WEBVTT 00:03.300 --> 00:04.990 Prof: You're going to get more numbers today. 00:04.990 --> 00:07.790 I know you--how many love numbers? 00:07.790 --> 00:09.920 You can't live without numbers. 00:09.920 --> 00:17.330 What did I tell you was the traditional, before modern 00:17.325 --> 00:20.115 times, death rate? 00:20.120 --> 00:22.830 A number you should keep, or birth rate, 00:22.828 --> 00:25.118 it's the same--about per 1,000? 00:25.120 --> 00:35.460 About 40 to 50 per 1,000 is the birth and death rate at a life 00:35.461 --> 00:42.341 expectancy of 20 years, that means 1/20th of the people 00:42.337 --> 00:47.267 die every year and so you need 50 out of 1,000 births 1/20th of 00:47.271 --> 00:50.911 your people to be births; so births and deaths, 00:50.912 --> 00:53.202 in what we call primitive times, 00:53.200 --> 00:56.220 which might mean up to the Napoleonic Revolution, 00:56.220 --> 01:04.780 almost is 40 to 50 births and 40 to 50 deaths a year. 01:04.780 --> 01:07.120 Now here is modern times. 01:07.120 --> 01:11.310 We're starting in 1950 in all of these graphs and coming in 01:11.305 --> 01:15.865 the period of the popular-- main--beginning births of the 01:15.870 --> 01:20.470 population explosion 1950 to 1990 in all these cases. 01:20.470 --> 01:25.170 And here are the various parts of the world and you'll notice 01:25.165 --> 01:32.455 that this is the death-- I'm sorry the birth rate is 50, 01:32.456 --> 01:39.916 birth rate is 43 or something 42,43, 45,45. 01:39.920 --> 01:46.400 That 1950 the birth rate is at approximately its level for 01:46.400 --> 01:48.790 centuries way back. 01:48.790 --> 01:53.170 We know that not too much before this time since 01:53.174 --> 01:57.004 population was not growing until some-- 01:57.000 --> 02:00.930 a little bit before this time that the death rate must have 02:00.927 --> 02:04.867 been the same, so the death rate was also 40 02:04.872 --> 02:06.222 to 50 people. 02:06.219 --> 02:07.299 Look what happened. 02:07.299 --> 02:12.539 By 1950 the death rate is already down to half of its 02:12.536 --> 02:17.466 traditional level, even in Sub-Saharan Africa it's 02:17.471 --> 02:21.321 almost reduced to half; in Central America, 02:21.322 --> 02:23.172 the Caribbean, less than half; 02:23.169 --> 02:26.759 South America less than half; China about half; 02:26.759 --> 02:31.229 South Asia about half; Southeast Asia about half. 02:31.229 --> 02:35.929 In most of the world by the 1950s the birthrate was still 02:35.930 --> 02:39.460 extremely high, but the death rate had come 02:39.455 --> 02:43.145 down to half of what it had always been. 02:43.150 --> 02:47.630 What was going on is that these countries were almost all still 02:47.627 --> 02:51.887 under colonial rule with the exception of South America, 02:51.889 --> 02:55.249 which might be a reason why it's even better. 02:55.250 --> 03:00.140 And, among all their faults, the colonialists did institute 03:00.141 --> 03:03.281 basic sanitation, basic public health, 03:03.276 --> 03:07.256 basic public order and they stopped a lot of the warfare 03:07.256 --> 03:08.916 between communities. 03:08.919 --> 03:12.629 They imposed a lot of violence upon the people but that was 03:12.633 --> 03:16.483 apparently much less then the violence that local communities 03:16.476 --> 03:19.866 imposed upon each other in the pre-colonial era, 03:19.870 --> 03:25.750 so the death rate was down by the 1950s. 03:25.750 --> 03:28.160 Sometime in 50s, around 1950, 03:28.156 --> 03:33.396 the birth rate started coming down in all those countries, 03:33.400 --> 03:36.760 and even though the birthrate starts at these very, 03:36.756 --> 03:40.986 very high levels they come down almost everywhere with of course 03:40.985 --> 03:43.935 the exception being Sub-Saharan Africa, 03:43.940 --> 03:46.810 and you've read about why that is and I keep saying that almost 03:46.807 --> 03:50.347 everything we say, SubSaharan Africa is an 03:50.354 --> 03:52.934 exception to the rate. 03:52.930 --> 03:57.420 Even though the death rate was down, 03:57.419 --> 04:00.209 the birth rate didn't change much, but in every other part of 04:00.206 --> 04:02.016 the developing regions of the world, 04:02.020 --> 04:07.450 the birth rate and the death rate came down approximately in 04:07.453 --> 04:09.943 parallel with each other. 04:09.938 --> 04:15.158 Of course the difference between that birth and death 04:15.163 --> 04:20.993 rate is population increase - and this is the heyday of the 04:20.988 --> 04:23.498 population explosion. 04:23.500 --> 04:28.170 Remember this is per 1,000 so it's a percent kind of a number, 04:28.170 --> 04:31.950 so as the population grows the number of people represented by 04:31.954 --> 04:34.194 this percent cap grows and grows, 04:34.190 --> 04:40.150 and grows, and so this explains the graph I showed you last 04:40.148 --> 04:46.518 time, or two times ago. 04:46.519 --> 04:51.949 Starting again in 1950 to 1990, the number of people added each 04:51.946 --> 04:55.896 year just keeps growing, with one blip and you'll see 04:55.899 --> 04:59.549 later in the course, I've shown you that blip 04:59.550 --> 05:04.050 before, but we'll discuss what that blip is. 05:04.050 --> 05:07.840 The data for the individual regions of the world and this 05:07.843 --> 05:10.083 all fits together, makes sense. 05:10.079 --> 05:14.799 Now we've been through the European population story, 05:14.800 --> 05:17.040 and again we saw that, not always but mostly, 05:17.040 --> 05:20.650 the death rate fell first and then the birth rate fell and 05:20.649 --> 05:23.499 Europe went through a population explosion. 05:23.500 --> 05:26.160 To say this story the way I've been telling you, 05:26.160 --> 05:29.100 no differences, that the third world is just 05:29.096 --> 05:32.506 going through exactly what Europe went through, 05:32.509 --> 05:34.609 but it isn't true. 05:34.610 --> 05:40.560 Let's compare two of the fertility transitions. 05:40.560 --> 05:46.140 This is Sweden and this is Mexico, and you'll notice that 05:46.137 --> 05:52.107 Sweden has birth and death kind of hanging around until maybe 05:52.113 --> 05:54.183 here, until 1860s, 05:54.177 --> 05:59.157 and that's just what the Princeton Project found out that 05:59.161 --> 06:04.231 the really serious decline happened somewhere in this 1870 06:04.233 --> 06:08.703 region, and then the death rate 06:08.697 --> 06:16.027 declines rather continuously on through the time, 06:16.029 --> 06:17.859 and the birth rate declines. 06:17.860 --> 06:20.360 This starts around 1870. 06:20.360 --> 06:23.820 Mexico's decrease starts around 1970. 06:23.819 --> 06:27.499 So between what we now call the developing countries or the 06:27.495 --> 06:30.935 third world countries, about 100 year difference 06:30.940 --> 06:34.960 between when Europe started its transition and when the 06:34.961 --> 06:38.611 developing countries started their transition. 06:38.610 --> 06:40.660 Now 100 years may seem a lot to you, 06:40.660 --> 06:42.680 but in the course of human history, 06:42.680 --> 06:47.060 since these numbers had been going on forever, 06:47.060 --> 06:50.130 100 years is a very, very short time. 06:50.129 --> 07:08.449 Another difference you should note is--Hang on, 07:08.452 --> 07:16.422 I just fixed this. 07:16.420 --> 07:29.210 Usually that's all that required I hope. 07:29.209 --> 07:40.459 Nope. 07:40.459 --> 07:52.279 Anybody have a laser pointer by any miracle? 07:52.279 --> 07:56.249 All right, we're going to have a little bit of trouble today 07:56.254 --> 07:58.954 but I think you can figure things out. 07:58.949 --> 08:05.979 Notice that the levels of everything there are lower in 08:05.978 --> 08:08.878 Sweden, that Sweden starts and the 08:08.880 --> 08:12.580 European countries generally start at a lower level of births 08:12.577 --> 08:15.767 and a lower level of deaths, so they were already, 08:15.766 --> 08:18.716 by the time that their serious transition starts, 08:18.720 --> 08:23.280 they're already quite a ways down compared to where Mexico 08:23.278 --> 08:23.998 starts. 08:24.000 --> 08:37.630 Notice that the deaths and the births are much higher in Mexico 08:37.631 --> 08:41.371 than in Europe. 08:41.370 --> 08:46.770 Now those are important, but notice the gradualness of 08:46.773 --> 08:48.713 the decline here. 08:48.710 --> 08:53.030 That Sweden had a long time to adjust to these changes, 08:53.029 --> 08:57.509 whereas, look at the drop in the death rate in Mexico. 08:57.509 --> 08:58.989 Boom! 08:58.990 --> 09:02.730 Basically all of a sudden and then give it a generation, 09:02.731 --> 09:05.251 look at the drop in the birth rate. 09:05.250 --> 09:10.490 That's the most amazing thing, how rapidly things change in 09:10.488 --> 09:15.098 the developing world, compared to the way it changed 09:15.095 --> 09:16.355 in Europe. 09:16.360 --> 09:22.780 Because of this rapidity of this decline and a natural delay 09:22.778 --> 09:25.628 here, whereas in Sweden that might be 09:25.625 --> 09:27.815 the delay, the delay means because of the 09:27.815 --> 09:31.585 rapidity of the decline, that the difference now between 09:31.586 --> 09:36.086 births and deaths is this huge amount compared to a much 09:36.086 --> 09:37.966 smaller amount here. 09:37.970 --> 09:40.900 Europe never had to cope with the rate of increase, 09:40.899 --> 09:43.359 the number of people added every year, 09:43.360 --> 09:47.460 the percentage of the population, never had to cope 09:47.457 --> 09:52.127 with anything like what the currently developing countries 09:52.129 --> 09:55.899 had and that's a result of the rapid drop. 09:55.899 --> 09:59.719 The other thing to note, of course, 09:59.720 --> 10:02.590 is that by this time, the births and the deaths in 10:02.586 --> 10:06.406 Sweden are essentially equal, and Sweden's population is not 10:06.407 --> 10:10.167 growing anymore and that as you heard from Dr. Teitelbaum's 10:10.171 --> 10:13.491 lecture, is characteristic of Europe as 10:13.486 --> 10:16.376 a whole, as well as Japan, 10:16.375 --> 10:21.155 and a lot of the East Asian countries. 10:21.158 --> 10:26.618 A cartoon of this which has--a lot right about and one big 10:26.624 --> 10:30.184 thing wrong with it, is that here's the rich 10:30.179 --> 10:33.819 countries, they start-- this is the pop--rate of 10:33.817 --> 10:38.947 increase of population growth, that they start earlier, 10:38.946 --> 10:42.266 he starts it quite early in France, 10:42.269 --> 10:46.579 and 100 years later--in this graph it's called 'poor 10:46.582 --> 10:48.192 countries' start. 10:48.190 --> 10:51.920 The peak, the rise is slow, the fall is slow, 10:51.918 --> 10:54.798 the rise is fast, the fall is fast, 10:54.798 --> 10:57.508 the peak is much lower here. 10:57.509 --> 10:59.389 The peak is about 1%. 