UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
Distr.
GENERAL
E/CONF.84/PC/8
22 March 1993
ORIGINAL: ENGLISH
PREPARATORY COMMITTEE FOR THE
INTERNATIONAL CONFERENCE ON
POPULATION AND DEVELOPMENT
Second session
10-21 May 1993
Item 4 of the provisional agenda*
PREPARATIONS FOR THE CONFERENCE
Recommendations of the Expert Group Meeting on
Population Growth and Demographic Structure
Report of the Secretary-General of the Conference
SUMMARY
In response to Economic and Social Council resolution 1991/93, the
Expert Group Meeting on Population Growth and Demographic Structure was
convened in Paris from 16 to 20 November 1992 as part of the preparations
for the International Conference on Population and Development to be held
in 1994. The findings of the Expert Group are presented in this report
for consideration in the context of the review and appraisal of the World
Population Plan of Action by the Preparatory Committee for the
Conference. The Expert Group examined the policy implications to be
derived from the current state of knowledge of the complex
interrelationships between population growth, changing demographic
structure and patterns of social and economic development. The
deliberations had as an essential perspective the goals of the World
Population Plan of Action and specific policy measures that would promote
the achievement of those goals. The recommendations deal with
integration of technological, economic, environmental and population
policy-making and planning; research, education and awareness creation;
and international cooperation.
* E/CONF.84/PC/3/Rev.1.
93-16637 (E) 150493 /...
CONTENTS
Paragraphs Page
INTRODUCTION ................................................. 1 - 7 3
A. Background .......................................... 1 - 3 3
B. Opening statements .................................. 4 - 7 3
I. SUMMARY OF THE PAPERS AND DISCUSSION .................... 8 - 56 5
A. Population growth and socio-economic development .... 13 - 16 6
B. Confronting poverty in development countries ........ 17 - 24 7
C. Demographic impacts of development patterns ......... 25 - 30 8
D. Demographic and health transitions .................. 31 - 38 10
E. Population growth and employment .................... 39 - 42 12
F. Social changes and the elderly in developing
countries ........................................... 43 - 51 13
G. Social development and ageing in developed countries 52 - 56 14
II. RECOMMENDATIONS ................................................... 16
A. Preamble ...................................................... 16
B. Recommendations ............................................... 16
INTRODUCTION
A. Background
1. The Economic and Social Council, in its resolution 1991/93 of 26
July 1991, decided to convene an International Conference on Population
and Development under the auspices of the United Nations and decided that
the overall theme of the Conference would be population, sustained
economic growth and sustainable development. The Council authorized the
Secretary-General of the Conference to convene six expert group meetings
as part of the preparatory work.
2. Pursuant to that resolution, the Secretary-General of the Conference
convened the Expert Group Meeting on Population Growth and Demographic
Structure in Paris from 16 to 20 November 1992. The Meeting was
organized by the Population Division of the Department of Economic and
Social Development of the United Nations Secretariat in consultation with
the United Nations Population Fund (UNFPA). The participants,
representing different geographical regions, scientific disciplines and
institutions, included 15 experts invited by the Secretary-General of the
Conference in their personal capacities; representatives of the United
Nations Office at Vienna, the United Nations Environment Programme
(UNEP), the United Nations University (UNU), the five regional
commissions, the International Labour Organisation (ILO), the Food and
Agriculture Organization of the United Nations (FAO), the United Nations
Educational, Scientific and Cultural Organization (UNESCO) and the World
Bank. Also represented were the following intergovernmental and non-
governmental organizations: Commission of European Communities, Council
of Europe, League of Arab States, Organisation for Economic Cooperation
and Development (OECD), Organization of African Unity (OAU),
International Planned Parenthood Federation (IPPF), International Union
for the Scientific Study of Population (IUSSP) and Population Council.
The International Institute on Aging (INIA) and the San Diego State
University International Conference on Population Ageing were also
represented.
3. As a basis for discussion, 14 of the experts had prepared papers on
the agenda items. The Department of Economic and Social Development had
prepared a background paper for the Meeting, entitled "Population growth
and changes in the demographic structure: trends and diversity".
