Family Planning in Asia and the Pacific - International Council on ...

to limit fertility, or had that effect, it is highly probablethat traditional fertility levels were not particularlyhigh (Carroll, 1975). There is also evidence that, dur<strong>in</strong>gtraditional times <strong>and</strong> well <strong>in</strong>to <strong>the</strong> modern period, women<strong>in</strong> <strong>the</strong> <strong>Pacific</strong> were not particularly enthusiastic abouthav<strong>in</strong>g many children (Connell, 1977; Carroll, 1975). InKiribati, historical data suggests that fertility was relativelylow, probably about four children per woman, prior to <strong>the</strong>1920s (Tesfaghiorghis, 1995). It is <strong>the</strong>refore unlikely thathigh fertility was necessary to compensate for high <strong>in</strong>fantmortality, as presupposed by some versions of demographictransition <strong>the</strong>ory. Pirie (1995; 2000) has argued that<strong>in</strong> Polynesia general mortality due to disease was notparticularly high <strong>in</strong> traditional times (given <strong>the</strong> absence of<strong>the</strong> diseases found <strong>in</strong> <strong>Asia</strong> or Europe) so periods of highfertility would have resulted <strong>in</strong> resource pressures, <strong>and</strong>countermeasures, such as <strong>in</strong>fanticide <strong>and</strong> abortion, wouldhave been employed.As demonstrated by Harris <strong>and</strong> Ross (1987) all pre<strong>in</strong>dustrialsocieties have a particular “mode of reproduction”that is associated <strong>in</strong> broad general terms with its mode ofproduction. Hunter-ga<strong>the</strong>rer societies, for example, tendto limit fertility through abortion or <strong>in</strong>fanticide because<strong>the</strong> ability of women to move with <strong>the</strong> group would beconstra<strong>in</strong>ed by hav<strong>in</strong>g too many young children, giventhat long periods of breastfeed<strong>in</strong>g were essential to childsurvival. At higher levels of economic development thatpermits a more sedentary way of life, higher fertility can betolerated, because <strong>the</strong>re is less conflict between childcare<strong>and</strong> women’s work. As <strong>in</strong>dustrialization develops, <strong>the</strong>conflict between women’s work <strong>and</strong> childbear<strong>in</strong>g <strong>in</strong>creasesaga<strong>in</strong>, <strong>and</strong> <strong>the</strong> tendency to apply fertility control <strong>in</strong>creases.While remnants of traditional practices <strong>and</strong> ideologiesassociated with fertility limitation still exist <strong>in</strong> some <strong>Pacific</strong>countries (Pulea, 1986), reference to traditional “modes ofreproduction” as a way of encourag<strong>in</strong>g <strong>Pacific</strong> isl<strong>and</strong> peopleto adopt family plann<strong>in</strong>g has not proven to be an effectivestrategy. The reasons for this are many <strong>and</strong> complex. First,<strong>in</strong>itial contact with European visitors resulted <strong>in</strong> <strong>the</strong>importation of diseases that previously did not exist <strong>and</strong>to which <strong>Pacific</strong> peoples had no immunity. The epidemicsthat followed <strong>in</strong>creased <strong>the</strong> death rate well above <strong>the</strong> birthrate, result<strong>in</strong>g <strong>in</strong> low or negative population growth <strong>and</strong>fears of “depopulation”. Missionary <strong>and</strong> later colonialauthorities adopted pronatalist policies <strong>and</strong> suppressedmemory of earlier fertility <strong>and</strong> mortality control practicesthat <strong>in</strong> any case were considered immoral. The suppressionof collective memory took place over several generationsto <strong>the</strong> po<strong>in</strong>t where most <strong>Pacific</strong> isl<strong>and</strong>ers today woulddeny that any such practices ever occurred <strong>in</strong> traditionaltimes. Colonial authorities with <strong>the</strong> support of churchesensured that abortion <strong>and</strong> <strong>in</strong>fanticide were crim<strong>in</strong>alized.Formal laws regard<strong>in</strong>g marriage, births <strong>and</strong> deaths werefor <strong>the</strong> most part derived from church law. The decl<strong>in</strong>e<strong>in</strong> traditional population control methods such as