GLOBAL POPULATION GROWTH - IS IT SUSTAINABLE? MEETING OF THE PARLIAMENTARY AND SCIENTIFIC COMMITTEE ON MONDAY 22ND OCTOBER 2007

Dr Malcolm Potts MB, BChir, FRCOG Bixby Professor Population, and Maternal Health, University of California, Berkeley

Is population growth a every decade. Petroleum geologists problem? suggest oil production could peak as early as 2020. Perhaps less profligate Global population grows more rapidly use and alternative sources of energy now (217,000 more births than deaths will keep pace with demand, but if each day) than in the 1960s (165,000 they do not the world economy could more). Rapid population growth used spiral downwards. to command wide attention, but today it meets a collective yawn. Some scientists suggest that human activity exceeded the Earth’s capacity Ninety-nine per cent of the projected to support it in 1985. Such predictions In Kenya, prior to Cairo, when family growth in population by 2050 will have wide margins of error and even planning was emphasised, the TFR fell take place in the developing world. bringing today’s global population to from 8 to below 5. After Cairo, family Already 1.2 billion lack access to clean western standards of consumption and planning budgets dropped, unwanted water. By 2025 a staggering 3 billion pollution would probably exceed the births doubled, and the fall in the TFR people will be short of water. world’s resources. In 1993, a stalled. The population in 2050 could Population Summit of 60 national be 83 million instead of 44 million. Population projections depend on scientific academies, including the Unless there is a renaissance of interest calculating the total fertility rate (TFR) Royal Society, issued a sombre and investment in family planning, – the average number of children a warning, “science and technology may Kenya will become a failed state, like woman will have over her fertile life, not be able to prevent irreversible Somalia and the Congo. based on current age-specific fertility degradation and continued poverty for rates. The Ethiopian TFR is 5.4. The Last year, the All Party Parliamentary much of the world.” The Academies population has multiplied 15 times Group on Population, Development recommended “zero population since 1900 and unless family planning and Reproductive Health held hearings growth within the lifetime of our receives more attention it will reach on the impact of population growth on children.” 145 million in 2050. Already, 8 the Millennium Development Goals. million Ethiopians depend on external Unfortunately, a year later the After taking a great deal of expert food aid. Niger has a TFR of 8. Four International Conference on evidence, they concluded that it is out of 10 children are malnourished Population and Development in Cairo “difficult or impossible” to achieve the and 84% of adults are illiterate. If the did not listen to the world’s scientists. MDGs in high fertility countries. TFR falls to 3.6 the population will Women advocates “redefined” If population growth is a problem can grow from 14 million today to 50 population, framing anything to do anything be done about it? million in 2050: if it remains constant with “population” as intrinsically there will be 80 million. coercive, and even the word In the 1960s offering family planning “demographic” became politically to lower birth rates in the absence of For the 2 billion people living on 50p incorrect. Compelling evidence of the socio-economic improvements was a day or less, future population growth success of family planning dubbed “wishful thinking”. Now we is unsustainable. The rich also face programmes was ignored, or criticised know that socio-economic changes are formidable problems. World Bank as “target driven”. It was asserted that not a prerequisite for dropping the projections suggest a four-fold increase fertility decline would occur when birth rate. In fact, some countries in the global domestic product in the holistic social and health goals were cannot get out of poverty unless next 50 years. Past growth has reached. population growth is slowed. As a depended on doubling oil output result of rapid population growth,