10:59.389 --> 11:04.569 The maximum rate of growth that Europe ever experienced was 1%, 11:04.567 --> 11:09.327 whereas, for poor countries, the average was 2.5% and some 11:09.326 --> 11:10.826 were up at 3%. 11:10.830 --> 11:18.790 So, enormously greater stress on the countries that went 11:18.792 --> 11:23.282 through this very, very fast. 11:23.279 --> 11:26.359 Why did this happen? 11:26.360 --> 11:28.290 Why is it so much faster in developing countries? 11:28.288 --> 11:31.708 We say that as each country, as it gets into their 11:31.710 --> 11:35.340 transition phase later, everything happens faster. 11:35.340 --> 11:38.210 It's quite a robust phenomenon. 11:38.210 --> 11:41.390 Every few years, you say, oh man China or some 11:41.392 --> 11:43.322 country, Korea, Taiwan, 11:43.317 --> 11:48.147 had the fastest decline ever and then a few years later some 11:48.153 --> 11:52.993 new countries enter in and their decline is even faster. 11:52.990 --> 11:57.230 One of the main reasons is that contraceptives were invented 11:57.225 --> 11:58.225 around here. 11:58.230 --> 12:02.050 The pill, the diaphragm, kind of all that-- 12:02.048 --> 12:05.958 well some of them went way back here but the modern method, 12:05.960 --> 12:10.110 the really modern methods were all like the pill in around the 12:10.105 --> 12:10.645 1960s. 12:10.649 --> 12:15.239 This is a graph showing that the developing countries are 12:15.235 --> 12:18.635 using contraception, so here is contraceptive 12:18.644 --> 12:20.784 prevalence, the percent of women and 12:20.777 --> 12:23.117 childbearing ages that use contraception, 12:23.120 --> 12:28.450 and it ranges from very little, less than 10% to like 70%. 12:28.450 --> 12:29.160 The U.S. 12:29.160 --> 12:31.650 is in the 60% to 70% range. 12:31.649 --> 12:34.409 Notice that the fertility, the total fertility rate, 12:34.408 --> 12:36.738 if the country's not using contraception, 12:36.740 --> 12:40.430 very high fertility rate, as they use more and more 12:40.433 --> 12:43.763 contraception their fertility rate goes on. 12:43.759 --> 12:47.199 The mechanism in the developing countries is use of 12:47.197 --> 12:50.497 contraception and mostly modern contraception. 12:50.500 --> 12:53.230 Whereas, when Europe went through its transition, 12:53.227 --> 12:55.727 they didn't have hardly any contraception. 12:55.730 --> 13:00.700 Some condoms were just beginning to come in but none of 13:00.695 --> 13:05.935 the modern chemical methods or the better kinds of barrier 13:05.936 --> 13:07.036 methods. 13:07.038 --> 13:11.438 The story is kind of--that, why the developing countries 13:11.440 --> 13:15.520 are faster is that the science is already there, 13:15.519 --> 13:19.329 the medical stuff is there, the death rate comes down 13:19.331 --> 13:23.881 because again Europe developed the medical know how and then it 13:23.876 --> 13:27.466 just got transferred very rapidly: vaccines, 13:27.470 --> 13:31.540 vitamins, viruses, all of those were discovered 13:31.543 --> 13:34.203 before the transition there. 13:34.200 --> 13:38.410 Just as important as the knowledge was an attitude toward 13:38.413 --> 13:42.023 civil government and civil society that it is the 13:42.024 --> 13:46.844 responsibility of governments to take care of the health of their 13:46.841 --> 13:47.821 people. 13:47.820 --> 13:49.100 That's not a given. 13:49.100 --> 13:51.120 Most countries, through most of history, 13:51.119 --> 13:54.019 the government was rapacious and their idea was to get as 13:54.019 --> 13:56.349 much taxes from the peasants as possible. 13:56.350 --> 14:00.000 The peasants were sort of like non-humans and use those taxes 13:59.998 --> 14:03.828 to have an army and go try to get--enlarge their territories. 14:03.830 --> 14:07.850 The idea of civil government, where the government is for the 14:07.850 --> 14:12.010 people is a fairly modern idea and one of the basic things that 14:12.006 --> 14:14.886 governments try to do is public health. 14:14.889 --> 14:19.319 Then of course--on the technology, 14:19.320 --> 14:22.450 the contraceptives I've mentioned, the means of mass 14:22.447 --> 14:25.747 communication, I'll show you a slide later 14:25.751 --> 14:30.531 that change in behavior is triggered a lot by what you see 14:30.528 --> 14:34.548 on television and what you see on the radio, 14:34.549 --> 14:37.239 what you see in newspapers. 14:37.240 --> 14:39.570 As in chimpanzees, we're a very social species, 14:39.570 --> 14:42.050 and we're always looking to see what's acceptable, 14:42.053 --> 14:44.083 what kind of behavior is acceptable. 14:44.080 --> 14:47.150 Gossip, maybe I mentioned this, that most of what humans say to 14:47.149 --> 14:49.969 each other is gossip and the function of gossip is to find 14:49.971 --> 14:52.351 what are the limits of acceptable behavior, 14:52.350 --> 14:56.980 so the mass media is extremely important in like telling people 14:56.976 --> 15:01.676 in this case that two children is the proper way of families. 15:01.678 --> 15:04.908 They see American television, American movies, 15:04.907 --> 15:07.487 or Japanese, and what do they see? 15:07.490 --> 15:10.270 Rich people with two children, whereas as they previously 15:10.273 --> 15:13.163 believed that in order to be rich in some sense you have to 15:13.157 --> 15:18.497 have eight children, so the media are very important 15:18.500 --> 15:21.810 in changing perceptions. 15:21.808 --> 15:23.768 Also, for a very long time, maybe not now, 15:23.769 --> 15:28.409 the West had--cachet--was considered the future, 15:28.408 --> 15:31.378 the modernity, the West was very respected and 15:31.375 --> 15:34.075 loved around the world and so the use-- 15:34.080 --> 15:39.620 the small family norm was a characteristic of the Western, 15:39.620 --> 15:42.840 a lot of people tried to become like the West, 15:42.840 --> 15:44.820 there was that cachet. 15:44.820 --> 15:47.310 Of course family planning programs, the west had a long 15:47.307 --> 15:49.287 experience with family planning programs. 15:49.288 --> 15:51.908 You've read some of the Margaret Sanger stuff from 15:51.910 --> 15:54.280 America, the Marie Stopes stuff from 15:54.279 --> 15:56.649 England, where people are struggling 15:56.647 --> 16:00.117 with these things and finally come out the other end and 16:00.124 --> 16:02.974 decide to gain control of their fertility. 16:02.970 --> 16:06.700 In a sense, both medically and culturally, 16:06.700 --> 16:11.660 Westerners were the guinea pigs for this fertility transition 16:11.663 --> 16:14.633 and then once it was, in some sense, 16:14.629 --> 16:17.219 perfected and finished in the West, 16:17.220 --> 16:22.920 it was sort of transferred wholesale to the newly 16:22.918 --> 16:25.648 developing countries. 16:25.649 --> 16:31.049 Now another thing about the fertility transition is that not 16:31.052 --> 16:35.722 only is it more intense demographically with all the 16:35.724 --> 16:40.964 statistics that we can gather, but it's also more intense 16:40.956 --> 16:41.966 emotionally. 16:41.970 --> 16:46.760 As you're for sure well aware by now in this course, 16:46.759 --> 16:50.729 there's enormously strong social norms about sex and 16:50.732 --> 16:53.972 reproduction, and if those norms are about to 16:53.972 --> 16:57.772 change it attacks one of the most important foundations of a 16:57.765 --> 17:02.205 culture and there's-- that does not happen without a 17:02.214 --> 17:05.704 lot of conflict within the culture. 17:05.700 --> 17:09.270 In the West, although there's a lot of 17:09.268 --> 17:13.368 discussion about this, the idea of individualism, 17:13.368 --> 17:17.398 that people individually go out and do what's good for them, 17:17.400 --> 17:20.300 they make choices based on their own desires. 17:20.298 --> 17:23.448 There's kind of a long history of that and it was sort of 17:23.454 --> 17:26.164 formalized by Adam Smith in economics saying, 17:26.160 --> 17:29.440 that if everybody went out and tried to get as rich as possible 17:29.444 --> 17:31.464 it would be wonderful for everybody. 17:31.460 --> 17:34.310 In most of the developing countries they have a more 17:34.308 --> 17:38.378 communal kind of attitude, whereas, often if you speak to 17:38.384 --> 17:39.914 older, say Chinese, 17:39.913 --> 17:44.363 or Indians--the smallest unit of desire which they speak of is 17:44.358 --> 17:46.938 the family; very hard to get them to think 17:46.941 --> 17:47.931 of what THEY want. 17:47.930 --> 17:51.680 It's the family, or village, or some larger 17:51.676 --> 17:52.476 entity. 17:52.480 --> 17:57.020 When you start changing norms, the norms in non-Western 17:57.018 --> 18:02.308 societies or pre-modern western societies are very much stronger 18:02.311 --> 18:04.751 in control of the people. 18:04.750 --> 18:07.790 People have less latitude to go and do their own thing; 18:07.788 --> 18:13.848 they're under social--much more social control. 18:13.848 --> 18:18.508 Of course all of these things multiply--square these things, 18:18.512 --> 18:22.152 quadruple them, if you're talking about sex. 18:22.150 --> 18:24.220 One of the readings, I don't know if you're going to 18:24.215 --> 18:26.525 do it tonight or you did it already, about the Palestinian 18:26.526 --> 18:27.536 woman who was killed. 18:27.538 --> 18:32.328 Did you--was that--not in your reading yet. 18:32.328 --> 18:36.768 What it is, that a Palestinian woman was suspected of some 18:36.769 --> 18:39.659 infidelity, no hard evidence for it, 18:39.656 --> 18:44.146 and her little brother killed her after searching for her for 18:44.151 --> 18:45.201 many years. 18:45.200 --> 18:49.370 The idea of giving you that article is it's a tear jerker, 18:49.368 --> 18:56.438 but it gives you an idea of the emotionality of the-- 18:56.440 --> 18:59.530 strength with which the older social norms are held and 18:59.532 --> 19:01.712 someone who appears on the surface, 19:01.710 --> 19:05.470 even mildly, to violate it, 19:05.470 --> 19:07.930 can get killed. 19:07.930 --> 19:14.240 A Jordanian woman has just come out with a book 2003, 19:14.240 --> 19:16.840 Honor Lost, and she talked about her best 19:16.835 --> 19:19.095 friend and this is what triggered her, 19:19.099 --> 19:20.609 apparently, to write the book. 19:20.608 --> 19:23.858 This woman, her friend, had been seen in public walking 19:23.855 --> 19:26.015 with a man who was not a relative. 