POPULATION CONTROL POLICY: HISTORY, ETHICS, AND GLOBAL IMPLEMENTATION A MASTERS LEVEL COURSE CURRICULUM By Joanna Davis A paper presented to the faculty of The University of North Carolina at Chapel Hill on April 1st, 2015 Approved by: ____________________ Advisor ____________________ Reader It is tempting to view issues surrounding population control as relatively new phenomena, as we note the contentious debates surrounding abortion, resource inequalities, and environmental degradation as top concerns of the twenty-first century. However, the “issue of population control” dates back thousands of years, to the scholars of Greece, China, and Rome as they theorized appropriate population sizes.1 Population control, as we know it, began in the late 1700’s, as Reverend Thomas Robert Malthus described the ill-effects of unchecked population growth on food supply, arguing “Population, when unchecked, increases in a geometrical ratio. Subsistence increases only in an arithmetical ratio.”2 He believed that it was impossible for the world to sustain this exponential growth without tragedy in the form of mass starvation. In the 1960’s, when the world’s population reached three billion and Paul Ehrlich wrote the best-selling “The Population Bomb” which warned of overpopulation leading to global disaster3, many started to support the idea of curbing population growth. Globally, the concept that government intervention in the form of public campaigns and mandates could influence human fertility was also catching on.4 The world saw changes in how governments reacted to population growth. In India, the response to a rapidly growing and impoverished population included incentivizing sterilization;5 in Singapore, a post-war baby boom saw the promotion of delayed marriage and the liberalization of abortion restrictions.6 Perhaps most famously, in China, the newly sovereign nation went from a pro-natalist view under Mao Zedong,7 who saw a large population as a building block for economic development, to the coercive and unevenly enforced “One Child Policy.”8 Programs that limit population growth in particular areas of the world have sparked some of the largest public health controversies of our time, dividing factions of people who believe that it is our responsibility to limit the exponential growth of earth’s people to sustain human life, and those who believe that fertility choices should be individually mandated. Efforts to control population via direct mandates and indirect influences have caused both distal and proximal effects beyond the scope of what Malthus might have imagined. These effects of population control policies are explored in this course, as students compare and contrast the programmatic approaches of countries in Asia, Africa, North and South America to 1 Neurath P. From Malthus to the club of Rome and back: Problems of limits to growth, population control, and migrations. Armonk, New York: M.E. Sharpe; 1994:227. 2 Llyod PJ. Early Geometric/Arthimetic series and early production theory. J Polit Econ. 1969;77(1):21. 3 Ehrlich P. The population bomb. New York: Sierra Club-Ballantine; 1968: 201 4 Foleya EE, Hendrixson A. From population control to AIDS: Conceptualising and critiquing the global crisis model. Glob Public Health. 2011;6(3):S310-S322. 5 Tiago de Oliveira I, Dias JG, Padmadas SS. Dominance of sterilization and alternative choices of contraception in india: An appraisal of the socioeconomic impact. PLoS One. 2014;9(1):e86654. 6 Wong T, Yeoh BSA. Fertility and the family: An overview of pro natalist population policies in Singapore. Asia MetaCentre Research Paper Series No 12. 2003. 7 China’s one child policy: The policy that changed the world. The BMJ. 2006;333:361-362. 8 Cheng TO. China's little emperors: Medical consequences of china's one-child policy. Int J Cardiol. 2013;168:5121-5125. control population. This course includes an examination of how population policies result in economic, environmental, social, and cultural changes. Often times, this link is neither clear nor linear, as shifts in population and demographics transversely affect these factors as well. The idea of fertility manipulation through population control is critical in the study of Maternal and Child Health, which encompasses the care for women’s reproductive health. The consequences of coercive, forced, or poorly enforced family planning programs unequally affect women. With the current shift towards a human-rights based approach to fertility control, and a focus on family planning, public health practitioners are creating, advocating for, and monitoring family-planning programs that allocate the decision of fertility to the individual. However, there is still much that needs to be done in this arena, including creating programs in which birth control is accessible, affordable, and the decision to receive either short-term or long-term contraceptives is made by the individual. This course explains these problems, and looks towards the future in assessing how viable and long-term solutions might be achieved. MCH791: POPULATION CONTROL POLICY: HISTORY, ETHICS, AND GLOBAL IMPLEMENTATION Class Meeting Time: Wednesdays 9:00-12:00pm, Fall 2015 Course Overview This course is divided into three distinct parts. The first part contains classes that overview major overlying themes in population control, such as the ethics behind controlling population and the economic factors that affect population trends. These broad topics will create a foundation for understanding individual case studies of population control policies. In the second section of the course, students will examine population control policies in individual countries and will compare and contrast these efforts on a larger scale. Finally, students will explore both the indirect and direct effects of population control on other issues, including the environment, migration, and gender, and abortion as well as learn how current trends contribute to the future of family planning. Students will explore patterns noted in DHS data from countries outside the US, as well as examine global population control policies that have been successful historically to make predictions and recommendations for the future of family planning. Course Objectives By the end of this course, students will be able to: 1) Identify how demographic transition and economic development are related to population trends 2) Compare and contrast population control policies in modern-day Asian, African, North and South American countries 3) Explore the relationship between human population and the environment 4) Discuss ethical considerations of controlling population from a human rights perspective 5) Understand current trends in family planning Course Learning Objectives and MCH Competencies: Class Learning Objective Competency Addressed Demonstrate effective written and oral health Communication communication skills appropriately adapted to professional and lay audiences with varying knowledge and skills in interpreting health information. Utilize information technology tools and Communication effective core public health functions such as retrieval of institutional and online public health data and dissemination of public health information Engage in collective information sharing, Communication discussion, and problem solving. Show effective and productive skills in Diversity and Cultural Competency working with diverse individuals Demonstrate basic team building, negotiation, Leadership and conflict management skills Create a climate of trust, transparency, mutual Leadership cooperation, continuous learning, and openness for suggestion and input with co-workers, partners, other stakeholders, and/or clients. Exercise productive organizational, time- Leadership management, and administrative skills Develop knowledge of one’s individual Leadership strengths and challenges, as well as mechanisms for continued personal and professional development. Respond to identified public health needs Systems Thinking within their appropriate contextual setting. Apply evidence-based concepts in public Professionalism & Ethics health decision-making Consider the effect of public health decisions Professionalism & Ethics on social justice and equity. Identify needed resources for public health Program Planning programs or research. Requirements Requirements for this course aim to measure the five key competencies listed above. Requirements include in-class, individual, and group-based assignments. The Class Participation requirement measures Communication, Leadership, and Diversity and Cultural competency, as students will be expected to lead discussions and include alternative opinions and attitudes towards population control policies and ethics as they work to create a climate of mutual respect and acceptance. The individual assignments, including the Midterm and Individual Paper, will measure Professionalism and Ethics, Program Planning, and Communication skills, as students will examine the effects of population control methods proximally and distally, as well as develop family planning programs by using real life examples and best practices to respond to public health needs. Finally, group-based assignments will measure Leadership, Communication, and Diversity and Cultural Competency as students work together to review real public health data to examine family planning policies and make future recommendations. Students will have to manage their time individually and as a group, and cooperate to turn in a finished product that