NCL NIC PAN PRY CZE FIN CYP EST GEO DEU DNK CAN CHN ISL PRK LBN ITAMKD GRC HUN JPN KOR LUX HKG LVA LTU MDV MNG TUNTURLKASUR ZAF TKM PER MDA MLT MNE QAT MMR NPL PRI MUS NLD NOR NZL SRB ARE UZBURY VEN ROMRUS POLPRT SVN TTO VCTLCA GBR SWE SVKSGP ESP UKR VIR USA CHE THA VNM MAC Female LFPR Female LFPR Notes: The figure shows the scatter plots and smoothed polynomial relationship between fertility rates and female labour force participation at the start of each decade (data is only available from 1980 onwards) for all countries. Female labour force participation is measured as the proportion of women aged 15+ years in the labour force. Data comes from the WDI database. 13

14 D Fertility, Mortality, and Replacement Rates Infant and child mortality rates are often proposed as key determinants of fertility rates. The premise is that in countries with high mortality rates, the number of births needed to produce the desired number of children is higher, leading to a positive relation between and infant and child mortality rates. This interpretation, based on an individual family s rational calculation, proves to be problematic when confronted with two additional pieces of evidence. The first is that is also positively associated with the risk of maternal death (defined as the probability that a 15-year-old female will die eventually from a childbirth-related cause assuming that current levels of fertility and mortality including maternal mortality do not change in the future, taking into account competing causes of death). In a rational setting, a higher risk of maternal death should decrease rather than increase. The strong positive correlation in the data between and the risk of maternal death casts some doubt on the survival probability interpretation offered to explain the positive correlation between and infant and child mortality rates. 9 Rather, it would seem that health or broader economic factors that increase all types of mortality rates are positively correlated with. The mortality rate for infants are plotted against in Figure 7, while the mortality rates for children are plotted against in Figure 8. Figure 9 plots the risk of maternal death against. In the next section, we argue that the decline in overall mortality rates was important in triggering the global population-control program, which originated from a concern about explosive population growth. 9 There is also a positive correlation between and the maternal mortality rate (defined as the number of maternal deaths per 100,000 live births) though the number of observations available is much smaller. 14

15 FIGURE 7 Total Fertility Rate and Infant Mortality Rate KEN RWA ZWE DOM JOR SYRHND DZA PHL C IV SLV SEN MAR BGD PAK THA SDNTZA ZMB GHA UGA MRT N BHR ARE IC BDI FJI PRY MEX VUT LBY KWT VENCOL VNM BWA SWZ GTM BRA IRQ SLB PNGTUR BFA TGO MYS MUS BOLEGY BEN HTI LBR MLI COGLSO N PL GUY GMB IDN C IND SLE CMR AF GIN LBN PAN KOR ECU PER CHL TTO JLKA AM ISL NZL BRB C AN NLD UIRL AUS MLT SA POLPRT NOR FRAURY DNK FIN GBRESP SWE CHE BEL AUT ITA J PN GRC HUN KEN RWA JOR SYR LBY ZWE IRQZMB AFG HND MDG BDI MWI SLB SDN UGA SEN DZA C IV CSWZ PV TZA ICETH BGD VNM BEN MDV YEM KWT N ER MRT GHA TGO BWA MLI TUN ERI IRN MOZ BTN COG KIR PNG SLV CMR PAK