Posted January 1999
Improvements in education and health are closely linked to demographic modernization. Caldwell's (1986) analysis of low-mortality "outliers" among poor countries argues the mortality case; the fertility relationship is attested by numerous quantitative studies. Significantly, education and health are precisely the sectors where government action, properly designed, can also most readily serve redistributive ends. Sectoral budgets themselves may not mean much: universities and high-technology hospitals can consume large amounts of resources but reach few in the population and raise rather than reduce economic inequality. Primary and secondary schooling and primary health care are the relevant extension services, contributing directly to well being as well as to earning capacity. Achievement of high primary- and secondary school enrolment rates necessitates near universality of service provision; and to be effective, primary health care must similarly be widely available at the local level and acceptable in quality.
The administrative and financial structures of these sectors are also relevant to their impact. Accountability to clients may be a surer means of achieving service quality than bureaucratic supervision. Such accountability is more likely to be found where the financing of services includes a significant locally raised component-through local taxes and perhaps user fees (provided access is not thereby skewed). De facto, such devolved financing is often the case, but without insistence on accountability.
There is some evidence at the macro level that rapid population growth is associated with poorer budgetary provision for education and health (see G.W. Jones 1990). This is a disputed area, however. Budgets reflect government priorities, and social services often do not rank very high. Conditionality stipulations-particularly those associated with structural adjustment programs-are sometimes blamed for this ranking, but the case tends to be weak. Conditionality may even work in the opposite direction: the 1990 World Development Report argued that aid allocations "should be based on a demonstrated commitment to the goal of reducing poverty" (p.141).
Family planning programs, at least in their pre-Cairo formulation, are in essence just another kind of extension service. The client-demand may be softer than in the case of health and education, but the administrative requirements qua program are not radically different. Their welfare effect on the poor is less easily identified, however. Most of this review has assumed that fertility outcomes reflect the interests of parents or families; but some part of fertility reflects ineffectiveness of available birth control methods. Access to safe and effective birth control is likely to be strongly associated with parents' socioeconomic status, in particular with education and income. Thus "unwanted" fertility is disproportionately found among the poor. Family planning programs, aimed principally at those who lack access to private sources of modern contraception, thus have an important distributional dimension: the services they provide, in addition to any social gain that may come from reduced fertility, offer a private gain mostly to the poor. (This, of course, assumes that the services are fully voluntary; if they are not, the social gain would be set against a private cost.)
Family planning post-Cairo, with its aim of cutting back any explicit demographic intentions and focusing instead on improving the reproductive health of women and their access to high-quality services, is still closer to an extension service-conceptually not distinct from other more or less specialized components of the health program. The changed orientation may attenuate the program's redistributive effect: as service quality is raised, the program may well find itself catering to a more middle-class clientele than before.
Women are more often in poverty than men. Detailed statistical materials, for example from the 1995 Human Development Report, support the proposition. A.M. Basu (1994: 18) finds conclusive evidence of "a widespread disproportionate impact of poverty on women". Kabeer (1996: 19) remarks that women "are less able than men to translate labour into income, income into choice and choice into personal well-being."
Two fairly distinct phenomena are implicated. One relates to the status of women who are widowed, divorced, or separated, and to the level of autonomy and economic opportunity open to single women; the other, to the position of women within marriage and within the household. The first of these combines effects of gender with those of social isolation and old-age dependency (sex differences in average age at marriage and in adult mortality mean that the single elderly are predominantly women). Poverty can be linked to gender-differentiated aspects of law and social practice in areas of property, inheritance, and occupational choice, and to the (precarious) economics of single-person or single-parent households. Children, and sons especially, may be an important economic resource for widows-as stressed, for instance, by Cain (1978)-but this fertility connection would plausibly diminish as alternative sources of security emerge in the course of economic development.
The second phenomenon is more complex. Its documentation hinges on fairly intricate research on intra-household allocation and on assumptions about nutritional needs, culture, and equity (see Haddad et al. 1994). South Asia has been the locus of much of this research. Harriss (1990) presents a lengthy and thorough survey of the evidence and explanations for intra-household food allocation in that region. External conditions may give rise to a material rationale for discrimination against women and girls under conditions of scarcity, in terms of a household's survival strategy in confronting a labour market structured in favour of males and in terms of differences in expected future costs and returns to child rearing between girls and boys. There is also a cultural level of explanation, involving "observance of the moral order governing distribution" of food (p. 409)-an order that seemingly is poorly informed of nutritional basics. Allocative outcomes are conditioned by patriarchal beliefs and social relations - ones that exist as much outside the household as within it. Harriss lists the various elaborate proposals for "more or less highly targeted therapeutic interventions to remedy nutritional discrimination" (p.411) but is quite skeptical of their worth.
