The environment, population, and women's human rights.
In the view of many current observers, the state of the earth's environment and the population it sustains has reached a critical point. A host of serious problems face the world community and satisfactory solutions appear difficult to reach or even, in the eyes of the most pessimistic, to be unreachable. The world's population has doubled since 1950 to nearly six billion, with over eighty million new births each year.(1) Predictions for future growth range as high as 11.2 billion by the end of the next century. Deforestation and soil erosion are occurring at unprecedented rates.(2) Levels of carbon dioxide and other so-called greenhouse gases are continuing to increase.(3) Although the precise magnitude and consequences are unclear, global warming is taking place and sea levels are rising, threatening, if the trend continues, a number of low-lying countries.(4) Fisheries are being depleted, as are natural aquifers and the rivers that supply water for irrigation of crops.(5) The rate of growth in food production has decreased from previously high levels, raising fears of widespread famine.(6) In light of these facts, it is not surprising that some have adopted a highly pessimistic, if not "doomsday," approach to prospects for the world's continued development, believing that the point of no return may be close at hand.(7)
And yet, by no means are all of the earth's current vital signs disheartening.(8) Population stabilization has been achieved in some thirty countries,(9) and the rate of population growth is falling at historically high rates in virtually all parts of the world.(10) United Nations estimates of the total current population of the earth have been revised downward by twenty-nine million from estimates made just two years ago.(11) Use of alternative sources of energy is increasing as the prices for generating this energy fall.(12) Recent food shortages have been due far more to civil wars and problems in distribution than to a lack of food.(13) The most recent analyses of food production estimates predict enough food to feed the world's population through at least the first quarter of the coming century.(14) There are also wide variations in predictions of future population growth, ranging from a high of 11.2 billion to a low of 7.7 billion by the year 2100.(15)
Moreover, if history has any value as a guide, it demonstrates that doomsday predictions about overpopulation and the depletion of the world's resources which have been made from the time of Malthus up to the present have proven to be largely wrong.(16) Human ingenuity and technological progress have so far managed to outpace the natural forces conspiring to bring about the downfall of mankind and the despoliation of the environment.(17) Ways have been found to solve even the most seemingly insurmountable problems.
By raising this alternative viewpoint, I do not want to assume an overly optimistic role. Just because history has proven most environmental doomsday scenarios wrong, this does not mean that it will necessarily do so in the future. The earth is finite and there may well be limits to what scientists have called its "carrying capacity."(18) Neither do I count myself among those who would leave the problems confronting the environment and mankind to the forces of the marketplace--swearing off government intervention as needless and perhaps counterproductive meddling.(19) I do believe that we must address the world's formidable environmental and population problems. We need to lower the rate of population growth and lessen the degradation of the environment.(20)
Rather, I raise this more optimistic viewpoint because I believe that embracing the doomsday approach without consideration of all the facts has had major harmful consequences, particularly with respect to questions of population control. First, it has led to major excesses and mistakes in the planning and implementation of population policies and programs. There has been a rush to adopt measures to lower the rate of population growth, such as directly inducing people to accept contraception to the point of using force, but the measures have not been thought through either as to their ultimate efficacy or to the impact that they have on the lives of individuals.(21) The result has been practices that seriously implicate human rights, particularly women's human rights since the fertility of women is the target of most population programs. Fear of an unsustainable future for all has created immediate suffering for many.
Second, acceptance of the doomsday approach has precluded the adoption of more balanced and rational strategies for reducing the rate of population growth, ones not focused so single-mindedly on the provision of contraception. Such strategies would involve careful and objective examination of the issues and an analysis of what is known about the dynamics of population change and the factors that actually bring about a decrease in the rate of population growth.(22) Such strategies would not ignore the need to provide contraception to the millions of women who want and need it,(23) but would reject so heavy a reliance on finding contraceptive acceptors and meeting targets, and would fully respect the human rights of contraceptive users. This strategy might achieve more success than many of the programs that have been adopted heretofore. Indeed, it may only be through respecting and promoting human rights (particularly women's human rights) that we can make a lasting impact on the rate of population growth.
II. COERCIVE POPULATION POLICIES
A. Pro-Natalist Policies
Due in large part to efforts of the press and women's health advocates, many of the major abuses perpetrated in the name of various population policies have been brought to light in recent years.(24) By the end of 1989, when the Ceausescu regime was overthrown, it became clear that the Romanian population had been subjected to one of the most highly restrictive pro-natalist population control policies ever devised. Believing Romania to be surrounded by ethnically hostile and more populous neighbors, as well as believing that a larger population was essential to national prosperity, President Ceausescu strove to increase the number of Romanians as rapidly as possible. To this end, he adopted measures prohibiting the great majority of abortions, restricting the sale of various kinds of contraceptives, permitting sterilization only for serious health reasons, and dispensing large doses of pro-natalist propaganda. Towards the end of his regime, President Ceausescu's enforcement of this policy was so intense that his Government instituted a system of workplace gynecological check-ups for women to ensure that those who became pregnant did not have their pregnancies terminated. At the same time, in what turned out to be a fatal error in political judgment, he instituted extreme austerity measures to pay off the entire foreign debt incurred earlier by his government.(25) The population as a whole was deprived of food, heat, electricity, personal amenities, and resources adequate to care for the children that they were urged to create.(26) This situation lasted until the end of 1989, when living conditions became so intolerable that the Government was overthrown and most of these measures were canceled.
The effect of this population policy on the health of the Romanian population was disastrous.(27) The infant and maternal mortality rates in Romania were among the highest in Europe, the latter some two and one-half times the maternal mortality rate in the United States. Approximately 10,000 deaths from illegally performed abortions have occurred since the imposition of the policy, around 5.2 million women are permanently sterile as a result of poorly performed abortions, and thousands of children were abandoned, many of whom were subsequently cared for in state orphanages under overcrowded and unsanitary conditions where they suffered from malnutrition and serious illness. Unfortunately, the legacy of Ceausescu's policy continues. The rate of abortions, which rose dramatically during the months immediately following the revolution, remains at very high levels.(28) Abortion is the primary means of controlling births, and Romania has the highest abortion rate in the world with three abortions performed for every live birth. Contraception is still not readily available, is more expensive than obtaining an abortion, and is regarded with suspicion, even by many medical personnel who were persuaded of its ill effects by the pro-natalist propaganda of the Ceausescu regime.(29)
B. Anti-Natalist Policies
Much more often, population policies are imposed as part of a strategy to lower the rate of population growth. As the world's population has increased dramatically since World War II, there has been growing acceptance of this strategy. High rates of population growth have been viewed as outstripping the ability of countries to sustain socioeconomic development, depleting the world's resources and causing major political instability. Stemming or reversing these rates has been judged to be the key to a sustainable and livable future. This strategy has gained widespread acceptance in the international population community, as well as in the planning departments of various governments.(30)
One of the most consistent proponents of this approach has been the government of India, which recognized early in its history the problems associated with high rates of population growth and, in response, adopted one of the first major population policies.(31) In the mid 1970s, the anxiety of the Indian government over the country's demographic prospects reached a fever pitch, leading it to adopt a highly coercive plan to lower the rate of population growth.(32) One major component of the plan was the promotion of widespread sterilization of Indian citizens. To carry out these sterilizations, the Indian government established mass camps where sterilizations were performed in assembly line fashion under unsanitary conditions. At the height of the campaign, millions of people were sterilized within a six-month period. Many of these people were rounded up against their will and taken to the sterilization camps. In some cases, police were called upon to enforce the policy.(33)
The most flagrant excesses of this plan were not long-lived. There was a public outcry over forced sterilizations and Prime Minister Indira Gandhi and her government, which had instituted the plan, were voted out of office in the next election. Nonetheless, the plan left lasting scars. First, it created a precedent for coercive action which has lasted until today. The Government still operates sterilization camps where conditions are unsanitary and women are pressured to be sterilized.(34) Second, it created a population that mistrusts government efforts to deal with increasing population growth. This fact is particularly apparent in the negative reactions of male Indians to the plan. The sterilization program was largely directed at men who were induced to undergo vasectomies. Measures since then have been directed primarily at the sterilization of women, even though it is easier, safer, and more cost effective to perform a sterilization on a man than a woman.(35)
The Chinese government has also engaged in major and well-publicized excesses in the execution of its population policy. The history of China's population policy has been one of broad fluctuations.(36) After the takeover of the government by Communist forces in 1949, the new regime aggressively pursued a policy of encouraging births. Like the government of President Ceausescu, the Chinese government urged more births in order to increase the rate of socioeconomic development and to strengthen the country. By the mid 1960s, however, China had largely reversed its policy. It began advocating the use of family planning, with a two child per family norm urged in some parts of the country. Despite this promotion of family planning and the continuing drop in the rate of population growth, by the end of the 1970s, the government tightened policy further. Alarmed by predictions that its population would exceed 1.2 billion before the end of the century and worried about the relative scarcity of domestic agricultural land to produce the food to sustain this population, the government adopted the one child per couple policy and instituted a series of strict measures to enforce it. Implicit or explicit threats of force were part of these measures that, on occasion, became real; persons who would not voluntarily comply with the policy were required to be sterilized or obtain an abortion.(37)
Because of the secrecy of Chinese society and the government's denials of responsibility, the extent of the use of actual force is very difficult to gauge. Nonetheless, there are sufficient independent and unbiased reports to leave little doubt that coerced abortions and sterilizations have occurred, including evidence that mass sterilization campaigns have been carried out in various provinces.(38) The government itself has acknowledged as much, although it places much of the blame for these excesses on overzealous local officials.(39) Indeed, given a population of over one billion people that has never known a democratic regime and in which force has, in recent years, played a prominent role, to suggest otherwise would be, at the least, to ignore human fallibility. Such excesses and the hostility that they generated, particularly in the rural population, were responsible for a major relaxation of the one child policy in the mid to late 1980s. During this time many exceptions to that policy were established for rural couples, ethnic minorities, and various other groups, including families that had given birth only to girls. Moreover, enforcement of existing laws was less stringent than before. However, by the beginning of the 1980s, policy had once again shifted.(40) Results of the 1990 census indicated that population targets had not been met, leading the government to tighten enforcement procedures once again.(41)
C. Non-Physical Forms of Coercion
Not all coercive activities carried out in the name of population control have been as obvious as forced sterilization, abortion, or forced motherhood. There are a number of more subtle ways in which governments have tried to enforce their will over citizens' reproductive behavior. One is through the use of incentives or disincentives.(42) The incentives fall into two broad categories: incentives to individuals to adopt various forms of family planning (or to bear children, as the case may be) and incentives to population and health workers designed to motivate them to induce other individuals to adopt various forms of family planning. Incentives have formed an integral part of the population policies of all three of the countries discussed above. The government of Romania provided special allowances to mothers of large families, special indemnities for the birth of third and subsequent children, and also increased the taxes imposed on persons with no children.(43) India gave monetary rewards to persons who agreed to be sterilized, made the salary of officials contingent on their ability to recruit sterilization acceptors, and imposed fines and imprisonment upon those who failed to meet demographic targets.(44) Since the emergency, India has continued to offer monetary incentives to both acceptors and recruiting officials and, relying heavily on sterilization to implement its policy, sets sterilization targets for villages.(45)
Similarly, a constant feature of China's population policy has been the penalization of couples who have more than the allotted number of children. This has been done by denial of social benefits, demotion at work, and imposition of fines. In contrast, those who adhere to the one child per couple policy have been rewarded with improved housing, access to better medical and educational benefits, and promotion at work.(46) Most recently, China has affirmed its belief in the efficacy of incentives by instituting a family planning responsibility system to enforce its population policy.(47) Under this policy, local officials are given the responsibility for reaching contraception targets set by the national government.(48) If they fail to do so, they are penalized.(49) The use of such incentives has also been commonplace in the implementation of the population policies of a number of other countries, including Vietnam(50) and Bangladesh.(51)
Another coercive method of enforcing population policies is through the application of various psychological pressures to bring about desired conduct. The Chinese government relies extensively on this method.(52) Friends, family members, co-workers, and local officials are all called upon to place pressure on women to use intra-uterine devices (IUDs) which they are forbidden to remove, to be sterilized after the birth of a second child, or to have an abortion if they become pregnant.(53) In some areas, the contraceptive use and pregnancy status of women are now monitored by officials by means of periodic physical examinations, much like those carried out under the Ceaususcu regime.(54) Often threats of more coercive measures accompany this pressure if the desired method of family planning is not adopted.
