Ethics and population.
Article Type: Essay
Subject: Birth rates (Control)
Family planning (Ethical aspects)
Family planning (Social aspects)
Family planning (Research)
Social scientists (Practice)
Social scientists (Services)
Author: Callahan, Daniel
Pub Date: 05/01/2009
Publication: Name: The Hastings Center Report Publisher: Hastings Center Audience: Academic; Professional Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2009 Hastings Center ISSN: 0093-0334
Issue: Date: May-June, 2009 Source Volume: 39 Source Issue: 3
Topic: Event Code: 290 Public affairs; 310 Science & research; 200 Management dynamics; 360 Services information Advertising Code: 91 Ethics
Product: Product Code: 9105260 Family Planning & Child Care; 8525010 Social Scientists NAICS Code: 92312 Administration of Public Health Programs; 54172 Research and Development in the Social Sciences and Humanities
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 220561055
Full Text: In 1969, just as I was working with Willard Gaylin to create The Hastings Center, I was visited by Bernard Berelson, a distinguished social scientist and president of the Population Council in New York. The council was at that time the world's leading research organization on family planning and population matters, heavily supported by the Rockefeller and Ford foundations. Would I be interested, Berelson asked me, in spending a year at the council working on the ethical problems of population limitation? Save for some writing by Berelson himself on the topic, there was no research or literature on these problems, and I knew little about them myself. But The Hastings Center, not yet incorporated, had no money, and I needed some work, so I eagerly agreed to take it on. That was in the heyday of international efforts to control high population growth in developing countries, taken to be a key element of economic development.

I spent an interesting year, learned a great deal about demography and the politics of fertility control, and came quickly to see the topic as one that should be important in the work of The Hastings Center. I published an article and some books on the topic, and set up a research group at the Center that was supported for much of the 1970s by the UNFPA, the United Nations Population Fund. (1)

The earliest efforts at population control were focused almost exclusively on family planning programs, heavily oriented toward providing contraceptives--"parachuting condoms into poor countries," as one critic later put it. The ethical discussions focused on the comparative moral legitimacy of education, persuasion, and coercion in lowering birthrates. The technology-oriented approach was, in any case, not a great success and was gradually repudiated by a series of U.N. conferences. The 1994 conference in Cairo made clear a decisive shift in focus--emphasizing the education of women, a reduction of infant and child mortality, and gender equity.

By the end of the 1970s, we decided that there was not much more we had to contribute to population issues. Nor had our own work drawn many others to the field, which amounted to just a handful of people in ethics (for example, Ruth Macklin, Robert M. Veatch, and Arthur Dyck). Somehow or other, population issues did not make it into the topical canon of bioethics, which had moved in a heavily clinical direction during the 1970s. And I moved on myself.

Yet, at least in my own case, there was to be a second act. Ever since the 1970s, I had become addicted to reading a leading demography journal, the Population and Development Review. About four or five years ago, I began noticing a shift in its articles. There were far fewer on population limitation. Save for the poorest countries, most other developing nations had seen a sharp decline in birthrates and family size over the previous twenty years. The new emphasis was on the exceedingly low birthrates that had begun to appear in most developed countries by the late 1980s. Some nations are, in fact, facing a severe decline in population over the next few decades (Italy, Spain, and Germany, for instance). The goal was and remains zero-population growth (ZPG), taken to be 2.1 babies per woman, on average, but where previously the aim of many groups was to get down to ZPG, the new emphasis was on getting birthrates back up to it. How and why that had happened was the question that demographers (and I, as an onlooker) were trying to answer.

Something else caught my eye, as well--the relationship between low birthrates and a rising number of the elderly. This meant that the "dependency" ratio of working young to elderly retirees was changing, with fewer young people to support more old people, falling from a ratio of 4 to 1 to 2.5 to 1. Many countries where that change was taking place had also recently put in place a lower age for retirement (down to fifty-five in some countries), as well as a higher guaranteed retirement income (100 percent salary parity in Italy). A declining population size, proportionately fewer young people, and a growing number of the elderly have been quite enough to give a number of U.N. agencies, and many governments, fits.

