Correct History


National Security Study Memorandum 200
Part 3

                 Title X Funding for Population


      +----------------------------------------------------+
      |  Year                           Amount ($ million) |
      +----------------------------------------------------+
      | FY 1972  - Actual Obligations         123.3        |
      | FY 1973  - Actual Obligations         125.6        |
      | FY 1974  - Actual Obligations         112.4        |
      | FY 1975  - Request to Congress        137.5        |
      | FY 1976  - Projection                 170          |
      | FY 1977  - Projection                 210          |
      | FY 1978  - Projection                 250          |
      | FY 1979  - Projection                 300          |
      | FY 1980  - Projection                 350          |
      +----------------------------------------------------+




These Title X funding projections for FY 1976-80 are general magnitudes based on preliminary estimates of expansion or initiation of population programs in developing countries and growing requirements for outside assistance as discussed in greater detail in other sections of this paper. These estimates contemplated very substantial increases in self-help and assistance from other donor countries.

Our objective should be to assure that developing countries make family planning information, educational and means available to all their peoples by 1980. Our efforts should include:

We believe expansions in the range of 35-50 million annually over the next five years are realistic, in light of potential LDC needs and prospects for increased contributions from other population assistance instrumentalities, as well as constraints on the speed with which AID (and other donors) population funds can be expanded and effectively utilized. These include negative or ambivalent host government attitudes toward population reduction programs; the need for complementary financial and manpower inputs by recipient governments, which must come at the expense of other programs they consider to be high priority; and the need to assure that new projects involve sensible, effective actions that are likely to reduce fertility. We must avoid inadequately planned or implemented programs that lead to extremely high costs per acceptor. In effect, we are closer to "absorptive capacity" in terms of year-to-year increases in population programs than we are, for example, in annual expansions in food, fertilizer or generalized resource transfers.

It would be premature to make detailed funding recommendations by countries and functional categories in light of our inability to predict what changes -- such as in host country attitudes to U.S. population assistance and in fertility control technologies -- may occur which would significantly alter funding needs in particular geographic or functional areas. For example, AID is currently precluded from providing bilateral assistance to India and Egypt, two significant countries in the highest priority group, due to the nature of U.S. political and diplomatic relations with these countries. However, if these relationships were to change and bilateral aid could be provided, we would want to consider providing appropriate population assistance to these countries. In other cases, changing U.S.-LDC relationships might preclude further aid to some countries. Factors such as these could both change the mix and affect overall magnitudes of funds needed for population assistance. Therefore, proposed program mixes and funding levels by geographic and functional categories should continue to be examined on an annual basis during the regular USG program and budget review processes which lead to the presentation of funding requests to the Congress.

Recognizing that changing opportunities for action could substantially affect AID's resource requirements for population assistance, we anticipate that, if funds are provided by the Congress at the levels projected, we would be able to cover necessary actions related to the highest priority countries and also those related to lower priority countries, moving reasonably far down the list. At this point, however, AID believes it would not be desirable to make priority judgments on which activities would not be funded if Congress did not provide the levels projected. If cuts were made in these levels we would have to make judgments based on such factors as the priority rankings of countries, then-existing LDC needs, and divisions of labor with other actors in the population assistance area.

If AID's population assistance program is to expand at the general magnitudes cited above, additional direct hire staff will likely be needed. While the expansion in program action would be primarily through grants and contracts with LDC or U.S. institutions, or through contributions to international organizations, increases in direct hire staff would be necessary to review project proposals, monitor their implementation through such instrumentalities, and evaluate their progress against pre-established goals. Specific direct hire manpower requirements should continue to be considered during the annual program and budget reviews, along with details of program mix and funding levels by country and functional category, in order to correlate staffing needs with projected program actions for a particular year.

Recommendations

1. The U.S. strategy should be to encourage and support, through bilateral, multilateral and other channels, constructive action to lower fertility rates in selected developing countries. The U.S. should apply each of the relevant provisions of its World Population Plan of Action and use it to influence and support actions by developing countries.

2. Within this overall strategy, the U.S. should give highest priority, in terms of resource allocation (along with donors) to efforts to encourage assistance from others to those countries cited above where the population problem is most serious, and provide assistance to other countries as funds and staff permit.

3. AID's further development of population program priorities, both geographic and functional, should be consistent with the general strategy discussed above, with the other recommendations of this paper and with the World Population Plan of Action. The strategies should be coordinated with the population activities of other donors countries and agencies using the WPPA as leverage to obtain suitable action.

4. AID's budget requests over the next five years should include a major expansion of bilateral population and family planning programs (as appropriate for each country or region), of functional activities as necessary, and of contributions through multilateral channels, consistent with the general funding magnitudes discussed above. The proposed budgets should emphasize the country and functional priorities outlined in the recommendations of this study and as detailed in AID's geographic and functional strategy papers.

II. B. Functional Assistance Programs to Create Conditions for Fertility Decline

Introduction

Discussion

It is clear that the availability of contraceptive services and information, important as that is, is not the only element required to address the population problems of the LDCs. Substantial evidence shows that many families in LDCs (especially the poor) consciously prefer to have numerous children for a variety of economic and social reasons. For example, small children can make economic contributions on family farms, children can be important sources of support for old parents where no alternative form of social security exists, and children may be a source of status for women who have few alternatives in male-dominated societies.

The desire for large families diminishes as income rises. Developed countries and the more developed areas in LDCs have lower fertility than less developed areas. Similarly, family planning programs produce more acceptors and have a greater impact on fertility in developed areas than they do in less developed areas. Thus, investments in development are important in lowering fertility rates. We know that the major socio-economic determinants of fertility are strongly interrelated. A change in any one of them is likely to produce a change in the others as well. Clearly development per se is a powerful determinant of fertility. However, since it is unlikely that most LDCs will develop sufficiently during the next 25-30 years, it is crucial to identify those sectors that most directly and powerfully affect fertility.

In this context, population should be viewed as a variable which interacts, to differing degrees, with a wide range of development programs, and the U.S. strategy should continue to stress the importance of taking population into account in "non-family planning" activities. This is particularly important with the increasing focus in the U.S. development program on food and nutrition, health and population, and education and human resources; assistance programs have less chance of success as long as the numbers to be fed, educated, and employed are increasing rapidly.

Thus, to assist in achieving LDC fertility reduction, not only should family planning be high up on the priority list for U.S. foreign assistance, but high priority in allocation of funds should be given to programs in other sectors that contribute in a cost-effective manner in reduction in population growth.

There is a growing, but still quite small, body of research to determine the socio-economic aspects of development that most directly and powerfully affect fertility. Although the limited analysis to date cannot be considered definitive, there is general agreement that the five following factors (in addition to increases in per capita income) tend to be strongly associated with fertility declines: education, especially the education of women; reductions in infant mortality; wage employment opportunities for women; social security and other substitutes for the economic value of children; and relative equality in income distribution and rural development. There are a number of other factors identified from research, historical analysis, and experimentation that also affect fertility, including delaying the average age of marriage, and direct payments (financial incentive) to family planning acceptors.

