The problem of high fertility rates is not limited to sub-Saharan Africa. Women in Asia and other parts of the world are also bearing children at an unsustainable rate. Consequently, some of these countries have adopted national policies to lower fertility. By contrast, Japan and some European nations with the lowest fertility levels and a declining workforce are promoting higher fertility. Still other nations, particularly in the Americas, pursue policies of nonintervention in fertility decisions (Figure 5.19). Before considering how individual countries attempt to manage fertility, let’s step back and consider the factors that have traditionally led families to produce many children.

The lack of effective contraceptives in the past is one of the major reasons why family size has historically been so large. But there are also good reasons why people have wanted to have large families. Poor nutrition, sanitation, and health care meant that many children would die shortly after birth or at a very young age. Large families provide a hedge against loss of children to disease and accidents. As you probably know from growing up, children are a free source of labor to their parents. They can do chores such as tending crops and livestock, and they can help sell goods at the market. As parents and grandparents age, children can help take care of them.

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Today, birth control pills, condoms, sterilization, and other forms of contraception are a key element in most national programs for reducing population growth. The United Nations encourages the use of contraceptives to reduce birthrates where population growth is rapid. Abortion of unwanted and dangerous pregnancies, though controversial, also plays a role in some programs. The UN has stated, “All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so.” The United Nations recognizes the importance of controlling population growth in a manner that respects local laws and customs and encourages all countries to provide “universal access to a full range of safe and reliable family-planning methods and related health services which are not against the law [emphasis added].”

In a 2007 study, the United Nations found that contraceptive use varies little among most world regions (Figure 5.20). Worldwide, the range of contraceptive use by reproductive-age women among most regions varied only from 60% to 73%. The major exception was sub-Saharan Africa, where the rate of contraceptive use averaged 21.5%. However, contraceptive use varies significantly within all regions, including sub-Saharan Africa. The pattern shown in Figure 5.21 indicates a clear correlation between access to contraceptives and reduced birthrates. This relationship suggests that providing access to family-planning information and contraceptives can reduce fertility rates substantially. For instance, in African countries where contraceptive use is prevalent, birthrates are nearly as low as in the most developed countries.

Let’s examine the history of two countries that have invested heavily in population planning. Two of the most prominent examples of national population policies are those of India and China, home to over 35% of the global population.

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Concerned that India’s economic development would be disrupted by the rapid growth of its population, India developed the world’s first national policy on population in 1952. Under India’s National Population Policy, the government provides all citizens with the information and means to make informed choices regarding childbearing. However, participation in any family-planning service is entirely voluntary (Figure 5.22). A key element of India’s population program is collaboration between national planners and local communities to improve prenatal and postnatal health care and to provide access to contraceptives. The program also offers economic incentives to couples that wait until the mother is 21 to have their first child and to stop reproducing after their second child. Public-health campaigns reinforce the advantages of small families over large ones.

Though available funds have been inadequate to entirely meet the goals of its population policy, India has made remarkable progress over the past half-century. After 1951 India’s total fertility rate decreased from 6 children per woman to 2.6 children in 2012 (Figure 5.23). During the same period, the infant mortality rate declined from 146 deaths to 32 deaths per 1,000 live births, while life expectancy at birth increased from 37 years to 67 years. However, some regions of India have achieved exceptional results. For instance, the Indian state of Kerala adopted a population-control plan centered around three “e’s”: education, employment, equality. Kerala’s school system boasts a 90% literacy rate, identical for boys and girls. Educated women join the workforce before having children, and 63% (compared with 48% in India as a whole) use contraceptives. This has stabilized the state’s birthrate at 2.0. Despite this progress, India’s population will continue growing, though at slower and slower rates, through 2050.

In 1970 the Chinese government introduced a voluntary program that simply encouraged smaller families. However, its population continued to swell, and by 1979 China was home to nearly one-quarter of the world’s population, living on 7% of Earth’s land area. That’s when the government made the radical decision to restrict the number of children a family could have, punishing those who broke the rules.

The one-child family policy restricted most families to a single child, a limit that is strictly enforced for government employees and urban dwellers. In rural areas, couples are generally allowed a second child if their first child is a girl. However, the policy stipulates a span of five years between the first and second child. The policy also allows ethnic minorities, such as Mongols, Tibetans, and Uyghurs, as well as other people living in remote areas with low population densities, to have a third child. The one-child policy is supported by a complex system of campaigns promoting small families, reproductive education, universal access to contraceptives, and economic rewards. These measures are backed up by an array of punishments for noncompliance, including substantial fines and confiscation of property.