The United States has been an exception among developed countries. Our birthrates have been high (remaining at the replacement level), much helped by immigrants. Our Social Security system has managed to stave off, for some thirty or more years at least, the retirement meltdown that is occurring in some European countries. Our Medicare program is in danger, however, but less for demographic reasons than because of the high cost of health care, which will intensify over the next few decades as the baby boom generation retires. Where some European countries have worked to raise birthrates by various policies as a way of dealing with the aging problem, the United States has focused on a reform of Medicare to do the job.

Historically speaking, though, the baby boom generation would have been better off bearing as many children as their parents, thereby putting in place a larger pool of young people to support them in their aging. But that could not easily have been done, even if anyone wanted to do it. The baby boom era (1947--1964) was also the most prosperous period of the twentieth century: families could afford to have many babies, even with only one wage-earner. The subsequent era was not so well off, jobs were increasingly scarce, more women were working, and birthrates fell.

As far as I can make out, no one in bioethics has become interested in the more recent problems of birthrates, aging societies, and their interrelationships. They are examples of what I call the downstream problems that emerge from technological and social advances of medical progress, which in turn were generated by earlier advances. Though it turned out to be a mistaken emphasis, the advent of effective contraception in the 1950s and 1960s made possible the development of family planning policies that focused on the poor. But it was the change in other variables, such as women's education, that made the real difference. Birthrates declined in developing countries in the decades that followed.

Little noticed for a time was the decline of birthrates in developed countries, also brought about in part by effective contraception and legal abortion. I say "in part" because other, more important influences were at work as well. A major factor in declining birthrates everywhere was the gradual decline in infant mortality, which got under way during the nineteenth century, and a parallel decline in maternal mortality as well. The feminism of the 1970s, the rapid increase in the number of educated women, and the rising costs of childrearing also made a difference. But running through these changes was the impact of medical and public health improvements.

As with many such improvements, however, there has been fallout. Low birthrates have some economic disadvantages, not the least of which are the changes, in a negative direction, of the dependency ratio. But there is also a cadre of economists who contend that the economic vitality of societies depends on a continuing influx of young workers. Efforts are now underway in many countries to keep the elderly in the work force by opening up new work opportunities and raising the retirement age.

Still another issue of neglected importance is that women are deferring procreation until their late thirties and early forties. The result has been what, in other contexts, would seem a clear public health problem: increased hazards to mother and child from later procreation and, for many, the impossibility of having children at all (helped but not overcome by in vitro fertilization). There is now an abundance of books and articles, going back many years, dealing with women, work, and procreation. Women and men both have yet to find an entirely satisfactory way to blend the exigencies of modern professional life with the raising of children. And some feminists bemoan a small-but-growing trend of educated mothers dropping out of the workforce altogether (though most, in my experience, use their energy and education in local community, political, and school activities, as well as in part-time or consulting jobs).

As it turns out, the European countries that have the highest birthrates (France most notably) are those with the best programs and policies for working mothers and child care. What serves women best also serves the birthrates best. Those countries with what demographers call the "lowest low" birthrates all have poor policies. The populations of northern European countries have long looked to the welfare state to help them with procreation and child rearing. The southern European countries, which traditionally look to families to care for each other, come off badly in comparison.

In 1969, determining how best to lower birthrates was a contentious issue. In many countries now, it is the government's effort to raise birthrates that is contentious. Just as few people earlier (save for China) were willing to tolerate coercive policies to force women not to have children, the argument now is how far and in what ways governments can go to change procreative patterns in order to raise birthrates. Some feminists find the whole idea of such efforts obnoxious, just as some environmentalists think declining populations are a good thing anyway.

In its own eerie way, it seems we have come full circle. What was true earlier seems no less true today: there is considerable international agreement that there should be freedom of procreation, but there is no less a parallel perception that the aggregate effect of those individual decisions, depending on the way it goes, can have a profound social effect. Too many children or too few? Too many elderly or too few? What is the right balance, and how can we get there?

References

(1.) D. Callahan, "Ethics and Population Limitation," Science 175, no. 21 (1972): 487-94; D. Callahan, ed., The American Population Debate (New York: Doubleday, 1971); D. Callahan, ed., Ethical Issues in Population Aid(New York: Plenum Press, 1981). For a discussion of the Center's work with the UNFPA, see D.P. Warwick, Bitter Pills: Population Policies and Their Implementation in Eight Developing Countries (Cambridge, U.K.: Cambridge University Press, 1982).

Daniel Callahan, "Ethics and Population," Hastings Center Report 39, no. 3 (2009): 11-13.
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