BOL BFA COM OMN QAT STPDOM MAR TCD NGA LBR SLE PHL BHR LCA N TON VUTECU GTM MMR GMB LSO C AF ZAR EGY N PL GIN THA IDNIND HTI J AM PRY VCT BLZ ARE AM MEX PER VENCOL CHN TUR MYS LBN PAN GUY CRI KGZ BRA KOR FJI LKA IRLCUB MUS CHL TTO BRB ISL NZL BHS ESPURY PRT ROM ARG GBR AUS NLD NOR FRA JC U PNPOL SA BGR GRC DAN SWE FIN BEL LTU AUT ITA DNK CHE MLT EU RUS HUN YEM OMN RWA LBY KENSEN C IV TGO BDI N ER MWI JOR SYR ZMB DZA MDV TZA C PV CMR N IC ERI BFA COM BEN UGA AGO ETH AFG ZWE SAU IRQ NGA SLE STP SWZ SDN TCD MLI SLB LBRSSD HNDMRT GHA BWA N AM IRN MOZ COG GTM GMB MDG MNG DJI PAK ZAR BGD BTN HTI LAO GIN GAB C AF TON QAT ARE KWT BLZ VUTPNG TUN LSO MAR TJK BOL VNM PRYSLV EGY KHMN PL BHR PHL ZAF KIR UZB ECU PER MMR TKM LCAMEX DOM IDN IND VEN TUR FJI PAN LBN VCT COL BRA KGZ CRI MYS J AM THA GUY TTO ARG LKA ALB IRL ISR KOR BHS MUS URY ROM CHN KAZ ISLCHL C ARM BLR POL GRC PRT YP MDA CUB HUN BRB BGR GEO AUS GBR LVA CHE NOR MLT SWE FIN JDNK CBEL ITA PN LTU AN U RUS KR NLD UNZL ESP FRA EST AUT SA D EU YEM AFG N ER RWA BDI OMN SOM BFA UGA ZAR TCD ETH AGO SEN BENGNB TZA ZMBGIN SSD MOZ SLB DJI SWZ KEN MDV SDN TGO LBR IRQ GMB CMR MLI MWI ERI MDG CLAO IVNGASLE MRTPAK GTMKHMC GNQ JOR SAU AF SYRGAB COG STP GHA COM BTN W HTITMP BWA IRN HND CZWE PV LBY N AM IC PNG LSON PL DZA EGY KIR BOL TJK ARE TON VUT FSM BLZ PRY BGD GRD QAT PHL SLV MAR MNG VNM ECU IND VEN TUN DOM ZAF KGZ PER UZB TKM BRN MYS BHR CRI LCA FJI MMR ARG PAN MEX ISR VCT LBN COL ALB BRA TUR IDN CCHL J AM LKA URY CHN KAZ GUY POL MUS YP MDA TTO SUR ISL MNE THA MKD ARM CUB HRV BLR GEO AZE SWE FIN IRL NZL MLT KWT BHS NOR KOR CHE CDNK AUS BEL CZE PRT BIH BRB EST HUN BGR SA ATG ROM DNLD FRA GBR LTU SVK ULVA AN RUS KR PRK JITA AUT SVN ESP GRC PN EU AFG NSOM ER TMP TCD UGA BDIZAR BFAMLI MWI ERI GMB YEM AGO ETH CMR RWA NGA MDG COM COG MRT TZA BEN ZMB GNB SSD LBRSLE SDN SEN GNQ GIN MOZ TGO C IV C AF SLB IRQ GTMKEN PNG STP GHA TON WVUT SM DJI PAK SYR HND GAB KIR BOL NZWE PL HTI LSO SWZ LAO OMN SAU JOR FSM N AM C PV TJK BLZ KHM NMDV EGY ICBWA BTN MYS LBY SLV DOMBGD IND ARE BHR ECU PER GRD DZA IDN MAR IRN BRA TUR GUY ZAF LBN ARG MEX KGZ UZB LKA SUR MNG MMR CHL URY VCT MNE BRB MUS J FJI PRY PHL ISR QAT KWT VEN COL PAN TUN THA VNM AM TKM BRN CRI ALB ISL LCA HRV BIH BLR BGR TTO AZE PRT KOR AUS IRL BHS ATG NOR NZL CUB MKD YP JSWE FIN AUT BEL DNK FRA MLT POL MDA ARM HUN LTU SVK PN ROM CHN GEO ITALVA DSVN CHEC GBR NLD U SA ESP GRC EST EU AN RUS KAZ PRK CZE U KR N ER MLI SOM UGA GMB BDI NGA TCD ZAR TZA MWI ZMB BFA AGO ERI COG SENAFG TMP MOZ ETH TGO BEN COM SSD MRT CGNB IV RWA LBR GIN SDN STP YEM C AF IRQ GAB MDG CMR GNQSLE W KEN SLB SM TON GTMGHA TJK PNG VUT SYR HND BOL ZWE DZA KIR HTI SWZ DJI ISR JOR KGZ EGY PHL MDV GUY SLV NC MNG MAR FSM PAK KHM LAO LSO DOM BTN IC BGD PV BWA TUNIND CHN GRD PER BHR J FJI MEX BRA IRN TUR AM IDN N PL VNM TTO UZB TKM MMR PRT HRV MNE ARE POL MKD URY KAZ PRY N AM VEN BLZ LKA KWT OMN LBY SAU PANZAF ECU BLR CHL CRI BIH ROM KOR THA MDA ALB BRB LCA CUB ARM VCT AZE HUN LBN MYS ARG COL SUR FIN ISL FRA AUS EST BGR GEO JSVN CZE DNK NOR SWE DCHE BEL IRL ESP ITA NLD GBR NZL LTU UQAT ATG BRN MLT SVK LVA RUS BHS SA PRK AUT C GRC PN MUS YP EU AN KR IMR IMR IMR FIGURE 8 Total Fertility Rate and Child Mortality Rate KEN RWA DOM JOR SYR HND DZA AFG PHLZWE N