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Population, Gender, and Development in Latin America Kimberly Grahling Charles McKittrick Mark...
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Transcript of Population, Gender, and Development in Latin America Kimberly Grahling Charles McKittrick Mark...
Population, Gender, andDevelopment in
Latin America
Kimberly GrahlingCharles McKittrick
Mark RobinsonGary Wu
Agenda
• Why is population control so important and what other issues influence growth?
• What Latin American countries are doing to control population growth and the results are they seeing
• Puerto Rico and Peru
• Desired long-term results and our conclusions
The Economics of Population
• Fertility and education
• GDP Per Capita = GDP / Population
ISIExport orientationPrivatizationInflationEconomic enclavesDebtExchange ratesetc.
Decrease
Drivers of High Population
• Colonial legacy
• Culture of machismo
• Agrarian economy
• Lack of education
• Lack of access to birth control
• Religious influence
Latin American governments• % of governments thinking their country’s
population was too high in 1999:
Source: 1999 World Population Data Sheet, Population Reference Bureau
Central America 88%Caribbean 47%South America 15%
Population Control Participants
Foreign governments• Spend $2 billion/year subsidizing family planning
worldwide.• Largest contributors:
– United States through U.S. AID– Netherlands– Germany– United Kingdom– Japan
Source: United Nations and New York Times
Population Control Participants
Nongovernmental Organizations (NGOs) - Funded by local and foreign governments
• International– U.N. Population Fund– World Health Organization
• U.S.-based– International Planned Parenthood Federation– Family Health International– The Population Council– Pathfinder International
Population Control Participants
Nongovernmental Organizations (NGOs)• Private donors
– Ford Foundation– Rockefeller Foundation– Mellon Foundation– MacArthur Foundation– Gates Foundation
Population Control Participants
U.S. AID Funding in Latin America for health and family planning FY2000
CountryFunding
($000) TFRHaiti 22,300$ 4.8Peru 13,500$ 3.5Bolivia 13,000$ 4.2El Salvador 7,145$ 3.6Guatemala 6,000$ 5.1Honduras 4,318$ 4.4Nicaragua 4,000$ 3.9Brazil 2,900$ 2.3Paraguay 2,000$ 4.4Jamaica 1,450$ 2.8
Source: U.S. AID and Population Reference Bureau
Population Control Participants
• Sterilization• Long-term, low-cost, convenient
Population Control Tools
• Increased access to modern birth control• Reversible• Higher efficacy rates than traditional methods
• Family planning education• Most important aspect of population control
• Measured by Total Fertility Rate (TFR)• U.S. has a TFR of 2.0.• TFR of 2.1 is replacement-level fertility
• Latin America’s TFR fell from 5.9 in the 1950’s to 2.9 in 1999.
• Population will double in ~38 years
• Population control policies have reduced population growth rate in Latin America
Results
Case Studies
Successful vs. unsuccessful examples of population
control programs
Case Studies of Two Women's Health Projects in BoliviaGender, Power and Population Change, Population Reference Bureau
Puerto Rico
Peru
What are the parameters of success?
Initially sought to compare effective vs. ineffective examples
Traditional Metrics - focus on short term results:
• Funds invested to number of client visits, IUDs inserted, pills
distributed
• Births per thousand - TFR
New Metrics - focus on medium & long term results
• Quality of service
• Impact on client's health and well-being
• Participant internalization of health knowledge and responsibility
• How participation has affected health and well-being in the medium
and long term.
Case Studies of Two Women's Health Projects in BoliviaGender, Power and Population Change, Population Reference Bureau
Puerto Rico: Effective results ...
Low Cost - high efficiency - Immediate results
• Population control expenditures 100% more effective in raising
per capita income than expenditures in accelerating
conventional economic growth (General Electric Tempo Research Center)
• $5 of birth control = $100 of economic development (Lyndon Johnson's '65 speech to UN)
• Every prevented birth worth 2.6 times per capita output…
births prevented in Puerto Rico ('68) = $3,600 per birth
• Study suggested that improved management efficiency and
more permanent birth control might result in over $12.5M gain
for Puerto Rico
Puerto Rico: Effective results…but at what cost?