Discussion notes were provided by the Economic Commission for Africa
(ECA), the Economic Commission for Europe (ECE), the Economic Commission
for Latin America and the Caribbean (ECLAC), the Economic and Social
Commission for Asia and the Pacific (ESCAP), the United Nations Office at
Vienna, the International Institute on Aging and the Secretary-General of
the San Diego University International Conference on Population Ageing.
B. Opening statements
4. Opening statements were made by Mr. Grard Moreau, Director of the
Directorate of Population and Migration of the Ministry of Social Affairs
and Integration, on behalf of the Government of France; Dr. Nafis Sadik,
Secretary-General of the International Conference on Population and
Development; and Mr. Shunichi Inoue, Deputy Secretary-General of the
Conference.
5. Mr. Moreau recalled that at the time of the 1974 World Population
Conference much of the debate revolved around the question of whether
economic development was a prerequisite for successful population
policies or whether the reverse was the case. He noted that, at the
present time, that debate had become irrelevant in so far as both views
operated in unison. Mr. Moreau proposed that family-planning policies
not be considered in isolation but should be a part of a broad approach,
particularly with regard to the health of women and children. Mr. Moreau
noted that international migration was of major concern to both the
developed and the developing countries and suggested that migration
should become an instrument of economic development and not be viewed
simply as the result of population growth and lack of development.
6. In her opening statement, Dr. Sadik introduced many of the themes
that were discussed at the Meeting. She emphasized the importance of
social development, considering that the process of demographic
transition was part of a global process of social and economic change.
Reference was made to the experience of countries that had given high
priority to education, health and family planning, promoted women's
status and encouraged community participation, and had seen a rapid
fertility decline, even in the absence of significant economic growth.
Dr. Sadik stressed that improving the status of women had proved to be
critical for successful family-planning programmes. In concluding,
Dr. Sadik stated that, beyond universal access to quality family-planning
services, social development, poverty eradication and suppression of
gender-related discrimination were required in order to achieve the long-
term global population goals set by the Amsterdam Declaration on a Better
Life for Future Generations.
7. Mr. Inoue noted that the recommendations of the world population
conferences held in 1974 and 1984 had played an important role in policy
formulation at the national and international levels, but it was time to
go beyond those recommendations because they were too general and
difficult to translate into concrete actions. He believed that this was
particularly relevant because, during the past two decades, population
policies had been brought closer to the mainstream of governments'
policy-making and the political atmosphere had improved in favour of
promoting family planning.
I. SUMMARY OF THE PAPERS AND DISCUSSION
8. The paper entitled "Population growth and changes in the demographic
structure: trends and diversity", prepared by the Population Division of
the Department of Economic and Social Development of the United Nations
Secretariat, provided the demographic background for the discussions of
the Meeting. The participants were informed that three phases could be
delineated in the growth of the world population between 1950 and 1990.
First, between 1950 and 1970, the rate of growth of the world population
rose (from 1.8 per cent per annum in 1950-1965 to 2.1 per cent in 1965-
1970) because mortality declined rapidly in all parts of the less
developed regions, while fertility remained relatively constant.
Secondly, in the 1970s, the world population growth rate fell because
fertility declined fast in several Asian countries (particularly China),
as well as to a lesser extent in Latin America, and mortality decline
slowed down. Since the late 1970s, the growth rate of the world
population has remained relatively constant (about 1.7 per cent per
annum), while diverging regional trends have been observed. In Latin
America, the rate of population growth has continued to decline. In
Asia, it has remained constant and in Africa it has increased.
9. The slow-down in the growth of the world population has not yet been
translated into declining absolute numbers. According to the medium
variant of the 1990 revision of the United Nations population estimates
and projections, the annual increment to the world population, which grew
from an average of 47 million between 1950 and 1955 to an average of 88
million between 1985 and 1990, was expected to continue to increase until
it reaches a high of 98 million between 1995 and 2000. The annual
increment was not expected to start to decline until after 2000; it would
reach an average of 83 million between 2020 and 2025, which was about the
level that existed in 1985.
