Mikko A. Salo University of Joensuu
Social policies have been used widely to regulate growth of population.
Traditionally, the aim has been to increase the birth rate by providing family allowances, housing subsidies and health services. There are, however, also cases where the improvements in social security, health and welfare have been planned - not to increase
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but to slow down the rate of population growth. The work of the Titmuss Commission in Mauritius in the early 1960s is one example.The Titmuss Program was an example of what might be called a social population policy. It contained family and maternity benefit schemes, marriage benefits and other forms of family aid. It suggested new legislation for old age pensions and workmen's compensation as well as new forms of social insurance policies covering the risks of unemployment and sickness. All of this was needed
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as the Commission claimed-
t o create a healthier and more secure family life, a necessary condition for the motivation t o have smaller families.The Titmuss Program was never implemented as such. The Legislative Council of Mauritius rejected most of it.' Nevertheless, the decline in fertility rates in Mauritius has been remarkable during the last three decades. The total fertility rate for Mauritius was 5.9 in 1960 but only 2.7 in 1980 and 1.9 in 1988 (Grant, 1990, p. 93). This means that the average annual reduction in the total fertility rate has been 3.9 per cent in 1960-1980 and as high as 4.4 per cent in 1980- 1988! Very few countries have attained such good results in their efforts to promote fertility decline (see Table 1 .). In fact, in most of the Third World fertility rates have declined by less than 1 per cent per year in the 1980s and the reduction rate was even lower in the 1960s and 1970s.
In 1985, Robert J. Lapham and W. Parker Mauldin published the results of an extensive comparative study of family planning programs in 1 0 0 developing countries (Lapham and Mauldin, 1985, pp. 1 17-1 37). What they were interested in was the family planning program effort. By family planning program is meant organized programs designed to provide the information, supplies, and services of the modern means of fertility control t o those interested (Freedman and Berelson,
'would it have worked if put into effect? This question has always interested me so much that I started my academic career by writing my doctoral thesis on it in 1 9 8 2 . (Salo, 19821.
1976, vol 7, pp. 3-40). Family planning program effort, as defined by Barbara Entwisle, is "the degree of commitment to these goals, in the private and public sectors" (Entwisle, 1989, vol. 26, pp.53-76).
Table 1. Ten countries with the world's highest average annual rates of total fe- rtility rate reduction in 1980-1988 (Grant, 1990, p. 93).
Country Total fertility Average annual rate of reduction
rate (TFR) (%) of TFR
Mauritius S. Korea Thailand Indonesia Sri Lanka Guyana Jamaica Tunisia Mexico Vietnam
Mean 2.9 2.2 3.8
Lapham and Mauldin based their measurements on a 30-item scale. They described their method as follows:
Our measures of program effort, for 1982
...
are based on...
a studyconducted in the last half of 1983 and early 1984, in which some 400 population specialists2 around the world provided information on 3 0 items related to family planning programs
...
We are confident that programs with higher scores are relatively better programs, and that those with low scores are not as good.The items on the scale covered many aspects of family planning programs:
policies, resources, and stage-setting activities; service and service-related activities; record-keeping and evaluation; and availability and accessibility of fertility regulation supplies and services. The rating of each criterion was on a scale from zero t o four, with four indicating a strong policy or much activity on an item.
Thus, with 3 0 items, the scoring range was from zero to 120. Countries which
'~opulation specialists whose estimations and opinions Lapham and Mauldin collected were
"high level program administrators, representatives of bilateral and multilateral funding agencies, and a variety of other qualified experts" (see Entwisle, 1989, p. 54.).
had a score o f 8 0 or more were considered as having been able t o implement a strong program effort. Scores o f less than 25 were assumed t o indicate that the program effort was very weak or nil.
Mauritius ranked very high on program effort in 1982. In fact, there were only nine countries which had a score higher than 80. Mauritius was one of them (see Table 2.). Most o f the developing countries had much "weaker" program efforts.
Table 2. Countries with a Lapham-Mauldin family planning program effort score higher than 80.
