TABLE 4.-Birth rates and rates of natural increase, world and major regions, 1960, and projected, 1970-2000, medium assumptions

1 Not including some areas of Asia and Oceania as indicated in footnotes 2, 3, 4, 5, and 6.

* Not including Hong Kong, Mongolia, Macao, Northern Korea, and Ryukyu Islands. Mainland China only.

Corresponding to immigration assumptions in original projections.

Not including Polynesia and Micronesia.

NOTE.-Death rates, table 2. For explanation, see text.

Source of data: United Nations, "Preliminary report on world population prospects as assessed in 1963," (ST/SOA/Ser. R/7), 1964, app. C, tables I and III.

Senator GRUENING. An article appeared in the New York Times on August 10, 1965, which is pertinent to our discussion here today. According to this article, India has begun the production of Lippes loops with a factory in Kanpur, the largest city in Uttar State. The factory will operate around the clock, and is expected to produce more than 5 million loops during the first year "far more than India's struggling family planning program can hope to use."

Also with regard to India, there is an article in this month's Finance & Development magazine, by K. S. Sundara Rajan, which examines the population problems of India in some detail. I direct that both the New York Times article and Mr. Rajan's work be made part of the hearing record at this point.

(The items referred to follow :)

EXHIBIT 231

"INDIA BEGINS PRODUCTION OF BIRTH CONTROL DEVICE"

[New York Times, Aug. 10, 1965]

FIRST FACTORY IS DEDICATED AT KANPUR-WILL PRODUCE 14,000 LOOPS A DAY (Special to the New York Times)

KANPUR, INDIA, August 9.-India began production of the much-heralded "Lippes loop" today.

Six hundred guests attended the dedication of India's first factory making intrauterine contraceptive devices.

The factory will turn out 14,000 white loops a day. India hopes to use them soon to bring her surging birth rate under control.

Over the next year, the factory-now just three rooms at one end of an electroplating plant-is expected to turn out more than 5 million loops. This is far more than India's struggling family-planning program can hope to use. At the dedication ceremony, Mrs. Sucheta Kripalani, the Chief Minister of Uttar state, said it was appropriate that the factory should be established here in Uttar's biggest city.

INDIA'S MOST POPULOUS STATE

Mrs. Kripalani noted that Uttar, with about 75 million inhabitants, is the most populous state in the country and is growing rapidly.

She recalled that Kanpur, which had only 970,000 residents in the 1961 census. is now believed to have over 1,200,000. Many of the new residents are migrants drawn from the countryside by the city's burgeoning industry. However, many others are the products of the soaring birth rate.

Kanpur and Uttar both are "vitally concerned with the success of this program," she said.

Joining Mrs. Kripalani in an appropriately all-female ceremony, Dr. Shushila Nayyar, the gray-haired spinster who is India's Minister of Health, said the entire country had a stake in the factory because the loop represented a "notable technological breakthrough" in the field of birth control.

Those who know the history of the factory know there was almost no breakthrough there.

The factory was originally to have opened in June at Etawah, a small town 85 miles north of here.

EARLIER PROJECT A FIASCO

However, the Etawah project was a fiasco. Essential equipment failed to meet specifications, the electric power was not sufficient and qualified technicians could not be found.

In mid-June the project was moved to Kanpur and put in the capable hands of Chandra Narain, a development officer in the Uttar Department of Industries. Within 5 weeks the vacant end of the electroplating plant was transformed into a factory. Fourteen skilled technicians were found to man the three shifts that will keep the factory operating 24 hours a day.

Not everyone here is convinced of the loop's value. One official of the Department of Industries took an American aside before the ceremony and asked: "Do you really use these things in the United States? My wife says she won't use one. She says it will give her a disease. I think maybe she's right."

HOW DEVICE IS USED

The Lippes loop is an S-shaped twist of plastic that is inserted into a woman's uterus. By a means that doctors have yet to fully analyze, the loop prevents the formation of the fetus. The loop can stay in permanently, or at least until the woman decides to have a child. Then it can be pulled out easily with a thread that is attached to it.

The loop was devised by Dr. Jack Lippes of Buffalo General Hospital.

EXHIBIT 232

"INDIA'S POPULATION PROBLEM"

(By K. S. Sundara Rajan)

(Article in “Finance and Development," a quarterly publication of the International Monetary Fund and the International Bank for Reconstruction and Development, Vol. II, No. 3, September 1965, pp. 144–151)

In many countries population is expanding too rapidly for resources. India faces one of the most difficult of such problems-a population which, if its expansion is not checked, might reach a billion by the end of the century. In this article the Executive Director of the World Bank for India recounts some of the steps the Government is taking to deal with this problem.

