Commentary: Maurice King versus Sheldon Segal: an unnecessary battle

John C Caldwell

Demography and Sociology Program, Research School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia. E-mail: jack.caldwell{at}anu.edu.au

I have, in essence, been invited to review both Sheldon Segal's professional autobiography, Under the Banyan Tree,1 and Maurice King's review of it.2 The situation has a certain irony in that King bites the hand of one of the people ideologically closest to him in the population debate. Both King and Segal have a deep sympathy for the poor of the Third World, an empathy gained from residence in Uganda and India respectively. Both believed that the people of these countries were likely to remain poor unless the great spurt in population growth after the Second World War was brought to a close.

First, let me put my own position. Scientific advances and a new era of international co-operation led to unpredictably rapid mortality decline in developing countries after 1945. In that year these countries probably had a life expectancy at birth of little more than 35 years which is compatible with the United Nations estimate of 41 years for 1951–1955, following the spectacular mortality declines immediately after the war. Now, life expectancy is around 64 years. To take for that period the two countries Segal writes most about, the increase in India was around 30 years and in China 33 years. This was no disaster, but, on the contrary, probably the greatest single achievement of our time. King played a significant and much admired role in the reduction of mortality both by teaching in an African medical school and writing influential textbooks on how better health could be attained in very poor environments.

Certainly, the sudden drop in mortality implied problems: run-away population growth threatening to reach in the Third World 3.5% per year or more which would eventually drive world population far beyond 10 billion. The immediate concern was that rapid population growth would retard per capita income increase (not as clearly proven in the subsequent statistical evidence as many people believe) and the concern in recent years has been that the ultimate world population would be too high to be sustainable in terms of global systems providing a tolerably pure atmosphere, stable soils, and natural resources that were not continually degrading. No one knows what the upper population limit is for such stability but the risk that it is below 10 billion means that we cannot experiment with that number.

For 20 years after the war, the future looked grim as the world population increased by one billion. The first national family planning programmes began in India and Pakistan but they failed to halt the escalation in population growth.

The problem was the lack of adequate contraception. The necessary scientific break-throughs came in the 1960s in the form of the intra-uterine device, and pill and contraceptive injectables, as well as suction abortion and improved female sterilization techniques. This was probably the second greatest achievement of our time. It soon became clear that these inventions could curb population growth, and national family planning programmes employing them sprang up widely, especially in Asia and North Africa. In the late 1960s global rates of population increase stopped climbing and began a long slow decline. Now we know that the world population will probably never reach 10 billion. It may not even reach 9 billion and will probably thereafter decline. Segal played a central role in these magnificient scientific achievements, both as a researcher and a scientific administrator. He is justly proud of it as his professional autobiography shows. He was able to play his part well because of his broad human and humane sympathies and his understanding that social and behavioural change was involved.

I am proud of the role of demographers and other social scientists in showing that the miserable and poor of the world would move towards having smaller families but that there was a limit to the pace at which social practices and the role of children could change. It was not a war but an attempt to improve the condition of the human race, and that would not be achieved by causing untold human misery. Family size (as measured by the total fertility rate) had halved by 1990 in both Asia and Latin America. It had done so, outside China and India during the 1975–1977 Emergency, without coercion. Most of the original science and leadership came from the US which had to bear considerable criticism for intruding in this way into other societies. Since 1984, as a result of internal political divisions, the US policies have varied according to which political party is in power and have become absurd in the area of abortion. But these changes came too late to have any significant impact on the fertility transition, and have not stopped a continued flow of American family planning assistance.

There is one exception to this picture, and that is sub-Saharan Africa where poverty, the role of fertility in culture and traditional religion, high child mortality, and recently constructed governmental systems have impeded the fertility decline which started 20 years after that of the rest of the developing world and still characterizes only Southern Africa and urban areas elsewhere. Sub-Saharan Africa has quadrupled its population since 1950, lifting its share of the world's population from 7% to 11%, and it is finally destined to reach about one-quarter of the human race. Huge growth raises all kinds of difficulties in a resource-poor region. Such growth, if it proves possible, will be unfortunate for the region and for the whole world, and cries out for much more technical aid assistance than is at present being received. The comparative failure to control population growth should show the need for assistance but is instead off-putting. The whole situation has become even more complex with the AIDS epidemic.

Such potentially development-forbidding population growth suggests the possibility of ‘demographic entrapment’ being broken only by coercive population measures. The idea has been around for a long time but reality seems to be different. Clifford Geertz in 1963 painted such a picture for Indonesia in his Agricultural Involution3 but soon after a regime change led to quite dramatic economic growth and fertility decline. This is not to say that sub-Saharan Africa does not have major problems where solutions will be assisted by smaller families. Economic growth has been miserably low over the last quarter of a century and so has mortality decline. The former has not benefited as much as was envisaged from structural adjustment programmes; and user-pays principles have combined with a poor health infrastructure to halt the march to better health.

King's attack on Segal seems to focus on the latter's failure to recommend a one-child policy for sub-Saharan Africa. It is not clear what King is advocating. Is it that the developed world should press for a one-child policy for the region or is it that such a policy should be mandated and carried through compulsorily? It would prove to be the crime of the millennium. China has a strangely disciplined society which, unlike sub-Saharan Africa, is not prepared to fight such measures tooth and nail. More importantly, 4% of its births result in deaths by 5 years of age. In contrast Malawi and Rwanda lose 20–22%. King also appears to believe that those against a one-child policy for Africa are blocking another international population conference and the truth is that the 1994 Cairo conference eroded the population control mission and a 2004 conference would probably go further in that direction.

This is a sad confrontation. In terms of population control attitudes, Segal is on King's wing in that he is willing to sympathize with the Chinese approach. He is not as extreme as King and is torn to pieces by the latter who, almost alone, advocates a one-child policy for Africa. Because of the rhetoric, we are distracted from following the extraordinary exciting story of reproductive science research.


    References
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 References
 
1 Segal SJ. Under the Banyan Tree. New York: Oxford University Press, 2003.

2 King M. Population policy: ‘Under the Banyan tree’. A political determinant of starvation and violence of enormous magnitude. Int J Epidemiol 2004;33:428–30.[CrossRef][Medline]

3 Geertz C. Agricultural Involution. Berkeley, CA: University of California Press, 1963.





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