10. The total population of the world increased from 2.5 billion in 1950
to 5.3 billion in 1990. According to the medium variant of the 1990
revision of the United Nations population estimates and projections, the
world population was projected to reach 6.3 billion in 2000 and 8.5
billion in 2025. It must be recognized that the medium variant was a
plausible but not a certain course of future population growth. An
appraisal of the range of prospects for future growth was indicated by
the high- and low-variant projections. In the high variant, which
assumed a slower fertility decline, the average annual growth rate would
increase to 1.9 per cent per annum in 1990-1995 and then decline slowly
to 1.4 per cent in 2020-2025, resulting in a world population of
9.4 billion in 2025. In the low variant, which assumed a faster
fertility decline, the average annual growth rate would resume its
decline and reach 0.6 per cent in 2020-2025, resulting in a world
population of 7.6 billion in 2025. Those projections clearly showed that
the patterns of fertility and mortality decline in the coming decades
would be crucial determinants of the size of the world population.
11. The Expert Group Meeting was also informed that during the four
decades 1950-1990, age distribution became younger in countries where
fertility had not yet started to fall (pre-initiation countries).
Population ageing started in countries that experienced a significant
decline in fertility (late-initiation countries) and proceeded further in
low-fertility countries (early-initiation countries). Between 1990 and
2025, ageing would be very limited in pre-initiation countries, marked in
late-initiation countries and rapid in early-initiation countries. A
rapid growth of the elderly was also projected in all countries of the
less developed regions. Both rapid ageing in early-initiation countries
and rapid growth of the elderly in pre- and late-initiation countries
were expected to reach unparalleled levels between 2010 and 2020.
12. The participants were informed that the estimates of future
populations prepared by the Population Division were not to be viewed as
targets, but as projected populations, and that a review of past
projections by a group of independent experts had shown that the medium-
and long-term accuracy of those projections had been relatively good.
The participants noted that, in view of the critical role of mortality in
the ageing process, it would be useful to consider alternative mortality
assumptions as was the case for fertility.
A. Population growth and socio-economic development
13. The Meeting devoted its first session to a general exchange of views
on the interrelationships between population growth and economic growth.
The participants were in agreement that, although the findings of recent
research on the consequences of rapid population growth for the process
of economic development were mixed, they supported the conclusion that a
slower population growth would be beneficial to economic development for
most developing countries.
14. The participants also noted that a strongly negative correlation
between the growth of the gross domestic product (GDP) per capita and
population growth had clearly emerged in the 1980s. On the other hand,
empirical studies carried out in the 1960s and 1970s had consistently
found the absence of any significant correlation. The interpretation of
this reversal had raised difficulties of both a theoretical and a
statistical nature and the demo-economic literature did not provide any
clue for explaining this reversal. Neo-Malthusian authors had long
maintained that such correlations were meaningless, while according to
the models favoured by anti-Malthusians, the correlation between
population growth and economic growth should have been negative at first
and then positive, namely, the reverse of what had been observed. It was
suggested that the reversal observed in the 1980s might be related to the
deterioration of the international economic environment. Certain
countries might have succeeded in adjusting to their rapid population
growth in the past through external factors such as aid, indebtedness or
export earnings. At the present time, that adaptative margin had
disappeared. In addition, when economic growth slackened, the priority
given to satisfying immediate demographic needs negatively affected
current levels of saving and investment and, consequently, future output.
Similarly, increasing returns might have been achieved in the short run
at the price of a certain tapping of natural resources whose negative
effects made themselves felt in the long run. Some participants were of
the opinion that the negative impact of population growth in recent years
was primarily the result of institutional and market failures.
15. Another main difficulty in interpreting the reversal observed arose
from the fact that the value of the regression coefficient implied that
increasing the economically active population would reduce total output.
In the short run, the capital available and the quantity and quality of
natural resources remained virtually fixed factors and the marginal
productivity of labour could not be negative. Results of a simulation
exercise were presented to the participants, which showed that observed
correlation coefficients were biased by the complex interactions between
population growth and economic growth and that changes in face value of
coefficients might occur even under the assumption of a constant causal
effect of population growth on the growth of the per capita output.
16. Some participants argued that the use of income-on-population
regressions had little policy relevance and created a false polarization
between neo-Malthusian and anti-Malthusian interpretations. Those
participants observed that there was no doubt that population growth was
not the dominant factor affecting development but that did not mean that
such growth played no role in the development process. Other
participants, however, noted that, at least implicitly, one was either
Malthusian or anti-Malthusian. Therefore, regression analyses of
population growth effects on developmental progress were needed because
they allowed weighing those respective points of view.
