• A. Basic Global Strategy
• B. Key Country priorities in U.S. and Multilateral Population Assistance.
• C. Instruments and Modalities for Population Assistance
• D. Provision and Development of Family Planning Services, Information and Technology
• E. Creating Conditions Conducive to Fertility Decline
• F. Development of World-Wide Political and Popular Commitment to Population Stabilization and Its Associated Improvement of Individual Quality of Life.
• An Alternative View & Conclusion

There is no simple single approach to the population problem which will provide a "technological fix". As the previous analysis makes clear the problem of population growth has social, economic and technological aspects all of which must be understood and dealt with for a world population policy to succeed. With this in mind, the following broad recommended strategy provides a framework for the development of specific individual programs which must be tailored to the needs and particularities of each country and of different sectors of the population within a country. Essentially all its recommendations made below are supported by the World Population Plan of action drafted at the World Population Conference.

A. Basic Global Strategy

The following basic elements are necessary parts of a comprehensive approach to the population problem which must include both bilateral and multilateral components to achieve success. Thus, USG population assistance programs will need to be coordinated with those of the major multilateral institutions, voluntary organizations, and other bilateral donors.

The common strategy for dealing with rapid population growth should encourage constructive actions to lower fertility since population growth over the years will seriously negate reasonable prospects for the sound social and economic development of the peoples involved.

While the time horizon in this NSSM is the year 2000 we must recognize that in most countries, especially the LDCs, population stability cannot be achieved until the next century. There are too many powerful socio-economic factors operating on family size decisions and too much momentum built into the dynamics of population growth to permit a quick and dramatic reversal of current trends. There is also even less cause for optimism on the rapidity of socio-economic progress that would generate rapid fertility reduction in the poor LDCs than on the feasibility of extending family planning services to those in their populations who may wish to take advantage of them. Thus, at this point we cannot know with certainty when world population can feasibly be stabilized, nor can we state with assurance the limits of the world's ecological "carrying capability". But we can be certain of the desirable direction of change and can state as a plausible objective the target of achieving replacement fertility rates by the year 2000.

Over the past few years, U.S. government-funded population programs have played a major role in arousing interest in family planning in many countries, and in launching and accelerating the growth of national family planning programs. In most countries, there has been an initial rapid growth in contraceptive "acceptors" up to perhaps 10% of fertile couples in a few LDCs. The acceleration of previous trends of fertility decline is attributable, at least in part, to family planning programs.

However, there is growing appreciation that the problem is more long term and complex than first appeared and that a short term burst of activity or moral fervor will not solve it. The danger in this realization is that the U.S. might abandon its commitment to assisting in the world's population problem, rather than facing up to it for the long-run difficult problem that it is.

From year to year we are learning more about what kind of fertility reduction is feasible in differing LDC situations. Given the laws of compound growth, even comparatively small reductions in fertility over the next decade will make a significant difference in total numbers by the year 2000, and a far more significant one by the year 2050.

The proposed strategy calls for a coordinated approach to respond to the important U.S. foreign policy interest in the influence of population growth on the world's political, economic and ecological systems. What is unusual about population is that this foreign policy interest must have a time horizon far beyond that of most other objectives. While there are strong short-run reasons for population programs, because of such factors as food supply, pressures on social service budgets, urban migration and social and political instability, the major impact of the benefits - or avoidance of catastrophe - that could be accomplished by a strengthened U.S. commitment in the population area will be felt less by those of us in the U.S. and other countries today than by our children and grandchildren.

B. Key Country priorities in U.S. and Multilateral Population Assistance

One issue in any global population strategy is the degree of emphasis in allocation of program resources among countries. The options available range from heavy concentration on a few vital large countries to a geographically diverse program essentially involving all countries willing to accept such assistance. All agencies believe the following policy provides the proper overall balance.

In order to assist the development of major countries and to maximize progress toward population stability, primary emphasis would be placed on the largest and fastest growing developing countries where the imbalance between growing numbers and development potential most seriously risks instability, unrest, and international tensions. These countries are: India, Bangladesh, Pakistan, Nigeria, Mexico, Indonesia, Brazil, The Philippines, Thailand, Egypt, Turkey, Ethiopia, and Colombia. Out of a total 73.3 million worldwide average increase in population from 1970-75 these countries contributed 34.3 million or 47%. This group of priority countries includes some with virtually no government interest in family planning and others with active government family planning programs which require and would welcome enlarged technical and financial assistance. These countries should be given the highest priority within AID's population program in terms of resource allocations and/or leadership efforts to encourage action by other donors and organizations.

