If we went by the long experience of the past, we would have to expect that the present rapid growth in Asia, Africa, the Middle East and South America would soon begin to slow before the attack of the Four Horsemen. One of them, hunger, seems almost ready to begin. In most of these areas per capita food consumption is less than it was ten or twenty years ago. Malnutrition is increasingly endemic. The diseases which feed on such conditions may not much longer be held back by modern methods of public health, while the social and political organization of some large areas is showing signs of breakdown, the processes of change being handicapped by pressures of rapid growth and the failure to meet the rising expectations of the worlds impoverished masses. If there were no new conditions to change these historic processes, it is only a question of time until all the world, or certainly most of it, would be back on the Malthusian basis it has always lived under in the past; the mass of the world's people poor to the edge of starvation, ruled by those who have acquired control of wealth and modern arms.

But the recent history of the people of European descent tells us that there is an alternative to such a disappointing future. For over a hundred years, first in France, then in England, later in the United States, in Germany and in the rest of Europe, the birth rate has gone down by the voluntary decision of the people that they would have smaller families. Women married in England in 1860 were averaging six children during their reproductive years. Women married twenty years later averaged only four children, and size of family kept going down in England until in the depression of the nineteen thirties the rate of reproduction was for a time well below that needed for replacement. A similar decline in births took place in most European countries. Even in the United States the birth rate during the depression was not much above replacement. Malthus had predicted the use of what he called "prudential checks," late marriage, or continence; but these people were using a prudential check not foreseen or recognized by Malthus, the method of birth control or contraception.

The birth control methods available before 1960 were used effectively by people with some education and at an economic level above that of extreme poverty. But in the United States at least they were not equally effective among the people on the borderline of poverty or on relief. Extensive studies carried out in India and other Asian countries showed that agricultural people at the lower economic levels and with little education had neither the facilities nor the diligence to apply the older methods of birth control effectively or continuously, even when the great majority were anxious not to have more than three or four children. It looked as though this new check on population growth would be only partially effective, reducing the rate of births in the more advanced countries, but leaving the rest of the world on the old Malthusian basis. Even in the advanced countries the least educated and poorest groups appeared destined to increase at a rate which would greatly increase their number in proportion to the rest of the people, who would then carry a corresponding increase in the cost of welfare and relief. There was danger that in the west the people would be divided into two classes; the more educated and better off, practicing birth control and constantly improving their position, and the least educated and poorest groups, not practicing birth control effectively and with a declining position. In the world as a whole the industrialized countries, using the prudential check of birth control, would tend to have low birth rates and continued low death rates, with a constantly increasing level of living. The less developed countries with large popula

tions at a low level of living and little education, would not use birth control effectively, their birth rate would remain high, and their numbers would increase faster than their per capita production to the point where the death rate rose to meet the birth rate, under the positive checks of famine, plague and war. It would seem unlikely that the education and standards of the mass of the world's people could under these conditions, be raised fast enough to get them to use the old methods of birth control effectively. It was a gloomy picture of the future, but the only one justified by the experience of the past.

Then, six or seven years ago, the picture changed because of two new and striking developments, one coming right after the other. In 1961 an oral contraceptive, the famous "pill," was put on the market. It required only to be taken regularly every day for each twenty days in the month. For the first time there was available a method of contraception which was wholly separated from the act of procreation in time or application. It required a minimum of diligence and was highly effective. Its cost was within the means of almost everyone in the United States. By 1965 it was being used by millions of women, and was being dispensed free by an increasing number of hospitals and public health clinics all over the country. It is as acceptable among people at the lowest economic and educational levels as it is among the better educated and well to do. Barring some unexpected change, we may now assume that before long birth rates will decline in all groups in the industrialized countries to meet the low death rates they now enjoy, so that their growth will be slowed to the point where it will be well below the annual increase in their per capita production.

The cost of the pill greatly limits its use among the mass of the world's people outside the industrialized countries, where every cent must be spent on bare subsistence. But another new and even more revolutionary change in birth control methods is now taking place. The intra-uterine coil or loop of polyethylene plastic has recently been tested on some thirty thousand women in the United States and Asia over a period of two years or more, and with smaller groups over much longer periods. It has shown no signs of injury nor of causing future trouble. It is easily accepted by people at different economic levels and in different areas of the world. For the 85% of the women who retain the device after the first insertion its contraceptive effectiveness is greater than that of any other method. It is like an easily reversible sterilization. But most important of all, it makes it possible for governments to carry out mass programs of fertility control in much the same way that they would carry out programs for the control of epidemics using inoculations or immunizations. The postpartum insertion of an I.U.D. seems welcomed by the very great majority of women who have already had three or four children, whether in the U. S. or in Asia. The cost is negligible, in Asia only a few cents. No further care or effort is required of the women, and thus their economic level, lack of education or care does not lessen the effectiveness of the method. If another child is desired, the device can be easily removed. For the first time it has become possible to extend effective voluntary birth control to all of the world's people. The means for doing so are at hand, the speed with which it is done will depend on the will to do it.

These new means are certainly not the last word in birth control. They will be followed by even more acceptable methods, such as methods of immunization which would be available to men as well as to women. But the several years' experience

with the pill and the I.U.D. casts new light on probable future changes in the pattern of population growth.