There are, however, a number of questions which must be addressed before one can move from identification of factors associated with fertility decline to large-scale programs that will induce fertility decline in a cost-effective manner. For example, in the case of female education, we need to consider such questions as: did the female education cause fertility to decline or did the development process in some situations cause parents both to see less economic need for large families and to indulge in the "luxury" of educating their daughters? If more female education does in fact cause fertility declines, will poor high-fertility parents see much advantage in sending their daughters to school? If so, how much does it cost to educate a girl to the point where her fertility will be reduced (which occurs at about the fourth-grade level)? What specific programs in female education are most cost-effective (e.g., primary school, non-formal literacy training, or vocational or pre-vocational training)? What, in rough quantitative terms, are the non-population benefits of an additional dollar spent on female education in a given situation in comparison to other non-population investment alternatives? What are the population benefits of a dollar spent on female education in comparison with other population-related investments, such as in contraceptive supplies or in maternal and child health care systems? And finally, what is the total population plus non-population benefit of investment in a given specific program in female education in comparison with the total population plus non-population benefits of alternate feasible investment opportunities?

As a recent research proposal from Harvard's Department of Population Studies puts this problem: "Recent studies have identified more specific factors underlying fertility declines, especially, the spread of educational attainment and the broadening of non-traditional roles for women. In situations of rapid population growth, however, these run counter to powerful market forces. Even when efforts are made to provide educational opportunities for most of the school age population, low levels of development and restricted employment opportunities for academically educated youth lead to high dropout rates and non-attendance..."

Fortunately, the situation is by no means as ambiguous for all of the likely factors affecting fertility. For example, laws that raise the minimum marriage age, where politically feasible and at least partially enforceable, can over time have a modest effect on fertility at negligible cost. Similarly, there have been some controversial, but remarkably successful, experiments in India in which financial incentives, along with other motivational devices, were used to get large numbers of men to accept vasectomies. In addition, there appear to be some major activities, such as programs aimed to improve the productive capacity of the rural poor, which can be well justified even without reference to population benefits, but which appear to have major population benefits as well.

The strategy suggested by the above considerations is that the volume and type of programs aimed at the "determinants of fertility" should be directly related to our estimate of the total benefits (including non-population benefits) of a dollar invested in a given proposed program and to our confidence in the reliability of that estimate. There is room for honest disagreement among researchers and policy-makers about the benefits, or feasibility, of a given program. Hopefully, over time, with more research, experimentation and evaluation, areas of disagreement and ambiguity will be clarified, and donors and recipients will have better information both on what policies and programs tend to work under what circumstances and how to go about analyzing a given country situation to find the best feasible steps that should be taken.

Recommendations:

1. AID should implement the strategy set out in the World Population Plan of Action, especially paragraphs 31 and 32 and Section I ("Introduction - a U.S. Global Population Strategy") above, which calls for high priority in funding to three categories of programs in areas affecting fertility (family-size) decisions:

a. Operational programs where there is proven cost-effectiveness, generally where there are also significant benefits for non-population objectives;

b. Experimental programs where research indicates close relationships to fertility reduction but cost-effectiveness has not yet been demonstrated in terms of specific steps to be taken (i.e., program design); and

c. Research and evaluation on the relative impact on desired family size of the socio-economic determinants of fertility, and on what policy scope exists for affecting these determinants.

2. Research, experimentation and evaluation of ongoing programs should focus on answering the questions (such as those raised above, relating to female education) that determine what steps can and should be taken in other sectors that will in a cost-effective manner speed up the rate of fertility decline. In addition to the five areas discussed in Section II. B 1-5 below, the research should also cover the full range of factors affecting fertility, such as laws and norms respecting age of marriage, and financial incentives. Work of this sort should be undertaken in individual key countries to determine the motivational factors required there to develop a preference for small family size. High priority must be given to testing feasibility and replicability on a wide scale.

3. AID should encourage other donors in LDC governments to carry out parallel strategies of research, experimentation, and (cost-effective well-evaluated) large-scale operations programs on factors affecting fertility. Work in this area should be coordinated, and results shared.

4. AID should help develop capacity in a few existing U.S. and LDC institutions to serve as major centers for research and policy development in the areas of fertility-affecting social or economic measures, direct incentives, household behavior research, and evaluation techniques for motivational approaches. The centers should provide technical assistance, serve as a forum for discussion, and generally provide the "critical mass" of effort and visibility which has been lacking in this area to date. Emphasis should be given to maximum involvement of LDC institutions and individuals.

The following sections discuss research experimental and operational programs to be undertaken in the five promising areas mentioned above.

II. B. 1. Providing Minimal Levels of Education, Especially for Women

Discussion

There is fairly convincing evidence that female education especially of 4th grade and above correlates strongly with reduced desired family size, although it is unclear the extent to which the female education causes reductions in desired family size or whether it is a faster pace of development which leads both to increased demand for female education and to reduction in desired family size. There is also a relatively widely held theory -- though not statistically validated -- that improved levels of literacy contribute to reduction in desired family size both through greater knowledge of family planning information and increasing motivational factors related to reductions in family size. Unfortunately, AID's experience with mass literacy programs over the past 15 years has yielded the sobering conclusion that such programs generally failed (i.e. were not cost-effective) unless the population sees practical benefits to themselves from learning how to read -- e.g., a requirement for literacy to acquire easier access to information about new agricultural technologies or to jobs that require literacy.

Now, however, AID has recently revised its education strategy, in line with the mandate of its legislation, to place emphasis on the spread of education to poor people, particularly in rural areas, and relatively less on higher levels of education. This approach is focused on use of formal and "non-formal" education (i.e., organized education outside the schoolroom setting) to assist in meeting the human resource requirements of the development process, including such things as rural literacy programs aimed at agriculture, family planning, or other development goals.

Recommendations

1. Integrated basic education (including applied literacy) and family planning programs should be developed whenever they appear to be effective, of high priority, and acceptable to the individual country. AID should continue its emphasis on basic education, for women as well as men.

2. A major effort should be made in LDCs seeking to reduce birth rates to assure at least an elementary school education for virtually all children, girls as well as boys, as soon as the country can afford it (which would be quite soon for all but the poorest countries). Simplified, practical education programs should be developed. These programs should, where feasible, include specific curricula to motivate the next generation toward a two-child family average to assure that level of fertility in two or three decades. AID should encourage and respond to requests for assistance in extending basic education and in introducing family planning into curricula. Expenditures for such emphasis on increased practical education should come from general AID funds, not population funds.

II. B. 2. Reducing Infant and Child Mortality

Discussion:

High infant and child mortality rates, evident in many developing countries, lead parents to be concerned about the number of their children who are likely to survive. Parents may overcompensate for possible child losses by having additional children. Research to date clearly indicates not only that high fertility and high birth rates are closely correlated but that in most circumstances low net population growth rates can only be achieved when child mortality is low as well. Policies and programs which significantly reduce infant and child mortality below present levels will lead couples to have fewer children. However, we must recognize that there is a lag of at least several years before parents (and cultures and subcultures) become confident that their children are more likely to survive and to adjust their fertility behavior accordingly.