However, other countries would not be ignored. AID would provide population assistance and/ or undertake leadership efforts with respect to other, lower priority countries to the extent that the availability of funds and staff permits, taking into account of such factors as: long run U.S. political interests; impact of rapid population growth on its development potential; the country's relative contribution to world population growth; its financial capacity to cope with the problem; potential impact on domestic unrest and international frictions (which can apply to small as well as large countries); its significance as a test or demonstration case; and opportunities for expenditures that appear particularly cost-effective (e.g. it has been suggested that there may be particularly cost-effective opportunities for supporting family planning to reduce the lag between mortality and fertility declines in countries where death rates are still declining rapidly); national commitment to an effective program.

For both the high priority countries and the lower priority ones to which funds and staff permit aid, the form and content of our assistance or leadership efforts would vary from country to country, depending on each nation's particular interests, needs, and receptivity to various forms of assistance. For example, if these countries are receptive to U.S. assistance through bilateral or central AID funding, we should provide such assistance at levels commensurate with the recipient's capability to finance needed actions with its own funds, the contributions of other donors and organizations, and the effectiveness with which funds can be used.

In countries where U.S. assistance is limited either by the nature of political or diplomatic relations with those countries or by lack of strong government desire. In population reduction programs, external technical and financial assistance (if desired by the countries) would have to come from other donors and/or from private and international organizations, many of which receive contributions from AID. The USG would, however, maintain an interest (e.g. through Embassies) in such countries' population problems and programs (if any) to reduce population growth rates. Moreover, particularly in the case of high priority countries, we should be alert to opportunities for expanding our assistance efforts and for demonstrating to their leaders the consequences of rapid population growth and the benefits of actions to reduce fertility.

In countries to which other forms of U.S. assistance are provided but not population assistance, AID will monitor progress toward achievement of development objectives, taking into account the extent to which these are hindered by rapid population growth, and will look for opportunities to encourage initiation of or improvement in population policies and programs.

In addition, the U.S. strategy should support in these LDC countries general activities (e.g. big-medical research or fertility control methods) capable of achieving major breakthroughs in key problems which hinder reductions in population growth.

C. Instruments and Modalities for Population Assistance

 Bilateral population assistance is the largest and most invisible "instrument" for carrying out U.S. policy in this area. Other instruments include: support for and coordination with population programs of multilateral organizations and voluntary agencies; encouragement of multilateral country consortia and consultative groups to emphasize family planning in reviews of overall recipient progress and aid requests; and formal and informal presentation of views at international gatherings, such as food and population conferences. Specific country strategies must be worked out for each of the highest priority countries, and for the lower priority ones. These strategies will take account of such factors as: national attitudes and sensitivities on family planning; which "instruments" will be most acceptable, opportunities for effective use of assistance; and need of external capital or operating assistance.

For example, in Mexico our strategy would focus on working primarily through private agencies and multilateral organizations to encourage more government attention to the need for control of population growth; in Bangladesh we might provide large-scale technical and financial assistance, depending on the soundness of specific program requests; in Indonesia we would respond to assistance requests but would seek to have Indonesia meet as much of program costs from its own resources (i.e. surplus oil earnings) as possible. In general we would not provide large-scale bilateral assistance in the more developed LDCs, such as Brazil or Mexico. Although these countries are in the top priority list our approach must take account of the fact that their problems relate often to government policies and decisions and not to larger scale need for concessional assistance.

Within the overall array of U.S. foreign assistance programs, preferential treatment in allocation of funds and manpower should be given to cost- effective programs to reduce population growth; including both family planning activities and supportive activities in other sectors.

