Will the circle be unbroken?

Everyone has the right to life, liberty and the security of person.

- Universal Declaration of Human Rights, Article 3

The demographic transition which has been under way in the developing countries since the middle of the twentieth century has shown much difference, both in its course and in the factors behind it, from the transition which started two centuries ago in countries that are now developed.

In the developed countries, the gradual improvement in living conditions accompanying industrialization and urbanization, coupled with broadening education and sanitation and a growing understanding of the principle of hygiene and nutrition, resulted in progressive gains in child survival and declines in mortality at all ages. These same forces of development were progressively changing attitudes towards reproduction, reducing the demand for children and lowering marital fertility.

In the developing countries, there have been unprecedented declines in mortality over a few decades since mid-century. Only sub-Saharan Africa as a whole Ires not yet entered into this phase of demographic transition to a significant extent. A distinguishing feature of this transition has been that declines in mortality and fertility were not accompanying major gains in economic development.

One major driving force behind these dramatic demographic changes has been the revolution in biomedical technology. After the Second World War, insecticides and antibiotics were introduced, followed by vaccines for poliomyelitis and measles, plus oral rehydration therapy, as well as a whole range of modern contraceptives. There is ample evidence that the success of child survival programmes may increase contraceptive practice and hence bring about fertility decline.

This observation raises the wider issue of the effects on fertility of decline in child mortality and the mechanisms through which those effects operate. It has been well established that child survival influences fertility levels. Improvements in child survival usually precede sustained fertility decline; interventions to improve the health of children will eventually be followed by fertility decline, depending upon the type of intervention and prevalent attitudes towards family size.

The desired family size is also important in studying the impact of child mortality on fertility. When parents become confident that their children will live and thus become more assured of the returns for physical and emotional investments in their children, they are more inclined to devote their limited resources to child-rearing. Consequently, the ensuing constraints would stimulate the move towards fewer children of higher quality. This "quality effect" would result in fewer living children being desired under low mortality conditions, with the chances being greatest where parents realize the opportunities to invest meaningfully in the upbringing of their children. Increases in investments in children would affect their fertility behaviour in adulthood, with family-size desires declining with the rising aspirations of younger generations.

Infant mortality rates in rural Ecuador showed large differentials according to the availability or absence of oral rehydration service and maternal and child health programmes. The same is true with respect to availability of family planning, with the areas where this service is available showing a much steeper decline in infant mortality than the areas where family planning clinics are not available.

The study shows that the difference in fertility between women with and without child mortality experience in rural Ecuador was larger when the women had access to a health centre. It maybe possible to generalize from the sample on which this observation is based.

One can conclude that integrated interventions such as health centres, which provide family planning services in addition to health services, are beneficial in achieving the goals of lower fertility and child mortality.

A study in Zimbabwe shows clearly that the survival of a child has a significant impact on fertility by demonstrating, after taking all other relevant factors into consideration, that if a child dies, the interval until the next birth is shorter than if he survives indicating, besides the termination of the ovulation-inhibiting effect of breast-feeding, the non-use of family planning in order to replace the child that died. The analysis also indicates that coverage and visit by mobile family planning clinics have a highly significant impact on fertility in the rural areas.

On the other hand, access to health services was found to have a significant effect on fertility in urban areas, but not in rural areas. In the urban areas, well over half of the population has a clinic or health centre located within two kilometres, while less than one fourth of the rural population has this service within the same distance.

Studies find that, in general, women living in areas that are more accessible to schools have lower fertility than those living farther from schools, perhaps because of better community development in the former. Also, women living in rural communities with paved roads and those with sanitary toilets in their homes tend to have lower fertility rates than women who do not have those facilities.

The studies also showed that the children of women living within easy access to primary or secondary schools have better chance for survival. Both infant and child mortality rates are usually lower among children of women with access to a health service, compared with children of women that do not have such access. This observation is also true for urban and rural areas separately, although the differences are smaller in rural communities.

RELATED ARTICLE: Financial Failure Plus Five?

Failure to provide population assistance to developing States could lead to a grim harvest of at least 120 million unwanted pregnancies, 49 million abortions, 5 million deaths of infants and young children, and 65,000 maternal deaths between the years 1995 and 2000, says the United Nations Population Fund (UNFPA).

According to preliminary conclusions of a UNFPA study, a resource shortfall emerged because the population assistance of donor countries stood at $2 billion in 1995, even though the 1994 International Conference on Population and Development, held in Cairo, asked them to provide $5.7 billion of the $17 billion required annually for reproductive health and family planning.

While $2 billion was a 40 per cent increase over 1994, there would be no increase in those amounts from 1995 to 1996. Sums given by individual donors, such as Denmark and the Netherlands, had risen significantly, but that has been offset by other States' reductions or maintenance of their current levels of assistance. These shortfalls were worsened by the relative strength of the United States dollar against major European currencies.

Despite such grim facts, developing countries and those with economies in transition spent $7.5 billion on population programmes in 1995, indicating that they could reach the Cairo Conference target of $11.3 billion by the year 2000.

However, the shortfall in the annual target set for donor countries remained a cause for concern. And since donor assistance must rise by 23 per cent yearly until the year 2000 in order to meet the $5.7 billion target, States should resolve to abide by the target set at the Cairo Conference.