Considerable reduction in infant and child mortality is possible through improvement in nutrition, inoculations against diseases, and other public health measures if means can be devised for extending such services to neglected LDC populations on a low-cost basis. It often makes sense to combine such activities with family planning services in integrated delivery systems in order to maximize the use of scarce LDC financial and health manpowder (sic.) resources (See Section IV). In addition, providing selected health care for both mothers and their children can enhance the acceptability of family planning by showing concern for the whole condition of the mother and her children and not just for the single factor of fertility.

The two major cost-effective problems in maternal-child health care are that clinical health care delivery systems have not in the past accounted for much of the reduction in infant mortality and that, as in the U.S., local medical communities tend to favor relatively expensive quality health care, even at the cost of leaving large numbers of people (in the LDC's generally over two-thirds of the people) virtually uncovered by modern health services.

Although we do not have all the answers on how to develop inexpensive, integrated delivery systems, we need to proceed with operational programs to respond to ODC requests if they are likely to be cost-effective based on experience to date, and to experiment on a large scale with innovative ways of tackling the outstanding problems. Evaluation mechanisms for measuring the impact of various courses of action are an essential part of this effort in order to provide feedback for current and future projects and to improve the state of the art in this field.

Currently, efforts to develop low-cost health and family planning services for neglected populations in the LDC's are impeded because of the lack of international commitment and resources to the health side. For example:

A. The World Bank could supply low-interest credits to LDCs for the development of low-cost health-related services to neglected populations but has not yet made a policy decision to do so. The Bank has a population and health program and the program's leaders have been quite sympathetic with the above objective. The Bank's staff has prepared a policy paper on this subject for the Board but prospects for it are not good. Currently, the paper will be discussed by the Bank Board at its November 1974 meeting. Apparently there is some reticence within the Bank's Board and in parts of the staff about making a strong initiative in this area. In part, the Bank argues that there are not proven models of effective, low-cost health systems in which the Bank can invest. The Bank also argues that other sectors such as agriculture, should receive higher priority in the competition for scarce resources. In addition, arguments are made in some quarters of the Bank that the Bank ought to restrict itself to "hard loan projects" and not get into the "soft" area.

A current reading from the Bank's staff suggests that unless there is some change in the thinking of the Bank Board, the Bank's policy will be simply to keep trying to help in the population and health areas but not to take any large initiative in the low-cost delivery system area.

The Bank stance is regrettable because the Bank could play a very useful role in this area helping to fund low-cost physical structures and other elements of low-cost health systems, including rural health clinics where needed. It could also help in providing low-cost loans for training, and in seeking and testing new approaches to reaching those who do not now have access to health and family planning services. This would not be at all inconsistent with our and the Bank's frankly admitting that we do not have all the "answer" or cost-effective models for low-cost health delivery systems. Rather they, we and other donors could work together on experimentally oriented, operational programs to develop models for the wide variety of situations faced by LDCs.

Involvement of the Bank in this area would open up new possibilities for collaboration. Grant funds, whether from the U.S. or UNFPA, could be used to handle the parts of the action that require short lead times such as immediate provision of supplies, certain kinds of training and rapid deployment of technical assistance. Simultaneously, for parts of the action that require longer lead times, such as building clinics, World Bank loans could be employed. The Bank's lending processes could be synchronized to bring such building activity to a readiness condition at the time the training programs have moved along far enough to permit manning of the facilities. The emphasis should be on meeting low-cost rather than high-cost infrastructure requirements.

Obviously, in addition to building, we assume the Bank could fund other local-cost elements of expansion of health systems such as longer-term training programs.

AID is currently trying to work out improved consultation procedures with the Bank staff in the hope of achieving better collaborative efforts within the Bank's current commitment of resources in the population and health areas. With a greater commitment of Bank resources and improved consultation with AID and UNFPA, a much greater dent could be made on the overall problem.

B. The World Health Organization (WHO) and its counterpart for Latin America, the Pan American Health Organization (PAHO), currently provide technical assistance in the development and implementation of health projects which are in turn financed by international funding mechanisms such as UNDP and the International Financial Institutions. However, funds available for health actions through these organizations are limited at present. Higher priority by the international funding agencies to health actions could expand the opportunities for useful collaborations among donor institutions and countries to develop low-cost integrated health and family planning delivery systems for LDC populations that do not now have access to such services.

Recommendations:

The U.S. should encourage heightened international interest in and commitment of resources to developing delivery mechanisms for providing integrated health and family planning services to neglected populations at costs which host countries can support within a reasonable period of time. Efforts would include:

1. Encouraging the World Bank and other international funding mechanisms, through the U.S. representatives on the boards of these organizations, to take a broader initiative in the development of inexpensive service delivery mechanisms in countries wishing to expand such systems.

2. Indicating U.S. willingness (as the U.S. did at the World Population Conference) to join with other donors and organizations to encourage and support further action by LDC governments and other institutions in the low-cost delivery systems area.

A. As offered at Bucharest, the U.S. should join donor countries, WHO, UNFPA, UNICEF and the World Bank to create a consortium to offer assistance to the more needy developing countries to establish their own low-cost preventive and curative public health systems reaching into all areas of their countries and capable of national support within a reasonable period. Such systems would include family planning services as an ordinary part of their overall services.

B. The WHO should be asked to take the leadership in such an arrangement and is ready to do so. Apparently at least half of the potential donor countries and the EEC's technical assistance program are favorably inclined. So is the UNFPA and UNICEF. The U.S., through its representation on the World Bank Board, should encourage a broader World Bank initiative in this field, particularly to assist in the development of inexpensive, basic health service infrastructures in countries wishing to undertake the development of such systems.

3. Expanding Wage Employment Opportunities, Especially for Women

Discussion

Employment is the key to access to income, which opens the way to improved health, education, nutrition, and reduced family size. Reliable job opportunities enable parents to limit their family size and invest in the welfare of the children they have.

The status and utilization of women in LDC societies is particularly important in reducing family size. For women, employment outside the home offers an alternative to early marriage and childbearing, and an incentive to have fewer children after marriage. The woman who must stay home to take care of her children must forego the income she could earn outside the home. Research indicates that female wage employment outside the home is related to fertility reduction. Programs to increase the women's labor force participation must, however, take account of the overall demand for labor; this would be a particular problem in occupations where there is already widespread unemployment among males. But other occupations where women have a comparative advantage can be encouraged.

Improving the legal and social status of women gives women a greater voice in decision-making about their lives, including family size, and can provide alternative opportunities to childbearing, thereby reducing the benefits of having children.

The U.S. Delegation to the Bucharest Conference emphasized the importance of improving the general status of women and of developing employment opportunities for women outside the home and off the farm. It was joined by all countries in adopting a strong statement on this vital issue. See Chapter VI for a fuller discussion of the conference.

Recommendation:

1. AID should communicate with and seek opportunities to assist national economic development programs to increase the role of women in the development process.

2. AID should review its education/training programs (such as U.S. participant training, in-country and third-country training) to see that such activities provide equal access to women.

3. AID should enlarge pre-vocational and vocational training to involve women more directly in learning skills which can enhance their income and status in the community (e.g. paramedical skills related to provision of family planning services).

4. AID should encourage the development and placement of LDC women as decision-makers in development programs, particularly those programs designed to increase the role of women as producers of goods and services, and otherwise to improve women's welfare (e.g. national credit and finance programs, and national health and family planning programs).