While some have argued for use of explicit "leverage" to "force" better population programs on LDC governments, there are several practical constraints on our efforts to achieve program improvements. Attempts to use "leverage" for far less sensitive issues have generally caused political frictions and often backfired. Successful family planning requires strong local dedication and commitment that cannot over the long run be enforced from the outside. [** There is also the danger that some LDC leaders will see developed country pressures for family planning as a form of economic or racial imperialism; this could well create a serious backlash.**]

Short of "leverage", there are many opportunities, bilaterally and multilaterally, for U.S. representations to discuss and urge the need for stronger family planning programs. There is also some established precedent for taking account of family planning performance in appraisal of assistance requirements by AID and consultative groups. Since population growth is a major determinant of increases in food demand, allocation of scarce PL 480 resources should take account of what steps a country is taking in population control as well as food production. In these sensitive relationships, however, it is important in style as well as substance to avoid the appearance of coercion.

D. Provision and Development of Family Planning Services, Information and Technology

Past experience suggests that easily available family planning services are a vital and effective element in reducing fertility rates in the LDCs.

Two main advances are required for providing safe and effective fertility control techniques in the developing countries:

1. Expansion and further development of efficient low-cost systems to assure the full availability of existing family planning services, materials and information to the 85% of LDC populations not now effectively reached. In developing countries willing to create special delivery systems for family planning services this may be the most effective method. In others the most efficient and acceptable method is to combine family planning with health or nutrition in multi-purpose delivery systems.

2. Improving the effectiveness of present means of fertility control, and developing new technologies which are simple, low cost, effective, safe, long- lasting and acceptable to potential users. This involves both basic developmental research and operations research to judge the utility of new or modified approaches under LDC conditions.

Both of these goals should be given very high priority with necessary additional funding consistent with current or adjusted divisions of labor among other donors and organizations involved in these areas of population assistance.

E. Creating Conditions Conducive to Fertility Decline

It is clear that the availability of contraceptive services and information is not a complete answer to the population problem. In view of the importance of socio-economic factors in determining desired family size, overall assistance strategy should increasingly concentrate on selective policies which will contribute to population decline as well as other goals. This strategy reflects the complementarity between population control and other U.S. development objectives, particularly those relating to AID's Congressional mandate to focus on problems of the "poor majority" in LDC's.

We know that certain kinds of development policies e.g., those which provide the poor with a major share in development benefits both promote fertility reductions and accomplish other major development objectives. There are other policies which appear to also promote fertility reduction but which may conflict with non-population objectives (e.g., consider the effect of bringing a large number of women into the labor force in countries and occupations where unemployment is already high and rising).

However, AID knows only approximately the relative priorities among the factors that affect fertility and is even further away from knowing what specific cost-effective steps governments can take to affect these factors.

Nevertheless, with what limited information we have, the urgency of moving forward toward lower fertility rates, even without complete knowledge of the socio-economic forces involved, suggests a three-pronged strategy:

1. High priority to large-scale implementation of programs affecting the determinants of fertility in those cases where there is probable cost- effectiveness, taking account of potential impact on population growth rates; other development benefits to be gained; ethical considerations; feasibility in light of LDC bureaucratic and political concerns and problems; and time-frame for accomplishing objectives.

2. High priority to experimentation and pilot projects in areas where there is evidence of a close relationship to fertility reduction but where there are serious questions about cost-effectiveness relating either to other development impact (e.g., the female employment example cited above) or to program design (e.g., what cost-effective steps can be taken to promote female employment or literacy).

3. High priority to comparative research and evaluation on the relative impact on desired family size of the socio-economic determinants of fertility in general and on what policy scope exists for affecting these determinants.

In all three cases emphasis should be given to moving action as much as possible to LDC institutions and individuals rather than to involving U.S. researchers on a large scale.

Activities in all three categories would receive very high priority in allocation of AID funds. The largest amounts required should be in the first category and would generally not come from population funds. However, since such activities (e.g., in rural development and basic education) coincide with other AID sectoral priorities, sound project requests from LDC's will be placed close to the top in AlD's funding priorities (assuming that they do not conflict with other major development and other foreign policy objectives).

The following areas appear to contain significant promise in effecting fertility declines, and are discussed in subsequent sections.