18 Science in Parliament Vol 65 No 1 Spring 2008 developing countries need 2 million lack of access to contraception, not a which now has more women than more teachers annually, just to hold desire for bigger families which is men in universities, and, along with class size constant. driving the disparity. Family planning much slower population growth, is is often over-medicalised raising likely to be increasingly stable. Iran Slowing population growth pays what innumerable, unnecessary obstacles demonstrates that a pack of oral has been called a demographic between women and the methods they contraceptives and access to voluntary dividend. Individuals with smaller need. Providers, fearful a woman sterilisation can help start a social families have more income to invest might be pregnant, often refuse revolution from within. Ultimately, the and a rapid fall in the birth rate contraceptive advice unless she is Pill is mightier than the sword. produces a relatively large work force. menstruating when she visits the When all the other parameters are clinic. Reasons for hope fixed demographic changes by The wonderful discovery of the past themselves pushed the savings rate in India and Iran Taiwan higher than in the US or 50 years has been that people all over France where the birth rate fell more India was the first nation to develop a the world want voluntary family slowly. It is precisely the countries that national population policy, but it still planning. Tragically, 200 million have been able to slow population grew from 357 million to over one women, almost all in poor countries, growth, which are now undergoing billion in 50 years. The government cannot get access to the choices they rapid economic expansion, and often built a top-down national programme need and deserve. becoming more democratic. around western trained physicians, It is imperative to make as wide a while most of India’s population range of fertility regulation options Jeffrey Sachs writes in The End of growth is in rural areas where there available, through as wide a range of Poverty, “. . . that impoverished are no doctors. Instead of correcting distribution channels as resources families choose to have lots of this shortcoming, Indira Ghandi’s permit. Priority must be given to children.” But, the decision to have a government used coercive measures to ensuring modern contraceptives and child is not like choosing to buy a car, meet demographic targets, leading to the information people need to use where the person balances their election defeat in 1977. The Islamic them. Government services are finances against their perceived need. Republic of Iran was one of the last overloaded, have weak logistics and Sex is often irrational and passionate, countries to confront rapid population lack incentives, and the very poor tend and human beings have sexual growth. In 1988, Ayatollah Khomeini to use the private/informal health intercourse up to a thousand times was pursuaded to adopt a national sector. As the All Party Report points more frequently than is necessary to family planning policy: contraceptive out, an emphasis on Sector-Wide conceive the children they want. factories were built, every newlywed Approaches (SWAps) in foreign aid Having a child is not a single decision couple is required to attend family misses some of the poorest and most made one night to turn fertility on, but planning instruction, and vulnerable groups. a difficult, consistent, prolonged appropriately trained health workers struggle to turn fertility off. are stationed in the rural areas. Iranian As the world’s scientific academies Impoverished families have “lots of family size fell from six to two - as foresaw a decade and a half ago, and children” not because they want them, rapidly as in China, but without any as the All Party Group reiterated in but because they do not have access to coercion. January this year, without a significant modern contraceptives to turn fertility slowing of population growth we face off. The 9/11 Commission Report called “a “irreversible degradation of the natural large, steadily increasing population of environment and continued poverty Over the past decade the disparities in young men [is] a sure prescription for for much of the world.” Building on family size between rich and poor in social turbulence.” Pakistan, which the All Party Report, there is no better developing countries have increased – never had a well-organised family place in the world to make this implying less education for the planning programme, will more than happen than here, in the mother of children of the poor, more hunger, double its population by 2050 and Parliaments. more women dying and more infants become increasingly violent. Iran, dying. The poor use contraception less, but the statistics also show that The Report of Hearings by the All Party Group on Population, Development and they have a much greater unmet need Reproductive Health (Return of the Population Growth factor: Its Impact upon the for family planning, suggesting it is Millennium Development Goals) is on the web at www.appg-popdevrh.org.uk

Science in Parliament Vol 65 No 1 Spring 2008 19 GLOBAL POPULATION GROWTH - IS IT SUSTAINABLE? Lessons from China Dr Therese Hesketh Clinical Senior Lecturer, Centre for International Health and Development, University College London

urrently 1.7 billion people live consequence of high fertility, and in countries where the Total improved survival, resulting from CFertility Rate is between three relative societal stability, food security and five children for every woman of and improved public health measures. Bureau sets targets and policy reproductive age. A further 740 direction, but implementation is the Concerns about this rapid growth and million people live in countries where responsibility of local family planning particularly the possibility of food the TFR is greater than five. Almost all committees, so there is great variation shortages, led to the “Late, Long, Few” of these countries are among the least in implementation. The one child rule policy in 1970. This was a voluntary developed and this level of population applies only to urban areas and to policy focusing on late marriage, a growth is unsustainable, given limited government workers. Two children are long gap between children and fewer natural resources. China is the only allowed in most rural areas, which children. This was underpinned by country to have taken sustained, applies to around 70% of the easy access to contraception, and enforced and sometimes controversial population. There are a number of while there was considerable social measures to control its growing exceptions to the Policy. This includes pressure to comply, there was no population. The question is does ethnic groups, certain occupations like coercion. As a result fertility rates China’s experience of population mining, and where the first child has a dropped dramatically in just a decade control have any relevance for those disability or chronic illness. As with from 5.8 in 1970 to 2.9 in 1979. But countries facing rapid population the “Late, Long, Few” policy, marriage the population continued to grow growth today? is not permitted before certain ages, because the baby boomers of the 50s which vary by location and gender, and 60s were entering their Before the One Child Policy and second children are generally only reproductive years, and by 1979 two- allowed after a gap of four to five China had some lessons for other thirds of the population were under years. Sometimes this is only allowed countries long before the One Child 30. if the first child is a girl, clearly Policy was instigated. When Mao Ze This worried Deng Xiao Ping, who acknowledging the traditional Dong came to power in 1949 he assumed power in 1978, and prepared preference for boys. inherited an impoverished country, to embark on a hugely ambitious which had been ravaged by decades of The policy is underpinned by a system economic reform programme. He civil war, not unlike many of the of rewards and penalties. The rewards recognised that curbing population countries with highest population include economic incentives such as growth was essential for economic growth today. He believed that human payments of cash, low interest loans expansion and improved living resources would have to be China’s and preference in schooling. The standards. So he introduced the One main weapon in the widely predicted commonest penalties are very Child Policy. Third World War. So couples were substantial fines, and for those unable encouraged to have large families with to pay, confiscation of belongings. What is the One Child Policy? the result that in the early Mao years Government employees risk losing fertility was very high. From 1950 to The One Child Policy is a set of rules their jobs. The Policy is supported by 1970 the population increased from and regulations governing approved a massive propaganda campaign, 540 million to 850 million, as a family size. The State Family Planning stressing the societal benefits and the