19:26.019 --> 19:28.269 Now not doing anything bad but right there in public, 19:28.269 --> 19:33.489 so you know nothing was going on on the streets and this being 19:33.490 --> 19:36.660 seen alone-- being seen on the streets with 19:36.664 --> 19:40.624 a man who was not a relative was such a stain on the family's 19:40.615 --> 19:44.295 honor that the woman's father stabbed her 12 times in the 19:44.301 --> 19:48.191 chest and then stood over the body to make sure that she was 19:48.185 --> 19:50.815 dead before calling an ambulance. 19:50.818 --> 19:55.568 Imagine the strength of the cultural norms that allows a 19:55.566 --> 19:59.706 brother to kill a sister, or a father to kill his 19:59.708 --> 20:00.828 daughter. 20:00.828 --> 20:03.548 In this last case, this woman who the father 20:03.545 --> 20:06.595 killed her, the family was not poor and was 20:06.598 --> 20:09.398 not Muslim, even though it's in Jordan but 20:09.403 --> 20:12.123 they were middle class and Roman Catholic. 20:12.118 --> 20:16.408 So that means--almost nobody in these cultures escapes the 20:16.413 --> 20:20.633 cultural norms even though Catholics in Jordan are a very 20:20.632 --> 20:24.552 small minority as is the middle class in Jordan. 20:24.548 --> 20:29.848 They obey the same rules of the culture as everyone else. 20:29.848 --> 20:33.618 The author of that book claims that this happens to thousands 20:33.615 --> 20:37.315 of women, that there's thousands of women dying in honor--so 20:37.317 --> 20:38.947 called honor killings. 20:38.950 --> 20:40.830 Now, of course, it's not restricted to the 20:40.830 --> 20:43.500 Middle East, you will read a little bit 20:43.500 --> 20:47.610 later a reading for India where a woman is raped by her 20:47.614 --> 20:52.114 father-in-law and her own father insists on killing her. 20:52.109 --> 20:54.289 That's from India. 20:54.288 --> 20:58.368 You have to contrast this with, not all cultures are like this, 20:58.368 --> 21:05.388 so contrast this very tight strict norm about women's-- 21:05.390 --> 21:08.270 not giving women any possibility for going beyond the 21:08.267 --> 21:10.317 norm, compare it with the Na of China 21:10.315 --> 21:12.175 which I think you've already read, 21:12.180 --> 21:14.870 where everything is totally free, or the Japanese, 21:14.868 --> 21:18.378 the story of the Suye Mura women; 21:18.380 --> 21:20.270 have you read that yet? 21:20.269 --> 21:22.959 Again, there's a huge amount of sexual freedom. 21:22.960 --> 21:29.100 So it isn't that all cultures have the same cultural norms, 21:29.098 --> 21:34.548 but they all do have cultural norms and violation of those 21:34.548 --> 21:37.798 cultural norms will be punished. 21:37.798 --> 21:41.078 Another thing is that, in the different stream, 21:41.078 --> 21:44.758 the Western and Eastern fertility transition, 21:44.759 --> 21:48.529 is that the economic constraints, the level of 21:48.532 --> 21:53.652 poverty in the third world is much worse than it was in Europe 21:53.647 --> 21:56.497 at the time of its transition. 21:56.500 --> 22:00.350 Everything is more difficult when you're poor and you live in 22:00.347 --> 22:03.357 a poor country with poorly developed government, 22:03.363 --> 22:05.483 everything is more difficult. 22:05.480 --> 22:11.000 In your reading packet is a one page collection of headlines 22:10.999 --> 22:16.609 from Tanzania and you just see all the problems that Tanzania 22:16.611 --> 22:22.221 is going through in a period when their fertility is high and 22:22.223 --> 22:26.343 maybe beginning to start falling down. 22:26.338 --> 22:32.978 We have some understanding of the many ways in which 22:32.977 --> 22:36.477 statistically, except by magnitude, 22:36.479 --> 22:39.639 the fertility of the demographic transition in the 22:39.638 --> 22:43.378 countries that have entered since 1960 looks very different 22:43.380 --> 22:45.960 from those that entered it in 1860. 22:45.960 --> 22:50.010 Quantitatively also, when you go through a period of 22:50.010 --> 22:53.120 population growth, the question is well how much 22:53.121 --> 22:55.901 did your population grow altogether between the beginning 22:55.904 --> 22:58.894 of the transition which we've had the beginning in Europe and 22:58.886 --> 23:04.396 the end in Europe, as your text says something 23:04.395 --> 23:14.305 like 1870 to 1930 and Europe grew by about a factor of four, 23:14.309 --> 23:16.969 so the population quadrupled. 23:16.970 --> 23:19.790 This was the time when the population of the developing 23:19.787 --> 23:21.507 countries was staying constant. 23:21.509 --> 23:24.549 But developing countries--India actually, 23:24.548 --> 23:27.468 as far as we can predict, is having one of the smallest 23:27.474 --> 23:30.954 between four and five, so they're sort of at the 23:30.949 --> 23:34.269 maximum for Europe, no country in Europe was more 23:34.269 --> 23:36.919 than four and India, one of the lowest countries for 23:36.921 --> 23:39.731 the developing world, would be somewhere between four 23:39.730 --> 23:41.000 and five so we expect. 23:41.000 --> 23:45.310 Mexico will have grown by a factor of seven to ten times; 23:45.308 --> 23:49.678 Kenya by more than fifteen times, so here is again, 23:49.680 --> 23:52.150 countries that started the transition poor, 23:52.150 --> 23:56.760 they're still moderately poor, Mexico is doing better but 23:56.755 --> 24:01.685 certainly Kenya is not and India is doing somewhat better. 24:01.690 --> 24:05.540 And now they have to cope with five, six, seven, 24:05.537 --> 24:09.137 eight, nine, ten times as much population. 24:09.140 --> 24:13.050 Because of these multipliers, the fraction of people in the 24:13.045 --> 24:17.015 different parts of the world goes first one way and then the 24:17.017 --> 24:17.957 other way. 24:17.960 --> 24:22.210 Before the mortality transition, Europeans 24:22.208 --> 24:27.388 represented about 18% of the world's population. 24:27.390 --> 24:30.080 At its maximum, when Europe had the maximum, 24:30.078 --> 24:32.178 Europe and European people in America, 24:32.180 --> 24:33.870 Australia, New Zealand and so forth, 24:33.868 --> 24:37.658 but European stock people their fraction-- 24:37.660 --> 24:40.230 the European fraction of the world population doubled, 24:40.230 --> 24:45.090 more than doubled actually from--about doubled from 18% to 24:45.089 --> 24:47.129 35% so they-- Europe was 24:47.127 --> 24:51.227 undergoing--Europeans were undergoing a huge population 24:51.226 --> 24:51.906 thing. 24:51.910 --> 24:57.510 Now--by 1995 because Europe's population growth is over, 24:57.509 --> 25:01.939 European people's are over, and the developing countries 25:01.940 --> 25:06.610 population growth is starting it's back to where it started 25:06.612 --> 25:09.112 and it's back to about 18%. 25:09.108 --> 25:13.768 Now--that's 1995 and we've had already 13 years of population 25:13.765 --> 25:17.875 growth continuing in the developing countries and it's 25:17.877 --> 25:21.057 continuing and getting more and more. 25:21.058 --> 25:25.818 The relative percentage of people in, 25:25.818 --> 25:29.428 what's now called the developing world versus the 25:29.433 --> 25:32.703 European world, is going now to be so high in 25:32.701 --> 25:36.521 the developing countries that it's way beyond anything that 25:36.522 --> 25:41.042 was historically the case, except maybe when humans 25:41.040 --> 25:47.500 started moving out of Africa and into the Middle East and into 25:47.500 --> 25:48.560 Europe. 25:48.558 --> 25:52.708 This may not stabilize--so far there is no sign that European 25:52.711 --> 25:55.371 population, almost all of the European 25:55.374 --> 25:59.354 populations now have fertility rates below 2.1 and so they are 25:59.347 --> 26:01.627 going-- if they continue with that of 26:01.626 --> 26:04.206 course they eventually disappear altogether, 26:04.210 --> 26:09.220 and the idea that there's going to be some stabilization at some 26:09.224 --> 26:13.294 ratio of say rich and poor countries is dependent on 26:13.285 --> 26:18.295 fertility coming up in developed countries and we don't have any 26:18.299 --> 26:20.529 reason to expect that. 26:20.528 --> 26:23.278 This is an important factor because, 26:23.278 --> 26:30.028 if part of the developing countries coming out of poverty, 26:30.028 --> 26:33.318 is aid from the West and that's again-- 26:33.318 --> 26:35.768 everything is debatable in this course, 26:35.769 --> 26:38.409 how much help aid does. 26:38.410 --> 26:40.000 It actually--there's no question about that in some 26:39.999 --> 26:41.079 cases it's tremendously helpful. 26:41.078 --> 26:46.108 That if there's nobody left in the developed countries to give 26:46.112 --> 26:50.642 the aid, then one of the props which 26:50.641 --> 26:58.421 helps developing countries come up will have disappeared. 26:58.420 --> 27:02.770 We've gone through the quantities of the transition, 27:02.769 --> 27:06.039 but we have compared the demographic transition of 27:06.042 --> 27:09.252 developing countries with European countries, 27:09.250 --> 27:15.410 but we haven't compared it to anything else. 27:15.410 --> 27:21.270 The world population, as I say, is growing something 27:21.271 --> 27:25.641 like 70 to 80 million people a year. 27:25.640 --> 27:29.010 The question is, if we imagine some sort of a 27:29.012 --> 27:32.622 landing for this, what kinds of things are going 27:32.615 --> 27:35.525 to stop this population explosion? 27:35.529 --> 27:38.279 There's bad things and there's good things; 27:38.279 --> 27:41.209 bad possibilities and good possibilities. 27:41.210 --> 27:45.340 The bad possibilities and have been known-- 27:45.338 --> 27:48.278 have been thought about for a long time is 1) famine, 27:48.279 --> 27:51.529 that people could start starving, disease, 27:51.529 --> 27:54.289 AIDS, people are always talking about Aids balancing the 27:54.291 --> 27:55.801 population explosion or war. 27:55.798 --> 27:59.748 I'm going to give you some idea of the magnitude of these 27:59.752 --> 28:00.462 factors. 28:00.460 --> 28:04.000 Famine, one way that famine operates is, 28:04.000 --> 28:07.400 some country has a big drought and they go through a short 28:07.400 --> 28:11.220 period of terrible famine, but that's not the main thing. 28:11.220 --> 28:15.990 People all over world and especially children are 28:15.990 --> 28:20.860 malnourished and malnourished leads to disease. 28:20.858 --> 28:25.058 It's very hard to get these statistics and to gather these 28:25.063 --> 28:29.123 statistics, and it depends on who you're talking too. 28:29.118 --> 28:33.018 I was teaching in a health course and we sort of did serial 28:33.017 --> 28:37.077 lectures and Michelle Barry, a professor of international 28:37.082 --> 28:41.302 infectious diseases, gave the lecture before mine, 28:41.298 --> 28:46.248 so I went to her lecture to see the lay of the land, 28:46.250 --> 28:50.190 and she was describing millions of deaths from various diseases. 