MCDB 150: Global Problems of Population Growth

Lecture 13

 - Fertility Attitudes and Practices


Surveys show that most women are having more children than they would prefer to have. Further, studies show that the vast majority of women know about various forms of contraception. One World Bank study has shown that family planning programs have little impact unless they are attended by improved living standards and increasing status of women.

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Global Problems of Population Growth

MCDB 150 - Lecture 13 - Fertility Attitudes and Practices

Chapter 1. Children in Bolivia [00:00:00]

Professor Robert Wyman: This is data from Bolivia. It came out the end of last year and it’s from the year 2003. Demographic data is always delayed because it takes a long time to collect it, and analyze it, and so forth. This is a fairly standard thing that’s happening. This is various five year bunches, they take these surveys every five years, this is from a thing called The Demographic and Health Surveys which are done basically in every developing country of the world by their own statistical service. Every country has a fairly decent census and statistical service and they go and ask either all the women, if it’s a census year, or a subset of the women if it’s not a census year and they ask all kinds of questions, some of which you will see.

The first thing of course is how many children do you have? They used–when they started these kind of surveys they used to ask men and they would get a number, the husband. Then they’d ask the wife, get a different number, and when they checked it turns out the woman was right and the man had no clue. Veena will tell you, maybe some stories about it’s not even a simple question, even to the woman how many children have you had.

In a lot of ways, men’s data was unreliable and in the early days they really were interested in getting a real ground–they didn’t know how many people there were in the world, what the fertility rates were, how fast population was growing, so just to get the basic ideas, women were asked. From that date on men have somewhat been excluded from the data collection, so a lot of what we know, in fact almost all of what we know is about women, but nowadays its changing. In the last number of year’s people realize it takes two to tango and men are starting to come more into the picture.

Anyway here by 19–so this is a five-year age group and this is the total fertility rate. In 1965 and 1970 and other years they were having roughly 6.6 children, then gradually every five-year increment it came down until the most recent number is 3.8 children. Now keep that 3.8 number in mind because we want to compare that to some other things, and you probably know a little about Bolivia. It’s totally Catholic, it’s quite poor, it’s mostly agricultural, it’s not very urbanized, education is at a fairly low level, and the status of women there is not really wonderful.

With all those indicate–what they call social indicators what would you think about the fertility desires of women in Bolivia? High? Low? High. All of those are sort of standard classical factors that would make you think that they want a lot of children, but when you look at the actual data it’s rather moderate. It’s still very high by our standards of one or two children but still–and it’s still important for the world because at 3.8 you double the population almost every–not quite double it every generation so this is quite high, but it’s nothing like a 6, 7 child thing or in the past the traditional number of 7 or 8, or maybe 9 children per woman, so it’s a situation of moderate fertility.

Now what–the next kind of set of questions is well this is the number of children you’re having, how many do you want? They asked–this is asked–it’s a very tricky kind of question as you’ll probably hear so there’s a lot of different ways of spinning this question. The first is they ask you, ‘did you want your last child?’ That has a whole complicated set of answers and just look out here for the total numbers that ‘did you want the child at the time that you had it?’ Well 38% of women said, yes I wanted it when I had it, but not wanted at all, somewhat larger 40% of women didn’t want it at all. That’s a surprising split and then in between there’s another 20% of women who gave a more ambiguous answer, ‘well I didn’t really want the child right then but I probably would have wanted a child in the future,’ and a lot of guess work on the part of the respondent in that about what their future desires will be. As you know, humans change their mind every five minutes on important topics, but that’s a very interesting statistic that there’s more children unwanted than are wanted and that’s somewhere in between.

Now there’s probably a lot of bias in this data. This is not considered wonderful data because you’re asking a woman who’s just had a child, or fairly recently had a child, did you want that child? What’s the bias? You say yes. I mean it’s very–you have to really not like that child in order to say, ‘oh yeah I had him but I didn’t want him.’ It happens and you see that at 40% of women do say that, but this data is probably biased to put more kids in this category then what the woman really feels, although again, intentions are very changeable and attitudes toward other people, husbands, children, one minute you love them and the next minute hate them and so forth, so that’s problematic, the data there.

One way of getting around that particular problem is to ask them, ‘do you want another child in the future’ because that’s more volitional, that’s not saying I did something wrong or something that I didn’t want and so here’s that set of data; again all this from the Demographic and Health Survey. Again it’s sort of what you would expect, this is women who don’t want, want to stop childbearing, don’t want any more children. If they’ve had no children already very few of them don’t want any children 6.5%. If they’ve had one child already 30% say one child is enough, I’m ready to stop. If they had two children you’re up to 2/3 of the women now say that’s enough for me, I want to stop and when you get to three you’re almost at the maximum, and then four and above you’re into the 91%-92%.