5. AID should encourage, where possible, women's active participation in the labor movement in order to promote equal pay for equal work, equal benefits, and equal employment opportunities.

6. AID should continue to review its programs and projects for their impact on LDC women, and adjust them as necessary to foster greater participation of women - particularly those in the lowest classes - in the development process.

4. Developing Alternatives to the Social Security Role Provided By Children to Aging Parents

Discussion:

In most LDCs the almost total absence of government or other institutional forms of social security for old people forces dependence on children for old age survival. The need for such support appears to be one of the important motivations for having numerous children. Several proposals have been made, and a few pilot experiments are being conducted, to test the impact of financial incentives designed to provide old age support (or, more tangentially, to increase the earning power of fewer children by financing education costs parents would otherwise bear). Proposals have been made for son-insurance (provided to the parents if they have no more than three children), and for deferred payments of retirement benefits (again tied to specified limits on family size), where the payment of the incentive is delayed. The intent is not only to tie the incentive to actual fertility, but to impose the financial cost on the government or private sector entity only after the benefits of the avoided births have accrued to the economy and the financing entity. Schemes of varying administrative complexity have been developed to take account of management problems in LDCs. The economic and equity core of these long-term incentive proposals is simple: the government offers to return to the contracting couple a portion of the economic dividend they generate by avoiding births, as a direct trade-off for the personal financial benefits they forego by having fewer children.

Further research and experimentation in this area needs to take into account the impact of growing urbanization in LDCs on traditional rural values and outlooks such as the desire for children as old-age insurance.

Recommendation:

AID should take a positive stance with respect to exploration of social security type incentives as described above. AID should encourage governments to consider such measures, and should provide financial and technical assistance where appropriate. The recommendation made earlier to establish an "intermediary" institutional capacity which could provide LDC governments with substantial assistance in this area, among several areas on the "demand" side of the problem, would add considerably to AID's ability to carry out this recommendation.

5. Pursuing Development Strategies that Skew Income Growth Toward the Poor, Especially Rural Development Focusing on Rural Poverty

Income distribution and rural development: The higher a family's income, the fewer children it will probably have, except at the very top of the income scale. Similarly, the more evenly distributed the income in a society, the lower the overall fertility rate seems to be since better income distribution means that the poor, who have the highest fertility, have higher income. Thus a development strategy which emphasizes the rural poor, who are the largest and poorest group in most LDCs would be providing income increases to those with the highest fertility levels. No LDC is likely to achieve population stability unless the rural poor participate in income increases and fertility declines.

Agriculture and rural development is already, along with population, the U.S. Government's highest priority in provision of assistance to LDCs. For FY 1975, about 60% of the $1.13 billion AID requested in the five functional areas of the foreign assistance legislation is in agriculture and rural development. The $255 million increase in the FY 1975 level authorized in the two year FY 1974 authorization bill is virtually all for agriculture and rural development.

AID's primary goal in agriculture and rural development is concentration in food output and increases in the rural quality of life; the major strategy element is concentration on increasing the output of small farmers, through assistance in provision of improved technologies, agricultural inputs, institutional supports, etc.

This strategy addresses three U.S. interests: First, it increases agricultural output in the LDCs, and speeds up the average pace of their development, which, as has been noted, leads to increased acceptance of family planning. Second, the emphasis on small farmers and other elements of the rural poor spreads the benefits of development as broadly as is feasible among lower income groups. As noted above spreading the benefits of development to the poor, who tend to have the highest fertility rates, is an important step in getting them to reduce their family size. In addition, the concentration on small farmer production (vs., for example, highly mechanized, large-scale agriculture) can increase on and off farm rural job opportunities and decrease the flow to the cities. While fertility levels in rural areas are higher than in the cities, continued rapid migration into the cities at levels greater than the cities' job markets or services can sustain adds an important destabilizing element to development efforts and goals of many countries. Indeed, urban areas in some LDCs are already the scene of urban unrest and high crime rates.

Recommendation

AID should continue its efforts to focus not just on agriculture and rural development but specifically on small farmers and on labor-intensive means of stimulating agricultural output and on other aspects of improving the quality of life of the rural poor, so that agriculture and rural development assistance, in addition to its importance for increased food production and other purposes, can have maximum impact on reducing population growth.

6. Concentration on Education and Indoctrination of The Rising Generation of Children Regarding the Desirability of Smaller Family Size

Discussion:

Present efforts at reducing birth rates in LDCs, including AID and UNFPA assistance, are directed largely at adults now in their reproductive years. Only nominal attention is given to population education or sex education in schools and in most countries none is given in the very early grades which are the only attainment of 2/3-3/4 of the children. It should be obvious, however, that efforts at birth control directed toward adults will with even maximum success result in acceptance of contraception for the reduction of births only to the level of the desired family size -- which knowledge, attitude and practice studies in many countries indicate is an average of four or more children.

The great necessity is to convince the masses of the population that it is to their individual and national interest to have, on the average, only three and then only two children. There is little likelihood that this result can be accomplished very widely against the background of the cultural heritage of today's adults, even the young adults, among the masses in most LDCs. Without diminishing in any way the effort to reach these adults, the obvious increased focus of attention should be to change the attitudes of the next generation, those who are now in elementary school or younger. If this could be done, it would indeed be possible to attain a level of fertility approaching replacement in 20 years and actually reaching it in 30.

Because a large percentage of children from high-fertility, low-income groups do not attend school, it will be necessary to develop means to reach them for this and other educational purposes through informal educational programs. As the discussion earlier of the determinants of family size (fertility) pointed out, it is also important to make significant progress in other areas, such as better health care and improvements in income distribution, before desired family size can be expected to fall sharply. If it makes economic sense for poor parents to have large families twenty years from now, there is no evidence as to whether population education or indoctrination will have sufficient impact alone to dissuade them.

Recommendation

1. That U.S. agencies stress the importance of education of the next generation of parents, starting in elementary schools, toward a two-child family ideal. 2. That AID stimulate specific efforts to develop means of educating children of elementary school age to the ideal of the two-child family and that UNESCO be asked to take the lead through formal and informal education. General Recommendation for UN Agencies

As to each of the above six categories State and AID should make specific efforts to have the relevant UN agency, WHO, ILO, FAO, UNESCO, UNICEF, and the UNFPA take its proper role of leadership in the UN family with increased program effort, citing the World Population Plan of Action.

II.

C. Food for Peace Program and Population

Discussion:

One of the most fundamental aspects of the impact of population growth on the political and economic well-being of the globe is its relationship to food. Here the problem of the interrelationship of population, national resources, environment, productivity and political and economic stability come together when shortages of this basic human need occur.

USDA projections indicate that the quantity of grain imports needed by the LDCs in the 1980s will grow significantly, both in overall and per capita terms. In addition, these countries will face year-to-year fluctuations in production due to the influence of weather and other factors.

This is not to say that the LDCs need face starvation in the next two decades, for the same projections indicate an even greater increase in production of grains in the developed nations. It should be pointed out, however, that these projections assume that such major problems as the vast increase in the need for fresh water, the ecological effects of the vast increase in the application of fertilizer, pesticides, and irrigation, and the apparent adverse trend in the global climate, are solved. At present, there are no solutions to these problems in sight.