28:50.190 --> 28:52.360 The medical students, this was to medical students, 28:52.358 --> 28:55.618 had no clue and they were just absolutely shocked at the 28:55.622 --> 28:58.922 magnitude of what's going on, especially in developing 28:58.924 --> 28:59.574 countries. 28:59.568 --> 29:01.638 She was listing, maybe you know, 29:01.642 --> 29:04.982 Aids is about--back then it was two million a year, 29:04.983 --> 29:08.063 it might be three million and coming down; 29:08.058 --> 29:11.928 Malaria, tuberculosis from the one to two million deaths a year 29:11.931 --> 29:14.561 kind of thing; diarrhea in children, etc. 29:14.558 --> 29:19.168 These are--the massive killers in the world. 29:19.170 --> 29:22.450 Next week I came on and said, you know what, 29:22.450 --> 29:26.270 there's x millions of deaths from malnutrition and they were 29:26.271 --> 29:29.701 shocked because it was an even bigger number then what 29:29.704 --> 29:31.394 Dr. Barry had given. 29:31.390 --> 29:34.640 I said, you know what, they're the same deaths you 29:34.637 --> 29:36.227 heard about last week. 29:36.230 --> 29:39.920 The thing is something like--I don't remember the number, 29:39.920 --> 29:43.360 something like if you take a skin test for tuberculosis, 29:43.358 --> 29:47.618 something like a third to a half of us have been exposed to 29:47.622 --> 29:51.372 the TB bug so that we have antibodies against it. 29:51.368 --> 29:54.238 We basically in some sense, in a small sense, 29:54.244 --> 29:55.164 have had TB. 29:55.160 --> 29:59.240 If you go to India more people have had it but the fraction 29:59.239 --> 30:02.329 that actually come down and get sick is much, 30:02.334 --> 30:03.464 much higher. 30:03.460 --> 30:04.120 Why? 30:04.119 --> 30:05.319 Malnutrition. 30:05.318 --> 30:08.018 That all of the diseases, if you're malnourished your 30:08.017 --> 30:10.917 immune system and your other body systems can't fight the 30:10.923 --> 30:13.643 bug, so you actually get sick and 30:13.635 --> 30:14.915 will often die. 30:14.920 --> 30:21.290 There's a big discussion of when you see a death to say TB, 30:21.291 --> 30:27.771 is that death caused by the tuberculosis bacillus or is that 30:27.773 --> 30:31.403 death caused by malnutrition? 30:31.400 --> 30:35.870 The World Health Organization and a lot of other groups are 30:35.873 --> 30:40.653 now saying that the about half the deaths from all these things 30:40.654 --> 30:44.284 are really at base caused by malnutrition, 30:44.279 --> 30:47.469 that at the level of infection that the people are exposed to, 30:47.470 --> 30:52.540 you should see so many deaths but you actually see twice that 30:52.538 --> 30:55.918 many deaths because people are hungry. 30:55.920 --> 30:59.710 The numbers from the Food and Agriculture Organization of the 30:59.710 --> 31:04.660 United Nations are-- is that 25,000 people die every 31:04.660 --> 31:07.650 day, like today, 25,000 people will 31:07.646 --> 31:10.476 die from starvation or malnutrition. 31:10.480 --> 31:12.340 That's a huge number. 31:12.338 --> 31:16.908 That's nine million deaths a year and so I calculated it out, 31:16.907 --> 31:21.247 during the course of this lecture 1,300 people will die of 31:21.249 --> 31:23.609 starvation or malnutrition. 31:23.609 --> 31:26.949 It's really very serious. 31:26.950 --> 31:28.280 Most of the death--yeah? 31:28.278 --> 31:29.908 Student: How many people are born during this 31:29.906 --> 31:30.216 lecture? 31:30.220 --> 31:31.160 Prof: What? 31:31.160 --> 31:33.520 Student: How many people will be born during this 31:33.518 --> 31:33.938 lecture? 31:33.940 --> 31:36.580 Prof: Also a very large number, more than the deaths. 31:36.578 --> 31:40.848 We've seen that the--you can calculate it yourself that the 31:40.852 --> 31:44.022 birthrate is something like three times, 31:44.019 --> 31:45.289 two and a half times the death rate, 31:45.288 --> 31:49.278 but that's not just that--you can sort of double the total 31:49.279 --> 31:52.919 number of deaths will be something a little more than 31:52.920 --> 31:55.790 double the deaths from malnutrition, 31:55.789 --> 31:56.669 so a lot. 31:56.670 --> 32:00.310 The population is still growing I'll bet, as you've seen, 32:00.306 --> 32:03.416 because we do have a lot more births than deaths, 32:03.422 --> 32:05.892 and I showed you that data before. 32:05.890 --> 32:09.800 Malnutrition is the leading cause of death in children in 32:09.803 --> 32:15.193 developing countries, and the numbers you read are 32:15.193 --> 32:20.403 all over the place, and one number that I pulled 32:20.397 --> 32:25.667 out is 13 million child deaths a year and I've seen lower than 32:25.667 --> 32:26.357 that. 32:26.358 --> 32:29.988 The World Bank in the--it's millennium goals, 32:29.990 --> 32:32.150 you know the big millennium goal thing what the whole world 32:32.146 --> 32:34.856 is supposed to go to, says again, that half the 32:34.856 --> 32:39.216 deaths of children under five are due to malnutrition and-- 32:39.220 --> 32:41.300 there's altogether, for all reasons, 32:41.298 --> 32:45.588 there's 13 million child deaths a year and you get numbers from 32:45.590 --> 32:49.330 different studies saying anywhere between a third and a 32:49.327 --> 32:52.717 half of these deaths are due to malnutrition. 32:52.720 --> 32:54.130 What does malnutrition look like? 32:54.130 --> 33:00.980 You may have seen--this is kwashiorkor, how many of you 33:00.983 --> 33:03.653 have heard of that? 33:03.650 --> 33:04.660 It's a very prevalent kind of thing. 33:04.660 --> 33:05.810 Do I have a slide? 33:05.808 --> 33:10.108 You go to a village in poor places and you see these 33:10.105 --> 33:11.785 distended bellies? 33:11.788 --> 33:15.548 This is everywhere and actually we don't even--in --there's a 33:15.554 --> 33:19.014 tremendously prevalent thing, we don't actually know the 33:19.006 --> 33:20.006 cause of it. 33:20.009 --> 33:24.119 The old story was that it's a protein deficiency disease and 33:24.117 --> 33:27.807 protein makes albumin and albumin holds water into the 33:27.808 --> 33:31.738 blood and the tissues, and when you can't hold water, 33:31.736 --> 33:35.416 it sort of floods into your tissues and spreads out, 33:35.420 --> 33:39.170 but now there's a lot of other theories and we just don't know 33:39.170 --> 33:42.060 really what's the basic cause of kwashiorkor. 33:42.058 --> 33:43.478 It is malnutrition. 33:43.484 --> 33:47.694 That's--there's no question about it, but exactly what in 33:47.688 --> 33:50.988 the diet is missing is not totally clear. 33:50.990 --> 33:55.050 Here's another kind of shocking thing, now I'm going to give you 33:55.046 --> 33:58.646 some shocking pictures and tearjerkers but it's important 33:58.651 --> 33:59.361 to see. 33:59.359 --> 34:01.519 This you've seen. 34:01.519 --> 34:05.079 This is an American missionary or aid worker, 34:05.075 --> 34:09.755 I don't know which and that's her baby and that's this baby 34:09.762 --> 34:13.482 and they're both six months old in Africa. 34:13.480 --> 34:17.960 Another thing that happens is that population-- 34:17.960 --> 34:21.500 when population grows the people who are strongest take 34:21.503 --> 34:25.643 the best land and they push out people that are less strong, 34:25.639 --> 34:28.319 or have less population or are less violent or whatever reason, 34:28.320 --> 34:31.340 or less technologically advanced, they push them into 34:31.342 --> 34:33.032 marginal land like deserts. 34:33.030 --> 34:37.500 This is the site in Mali of what used to be one of the 34:37.503 --> 34:42.233 largest lakes in Africa and then it goes through periodic 34:42.231 --> 34:45.821 climatic things; it dries out every so often. 34:45.820 --> 34:48.620 In some sense, people should not be living 34:48.623 --> 34:51.363 there because you know it's going to-- 34:51.360 --> 34:53.030 it goes every so often through droughts, 34:53.030 --> 34:56.230 but they have no choice because stronger people's in the past 34:56.230 --> 34:59.110 have pushed them into these desert kind of regions, 34:59.110 --> 35:01.710 one of the results of population explosion. 35:01.710 --> 35:04.340 I've told you, in Europe, where the extra 35:04.340 --> 35:08.550 farmers had to go up hillsides and into less profitable land, 35:08.550 --> 35:14.000 so there they are in this very arid region and in normal years 35:14.001 --> 35:17.781 they can survive, but then comes a drought and 35:17.784 --> 35:20.924 this kind of thing happens and the result, 35:20.920 --> 35:24.490 of course--this is a boy who is I think nine years old or 35:24.490 --> 35:29.310 something, he's 13 pounds and almost 35:29.306 --> 35:34.886 impossible to keep that boy alive. 35:34.889 --> 35:38.369 Here's one of the really saddening pictures that-- 35:38.369 --> 35:43.149 in the political discourse about population, 35:43.150 --> 35:45.720 and fertility, and family planning in America 35:45.715 --> 35:49.925 there's a lot about motherhood, how wonderful motherhood is -- 35:49.927 --> 35:53.467 everything but you have to see-- well I didn't show that. 35:53.469 --> 35:57.869 I've got--I put in the wrong picture which is maybe good for 35:57.871 --> 35:58.321 you. 35:58.320 --> 36:00.410 Now you've seen a lot of these pictures. 36:00.409 --> 36:03.029 The organizations, they want you to give money 36:03.032 --> 36:06.592 show a lot of them and one of the discussion items about these 36:06.590 --> 36:09.970 kind of pictures is that they make people in poor countries 36:09.971 --> 36:12.771 seem sort of helpless and that's not true. 36:12.768 --> 36:16.248 The amount of stuff that people in these countries are doing to 36:16.253 --> 36:18.393 try to help themselves is enormous, 36:18.389 --> 36:20.139 they can be very strong and very smart people, 36:20.139 --> 36:27.539 but their resources are very limited what they work with. 36:27.539 --> 36:34.119 The bottom line of this little bit is that given the number of 36:34.121 --> 36:40.811 deaths that we understand to be from malnutrition and given the 36:40.813 --> 36:47.293 number of population increase, if the solution is to be solved 36:47.286 --> 36:49.526 by famine, if the balancing of births and 36:49.530 --> 36:51.250 deaths is going to be a famine situation, 36:51.250 --> 36:55.340 the starvation rate must increase by a factor of eight, 36:55.340 --> 36:57.960 plus or minus. 36:57.960 --> 37:01.910 The next thing is disease; disease is the second of our 37:01.913 --> 37:03.713 triplet of horrible solutions. 