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Give birth and perish? Setting a population policy

Give birth and perish? Setting a population policy


At the launch of Cambodia's first census in September 1999, then-acting Prime Minister,

Sar Kheng, called for a population policy. The fact that such a policy did not exist,

he said at the time, meant it was "high time" the country developed one.

Waiting for her first injection: the latest addition at Calmette Hospital helps propel the population towards the 18.5 million mark by 2016. High fertility rates are often linked to poverty, says the UN.

More than three years later there is still no policy, although moves towards getting

one have begun. Prime Minister Hun Sen heads the National Committee on Population

and Development (NCPD), and there is now a Population and Development Policy Unit

within the Council of Ministers.

The Ministry of Planning (MoP) has created a Population Analysis Unit, and students

at the Royal University of Phnom Penh can now enroll in a population studies program.

High fertility

The government aims to develop a policy by the end of this year and a strategy by

the end of 2005. There is already consensus on what constitutes the biggest problem.

"High fertility is the key population issue and a major obstacle to poverty

reduction," says Yoshiko Zenda, representative of the UN Population Fund (UNFPA).

Before 1990 Cambodia had a 'populate or perish' mentality and a 'pro-natalist' policy.

In other words, worried about its more populous neighbors, the government encouraged

families to have many children. Only in 1994 did it reverse this by adopting a policy

promoting birth-spacing.

But the old mindset - promote high population growth to offset the perceived threat

posed by the country's neighbors - still holds true in some circles, says Kim Saysamalen,

undersecretary of state at the MoP.

With only 64 people per square kilometer, a far lower rate than in Thailand or Vietnam,

some in government worry the country will prove attractive to "foreign occupiers",

he explains.

But others in government are aware that rapid population growth also carries costs,

though not the dire predictions of Malthus, who in the late 18th century propounded

that population growth would inevitably lead to overcrowding and starvation.

In the 1970s and 1980s economists and social scientists revisited the question, says

Zenda. They emphasized the positive effects that population growth has on innovation

and productivity, as well as the benefits of large domestic markets and economies

of scale.

However, as she points out, there is no "straight line" between population

growth and economic growth. But her organization's latest report on the subject makes

a strong case for the link between lowering fertility and raising a developing country's

Gross Domestic Product (GDP).

UNFPA's report is titled State of the World Population 2002; People, Poverty and

Possibilities: Making Development Work for the Poor. In its summary it notes that

over the past 30 years, those developing countries with lower fertility and slower

population growths have gained through higher savings rates, more productive investment,

and faster economic growth.

"Long term demographic and economic data from 45 developing countries show that

high fertility increases poverty by slowing economic growth and by skewing the distribution

of consumption against the poor," it states.

By way of example UNFPA cites Brazil, where declining fertility has resulted in an

equivalent 0.7 percent increase in GDP per capita per year.

The concern is that Cambodia, with the region's second-highest growth rate of 2.5

percent, could be breeding itself further into poverty.

Estimates from Jacqueline Desbarats, a researcher at Arizona State University, suggest

that by 1983 the post-Khmer Rouge baby boom returned the population to its pre-1970

population of seven million.

By the time of the 1998 census, 43 percent of the population was under 15. Providing

health care and schooling to such a large, dependent population is enormous, says


"If you have too many in the zero to 15 [age] range, you have a drain on resources.

In developing countries like Cambodia children usually work, but that doesn't necessarily

compensate," she says.

Population strategy

How best to tackle the issue is the preserve of the MoP's Saysa-malen, whose ministry

published a report in July 2002 urging the country adopt a population strategy. Towards

a Population and Development Strategy for Cambodia outlines the extent of the educational

demands created by its young population.

Around 40 percent of girls aged between six and eleven today are not enrolled in

school. That amounts to 412,000 children. The strategy points out that over the next

decade the government will need to fund a further 66,000 places simply to maintain

current enrollment levels for schoolgirls. If it wishes to raise enrollment to 100

percent, it will need to create 522,000 extra places over the decade.

The strategy report also notes the 'echo effect' that has begun as the 1980s baby

boomers enter prime childbearing age. No matter what policies the government adopts,

the population is still set to increase rapidly.

"Even if the average number of births per woman declines steadily over the next

one or two decades, the total number of children born each year will increase,"

states the Cambodia Country Report presented by the ministry at a recent UN population

conference in Bangkok.

That is borne out by the estimates from the National Institute of Statistics. It

suggests the population will reach 18.5 million in 2016, up from 11.4 million recorded

in the 1999 census report.

That will create huge pressures on the scarce amounts of land held by the typical

family, which is already unable to subdivide it among their many children. The strategy

report warns that demographic growth is the single biggest cause of landlessness.

The report also raises the specter of environmental degradation and calls for the

consideration of an appropriate "carrying capacity" - the number of people

able to be sustained by the natural environment - to be studied.

Zenda says there are other good reasons to reduce the size of families.

"Where there is high fertility the mother is usually in poor health and, from

the fourth child onwards, the under-five mortality rate increases sharply,"

she says. And where the mother is sick or dies, the poverty cycle typically continues.

"Maternal survival directly correlates to child survival, especially for children

under five," Zenda explains. "Where the mother is present, children attain

better education and are more exposed to health care and other social services."

Although Cambodian women typically have four children, surveys show they ideally

would like only three. Demographers expect that economic growth will lead to smaller

families, but with a sizable time lag.

"As an economy increases in size, the rate of death starts to decline, but typically

the birth rate doesn't decline until a generation later," says Zenda.

The MoP report recommends nine policy options to lower the unsustainable birth rate.

Most revolve around better family planning, but others define carrying capacity,

efforts to reduce infant mortality, and support for more research into the demographic

causes and consequences of poverty.

Demographic dividend

Another claim of the UNFPA report is that almost one-third of the decline in global

fertility is as a result of family planning policies. The economic dividend, the

report argues, is "in the form of a large group of working age people supporting

relatively fewer older and younger dependents".

And for as long as the working age population is growing faster than both their younger

and older dependents, production per head of population increases. Women in families

that have fewer children are better able to enter the workforce; thus more is invested

in educating and preparing the next generation.

The dividend of lower fertility presents what is termed the "demographic window",

which the report argues can lead to potential economic growth within one generation.

However it warns this window "opens once only" and must be supported by

other pro-poor policies.

The UNFPA states that countries must invest in health, family planning, education

and employment opportunities. The so-called Asian tigers seized this opportunity,

it notes, and the result of doing so was that it accounted for one-third of their

annual economic growth in the 1980s and 1990s.

The end result, says Zenda, is that Cambodia is well-placed to reap an economic windfall

from lower fertility. However there is a caveat: "It depends on the quality

of the productive group. You need high levels of literacy, ability to operate complex

machinery and so on," she says.

But the MoP is pessimistic. It sees those entering the productive 15-60 age bracket

as more of a problem than an opportunity. The country's labor force is currently

growing by 200,000 a year. In 2001 there were 7.4 million people in that age group;

by 2011 there will be 9.68 million.

"The capacity of the economy to generate sufficient jobs quickly enough is bleak,"

the MoP report states.

The fact that the country's formal sector generated enough jobs for only one in ten

of those entering the labor market in 2001 gives substance to the ministry's glum

assessment. And the situation is further complicated by the fact that the government

does not have accurate statistics on migration.

Saysamalen says that further work is needed to calculate the ideal rate for creating

the demographic window. A stakeholder meeting scheduled for March will further develop

the policy.

"We still do not know what the ideal target population is," he says. "But

we do not want to have the problems of India or China. We want a policy that will

match the population growth with sustainable development and poverty reduction."


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