The major challenge will be to increase food production in the LDCs themselves and to liberalize the system in which grain is transferred commercially from producer to consumer countries. We also see food aid as an important way of meeting part of the chronic shortfall and emergency needs caused by year-to-year variation at least through the end of this decade. Many outside experts predict just such difficulties even if major efforts are undertaken to expand world agricultural output, especially in the LDCs themselves but also in the U.S. and in other major feed grain producers. In the longer run, LDCs must both decrease population growth and increase agricultural production significantly. At some point the "excess capacity" of the food exporting countries will run out. Some countries have already moved from a net food exporter to a net importer of food.

There are major interagency studies now progressing in the food area and this report cannot go deeply into this field. It can only point to serious problems as they relate to population and suggest minimum requirements and goals in the food area. In particular, we believe that population growth may have very serious negative consequences on food production in the LDCs including over-expectations of the capacity of the land to produce, downgrading the ecological economics of marginal areas, and overharvesting the seas. All of these conditions may affect the viability of the world's economy and thereby its prospects for peace and security.

Recommendations:

Since NSC/CIEP studies are already underway we refer the reader to them. However the following, we believe, are minimum requirements for any strategy which wishes to avoid instability and conflict brought on by population growth and food scarcity:

(1) High priority for U.S. bilateral and multilateral LDC Agricultural Assistance; including efforts by the LDCs to improve food production and distribution with necessary institutional adjustments and economic policies to stimulate efficient production. This must include a significant increase in financial and technical aid to promote more efficient production and distribution in the LDCs.

(2) Development of national food stocks15 (including those needed for emergency relief) within an internationally agreed framework sufficient to provide an adequate level of world food security;

(3) Expansion of production of the input elements of food production (i.e., fertilizer, availability of water and high yield seed stocks) and increased incentives for expanded agricultural productivity. In this context a reduction in the real cost of energy (especially fuel) either through expansion in availability through new sources or decline in the relative price of oil or both would be of great importance;

(4) Significant expansion of U.S. and other producer country food crops within the context of a liberalized and efficient world trade system that will assure food availability to the LDCs in case of severe shortage. New international trade arrangements for agricultural products, open enough to permit maximum production by efficient producers and flexible enough to dampen wide price fluctuations in years when weather conditions result in either significant shortfalls or surpluses. We believe this objective can be achieved by trade liberalization and an internationally coordinated food reserve program without resorting to price-oriented agreements, which have undesirable effects on both production and distribution;

(5) The maintenance of an adequate food aid program with a clearer focus on its use as a means to make up real food deficits, pending the development of their own food resources, in countries unable to feed themselves rather than as primarily an economic development or foreign policy instrument; and

(6) A strengthened research effort, including long term, to develop new seed and farming technologies, primarily to increase yields but also to permit more extensive cultivation techniques, particularly in LDCs.

III. International Organizations and other Multilateral Population Programs

A. UN Organization and Specialized Agencies

Discussion

In the mid-sixties the UN member countries slowly began to agree on a greater involvement of the United Nations in population matters. In 1967 the Secretary-General created a Trust Fund to finance work in the population field. In 1969 the Fund was renamed the United Nations Fund for Population Activities (UNFPA) and placed under the overall supervision of the United Nations Development Program. During this period, also, the mandates of the Specialized Agencies were modified to permit greater involvement by these agencies in population activities.

UNFPA's role was clarified by an ECOSOC resolution in 1973: (a) to build up the knowledge and capacity to respond to the needs in the population and family planning fields; (b) to promote awareness in both developed and developing countries of the social, economic, and environmental implications of population problems; (c) to extend assistance to developing countries; and (d) to promote population programs and to coordinate projects supported by the UNFPA.

Most of the projects financed by UNFPA are implemented with the assistance of organizations of the Untied Nations system, including the regional Economic Commission, United Nations Children's Fund (UNICEF), International Labour Organization (ILO), Food and Agriculture Organization (FAO), United Nations Educational Scientific and Cultural Organization (UNESCO), the World Health Organization (WHO). Collaborative arrangements have been made with the International Development Association (IDA), an affiliate of the World Bank, and with the World Food Programme.

Increasingly the UNFPA is moving toward comprehensive country programs negotiated directly with governments. This permits the governments to select the implementing (executing) agency which may be a member of the UN system or a non-government organization or company. With the development of the country program approach it is planned to level off UNFPA funding to the specialized agencies.

UNFPA has received $122 million in voluntary contributions from 65 governments, of which $42 million was raised in 1973. The Work Plan of UNFPA for 1974-77 sets a $280 million goal for fund-raising, as follows:


     1974 - $54 million
     1975 - $64 million
     1976 - $76 million
     1977 - $86 million




Through 1971 the U.S. had contributed approximately half of all the funds contributed to UNFPA. In 1972 we reduced our matching contribution to 48 percent of other donations, and for 1973 we further reduced our contribution to 45%. In 1973 requests for UNFPA assistance had begun to exceed available resources. This trend has accelerated and demand for UNFPA resources is now strongly outrunning supply. Documented need for UNFPA assistance during the years 1974-77 is $350 million, but because the UNFPA could anticipate that only $280 million will be available it has been necessary to phase the balance to at least 1978.

Recommendations

The U.S. should continue its support of multilateral efforts in the population field by:

a) increasing, subject to congressional appropriation action, the absolute contribution to the UNFPA in light of 1) mounting demands for UNFPA Assistance, 2) improving UNFPA capacity to administer projects, 3) the extent to which UNFPA funding aims at U.S. objectives and will substitute for U.S. funding, 4) the prospect that without increased U.S. contributions the UNFPA will be unable to raise sufficient funds for its budget in 1975 and beyond;

b) initiating or participating in an effort to increase the resources from other donors made available to international agencies that can work effectively in the population area as both to increase overall population efforts and, in the UNFPA, to further reduce the U.S. percentage share of total contributions; and

c) supporting the coordinating role which UNFPA plays among donor and recipient countries, and among UN and other organizations in the population field, including the World Bank.

B. Encouraging Private Organizations

Discussion:

The cooperation of private organizations and groups on a national, regional and world-wide level is essential to the success of a comprehensive population strategy. These groups provide important intellectual contributions and policy support, as well as the delivery of family planning and health services and information. In some countries, the private and voluntary organizations are the only means of providing family planning services and materials.

Recommendations:

AID should continue to provide support to those private U.S. and international organizations whose work contributes to reducing rapid population growth, and to develop with them, where appropriate, geographic and functional divisions of labor in population assistance.

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

In addition to creating the climate for fertility decline, as described in a previous section, it is essential to provide safe and effective techniques for controlling fertility.

There are two main elements in this task: (a) improving the effectiveness of the existing means of fertility control and developing new ones; and (b) developing low-cost systems for the delivery of family planning technologies, information and related services to the 85% of LDC populations not now reached.

Legislation and policies affecting what the U.S. Government does relative to abortion in the above areas is discussed at the end of this section.

IV. A. Research to Improve Fertility Control Technology

Discussion

The effort to reduce population growth requires a variety of birth control methods which are safe, effective, inexpensive and attractive to both men and women. The developing countries in particular need methods which do not require physicians and which are suitable for use in primitive, remote rural areas or urban slums by people with relatively low motivation. Experiences in family planning have clearly demonstrated the crucial impact of improved technology on fertility control.