37:03.710 --> 37:07.010 In 2008 it killed about three million people, 37:07.005 --> 37:10.825 up from two million, and this is clearly--apparently 37:10.826 --> 37:11.796 the peak. 37:11.800 --> 37:15.670 Everyone apparently--Because of the retrovirals and various 37:15.668 --> 37:19.468 other public health measures, the number is supposed to go 37:19.469 --> 37:20.069 down. 37:20.070 --> 37:22.460 The numbers are already changing. 37:22.460 --> 37:26.620 At the end of 2007, the UN got a whole bunch of 37:26.623 --> 37:31.513 better data from certain countries and they had to-- 37:31.510 --> 37:36.330 they lowered the number of people they thought to be 37:36.331 --> 37:40.681 infected with the AIDS virus by 6.3 million. 37:40.679 --> 37:44.859 So something like 33 million people infected with AIDS, 37:44.860 --> 37:47.830 and presumably they will all die at some point, 37:47.829 --> 37:51.349 although the retrovirals can keep them alive a long time. 37:51.349 --> 37:56.149 Notice that 33 million is less than half of one year's 37:56.150 --> 37:58.870 population growth from AIDS. 37:58.869 --> 38:04.189 It's--the way it works out demographically is here is 38:04.190 --> 38:10.180 somewhat older data at the-- from the peak of the AIDS 38:10.175 --> 38:12.985 epidemic, this is the impact in 38:12.992 --> 38:16.132 Sub-Saharan Africa with and without AIDS, 38:16.130 --> 38:23.310 so the gray--the purple is the way the population -was modeled 38:23.306 --> 38:27.966 to increase without AIDS, as if there was no AIDS, 38:27.965 --> 38:30.545 and then with AIDS, AIDS kills these people 38:30.554 --> 38:32.684 basically, prevents these births, 38:32.679 --> 38:36.239 you still have an enormous population increase for 38:36.240 --> 38:40.240 Sub-Saharan Africa which is the worst affected place. 38:40.239 --> 38:43.669 This is one of the worst scenarios --they did a worst 38:43.670 --> 38:47.430 case scenario run which they sort of imagined things to be 38:47.429 --> 38:49.739 about as bad as they could get. 38:49.739 --> 38:53.339 This thing, when you do it for a whole--most of a continent 38:53.340 --> 38:56.590 hides a lot of difference; this is Uganda, 38:56.594 --> 39:02.354 which had a very intelligent response to AIDS and here, 39:02.349 --> 39:05.039 with AIDS there will be this much, and without AIDS there 39:05.043 --> 39:08.203 would have been this much, but population keeps growing. 39:08.199 --> 39:10.009 In any case, in South Africa, 39:10.007 --> 39:14.007 which is about the worst really badly hit place you do see that 39:14.010 --> 39:17.560 population growth without AIDS would be this and they're 39:17.561 --> 39:21.441 actually expecting population growth to come down as a result 39:21.436 --> 39:22.466 of AIDS. 39:22.469 --> 39:25.749 In some countries, it has an important demographic 39:25.746 --> 39:28.816 effect, but for Sub-Saharan Africa, as a whole, 39:28.824 --> 39:30.634 not an enormous effect. 39:30.630 --> 39:33.110 In the rest of world, where, at least so far, 39:33.114 --> 39:35.774 the numbers are much smaller, a minor effect. 39:35.768 --> 39:38.518 It can easily get lost in the statistical noise that we don't 39:38.516 --> 39:40.206 know how many people are on earth, 39:40.210 --> 39:45.460 we don't know exactly how fast the population is growing and 39:45.456 --> 39:49.366 AIDS can be within that statistical noise. 39:49.369 --> 39:55.369 From a demographic point of view, AIDS as a killer, 39:55.369 --> 39:57.409 is significant. 39:57.409 --> 40:01.699 Let me show you there's another thing that kills 1.6 million 40:01.695 --> 40:04.815 people more than half of the AIDS number. 40:04.820 --> 40:08.730 You'll never guess what that is? 40:08.730 --> 40:12.780 It's this, it's smoke from cooking fires, 40:12.780 --> 40:15.100 that in the developing countries, in the poor 40:15.103 --> 40:17.703 countries, this is the way people cook and 40:17.702 --> 40:20.732 the smoke fills the room, gets into their lungs, 40:20.731 --> 40:24.261 and they get all kinds of diseases extra and the estimates 40:24.257 --> 40:28.917 of that is 1.6 million deaths; comparable to tuberculosis and 40:28.918 --> 40:32.148 malaria and somewhat less than AIDS. 40:32.150 --> 40:36.440 They have a solution to this and it's a stove that 40:36.443 --> 40:41.093 keeps--that you don't get these kind of smoke with. 40:41.090 --> 40:46.340 And those cost $10 each and they'll cut out a number of 40:46.340 --> 40:50.910 deaths equivalent to half of the AIDS deaths. 40:50.909 --> 40:54.289 One of the things--if you're interested in understanding the 40:54.286 --> 40:56.686 magnitude of the problems of the world, 40:56.690 --> 40:59.740 one of the things you just have to pay attention is the 40:59.742 --> 41:03.192 magnitude of the problem and the magnitude of any solution. 41:03.190 --> 41:08.060 When there's an almost sure thing of $10 available and 41:08.056 --> 41:13.476 retrovirals cost an awful lot more, which kind of person are 41:13.476 --> 41:16.136 you going to try to save? 41:16.139 --> 41:19.919 The person that can be saved by $10 or the person that needs 41:19.920 --> 41:23.510 $1,000 to be saved if you have limited kinds of money. 41:23.510 --> 41:28.400 From a demographic point of view the problem with-- 41:28.400 --> 41:31.630 almost worse than the total number of deaths because 41:31.632 --> 41:34.742 malaria's been killing people for a long time, 41:34.739 --> 41:36.799 and TB and these are all horrible situations, 41:36.800 --> 41:39.860 of course every death is a horrible sort of thing, 41:39.860 --> 41:44.990 but AIDS kills people in the prime of their life and that's-- 41:44.989 --> 41:47.729 this is what we call hollowing out of the Age structure so 41:47.731 --> 41:49.561 there's children who are dependent, 41:49.559 --> 41:52.049 there's adults who work and there's old people who are 41:52.045 --> 41:52.605 dependent. 41:52.610 --> 41:56.650 If you kill off your working people that leaves the kids with 41:56.650 --> 42:00.390 no one to take care of them, no one to provide economically 42:00.393 --> 42:03.413 for them, that leaves the old people with 42:03.411 --> 42:05.671 no one to take care of them. 42:05.670 --> 42:12.930 The direct deaths from AIDS itself is one horrible thing, 42:12.929 --> 42:17.639 but what they do to taking care of everybody else in the 42:17.637 --> 42:21.487 population multiples that effect by a lot, 42:21.489 --> 42:24.859 and as of 2001 the last statistics that I could find, 42:24.860 --> 42:29.820 there's about 12 million children that have been orphaned 42:29.822 --> 42:31.952 in Africa due to AIDS. 42:31.949 --> 42:36.129 That is--we do a lot of work in the political refugees, 42:36.130 --> 42:40.470 that's triple the number of political refugees that there 42:40.465 --> 42:41.855 are in Africa. 42:41.860 --> 42:45.660 We've done famine, disease, and wars is the last 42:45.659 --> 42:50.429 set of numbers and you hear it at cocktail parties that some 42:50.431 --> 42:52.921 war, whatever the current war is, 42:52.918 --> 42:54.928 will balance births and deaths. 42:54.929 --> 42:58.249 The worst we've had is the atom bombs, 42:58.250 --> 43:01.160 and I don't know if you know what the numbers on the atom 43:01.163 --> 43:03.973 bombs are, but the Hiroshima bomb killed 43:03.972 --> 43:07.672 75,000 people, the Nagasaki bomb killed 25,000 43:07.668 --> 43:08.318 people. 43:08.320 --> 43:14.780 That's 100,000 people dead in two quick flashes. 43:14.780 --> 43:20.990 The population on earth grows by approximately 200,000 a day. 43:20.989 --> 43:22.949 What that means is that, if we can imagine, 43:22.949 --> 43:27.029 and all these are imaginary, if we imagine that some wars 43:27.032 --> 43:31.552 are going to balance births and deaths on earth that means that 43:31.552 --> 43:35.562 every day you have to blow up two Nagasaki bombs and two 43:35.563 --> 43:38.673 Hiroshima bombs, killing that equivalent number 43:38.672 --> 43:40.062 of people just to keep even. 43:40.059 --> 43:44.949 That doesn't reduce population, that just keeps population 43:44.949 --> 43:45.549 flat. 43:45.550 --> 43:50.020 The idea of giving you all these horrible numbers is just 43:50.023 --> 43:54.663 to give you an idea of the magnitude of this issue and that 43:54.657 --> 43:58.887 it's of course absolutely unthinkable that one sort of 43:58.891 --> 44:03.531 continues to just let this situation go rampantly until one 44:03.525 --> 44:07.675 of these negative kind of disasters happens. 44:07.679 --> 44:11.179 There's got to be a solution. 44:11.179 --> 44:16.139 We have to figure it out in some way. 44:16.139 --> 44:19.569 So far in the last lecture or so, I've obviously been what we 44:19.572 --> 44:20.662 call apocalyptic. 44:20.659 --> 44:26.809 The world is coming to an end due to population explosion, 44:26.809 --> 44:30.159 but there's a famous saying to the opposite, 44:30.159 --> 44:32.949 which is that if something can't go on forever, 44:32.949 --> 44:34.989 it won't. 44:34.989 --> 44:40.699 I think that has a large chance of happening and I've described 44:40.702 --> 44:46.232 some of this already to you in our last lecture and I'm going 44:46.231 --> 44:49.551 to talk more about it right now. 44:49.550 --> 44:54.430 Consider these two interviews, one is an interview very much 44:54.432 --> 44:58.992 like one of the ones in your readings, it's from Mali in 44:58.985 --> 45:00.305 1983, Sitan. 45:00.309 --> 45:04.399 This is a woman who's heard about the contraceptive pill but 45:04.400 --> 45:05.650 has not used it. 45:05.650 --> 45:07.170 Interviewer: "Sitan, 45:07.170 --> 45:10.590 how many children more would you like to have?" 45:10.590 --> 45:13.570 "That is for God to decide." 45:13.570 --> 45:14.980 Interviewer: "You yourself, 45:14.980 --> 45:17.150 how many more children would you like-- 45:17.150 --> 45:20.240 how many children would you like to have in your whole 45:20.240 --> 45:21.000 life?" 45:21.000 --> 45:22.180 "I don't know the number. 45:22.179 --> 45:26.059 It's when God stops my births." 45:26.059 --> 45:27.469 Interviewer: "How many boys and how 45:27.474 --> 45:29.004 many girls would you like to have?" 45:29.000 --> 45:30.340 "It's God that gives me children. 45:30.340 --> 45:34.000 Since it is God that gives or not, you cannot make a choice 45:34.001 --> 45:35.771 about your children." 45:35.768 --> 45:37.278 You've read some of these, this is a different country, 45:37.280 --> 45:40.930 a different time, but this is a not uncommon sort 45:40.929 --> 45:44.909 of attitude where people, women especially, 45:44.913 --> 45:50.803 just can't--it's not within their calculus of conscious 45:50.798 --> 45:51.888 choice. 45:51.889 --> 45:54.929 Now in Bangladesh, which is again, 45:54.927 --> 45:59.807 both of these countries are Muslim, Bangladesh is more 45:59.809 --> 46:02.479 conservative religiously. 