postpartumabst<strong>in</strong>ence <strong>and</strong> abst<strong>in</strong>ence from sexual activitydur<strong>in</strong>g ceremonial events resulted <strong>in</strong> an <strong>in</strong>creas<strong>in</strong>g “supply”of children, encouraged by <strong>the</strong> belief <strong>in</strong>stilled by <strong>the</strong> churchthat children are a “gift from God”.It took several decades for mortality levels to decl<strong>in</strong>e <strong>and</strong>fertility to rise to <strong>the</strong> po<strong>in</strong>t where natural <strong>in</strong>crease becamepositive. In some <strong>Pacific</strong> groups this did not occur until<strong>the</strong> 1940s (Bayliss-Smith, 1975). By <strong>the</strong> 1950s, many<strong>Pacific</strong> countries were approach<strong>in</strong>g <strong>the</strong> “natural” fertilitylevels presupposed by demographic transition <strong>the</strong>ory tocharacterize all pre-<strong>in</strong>dustrial societies. By <strong>the</strong> 1950s <strong>in</strong>some areas <strong>and</strong> <strong>the</strong> 1960s <strong>in</strong> o<strong>the</strong>rs, fertility had reachedhigh levels, with TFRs of 7-8 quite common at <strong>the</strong>national level <strong>and</strong> even higher <strong>in</strong> some subregions. At <strong>the</strong>same time, while overall mortality had decl<strong>in</strong>ed relative to<strong>the</strong> period follow<strong>in</strong>g <strong>the</strong> missionary work, <strong>in</strong>fant mortalityrates rema<strong>in</strong>ed quite high. Thus, <strong>the</strong> demographic regimeoperat<strong>in</strong>g <strong>in</strong> most <strong>Pacific</strong> societies began to approximate<strong>the</strong> pretransition situation of “high mortality, high fertility”envisioned by demographic transition <strong>the</strong>ory 10 . Whenfamily plann<strong>in</strong>g programmes were first <strong>in</strong>troduced bycolonial adm<strong>in</strong>istrations, <strong>the</strong> demographic circumstanceswere quite different from those that prevailed <strong>in</strong> traditionaltimesModern family plann<strong>in</strong>g programmes<strong>Family</strong> plann<strong>in</strong>g programmes <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> were<strong>in</strong>itiated <strong>in</strong> <strong>the</strong> late 1950s <strong>and</strong> early 1960s to enhancesocio-economic development through reduction of <strong>the</strong>population growth rate, as well as to improve women’s <strong>and</strong>children’s health (House, 1999a). The earliest programmeswere established <strong>in</strong> Fiji <strong>and</strong> Tonga <strong>in</strong> <strong>the</strong> late 1950s withan official government policy <strong>in</strong> place by 1962 (Pirie,1995; Ivarature, 2000). In Fiji <strong>the</strong> Medical Departmenttook on <strong>the</strong> responsibility of family plann<strong>in</strong>g but <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Associations (affiliated with IPPF) also becameactive. IPPF surveys that revealed high fertility <strong>and</strong> ris<strong>in</strong>gpopulation growth rates provided <strong>the</strong> <strong>in</strong>itial impetus for<strong>the</strong>se family plann<strong>in</strong>g programmes. The Fiji programmewas considered a success as fertility rates among Indo-Fijian women immediately decl<strong>in</strong>ed while <strong>the</strong> fertility ofethnic Fijians began to decl<strong>in</strong>e a decade later <strong>and</strong> at a ra<strong>the</strong>rslower pace (Lev<strong>in</strong> <strong>and</strong> Re<strong>the</strong>rford, 1986). Differentialrates of fertility <strong>and</strong> contraceptive use between <strong>the</strong> twomajor ethnic groups <strong>in</strong> Fiji have persisted until today, withTFR for Indo-Fijians now below replacement level.In Tonga, <strong>the</strong> family plann<strong>in</strong>g programme was supportedby <strong>the</strong> K<strong>in</strong>g, who expressed concern about <strong>the</strong> <strong>in</strong>creas<strong>in</strong>gpopulation, <strong>the</strong> ris<strong>in</strong>g population density of <strong>the</strong> Tongatapuurban area <strong>and</strong> <strong>the</strong> difficulty of provid<strong>in</strong>g traditional l<strong>and</strong>allotments to all eligible males. The programme was<strong>in</strong>stitutionalized when a Tongan medical officer became74