• providing minimal levels of education especially for women;
• reducing infant and child mortality;
• expanding opportunities for wage employment especially for women;
• developing alternatives to "social security" support provided by children to aging parents;
• pursuing development strategies that skew income growth toward the poor, especially rural development focusing on rural poverty;
• [** concentrating on the education and indoctrination of the rising generation of children regarding the desirability of smaller family size.**]

The World Population Plan of Action includes a provision (paragraph 31) that countries trying for effective fertility levels should give priority to development programs and health and education strategies which have a decisive effect upon demographic trends, including fertility. It calls for international information to give priority to assisting such national efforts. Programs suggested (paragraph 32) are essentially the same as those listed above.

Food is another of special concern in any population strategy. Adequate food stocks need to be created to provide for periods of severe shortages and LDC food production efforts must be reinforced to meet increased demand resulting from population and income growth. U.S. agricultural production goals should take account of the normal import requirements of LDC's (as well as developed countries) and of likely occasional crop failures in major parts of the LDC world. Without improved food security, there will be pressure leading to possible conflict and the desire for large families for "insurance" purposes, thus undermining other development and population control efforts.

F. Development of World-Wide Political and Popular Commitment to Population Stabilization and Its Associated Improvement of Individual Quality of Life.

A fundamental element in any overall strategy to deal with the population problem is obtaining the support and commitment of key leaders in the developing countries. This is only possible if they can clearly see the negative impact of unrestricted population growth in their countries and the benefits of reducing birth rates and if they believe it is possible to cope with the population problem through instruments of public policy. Since most high officials are in office for relatively short periods, they have to see early benefits or the value of longer term statesmanship. In each specific case, individual leaders will have to approach their population problems within the context of their country's values, resources, and existing priorities.

Therefore, it is vital that leaders of major LDCs themselves take the lead in advancing family planning and population stabilization, not only within the U.N. and other international organizations but also through bilateral contacts with leaders of other LDCs. Reducing population growth in LDCs should not be advocated exclusively by the developed countries. The U.S. should encourage such a role as opportunities appear in its high level contact with LDC leaders.

The most recent forum for such an effort was the August 1974 U.N. World Population Conference. It was an ideal context to focus concerted world attention on the problem. The debate views and highlights of the World Population Plan of action are reviewed in Chapter VI.

The U.S. strengthened its credibility as an advocate of lower population growth rates by explaining that, while it did not have a single written action population policy, it did have legislation, Executive Branch policies and court decisions that amounted to a national policy and that our national fertility level was already below replacement and seemed likely to attain a stable population by 2000.

The U.S. also proposed to join with other developed countries in an international collaborative effort of research in human reproduction and fertility control covering big-medical and socio-economic factors.

The U.S. further offered to collaborate with other interested donor countries and organizations (e.g., WHO, UNFPA, World Bank, UNICEF) to encourage further action by LDC governments and other institutions to provide low-cost, basic preventive health services, including maternal and child health and family planning services, reaching out into the remote rural areas.

The U.S. delegation also said the U.S. would request from the Congress increased U.S. bilateral assistance to population-family planning programs, and additional amounts for essential functional activities and our contribution to the UNFPA if countries showed an interest in such assistance.

Each of these commitments is important and should be pursued by the U.S. Government.

[** It is vital that the effort to develop and strengthen a commitment on the part of the LDC leaders not be seen by them as an industrialized country policy to keep their strength down or to reserve resources for use by the "rich" countries. Development of such a perception could create a serious backlash adverse to the cause of population stability.**] Thus the U.S. and other "rich" countries should take care that policies they advocate for the LDC's would be acceptable within their own countries. (This may require public debate and affirmation of our intended policies.) The "political" leadership role in developing countries should, of course, be taken whenever possible by their own leaders.

[** The U.S. can help to minimize charges of an imperialist motivation behind its support of population activities by repeatedly asserting that such support derives from a concern with:

(a) the right of the individual couple to determine freely and responsibly their number and spacing of children and to have information, education, and means to do so; and

(b) the fundamental social and economic development of poor countries in which rapid population growth is both a contributing cause and a consequence of widespread poverty. **]

Furthermore, the U.S. should also take steps to convey the message that the control of world population growth is in the mutual interest of the developed and developing countries alike.