Pressure of a slightly different nature has been a continuing feature of the Indonesian population policy.(55) "Safaris," caravans of medical personnel, officials, and members of the police or military who enter rural towns have applied this pressure. They gather the populace together, deliver lectures upon the benefits of contraception, usually one favored form, and, sometimes under implicit threat, sign up acceptors and dispense the particular contraceptive being promoted. Indonesia also has relied on a system of village group pressure under which officials and community leaders make efforts to persuade women to accept family planning.(56) Meetings are held periodically at which the women of a village gather together to discuss family planning in terms that utilize collective pressure to strengthen compliance with national policy.
D. Reproductive Technologies
One of the most subtle, and widespread, forms of coercion is the misuse of technology to enforce population policieS.(57) One of the major occupations of the population movement has been the continuing search for ever more sophisticated, easy-to-use, and effective means of family planning. Such contraception would remove uncertainty and human fallibility from the process of controlling births. One step in this search has been the introduction of hormonal contraceptives, chiefly oral contraceptives, which have the advantage of greater reliability and greater convenience than less technologically advanced barrier forms of contraception. With the increasing pace of technological innovation have come new developments in contraception in the form of long-lasting hormonal injections; or implants such as Depo-Provera and NORPLANT, and anti-fertility vaccines.(58) These are more reliable than oral contraceptives and do not require daily ingestion, which is a major disadvantage of oral contraceptives. In a sense, they are fail-proof in their contraceptive effects, as they depend so little on the responsibility or efficiency of the user. An injection of Depo-Provera lasts for three months, while a NORPLANT implant is effective for up to five years.(59) Moreover, since hormonal contraceptives do not involve genitalia, they may be more acceptable to their target population.
There is little doubt that many of these contraceptive innovations, in particular oral contraceptives, have made the lives of millions of women easier, freeing them from the fear of unwanted pregnancy. They are effective, reliable, and relatively safe when used properly and with fully informed consent and knowledge of side effects. Safe and effective use also requires a preliminary medical examination, follow-ups at regular intervals, and treatment if there are complications.(60) Although this is the sort of care that a woman in Western Europe, North America, or the more developed parts of Asia would be likely to obtain, women in most developing countries are not as fortunate. The distribution and use of hormonal contraceptives in developing countries has often been accompanied by no information, no preliminary medical examinations, no fully informed consent, no supervision or follow-up, and no treatment in the case of complications. The providers' concern has often focused more on persuading or inducing a woman to accept hormonal contraceptives rather than on determining whether a particular contraception method would be appropriate for the woman. Hormonal contraceptives have also been provided in settings where other forms of contraception are unavailable or discouraged by providers, as part of undisclosed clinical trials, or when the full effects of the contraceptive are not yet fully known. On occasion, women's requests to discontinue using them have been denied.(61)
An instructive example is the Indonesian government's recent enthusiastic promotion of NORPLANT as a major component of its population policy.(62) A 1990 report produced internally by the National Family Planning Coordinating Board evaluating the success of the introduction of NORPLANT found serious deficiencies. It concluded that only one-half of the doctors and midwives and few field workers had received training in the use of NORPLANT, that most acceptors had no knowledge about the possible side effects of the drug or that the drug could be removed before five years, that sanitary conditions were not consistently maintained, that the reuse of disposable syringes and use of unsterilized instruments was a particular problem, that not all medical personnel believed that screening and counseling were procedures which needed to be followed, that only one-half of acceptors had their medical histories taken, and that some persons wanting NORPLANT removed before five years had to pay for the removal themselves.(63)
E. The Impact of Coercive Policies on Existing Human Rights Problems
1. Son Preference and Pre-Natal Sex Selection
In addition to being questionable in terms of their own human rights implications, many of the practices detailed above have exacerbated already existing human rights problems. One of the most serious of these is the problem of son preference. Many countries have long and deeply held traditions of preferring the birth of male children.(64) This preference has a number of sources. Sons are often believed to provide greater benefits to rural families than girls because they are capable of undertaking more difficult agricultural labor. Moreover, girls are viewed as losing what productivity they do have because they leave the family when they reach the age of marriage and may be considered a substantial burden in some societies because of the need for a sizable dowry. Sons also carry on the family name and heritage, which is extremely important to many rural families that rely on a sense of family for social support. In part, son preference is also a matter of deeply ingrained cultural and customary belief, in many cases buttressed by religion. Some of the adverse consequences of son preference include higher rates of female than male mortality, provision of poorer health care to girls than boys, and even physical neglect and abuse of girls.
Whatever the causes of son preference, the imposition of restrictive population policies has heightened the intensity of its practice.(65) If families are allowed to have only one or two children, they will often want to ensure that these children are males and will occasionally resort to extraordinary measures to achieve this goal. Such measures include infanticide, or the abandonment or physical neglect of girls resulting eventually in death.(66) With the introduction of modern technology in the form of ultrasound and amniocentesis, the goal of having male children is easier to achieve than ever.(67) A family can have a test performed to determine whether the fetus is male or female and, if the latter, terminate the pregnancy, hoping that the next pregnancy will produce a male. Since abortion is legal or tolerated in many of these countries, there is little problem in obtaining one. Due in part to the restrictions imposed by anti-natalist population policies, ratios between males and females have reached an historic high in a number of Asian countries, including China(68) and Indian,(69) as well as the Republic of Korea(70) and Taiwan.(71) In India, instead of the expected number of 105 women for every 100 men, there are 93 women for every 100 men.(72) When extrapolated to the whole population of India, this discrepancy results in many fewer girls than expected. This has prompted some observers to inquire rhetorically about the whereabouts of the millions of "missing women."(73)
The Indian government has tried to combat the most recent manifestation of son preference by enacting legislation banning most prenatal tests to ascertain the sex of fetuses.(74) China has also enacted such legislation.(75) However, it is doubtful that this legislation will be effective given that ultrasound machines are highly mobile and their supervision lax. Moreover, China's attempt to fight son preference is negated in part by laws that reinforce son preference. For example, as part of its efforts in the mid 1980s to loosen some restrictions in the one child per couple policy, the Government created exceptions that discriminate on the basis of sex by allowing rural couples to have an additional male child if their only child is a girl.(76)
Another problem made worse by the introduction of restrictive population policies is the practice of eugenics. Although the eugenics movement was a powerful force from the late 19th to the mid-20th centuries, in recent years most observers have considered it to be largely a matter of historical record. The discrediting of the scientific theories upon which eugenics was based, as well as the notorious excesses perpetrated in its name by the German National Socialist regime, seemed to sound the death knell of eugenics.
However, eugenic features can be discerned in the population policies of various countries. For example, the government of Singapore, which in recent years has reversed its population policy and adopted a pro-natalist stance, has targeted many of its incentives at the most highly educated parts of its population.(77) Successful female college graduates have been encouraged through various social benefits to give birth to more children in order to maintain the high standard or `quality' of the population, while the poor have been offered nothing. In this case, the policy also has racial overtones, since most of the successful college graduates are ethnic Chinese and most of the poor are not. Such a racially-motivated policy was also promoted by the apartheid government of South Africa(78) and has been suspected in the Indonesian government's implementation of population policies in East Timor.(79)
The phrase "quality of the population" has, in fact, become a euphemism in a number of countries for eugenic theories and practices. The term appears, for example in laws of the Republic of Korea,(80) Indonesia,(81) China, and Japan.(82) However, in response to recent criticism, the Japanese have removed the word eugenics from their law and revised some of its more objectionable features.(83) The practice of eugenics has seen its greatest implementation in China, where, in the mid-1980s, a number of provinces adopted laws calling for sterilization of the mentally and physically disabled and those suffering from hereditary diseases to prevent them from bearing children. The concern was that scarce resources were being spent on caring for millions of disabled persons, rather than on more productive projects. In 1994, China released a draft law instituting such measures on a country-wide basis.(84) The criticism from abroad was so vociferous that the government withdrew the draft, removed some of its most coercive features, and toned down its language. While the new law is an improvement over the draft version, it nonetheless contains some disturbing provisions.(85) People diagnosed during the required pre-marital examination with a serious genetic disease are deemed unsuitable for reproduction and may not marry unless they take "long-lasting contraceptive measures" or undergo tubal ligation.(86) The detection of such a disease in a married couple also requires the adoption of "appropriate measures."(87) In addition, those diagnosed with a communicable disease in a contagious phase or a manifest mental disease must postpone their marriage. These provisions place significant restrictions on the abilities of certain persons to marry and bear children. Moreover, because the law does not define any of the categories of diseases to which it refers, the restrictions are open-ended. Because the law will be implemented at the local level with local regulations, it could be interpreted so as to allow for even greater restrictions, on what many would consider important human rights.