46:02.480 --> 46:07.450 The poverty getting better now, but it was about the same, 46:07.449 --> 46:11.229 so there's the socioeconomic indicators for the two countries 46:11.231 --> 46:14.111 are about the same, but the government in 46:14.112 --> 46:17.742 Bangladesh was very different and the government, 46:17.739 --> 46:21.409 from very early on, decided that they would make 46:21.407 --> 46:26.167 family planning available in the country and the international 46:26.168 --> 46:29.288 groups then came on board and said, 46:29.289 --> 46:33.399 okay, we will help you. 46:33.400 --> 46:37.750 This is now another interview with an 18 year old girl named 46:37.746 --> 46:41.646 Shamiran and she is just learning that there is such a 46:41.650 --> 46:43.640 thing as birth control. 46:43.639 --> 46:47.009 The reason she knows about it is that, 46:47.010 --> 46:49.940 and you'll read about--you're going to read about the family 46:49.943 --> 46:52.433 planning program and the results in Bangladesh, 46:52.429 --> 46:55.439 is that as I said Bangladesh is a very conservative Muslim 46:55.440 --> 46:55.970 country. 46:55.969 --> 46:59.469 So, women generally are not allowed out of the house to get 46:59.469 --> 47:01.339 medical service for instance. 47:01.340 --> 47:03.770 Just to go out and talk to women's meetings where these 47:03.773 --> 47:04.813 things get discussed. 47:04.809 --> 47:06.369 No. They can't do that. 47:06.369 --> 47:10.029 The family planning program in Bangladesh, 47:10.030 --> 47:11.930 the government program and the private program, 47:11.929 --> 47:15.739 hired high class women from that community, 47:15.739 --> 47:19.899 who themselves were using family planning and thought it 47:19.898 --> 47:24.058 was good and sent them into the houses of poor women who 47:24.056 --> 47:25.716 couldn't come out. 47:25.719 --> 47:28.309 This is kind of like if Muhammad--the mountain won't 47:28.309 --> 47:30.339 come to Muhammad, Muhammad will go to the 47:30.340 --> 47:31.000 mountain. 47:31.000 --> 47:33.640 The people in the village all know about this woman who, 47:33.639 --> 47:36.949 Mukti Ma, that was her name, and she's considered a health 47:36.949 --> 47:39.329 worker and she actually gave her aunt, 47:39.329 --> 47:42.859 her aunt was an acceptor and Mukti Ma was giving-- 47:42.860 --> 47:46.960 came by regularly to give her aunt pills and the girls knew 47:46.961 --> 47:47.741 about it. 47:47.739 --> 47:50.869 But they didn't really understand it and so they went 47:50.873 --> 47:53.383 and asked the aunt, the girl Shamiran, 47:53.384 --> 47:57.204 and the aunt refused to tell her anything because again the 47:57.199 --> 48:00.239 social conservatism, that these matters will be 48:00.239 --> 48:03.719 explained to her only when she is married and she's not to know 48:03.722 --> 48:05.242 anything about this now. 48:05.239 --> 48:06.469 What did the kid do? 48:06.469 --> 48:08.759 Like every kid everywhere else in the world she goes to school 48:08.762 --> 48:12.202 and talks with her friends, and they all pick little bits 48:12.197 --> 48:17.047 of information or misinformation and pull it together from the 48:17.054 --> 48:18.254 other girls. 48:18.250 --> 48:21.270 Some of them apparently knew of Mukti Ma, some of them didn't 48:21.273 --> 48:22.133 know about her. 48:22.130 --> 48:23.510 I'm sorry I said everyone in the village knows, 48:23.510 --> 48:27.290 apparently they didn't, but since this girl's aunt was 48:27.291 --> 48:30.791 getting pills from Mukti Ma she knew about it, 48:30.789 --> 48:33.529 but every one of her schoolmates was interested. 48:33.530 --> 48:36.290 One girl said, "I would like to work as 48:36.289 --> 48:38.279 she does," she Mukti Ma. 48:38.280 --> 48:40.950 "Look at her, she wears her sari so nicely 48:40.952 --> 48:43.162 and goes to different neighborhoods. 48:43.159 --> 48:46.279 My sister told me she earns a good amount of money." 48:46.280 --> 48:48.760 Others said, "but my father and 48:48.755 --> 48:52.075 grandmother says she's not a good lady." 48:52.079 --> 48:54.949 Shamiran said, "Grandmothers and fathers 48:54.947 --> 48:58.387 are always behind the times, they do not want to let girls 48:58.393 --> 49:00.993 go to school, I don't want to consider their 49:00.987 --> 49:03.487 opinions, I like Mukti Ma's work and I 49:03.487 --> 49:06.147 will have pills to control births." 49:06.150 --> 49:08.780 Some girls said, "Yes, I think we should 49:08.782 --> 49:12.312 have this medicine so we will not have so many problems with 49:12.313 --> 49:13.573 so many children. 49:13.570 --> 49:17.050 With few children, we'll be able to keep our saris 49:17.050 --> 49:20.740 clean and nice," Then everybody laughed together 49:20.742 --> 49:23.942 and that apparently ended that interview. 49:23.940 --> 49:28.990 This is an older generation versus a younger generation and 49:28.987 --> 49:32.117 there's an interest of the girls, 49:32.119 --> 49:34.569 as they self perceive it, and the interest of the older 49:34.572 --> 49:37.322 generation, as they are trying to impose it 49:37.320 --> 49:39.160 on the younger generation. 49:39.159 --> 49:42.009 It's a very clear kind of a conflict situation. 49:42.010 --> 49:44.460 The girls see having many children as just causing a lot 49:44.456 --> 49:47.166 of problems and what the girls are interested in is not having 49:47.172 --> 49:49.552 a lot of children as-- which was terribly important to 49:49.545 --> 49:50.975 their-- certainly their grandparents 49:50.980 --> 49:52.100 and probably their parents. 49:52.099 --> 49:55.329 They want to have nice clean saris and look nice. 49:55.329 --> 49:59.369 They want to be able to earn money and go around to different 49:59.371 --> 50:00.451 neighborhoods. 50:00.449 --> 50:04.489 The older generation is trying to keep them out of school, 50:04.485 --> 50:08.875 keep this information away from them, and keep them in the mold 50:08.876 --> 50:09.936 previously. 50:09.940 --> 50:14.600 The girls in that society are pretty much powerless because 50:14.601 --> 50:18.221 even though the age at marriage has risen, 50:18.219 --> 50:21.469 Shamiran's already 18, which traditionally is terribly 50:21.467 --> 50:23.487 old for a girl to be unmarried. 50:23.489 --> 50:26.369 She'll eventually get married, moved in with her husband, 50:26.369 --> 50:29.799 and the husband will also be a teenager probably and will have 50:29.802 --> 50:33.652 not much say -- the husband's mother will be 50:33.652 --> 50:38.172 the arbiter of medical things, reproductive things, 50:38.168 --> 50:41.608 so that both the son and the daughter-in-law will be under 50:41.614 --> 50:45.064 the control primarily of the mother-in-law and so it's the 50:45.059 --> 50:47.599 mother-in-law's opinions that count, 50:47.599 --> 50:51.199 the mother-in-law's attitude toward reproduction that counts. 50:51.199 --> 50:53.269 Very often we, in the west, 50:53.266 --> 50:56.006 say that-- the problem is all with men, 50:56.012 --> 50:59.992 the macho men force women into having children and some of that 50:59.985 --> 51:03.885 is certainly true and sometimes in Latin America a fair amount 51:03.893 --> 51:07.743 of that can be true, but in Asia it's very often the 51:07.742 --> 51:08.802 mother-in-law. 51:08.800 --> 51:10.230 Wherever you see that the young girl-- 51:10.230 --> 51:12.880 they get married young, the husband and wife are both 51:12.880 --> 51:15.600 young, they move into the husband's 51:15.596 --> 51:18.816 house which is the grandparents house, 51:18.820 --> 51:21.740 then the boy will be under control of his mother and the 51:21.740 --> 51:24.770 new wife will be perhaps almost a slave to that mother. 51:24.768 --> 51:27.698 You have many, many instances where both the 51:27.699 --> 51:31.719 boy--the husband and the young girl wife do not want to have 51:31.721 --> 51:34.721 children but they don't have any choice. 51:34.719 --> 51:41.879 In matters of reproduction it's mother-in-laws who are the 51:41.876 --> 51:49.656 dominant transmitters of culture in the thing--in the world. 51:49.659 --> 51:53.389 I showed you in the data at the beginning of last lecture that 51:53.393 --> 51:56.393 the Shamirans of the earth, who are not so enamored of 51:56.387 --> 51:58.897 having a lot of children, have taken over from the 51:58.902 --> 52:02.342 Sitan's of the earth, who will have as many as 52:02.335 --> 52:04.415 they're going to have. 52:04.420 --> 52:08.540 The data was very strong that women in the developing 52:08.541 --> 52:13.221 countries don't want all the children that they're currently 52:13.217 --> 52:14.087 having. 52:14.090 --> 52:18.410 You've seen new data and you've seen old data from that. 52:18.409 --> 52:20.009 I showed you Bolivia new data you could-- 52:20.010 --> 52:23.260 I can--you can come up to my office and see the Demographic 52:23.264 --> 52:26.804 & Health Surveys and pick a country and it's pretty much all 52:26.800 --> 52:27.530 the same. 52:27.530 --> 52:30.500 With the exceptions of Sub-Saharan Africa is somewhat 52:30.503 --> 52:33.023 exception and some of the Arab countries, 52:33.018 --> 52:36.128 not the Muslim countries, many Muslim countries have 52:36.132 --> 52:39.672 really reduced their fertility but Arab countries are going 52:39.670 --> 52:41.930 through a non-standard situation. 52:41.929 --> 52:47.019 This information has been--we've had this since about 52:47.016 --> 52:48.186 the 1960s. 52:48.190 --> 52:52.000 We've had it for about a half a century, knowledge that women in 52:51.996 --> 52:55.316 the developing world don't really want the children that 52:55.320 --> 52:56.470 they're having. 52:56.469 --> 53:00.959 In the 1960s they started with a survey called KAP, 53:00.963 --> 53:03.843 knowledge, attitude, practice. 53:03.840 --> 53:06.870 Knowledge: did you know about contraception? 53:06.869 --> 53:10.119 Attitude: do you want it, what do you think about it? 53:10.119 --> 53:12.929 Practice: are you actually using it? 53:12.929 --> 53:18.029 Then from 1972 to 1982 there were surveys called The World 53:18.027 --> 53:23.037 Fertility Survey which were improved from the KAP surveys 53:23.036 --> 53:28.936 and they reached 62 countries with 350,000 women interviewed, 53:28.940 --> 53:32.730 and then from 1985 they've been coming along with these 53:32.726 --> 53:35.246 Demographic & Health Surveys, 53:35.250 --> 53:37.970 which are more or less standardized across the world, 53:37.969 --> 53:42.589 and from which the data I gave you came. 53:42.590 --> 53:48.040 If you listen to the verbal report of these women, 53:48.043 --> 53:52.723 they say they don't want these children. 53:52.719 --> 53:55.779 The question--you have to always question--scientists 53:55.777 --> 53:58.477 always question everything, okay they say that, 53:58.483 --> 53:59.603 but how much oomph! 