• By 1968 ~34% of women of child bearing age had been
sterilized - 2/3s of whom were still in their early twenties
• Lowest natural population increases in Latin America:
19.1/thousand vs. 29/thousand
Year Age Percent Sterilized1947-48 15 + 6.6
1948 n/a 6.91953-54 20 + 16.5
1965 20-49 341968 20-49 35.3
Year Age Percent Sterilized1947-48 15 + 6.6
1948 n/a 6.91953-54 20 + 16.5
1965 20-49 341968 20-49 35.3
Puerto Rico: Context and players
Primary participants:
• Puerto Rican government
• NGOs
• Foreign governments
• Private donors to NGOs (with linked economic interests)
Population Control Policies:
• Sterilization
• IUD & the Pill
Rationalization:
• Demand Statistics
Sterilization
1) Underdeveloped health-care services
2) Abortion difficult to obtain (2 year prison term)
3) Non-prescription use of the pill
4) IUD's expensive and poorly distributed
5) Sterilization is free
6) Reimburse $50 and 90% of hospital cost
7) Sterilization post partum - consent is obtained during labor
Sterilization
1) Underdeveloped health-care services
2) Abortion difficult to obtain (2 year prison term)
3) Non-prescription use of the pill
4) IUD's expensive and poorly distributed
5) Sterilization is free
6) Reimburse $50 and 90% of hospital cost
7) Sterilization post partum - consent is obtained during labor
Peru: Family Planning and Good Intentions
Fujimori places family planning at forefront of national agenda (4/95)
• Method for reducing poverty in Peru.
• Goal: state to prevent the birth of 500,000 Peruvians by 2000
• Population control linked to shift in market-oriented economic
policies
Good intentions
• 1st step in reducing poverty decrease size of low income families
• Accessible family planning for all classes
Peru: Family Planning and Good Intentions
Case Studies of Two Women's Health Projects in BoliviaGender, Power and Population Change, Population Reference Bureau
Population Control Tool-set• Network of clinics
• Access to latest techniques (including female condom and Norplant)
• Voluntary sterilization program • (including vasectomies for men and tubal ligations for women)
• Three most practiced forms of contraception in Peru:
(1) Abstinence / 'natural methods'; (2) IUD; (3) Tubal ligation
• Abortion Illegal - though ~ 300K abortions performed a year
• 1 in 3 pregnancies end in abortion
Primary Participants• Peruvian government
• U.S. AID
Peru: Family Planning and Good Intentions
Case Studies of Two Women's Health Projects in Bolivia
Constraints:• Catholic Church:
• Moral arguments
• Church claims plan ignores declining birth rate;
• Blames the poor for the country's economic problems.
• Cultural:
• Male perception of loss of control over women
• Fear of male impotence
Economic
• 1/2 of Peru's 23 million people live in poverty
Peru: Family Planning and Good Intentions
Results & Pitfalls
• '97 sterilization's result in 26,000 fewer births in '98
• Quotas motivate State health-care workers to take advantage
of rural poor women
• Promotions and cash incentives stimulate hurried, low quality
care
• Going rate: two dresses and a t-shirt.
YearFemale
SterilizationsMale
Sterilizations1995 10,000 n/a1996 30,000 n/a1997 110,000 10,000
YearFemale
SterilizationsMale
Sterilizations1995 10,000 n/a1996 30,000 n/a1997 110,000 10,000
Future Trends: An Alternative Viewpoint
Population control guided by improving human welfare instead of
reducing overcrowding
• Invest in the conditions that facilitate use of programs in addition to the
programs themselves.
Integrated approaches to service delivery
• Emphasis on continued education and growth
• Focus on interpersonal relationships
New Paradigm:
• Health more complex than medical service and necessarily linked to
education, human rights, personal empowerment
• Transforms relationship between clinician and patient so delivery more
effective
Positive Results of Population Control
Women have fewer children
More opportunities for education and work
Women gain higher-paying jobs
Women achieve higher economic status
Economy gains from more productive workers
Higher standard of living
Four Key Indicators of Women’s Quality of Life
Region 1970 1990 1970 1990 1970 1990 1970 1990Latin America and the Caribbean 89% 103% 39% 52% 64 70 5.0 3.2
Life Expectancy
(years) FertilityGirls Enrolled in Primary School
Women Aged 15-44 Using
Modern Contraception
Source: Women in Poverty: A New Global Underclass, Family Health International
Positive Results of Population Control
Conclusions
• Humane population control cannot be achieved with only one tool
• Population control as a development tool is a long- term undertaking
• Education is a key component of economic development
• The most effective population control policies focus on both genders.
Costs and Benefits of One Additional Year of Schooling For 1,000 women in
Pakistan (estimated):Costs
•Schooling costs for 1,000 women = $30K
Benefits
•Increase in wages = 20%
•Child deaths averted = 60
•Alternative health intervention to save 60 lives = $48K
•Total births averted = 500
•Alternative family planning costs per 500 births averted = $33K
•Total maternal deaths averted = 3
•Alternative costs per 3 averted maternal deaths = $7.5K
Results