Another human rights issue of growing concern that is implicated in population policies is euthanasia. In China, serious proposals have already been made to enact legislation authorizing euthanasia. In 1995, deputies to the National People's Congress submitted a draft law that would allow technically advanced hospitals in large cities to perform euthanasia on terminally ill patients.(88) Under the draft, a patient would have to request the procedure, which would have to be approved by two medical experts, and relatives would also need to consent.(89) In 1996, a group of prominent doctors gave its endorsement to the legislation, as did deputies to Shanghai's local legislature who approved a proposal calling for patients "to have the right to live and the right to die."(90) The Chinese Government has not yet taken any action, although there is speculation that it is preparing the way to pass a national law on euthanasia.(91)
One reason for this recent interest in legalizing euthanasia may be the imbalance in the age structure of the population created by the rapid drop in birthrates.(92) As birthrates have, dropped and medical advances have increased the average life span, the population of China has begun to age markedly. For example, China's percentage of elderly (over the age of sixty) is projected to grow by 403.3% between 1980 and 2025, with the actual number of elderly increasing by 143 million, from 4.72% to 12.86% of the population.(93) These figures will have serious economic consequences, as the ratio of elderly dependents to persons of working age grows to twice that of Western industrialized countries.(94) The imbalance will strain social resources and the rather chaotic and rudimentary Chinese retirement system to the breaking point.(95) Euthanasia appears to be one strategy that the government of China is exploring to deal with this troubling situation.
F. The Role of Law in Coercive Policies
One important point to emphasize, at least from the viewpoint of law, is that all of these population policies are or were supported by a carefully drafted series of laws. They are not simply informal policies implemented sub rosa, or as the government of China would try to convince the rest of the world, isolated excesses carried out by overzealous local officials.(96) The governments sought to give legitimacy through the legal system to what otherwise might seem thoroughly illegitimate. For example, under President Ceausescu, laws were enacted and regulations issued that restricted abortion and sterilization, prohibited certain forms of contraception, and created a series of pro-natalist benefits.(97) At the time of the most intense pressure to perform sterilizations in India, the state of Maharashtra enacted legislation to justify its actions.(98) The duty to practice family planning is enshrined in the Chinese constitution, which is one of only two constitutions in the world to contain such a provision.(99) Local family planning laws spell out in detail the sorts of steps to be taken to fulfill this duty.(100) In addition, many local laws make explicit what the government tries to deny--that coercion is endemic and, in fact, a key in the eyes of the government to population policy. Such laws often provide that excess pregnancies must be terminated and that persons who have exceeded targets must undergo operations or, in more euphemistic terms, "measures" must be adopted.(101)
G. Effectiveness of Coercive Policies
A second point to note about these policies is that they do not achieve their desired results.(102) Although rising markedly after the sudden imposition of its pronatalist policy, Romania's birthrate soon began to fall and continued falling for decades until the very end of Ceausescu's regime when it stood at below replacement level.(103) In addition, abortion rates remained high, even in face of legal prohibitions and harsh penalties for those caught performing or undergoing illegal abortions.(104) Similarly, the harsh measures imposed by the Indian government and additional measures adopted in their wake did not significantly lower the birth rate in India.(105) Despite all the efforts and resources of the Indian government, the rate remained essentially static until the late 1980s and 1990s.(106) Indeed, one factor responsible for the inability of the government to lower fertility rates has certainly been the mistrust engendered by the program in the Indian population at large.(107)
Unlike the results of the policies implemented by Romania and India, there is more disagreement about the effectiveness of China's restrictive population policy. The Chinese government would have outsider observers believe, and most do, that their population policy has been a great success. Indeed, the figures are impressive: in the thirty years that the policy has been in existence, the rate of population growth has dropped to nearly that of major industrialized countries.(108) Yet, some observers are unconvinced.(109) First, some figures are not entirely encouraging, even in the Chinese government's eyes.(110) Despite its adoption of severe measures, the total number of people in China will exceed the target of 1.2 billion set for the end of the century by almost 250 million--that is, by as many people as there are in the United States.(111) The policy has generated substantial hostility and outright defiance, which, given the strong tradition of conformity in Chinese society, is notable.(112) Couples have hidden births, have sent newly born children, primarily girls, to live with relatives in remote parts of the country, and have chosen to give birth despite the prospect of harsh punishment. Indeed, the reason that the government in the mid-1980s was forced to retreat from its blanket one child per couple policy was the strength of the opposition from ethnic and rural populations.(113)
There are persuasive observers who argue that the lion's share of the fall in the rate of China's population growth has been due not to the most restrictive measures, but to changes that occurred in China during and before the period of implementation of the policy.(114) Among these were the improvement of the social welfare of the population as a whole due to the provision of health, education, and housing benefits, as well as enough to eat. Also cited are the promotion of the status and education of women, their entry into the non-agricultural workplace, and more recently, the rapid industrialization of coastal areas of China and the concomitant increase in income. These observers would contend that the demographic transition observed today in China began well before the imposition of the harshest measures which (they would argue) have had relatively little impact on the rapid fall in the fertility rate.(115) For example, throughout the 1980s, the total fertility rate remained relatively stable, around 2.4 children per woman.(116)
III. HUMAN RIGHTS INSTRUMENTS AND COERCIVE POPULATION POLICIES
Many of the practices carried out in the name of population policy have important human rights implications under both binding international agreements and less formal documents signed by country representatives at international conferences.(117) The issue of human rights in the area of population policy is complex, and has been provided with a theoretical framework only in the last several years.(118) Traditional human rights concerns may seem alien to this field in a number of ways. Historically, human rights activism has largely focused on classic abuses of civil and political rights abuses such as torture, unjust imprisonment, political persecution and disappearances, denial of freedom of speech and correspondence, unfair trials, and similar occurrences. One characteristic feature of these abuses has been their public nature; they have been perceived as involving government action in a public setting. The direct intervention of the government has resulted in individuals being deprived of rights that they would otherwise have.
If considered at all, the rights implicated in population policies--namely reproductive rights--have appeared not to fit this model. They involve private settings, family relations, sexual conduct, and social custom and policy. Demands for reproductive rights seem to belong more to the province of economic and social rights, that is, part of claims for the provision of various generalized social benefits such as health, education, housing, and employment.(119) They have been thought of not as lights inherent to the individual, which only the government could take away, but rights that exist theoretically and cannot be exercised without the intervention of the government to actualize them. Moreover, it certainly is not a coincidence that the human rights aspects of population policies relate to the concerns of women in a far more central way than most classic human rights issues. Indeed, they deal with issues that are, in some sense, unique to women's actual experiences: conception, pregnancy, and childbirth, issues which have often been considered part of the private sphere.(120) Because the human rights community has traditionally been less interested in social, economic, and women's rights than in civil and political rights, reproductive rights have been treated somewhat as a stepchild of the international rights community.
It is important, however, to recognize that the rights implicated in population policies do, in significant ways, fit into a traditional human rights framework. They do involve government action of a highly organized and coercive nature. Population policies are formulated by governments and involve government officials at many levels, from central planners to regional and local officials to medical workers involved with the treatment of specific persons. They represent the intrusion of government into the very core of individual's lives and are not simply a matter of relations between husbands and wives and family members. Further, population policies are often implemented in public settings, such as hospitals, clinics, etc., where operations can be performed and family planning devices dispensed, inserted, or implanted. Enforcement is often achieved through mass meetings or through the public pressure of local officials and work associates, or even the police in extreme situations. As discussed above, these policies are also supported by laws.
Accordingly, there are provisions of civil and political human rights treaties that are highly relevant to reproductive rights.(121) For example, although it does not refer to reproductive rights by name, the Covenant on Civil and Political Rights (the human rights document traditionally regarded with the greatest respect by international human rights groups) contains provisions that are highly applicable.(122) It guarantees the right to life, the right not to be subjected to medical or scientific experimentation without consent, the right not to be subjected to inhumane or degrading treatment, the right to liberty and security of person, the right not to be subjected to arbitrary or unlawful interference with privacy or the family, and the right to marry and found a family.(123) The Covenant also endorses the general principle that it is to be implemented without discrimination on the basis of sex.(124) It does not require a strained reading of the Convenant to see how many of the activities associated with population policies violate these civil and political rights and discriminate on the basis of sex.
In addition, reproductive rights are the named subject matter of the Convention on the Elimination of All Forms of Discrimination against Women, which was endorsed by the United Nations General Assembly and opened for ratification in 1979.(125) This Convention had its origin in the international community's perception that although the major human rights conventions all prohibited discrimination on the basis of sex and indicated that their provisions were to be implemented without such discrimination, their statements on this issue were too general. Further attention needed to be devoted to specific aspects of sex discrimination, with an emphasis on some of the particular problems facing women, including reproduction.
The result is a treaty based on the equality of men and women which guarantees a broad array of rights-civil, political, social, and economic. By the end of 1995, the treaty had 151 parties, however, the United States was not among them.(126) The Convention specifically endorses the following rights: 1) access to information on health and to information and advice on family planning, 2) the right to protection of the function of reproduction, 3) the right of access to health care services, including family planning, 4) the right to freely and responsibly decide on the number and spacing of children, and 5) the right to have access to the education and means to exercise this right.(127) It is relatively easy to see the applicability of these provisions to coercive population policies.
The rights to decide freely and responsibly on the number and spacing of children, and to have access to the education and means to exercise these rights are of particular interest. This phrase constitutes what one might call, at this point in the evolution of thinking on population issues, the classic formulation of reproductive rights in an international context. The phrase's first recorded use was in the final document approved by the Teheran Conference on Human Rights in 1968.(128) Since then, in various wordings, it has been a staple of population thinking, taken up by a number of individual governments in population policy statements and laws, and reiterated prominently in the documents adopted by the three international population conferences, held in Bucharest in 1974, in Mexico City in 1984, and, most recently, in Cairo in 1994.(129)
This is not to say that a one-to-one correspondence can automatically be made between various coercive population policy measures and the rights that they violate. Relying on human rights documents is not as simple a matter as connecting dots in a picture. There are a number of issues that must be taken into consideration in examining the human rights aspects of population policies. One is the issue of cultural relativism, the principle that in different countries widely differing customs, religious beliefs, and social and cultural expectations play a significant role in determining how moral elements of a particular action are perceived. Another is the issue of necessity, the principle that actions taken in one context might seem thoroughly inappropriate, but in another might appear to be the only rational choice because of the gravity of the problem.
This latter principle is inherent in the classic formulation of reproductive rights itself, which has been the subject of heated debate and detailed exegesis nearly from the beginning.(130) The primary issue is the interpretation of the contrasting words `freely' and `responsibly,' linked together as delimiters of reproductive rights. This linkage has prompted a series of questions. Is there a true `free' reproductive right if it must be exercised `responsibly?' Who is to determine what constitutes responsible action: the individual, the couple, the family, the community, or the government? What are the limits of `responsible' action? For example, does responsibility entail undergoing sterilization and abortion when not desired, bearing children that are unwanted, submitting to contraception (including contraception that may be harmful to health) or, conversely, bearing more children than can be properly cared for? Does a government have a right to impose strict population control measures in the name of responsibility for the purpose of providing a better life for future generations? The answers to these questions have fueled recent debates over population, the environment, and reproductive rights.