53:59.601 --> 54:00.661 is behind it? 54:00.659 --> 54:02.759 It could be an interviewer comes in, 54:02.760 --> 54:05.610 obviously a very modern person, you know that modern people 54:05.612 --> 54:08.712 sort of think that the modern way is to have fewer children, 54:08.710 --> 54:12.120 so you may very well answer them in that way so you can 54:12.123 --> 54:14.213 never be sure of these surveys. 54:14.210 --> 54:18.430 You always have to look at what are people actually doing and 54:18.429 --> 54:22.859 there are various ways that you can find out if this a real-- 54:22.860 --> 54:27.590 a desire backed by behavior. 54:27.590 --> 54:31.920 One of the things is well how permanent--of those women that 54:31.922 --> 54:35.012 choose some sort of family planning method, 54:35.007 --> 54:36.767 how permanent is it? 54:36.769 --> 54:38.039 How good is it? 54:38.039 --> 54:43.009 It turns out that basically everywhere in the world 54:43.012 --> 54:48.882 sterilization is the dominant choice for family planning. 54:48.880 --> 54:52.470 In Brazil, for instance, by the late 1980s and their 54:52.472 --> 54:55.082 fertility has come down from then, 54:55.079 --> 55:00.429 40% of married women using contraception in fact chose to 55:00.431 --> 55:04.541 be sterilized over all the other methods. 55:04.539 --> 55:08.289 Now you might think that this was the poorest women who chose 55:08.293 --> 55:10.863 this, that they were kind of desperate. 55:10.860 --> 55:13.320 Maybe they were influenced by family planning workers to just 55:13.320 --> 55:16.470 get it over with, and I've heard polemical 55:16.474 --> 55:20.854 arguments saying that, Oh, these sterilization things 55:20.853 --> 55:24.943 are because that was what was pushed upon them by some family 55:24.938 --> 55:26.368 planning program'. 55:26.369 --> 55:30.479 In fact, statistics are very clear that the higher the income 55:30.481 --> 55:33.911 level of the woman, the greater likelihood that she 55:33.907 --> 55:36.097 was to choose sterilization. 55:36.099 --> 55:40.629 One of these--have any of you seen this film about testing the 55:40.625 --> 55:45.295 birth control pill in Puerto Rico called La Operacion? 55:45.300 --> 55:49.070 It's sort of a far feminist thing but very--shown very 55:49.065 --> 55:49.985 frequently. 55:49.989 --> 55:54.229 One of the places that the birth control pill, 55:54.228 --> 55:59.218 invented in America, was tested was in Puerto Rico. 55:59.219 --> 56:02.129 It shows a lot of people, they're talking in Spanish, 56:02.130 --> 56:04.900 but there's a narrator speaking in English which most everybody 56:04.896 --> 56:07.336 can understand, and the narrator is saying how 56:07.338 --> 56:10.618 terrible everything is and that these women weren't told what 56:10.615 --> 56:11.485 was going on. 56:11.489 --> 56:14.939 What you see when the narrator is speaking is an older woman 56:14.943 --> 56:17.933 who wasn't eligible to be a subject in the test, 56:17.929 --> 56:21.899 at night climbing into the window at the basement of the 56:21.898 --> 56:25.798 hospital to get the birth control pill and the narrator 56:25.795 --> 56:29.105 says nothing about that, but they're showing this to you. 56:29.110 --> 56:30.660 Have you seen it? 56:30.659 --> 56:32.929 I saw--had sort of a hand up. 56:32.929 --> 56:35.839 In the U.S., among affluent, 56:35.842 --> 56:42.212 educated women that nobody is presumably pushing around 13.8 56:42.206 --> 56:45.256 million-- women use tubal ligation, 56:45.262 --> 56:49.362 a female form of sterilization as their method of birth control 56:49.364 --> 56:53.274 and less than that 13.2 million were using the birth control 56:53.268 --> 56:53.928 pill. 56:53.929 --> 56:59.069 In the United States, like in almost every other 56:59.074 --> 57:04.004 country, sterilization is the chosen means. 57:04.000 --> 57:08.440 I think that's one indicator that when people say they want 57:08.443 --> 57:11.513 reduced fertility they really mean it. 57:11.510 --> 57:17.590 Sometimes family planning--contraception is not 57:17.594 --> 57:24.474 available and then people can get into very desperate 57:24.474 --> 57:26.464 situations. 57:26.460 --> 57:31.300 An American maternity nurse went to Lusaka in Zambia and 57:31.297 --> 57:35.957 this is the University teaching hospital in Zambia. 57:35.960 --> 57:38.600 So, most of these developed countries will have a capital 57:38.597 --> 57:41.277 city and they have one high class hospital that'll usually 57:41.282 --> 57:44.062 be attached to a university and that's demanded by the upper 57:44.063 --> 57:46.663 class of that country, the political elite, 57:46.655 --> 57:50.265 the economical elite demand good modern medical services, 57:50.269 --> 57:52.309 it'll be one hospital there. 57:52.309 --> 57:55.749 You can look at the public health budget for these 57:55.746 --> 57:59.176 countries and a very disproportionate amount of it 57:59.184 --> 58:01.504 will go to this one hospital. 58:01.500 --> 58:05.370 This University teaching hospital in Lusaka is the high 58:05.373 --> 58:07.313 level hospital in Zambia. 58:07.309 --> 58:09.719 This nurse went into the maternity ward; 58:09.719 --> 58:14.009 she was a maternity nurse, expecting to see a lot of women 58:14.005 --> 58:15.355 having children. 58:15.360 --> 58:18.280 Instead this is what--this is her report. 58:18.280 --> 58:22.350 "Ten women with botched abortions were lying on nine 58:22.351 --> 58:22.861 beds. 58:22.860 --> 58:26.250 Five others were sprawled on the concrete floors of the 58:26.248 --> 58:26.938 hallways. 58:26.940 --> 58:30.580 A few more were in the hall--on the floor outside the entrance. 58:30.579 --> 58:33.729 There were no blankets or covers. 58:33.730 --> 58:37.640 Most wait 12 hours for treatment from a physician. 58:37.639 --> 58:41.499 The 'average' woman ends up overnight on the floor; 58:41.500 --> 58:44.540 she receives no food or water. 58:44.539 --> 58:48.139 The women were aborting on the floors or on their way to the 58:48.137 --> 58:50.817 single toilet at the end of the long hall; 58:50.820 --> 58:54.130 30% of the patients complete their abortions on the concrete 58:54.132 --> 58:55.762 floor with no medical care. 58:55.760 --> 58:57.820 All we can do is clean it up." 58:57.820 --> 59:02.220 That's what the head nurse there said, that all we can do 59:02.222 --> 59:03.562 is clean it up. 59:03.559 --> 59:05.599 This is not isolated to this one hospital. 59:05.599 --> 59:10.359 You can go anywhere in the underdeveloped world and at 59:10.364 --> 59:16.034 least half the beds in maternity wards are taken up with botched 59:16.030 --> 59:17.290 abortions. 59:17.289 --> 59:19.159 What goes on is, in most of Africa, 59:19.159 --> 59:22.279 and a lot of the world, abortion is illegal, 59:22.280 --> 59:25.800 so doctors can't do it, so they go to what they call 59:25.795 --> 59:28.545 bush doctors, some very poorly trained 59:28.547 --> 59:31.907 midwife or someone who just says they'll do it, 59:31.909 --> 59:36.749 and they have this operation and usually something is put up, 59:36.750 --> 59:40.800 a stick or coat hanger or something up the uterus and they 59:40.804 --> 59:42.944 try to scrape out the fetus. 59:42.940 --> 59:45.610 But, in fact, they often puncture the uterus 59:45.608 --> 59:49.268 which allows infection to get into the main body cavity, 59:49.268 --> 59:53.238 and then after a few days they're getting very sick from 59:53.235 --> 59:57.415 the infection which is now systemic because it's inside the 59:57.418 --> 59:59.698 body, plus the wound doesn't heal 59:59.702 --> 1:00:02.952 because of the infection so there's constant bleeding and 1:00:02.945 --> 1:00:04.215 they can bleed out. 1:00:04.219 --> 1:00:06.069 Huge death rates, we're going to talk about 1:00:06.072 --> 1:00:08.462 abortion later and I'll give you some of these numbers, 1:00:08.456 --> 1:00:09.556 but huge death rates. 1:00:09.559 --> 1:00:13.739 Important point for this course is that probably all of these 1:00:13.739 --> 1:00:17.989 women know of someone else who has died from one of these-- 1:00:17.989 --> 1:00:24.039 shall we call them unprofessional abortions. 1:00:24.039 --> 1:00:28.819 Yet, when they get pregnant, their desire not to have that 1:00:28.824 --> 1:00:33.784 extra child is so strong that they will themselves choose to 1:00:33.777 --> 1:00:40.367 undergo this very, very serious operation with a 1:00:40.369 --> 1:00:44.709 very high threat of death. 1:00:44.710 --> 1:00:49.180 That's one of the things that the Planned Parent Federation in 1:00:49.175 --> 1:00:53.855 its international efforts like what you saw is trying to cure. 1:00:53.860 --> 1:00:58.600 They had one project to go to Kenya to train local private 1:00:58.599 --> 1:01:03.339 doctors who somewhat escape the law in family planning and 1:01:03.340 --> 1:01:05.170 abortion services. 1:01:05.170 --> 1:01:07.970 The local doctors had been turning away abortion clients 1:01:07.972 --> 1:01:10.472 because they did not know where to refer them, 1:01:10.469 --> 1:01:15.599 so that means they got some unskilled practitioner. 1:01:15.599 --> 1:01:18.699 One physician told the project director that he had turned away 1:01:18.702 --> 1:01:21.662 a young girl only to find her in a hospital a few days later 1:01:21.657 --> 1:01:24.007 after she had procured an illegal abortion. 1:01:24.010 --> 1:01:25.840 The girl died. 1:01:25.840 --> 1:01:28.410 The private doctor said that he had since then lived with a 1:01:28.413 --> 1:01:29.393 great deal of guilt. 1:01:29.389 --> 1:01:33.409 He is happy now that he can provide treatment using a very 1:01:33.409 --> 1:01:34.609 safe procedure. 1:01:34.610 --> 1:01:39.700 In between that they've legalized things to some degree 1:01:39.702 --> 1:01:40.742 in Kenya. 1:01:40.739 --> 1:01:43.959 It's not only the third world in which this takes place. 1:01:43.960 --> 1:01:48.740 In Bulgaria, sometime back under the Soviet 1:01:48.739 --> 1:01:54.089 system, 57% of pregnancies ended in abortion. 1:01:54.090 --> 1:01:56.260 You'll hear during the abortion lecture in the United States, 1:01:56.260 --> 1:01:59.660 there's one abortion for every three live births, 1:01:59.659 --> 1:02:03.819 and something like 40 to 50 million abortions worldwide and 1:02:03.818 --> 1:02:08.408 about half of these are illegal and illegal means very unsafe. 1:02:08.409 --> 1:02:11.429 A woman dies, it's about every three minutes 1:02:11.434 --> 1:02:14.884 from a botched--one of these illegal abortions. 