20 Science in Parliament Vol 65 No 1 Spring 2008 personal material benefits of having But the proportion of the elderly strict enforcement necessitated under just one child. population above 65 will rise to only the One Child Policy, though perhaps 18% by 2025, about the same as most not to the levels of today. The results of the Policy Western countries today. Third, there Even in China the One Child Policy are problems with unapproved The TFR in China has now fallen to now seems somewhat anachronistic , with women prevented around 1.7, so below replacement, with something along the lines of the from delivering in a health facility if a although the population is still “Late, Long, Few” seeming more is not approved with expected to rise until 2030, because of appropriate. China has changed potential risk to the health of mother the baby boom of the 1950s and 60s. immensely over the 28 years since the and baby. Fourth, there is very little On the positive side the Government onset of the Policy. Its GNP has seen choice in contraception: there is strong claims that the Policy has prevented sustained two-digit growth for two reliance on long term forms of 300 million births (equivalent to the decades; it is now open to the outside contraception (the intrauterine device population of the United States) and world. The people have freedoms only initially and later sterilisation). has helped to lift over 200 million dreamed-of 30 years ago. The Policy is people out of poverty. With women So what are the lessons from the also now more difficult to enforce: having fewer pregnancies they can Chinese experience? more people can afford the fines, and acquire skills and training and thus massive rural-urban migration makes The goal for most countries is to can expect better work opportunities. it more difficult to track individuals achieve a small family culture where is legal and safe with early who might want to flout the Policy. abortion greatly encouraged, which the average preferred number of But compliance now relies more on reduces complications. This is in stark children per couple is around two. the acceptance of the small family contrast to the situation in many This has occurred in most parts of the culture than any fear of the penalties. countries where abortion is illegal, and developed world with East Asia taking Despite this the Government will not a significant contributor to maternal the lead. Hong Kong has the lowest go as far as allowing two children for mortality. TFR in the world at 0.98; Singapore everyone, which has been and Japan also have very low TFRs at recommended by many On the negative side the One Child 1.2 and 1.38 respectively. Evidence demographers, and which would be Policy has created a number of from China suggests that it too has acceptable to the majority of the problems. First, sex ratios at birth become a small family culture with the population. The Chinese response has (that is the number of male live births preferred number of children for been to tinker with the Policy allowing for every 100 female) has risen from women starting families now at for some relaxation. For example, 106 in 1979 (which is within normal between one and two. So the key urban couples consisting of two only limits) to an alarming 120 in 2005. question is how best can this be children, may now have two children However, while the Policy has achieved? We know from experience themselves. undoubtedly contributed to this, high elsewhere that wealth and education sex ratios are not unique to China: are key factors in reducing population To summarise there are two main India, Taiwan, Singapore, Vietnam, growth. China shows that population lessons from China for those countries Nepal and South Korea also have high growth can also be brought about currently experiencing rapid growth: sex ratios, because of the combination through a combination of easy of son preference and easy access to - A period of high fertility and low availability of contraception and a sex selective abortion, though they are mortality will impact on the strong determination to reduce fertility not as extreme as those seen in parts population growth for decades and rates. of China. Second, there is a growing therefore should be avoided. aged-dependency ratio: rapidly falling Perhaps the most interesting lesson - To reduce population needs strong birth rates leading to growing numbers from China is that the totally voluntary leadership, excellent access to of elderly people who need to be cared “Late, Long, Few” policy of the 1970s contraception and a comprehensive for by the working population. In brought about the most dramatic falls public education programme rural areas where the elderly have no in fertility. Perhaps there would have extolling the benefits of limiting pensions this is a particular concern. been further reductions without the family size.