Most observers would probably agree that forcing a woman to undergo sterilization or abortion, or to bear a child, as the policies of Romania, China, and India have done, constitutes a human rights violation. Agreement, however, becomes more difficult when the issue is the forced use of contraception (which the Government of China does not deny), and much more difficult in the case of incentives or the application of psychological pressure. The task then becomes one of balancing conflicting considerations, such as, how coercive are the measures adopted, how urgent is the need for action, and what will be the response of the population affected? Also, are there less coercive alternatives that could be applied, and if so, what is the probability that the measures adopted will actually achieve the result desired?
The extreme complexity of the task is well illustrated by the issues of incentives and the application of pressure.(131) All governments, including our own, use incentives of various sorts to bring about policy change; one need only think of the manipulation of the United States Internal Revenue (Tax) Code as an example.(132) In addition, incentives can vary enormously, from providing a desperately poor person with clothing or money to be sterilized, to paying family planning workers a sum for each acceptor that they recruit, to denying health care and education to children born outside of birth plans, or to giving preference in new housing or additional family subsidies to families that accept limits on their size. Similarly, it is part of the human condition to receive pressure from family, colleagues, and the government over matters of public and private behavior. This sort of pressure is particularly common in the sphere of sexuality and marriage. There are also great gaps between public humiliation and ostracism and lengthy individual interrogations on the one hand, and strong educational campaigns or appeals to the common good, to friendship, or to family harmony on the other. The range in these areas is from the relatively benign to the deceptive, cruel, and inhumane; exactly where the boundary of the permissible is crossed is highly problematic. However, I suggest that a warning Rag be raised when incentives become punishment or disproportionate to the sacrifice being demanded and when pressure leaves an individual with no practical choice but to comply.
Nor is the question of cultural relativism to be taken lightly. It is a historical fact that the concept of universal human rights as understood by the human rights community is largely a product of the Western imagination, strongly influenced by eighteenth century Enlightenment philosophy and ideas of personal autonomy and freedom. The key issue has been how to keep the government from intruding on personal rights to which individuals are entitled. Although increased interest in social and economic rights has changed this formula somewhat, even these rights are most often approached from the perspective of governmental denial of personal entitlements.
To many developing societies these are unfamiliar if not alien ideas. Persons within these societies often think of themselves more as a part of the family or community than as individuals and value ideas of cooperation, compromise, and shared responsibility more than self-expression. Consensus and the well-being of society are often more important than individual self-fulfillment and personal entitlement. Moreover, in many developing countries where day-to-day survival and the lack of basic health and educational services are uppermost concerns, the assertion of collective economic and social rights seems far more relevant than the expression of individual civil and political rights. Countries such as China that have implemented population policies with coercive features make just this point, arguing that the collective economic and social welfare of their population in the future justifies any denial of personal rights that may occur in the present.(133)
Despite the complexity of these matters, several principles are worth keeping in mind, such as healthy skepticism about the claims of population policies (even the ones made here), and compassion when possible human rights violations are involved. The arguments of governments about the need for restrictive measures are all too easy to accept at face value. If there were indisputable evidence that specific disasters would occur unless population growth rates were drastically and immediately curbed, strong measures might be warranted. But there is no such evidence. As noted earlier, few of the calamities predicted in recent decades have come to pass.(134) Similarly, if there were indisputable evidence that the rate of population growth could be significantly changed by adopting a Draconian policy, stem measures might be warranted. There is again, however, little evidence of this translation of policy into result. Indeed, much evidence indicates the opposite. A number of highly coercive policies have not worked.(135) They do not respond to the actual needs of the population subjected to them. Rather, these policies create a backlash of resistance, dishonesty, and distrust. They reflect a fundamental pessimism as to the ability of people to make the right choices for themselves and their families when given security and the ability to choose.(136)
It is also tempting to avoid dealing with ethical dilemmas by adopting an approach of cultural relativism. Before doing so, however, certain questions should be asked: who is making the argument that cultural relativism supports coercive measures--the government that is imposing the policy, or the people who are subject to the policy? If it is the government, was it freely chosen by the people under conditions in which issues such as population regulation could be openly and frankly discussed? Or was it an undemocratic regime that permitted little dissent? Has it committed itself to upholding universal civil and political human rights by ratifying international human rights treaties and guaranteeing such rights in its constitution? If so, how does it view its commitment? Moreover, it is worth considering whether there may not be certain basic universal values, whether called human rights or not, that transcend national and cultural boundaries. Examples include values of bodily integrity, respect for the person, and humane treatment. Finally, there are customs or practices that have a long tradition and are widely viewed as acceptable within a society that still clearly constitute violations of human rights, for example, female genital mutilation, bride burning, and foot binding. Above all, if we defend human rights in our own country, are we not under an obligation to question policies that in terms of these same human rights we would not tolerate here?
IV. CAUSES OF FERTILITY DECLINE AND WOMEN'S HUMAN RIGHTS
A. Demographic Transition
Most discussions of the causes of fertility decline begin with reference to the theory of "demographic transition," which gained prominence after the Second World War to explain the stabilization of population in industrialized countries between the 19th and 20th centuries.(137) According to this theory, there are three demographic stages in a society's transition from a rural or traditional state to a more modern and industrialized state. The first stage, that of a rural and "undeveloped" country, is characterized by large families and high rates of fertility and mortality, resulting in a stable population. Children in such societies are valued for a number of reasons.(138) They are needed to carry out various kinds of work to ensure the survival of the family in an agricultural setting. They are also viewed as necessary to support parents when parents reach old age, particularly since so few rural societies have created social programs to perform this function. In some societies children are also the most visible sign of family status. Their numbers are high, in part, because of traditionally high rates of infant mortality. Enough children must be born to ensure that some will survive to carry out the various tasks that are required of them.(139)
During the second stage of demographic transition, mortality rates, particularly infant mortality rates, begin to drop as modernization occurs. This change is due primarily to the introduction of improved means of sanitation, the expansion of the quality and quantity of health care services, and increased access to a generally more reliable supply of food of higher nutritional content. At first, fertility rates stay high because the population is managing its affairs under the traditional assumption that high fertility rates are necessary to maintain the family's survival. The result is a soaring rate of population growth as births greatly exceed deaths.
The third stage of the demographic transition occurs when fertility rates begin to drop and eventually achieve balance with mortality rates, resulting in a stabilized population. This drop in fertility rate is due to a number of factors. As a country modernizes, increased urbanization and industrialization occur, the population becomes more highly educated, and governments provide greater social and economic benefits. Consequently, children are not viewed as necessary to maintain an agricultural pattern of life or to sustain parents in old age. Rather than being considered an asset in ensuring the survival of the family or as a sign of family status, they come to be seen more as an economic liability because they have to be educated to take part in a modem world and must be supported for the period of education. In addition, increased work outside of traditional structures contributes to the breakdown of traditional family patterns and the growth of self-reliance.
Although demographers have differed on the details of this theory, most have concluded that, in general terms, it does account for demographic developments observed in industrialized countries. For example, as the countries of Western and Northern Europe progressed towards greater industrialization during the 19th century, their populations at first grew at an accelerated rate. As these populations began to enjoy greater socioeconomic benefits, fertility rates began to drop, and have continued to do so until the present time. In many nations, fertility rates have reached historic lows, in fact so low that a number of these countries are experiencing negative rates of population growth. Some demographers have also concluded that this theory accurately explains what has occurred in the Pacific Rim countries that have had spectacular economic growth rates since the Second World War.(140) Nations such as Taiwan, the Republic of Korea, Singapore, and Hong Kong, have reached a state of population stabilization comparable to that achieved by Western European countries and Japan.
Although the theory of demographic transition is generally valid, it is increasingly clear that there are a number of other factors influencing declines in fertility. Nor is the timing and pace of the process uniform.(141) No exact formula can be applied to predict passage through the transition. The classic theory of demographic transition responded to developments in a fairly homogeneous section of the world--Western and Northern Europe--and occurring at a particular time. It is questionable whether the theory explains demographic behavior in the current developing world which is governed by customs, traditions, religions, and social practices very different from those of Western Europe. Developing populations are characterized by different features, such as initial family size and fertility rate, and even value placed on children. Such factors suggest the need for major conceptual changes in the way that the decline in fertility is approached. Even the validity of the theory of demographic transition for Western European countries has been questioned.(142)
B. The Role of Women in Demographic Transition
Another matter that the theory of demographic transition neglects--at least in its classic presentation--is the role of women in the transition. Specifically, it does not analyze closely enough the role that transformations in the position and consciousness of women play in the move towards smaller family size. Increasing interest in women's human rights and the realization of the central role of women in population policies, has done much in recent years to remedy this omission. The work of numerous researchers demonstrates that improvements in the status of women are one of the most reliable correlates of decreasing fertility rates.
Education is a significant factor accounting for this outcome.(143) For example, a study published by the United Nations in 1987 indicated that women who have completed seven years of education have on the average three fewer children than women with no education.(144) They also have lower infant mortality rates, which in turn leads to a desire for fewer children. (145) Education brings about this change in a number of ways.(146) It delays marriage, which delays childbearing and it gives women greater knowledge of the world in general and of methods of contraception in particular. This knowledge leads to less fear and greater use of contraception, as well as the knowledge of where to obtain contraception. Education takes women out of the household where they are often valued primarily for their functions as mothers and gives them other interests and avenues for personal fulfillment. Education provides women with greater family status and increased family respect for their views, and it makes it more likely that women will work outside the home, which often provides them with a greater sense of independence and greater control over resources. Education may also provide women with a greater sense of self-confidence and the willingness and ability to make reproductive decisions on their own, rather than according to what husbands or family members want. It may enhance communication with husbands. The present differential in education in much of the developing world experiencing high rates of population growth is striking. In South Asia between 1986 and 1989 there were only 73 enrolled females per 100 males, and in sub-Saharan Africa there were only 83 females per 100 males.(147) So strong is this link between the education of women and falling fertility rates that the World Bank estimated that if the educational status of men and women had been equalized thirty years ago, fertility levels today would be nearing the target of population stabilization. (148)
Increased education, of course, does not have a uniform effect on fertility rates across all population groups and all levels of society. There are also marked differences from one country to another. Moreover, small amounts of education appear to have little or even a positive effect on fertility rates. It appears that, in addition to the expansion of women's education, other conditions are necessary. The general status that women occupy within the society and within the family structure seems to be the crucial factor.(149) That is, the impact of education is greatest in societies where women are accorded the greatest equality with men, and where they have the greatest amount of personal autonomy over matters affecting their basic interests. Indeed, the two factors seem to work hand in hand: status allows women to obtain more education, and education brings status. Analysis of the status of women in various countries has tended to support this conclusion. For example, the status of women is higher in South and East Asian developing countries with the lowest rates of population growth than in neighboring countries with higher rates of population growth.(150) Examples include Singapore, Sri Lanka, Hong Kong, Thailand, and the Republic of Korea, as well as the Indian State of Kerala as compared to other Indian states.