1:02:14.880 --> 1:02:17.860 I think with these stories and the large numbers that are 1:02:17.856 --> 1:02:20.246 attached to them, I mean any woman in that 1:02:20.246 --> 1:02:24.846 situation that has an abortion, she does not want that child 1:02:24.853 --> 1:02:30.523 and when you say there's 50 million of them worldwide that 1:02:30.519 --> 1:02:35.889 means that the demand for control of fertility is very, 1:02:35.887 --> 1:02:37.377 very high. 1:02:37.380 --> 1:02:40.950 You'll read the Brazilian solution to this which is a 1:02:40.949 --> 1:02:42.939 modern form of infanticide. 1:02:42.940 --> 1:02:45.110 I don't know if you read yet, the Death Without 1:02:45.114 --> 1:02:48.494 Weeping, it's in your reading packet 1:02:48.494 --> 1:02:54.734 where mothers who know that they can't raise a child just leave 1:02:54.728 --> 1:03:00.658 the child to die and they say that 'God can take better care 1:03:00.659 --> 1:03:06.189 of it then I can' and they just let the child die. 1:03:06.190 --> 1:03:11.580 This is not to say that--So, what has happened in the world 1:03:11.579 --> 1:03:17.339 is that fertility has come down drastically and I've showed you 1:03:17.342 --> 1:03:23.292 that in previous graphs where the fertility is coming down, 1:03:23.289 --> 1:03:28.579 and in the peak period in Bolivia during the peak-- 1:03:28.579 --> 1:03:33.309 the number doubled from about 12% to 25% of people using a 1:03:33.311 --> 1:03:34.641 modern method. 1:03:34.639 --> 1:03:38.929 Ecuador, 50% of the women are using a modern mechanism. 1:03:38.929 --> 1:03:44.639 Tunisia, 60% and Iran is one of the really interesting cases. 1:03:44.639 --> 1:03:48.589 Iran had this very conservative government and they were against 1:03:48.592 --> 1:03:52.302 family planning and all this, and then they had the war with 1:03:52.295 --> 1:03:52.855 Iraq. 1:03:52.860 --> 1:03:54.170 Iraq invaded, with U.S. 1:03:54.172 --> 1:03:56.622 help, and huge numbers of people died, 1:03:56.619 --> 1:03:59.999 including a lot of kids, so afterwards their young 1:04:00.001 --> 1:04:03.041 people were depleted but once those kids-- 1:04:03.039 --> 1:04:04.779 they recovered a little bit from that, 1:04:04.780 --> 1:04:08.560 the government realized what was happening and decided on a 1:04:08.563 --> 1:04:10.263 family planning program. 1:04:10.260 --> 1:04:15.240 This is an Iranian woman packing condoms. 1:04:15.239 --> 1:04:19.089 We have this image of places like Iran as being so backwards 1:04:19.086 --> 1:04:22.136 and conservative and everything, but they have, 1:04:22.139 --> 1:04:25.389 in fact, now one of the best family planning programs in the 1:04:25.389 --> 1:04:27.969 world, and the UN a few years ago 1:04:27.972 --> 1:04:32.642 awarded it their top-- best program in the world and 1:04:32.635 --> 1:04:37.575 their fertility rate is now at replacement level. 1:04:37.579 --> 1:04:42.639 Fertility is coming down almost everywhere, with again 1:04:42.643 --> 1:04:48.473 Sub-Saharan Africa and some of the Arab countries as a counter 1:04:48.472 --> 1:04:49.622 example. 1:04:49.619 --> 1:04:52.149 Birth rates not only--Birth rates fell; 1:04:52.150 --> 1:04:56.890 Thailand 50% in 12 years; Columbia 40% in 14 years, 1:04:56.893 --> 1:04:58.683 this is at the peak. 1:04:58.679 --> 1:05:03.279 Indonesia 48% in 20 years; Morocco 31% in 12 years; 1:05:03.280 --> 1:05:07.180 Turkey 21% in ten years; Brazil 60% in 25 years; 1:05:07.179 --> 1:05:11.829 Mexico 30% in just six years; Botswana 26%; 1:05:11.829 --> 1:05:14.989 Zimbabwe 18%; Kenya 35%, I mean everywhere 1:05:14.992 --> 1:05:18.472 that you look the actual fertility is coming down, 1:05:18.469 --> 1:05:23.549 so people are using contraception and using it 1:05:23.552 --> 1:05:29.772 efficiently and the world birth rate has come down quite 1:05:29.766 --> 1:05:31.796 significantly. 1:05:31.800 --> 1:05:36.830 None of this is to minimize that people in developing 1:05:36.829 --> 1:05:42.309 countries are caught in a bind, that you all have heard all 1:05:42.313 --> 1:05:47.273 kinds of reasons why they might want to have a lot of children 1:05:47.269 --> 1:05:49.789 and one is extra farm labor. 1:05:49.789 --> 1:05:52.769 One is support for children in old age, a major kind of 1:05:52.768 --> 1:05:53.318 problem. 1:05:53.320 --> 1:05:56.320 One their religion might demand it. 1:05:56.320 --> 1:05:59.440 Two cultural reasons, various ancestor worship 1:05:59.436 --> 1:06:00.126 reasons. 1:06:00.130 --> 1:06:04.190 In India you have to have a son to light the funeral pyre, 1:06:04.193 --> 1:06:07.833 no son you don't go into the afterworld properly. 1:06:07.829 --> 1:06:10.319 We discussed some of this with respect to Africa. 1:06:10.320 --> 1:06:13.560 Status reasons, you have more children you have 1:06:13.559 --> 1:06:16.939 more prestige for both the man and the woman, 1:06:16.940 --> 1:06:21.990 there's macho reasons to prove your fertility and the list goes 1:06:21.992 --> 1:06:22.972 on and on. 1:06:22.969 --> 1:06:27.129 The reasons they may not use birth control are many, 1:06:27.128 --> 1:06:32.428 one of which is family planning services can be very primitive. 1:06:32.429 --> 1:06:35.769 It's not a great slide but it's an old bus in India with a red 1:06:35.766 --> 1:06:38.876 cross on it and this is the family planning clinic in this 1:06:38.884 --> 1:06:40.584 part of India at that time. 1:06:40.579 --> 1:06:43.229 People were supposed to go on this bus and have some operation 1:06:43.228 --> 1:06:45.138 that they didn't understand done to them, 1:06:45.139 --> 1:06:48.399 sterilization or IUD insertion or something, 1:06:48.400 --> 1:06:55.090 and you know you wouldn't be exactly very anxious to get on 1:06:55.094 --> 1:06:56.714 to that bus. 1:06:56.710 --> 1:07:03.450 Another thing that I mentioned last time with respect to 1:07:03.451 --> 1:07:07.311 Veena's lecture, that the worry about medical 1:07:07.309 --> 1:07:10.699 complications is one of the most major reasons why women either 1:07:10.697 --> 1:07:14.697 don't use contraception at all, or start it and then stop using 1:07:14.699 --> 1:07:14.969 it. 1:07:14.969 --> 1:07:18.029 What does this mean in a pre-medical country where they 1:07:18.027 --> 1:07:20.347 don't have really modern medical ideas. 1:07:20.349 --> 1:07:22.539 You take the pill, you're scared of it. 1:07:22.539 --> 1:07:25.619 Anything that happens to you, you get a tummy ache, 1:07:25.621 --> 1:07:29.071 you fall and break your leg, anything that happens to you 1:07:29.072 --> 1:07:30.432 what do you blame? 1:07:30.429 --> 1:07:31.819 You blame the pill. 1:07:31.820 --> 1:07:33.840 So here is a culture without much medicine, 1:07:33.840 --> 1:07:36.830 a low standard of living; they're getting sick a lot. 1:07:36.829 --> 1:07:40.259 People in developing countries are not generally very healthy 1:07:40.262 --> 1:07:43.812 and they get sick and they don't know what it was caused by. 1:07:43.809 --> 1:07:46.099 You probably read already about The Evil Eye. 1:07:46.099 --> 1:07:49.049 Did you read the Egyptian--the Kul Khaal yet? 1:07:49.050 --> 1:07:50.710 The Evil Eye is the reason. 1:07:50.710 --> 1:07:53.430 If you've taken the pill you know that's changing your body 1:07:53.434 --> 1:07:55.354 in some way, and you're afraid of it, 1:07:55.353 --> 1:07:58.583 you get sick with anything, it's the pill was the reason 1:07:58.577 --> 1:08:02.277 for it and then you tell all your friends that and everybody 1:08:02.278 --> 1:08:05.918 in the community learns that such and such got some problem 1:08:05.918 --> 1:08:09.498 because of the pill so they're very much afraid to use the 1:08:09.496 --> 1:08:10.246 pill. 1:08:10.250 --> 1:08:16.700 On an on, there's a big conflict, big contestation, 1:08:16.698 --> 1:08:21.008 the media, I think this is in Morocco, 1:08:21.010 --> 1:08:27.290 this is a cave, this is the desert around here, 1:08:27.288 --> 1:08:29.978 they're in a cave and what they're watching is a TV show. 1:08:29.979 --> 1:08:34.189 I was in Morocco in the far desert and you see these little 1:08:34.194 --> 1:08:38.194 villages of just a few mud houses and they all had solar 1:08:38.192 --> 1:08:41.102 arrays and they all had television, 1:08:41.100 --> 1:08:44.320 so media is passing on very strongly. 1:08:44.319 --> 1:08:47.629 On the other side of the equation is all kinds of reasons 1:08:47.631 --> 1:08:50.471 that they don't use it or that they do use it. 1:08:50.470 --> 1:08:53.050 It's a very much in contestation. 1:08:53.050 --> 1:08:57.760 In the West, especially activists, 1:08:57.760 --> 1:09:00.830 liberal people, people in the Forestry School 1:09:00.827 --> 1:09:04.797 believe that we shouldn't support family planning programs 1:09:04.801 --> 1:09:07.661 because it's politically contentious. 1:09:07.658 --> 1:09:09.308 Why is it politically contentious? 1:09:09.310 --> 1:09:12.110 Because people on the right are opposed to it for religious or 1:09:12.109 --> 1:09:14.169 moral reasons, people on the more or less 1:09:14.170 --> 1:09:16.440 left, and these are characterizations right and 1:09:16.435 --> 1:09:16.825 left. 1:09:16.829 --> 1:09:20.409 We can't impose; we 'great white Westerners' 1:09:20.407 --> 1:09:24.357 can't impose our values on our 'poor little yellow and brown 1:09:24.355 --> 1:09:25.155 cousins'. 1:09:25.158 --> 1:09:28.998 It's utter nonsense and it's patronizing because the people 1:09:29.002 --> 1:09:32.852 in these developing countries have spoken very clearly when 1:09:32.846 --> 1:09:35.826 they add up all these pluses and minuses. 1:09:35.828 --> 1:09:39.948 That's their choice, and as I've showed data-- 1:09:39.948 --> 1:09:43.198 I've hit you over the head with data showing you that when 1:09:43.201 --> 1:09:46.341 people in the developing countries themselves add up the 1:09:46.338 --> 1:09:48.958 data, they want to be protected by 1:09:48.961 --> 1:09:50.061 contraception. 1:09:50.060 --> 1:09:51.900 I think that we, in the West, 1:09:51.903 --> 1:09:54.343 ought to take that very seriously, 1:09:54.340 --> 1:09:57.480 and starting with intellectuals who should know better, 1:09:57.479 --> 1:10:00.949 but since people don't give courses like this and people-- 1:10:00.948 --> 1:10:03.828 even environmentalists and all kinds of others, 1:10:03.828 --> 1:10:07.438 just don't pay any attention to human population because it's 1:10:07.443 --> 1:10:09.013 politically untouchable. 1:10:09.010 --> 1:10:12.190 The major organizations, the environmental organizations 1:10:12.193 --> 1:10:15.433 won't touch it because they do fundraising and the public 1:10:15.434 --> 1:10:19.434 opinion is that-- it's a horrible thing to push 1:10:19.429 --> 1:10:23.359 family planning on developing countries. 1:10:23.359 --> 1:10:32.019 I guess that is where we will end today. 1:10:32.020 --> 1:10:35.360 See you--yes one more this week before vacation. 1:10:35.359 --> 1:10:39.999