Consider policies that might lessen female poverty. The structural causes of poverty, such as women's second-class status in inheritance and property rights in some societies, may be resistant to change except over the long run; indirect means of enhancing female earning power and autonomy may have more prospects of near-term effect. Ensuring equal access to education is clearly important, as is ensuring that health and family planning programs meet women's needs. To the extent that net fertility and child rearing costs fall more heavily on women than men, the economic benefit of these programs also goes disproportionately to women. Design changes in certain other government extension activities can make them more oriented to women-for example, in credit systems or in the targeting of agricultural extension services in situations where food crops are predominantly cultivated by women.
What of the demographic effect of these measures? There is a general belief that policies to improve women's autonomy-particularly in their access to education and health services-are effective in reducing both fertility and mortality (A.M. Basu 1992: 241). Evidence on the mortality side seems incontestable; on fertility, the case is somewhat blurred by the prominent instances of fertility decline under much less than autonomous circumstances.
Attention to gender equity resounds in international declarations and covenants; it has become one of the routine emphases of the policy recommendations of international agencies. Increasingly, it is translated into practice by national governments. For example, Knodel and Jones (1996) find that gender inequality in access to secondary education is fast diminishing in much of the developing world. However, these authors caution that poverty considerations may get neglected along the way: "in most developing countries a specific gender focus [in education] is misplaced, or should be given only secondary priority relative to reducing socioeconomic inequality for both sexes" (p.698).
The link between poverty and high child dependency can involve both directions of causation as well as the joint effects of other factors. The income-diluting effect of a larger number of dependent consumers in the family would presumably diminish as the children become economically active, but it is not less real for being transitory. It may also have long run consequential effects by curtailing the children's education in the interests of raising family income.
To the extent that poorer families have more children, the proportion of children in poverty will be higher than the proportion of families or of adults in poverty. The usual pattern of fertility decline can exacerbate this effect. Jones and Potter (1978: 22) cited the case of Colombia over a period during which the annual growth rate decreased from 3.1 per cent to 2.2 per cent: "when the birth rate was above 45 in 1964 about half of each cohort was born into the poorest 50 percent of all households. In 1973, when the birth rate had declined to the low thirties, the share of children born into these households increased to about two-thirds."
In democratic welfare states, fertility decline can also worsen child poverty through the political arena. The proportionately more numerous elderly brought about by population aging acquire greater influence over social policy, particularly as it affects the direction and scale of transfer payments. Payments that benefit the older age groups may become politically unassailable, so that any constraints on the overall scale of budgetary transfers are disproportionately felt by other potential claimants-notably, poor families with dependent children. This is the generational politics argument developed in Preston (1984).
In most developing societies welfare-state institutions are in their infancy. In particular, broad-based provisions for old-age security have yet to emerge. Only a minority of employees, chiefly in the public sector, is covered by pension schemes. Instead, the state takes it for granted that old-age security should be the responsibility of families. It may even enshrine this obligation in law, as in the 1980 marriage law of China, seeking to insist on familial responsibility against the forces tending to erode it. But such efforts, whether hortatory or regulatory, seem bound to fail-if only because, with declining fertility, networks of kin become thinner (see Lutz 1989) and the burden of upward transfers per working member of the family increases. Moreover, there would remain a need to provide for the childless elderly and for those whose families for whatever reason default on this obligation.
Many elderly would of course expect to support themselves from accumulated assets. Some part of a family's support of its aged members is in fact a graduated process of asset transfer. Poverty among the old is concentrated among those with few or no assets: to a first approximation, it is a continuation of poverty among the population in general. The additional components are contributed by ill health and disability, by increased vulnerability to predation, and by whatever structural disadvantage there may be in the society's treatment of widowhood.
To the extent that low fertility and consequent population aging are occurring in contemporary societies at lower economic levels than experienced historically, problems of old-age support and of old-age poverty are the greater.
Ill health and disability are causes of poverty that are not only felt in old age. Disability in the sense of productivity impairment is not a well-defined concept: the degree of impairment may depend on numerous technological, societal and policy factors and be specific to occupation. Certain disease regimes, however, almost guarantee poverty-e.g. river blindness (see Evans 1989).
Problems with targeting
If the numbers in such categories start adding up to appreciable fractions of the whole population, any program benefits proffered would potentially include a large consumer surplus and become unaffordable. If the poor within each target group can be identified, of course, the group designation becomes redundant.
Programmatic efforts and the targeting that typically accompanies them entail close government involvement. Less statalist development strategies would rely primarily on the aggregate growth in the economy to raise base-level wages and absorb unskilled labour, and to effect changes in demand (particularly for education and for health and family planning services) that in turn elicit private-sector responses. The now-universal early development strategy of encouragement of labour-intensive manufactured exports is directed at overall economic growth rather than specifically at poverty reduction, but it was the underpinning of the strong "growth with equity" performance of the East Asian economies-and promises significant poverty alleviation elsewhere. The large ideological gap between the programmatic and growth-promotion approaches is narrowed in practice by the common fact of governments falling well short of declared program intent, together with de facto part-privatization of their operations.