MAR C IV SLV PAK BGD SEN THA SDNTZA BHR IC ZMB YEM ARE GHA UGA BDI GTM MRT FJI PRY MEX VUT LBY KWT VNM BWA SWZ BRA IRQ SLB PNGTUR TGO MYS MUS BOL HTI EGYSSD BEN LBR COG LSO N BFA PL GUY IDN IND C CMR GNB AF GIN SLE LBN KOR ECU OMN VENCOL PER PAN CHL GMB TTO JLKA AM ISL NZLBRB C AN NLD UIRL AUS MLT SA URY POLPRT NOR FRA DNK GBR FINESP SWE CHE BEL AUT ITA J GRC PN HUN MLI KEN RWA JOR SYR LBY C ZWE IRQ ZMBDZA IV AFG HND MDG SDN VNM BENSSD TUN TZA BDI MWI SLBSWZ NUGA SEN YEM KWT IC ETH MDV C PVBGD BWAMRT ERIBTN MLI IRNMOZ KIR COG SLV PAK GHA COM TGO OMN N ER QAT STPDOM MAR PNGCMR BOL TCD LBR NGA LSOC AFN GNB BFA SLE LCA BHR VUT TON GTM MMR ZAR EGYPL GMB GIN J AM PRY VCT BLZ ARE PHL N MEX ECU PER THA CHNIDN TUR IND HTI VEN COL MYS LBN PAN GUY CRI KGZ BRA KOR FJI LKA IRL CUB CHL MUS TTO BRB ISL NZL BHS ESP URY ROM PRT ARG GBR AUS NLD NOR FRA JC U POL PN GRC SA DBGR HUN RUS AN SWE FIN BEL LTU AUT ITA DNK CHE MLT EU YEM OMN RWA LBY KENC IV TGO SEN BDI MWI N ER JOR SYR SAU DZA MDV ZMB COM AGO ETH C PV TZA CMR IC HTI ERI BEN BFA IRQ NGA SLE STP SWZ SDN TCD MLI SLB LBRSSD HNDMRT GHA BWA IRN GNB MOZ COG GTM DJI PAK MDG MNG BGD BTN ZAR UGA AFG ZWE N AM LAO GMB GIN GAB C AF TON QAT PNG TUN LSO MAR VNM SLV EGY BOL KHM N PL ARE KWT BLZ TJK PRY VUT BHR PHL UZB ZAF KIR ECU MMR DOM IDN PER TKM LCA MEX IND VEN TUR PAN FJI LBN VCT COL BRA KGZ CRI MYS J AM THA GUY TTO ARG LKA ALB IRL ISR KOR BHS MUS URY ROM CHN KAZ ISL CHL C ARM BLR POL GRC YP MDA CUB HUN BRB PRT BGR GEO AUS GBR LVA CHE NOR MLT FIN DNK JC LTU SWE BEL ITA PN RUS AN KR NLD UNZL ESP FRA EST AUT SA D EU YEM AFG N ER RWA BDI OMN ZAR SOM UGA BFA ETH TCD AGO SEN BENGNB TZA ZMB GIN MOZ SLB MDV DJI SWZ KEN SDN TGO LBR SSD IRQ CMR MWI MLI CERI MDG LAO GMB IV NGASLE SAU MRT PAK GTMKHMC GNQ AF SYR JORGAB COG STP COM GHA BTN W HTI TMP BWA IRN HNDNPL CZWE PV LBY N NLSO AM TJK DZA PNG IC KIR BOL ARE TON VUT FSM BLZ PRY MAR EGYBGD QAT PHL GRD SLVMNG VNM ECU UZB TKM IND BRN MYS BHR VEN FJI TUN DOM ZAF KGZ PER CRI LCA MMR ARG PAN MEX ISR VCT LBN COL ALB BRA TUR IDN CCHL J LKA URY KAZ CHN GUY MNE POL MUS TTO MDA SUR AM ISLMKD YP ARM THA HRV CUB BLR GEO AZE SWE KOR FIN IRL MLT NZL KWT BHS NOR CHE CBEL DNK AUS CZE PRT BIH BRB HUN EST BGR ATG SA ROM DNLD RUS ITA AUT FRA GBR LTU SVK ULVA AN PRK KR JESP SVN GRC PN EU AFG SOMN ER TMP UGA BDI ZAR TCD BFA MLI MWI ERI YEM AGO ETH GMB CMR RWA NGA COM MDG MRT TZA BEN ZMB LBR GNB SSDSLE SDN COG TGO SEN GNQ MOZ GIN C IV C AF SLB IRQ GTMKEN PNG STP GHA TON WVUT DJI PAK HND FSM SYRKIR BOL GAB ZWE HTI PL LSO LAO SWZ OMN SAU JORN C PV KHM NEGY BTN MDV ICBWA TJK AM BLZ MYS LBY SLV DOM BGD IND ARE BHR PER DZA MAR BRA IRN TUR GUY ZAF LBN ARG SUR ECU GRD MEX KGZ IDN UZB LKAMNG MMR CHL URY VCT MNE BRB MUS J COL FJI PRY PHL ISR QAT KWT VEN PANTKM BRN CRI ALB ISL ATG LCA TUN THA TTO VNM AM NORAZE PRT HRV CUB BIH MKD BLR BGR MDA ARM YP HUN ROM GEO CHN KAZ KOR AUS IRL NZL BHS JSWE FIN MLT AUT BEL DNK FRAPRK ITA DSVN CHEC GBR NLD U SA ESP GRC POL EST LTU SVK LVA PN RUS EU AN CZE U KR N ER MLI SOM UGA GMB BDI NGA TCD ZAR TZA MWI ZMB BFA AGO ERI COG SEN TMP MOZ ETH COM TGO BEN MRT AFG CSSD GNB IV RWA LBR GIN YEM STP SDNC AF IRQ GAB MDG CMR GNQ KEN SLE TON W SLB GTMGHA TJK SM PNG VUT SYR HND BOL DJI DZA KIR HTI SWZ PAK ZWE ISR JOR KGZ EGY MDV