None of the currently available methods of fertility control is completely effective and free of adverse reactions and objectionable characteristics. The ideal of a contraceptive, perfect in all these respects, may never be realized. A great deal of effort and money will be necessary to improve fertility control methods. The research to achieve this aim can be divided into two categories:

1. Short-term approaches: These include applied and developmental work which is required to perfect further and evaluate the safety and role of methods demonstrated to be effective in family planning programs in the developing countries.

Other work is directed toward new methods based on well established knowledge about the physiology of reproduction. Although short term pay-offs are possible, successful development of some methods may take 5 years and up to $15 million for a single method.

2. Long-term approaches: The limited state of fundamental knowledge of many reproductive processes requires that a strong research effort of a more basic nature be maintained to elucidate these processes and provide leads for contraceptive development research. For example, new knowledge of male reproductive processes is needed before research to develop a male "pill" can come to fruition. Costs and duration of the required research are high and difficult to quantify.

With expenditures of about $30 million annually, a broad program of basic and applied bio-medical research on human reproduction and contraceptive development is carried out by the Center for Population Research of the National Institute of Child Health and Human Development. The Agency for International Development annually funds about $5 million of principally applied research on new means of fertility control suitable for use in developing countries.

Smaller sums are spent by other agencies of the U.S. Government. Coordination of the federal research effort is facilitated by the activities of the Interagency Committee on Population Research. This committee prepares an annual listing and analyses of all government supported population research programs. The listing is published in the Inventory of Federal Population Research.

A variety of studies have been undertaken by non-governmental experts including the U.S. Commission on Population Growth and the American Future. Most of these studies indicate that the United States effort in population research is insufficient. Opinions differ on how much more can be spent wisely and effectively but an additional $25-50 million annually for bio-medical research constitutes a conservative estimate.

Recommendations:

A stepwise increase over the next 3 years to a total of about $100 million annually for fertility and contraceptive research is recommended. This is an increase of $60 million over the current $40 million expended annually by the major Federal Agencies for bio-medical research. Of this increase $40 million would be spent on short-term, goal directed research. The current expenditure of $20 million in long-term approaches consisting largely of basic bio-medical research would be doubled. This increased effort would require significantly increased staffing of the federal agencies which support this work. Areas recommended for further research are:

1. Short-term approaches: These approaches include improvement and field testing of existing technology and development of new technology. It is expected that some of these approaches would be ready for use within five years. Specific short term approaches worthy of increased effort are as follows:

a. Oral contraceptives have become popular and widely used; yet the optimal steroid hormone combinations and doses for LDC populations need further definition. Field studies in several settings are required. Approx. Increased Cost: $3 million annually.

b. Intra-uterine devices of differing size, shape, and bioactivity should be developed and tested to determine the optimum levels of effectiveness, safety, and acceptability. Approx. Increased Cost: $3 million annually.

c. Improved methods for ovulation prediction will be important to those couples who wish to practice rhythm with more assurance of effectiveness than they now have. Approx. Increased Cost: $3 million annually.

d. Sterilization of men and women has received wide-spread acceptance in several areas when a simple, quick, and safe procedure is readily available. Female sterilization has been improved by technical advances with laparoscopes, culdoscopes, and greatly simplifies abdominal surgical techniques. Further improvements by the use of tubal clips, trans-cervical approaches, and simpler techniques can be developed. For men several current techniques hold promise but require more refinement and evaluation. Approx. Increased Cost $6 million annually.

e. Injectable contraceptives for women which are effective for three months or more and are administered by para-professionals undoubtedly will be a significant improvement. Currently available methods of this type are limited by their side effects and potential hazards. There are reasons to believe that these problems can be overcome with additional research. Approx. Increased Cost: $5 million annually.

f. Leuteolytic and anti-progesterone approaches to fertility control including use of prostaglandins are theoretically attractive but considerable work remains to be done. Approx. Increased Cost: $7 million annually.

g. Non-Clinical Methods. Additional research on non-clinical methods including foams, creams, and condoms is needed. These methods can be used without medical supervision. Approx. Increased Cost; $5 million annually.

h. Field studies. Clinical trials of new methods in use settings are essential to test their worth in developing countries and to select the best of several possible methods in a given setting. Approx. Increased Cost: $8 million annually.

2. Long-term approaches: Increased research toward better understanding of human reproductive physiology will lead to better methods of fertility control for use in five to fifteen years. A great deal has yet to be learned about basic aspects of male and female fertility and how regulation can be effected. For example, an effective and safe male contraceptive is needed, in particular an injection which will be effective for specified periods of time. Fundamental research must be done but there are reasons to believe that the development of an injectable male contraceptive is feasible. Another method which should be developed is an injection which will assure a woman of regular periods. The drug would be given by para-professionals once a month or as needed to regularize the menstrual cycle. Recent scientific advances indicate that this method can be developed. Approx. Increased Cost: $20 million annually.

Development of Low-cost Delivery Systems

Discussion

Exclusive of China, only 10-15% of LDC populations are currently effectively reached by family planning activities. If efforts to reduce rapid population growth are to be successful it is essential that the neglected 85-90% of LDC populations have access to convenient, reliable family planning services. Moreover, these people -- largely in rural but also in urban areas -- not only tend to have the highest fertility, they simultaneously suffer the poorest health, the worst nutritional levels, and the highest infant mortality rates.

Family planning services in LDCs are currently provided by the following means:

1. Government-run clinics or centers which offer family planning services alone;

2. Government-run clinics or centers which offer family planning as part of a broader based health service;

3. Government-run programs that emphasize door to door contact by family planning workers who deliver contraceptives to those desiring them and/or make referrals to clinics;

4. Clinics or centers run by private organizations (e.g., family planning associations);

5. Commercial channels which in many countries sell condoms, oral contraceptives, and sometimes spermicidal foam over the counter;

6. Private physicians.

Two of these means in particular hold promise for allowing significant expansion of services to the neglected poor:

1. Integrated Delivery Systems. This approach involves the provision of family planning in conjunction with health and/or nutrition services, primarily through government-run programs. There are simple logistical reasons which argue for providing these services on an integrated basis. Very few of the LDCs have the resources, both in financial and manpower terms, to enable them to deploy individual types of services to the neglected 85% of their populations. By combining a variety of services in one delivery mechanism they can attain maximum impact with the scarce resources available.

In addition, the provision of family planning in the context of broader health services can help make family planning more acceptable to LDC leaders and individuals who, for a variety of reasons (some ideological, some simply humanitarian) object to family planning. Family planning in the health context shows a concern for the well-being of the family as a whole and not just for a couple's reproductive function.