Science in Parliament Vol 65 No 1 Spring 2008 21 GLOBAL POPULATION GROWTH - IS IT SUSTAINABLE? The Critical Role of Water The Earl of Selborne KBE FRS

alcolm Potts has reminded us There is already a physical shortage of that 99% of the expected water throughout North Africa, South Mincrease in global population Africa, the Middle East, central Asia of approximately 3 billion will take and in much of India and China. place in developing countries, Much of the rest of Africa suffers from primarily in the least developed areas. what might be described as an To what extent is a lack of water economic water shortage. In other availability likely to impact on the words, the countries do not have the desalination plants and water transfer potential population of 9 billion and financial resources to make optimal systems at great cost to the federal and with what consequences? Are there use of the available water. Very little state budgets. It would seem much water management options which water storage has been provided in better value to buy up existing could mitigate such impacts? sub-Saharan Africa where the irrigated irrigation rights for growing rice or area is only 3.7% of the arable area. watering pasture and to import any I am indebted to Professor Brian Investment in appropriate technology food needed to make up the loss, but Hoskins of Reading University for data could give much of Africa access to that does not seem acceptable to the on global water use by humans. We safe and affordable water. It is still all-important rural vote. use for food, households, industry and common for women in parts of Africa So for those relatively rare regions energy purposes a mere 0.3% of global to spend several hours each day where economic resources are precipitation, and 1.5% of walking to and from water sources available but physical water resources precipitation over land. We use 10% of with containers. A modest investment are insufficient there are stratagems for the water flowing to the sea. On the in a treadle pump can often provide a the moment at least to provide face of it these figures may seem simple, easily maintained low adequate water at a heavy cost. For reassuring, and indeed there are many technology solution to the critical most of the regions of physical water parts of the world where water problem of access to safe water. scarcity, lower cost solutions must be shortage is not a problem now or sought. likely to be in the future. However, Where physical rather than economic water scarcity exists it is instructive to demand for water outstrips supply in a As total population moves to around note how prosperous economies, such growing number of countries. These nine billion by 2050, so absolute as Singapore and Australia, make up shortages occur almost exclusively in demand for food will also increase. the deficit. Singapore is an island state developing countries, which are ill Increasing urbanisation means people and has to depend heavily on equipped to adopt the policy and are likely to adopt new diets, imported water piped from Malaysia. technology measures needed to particularly those that involve a higher However, for strategic reasons it seeks address the crisis. The United Nations consumption of meat. Changing diets to maximise, almost irrespective of Environment Programme calculated in China will have massive cost, its own water supplies. It has that in the mid 1990s about 1.7 implications for water demand. A kilo invested heavily in desalination, in billion people lived in water stressed of grain requires about a tonne of recycling grey water, that is storm countries and that 20% (ie 340 water, a kilo of beef requires about 15 water and dirty water and even million) lacked access to safe drinking times that. water. By 2030 population growth proudly advertises bottled drinking alone could almost double these water which has been purified to the Climate change is one of the factors numbers, assuming a “business as highest standard from sewage waste. that is contributing to uncertainties usual” scenario. As Malcolm Potts told Having no agriculture on the island about future water supplies. The us, a staggering 3 billion people could Singapore imports virtual water in the Hadley Centre’s climate model be short of water. form of food and drink from other predictions indicate large reductions in countries. Irrigated agriculture river flows across Southern Europe, The International Water Management currently uses 70% of the world’s the Middle East, the Amazon basin Institute reports that, globally, water developed water supplies, which is the and the Danube. Increased flows are usage has increased six times in the proportion of Australia’s water supplies predicted in the River Congo, the past 100 years. used for irrigation. Like Singapore, Yangtze, and the Ganges. The Hadley Australia is now investing heavily in Centre has reported that its models

