World Development Report 1984

American countries could all benefit from stronger FIGURE8.5
policies. Rapid population growth in El Salvador Fertility in relation to income: selected developing
has been identified by many as a partial cause of its countries in South Asia, 1972 and 1982
civil war. In Bolivia and Haiti, the poorest coun- Total fertility rate
tries in the region, initiatives to slow population 8
growth are among the most urgent policy needs to 1972
combat poverty. U 1982
* 1982
7 Bangladesh
South Asia: expanding and improving programs Pakistan
The 930 million people of Bangladesh, India,
Nepal, Pakistan, and Sri Lanka comprise one-fifth 6 Nepa
of world population and one-quarter of the popu- Norm for 92 developing countries, 1972
lation of developing countries. Although incomes
in South Asia are among the lowest in the world, 5
the region's fertility has already fallen substan- India
tially (see Figure 8.5). In Sri Lanka, for example, riLanka
the total fertility rate fell from 5.5 in 1960 to 3.5 in 4 S L
1974; in India it dropped from 6.5 in the 1950s to /
4.8 in 1982. The rate of contraceptive use (both Norm for 98 developing countries, 1982
modern and traditional methods) is 55 percent in 3
Sri Lanka, the highest in the region. About 28 per- 0 $1000 $2000 $3000
cent of couples in India use modern contracep- Income per capita (1980 dollars)
tives. No other country at India's level of socioeconomic
development-measured by low literacy
and per capita income and high infant mortalityhas
a lower level of fertility. Bangladesh and Paki- Progress in South Asia has not been uniform,
stan have had more modest declines. In Bangla- however, and rapid population growth is a source
desh 19 percent of couples use either modern or of continuing concern. In India and Sri Lanka mortraditional
methods (see Figure 8.6). tality has declined as fast as, or faster than, fertil-
What accounts for this impressive record? Con- ity. As a result, population growth has increased in
tinued progress in raising female literacy and low- India-its population is now increasing by 16 milering
infant mortality, as well as a concerted effort lion a year, more than in any other country, includto
expand access to family planning, have both ing China. India's birth rate has remained at 33 to
been important. Within India there is wide varia- 34 per thousand since 1976; contraceptive use,
tion in fertility and in contraceptive use, a variation steady at 23 to 24 percent since 1976, has only
which closely corresponds to patterns of social recently begun to rise again. Total fertility has
development. For example, in the state of Kerala, stopped falling in Sri Lanka, and has been fluctuatwhich
has the lowest total fertility (2.7 in 1978), 75 ing between 3.4 and 3.7 since 1974. In Bangladesh
percent of rural women are literate, infant mortal- contraceptive use increased from 8 percent in 1975
ity is 47 per thousand live births, and 32 percent of to 19 percent in 1981, but appears to have made
couples are protected by modern contraception. In slow progress since then (though the share of
contrast, in the state of Uttar Pradesh total fertility modern methods has apparently risen). In Pakiwas
5.6 in 1978, infant mortality is almost four stan only about 5 percent of couples practice contimes
higher (171 per thousand), and female liter- traception, and in Nepal only 7 percent. Both of
acy and contraceptive use are, respectively, one- these countries lag behind others in providing
seventh and one-third the levels found in Kerala. health and family planning services, although both
The experience in Sri Lanka is similar. Despite a show signs of a renewed political commitment to
per capita income of only $320 in 1982, infant mor- curb population growth.
tality had been reduced to 41 per thousand and The experience in Sri Lanka and in some Indian
virtually all primary-school-age girls were enrolled states suggests that much more could be done to
in school. Of a contraceptive use rate of 55 percent, bring about fertility decline. In every country there
almost two-thirds comprised modern methods; is considerable scope for reducing infant mortality,
total fertility had declined to 3.4. raising the legal marriage age, and increasing
173