Finally, providing integrated family planning and health services on a broad basis would help the U.S. contend with the ideological charge that the U.S. is more interested in curbing the numbers of LDC people than it is in their future and well-being. While it can be argued, and argued effectively, that limitation of numbers may well be one of the most critical factors in enhancing development potential and improving the chances for well-being, we should recognize that those who argue along ideological lines have made a great deal of the fact that the U.S. contribution to development programs and health programs has steadily shrunk, whereas funding for population programs has steadily increased. While many explanations may be brought forward to explain these trends, the fact is that they have been an ideological liability to the U.S. in its crucial developing relationships with the LDCs. A.I.D. currently spends about $35 million annually in bilateral programs on the provision of family planning services through integrated delivery systems. Any action to expand such systems must aim at the deployment of truly low-cost services. Health-related services which involve costly physical structures, high skill requirements, and expensive supply methods will not produce the desired deployment in any reasonable time. The basic test of low-cost methods will be whether the LDC governments concerned can assume responsibility for the financial, administrative, manpower and other elements of these service extensions. Utilizing existing indigenous structures and personnel (including traditional medical practitioners who in some countries have shown a strong interest in family planning) and service methods that involve simply-trained personnel, can help keep costs within LDC resource capabilities.

2. Commercial Channels. In an increasing number of LDCs, contraceptives (such as condoms, foam and the Pill) are being made available without prescription requirements through commercial channels such as drugstores.16 The commercial approach offers a practical, low-cost means of providing family planning services, since it utilizes an existing distribution system and does not involve financing the further expansion of public clinical delivery facilities. Both A.I.D. and private organizations like the IPPF are currently testing commercial distribution schemes in various LDCs to obtain further information on the feasibility, costs, and degree of family planning acceptance achieved through this approach. A.I.D. is currently spending about $2 million annually in this area.

In order to stimulate LDC provision of adequate family planning services, whether alone or in conjunction with health services, A.I.D. has subsidized contraceptive purchases for a number of years. In FY 1973 requests from A.I.D. bilateral and grantee programs for contraceptive supplies -- in particular for oral contraceptives and condoms -- increased markedly, and have continued to accelerate in FY 1974. Additional rapid expansion in demand is expected over the next several years as the accumulated population/family planning efforts of the past decade gain momentum.

While it is useful to subsidize provision of contraceptives in the short term in order to expand and stimulate LDC family planning programs, in the long term it will not be possible to fully fund demands for commodities, as well as other necessary family planning actions, within A.I.D. and other donor budgets. These costs must ultimately be borne by LDC governments and/or individual consumers. Therefore, A.I.D. will increasingly focus on developing contraceptive production and procurement capacities by the LDCs themselves. A.I.D. must, however, be prepared to continue supplying large quantities of contraceptives over the next several years to avoid a detrimental hiatus in program supply lines while efforts are made to expand LDC production and procurement actions. A.I.D. should also encourage other donors and multilateral organizations to assume a greater share of the effort, in regard both to the short-term actions to subsidize contraceptive supplies and the longer-term actions to develop LDC capacities for commodity production and procurement.

Recommendations:

1. A.I.D. should aim its population assistance program to help achieve adequate coverage of couples having the highest fertility who do not now have access to family planning services.

2. The service delivery approaches which seem to hold greatest promise of reaching these people should be vigorously pursued. For example:

a. The U.S. should indicate its willingness to join with other donors and organizations to encourage further action by LDC governments and other institutions to provide low-cost family planning and health services to groups in their populations who are not now reached by such services. In accordance with Title X of the AID Legislation and current policy, A.I.D. should be prepared to provide substantial assistance in this area in response to sound requests.

b. The services provided must take account of the capacities of the LDC governments or institutions to absorb full responsibility, over reasonable timeframes, for financing and managing the level of services involved.

c. A.I.D. and other donor assistance efforts should utilize to the extent possible indigenous structures and personnel in delivering services, and should aim at the rapid development of local (community) action and sustaining capabilities.

d. A.I.D. should continue to support experimentation with commercial distribution of contraceptives and application of useful findings in order to further explore the feasibility and replicability of this approach. Efforts in this area by other donors and organizations should be encouraged. Approx. U.S. Cost: $5-10 million annually.

3. In conjunction with other donors and organizations, A.I.D. should actively encourage the development of LDC capabilities for production and procurement of needed family planning contraceptives. 17

C. Utilization of Mass Media and Satellite Communications Systems for Family Planning

1. Utilization of Mass Media for Dissemination of Family Planning Services and Information

The potential of education and its various media is primarily a function of (a) target populations where socio-economic conditions would permit reasonable people to change their behavior with the receipt of information about family planning and (b) the adequate development of the substantive motivating context of the message. While dramatic limitations in the availability of any family planning related message are most severe in rural areas of developing countries, even more serious gaps exist in the understanding of the implicit incentives in the system for large families and the potential of the informational message to alter those conditions.

Nevertheless, progress in the technology for mass media communications has led to the suggestion that the priority need might lie in the utilization of this technology, particularly with large and illiterate rural populations. While there are on-going efforts they have not yet reached their full potential. Nor have the principal U.S. agencies concerned yet integrated or given sufficient priority to family planning information and population programs generally.

Yet A.I.D.'s work suggests that radio, posters, printed material, and various types of personal contacts by health/family planning workers tend to be more cost-effective than television except in those areas (generally urban) where a TV system is already in place which reaches more than just the middle and upper classes. There is great scope for use of mass media, particularly in the initial stages of making people aware of the benefits of family planning and of services available; in this way mass media can effectively complement necessary interpersonal communications.

In almost every country of the world there are channels of communication (media) available, such, as print media, radio, posters, and personal contacts, which already reach the vast majority of the population. For example, studies in India - with only 30% literacy, show that most of the population is aware of the government's family planning program. If response is low it is not because of lack of media to transmit information.

A.I.D. believes that the best bet in media strategy is to encourage intensive use of media already available, or available at relatively low cost. For example, radio is a medium which in some countries already reaches a sizeable percentage of the rural population; a recent A.I.D. financed study by Stanford indicates that radio is as effective as television, costs one-fifth as much, and offers more opportunities for programming for local needs and for local feedback.

Recommendations

USAID and USIA should encourage other population donors and organizations to develop comprehensive information and educational programs dealing with population and family planning consistent with the geographic and functional population emphasis discussed in other sections. Such programs should make use of the results of AID's extensive experience in this field and should include consideration of social, cultural and economic factors in population control as well as strictly technical and educational ones.

2. Use of U.S. broadcast satellites for dissemination of family planning and health information to key LDC countries

Discussion:

One key factor in the effective use of existing contraceptive techniques has been the problem of education. In particular, this problem is most severe in rural areas of the developing countries. There is need to develop a cost-effective communications system designed for rural areas which, together with local direct governmental efforts, can provide comprehensive health information and in particular, family planning guidance. One new supporting technology which has been under development is the broadcast satellite. NASA and Fairchild have now developed an ATS (Applied Technology Satellite), now in orbit, which has the capability of beaming educational television programs to isolated areas via small inexpensive community receivers.

NASA's sixth Applications Technology Satellite was launched into geosynchronous orbit over the Galapagos Islands on May 30, 1974. It will be utilized for a year in that position to deliver health and educational services to millions of Americans in remote regions of the Rocky Mountain States, Alaska and Appalachia. During this period it will be made available for a short time to Brazil in order to demonstrate how such a broadcast satellite may be used to provide signals to 500 schools in their existing educational television network 1400 miles northeast of Rio de Janeiro in Rio Grande do Norte.