Country L-M score
China S. Korea Taiwan Singapore Indonesia Colombia Hong Kong Mauritius Sri Lanka
According t o Barbara Entwisle's recent re-analysis of Lapham's and Mauldin's results a program effort measure can be divided into eight
component^.^
Mauri- tius had a maximum score on one o f them, namely on pfficial ~ o l i c v (POLICY) which refers t o governmental commitment t o family planning (see Table 3.). In fact, this is close t o a world record because only t w o other countries (China and India) ranked so high on this component.Maximum values on the official ~ o l i c v component score were given by the evaluators if (1) the governmental policy strongly supported family planning acti- vities; (2) the head of the government and other high officials spoke publicly and favorably about family planning at least once or twice a year; (3) the import laws and legal regulations facilitated the importation of contraceptive supplies; and (41 the advertising o f contraceptives in the mass media was allowed w i t h no restrictions.
Mauritius' score on aovernmental s~onsorshio (GSPON) was 8.7 out of a possible 16. This component variable refers t o the strength o f the relationship between
3 ~ a u l d i n and ~ a ~ h a m themselves distinguished four components. More recently, Barbara Entwisle (1989) has re-analysed their results and proposed eight. This paper follows the Entwislean model.
the government and the administration of the program, and it had three indicators:
(1) the level of the governmental position held by the family planning director; (2) the extent t o which ministries and government agencies other than the one w i t h primary reponsibility for the delivery of family planning services assist in these ef- forts; (3) the portion of the total family planning budget coming from in-country sources; and (4) the involvement of the civil bureaucracy in carrying out family planning program directives.
Table 3. Family planning program effort component scores: Mauritius and the theoretical maximum values.
Scores
Program effort component Mauritius Maximum Proportion o f maximum
(%I
Official policy (POLICY) 16.0 1 6
Governmental sponsorship (GSPON) 8.7 1 6
Private sponsorship (PSPON) 2.7 4
Program organization and
management (POM) 24.3 3 2
Innovative delivery systems (IDS) 10.4 1 6
Demand generation (DG) 7.4 1 2
Supplementary methods (ASUPP) 11.1 1 2
Conventional methods (ACON) 1.3 1 2
There were twelve countries which had higher scores for this component, e.g.
China ( 1 5), Indonesia (14.51, Singapore ( 1 2.3), South Korea ( 1 2.01, India ( 1 1 ), etc.
Mauritius' score was, nevertheless, more than twice the average governmental sponsorship score among all 1 0 0 countries.
The third dimension o f a family planning program, private s ~ o n s o r s h i ~ (PSPON), is a measure o f the extent t o which private-sector groups and agencies assist w i t h family planning activities and other population activities. Mauritius' ranking for this component was also high. Only eleven countries had higher scores than Mauritius. T w o Latin American countries, namely Brazil and Colombia, gained maximum points here.
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(POM) is probably the most importantprogram effort component. This refers t o the degree t o which the organization, support, supervision, and activities of program personnel facilitate the delivery o f family planning activities. Several indicators were in use here. Some were measu- res of (1) the adequacy o f administrative structure and staff for the implementation o f plans regarding the delivery of services; (2) the adequacy of training for each
category o f staff; and (3) the extent t o which staff carried out assigned tasks.
Some indicators were evaluations o f the sufficiency of the logistics and transporta- tion systems for the provision of contraceptive supplies and related equipment t o service points. And finally there were indicators for (1) the degree t o which re- cord-keeping systems had been organized and implemented; (2) the adequacy of the collection, analysis and dissemination of data pertinent t o family planning program activities; and (3) the extent t o which program managers used the results o f evaluations t o improve the program.
Mauritius had a score o f 24.3 out of a possible 3 2 on POM. Only Hong Kong (29.8), Indonesia (29.5), Singapore (29.1
1,
Taiwan (29.01, South Korea (26.7) and Thailand (25.1) ranked higher.Also the extent t o which channels other than traditional family planning clinics, innovative deliverv s ~ s t e r n s , ~ were used t o provide family planning services was estimated t o be quite large in Mauritius. Its score for IDS was 10.4 out of 16. Sri Lanka got 15 and there were five other countries with somewhat higher scores than Mauritius (i.e. China, Colombia, Cuba, Fiji and Jamaica).