The change in growth patterns may come most rapidly in the United States. It is estimated that the married women of the U. S. are now averaging something over three children during their reproductive years. At present age-specific death rates something under 2.2 children per married woman are required for replacement. The result is a rate of growth of over 12 per cent a year, about the same as that of India. Birth rates are subject to several factors which can change quite quickly; proportion married, age at marriage, the extension of contraception to all classes, and changing fashions in size of family. Ever since the last war, age at marriage has been falling in the U. S. until now it is at a low of 20.3 years for girls and 22.7 years for men. Conditions for the employment of young married people have been most favorable since the war. They are likely to change for the worse as the great number of young people born during the "baby boom" in increasing numbers during 1965 and after. With fewer jobs open to them, more young people are likely to postpone marriage. The new methods of contraception are more effective than the old methods, and are increasingly being offered in state and county public health clinics which reach large numbers of people to whom reliable contraception has not previously been available. Finally, people are much affected by current fashions in size of family. During the depression the fashion was to have no more than one or two children; today it is to have three or four. There are some indications that it is already changing to a smaller number. There should be a sharp drop in the number of unwanted pregnancies and illegitimate births, which now account for some twenty per cent of all births. If they were entirely eliminated, the birth rate would be not much above replacement.

Taking into account present trends in age at marriage, fashions in size of family, and increasingly effective birth control, it is quite possible that the birth rate in the U.S. might drop by 1970 to no more than that needed for replacement. Even then, the population of the U. S. would reach 300,000,000 by the year two thousand, and grow slightly more after till it reached equilibrium. At present our population contains an unusually large proportion of people in the younger age groups due to the baby boom since the war, so that death rates per thousand of population will stay low until this now younger group grows to swell the proportion of older people. Of course the figure of 300 million by 2,000 and slow growth after that is only a guess. The factors which make for growth or decline are unpredictable from any past experience. But the guess is probably better than the figure arrived at by extrapolating present rates, which shows a population of six hundred million by 2,040. Even at 300 million by the year 2,000 we will have trouble in keeping up with education, housing and urban development.

For the countries of Europe the situation is less fluid. Their growth is already at about replacement and their birth rates if anything going down. No great change need be expected there.

The most difficult guess is that for Africa, South America and the Arab States and the countries of Asia (other than Japan ere the situation is like that of Europe.) All these areas have much in common: mass populations living on the land in a traditional society, at a low economic and educational level, with the high birth rates

of the past, and death rates falling. They have public health measures carried out by their governments or outside agencies, with little participation by the people themselves, and finally they have rates of increase of from 2 to 4% a year, generally more than can be matched by increases in their per capita production. Such conditions make it very difficult to raise levels of living and of education to the point where such populations will use the old methods of contraception consistently. Until the past couple of years the prospect for a rapid decline in births did not look hopeful. But the situation has changed with the development of the "pill" and more particularly, the intra-uterine device. Governments are now able to handle fertility control programs in the same way that they handle programs of public health; with the consent and cooperation of the people, but without requiring any great effort on the people's part. Many Asian governments have fertility control programs, including India, South Korea, and Pakistan which have made fertility control an important part of their public health services and budgeted large sums to support the programs; Malaysia, Ceylon, Barbados and Hong Kong where the governments are helping finance family planning organizations; and Taiwan, Tunisia, Turkey and the Arab Republic, where the governments have set up experimental projects looking to future country-wide programs of fertility control. Communist China has an active program, but little is known about it in this country. The manufacture of intra-uterine devices has begun on a large scale in Hong Kong, South Korea and shortly in India. In all these countries the I.U.D. seems to be rapidly superseding all other methods.

There is no basis for estimating how long it will take to reduce the rate of population growth to the point where it is exceeded by per capita production, or to a replacement rate which would give them a chance to catch up with their present overpopulation. If birth rates should go down steadily and reach the rate of replacement by 1990, staying at that point, world population would still rise to about six and three quarters billion by the year 2060, after which it would be at equilibrium. This is a large increase, almost double the present population, and most of it would take place before the year 2000. Any faster growth would probably be prevented by Malthusian checks. It will take all the world's resources to make birth control effective throughout the world in so short a time.

POPULATION, PROGRESS, AND INDIA

By

S. K. SINGH

First Permanent Secretary

to the Indian Mission to the U.N.

According to the best available estimates, 200 babies are born each minute in the world; out of these, 30 are born in India and 51 in China.

Since they attained political independence in 1947, the Indian people have been engaged in a massive struggle to improve their standard of living, through planned economic development. In a country with an area of 1.26 million square miles and a population of 476 million such a struggle is both exciting and grim. Exciting because the very prospect of improvement, and indeed the changes thus wrought each day, each month and each year in themselves are exhilarating to watch. Grim because the margin, in India, for development and improvement even to a basic subsistence level is a tremendous one, and in essence, the struggle is one to persuade the workers in the fields and factories to allow the fruits of their labour to be ploughed back into further development, rather than taking advantage of additional production for their own everyday needs. And this needs courage, fortitude, faith and self-abnegation. It is in this context that one has to view the geometric progression in the growth of our population and to realize that it is a factor militating against improvement in standards of living, within the country, becoming quickly discernible and apparent.

A few comparisons, not through any frustration or envy, but merely to put things in perspective, might be relevant. The total land area of India is one-third of that of the United States of America. Our population is almost two and a half times as large. While the area of India covers only 2.4% of the earth's surface, in our country lives more than 14% of the world's population. The population of India at the beginning of the 20th century was 220 million, in 1961 it was 440 million and in 1976, if present trends persist, it might be 625 million. While the aggregate increase in the national income of India, through planned economic development, in the tenyear period between 1954 and 1964 has been of the order of 42%, the increase in per capita income has totalled merely to 16%. These few basic figures would thus give a specific perspective to how Indians recognize, in the context of the developmental efforts and aspirations of the country, the problem posed by the multiplication table of population.

The rapid growth in India's population during this century, and more specially