Family planning programs should be supported by multilateral organizations wherever they can provide the most efficient and acceptable means. Where U.S. bilateral assistance is necessary or preferred, it should be provided in collaboration with host country institutions as is the case now. Credit should go to local leaders for the success of projects. The success and acceptability of family planning assistance will depend in large measure on the degree to which it contributes to the ability of the host government to serve and obtain the support of its people.

In many countries today, decision-makers are wary of instituting population programs, not because they are unconcerned about rapid population growth, but because they lack confidence that such programs will succeed. By actively working to demonstrate to such leaders that national population and family planning programs have achieved progress in a wide variety of poor countries, the U.S. could help persuade the leaders of many countries that the investment of funds in national family planning programs is likely to yield high returns even in the short and medium term. Several examples of success exist already, although regrettably they tend to come from LDCs that are untypically well off in terms of income growth and/or social services or are islands or city states.

We should also appeal to potential leaders among the younger generations in developing countries, focusing on the implications of continued rapid population growth for their countries in the next 10-20 years, when they may assume national leadership roles.

Beyond seeking to reach and influence national leaders, improved world-wide support for population-related efforts should be sought through increased emphasis on mass media and other population education and motivation programs by the U.N., USIA, and USAID. We should give higher priorities in our information programs world-wide for this area and consider expansion of collaborative arrangements with multilateral institutions in population education programs.

Another challenge will be in obtaining the further understanding and support of the U.S. public and Congress for the necessary added funds for such an effort, given the competing demands for resources. If an effective program is to be mounted by the U.S., we will need to contribute significant new amounts of funds. Thus there is need to reinforce the positive attitudes of those in Congress who presently support U.S. activity in the population field and to enlist their support in persuading others. Public debate is needed now.

Personal approaches by the President, the Secretary of State, other members of the Cabinet, and their principal deputies would be helpful in this effort. Congress and the public must be clearly informed that the Executive Branch is seriously worried about the problem and that it deserves their further attention. Congressional representatives at the World Population Conference can help.

An Alternative View

The above basic strategy assumes that the current forms of assistance programs in both population and economic and social development areas will be able to solve the problem. There is however, another view, which is shared by a growing number of experts. It believes that the outlook is much harsher and far less tractable than commonly perceived. This holds that the severity of the population problem in this century which is already claiming the lives of more than 10 million people yearly, is such as to make likely continued widespread food shortage and other demographic catastrophes, and, in the words of C.P. Snow, we shall be watching people starve on television.

[** The conclusion of this view is that mandatory programs may be needed and that we should be considering these possibilities now.**]

This school of thought believes the following types of questions need to be addressed:

• Should the U.S. make an all out commitment to major limitation of world population with all the financial and international as well as domestic political costs that would entail?
• Should the U.S. set even higher agricultural production goals which would enable it to provide additional major food resources to other countries? Should they be nationally or internationally controlled?
• [** On what basis should such food resources then be provided?
• Would food be considered an instrument of national power?
• Will we be forced to make choices as to whom we can reasonably assist, and if so, should population efforts be a criterion for such assistance?**]
• Is the U.S. prepared to accept food rationing to help people who can't/won't control their population growth?
• Should the U.S. seek to change its own food consumption patterns toward more efficient uses of protein?
• Are mandatory population control measures appropriate for the U.S. and/or for others?
• Should the U.S. initiate a major research effort to address the growing problems of fresh water supply, ecological damage, and adverse climate?

While definitive answers to those questions are not possible in this study given its time limitations and its implications for domestic policy, nevertheless they are needed if one accepts the drastic and persistent character of the population growth problem. Should the choice be made that the recommendations and the options given below are not adequate to meet this problem, consideration should be given to a further study and additional action in this field as outlined above.

Conclusion

The overall strategy above provides a general approach through which the difficulties and dangers of population growth and related problems can be approached in a balanced and comprehensive basis. No single effort will do the job. Only a concerted and major effort in a number of carefully selected directions can provide the hope of success in reducing population growth and its unwanted dangers to world economic will-being and political stability. There are no "quick-fixes" in this field.

Below are specific program recommendations which are designed to implement this strategy. Some will require few new resources; many call for major efforts and significant new resources. We cannot simply buy population growth moderation for nearly 4 billion people "on the cheap".