Kerala,(151) Sri Lanka,(152) Thailand,(153) Taiwan, and the Republic of Korea(154) are particularly instructive given their proximity to India, Indonesia, and China, countries that have expended great energy in implementing restrictive population policies. Unlike their larger neighbors, these nations have been able to lower their fertility rates dramatically without, for the most part, resorting to wholesale coercive measures.(155) Indeed, Kerala is the only Indian state that has a fertility rate comparable to those of developed countries.(156) Moreover, Kerala and Sri Lanka have lowered their fertility rates without much increase in wealth.(157)
It is important to note that while improving the education and status of women is crucial to achieving a stable rate of population growth, other changes are necessary. Among these are the satisfaction of the basic needs of society--in particular health care, education, and social security, so that societies will not feel the need for large families to support them in old age.(158) All of the societies that have managed to lower fertility rates have made major strides in these areas. Another factor is making contraceptives available to those persons who desire to use them, as well as safe abortion services when contraception fails. Here the promoters of traditional population polices have been right. Studies consistently show that there are hundreds of millions of persons throughout the world who would like to limit their number of births but do not have effective means to do so other than relying on natural and traditional methods, such as the rhythm method, withdrawal, breast-feeding, and abstinence.(159) Further, the accessibility of contraceptives and the manner and context in which contraceptives are presented can make a significant difference in the willingness of acceptors to continue to use them.(160) Although there is disagreement over the extent to which the greater availability of modem forms of contraception and abortion has been responsible for lowered birth rates in the last few decades, such rates certainly would have been more difficult to achieve without such availability. Unless socioeconomic conditions are as desperate as those prevailing in Romania under the Government of President Ceausescu, people will find it difficult to limit births without contraceptives.(161)
Nonetheless, the importance of improving the education and status of women to this process is vital. While there is no ironclad assurance that adopting this approach will bring about the desired results, there is strong evidence that it will, stronger than the evidence supporting coercive measures. At the least, unlike many of the other measures that have been tried, such an approach will be promoting human rights rather than compromising them.
(1) United Nations, Department for Economic and Social Information and Policy Analysis, Population Division, World Population Prospects: The 1996 Revision, Population Newsletter, No. 62, 1, 1-3 (Dec. 1996).
(2) Lester R. Brown, The Acceleration of History, in State of the World 1996: A Worldwatch Institute Report on Progress Toward a Sustainable Society 3, 6-7 (Worldwatch Institute ed., 1996) [hereinafter State of the World 1996].
(4) Id. at 14-15.
(5) Id. at 5-7.
(6) Id. at 7-11.
(7) See generally id. at 12 (summarizing environmental problems worldwide); Garrett Hardin, Living within Limits: Ecology, Economics, and Population Taboos (1993).
(8) For less pessimistic views of the future of the environment, see Gregg Easterbrook, A Moment on the Earth: The Coming Age of Environmental Optimism (1995); Nathan Keyfitz & Kersten Lindahl-Kiessling, The World Population Debate: Urgency of the Problem, in Population--The Complex Reality: A Report of the Population Summit of the World's Scientific Academies 21 (Francis Graham-Smith ed., 1994); Atiq Rahman et al., Exploding the Population Myth: Consumption Versus Population: Which is the Climate Bomb? (1993); Human Population and the Environmental Crisis (Ben Zuckerman & David Jefferson eds., 1996); Janice Jiggins, Changing the Boundaries: Women-Centered Perspectives on Population and the Environment (1994) [hereinafter Changing the Boundaries]; Paul Demeny, Tradeoffs Between Human Numbers and Material Standards of Living, in Resources, Environment, and Population: Present Knowledge, Future Options 408 (Kingsley Davis & Mikhail S. Bernstam eds., 1991) [hereinafter Present Knowledge].
(9) State of the World 1996, supra note 2, at 12.
(10) United Nations, supra note 1, at 1.
(12) See State of the World 1996, supra note 2, at 15. For an optimistic view of the growth of alternative energy sources, see generally Amory B. Lovins, Energy, People, and Industrialization, in Present Knowledge, supra note 8, at 95-124.
(13) For a discussion of the causes of the "world food problem," see Changing the Boundaries, supra note 8, at 65-82.
(14) See John Bongaarts, Population Pressure and the Food Supply System in the Developing World, 22 Population and Dev. Rev. 483, 498-99 (1996); World Agriculture: An FAO Study (Nikos Alexandratos ed., 1995); see generally Vaclav Smil, How Many People Can the Earth Feed, 20 Population and Dev. Rev. 255 (1994).
(15) See United Nations, supra note 1, at 3. For estimates on the low side, see generally The Future Population of the World. What Can We Assume Today? (Wolfgang Lutz ed., 1996).
(16) See Paul Streeten, Population Stabilizes, Economic Growth Continues? A Review Essay on Richard Easterlin's Growth Triumphant: The Twenty-First Century in Historical Perspective, 22 Population and Dev. Rev. 773, 774-80 (1996).
(17) One of the most forceful proponents of this view is Julian Simon. See The State of Humanity 7 (Julian Simon et a]. eds., 1995); Julian Simon, The Ultimate Resource 2 (1996) [hereinafter The Ultimate Resource].
(18) See John Atcheson, The Department of Risk Reduction or Risky Business, 21 Envtl. L. 1375, 1405 (1991) (discussing the concept of carrying capacity).
(19) See The Ultimate Resource, supra, note 17, at 109-26.
(20) See generally United Nations Population Fund, Population, Resources and the Environment: The Critical Challenges (1991) (discussing the linkage between the environment and population).
(21) See Paul Ehrlich, The Population Bomb at xi-xii (1968); Garrett Hardin, The Tragedy of the Commons, in Population Crisis--An Interdisciplinary Perspective 197 (Sue Titus Reid & David L. Lyon eds., 1972); Martha Kent Willing, Beyond Conception: Our Children's Children 161 (1971). Due to increasing evidence of the ineffectiveness of such measures and their detrimental effect on the health of women, some of the proponents of more drastic "population control" have muted their calls for coercion in recent years.
(22) See Paul Demeny, Policies Seeking a Reduction of High Fertility: A Case For the Demand Side, 18 Population and Dev. Rev. 323, 332 (1992) (discussing the interrelations between two major parts of the population solution, so called "supply" and "demand," i.e. making contraception available and bringing about changes that create a greater demand for contraception).
(23) See generally 24 Population Reports (1996) (discussing the "unmet need" for contraception in detail); Ruth Dixon-Mueller & Adrienne Germain, Stalking the Elusive `Unmet Need' for Family Planning, 23 Stud. in Fam. Plan. 330, 330-35 (1992) (analyzing unmet need); Lant H. Prichett, Desired Fertility and the Impact of Population Policies, 20 Population and Dev. Rev. 1, 29 (1994) (critiquing the concept of "unmet need").
(24) See Henry P. David, Abortion in Europe, 1920-91: A Public Health, Perspective, 23 Stud. in Fam. Plan. 1, 22 (1992) (generally discussing this policy); Reed Boland, Recent Developments in Abortion Law in Industrialized Countries, 18 Law, Med. & Health Care 404, 406-18 (1990).
(25) See H. Pain, Romanians' Health Another Victim of Ceausescu, The Reuter Library Report, Feb. 1, 1990, available in LEXIS, News Library.
(26) Henry Kamm, Cold Days Are Back in Romania, N. Y. TIMES, Jan. 4, 1987, at A3, available in LEXIS, News Library; Nick Sedan, Diversions: 1984 Is For Real in Transylvania, Fin. Times, Dec. 3, 1988, at xvi, available in LEXIS, News Library.
(27) Infant Deaths and Infant Mortality Rates by Urban\Rural Residence: 1983-1987, 1987 U.N. Demographic Yearbook 384, 385-87; see also Charlotte Hord et al., Reproductive Health in Romania: Reversing the Ceausescu Legacy, 22 Stud. in Fam. Plan. 23140 (1991); Patricia Stephenson et al., The Public Health Consequences of Restricted Induced Abortion-Lessons from Romania, 82 Am. J. of Pub. Health 1328 (1992).
(28) 1995 U.N. Demographic Yearbook 370 (1997). In 1994, 530,191 abortions were performed legally in Romania--more than three times the number performed in the United Kingdom, the European country where the next highest number of abortions was performed (excluding the Russian Federation).
(30) See Peter J. Donaldson, Nature Against Us: The United States and the World Population Crisis 1965-1980, at 113 (1990); Ruth Dixon-Mueller, Population Policy & Women's Rights: Transforming Reproductive Choice 79 (1993); Gita Sen et aL, Reconsidering Population Policies: Ethics, Development, and Strategies for Change, in Population Policies Reconsidered: Health, Empowerment, and Rights 3 (Gita Sen et al. eds., 1994) [hereinafter Population Policies Reconsidered]; Adrienne Germain et al., Setting a New Agenda: Sexual and Reproductive Health and Rights, in Population Policies Reconsidered, supra at 27; see generally Oscar Harkavy, Curbing Population Growth: An Insider's Perspective on the Population Movement (1995); Betsy Hartmann, Reproductive Rights and Wrongs: The Global Politics of Population Control & Contraceptive Choice (1987).
(31) D. Banjerli, Political Economy of Population Control in India, in Poverty and Population Control 83 (L. Bonderstam & S. Bergstrom eds., 1980); R. Ledbetter, Thirty Years of Family Planning in India, 24 Asian Surv. 736, 736-37 (1984) (discussing India's early realization that post-World War II modernization and economic growth would result in population increases and the need for a national population control policy); see generally Harkavy, supra note 30, at 129-59 (discussing numerous programs and approaches to addressing India's population concerns, including the Indian government's program and the influence of external organizations such as the Ford Foundation).
(32) For a report of the Indian Government's inquiry into activities in the state of Uttar Pradesh during this period, see Shah Commission of Inquiry, Ministry of Home Affairs Third and Final Report (1978).
(33) Id. at 195.
(34) S.G. Kabra & Ramji Narayanan, Sterilization Camps in India, Vol. 336, Lancet 224, 224-25 (1990); Harbans Singh, India's High Fertility Despite Family Planning: An Appraisal, in Population Policy: Contemporary Issues 121, 129 (Godfrey Roberts ed., 1990); cf, Harkavy, supra note 30, at 158 (explaining the organization, operation, and funding structure of India's sterilization camps).