The degree t o which strategies t o increase the demand for family planning services are implemented is called the demand aeneration (DG) component of program effort. This has three indicators: (1) the coverage of the frequency o f mass media messages providing information about family planning; (2) the proportion of the population covered by home-visiting workers; and (3) the use of incentives and disincentives t o promote small family sizes and the adoption of family planning.
Mauritius gained a score of 7.4 out of a possible 1 2 on DG. China was estimated t o reach the maximum level. Taiwan was very close t o it ( 1 1.5).
Finally, there are t w o components covering the availability and accessibility of fertility control methods.
Conventional
(ACON) refers t o the ease of access t o contraceptive pills, injectables, IUD and condoms. Sumlementarv methods (ASUPP), in turn, refers t o the availability o f medically adequate abortion and sterilization services.Mauritius was reported t o have an extremely high score for ASUPP (1 1.1 out of 12) but a surprisingly l o w score on ACON (1.3 out o f 12). The limited availability of conventional contraceptive methods is an interesting part o f Mauritian population policy.
4i.e., (1) coverage of new mothers by a postpartum program; ( 2 ) proportion of the country
covered by a social marketing program; (3) proportion of country covered by community based
distribution programs; and (4) the coverage and frequency of mass media messages providing information about family planning.
The z-values of the program effort component scores in Table 4 show clearly that Mauritius mostly has points well above the average values calculated for the 1 0 0 countries under study. The ACON component is the only exception.
Does this justify a conclusion that the decline in Mauritian fertility rates is due t o its strong family planning program effort?
Table 4. Z-values of program effort component scores for three countries.
Countrv
The relationship between fertility decline and family planning effort seems t o be somewhat more complicated. As shown above, China was the country which ranked highest for program effort. Nevertheless, its average annual rate of total fertility rate reduction in 1980-1988 was only 1 .O per cent. Guyana, o n the other hand, had a total effort score of only 3 2 and five of its component scores fell below the mean level, as shown in Table 4. Guyana's total fertility rate, however, declined by 3.6 % per annum in the 1980s. Thus, a strong family planning program effort does not seem t o have been a sufficient nor a necessary condition for a fast decline in fertility in the Third World of the 1980s. Fertility rates can stay high in spite of it and they can collapse without it.
This does not mean, however, that there is no connection at all. As Table 5 shows there seems to be a statistical correlation between the program effort and the rate of fertility decline. The stronger the effort the faster the decline. The mean of the average annual rates of total fertility was only 0.4 per cent among the 4 7 countries where the program effort was weak or nil but 2.8 per cent among the countries where the effort was strong. Consequently, the means for total fertility rates are much lower and the means for contraceptive prevalence much higher where the effort was strong.
Thus, in spite the lesson given us by the cases of China and Guyana, it seems very plausible that the role of the family planning program effort has been crucial in the developments which have resulted in the swift fertility decline in Mauritius. More
theoretical and empirical research is, however, needed t o determine the importance and coinfluence of other social and economic factors.
Table 5. Means of program effort scores 1982 (L-M), total fertility rates 1988 [TFR), average annual rates of TFR reduction (%) in 1980-1 988 and contraceptive prevalences in 1980-1987 (%) for 100 developing countries classified by family planning program effort levels5
Program effort L-M TFR TFR red Contraceptive
1982 1988 1980-88 prevalence
"Strongw (N = 9) 88.4 2.5 2.8 68
"Moderatew (N = 16) 65.3 3.6 2.5 48
"Weak" (N = 28) 36.0 5.2 1.3 28
"Very weak or none"
(N = 47) 10.5 6.2 0.4 9
REFERENCES
Entwisle, B. 1989. Measuring components of family planning program effort.
Demography 26:53-76.
Freedman, R. and B. Berelson. 1976. The record of family planning programs.
Studies in Family Planning 7:3-40.
Grant, J.P. 1990. The State of the World's Children 1990. Oxford: Oxford University Press.
Lapham, R.J. and W.P. Mauldin. 1985. Contraceptive prevalence
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the influence o f organized family planning programs. Studies in Family Planning 16:117-137.
Salo. M.A. 1982. Titmuss, Mauritius and the Social Population Policy. Annals of the University o f Turku, series B, vol. 158. Finland: University of Turku.
his
table has been derived from the demographic data provided b y Grant, 1990.93