Because of the advances in medicine and public health measures, the death rate, particularly in the developing countries, has declined rapidly, with the result that population is now increasing at an alarming rate all over the world. Currently the population of the world is increasing by 60 million every year. In 1930 it was 2 billion, but within 30 years it had increased to 3 billion, and we may in the next 30 years have another 3 billion inhabitants on this globe.

Though in the last 25 years production of foodstuffs has more than kept up with the increase in population-there was an increase in world grain production of almost 14 percent per capita-we cannot be sure that future growth in food production will be of this order. On an extremely sanguine view, assuming that the developing countries have the technical know-how, the necessary water, fertilizers, improved seeds, and trained labor, the increase in food production may in the next two decades or so be able to cope with the increase in population and also allow for somewhat increased consumption. There are also possibilities of revolutionary changes in food technology, such as artificial photosynthesis and greater utilization of the food resources of the sea, whether these be fish, algae, or other organisms. But one is bound to doubt whether, even with such revolutionary changes, we could sustain on this globe more than twice the present population. Since any measure taken now for controlling population growth can have its effect only some 15 to 20 years hence, there is not much time to lose. It has to be remembered that even if we succeed in bringing down the birth rate to the level of the death rate at any particular point of time, the demand for necessities like food and clothing will continue to increase for some time as a result of the children growing into adulthood.

This problem is disturbing for the world as a whole, but for some countries it is more than that-it is frightening. Among these is my own country, India. The population of India now is 480 million-almost twice what it was in 1921 when I was in school-and it is currently increasing at the rate of almost 1 million a month. In only 1 year we are adding to India population equivalent to the whole of Australia or to that of Sweden and Norway put together. In 10 years India's population will increase by more than twice the present total population of the United Kingdom or the Federal Republic of Germany, or more than half the population of the United States. At the present rate of growth the population of India will reach 1 billion by A.D. 2000-this was the population of the entire world in 1840. It is an appalling prospect, because our economy is already overburdened-we have one-third the area of the United States, but two and a half times its population. Though we produced 87 million tons of foodgrains in the 1963-64 crop year, we have still to import 8 to 9 million tons of foodstuffs each year. Much of it fortunately comes from the United States under Public Law 480. Even with these large imports, millions of people in India live out their lives on the edge of starvation.

India's spectacular increase in population has been the result of a drastic fall in mortality rates. In the decade 1921-31 the birth rate was 50.8 per thousand population and the death rate 40.4. These rates have been currently brought down to 39.4 and 16.3. Expectation of life has increased during the same period from about 27 years to 49.2 years. This is the result of the far-reaching public health and medical relief measures undertaken by the Government of India, especially since its independence. It is something of an irony that the very success of the Government in saving life and in eradicating diseases like malaria

should have left us with an even bigger problem-the population explosion, which means that all our economic development efforts have little meaning for the masses. In order to give economic development a meaning for ordinary people we should have to bring down the birth rate from the present level of 39.4 per thousand to something like 25 per thousand. If we could get it down to 20 per thousand, we would have a stable level of population and no problem.

POPULATION CONTROL

In these circumstances, India has no choice and no escape; we must control our population growth. While we must make every effort to step up the rate of our economic development and growth-and we are making such efforts-there is no doubt that to get the necessary increases in per capita income and improvements in the standard of living, the present rate of increase in population must be checked, and checked drastically. The Indian per capita income, as is well known, is one of the lowest in the world-even after 14 years of planned development and prodigious efforts by our people and assistance from abroad, our per capita annual income today is only $80, which works out to a little more than 20 cents a day. In the developed countries people eating three good meals a day spend more than that on a snack to keep them going between lunch and dinner. Again, as the 20 cents a day is an average, millions of people in India get much less. Though foodstuffs and clothing and such essentials are fortunately much cheaper in India than in the industrialized countries, it is still hard for people elsewhere even to imagine what deprivations, hunger, and lack of the barest necessities of life, these scores of millions of people have to suffer all their lives.

How much of our development effort is absorbed by the increase in population will be seen from the fact that though our national income has increased during the last 15 years from $18.42 billion to $31.19 billion (at constant prices), or by 68 percent, our per capita income has gone up by only 25 percent. Similarly, the production of foodgrains has increased by some 61 percent during the same period, but the per capita availability from indigenous production has increased by only 19 percent. In respect of clothing-we are the third largest textile producer in the world and only the United States and Russia produce more though our production has increased by 87 percent, our per capita availability has increased by only 39 percent. Indeed, because of the rapidly increas ing population, we in India, like the other developing countries, are running up an escalator that is marked "Down."