You notice it’s kind of interesting that it rises and then it stays flat, so there’s about 8% of women who no matter how many children they have they always say ‘no I want more, I don’t want to stop.’ This is what we call very traditional women, that as many as God gives me, here comes in one version or another, but it’s 8% it’s a very small number, women who don’t seem to have an idea of some number at which they want to stop, or some of them they’ve already had whether they want to now stop.

Now you can ask another kind of question, you say this is called an ideal number of children, and you ask a question like, if you could go back to the beginning before you had any children, how many children would you have wanted as your ideal number? You get these kinds of numbers that women who have no children want to have two–who now have no children asking what they think their ideal was; they want 2.1 children. Women who already have one child 2.1, those that have two say 2.4, and then the number goes on up, including women who have six or more children. Now it’s pretty clear that one should really expect this kind of thing because the simplest, most obvious reason is, women who want more children have more children. As you have more children that’s a sign that you wanted more children. That certainly may be the biggest factor, just a very simple kind of thing.

Another factor is women who have had more children are older. Remember we’re talking about a period in history, I mean this is recent, where ideas are changing, fertility is changing, standards and norms and personal desires are changing, so the older women just by the age factor will probably be of a somewhat older generation. I won’t go into it but this looks at that, here is the age of a woman and again, how many if you went back to the beginning, how many children would you have liked and you get just an age factor, but not wildly different from this. Just generational change is a bigger factor in that then you might expect.

And also in this rise is what we’ve just talked about that women already had a bunch of children, when they reconstruct back what they used to think or now think that they would think they–again well I have three I’m either happy or whatever they think about it, it’s hard for them to say no I don’t want this many.

Have you noticed anything funny now? Anything about the number, these numbers and the number I told you to remember? No class of woman wants more than 3.3 children. Most of the women are in the two range and only those that have six and more children want 3.3, and the same if you look it out by age, no group of women wants more than three. What did I say about how many they’re having? 3.8. This now accords with the other stuff that you’ve seen that women want–it looks like women want fewer children than they’re having. Well this is Bolivia, maybe there’s something a little bit special about Bolivia, and you always have to check and see whether you’re getting some sort of outlier or is this the general situation.

Chapter 2. Ideal Number of Children Across Countries [00:10:40]

You don’t have to look at that too closely yet. An economist at The World Bank, a guy named Lant Pritchett, did a paper and the first thing he did was collect all that data from every country. These Demographic and Health Surveys are published every time a country does its own statistical demographic survey, and so all of this information is available, and now it’s computerized and so forth, and there’s uniformity. There’s a group called Macro International that sort of helps these various countries design these surveys so that they can be compared internationally and get fairly good comparability of the data.

What he did is, of these various statistical ways of finding out how many children women want and they have different numbers. This is average ideal number of children, this is desired total fertility rate, and here’s a third one, the wanted total fertility rate and they all correct for different factors in different ways, but the only thing I think that you have to sort of notice is that they’re all about the same. No matter how you spin this you get a picture that looks something like this. What is it? Wanted TFR, in this case is how many children does the woman want? Self report, this is how many she says she wants, do you want 2, 3, 4, 5, 6, 7, 8 and this is the total fertility rate. How many children is she actually having?

The countries are luckily all named here, and you can see Syria for instance, the women want 5 children and they’re having 7. something children. Here is–pick another one, Pakistan, they want 4 children they’re having 6 children. You can look at that and every country is in there. One important thing is how important the desire, whatever children want, that there’s a very strong correlation between the number of children that you want and the number of children you actually have, aggregated by country. I mean we’re taking a lot of people and lumping them into two numbers, this number and this number, and there’s great variation of course within in each country but that’s certainly an important factor.

The key line, because Pritchett in gathering this data, wanted to make a different point which we’re not going to get to today. He leaves out a really important line here which is this line that I’ve drawn this in. What line is that? That’s the line where it is if you want two children you have two children, if you want three children you have three children, if you want nine children you have nine children, so any country that was on that line people are having the number of children that they want. What do you notice about all these countries? Every single one of them is above the line, meaning that in every single country they’re having more children then they want. What they want is what they have; they’re all above that line of equality.

This is some of the cleanest social science data I have ever seen, the way they’re all one side of the line, they follow very nicely the regression line. This is the regression line that he drew in which is just a line that is closest to all the points together, a statistical way of making the line as close as possible to all of the points. This gap here between what people want, if they got what they wanted and what they’re actually having is called unmet need. A very complicated idea, much argued about, and Veena may or may not discuss it, but what it tells you is that there’s a very noticeable difference between–it’s describing that difference between the number of children people have and what they want. It’s roughly one child per family here. This number in principle should be one and a half children, but there’s certain connections, it’s actually about one child per family; the difference between what they have and what they want.