GUY SLV NMAR PHL FSM KHM LAO LSO CDOM MNG BWA TUN BTN BGD IC PV IND CHN GRD PER FJI BHR MEX J BRA IRN TUR IDN AM N PL TTO VNM UZB TKM MMR PRT HRV MNE ARE POL MKD URY KAZ PRY N AM VEN BLZ LKA KWT OMN LBY SAU PAN ECU BLR CRI BIH ROM KOR THA MDA ALB ARM BRB AZE ZAF LCA VCT HUN CUB MYS CHL ARG COL SUR FIN ISL FRA AUS SVN NOR SWE GEO DEST CHE BEL IRL JCZE ESP ITA DNK NLD GBR LTU UNZL QAT ATG BRN SVK MLT LVA LBN RUS BGR BHS PRK SA GRC AUT CMUS PN YP EU AN KR under5_mort under5_mort under5_mort 15

16 FIGURE 9 Total Fertility Rate and Risk of Maternal Death YEM NER BFA ZAR SOM AFG UGA RWA BDI OMN ETH AGO TCD ZMB BEN MWI MLI SEN GNBGIN TZA MOZ SLB DJI MDV KEN TGO LBR SSD SDN CIV GMB MDG CMR NGA ERI SLE SAU IRQ PAK GTM SWZ MRT LAO CAF GAB STPHTI COG TMP KHM GNQ JOR SYR COM GHA BTN CPV LBY TJKHND IRN WSM NIC KIRBWA PNG BOLLSO NPL DZA FSM NAMZWE ARE TKM TON VUT BLZ EGY PRY BGD GRD UZB MNG PHL QAT SLVMAR BHR KGZ IND TUN VEN VNM ZAF PER BRN MYS ECU FJI DOMMR ALB CRI LCA TUR ARG PAN MEX VCT LBN COLIDN URY BRA CHN KAZ GUY MNE POL MKD LKA AZE THA MDA MUS TTO SUR JAM ISL ISR CYP ARM CHL USA IRL PRT HRV BIH BLR GEO BEL DNK BGR HUN KOR CUB BRB ROM ESP CHE FIN MLT AUS CZE SWE NZL KWT BHS FRA NOR CAN LTU ITA DEU EST RUS GRC AUT NLD JPN GBR SVK PRI UKR LVA PRK SVN NER AFG SOM UGA TMP MLI BDI ZAR BFA AGO YEM MWI ETH BEN ZMB GMB CMR RWA NGA COM MRT TGO MDG COG CIV TZA GNBLBR CAF IRQ GTM DJI KEN SDN ERI SSD SEN GNQ MOZ GIN SLB STP PNGGHA FSMPAK HND KIR BOL GAB NPL SWZ HTI SYR ZWE LSO LAO OMN SAU CPV TJK TON WSM VUT JOR KHM EGY BLZ PHL NAM PRY MDV NIC BWA BTN QAT LBY SLV DOM IND BGD ARE KWT ISR MYS FJI BHR ZAF PER TUR UZB DZA MAR IRN BRA GUY LBN ARG MEX IDN MNG KGZ MMR TUN LKA SUR ECU GRD TKM PAN VCT COL MNE VNM THA BLR MDA BRB MUS CHL ALB URY ARM CHN TTO AZE JAM VEN BRN CRI LCA HRV BIH CUB HUN PRT MKD AUS IRL NOR NZL ISL BHS MLT CYP POL BEL AUT SVK JPN BGR KOR LTU ROM GEO GRC SWE DNK USA FIN ITA DEU SVN CAN GBR FRA PRI CHE NLD ESP EST LVA RUS KAZ PRK CZE UKR TCD SLE NER SOM MLI AFG TCD BDI TMP BFA UGA AGOZAR ZMB MWINGA YEM GNQ BEN GMB LBR SLE MRT COM MDG IRQ PNG STP SDN ERI RWA TZA MOZ ETH CMR GNB GINSSD SEN TGO KEN CIV CAF WSM GTM SLB COG GAB GHA FSM TON PAK DJI EGY BWA KHM LAO SWZ SYR JOR TJK VUT BOL HTI ZWE PHL HND KIR NAM SAUNPL LSO LBY CPV NIC SLV DZA DOM IDN BGD TUR MDV PAN ECU GUY BTN IND ARE TUN BRA MNG MAR MMR THA CHN IRN VNM HUN BIH BGR LBN BHR OMN UZB BRB AZE URY GRD MEX CHL CRI COL PER MNE ARM LCA LKA TKM VEN ALB MUS MYS KAZ VCT ARG JAM FJI BLZ ZAF PRY QAT ISR KWT KGZ SUR CYP IRL MKD HRV TTO ROM MDA CUB KOR PRT GEO BLR POL LTU AUT ESP CZE CAN FIN NZL DNK GBR FRA BRN NOR SWE ISL USA JPN DEU SVK LVA CHE MLT NLD BEL AUS BHS ITA RUS EST PRI PRK GRC SVN UKR NER MLI SOM UGA GMB AGO NGA BFA ZAR TMP ZMB BDI TCD TZA MWI MRT SEN BEN ERI AFG COG MOZ GNQ ETH TGO GNB CIV RWA COMLBR GIN SDN SSD STP YEM CAF IRQGAB MDG CMR KEN SLE TJK WSM TON SLB GTMGHA PNG SYR JOR KGZ FSM VUT DZA KIR HND PAK BOL DJI ISR SWZ HTI ZWE EGY MDV IND GUY SLV MNG NIC MAR BWA KHM LAOLSO TUN CPV IRN BTN DOM TUR BHR GRD UZB TKM BGD IDN NPL CHN VNM BRA TTO PER PHL FJI MEX JAM MMR PRT MKD HRV MNE ARE POL THA ROM MDA URY KAZ ECU PRY NAM LBY OMN SAU KWT BLZ LKA PAN VEN ZAF FRA ALB CRI AZE ARM BRB BIH HUN BLR LCA VCT LBN BGR CHL CYP MYS ARG COL SUR AUS