(35) See A.M. Basu, Family Planning and the Emergency: An Unanticipated Consequence, 20 Econ, and Pol. Wkly. 422, 422-25 (1985).
(36) For a history of this policy, see Wang Hong, Vie Population Policy of China, in Population and Dev. Plan. in China 42 (Wang Jiye & Terence H. Hull eds., 1991); Terence H. Hull & Quanhe Yang, Fertility and Family Planning, in Population and Dev. Plan. in China 163, 175-87 (Wang Jiye et al. eds., 1991); Tyrene White, Two Kinds of Production: The Evolution of China's Family Planning Policy in the 1980s, in The New Politics of Population: Conflict and Consensus in Fam. Plan. 137 (Jason L. Finkle & C. Alison McIntosh eds., 1994) [hereinafter Two Kinds of Production]; Peng Xizhe, Demographic Transition in China: Fertility Trends Since The 1950s 16-61 (1991); Wang Feng, A Decade of the One-Child Policy: Achievements and Implications, in China: The Many Facets of Demographic Change 97 (Alice Goldstein & Wang Feng eds., 1996).
(37) See Judith Banister, China's Changing Population 192-215 (1987); John Aird, Slaughter of the Innocents (1990); Tyrene White, Post-Revolutionary Mobilization in China: The One-Child Policy Reconsidered, 43 World Pol. 53, 59-76 (1990) [hereinafter Post Revolutionary Mobilization]; Tyrene White, The Population Factor: China's Family Planning Policy in the 1990s, in China Briefing 97, 102-06 (William J. Joseph ed., 1991) [hereinafter The Population Factor]; Two Kinds of Production, supra note 36, at 145-48.
(38) See Susan Greenhalgh et al., Restraining Population Growth in Three Chinese Villages, 1988-93, 20 Population and Dev. Rev. 365, 386-87 (1994); Nicholas D. Kristof, China's Crackdown on Births: A Stunning, and Harsh Success, N.Y. Times, Apr. 25, 1993, at A1.
(39) Two Kinds of Production, supra note 36, at 145.
(40) See id.; Hull & Yang, supra note 36, at 180; Greenhalgh, supra note 38, at 365.
(41) See Kristof, supra note 38, at A1.
(42) Despite the use of incentives and disincentives for decades, no consensus exists as to whether they actually work. See John A. Ross & Stephen L. Isaacs, Costs, Payments, and Incentives in Family Planning Programs: A Review for Developing Countries, 19 Stud. in Fam. Plan. 271, 282-83 (1988).
(43) I. Ceterchi et al., Law and Population Growth in Romania 118, 243-44 (1974).
(44) See Banjerli, supra note 31, at 90-94; Ledbetter, supra note 31, at 748.
(45) See Harkavy, supra note 30, at 155-57; Singh, supra note 34, at 129; Kabra & Narayana, supra note 34, at 224-25; see also A. Guha, Population Programs: The National Scene, in Corporate Sector and Family Welfare Problems in India (B. Sengupta et. al. eds., 1990); G. Narayana, & John F. Kantner, Doing The Needful: The Dilemma of India's Population Policy 107-08 (1992).
(46) See Aird, supra note 37, at 16-19; Banister, supra note 37, at 184-86; H. Yuan Tien, China's Strategic Demographic Initiative 92-97 (1991); Xizhe, supra note 36, at 25; Susan Greenhalgh, The Peasantization of the One-Child Policy in Shaanxi, in Chinese Families in the Post-Mao Era 219, 239-40 (Deborah David & Stevan Harrell eds., 1993); Jiali Li, China's One-Child Policy: How and How Well Has It Worked? A Case Study of Hebei Province, 1979-1988, 21 Population and Dev. Rev. 563-65 (1995); The Population Factor, supra note 37, at 102.
(47) See Central Committee of the Communist Party of China and The State Council, Resolution on the Strengthening of the Family Planning Work and the Strict Controlling of Population Growth (1991), in 1992 Family Planning Yearbook of China (1992), cited in Tu Ping, IUD Discontinuation Patterns and Correlates in Four Counties in North China, 26 Stud. in Fam. Plan. 169, 170-79 (1995).
(48) Banister, supra note 37, at 194.
(49) Id. at 197-99.
(50) See Daniel M. Goodkind, Vietnam's One-or-Two Child Policy in Action, 21 Population and Dev. Rev. 85, 111 (1995).
(51) See Changing the Boundaries, supra note 8, at 164-73; John Cleland & W. Parker Mauldin, The Promotion of Family Planning By Financial Payments: The Case of Bangladesh, 22 Stud. in Fam. Plan. 1, 3-18 (1991).
(52) See Aird. supra note 37, at 12; Banister, supra note 37, at 200-03.
(53) Auto, supra note 37, at 12.
(54) See Ping, supra note 47, at 170; see also Herbei Issues Detailed Family Planning Rules, F.B.I.S., CHI-96-027, Feb. 8, 1996, at 61, 63.
(55) See Arthur Caplan, The Norplant Safaris: Birth Control Implant Leads To Population Control By Governments, Seattle Times, July 7, 1991, at A13, available in 1992 WL 4467335; Leah Makabenta, Indonesia: Population Success Story Has Shady Side, Inter Press Service, Nov. 2, 1992, available in 1991 WL 2485159; David Todd, Expert Sounds Alarm On Indonesian Birth-Control Program, Montreal Gazette, Nov. 22, 1991, at A1, available in 1991 WL 8571710. For a discussion of the pressure used in the Indonesian family planning program, see also Terence H. Hull & Valerie Johnson Hull, Politics, Culture, and Fertility: Transitions in Indonesia, Revised Paper for the John Caldwell Seminar on "The Continuing Fertility Transition," cited in Ronald Freedman, Do Family Planning Programs Affect Fertility Preferences? A Literature Review 28 Stud. in Fam. Plan. 1, 10 (1997).
(56) Donald Warwick, The Ethics of Population Control, in Population Policy: Contemporary Issues 21, 29-31 (Godfrey Roberts ed., 1990). Although more difficult to verify, there have been reports of much more overt coercion in the Indonesian population policy. See Benjamin White, Indonesia's Population Problems and Policies, in Dev. and Social Welfare: Indonesia's Experiences under the New Order 105-13 (Leiden ed., 1993); Wardah Hafidz, Poverties Beyond Economics, in Development and Social Welfare: Indonesia's Experiences under the New Order 219-22 (Frans Leiden ed., 1993).
(57) See Power and Decision: The Social Control of Reproduction, Harvard Center for Population and Dev. Stud. 153 (Gita Sen & Rachel C. Snow eds., 1994).
(58) Depo-Provera is a hormonal contraceptive administered by means of injection and is effective for three months. See Daniel T. Earl & Daniel J. David, Depo-Provera: An Injectable Contraceptive, Am. Fam. Physician, Mar. 1994, at 891; Richard Stone, Controversial Contraceptive Wins Approval From FDA Panel, Science, June 26, 1992, at 1754. Norplant is a hormonal contraceptive which is introduced into the body by means of six tubes implanted in the upper arm and prevents pregnancy at an almost one-hundred percent rate of effectiveness for five years. See The Norplant System Approved as New Contraceptive Implant, FDA Medical Bulletin May. 1991, available in LEXIS, News Library; Board of Trustees, American Medical Association, Requirements Or Incentives By Government For the Use of Long-Acting Contraceptives, 267 JAMA 1818 (1992); Ann P. McCauley & Judith S. Geller, Decisions for Norplant Programs: Surgically Implanted Contraceptive, Population REP., Nov. 1992, at 1. Antifertility vaccines work by temporarily interfering with the body's self-tolerance. They do this by encouraging an auto-immune attack on the cells involved in one of three basic reproductive processes: 1) production and/or maturation of human gametes, 2) fertilization, or 3) implantation and/or development of the early embryo. See Judith Richter, Beyond Control: About Antifertility `Vaccines,' Pregnancy Epidemics, and Abuse, in Power and Decision: The Social Control of Reproduction 205, 207 (Gita Sen et al. eds., 1994) (describing the drawbacks and uncertainties of antifertility vaccines).
(59) Earl & David, supra note 58, at 891.
(60) See Makabenta, supra note 55.
(61) Todd, supra note 55, at A1.
(62) H. Kasidi & P. Miller, Indonesia, National Family Planning Coordinating Board and the Population Council, Norplant Use Dynamics Diagnostics (1992). The government of Indonesia has stated that it intends to correct many of the abuses connected with Norplant. See Sonia Correa, Norplant In The Nineties: Realities, Dilemmas, Missing Pieces, in Power and Decision: The Social Control of Reproduction 207, 208-309 (Gita Sen et al., eds., 1994); see also S. Ward et al., Population Council, Service Delivery Systems and Quality of Care in Implantation of NORPLANT (1990).
(63) Similar problems, although on a much smaller scale, have been reported in a field experiment using Norplant that was carried out in four provinces of Northern China. See Tu Ping et al., Acceptance, Efficacy, and Side Effects of Norplant Implants in Four Counties in North China, 28 Stud. in Fam. Plan. 122, 131 (1997); see also Ruth Simmons et al., The Strategic Approach to Contraceptive Introduction, 28 Stud. in Fam. Plan. 79, 81-94 (1997) (discussing general difficulties in introducing new reproductive technology in developing countries and possible changes).
(64) See Yagyi B. Karki, Sex Preference and the Value of Sons and Daughters In Nepal, 19 Stud. in Fam. Plan. 169-78 (1988) (discussing son preference in Nepal); Jonathan Haughton & Dominique Haughton, Son Preference In Vietnam, 26 Stud. in Fam. Plan. 325-37 (1995) (discussing son preference in Vietnam); Yi Zeng et al., Causes and Implications of the Recent Increase in the Sex Ratio at Birth in China, 19 Population and Dev. Rev. 283-302 (1995) (discussing son preference in China); Mamta Murthi et al., Mortality, Fertility, and Gender Bias in India: A District-Level Analysis, 21 Population and Dev. Rev. 745-46 (1995) (discussing son preference in India); Women's Health in India: Risk and Vulnerability (Monica Das Gupta et al. eds., 1995).
(65) See Greenhalgh et al., supra note 38, at 382; Chai Bin Park & Nam-Hoon Cho, Consequences of Son Preference in a Low-Fertility Society: Imbalance of the Sex Ratio at Birth in Korea, 21 Population and Dev. Rev. 59, 70-84 (1995); Mizanur Rahman & Julie DaVanzo, Gender Preference and Birth Spacing in Matlab, Bangladesh, 30 Demography 315, 321-32 (1993).