Now in the developing world this is a little bit old data, but in the developing world today the average fertility rate is about 3.5. In order to come to stable population in the developing world it has to come down to 2.1, but if all the women here in these countries that are reporting what they want, if they actually had the number of children that they want you’d subtract out from the 3.5 (one child), you’re down to 2.5 and you’re actually very close then to what’s called replacement level fertility this 2.1 children.

This difference of what women want and what they have is an extremely important issue. In one version of the kind of thing that Planned Parenthood and other international and domestic organizations do is help women get to the fertility that they want. Not as pushing them into something but giving them something that they already want. This data, as in all data, brings up a whole bunch of questions. One: does this really reflect people’s data? Have we actually–have these kinds of questions and this kind of statistical analysis really tapped into the real emotions and feelings of the people? You always have to question these kinds of survey data.

You remember that you read this in readings in Africa, that when the women were asked how many children do you want, it was a meaningless question to them. They said whatever Ala says, whatever God says, they can’t–it’s just not in their–what their technical term is ‘calculus of rational choice.’ Well there’s women like that in this survey and what number do you put down for them? These women, as I’ve said is basically–is all collected from women. What about men, do men want more children? Do they want the same? Do they want less? Is it that women’s desires don’t matter? It is men’s desires that really matter? Why do women up here in Kenya and Mali at this time want so many children and have so many children? Whereas, countries you might not think of wildly different Trinidad, Dominican Republic, Fiji, various other places are way down here. Why some countries here and some countries there?

Another thing is that in most of the world people actually know about contraception. Here is data again from the Bolivian survey 2003 and do they know a method of contraception? Well they know any method yeah, 95% of the women know about contraception, and even the modern methods which are listed here, 92% of the women they know about it and many of the women know about more than one method, so 80% know about the pill, another 80% the IUD, another 80% the injectables. That means there’s a lot of overlap between these. They don’t know one method, they know two, and three, and male condom they know about, female sterilization they know about and so on. This is lactational amenorrhea which is the traditional method that we’ve talked about of spacing births and half the women know that if you breastfeed you’ll prolong the interval between your births.

Not only do they know about the method but they’ve used the method, 77% of women have tried something, a fair amount of that is 20% of these women are using only traditional methods which include rhythm type methods, but still 57% have actually used a modern method. Currently using drops down. They’ve tried it and for some reason they’ve stopped.

Chapter 3. Anecdotes on Contraception in Kenya [00:19:34]

One is this medical problem that the dominant reason why women say they’re not using contraception–so you’ve seen the data, they want to stop childbearing, it’s overwhelming. You saw like Bolivia–what was the final number, I don’t know I pointed it out, 70% I think it was–something like 70% of the women say ‘I don’t want any more children ever, I want to just plain old stop,’ and then if you add in those that are not sure about the future, but they say well at least not in the next two years and then beyond two years I don’t know so you add at least another 10%–something like 80% of women want some kind of protection, they either want to mostly stop totally or at least for the next two years.

You can even go down, this is again older data from Bolivia, that’s one of my favorite places; I was–spent some good times there. If you just take teenagers age 15 to 19 already about 40% of them say I’ve had all the children I want the whole rest of my life and the average age of that sample is 17 years old. So you have these huge number of women who don’t want–want to stop childbearing and yet if you look from the Demographic and Health Surveys at the contraceptive prevalence, like in Bolivia again, at the time of Robey article that you have read last night or are going to read, the women who want protection either–are about–were about 80% and the women that were using protection was like 12%, and you ask them why and largely, and especially more recently, it’s medical reasons. There is first of all a campaign by conservative, especially religious people in places like Kenya to–they’re opposed to the use of contraception and they really blow up medical problems, so the people are getting very poor information on it.

Now here’s an example, one of the undergraduates that took this course a few years back, a very energetic young lady and she got interested in this stuff and so I arranged for her to go to Kenya to answer exactly this question. Why is it that women–and you’ll hear a little later–why is it that women who say they don’t want any children, they’re living in Nairobi and there’s plenty of contraceptives available in Nairobi and you can get them more or less free, or a small cost, and they’re not using it, then they get pregnant. They can’t have that baby, they don’t want the baby, so they go to some bush doctor, and it’s illegal in most of Africa, Sub-Saharan Africa, all of Africa, abortion is illegal but here they got pregnant so they go to some horrible clinic. The death rate is very, very high.

Here’s women who don’t want children, don’t use contraception even though it’s available to them, and yet when they get pregnant they’re willing to undergo an operation, a very crude, illegal operation by an untrained practitioner that will lead to a very high rate of death and they’re well aware of that fate. Everybody knows somebody who’s died from a botched abortion and you’ve read some of that in the European–in the era in America and Europe when that was common.