GEO DEU EST FIN LVA CHE BEL IRL ISL SVK SVN JPN CZE ESP LTU ITA DNK QAT MLT NLD GBR NOR SWE NZL GRC CAN KOR UKR RUS BHS USA AUT BRN PRK PRI CUB MUS Risk of maternal death Risk of maternal death Notes: Figures 7, 8, and 9 show the scatter plots and smoothed polynomial relationship between and infant mortality, child mortality and the risk of maternal death at the start of each decade (data for risk of maternal death is only available from 1990). Infant and child mortality are calculated as the number of infant (less than 1 year old) or child (less than 5 years-old) deaths per 1,000 lives births. The lifetime risk of maternal death is the probability that a 15-year-old female will eventually die from a maternal cause assuming that current levels of fertility and mortality (including maternal mortality) do not change in the future, taking into account competing causes of death. The second piece of evidence suggesting that the reduction in fertility rates was not driven simply by a decline in mortality rates concerns the number of wanted children. The WDI reports on wanted fertility, meaning the average number of children reportedly desired by a woman in the survey. The data are available for different countries at different years. The number of wanted children has declined over time. Remarkably the unwanted fertility, that is, the difference between actual and wanted fertility is almost invariably positive and positively correlated with actual. This means that in countries with high fertility rates, people are not achieving their target: indeed, countries systematically err on the positive side, meaning that they always have more than the desired number of children. To some extent, this suggests that there is insuffi cient access to or use of contraception. Figure 10 illustrates this relationship. 16

17 FIGURE 10 Actual vs. Unwanted Fertility Unwanted fertility Total f ertility Notes: The figure plots against unwanted fertility. and wanted fertility are from the WDI database and unwanted fertility is calculated as the difference between and wanted fertility. The WDI publishes wanted fertility obtained from Demographic and Health Surveys from 90 developing countries. Taken together, these two additional pieces of evidence suggest that the is (or was) high, but not necessarily because of unconstrained rational decision making. In a rational setting it is hard to reconcile i) why increased risk of maternal death would increase fertility rates (unless of course, one was willing to argue that the infant mortality rate causes high fertility rates, but that maternal mortality rates are instead a consequence of high fertility rates); and ii) why people systematically have more than the desired number desired of children (e.g., the error is always one-sided). As already states, the latter suggests that there is insuffi cient access to or use of contraception. In the next section, we discuss how the global effort to reduce fertility rates surged in response to the lower overall mortality rates and took as part of its mission the goal of decreasing wanted fertility by establishing a small family as a new ideal. 17