Fortunately for us, our leaders realized the importance of population control as soon as we became independent. The Government of India in 1948-50 was among the first, and one of the very few governments then, that had offcially sponsored family planning programs. The first Indian 5-year plan, published in 1951, stated "The rapid increase in population and the consequent pressure on the limited resources available have brought to the forefront the urgency of problems of family planning. . . . All progress in this field depends first on creating a sufficiently strong motivation in favor of family planning in the minds of people, and next on providing the necessary advice and service based on acceptable, efficient, harmless, and economic methods." These words were written 14 years ago. To achieve this end, the 5-year plan made provision for giving advice in government hospitals and health centers on methods of family planning, for conducting field experiments on different methods, and collecting information based on scientifically tested experience in India and elsewhere-re search on medical and technical aspects as well as on popular attitudes and motivations.

CONTINUING GOVERNMENT CAMPAIGN

The successive 5-year plans of economic development for India have placed increasing emphasis on this program. The third plan states "The objective of stabilizing the growth of population over a reasonable period must therefore be at the very center of planned development. The program of family planning, involving intensive education, provision of facilities, and advice on the largest scale possible and widespread popular effort in every rural and urban community has therefore the greatest significance." The third plan provided for $60 million for family planning, and this has been increased to $200 million in the coming fourth plan. The program has received both financial and tech

nical support from the Ford Foundation, which has shown keen interest in it from the very beginning. The United Nations has also recently sent a team of international experts under the leadership of Sir Colville Deverell to advise the Government of India on its programs.

The family planning program in India now consists of—

1. Education of the people to accelerate the adoption of family planning as a "way of life" and to establish the norm of small families;

2. Provision of services, including contraceptive and sterilization facilities; 3. Training of workers;

4. Research programs in demography, medicine, biology, communication, and motivation;

5. Indigenous production of contraceptives;

6. Coordinating and strengthening the Family Planning Organization at all levels; and

7. Evaluation.

The national aim is to reduce the Indian birth rate as expeditiously as possible from the present 40 per 1,000 to 25 per 1,000. The operational goal is to create for 90 percent of the married population of India facilities for the adoption of family planning by

1. Promoting group acceptance of the concept of a small-sized family;

2. Imparting personal knowledge about family planning methods to individuals; and

3. Making supplies and services readily available.

The family planning program is an integrated effort throughout the entire population. For work in rural areas the unit selected is a community development block (roughly 100 villages with a population of 75,000), and in urban areas a unit of population of about 50,000. The program emphasizes community education, aimed at helping people to help themselves and to organize educational activities within their own groups, and at the supply of simple contraceptives requiring no clinical consultation. It is proposed to appoint one male and one female honorary worker (Parivar Kalyan Sahayak and Sahayaka) for every village or group of 1,000 population. Honorary family planning education leaders are also being appointed to mobilize public opinion in favor of family planning. As a result of all these efforts, 10,964 family planning centers were functioning in India by April 1964. They must have increased by another thousand by now. Of these, as many as 10,000 are in rural areas. In addition the central and state governments had organized 1,109 orientation camps for helping village leaders to understand, organize, and support the family planning effort in their villages. The attendance in these camps was over 22,000. In addition 66,860 general meetings for the public had been organized all over India. Nearly 14 million people attended these general meetings-an average of 200 per meeting. Full cooperation of private medical practitioners is secured by getting them onto the various boards and committees as well as by using their services "in the field."

In all these 11,000 centers, advice is given by qualified personnel. All contraceptives are supplied free to everyone in rural areas, and in urban areas to people in lower income groups.

In India, fortunately, there are no formal religious or social objections to family planning, yet even with these advantages, and with the efforts that we have made and with all the money that we have spent, we can hardly be said to have made an impact except on the middle classes and a fringe of the rural population. The main reasons for this are the difficulty of reaching the hundreds of millions of people in the villages-many of them illiterate and the absence hitherto of a safe, reliable, relatively cheap, and simple device for contraception.

METHODS

All the recognized contraceptive methods are in use in India, excepting induced abortion, which has proved so successful in Japan. It is not likely that India will ever have recourse to induced abortion, and reliance will have to be placed on other methods. Depending upon the individual's preferences, family planning centers advise and distribute prophylactics, diaphragms, foam tablets, cream, and jelly. They are all manufactured in India, though imported products are also freely allowed.

In the last 8 years, the sales of contraceptives in India has increased over a hundredfold. Sales of prophylactics alone have increased 208 times. Even