22 Science in Parliament Vol 65 No 1 Spring 2008 were able to reproduce observed more food with less water. Typically systems being developed in India and changes in drought. The same models irrigation systems on extensive elsewhere which raises the prospect of project that an additional 30% of cropping systems are 30 to 40% wider adoption, provided this global land mass is likely to experience efficient. Most of the water sent down technology is backed up by more drought by the end of the 21st century irrigation channels never reaches the realistic water pricing. under “business as usual” conditions, plant it is intended for. The demands though the regional details are still of that notoriously thirsty crop, cotton, For some countries it might be very uncertain. Already more than 40 have been responsible for the realistic to move their agricultural million people regularly need depletion of the Aral Sea and one of production away from the areas of emergency food aid. The predicted the world’s worst environmental water shortage. The North East of increase in drought areas can only disasters. Many other irrigation China has many regions of over- increase this figure. schemes throughout the world are exploitation of water and a decline in hopelessly inefficient. Where water availability for agricultural use. Most climate change models predict agricultural systems are based on The authorities have been trucking in that the dry regions will get drier and temporarily flooding the fields to be water to millions of people after wells the wet regions will get wetter. This cropped, most of the water is lost and rivers ran dry in the east of the would lead to increased yields in some through evaporation. country. Rather than truck water it northern latitudes, but decreased may prove more sustainable to move yields in most of Africa, the Middle The Israelis are credited with production away from these over- East and India. developing the modern trickle exploited areas. irrigation systems, using black Johann Rockstrom, a Swedish polythene pipes. In Jordan drip The Business Council on Sustainable hydrologist, has calculated that irrigation has reduced water use on Development published assessments meeting existing and future demands farms by a third, while raising yields in last year of the implications of water for food, and with the addition of the past 30 years. Fred Pearce reports shortage made by forecasters from three billion to the world population, in his book When the rivers run dry that some of the world’s leading corporate will require an extra annual water Israeli farmers have raised water users of fresh water. The three supply of 5,600 cubic kilometres, or productivity five fold in the same published scenarios foresaw growing an additional 80% of existing water period by using drip irrigation and by civil unrest, boom and bust economic availability. The International Water recycling urban waste water for crop cycles in Asia and mass migrations to Management Institute makes a higher production. Europe. But they also believed that estimate and believes that water usage water scarcity will encourage the will double. Even the most optimistic There is great scope for adopting this development of new water saving water engineer would acknowledge irrigation system elsewhere. India drip technologies and better management that supply management, through the irrigates less than 1% of its fields. The of water by business. provision of additional dams, reason for the slow uptake is cost. To exploitation of underused resources install the full trickle irrigation I agree. There is much scope for better and water transfer schemes simply equipment might originally have use of water by agriculturists, by cannot deliver on this scale. If required an initial outlay of at least industry and by domestic users. If sustainability is to be achieved $500 per hectare. Most farmers who suitable investment is made in different solutions are needed. Supply pump the water from beneath their recycling water and in research into management has to be accompanied fields get their water at heavily low cost, low energy desalination by demand management. subsidised prices, a tenth of the real technology, then a population of nine cost is typical everywhere from India billion could just prove to be As agriculture accounts for 70% of the to California. There is little incentive sustainable without unacceptable water consumed it is sensible to look to save water. There are now some impacts on our environment. first at the opportunities for producing much cheaper trickle irrigation

––––––––––––––––––––––––––––––– In discussion the following points were made: ––––––––––––––––––––––––––––––– The impacts of HIV and IVF have been negligible in relation to the overall growth of the global population. HIV is currently concentrated in countries with about 3% of the global population. Faith-based views have had variable impacts on population growth, but generally contribute positively. For example, Islam has changed, leading to greater use of natural methods of contraception. Catholicism however has a lot to answer for. For example, from comparable starting points Thailand has moved very rapidly to a smaller family size and a higher living standard compared with the Philippines where poverty is related a large family size. The current situation in Ireland was described as appalling. Greater use of early safe abortion was recommended. Predictions of population growth beyond 2050 will see further upward momentum. The population growth factor has been a matter for military assessment in order to identify future trouble spots around the globe. Water policy urgently requires governance with unbiased regulation that does not favour urban communities in preference to the countryside. NGOs have a major role to play especially in less populated areas for family planning and in water management, which is the best way to reduce poverty. For example, Rotary International is involved with population issues by educating people, but not telling people what to do. This is more effective than the World Bank buying a billion condoms for which they receive no kudos whatever. People like children, and need information, but not being told what to do.

Science in Parliament Vol 65 No 1 Spring 2008 23