In mid-1975, ATS-6 will be moved to a point over the Indian Ocean to begin beaming educational television to India. India is now developing its broadcast program materials. Signals picked up from one of two Indian ground transmitters will be rebroadcast to individual stations in 2500 villages and to ground relay installations serving networks comprising 3000 more. This operation over India will last one year, after which time India hopes to have its own broadcast satellite in preparation.

Eventually it will be possible to broadcast directly to individual TV sets in remote rural areas. Such a "direct broadcast satellite," which is still under development, could one day go directly into individual TV receivers. At present, broadcast satellite signals go to ground receiving stations and are relayed to individual television sets on a local or regional basis. The latter can be used in towns, villages and schools.

The hope is that these new technologies will provide a substantial input in family planning programs, where the primary constraint lies in informational services. The fact, however, is that information and education does not appear to be the primary constraint in the development of effective family planning programs. AID itself has learned from costly intensive inputs that a supply oriented approach to family planning is not and cannot be fully effective until the demand side - incentives and motivations - are both understood and accounted for.

Leaving this vast problem aside, AID has much relevant experience in the numerous problems encountered in the use of modern communications media for mass rural education. First, there is widespread LDC sensitivity to satellite broadcast, expressed most vigorously in the Outer Space Committee of the UN. Many countries don't want broadcasts of neighboring countries over their own territory and fear unwanted propaganda and subversion by hostile broadcasters. NASA experience suggests that the U.S. #notemust tread very softly when discussing assistance in program content. International restrictions may be placed on the types of proposed broadcasts and it remains technically difficult to restrict broadcast area coverage to national boundaries. To the extent programs are developed jointly and are appreciated and wanted by receiving countries, some relaxation in their position might occur.

Agreement is nearly universal among practitioners of educational technology that the technology is years ahead of software or content development. Thus cost per person reached tend to be very high. In addition, given the current technology, audiences are limited to those who are willing to walk to the village TV set and listen to public service messages and studies show declining audiences over time with large audiences primarily for popular entertainment. In addition, keeping village receivers in repair is a difficult problem. The high cost of program development remains a serious constraint, particularly since there is so little experience in validifying program content for wide general audiences.

With these factors it is clear that one needs to proceed slowly in utilization of this technology for the LDCs in the population field.

Recommendations:

1. The work of existing networks on population, education, ITV, and broadcast satellites should be brought together to better consolidate relative priorities for research, experimentation and programming in family planning. Wider distribution of the broad AID experience in these areas would probably be justified. This is particularly true since specific studies have already been done on the experimental ATS-6 programs in the U.S., Brazil, and India and each clearly documents the very experimental character and high costs of the effort. Thus at this point it is clearly inconsistent with U.S. or LDC population goals to allocate large additional sums for a technology which is experimental.

2. Limited donor and recipient family planning funds available for education/motivation must be allocated on a cost-effectiveness basis. Satellite TV may have opportunities for cost-effectiveness primarily where the decision has already been taken -- on other than family planning grounds -- to undertake very large-scale rural TV systems. Where applicable in such countries satellite technology should be used when cost-effective. Research should give special attention to costs and efficiency relative to alternative media.

3. Where the need for education is established and an effective format has been developed, we recommend more effective exploitation of existing and conventional media: radio, printed material, posters, etc., as discussed under part I above.

V. Action to Develop World-Wide Political and Popular Commitment to Population Stability

Discussion:

A far larger, high-level effort is needed to develop a greater commitment of leaders of both developed and developing countries to undertake efforts, commensurate with the need, to bring population growth under control.

In the United States, we do not yet have a domestic population policy despite widespread recognition that we should -- supported by the recommendations of the remarkable Report of the Commission on Population Growth and the American Future.

Although world population growth is widely recognized within the Government as a current danger of the highest magnitude calling for urgent measures, it does not rank high on the agendas of conversations with leaders of other nations.

Nevertheless, the United States Government and private organizations give more attention to the subject than any donor countries except, perhaps, Sweden, Norway and Denmark. France makes no meaningful contribution either financially or verbally. The USSR no longer opposes efforts of U.S. agencies but gives no support.

In the LDCs, although 31 countries, including China, have national population growth control programs and 16 more include family planning in their national health services -- at least in some degree -- the commitment by the leadership in some of these countries is neither high nor wide. These programs will have only modest success until there is much stronger and wider acceptance of their real importance by leadership groups. Such acceptance and support will be essential to assure that the population information, education and service programs have vital moral backing, administrative capacity, technical skills and government financing.

Recommendations:

1. Executive Branch

a. The President and the Secretary of State should make a point of discussing our national concern about world population growth in meetings with national leaders where it would be relevant.

b. The Executive Branch should give special attention to briefing the Congress on population matters to stimulate support and leadership which the Congress has exercised in the past. A program for this purpose should be developed by S/PM with H and AID.

2. World Population Conference

a. In addition to the specific recommendations for action listed in the preceding sections, U.S. agencies should use the prestige of the World Population Plan of Action to advance all of the relevant action recommendations made by it in order to generate more effective programs for population growth limitation. AID should coordinate closely with the UNFPA in trying to expand resources for population assistance programs, especially from non-OECD, non-traditional donors.

The U.S. should continue to play a leading role in ECOSOC and General Assembly discussions and review of the WPPA.

3. Department of State

a. The State Department should urge the establishment at U.N. headquarters of a high level seminar for LDC cabinet and high level officials and non-governmental leaders of comparable responsibility for indoctrination in population matters. They should have the opportunity in this seminar to meet the senior officials of U.N. agencies and leading population experts from a variety of countries.

b. The State Department should also encourage organization of a UNFPA policy staff to consult with leaders in population programs of developing countries and other experts in population matters to evaluate programs and consider actions needed to improve them.

c. A senior officer, preferably with ambassadorial experience, should be assigned in each regional bureau dealing with LDCs or in State's Population Office to give full-time attention to the development of commitment by LDC leaders to population growth reduction.

d. A senior officer should be assigned to the Bureau of International Organization Affairs to follow and press action by the Specialized Agencies of the U.N. in population matters in developing countries.

e. Part of the present temporary staffing of S/PM for the purposes of the World Population Year and the World Population Conference should be continued on a permanent basis to take advantage of momentum gained by the Year and Conference.

Alternate View on 3.c.

c. The Department should expand its efforts to help Ambassadorial and other high-ranking U.S.G. personnel understand the consequences of rapid population growth and the remedial measures possible.

d. The Department would also give increased attention to developing a commitment to population growth reduction on the part of LDC leaders.

e. Adequate manpower should be provided in S/PM and other parts of the Department as appropriate to implement these expanded efforts. 4. A.I.D. should expand its programs to increase the understanding of LDC leaders regarding the consequences of rapid population growth and their commitment to undertaking remedial actions. This should include necessary actions for collecting and analyzing adequate and reliable demographic data to be used in promoting awareness of the problem and in formulating appropriate policies and programs.

5. USIA.

As a major part of U.S. information policy, the improving but still limited programs of USIA to convey information on population matters should be strengthened to a level commensurate with the importance of the subject.


NSM-200 1974 PART-1

NSM-200 1974 PART-2

NSM-200 1974 PART-3


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