18 IV The Global Family Planning Movement and its Consequences The following section provides a brief overview of the global family planning program, discussing the historical context as well as outlining some of its characteristics. We then examine more systematically the link between fertility policy adoption and declines in fertility. 10 A Evolution of the Global Family Planning Program After World War II, there was growing preoccupation with the unprecedented levels of population growth observed in most of the developing world due to the combined effect of declining mortality rates and high fertility rates. The problem was identified early on in several of the world s most populous nations such as India (the first country to introduce a national population policy) and Egypt, though a prevalent belief among most developing nations held that larger populations translated into having greater political power. 11 A growing concern about the population explosion in developing countries was particularly notable in the United States. A neo-malthusian population-control movement developed, led by, among others, John D. Rockefeller III, whose main preoccupations were both the growing imbalance between population and resource growth, and the potential for political instability as most of the population growth was concentrated in the poorest countries of the world. In 1952, Rockefeller founded the Population Council, aimed at providing research and technical assistance for population programs across the world. The same year, India started the first national population program and, in parallel, the International Planned Parenthood Federation was established. 12 Private foundations including the Rockefeller and Ford Foundations, provided seed funding for research and planning programs, but it was in the mid-1960s when large-scale funding became available and the planning movement really took off. The first large-scale intervention was carried out by the Swedish government, which supported family planning efforts in Sri Lanka (then Ceylon), India, and Pakistan, starting in 1962 (Sinding 2007) This and the following section draw heavily on Robinson and Ross (2007) who provide a compilation of case studies for 22 countries across the world on their family planning programs. 11 This sentiment was observed in countries including Turkey, Indonesia, and Egypt in the 1950s and 1960s. 12 An early birth-control movement led by feminist Margaret Sanger in the United States (who set up the first birthcontrol clinic in the USA in 1916) and Elise Ottesen-Jensen in Sweden was another force leading to the efforts for fertility reduction This movement initially had a different focus: its goal was to promote individual control over fertility rather than an explicit population policy to avert explosive global population growth. 13 Over time, several international organizations, like USAID and the World Bank, joined in providing funds and support for family planning programs around the world. 18

