World Development Report 1984

planning program is critical to reducing fertility. adopted economic incentives to reduce fertility;
Indonesia's current birth rate is estimated at family planning services have provided couples
thirty-four per 1,000 people, which is a notable with the means to respond. In Colombia and Mexdrop
from an estimated forty-four in 1960. In Java ico work opportunities and household incomes of
and Bali, the two most densely populated islands women with little education were probably
of the country, the percentage of married women increasing in the 1960s and 1970s, which also
of reproductive age currently using modern con- encouraged the use of contraception.
traception more than doubled between 1974 and In several low-income countries family planning
1976 (11 to 24 percent), nearly doubled again to 42 programs have not been effective in reducing ferpercent
by 1980, and by 1983 had reached an esti- tility-for example, Ghana, Kenya, and Pakistan.
mated 53 percent. Lack of demand has been a factor, but so has lim-
Other developing countries and regions have ited availability of services and weak government
also had remarkable increases in contraceptive use support for the programs. Comparisons within
and rapid fertility declines, even among women countries show the difference actual availability
with little or no education. In Colombia a strong can make. In Mexico, Korea, Thailand, and India
private family planning program was under way contraceptive use is higher in communities with
by the late 1960s, and the government began sup- more sources of family planning supplies, even
porting family planning in 1969. In urban areas the when differences in development levels are taken
proportion of married women using contraception into account. In one district in India a 10 percent
increased from 43 to 53 percent between 1969 and increase in the number of clinics per hundred
1976, with a big switch from less effective meth- thousand people was associated with a 3 to 4 perods,
such as rhythm and withdrawal, to pills and cent increase in the combined acceptance rates of
IUDs (although the increase since then has slowed); intrauterine devices (IUDs) and sterilization; simiin
rural areas the proportion doubled, from 15 to larly, a 10 percent increase in the number of exten-
30 percent. As Figure 6.6 shows, the drop in fertil- sion workers raised acceptance rates by 4 to 6
ity for Colombian women with little schooling has percent.
paralleled that of better-educated women,
although fertility levels are still higher among FIELD PROJECTS. Experiments conducted in
those with less education. Fertility had begun to widely different communities have also revealed
fall by 1965, before family planning services numerous examples of the effectiveness of family
became widely available, but it declined faster in planning programs.
Colombia in the early 1970s than it did in Brazil or * In Matlab, a largely inaccessible part of
Mexico, where family planning services were less Bangladesh, trained local women provided comwidely
available. (Colombia has a somewhat lower prehensive family planning services in seventy vilper
capita income than does Brazil or Mexico, and lages. For the four years prior to the project, fertilsimilar
literacy and urbanization rates.) ity rates for these villages were comparable with
In Mexico, as in Colombia, fertility began to fall a those for seventy-nine other Matlab villages; over
few years before the establishment of extensive the two subsequent years, rates were 22 percent
family planning programs, both private and gov- lower (see Box 7.6).
ernment-sponsored; but as those programs gained * In San Pablo Autopan, Mexico, maternal and
momentum, the fall in fertility accelerated. The child health services and contraceptives were
government adopted a policy to reduce population delivered to individual households in 1976-77.
growth at the end of 1973-an abrupt shift from its Contraceptive use rose from 5 to 9 percent in the
earlier pronatalist position. Rates of contraceptive surrounding areas, and from 7 to 25 percent in the
use among married women aged fifteen to forty- area covered by the project.
nine more than doubled between 1973 and 1976, * On the island of Cheju, Korea, family planfrom
11 to 29 percent; by 1982 they had reached an ning staff distributed oral pills and condoms
estimated 48 percent. Public programs accounted through home visits in 1976-79 and also referred to
for virtually all of the increase. The total fertility clinics women who wanted IUDs and subsidized
rate fell from 6.7 in 1970 to about 4.6 in 1982. sterilization. Over the period, fertility in the sur-
Of course, the availability of family planning rounding areas fell by 29 percent; in Cheju it fell by
services has not been the only reason for falling 35 percent, mainly because of sterilization.
fertility in these countries. In China the govern- * In some parts of the island of Bohol, Philipment
has exerted considerable social pressure and pines, village workers (including midwives and
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