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The program had dramatic impacts on China’s population dynamics (see Figure 5.23). The total fertility rate in China, which averaged 5.9 children per woman in 1970, fell to 2.9 during the period of voluntary family planning. However, following the establishment of the strict one-child family policy, the total fertility rate fell further, reaching 1.5 children per woman by 2010, well below replacement-level fertility.

Demographers predict that China’s population will peak sometime after 2030 and begin declining thereafter. In contrast, India’s population is projected to continue growing past mid-century to become the most populous nation on earth (Figure 5.24). While effective, China’s one-child policy is considered unethical by some, particularly in Western nations, since it restricts the basic human right to reproduction and has been accompanied by reports of forced sterilizations and abortions. Such concerns have led to some reforms in the policy.

China has been gradually loosening its infamous policy. In 2013 it began allowing a second child when one of the parents was an only child. Previously, both parents had to be an only child in order to qualify. Then, in late 2015, it adopted a blanket two-child policy amid growing concerns about the economic consequences of an aging population. A second concern has been over an imbalance in the number of men and women in China’s population—because the culture has traditionally shown a preference for male children. This phenomenon is not limited to China, however.

The natural sex ratio at birth of human populations, defined as the ratio of male to female newborns, is about 103 to 107 male births for every 100 female births. In other words, there are 3% to 7% more male births than female births. This imbalance evens out with age to a ratio of approximately 100 males to 100 females in the population. That’s because males at all ages are more likely to die from disease and accidents. Recently, however, sex ratios at birth have become highly biased toward males in a number of Asian populations.

The prejudice among parents in North Africa, the Middle East, and Asia is that sons are more valuable than daughters. People in these regions believe that sons are better able to do agricultural work and are more capable of supporting aged parents. They are also, by custom or law, the inheritors of family property and can continue the family line. Today, even as the historical justifications for this bias have faded, families continue to prefer sons, a quest that has been assisted through sex-screening technology, such as ultrasound. Consequently, many of these populations have unbalanced sex ratios.

An imbalance in the proportions of males and females may be one of the unforeseen outcomes of China’s one-child family policy, where the sex ratio at birth was 117 boys to 100 girls in 2001. This difference translates into approximately 1 million excess male births in China each year. Highly male-biased sex ratios at birth also occur in other Asian populations, such as those in India and South Korea, countries that do not have restrictive family-size policies in place. In fact, demographers have documented sex ratios at birth as high as 126:100 in some regions of India. This suggests that prenatal sex screening and sex-selective abortions may be the most important factor distorting the sex ratio.

Countries across Asia have become alarmed about unbalanced sex ratios. Young men in China, concerned by their limited marriage prospects, sometimes take organized tours to neighboring countries, such as Vietnam, in search of a mate. Policy makers fear that populations with millions of single males with no prospects for marriage and family may lead to more violence and social instability. In response, several Asian countries, including India and China, have outlawed prenatal sex screening and sex-selective abortion. India has also increased educational and job opportunities for girls. The government of China has passed laws making it easier for daughters to inherit property and to provide financial benefits, such as waived school fees, to daughter-only families.

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In addition, China has produced public awareness campaigns aimed at warning of the social dangers of an imbalanced sex ratio and extolling the inherent value of a child of either sex (Figure 5.25). Public attitudes appear to be changing in China, where recent surveys have indicated that 37% of women expressed no preference for a son or daughter, and equal numbers, about 6%, preferred either a single daughter or a single son. The remainder of those surveyed said that their ideal family would include one son and one daughter. In India, similar campaigns have begun to reduce sex-selective abortions. In 2008, for the first time in many decades, female births slightly exceeded male births in Delhi.

As in India and China, total fertility rates are falling rapidly the world over due to a “reproductive revolution” caused by national policies, education, and contraception. As shown in Figure 5.26, between 1990 and 2010, total fertility rates fell significantly in countries at virtually all levels of development. The richest countries showed no change, in part, because fertility rates were already at 1.7 births per woman, well below replacement levels. At the global level, these declines translate into a decrease in fertility from 3.1 to 2.6 births in just two decades. Demographers predict that total fertility for the world will decline to the replacement level of 2.1 sometime before 2050.