19 By the 1960s, there was a strong consensus in development policy circles that curbing population growth was a high priority. Funding agencies began to be actively involved in providing financial and technical assistance for population programs in developing countries. The invention of the modern intrauterine device (IUD) and the oral contraceptive pill around the same time allowed for the possibility of easy-to-use and effective contraceptive methods becoming widely available for public use. These early family planning efforts showed rapid success in East Asian countries, with Hong Kong, South Korea, Singapore, and Thailand leading the rankings. Program implementation and success would take longer in other developing countries partly due to the diffi culty of overcoming cultural inhibitions and religious opposition towards birth control, as well as operational problems including inadequate transport infrastructure and insuffi cient funding. However, the World Population Conference in 1974 appeared to be a turning point for the global family planning movement. In 1976, 93 governments were providing direct support for family planning (some governments provided support for family planning for other than demographic reasons), while explicit policies to limit fertility were introduced in 40 countries (data on number of countries by policy comes from the UN World Population Policy database). 14 Between 1976 and 2013, 114 countries adopted policies to reduce fertility rates. The number of countries with policies to reduce fertility rates in a given year increased over the decades, with some countries eventually needing to reverse course in order to keep their population stable. This is clearly illustrated by the fact that at present, the number of countries wishing to maintain their level of fertility, or even raise it, is increasing, as birth rates have fallen below the replacement fertility rates. Together with this trend, the number of countries with state support for family planning has also continued to rise steadily (see Tables 3 and 4) For instance, in Latin America, the adverse effects of illegal abortions was the key rationale for establishing family planning programmes. 15 Note that while Table 3 refers to the number of countries by type of support for family planning by the government, it does not necessarily include the countries with private sector involvement in the provision of family planning services. 19

20 TABLE 3 Number of Countries by Fertility Policy Goals Year Lower Maintain No Raise Total Fertility Fertility Intervention Fertility Notes: The table shows the number of countries by fertility policy implemented. The data is obtained from the U.N. World Population Policies database and begins in Countries are categorized according to whether they had a policy to lower, maintain or raise fertility or if they had no intervention to change fertility. TABLE 4 Number of Countries by Government Support for Family Planning Year Direct Indirect No Limit Not Total support support support permitted Notes: The table shows the number of countries by the type of support extended by the state for family planning services. The data is obtained from the U.N. World Population Policies database and begins from Countries are categorized by whether their governments directly supported, indirectly supported or did not support family planning as well as if the government limited family planning services or did not permit family planning in the country. 20

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