One kind of policy intervention is aimed at dealing with the environment of risk faced by the poor. Mink (1993) emphasizes security of tenure for farmers and urban squatters and collective rights in the case of common property resources. This helps to lengthen time horizons and lessen the "mining" of resources. Institutional programs to cope with crisis events such as crop failure, to prevent distress sale of land, are also called for-such as formal or informal crop insurance, or supplementary public works schemes like that of Maharashtra (Cain 1981).
For those suffering from unilateral cost transfers and not able to organize to protect their interests, the options are few. Government may be persuaded to exercise a supervening authority in halting the transfers or granting some compensation; more often, little is done and perhaps little can be done. If overall poverty is diminishing, there is rarely any insistence on ensuring that the growth path obeys strict principles of Pareto improvement.
The most intractable setting for policy is that of the failed state, where much of the physical infrastructure has been damaged or destroyed and minimal social capital remains. While there is ample reason for pessimism that any development progress is possible in the worst cases, there are instances of countries that have undergone a prolonged deterioration in civil order but are again moving up. Ghana and Uganda are cases in point. People retain institutional memories, of course, but the scope for institutional renovation or redesign is potentially large.
For several decades up to the 1997 financial crisis, a number of East and Southeast Asian countries experienced both a remarkable performance in economic growth and at the same time major reductions in both poverty and fertility. The achievement was nearly uniformly applauded, but is variously interpreted. Good policy design is no doubt a major part of the explanation, but some analysts, both within and outside the region, also pointed to the restrictions imposed on populist political opposition.
Birdsall et al. (1995) stress the former explanation, emphasizing measures that raised productivity of the poor: promotion of a dynamic agricultural sector and labour-demanding, export-oriented manufacturing; and rapid expansion of basic education. One of the "virtuous circles" they identify has the growing numbers of educated workers eroding the scarcity rents of the more educated, reinforcing low inequality and further increasing the labour demand. Equally virtuous is the economic gain from the reduction in child dependency following from the fertility decline that the economic expansion promoted. Job creation, higher agricultural productivity, and improved health and education enhanced earnings power at the grass-roots level. These same trends, together with changed expectations about the economic future and recognition of the need for (and costs of) education, lowered family size goals. An effective distribution system for modern contraceptives met the consequent demand for birth control. Reduction in fertility among the poor has helped their economic circumstances under the new conditions in which "quality" rather than "quantity" of children matters.
Both in the implementation of programmatic measures and in the overall system of local administration most of the East and Southeast Asian states relied on strong government authority. Both in programs and administration, these pressures and mechanisms of control plausibly contributed to the resulting performance (see McNicoll 1997). In strictly economic terms, the major offsetting consideration is that the absence of political opposition may also have encouraged the so-called cronyism that led to poor investment policies in the modern sector and the dramatic economic reversals seen in the last year. In more general welfare terms, the offsetting consideration is the curtailment of individual liberty.
Economic and social policies necessarily have a political dimension, and one where rhetoric and practice may diverge. Thus, in the rhetoric of family planning policy a fully voluntaristic model prevails; in practice it may not. Birth control programs, like many other government activities, draw on the administrative power of the state. An authoritarian state tends to run authoritarian programs, whether in fertility or in the kinds of extension services that have contributed to a reduction in (narrowly construed) poverty. At least early in the course of development, program effectiveness, it seems, does not imply or require democracy. Once the development process has lifted a society significantly above subsistence levels, however, the case for taking seriously this further dimension of well being, and the voice for service quality that it makes room for, rapidly gains strength. The rhetoric of the Cairo Programme of Action, of course, sees individual rights as paramount throughout the course of development.
It is this stability-the equilibrium trap situation-that policy measures have to deal with. Equilibrium traps can, of course, be escaped from by simple geographic mobility: the option of "exit." That may be effective for those who move, but is would rarely be an adequate policy response. The two main policy-driven ways of escape considered above were programmatic interventions and institutional interventions. When tailored to the particular circumstances and existing organizational and administrative capabilities, either of these kinds of intervention can transform local perceptions and realities in ways that create new avenues of economic mobility and associated demographic behaviour. Needless to say, in neither case is success assured.
Objections to these policy directions have come from the left and the right of the political spectrum. On one side are those who oppose any linking of demographic concerns to poverty alleviation. They would see that linkage as in effect blaming the poor for their fertility as well as their poverty. On the other side are those who hold that these intervention efforts are mere sideline activities unconnected to the main task of creating a modern economy and the prosperity it affords-byproducts of which are assumed to be a modern demographic regime, disappearance of poverty, improved environmental quality, and democracy. That assumption, however, needs continual testing. Part of the problem of policy design in this area is to ensure that any such "sideline activities" clearly contribute to favourable economic, demographic, and environmental outcomes.
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