(66) Kay Johnson, The Politics of the Revival of Infant Abandonment in China, With Special Reference to Hunan, 22 Population and Dev. Rev. 77, 87-98 (1993); Terence Hull, Recent Trends in Sex Ratios at Birth in China, 16 Population and Dev. Rev. 63, 71-83 (1990); Ansley J. Coale & Judith Banister, Four Decades of Missing Females in China, 31 Demography 459, 465-80 (1994); Park & Cho, supra note 65, at 59-84.
(67) See Francis E. Kobrin & Robert G. Potter, Jr., Sex Selection Through Amniocentesis and Selective Abortion, in Sex Selection of Children 47 (Neil G. Bennett ed., 1983).
(68) See Park & Cho, supra note 65, at 114.
(69) UNICEF, The Progress of Indian States 57 (1995).
(70) See Park & Cho, supra note 65, at 114.
(71) See Daniel Goodkind, On Substituting Sex Preference Strategies in East Asia: Does Prenatal Sex Selection Reduce Postnatal Discrimination, 22 Population and Dev. Rev. 111, 113-14 (1996); Park & Cho, supra note 65, at 114.
(72) The Progress of Indian States, supra note 69, at 57.
(73) Amartya Sen, More Than 100 Million Women Are Missing, 37 N. Y. Times Rev. of Books 20, 61 (1990).
(74) Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act of 1994, Act No. 57 (India).
(75) See Presidential Decree Promulgating the Law of the People's Republic of China on the Protection of Maternal and Child Health, Decree No. 33 (Oct. 27, 1994), translated in 46 Int'l Digest of Health Legislation 39, 39-42 (1995).
(76) See Hong, supra note 36, at 52.
(77) See J. John Palen, Population Policy: Singapore, in Population Policy: Contemporary Issues 167-78 (Godfrey Roberts ed., 1990).
(78) See John C. Caldwell & Pat Caldwell, The South African Fertility Decline, 19 Population and Dev. Rev. 225, 262-66 (1993).
(79) See Emma Franks, Women and Resistance in East Timor: `The Centre, As They Say, Knows Itself By the Margins,' 19 Women's Stud. Int'l. F. 155-69 (1996) (charging that the government of Indonesia is attempting to dilute the indigenous population of East Timor in two ways: 1) by the large-scale transmigration of Indonesian citizens to East Timor, and 2) by promoting permanent contraceptive methods among the indigenous population).
(80) Mother-Child Health Act (Korea) (1986), translated in Current Laws of the Republic of Korea, at 3456(1)-(7).
(81) Law on Population, Development and Prosperous Family (1992), translated in 19 Ann. REV. of Population L. 181, 185 (1992).
(82) See Eugenic Protection Act, [sections] 105 (amended June 26, 1996) (Japan), summarized in 13 Ritsumeikan L. Rev., 192, 192 (1997).
(84) See Rajiv Chandra, China-Population: Unhealthy People Can't Be Parents, Inter Press Service, Nov. 3, 1994, available in Lexis, News Library.
(85) Presidential Decree Promulgating the Law of the People's Republic of China on the Protection of Maternal and Child Health, Decree No. 33 (Oct. 27, 1994), translated in 46 Int'l Digest of Health Legislation 39, 39-42 (1995).
(86) Id. at 40.
(88) See Chinese Parliament to Study Euthanasia, Agence France Presse, Mar. 15, 1995, available in LEXIS, News Library.
(90) See Mure Dickie, China Doctors Call For Euthanasia Law Soon, Reuters North American Wire, Mar. 14, 1996, available in LEXIS, News Library; see also China Legislators Make Fresh Attempt To Legalise Euthanasia, Agence France Presse, Mar. 14, 1996, available in LEXIS, News Library.
(91) See Nick Rufford, Euthanasia Fears For Old in China, Sunday Times (London), Apr. 21, 1996, available in LEXIS, News Library; Maggie Farley, Chinese Doctor Fights For Right of Terminally Ill To Die, L. A. Times, July 14, 1996, at A4. One part of the Government's strategy appears to be releasing polls indicating that 80% of the population in three large cities favors such a law. Id.
(92) Farley, supra note 91, at A4.
(93) See Rong Zhigang & Cheng Liankong, Population Aging and Social Security, in Population and Dev. Plan, in China 277-78 (Wang Jiye et al. eds., 1991).
(94) Id. at 283.
(95) Many Western industrialized countries (and Japan) are already familiar with this issue. The problem in Western industrialized countries, however, will be dwarfed by those of many of the recently industrialized countries of Asia. See Aging in East and South-East Asia (David R. Phillips ed., 1992). The lowering of birthrates to replacement level has occurred within the span of several decades, rather than a century, which has led to historically unprecedented age imbalances. Countries such as Singapore, Taiwan, and most recently, the Republic of Korea are experiencing great anxiety over this problem. Concerned about a deficit in the number of educated workers needed to keep their economies operating at full power, they have moved from antinatalist policies to pro-natalist policies. Freedman, supra note 55, at 328.
(96) See Two Kinds of Production, supra note 36, at 137.
(97) See David, supra note 24, at 20.
(98) The Maharashtra Family Act (1976), reprinted in 3 Ann. Rev. of Population L. 29 (1976).
(99) See Constitution of the People's Republic of China, art. 49 (Albert P. Blauenstein & Gisbert H. Flanz; eds., 1992). The other country is Vietnam. See Constitution of the Social 1st Republic of Vietnam, reprinted in United Nations Population Fund, 19 Annual Review of Population Law 228 (1992).
(100) See Karen Hardee-Cleaveland & Judith Banister, Fertility Policy and Implementation in China, in 14 Population and Dev. Rev. 245, 270-86 (1988) (summarizing laws from the mid-1980s).
(101) See Henan Provincial Rules and Regulations on Family Planning, Apr. 12, 1990, translated in Foreign Broadcast Information Service, F.B.I.S.-CHI-90-106, June 1, 1990; Sichuan Family Planning Regulations, July 2, 1987, translated in Joint Publications Research Service, JPRS-CHI-87-044, Sept. 8, 1990. There is some evidence that Vietnam may be heading down the same path as China. Vietnam's Law on Marriage and the Family, enacted on Dec. 29, 1986, requires that couples produce children in accordance with a plan, (Article 2) and that Spouses have the duty to implement planned parenthood together (Article 11). See Joint Publications Research Service, SEA-87-085, June 1, 1987. Decision No. 162 concerning a Number of Population and Family Planning Policies, approved in January 1989 by Vietnam's Council of Ministers, provides that practicing family planning is the responsibility of all society. Article 1 sets a limits of two on the number of children that certain groups are allowed to have, and establishes incentives. See Joint Publications Research Service, JPRS-SEA-89-007, Feb. 8, 1989. Vietnam has also enacted legislation prohibiting the unauthorized removal of IUDs. See Regulations on Medical Examinations, Treatment, and Functional Rehabilitation, translated in 44 Int'l Digest of Health Legislation 8 (1993).
(102) See Freedman, supra note 55, at 11 (concluding that even in China the evidence is far from conclusive that family planning programs affect fertility preferences).
(103) See supra notes 24-29 and accompanying text.
(105) See Singh, supra note 34, at 130. The birth rate was 34.5 births per 1000 people in 1974-1975 and 33.9 in 1984-1985. By 1994, the birth rate had fallen to 28.6 per 1000 people. See 1995 Demographic Yearbook, supra note 28, at 324.
(106) The percentages of population increase for the three decades ending 1971, 1981, and 1991 over the previous decades, are respectively 24.8%, 24.7%, and 23.9%, while the total fertility rate during this period dropped from 5.2 to 3.6 children per family. International Institute for Population Sciences, National Family Health Survey (MCH and Fam. Plan.) India 1992-93 17 (1995).
(107) Harkavy, supra note 30, at 157-58.
(108) 1995 Demographic Yearbook, supra, note 105, at 132-37.
(109) See Jiali Li, supra note 46, at 565; Greenhalgh et al., supra note 38, at 366; Carol A. Scotese, Can Government Enforcement Permanently Alter Fertility? The Case of China, 33 Econ. Inquiry 552-70 (1995) (arguing that a severely coercive program can bring about short-term changes in fertility, but not long-term decline).
(110) See Peng Yu, China's Experience in Population Matters: An Official Statement, in 20 Population and Dev. Rev. 488 (1994) (discussing demographic dimensions of China's population problems).
(111) According to data published by the Chinese Government, the population was greater than 1.2 billion by 1996. See Central Intelligence Agency, World Factbook 88 (1995).
(112) See Jiali Li, supra note 46, at 564; see also PRC: Difficulties of Enforcing Rural Family Planning Regulations, F.B.I.S., CHI-96-202, Oct. 18, 1996.
(113) See Karen Hardee-Cleaveland & Judith Banister, Fertility Policy and Implementation in China, 14 Population and Dev. Rev. 245 (1988); Susan Greenhalgh, Shifts in China's Population Policy, 1984-86: Views From the Central, Provincial, and Local Levels, 12 Population and Dev. Rev. 491 (1986).
(114) Terence H. Hull & Quanhe Yang, Fertility and Family Planning, in Population and Dev. Planning in China 163, 175-87 (Wang Jiye et al. eds., 1991); Martin K. Whyte & William L. Parish, Urban Life in Contemporary China (1984); Feng, supra note 36, at 98.
(115) Some commentators have suggested non-coercive methods for achieving lowered population growth in China. See D. Gale Johnson, Effects of Institutions and Policies on Rural Population Growth With Application to China, 20 Population and Dev. Rev. 503, 526-27 (1994) (setting forth a policy of changes in the system of land reallocation so as not to take into consideration family size, elimination of restrictions on rural-urban migration, strengthening of the social security system, and increasing the education of rural youth, particularly girls).
(116) See Feng, supra note 36, at 96. Since the tightening of enforcement of the one-child policy in the early 1990s, however, the Government has claimed that total fertility rates have fallen to 1.9 children per woman. There are some doubts that this figure is accurate, given evidence of underreporting. Nonetheless, even with underreporting taken into consideration, there seems to have been a drop to 2.1 or 2.2 children per woman. Some of this has been attributed to increased enforcement. Whether the rate can be maintained is unclear. See John Bongaarts & Susan Greenhalgh, An Alternative to the One-Child Policy in China, 11 Population and Dev. Rev. 585 (1988).
(117) See Reed Boland et al., Honoring Human Rights in Population Policies: From Declarations to Action, in Population Policies Reconsidered, supra note 30, at 89.