She went there and it turns out that women are very much influenced by rumors, what they hear, because their education is not really their thing. This student, this Yale undergraduate collected these rumors, and one of the rumors, one of the most extreme rumors was well mostly in Africa, and I think you read this–the people that haven’t been to university don’t distinguish between stomach and uterus, it’s all one big cavity. Was that in one of your readings? I think it was, anyway it doesn’t matter; it’s all one thing there.

Now you take a pill, and they know something about pills, penicillin and everything, but every day for the rest of my life, why do I have to keep taking this pill? Why don’t I take a pill and that settles the issue? Well they figure I get pregnant and the fetus starts to grow inside me. Well what does the pill do? The pill goes down and dissolves, they have some idea that it’s wet and dissolves, and then reforms over the fetus and starts coating it. But everyday they know the fetus is getting bigger, so you need to take another pill to add to the coat of it, and at the end what you grow and what you get is a mummy. You get a fetus that can be fully grown and coated with a white stuff like an egg and that’s what you deliver.

Well if you believe something like that you’re not going to go anywhere near pills, right? Some of these similar kinds of stories happen with everything else. This young lady herself got the five little silastic implants in her arm and she when she came back she was very–she got it in Kenya, one because she wanted it and two she wanted to show the women sees it’s not dangerous, I’m even doing it myself, but that’s irrelevant.

One thing is–any–no clue about medical stuff, physiology, digestion, anatomy inside, huge numbers of women don’t have any clue about this. This girl did a very clever thing, she was a Yalie, and she then asked the women–Kenyan women are not any stupider than anybody else, they’re smart women, they said do you believe such a rumor? They were just reporting it as a rumor and the women were of course very skeptical of this. Well I’ve heard this and that is it true or not and they were properly skeptical of it.

She collected this whole range of rumors, and she found that–she asked, which ones do you believe more than others, and she sort of could get a ranking on it, and then she asked all kinds of questions and it turned out that it was very simple, that they believed something depending on how many times they had heard it. This particular rumor was not one of the most prevalent, some other rumors were, equally not true, but if you hear it a lot then you believe it because they don’t have a sense of expertise, scientific competency, any of that sort of stuff.

A sociologist at Penn, Susan Watkins, who I may have mentioned before and certainly will mention again who works in Kenya in the Luo region, not in Nairobi, a different region, she attended a lecture where a local woman, speaking the local dialect had gone to Nairobi and gotten trained–a nurse type–she wasn’t trained–an official nurse–but working in that kind of establishment, went to Nairobi and got trained to be a reproductive health educator.

She comes back and is having some sort of a white coat or uniform, or a blouse or something and she gives a lecture to the women with–they have these models of pregnancy models, models of internal anatomy slides, very nice and she was good at it, and the women were absolutely rapt, they were listening to every word. But as they left the room they started sort of staring each other, what are we going to make out of this, and outside there was a woman scrubbing the floor, a washer woman there and these women just dove onto the washer woman and said, is she telling–is what she’s telling is true, is this good for us, is she our kind of women that the–and really asked the washer woman all kinds of questions about this information which the washer woman had no technical expertise.

The idea being that they don’t have this sense of that knowledge comes from some sort of expertise, that more knowledge comes from someone like me is a more important variable than that you’ve been to Nairobi and gotten some kind of training. And the washer woman they perceived was closer to them than the woman who has gotten some education even though it was a local–a person from that local community.

It’s a very complicated issue and the big battle is in getting people thinking about this and trying to do some of that, is sort of how much of this difference and how much of the–people in general having more–how much of it is that there’s something wrong this data that they really do want a lot of children and many of them–in many countries up there they wanted 5, 6, 7, 8 children and how much of it is–they don’t have access–access doesn’t mean just handing out condoms.

This is the last story and I’ll shut up. There’s a famous story that passes around family planning circles about someone going into an African village, and finding in front of each hut a stick and the stick was an unrolled condom. That was very strange and so they went and asked what this is? We had a family planning worker and they showed us how to prevent pregnancy and they had this stick and they showed us how to unroll it and they did that.

I have heard this kind of story any number of times and I tossed it off–it’s something like–I had a little–the–more doubts, I just tossed the story off. Then I’m in Kline Tower and I came out one night, I work late, and the Forestry was having a party and some of the graduate students were out back smoking or chatting, so I chatted them up and one of them had been in a part of South Africa called Transkei, and she told me she went into this village and what did she see? It was cucumbers and all the people had cucumbers with condoms unrolled on them, so this is a student who’s here at Yale right now that saw this with her own eyes, so this is another one of these amazing stories that’s true and gives you sort of at least an anecdotal hint into what’s going on–scratching beneath this data.

Okay see you next week.

[end of transcript]

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