Population and Poverty
There is clear evidence that enabling people to have
fewer children, if they want to, helps to stimulate
development and reduce poverty, both in individual
households and at the macro-economic level.
FAMILY SIZE AND WELL-BEING. Recent research supports
the premise that having many (and unplanned
for) children imposes a heavy burden on the poor,
while smaller families have higher upward economic
Fertility impacts on a family’s poverty in several ways:
- Smaller families share income among fewer people,
and average income per capita increases. A family of a
certain size may be below the poverty line, but with
one less member may rise above the poverty threshold.
- Fewer pregnancies lead to lower maternal mortality
and morbidity, and often to more education and economic
opportunities for women. A mother’s death or
disability can drive a family into poverty. Her ability
to earn income can lead the family out of poverty.
- High fertility undermines the education of children,
especially girls. Larger families have less to
invest in the education of each child. In addition,
early pregnancy interrupts young women’s schooling,
and in large families mothers often remove
daughters from school to help care for siblings.
Less education typically implies increased poverty
for the family as well as the inter-generational
transmission of poverty.
- Families with lower fertility are better able to
invest in the health of each child, and to give their
children proper nourishment. Malnourishment
leads to stunted growth, cerebral underdevelopment
and subsequent inability to achieve high levels of
productivity in the labour force.
MACRO-ECONOMIC IMPACT. High fertility impedes
development in a variety of ways. The World Health
Organization (WHO) Commission on Macroeconomics
and Health noted in 2001, “At the societal level, rapid
rural population growth in particular puts enormous
stress on the physical environment and on food productivity
as land-labour ratios in agriculture decline.
Desperately poor peasants are then likely to crowd
cities, leading to very high rates of urbanization, with
additional adverse consequence in congestion and in
declining urban capital per person.”
Lower fertility, on the other hand, is linked to
economic gains. A 2001 study of 45 countries found
that if these countries had reduced fertility by 5
births per 1,000 people in the 1980s, the average
national incidence of poverty of 18.9 per cent in the
mid-1980s would have been reduced to 12.6 per cent
between 1990 and 1995.(3)
At the time of Cairo, econometric proof of this
“population effect” on economic growth was difficult
to obtain, and mainstream economists tended to dismiss
it or play down its importance. A 1986 study by
the National Research Council in the United States(4)
concluded that population growth had little or no
effect on overall economic growth, despite its important effects at the household level; but it relied on
data from the 1960s and 1970s, when many developing
countries were early in their demographic transition.
THE DEMOGRAPHIC WINDOW. A new round of
research in the mid-1990s,(5) using data from longer
periods, showed clearly that falling fertility opens
a “demographic window” of economic opportunity.
With fewer dependent children relative to the workingage
population, countries can make additional
investments which can spur economic growth and
help reduce poverty.
This window opens only once and closes as populations
age and the ratio of dependants (children and
the elderly) eventually starts to rise again.
Several countries in East Asia—the so-called Asian
Tigers—and a few others have taken advantage of this
economic bonus. China has seen a dramatic drop in
the incidence of poverty.(6) One study estimated that declining fertility in Brazil has raised the annual
growth of GDP per capita by 0.7 percentage points.
Mexico and other Latin American countries have
registered similar effects. On the other hand, some
countries have largely squandered the opportunity
for a one-time “windfall” because of a lack of good
governance or policies that have led to unproductive
In the poorest countries where fertility remains
high, the demographic window will not open for some
time, but investments now—particularly in improving
reproductive health service delivery—could
hasten its arrival and ensure future dividends.
The world’s regions are at different stages of the
demographic transition. South Asia will reach its
peak ratio of working-age to dependent-ages between
2015 and 2025. In Latin America and the Caribbean,
the proportion in working ages started to increase
earlier than in East Asia and will peak during 2020-2030, but the proportional change has been less
marked, and the economic bonus will be correspondingly
less sudden and less intense. Some Arab and
Central Asian countries will approach their demographic
opportunity within two decades, while others
are farther away.
In much of sub-Saharan Africa the demographic
bonus is still a long way off. The population is still
very young and the proportion in working ages relatively
low. Many countries are just beginning the
demographic transition, and others have not even
started. Only 11 countries are projected to reach their
maximum working-age proportion before 2050. Unmet
need for contraception in the region is high, however,
suggesting the expansion of quality programmes could
hasten the arrival of the bonus.
INEQUALITY IN REPRODUCTIVE HEALTH FOSTERS POVERTY
The ICPD recognized that ill health and unplanned births can determine whether a family falls into or escapes poverty, as the
poor themselves have long known. But policy makers have been slow to address the inequitable distribution of health information and services that helps keep people poor.
An analysis of data on access to reproductive
health among different income groups in 56 countries shows that the
poorest groups are clearly disadvantaged, in a number of ways:
- The biggest gap between richer and poorer populations is in delivery by a
skilled attendant, the most expensive of the reproductive health services;
- Adolescent fertility showed the next largest differential—poorer women have
children at younger ages;
- Wealth-based health inequities are greater for safe motherhood, adolescent
fertility, contraceptive use and total fertility than for infant mortality;
- Poor women have more children throughout their lives than wealthier women;
- Poor countries have a heightened risk of maternal, infant and child death and illness,
and poor women in all countries face higher risks than others;
- Use of family planning, particularly of modern methods, is higher in richer segments
These findings corroborate those presented in The State of World Population 2002 which examined data from 44 countries.
Shortages of resources, skills, opportunities and outreach deprive the poor of access to
reproductive health information and services and the effects are apparent.
The information and service deficits result from various factors:
- Poor women and couples have less access to information and to the skills
education provides to expand their knowledge;
- Poor individuals and communities are riskaverse —less likely to try new behaviours—
since their room for error is so small;
- Costs for information and services (formal and informal monetary costs, and
transport and opportunity costs) are more daunting for the poor;
- When addressing the poor, service providers are less willing or able to interact
as closely as is required to exchange information and support about sensitive topics;
- Services are not in locations or open at times accessible to the poor;
- Richer populations are more skilled at working with formal institutions and
receiving a responsive hearing.
In 2000, only 3 per cent of gross domestic product was devoted to the
health sector in developing countries; in the least-developed countries the figure
was even lower. Expenditures in many countries still tend to favour hospitals and
medical facilities in the capital city, and there has been little progress towards
more equitable distribution of resources at local levels: the percentage of national
health expenditures devoted to local health services has stagnated in developing countries
and decreased in the least developed. See Sources