(118) See Dixon-Mueller, supra note 30, at 5-20; Sonia Correa, Population and Reproductive Rights, Feminist Perspectives from the South 56-97 (1994); Lynn P. Freedman & Stephen L. Isaacs, Human Rights and Reproductive Choice, 24 Stud. in Fam. Plan. 18, 20-30 (1993); Sonia Correa & Rosalind Petchesky, Reproductive and Sexual Rights: A Feminist Perspective, in Population Policies Reconsidered, supra note 30, at 107 (discussing history of reproductive lights in the context of human rights thinking).
(119) Richard L. Siegal, Socioeconomic Human Rights: Past and Future, 7 Hum. Rts. Q. 250, 255 (1985); see generally Arthur H. Robertson & John G. Merrills, Human Rights in the World (1989) (discussing sources of social and economic rights in modern human rights instruments).
(120) Charlotte Bunch, Human Rights As Human Rights: Toward a Re-Vision of Human Rights, 12 Hum. Rts. Q. 486, 488 (1990); see generally Karen Engle, International Human Rights and Feminism: When Discourses Meet, 13 Mich. J. Int'l L. 517 (1992) (discussing how women's rights fit into the sphere of human rights).
(121) See generally Conference on the International Protection of Reproductive Rights, 44 Am. U. L. Rev. 963 (1995) (collecting current scholarship regarding population, reproduction, and human rights in the international arena).
(122) International Covenant on Civil and Political Rights, GA Res. 2200 (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, 3 U.N. Doe. A/6316 (1967).
(125) Convention on the Elimination of All Forms of Discrimination Against Women, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1981) [hereinafter Convention on the Elimination on All Forms of Discrimination Against Women).
(126) Multilateral Treaties Deposited with the Secretary-General: Status as of 31 December 1995, (visited Sept. 23, 1997) <http://www.un.org/ Depts/Treaty>.
(127) Convention on the Elimination on All Forms of Discrimination Against Women, supra note 125, at 193.
(128) Final Act of the International Conference on Human Rights, International Conference on Human Rights, GA Res. IX, U.N. GAOR, 22nd Sess., U.N. Doc. A/CONF.32/41 (1968).
(129) World Population Plan of Action, United Nations World Population Conference, U.N. Doc. E/CONF.76/BP/1 (1984); Recommendations for Further Implementation of the World Population Plan of Action, in Report of the International Conference on Population, U.N. Doc. E/CONF.76/19 (1984); Programme of Action of the International Conference on Population and Development, in Report of the International Conference on Population and Development, U.N. Doc. A/CONF.171/13/Add. 1, Sales No. 95.XIII.18 (1995).
(130) See generally Reed Boland et al., Honoring Human Rights in Population Policies: From Declarations to Action, in Population Policies Reconsidered, supra note 30, at 89.
(131) See Stephen L. Issacs, Incentives, Population Policy, and Reproductive Rights: Ethical Issues, 26 Stud. in Fam. Plan. 363, 367 (1995).
(132) See I.R.C. [sections] 1(h) (1997) (granting favorable treatment for capital gains, thereby creating an incentive to investment).
(133) White Paper on Human Rights in China, Xinhua General Overseas News Service, Nov. 2, 1991, available in LEXIS, News Library.
(134) See Streeten, supra note 16, at 776.
(135) See supra notes 102-13 and accompanying text.
(136) See Keyfitz & Lindahl-Kiessling, supra note 8, at 3940.
(137) Simon Szreter, The Idea of Demographic Transition: A Critical Intellectual History, 19 Population and Dev. Rev. 659, 659-93 (1993) (reviewing the concept of demographic transition in detail); Klaus M. Leisinger & Karin Schmitt, All Our People: Population Policy with a Human Face 98-115 (1994) [hereinafter All Our People]. For discussion of the demographic transition and its limitations, see John Cleland, Different Pathways To Demographic Transition, in Population-The Complex Reality 229, 229-48 (Graham et a]. eds., 1994); Peter McDonald, Fertility Transition Hypothesis, in The Revolution in Asian Fertility: Dimensions, Causes, and Implications 3, 3-14 (Richard Leete et a]. eds., 1993) [hereinafter The Revolution in AsiaN Fertility]; John C. Caldwell, The Asian Fertility Revolution: Its Implications For Transition Theories, in The Revolution in Asian Fertility, supra at 299, 299-316; Loraine Donaldson, Fertility Transition: The Social Dynamics of Population Change (1991); Richard Leete, Malaysia's Demographic Transition: Rapid Development, Culture, and Politics 30-40 (1996).
(138) See generally Paul Demeny, Policies Seeking a Reduction of High Fertility: A Case Study For the Demand Side, 18 Population and Dev. Rev. 323, 323-32 (1992) (discussing elements that create a desire for smaller families).
(139) For a dissent to the view that there are social and economic imperatives to have many children, see John Cleland, Equity, Security, and Fertility: A Reaction to Thomas, 47 Population Stud. 345, 345-59 (1993).
(140) See All Our People, supra note 137, at 114.
(141) For a discussion of limitations in the theory of demographic transition with respect to India, see Murthi ET AL., supra note 64, at 746. See also Malcolm Potts, Sex and the Birth Rate: Human Biology, Demographic Change, and Access to Fertility Regulation, 23 Population and Dev. Rev. 1, 21 (1997); John Bongaarts & Susan Cotts Watkins, Social Interactions and Contemporary Fertility Transitions, 22 Population and Dev. Rev. 638, 639-82 (1996).
(142) See Keyfitz & Lindahl-Kiesserling, supra note 8, at 27.
(143) See Teresa Castro Martin, Women's Education and Fertility: Results From 26 Demographic and Health Surveys, 26 Stud. in Fam. Plan. 187 (1995); see generally Shireen J. Jejeebhoy, Women's Education, Autonomy, and Reproductive Behaviour: Experiences from Developing Countries (1995) (discussing the benefits of educating women); Women's Position and Demographic Change (Nora Federici et al. eds., 1995). For a discussion of other benefits produced by educating women, see Women's Education in Developing Countries: Barriers, Benefits, and politics (Elizabeth M. King & M. Anne Hill eds., 1993).
(144) United Nations, Department of International Economics and Social Affairs, Fertility Behavior in the Context of Development: Evidence from The World Fertility Survey 7 (1987) [hereinafter Fertility Behavior].
(145) See Jejeebhoy, supra note 143, at 97.
(146) See Fertility Behavior, supra note 144.
(147) See Jejeebhoy supra note 143, at 6. These figures are calculated from ratios provided in United Nations Children's Fund, The State of the World's Children 1992 (1992).
(148) See World Bank, The World Bank and the Environment 81-84 (1993). Opinion is by no means unanimous as to the value of improving women's education and status as means of lowering fertility rate. See Geoffrey McNicoll, Book Review, 20 Population and Dev. Rev. 656, 659-61 (1994) (reviewing Laurie A. Mazur, Beyond the Numbers: A Reader on Population, Consumption, and the Environment 1993); The Politics of Women's Education: Perspective from Asia, Africa, and Latin America (Jill K. Conway & Susan C. Bourque eds., 1993); John Knodel & Gavin W. Jones, Post-Cairo Policy: Does Promoting Girls' Schooling Miss the Mark, 22 Population and Dev. Rev. 683, 690-702 (1996). A complex and not always uniform relationship between the two is analyzed in Girl's Schoolings Women's Autonomy and Fertility Change in South Asia (Roger Jeffrey & Alaka M. Basu. eds., 1996) [hereinafter Girl's Schooling].
(149) See Jejeebhoy supra note 143, at 177-88; see also Simeen Mahmud & Anne M. Johnston, Women's Status, Empowerment, and Reproductive Outcomes, in Population Policies Reconsidered, supra note 30, at 151-59.
(150) See United nations Development Programme, Human Dev. Report 1996 at 33-37 (1996). Hong Kong, Singapore, the Republic of Korea, Thailand, and Sri Lanka are ranked 25th, 29th, 31st, 33rd, and 62nd respectively, while Myanmar, India, Pakistan, Bangladesh, and Nepal are ranked 102nd, 103rd, 107th, 116th, and 124th respectively on an index of gender disparity ranking 137 countries. China and Indonesia are ranked 76th and 79th, respectively. Within India, Kerala, the state with the lowest rate of population growth ranks highest, equivalent to 80 on the country scale, while Indian states with high rates of population growth rank lowest, equivalent to approximately 123rd. Id.
(151) See Richard W. Franke & Barbara H. Chasin, Kerala, Development Through Radical Reform (2d ed. 1994).
(152) See Iqbal Alam & Richard Leete, Pauses in Fertility Trends in Sri Lanka and the Philippines?, in The Revolution in Asian Fertility supra note 137, at 83; Bruce Caldwell, Female Education, Autonomy and Fertility in Sri Lanka, in Girl's Schooling, supra note 148, at 288-321.
(153) See John Knodel et al., Thailand's Reproductive Revolution: Rapid Fertility Decline in a Third-World Setting (1987).
(154) See Johnson, supra note 115, at 515-16.
(155) Id. It should be noted that a number of these countries relied on incentives in their family planning programs. Moreover, sterilization camps were a feature of Kerala's early population program.
(156) The total fertility rate in 1992 was 1.7 children per couple. The State of Tamil Nadu was not far behind, with a total fertility rate of 2.2. See Progress of Indian States, supra note 69, at 36.
(157) See Human development Report, supra note 150, at 81.
(158) See All Our People, supra note 137, at 192-93; Amartya Sen, Population: Delusion and Reality, 41 N. Y. Times Rev. of Books 1, 1-8 (1994). Satisfaction of basic needs appears to account for low fertility rates in Kerala and Sri Lanka, despite little increase of wealth.
(159) For a current presentation of this argument, see Potts, supra note 141, at 21; Population and Development: Old Debates, New Conclusions (Robert Cassen ed., 1994). Some observers believe that providing access to modem contraceptives accounts for a relatively small part of the decrease in fertility rates. See Prichett, supra note 23, at 29. For a rebuttal, see James C. Knowles et al., The Impact of Population Policies: Comment, 20 Population and Dev. Rev. 611, 625-30 (1994). See also, Keyfitz & Lindahl-Kiessling, supra note 8, at 29; Freedman, supra note 55, at 10-11. Freedman takes a cautious approach, commenting that family planning programs sometimes do not effect preferences but do help to crystallize late demand and noting that direct studies on the impact of programs on fertility preferences have not been done.
(160) See Siti Pariani et al., Does Contraceptive Choice Make a Difference to Contraceptive Use? Evidence From East Java, 22 Stud. In Fam. Plan. 384, 384-90 (1991); Ruth Simmons & Christopher Elias, The Study of Client-Provider Interactions: A Review of Methodological Issues, 25 Stud. In Fam. Plan. 1, 1-17 (1994).
(161) Such conditions may be largely responsible for the drop in birthrates that has occurred in parts of Eastern Europe since the fall of most of the Communist regimes.