B. Confronting poverty in developing countries
17. The Group agreed that one of the major challenges of development was
in the predominantly rural countries of South Asia and Africa.
Widespread poverty exacerbated the negative effects of population
pressure on land use and was a major obstacle to fertility and mortality
decline in rural areas. The participants agreed that the occurrence of
the demographic transition in predominantly rural countries in the coming
decades, as assumed by the United Nations population projections, was
conditioned on poverty alleviation.
18. A comparison of development trends in East Asia, South Asia and sub-
Saharan Africa showed that poverty trends were a reflection of
macroeconomic performances. The experience of East Asian countries
clearly illustrated that it took vigorous growth in both the agricultural
and non-agricultural sectors to obtain downward poverty trends and to
absorb a rapidly growing labour force. In South Asia, technological
change in the agricultural sector had brought the rate of growth of food
production above the rate of growth of population. Yet, because of
insufficient growth of employment in the other sectors, it had increased
the incidence of poverty among the majority of the landless, who were
pervasive in this region, as well as among many smallholders. In sub-
Saharan Africa, the deterioration of the agricultural production base,
which had paralleled the general economic decline during the 1980s, had
resulted in a dramatic increase in the incidence of poverty among
subsistence farmers.
19. Evidence was presented showing that the association between poverty
and high fertility was strongly related to the low economic and social
status of women. One participant stressed that where women had little
access to productive resources, and little control over family income,
they depended on children for social status and income security. The
Group agreed that creating mainstream development programmes that would
improve the status of women was central to poverty alleviation policies,
as well as for inducing fertility decline.
20. Evidence was also presented indicating that women's low levels of
education and access to health and family-planning services were
intermediate variables in the correlation between poverty on the one side
and child mortality and fertility on the other. This was best
illustrated by the experience of Sri Lanka and the Indian state of
Kerala, where investments in the health and education sectors had
resulted in sharp reductions in both fertility and child mortality,
despite low levels of per capita income.
21. The Group observed that predominantly rural countries tended to lack
the physical, institutional and human resources necessary to provide the
public services that were critical in promoting female education and
family health and welfare. The Group also observed that inadequate
infrastructure combined with population dispersion made services delivery
very expensive in rural areas. In addition, the participants drew
attention to a recent study of government expenditures which concluded
that, in many low-income countries, health expenditures were severely
constrained by servicing the foreign debt.
22. The Group noted that in sub-Saharan Africa, economic incentives to
bear children, in addition to other cultural and social factors, were
strong. Women's high fertility was typically associated with high labour
force participation in food production and related activities. Labour
requirements of households were much higher in rural Africa than in rural
Asia because water collected was much less easily accessible and fuelwood
was much more extensively used. Under-capitalization had also resulted
in highly labour-intensive/low-productivity agriculture. In addition,
low population densities, fragmented labour markets and acute seasonality
of rain-fed agriculture had caused recurrent labour shortages.
23. Some participants argued that there was no guarantee that population
growth and increased densities would automatically stimulate
intensification of agriculture in sub-Saharan Africa. Rather, improving
African agriculture required sound and committed public policies. They
also noted that prospects for economic growth and for rapid increase in
food production in Africa in the coming decades were generally believed
to be limited; therefore it was all the more important and yet all the
more difficult to reduce the rates of population growth in a situation of
growing poverty.
24. The Group agreed that increasing labour productivity, especially of
women who were primarily responsible for food production, by improving
their access to training and credit as well as by enhancing their legal
rights, was critical to increasing agricultural productivity and family
income. This would also lead to fertility reduction in sub-Saharan
Africa.
C. Demographic impacts of development patterns
25. The participants noted that it was now well-established that
demographic transition was always triggered by a rapid decline in
mortality. In the developing countries, mortality decline primarily
resulted from public health and sanitation programmes. The Group
observed that mortality decline initially had a positive effect on
fertility, thus causing a rapid population growth in the developing
countries. Mortality decline tended to raise fertility as the life-span
of couples and child survivorship increased, while maternal morbidity and
sterility decreased. In eighteenth- and nineteenth-century Europe, the
positive effect of mortality decline on fertility did not lead to rapid
population growth because mortality declined gradually, while marriage
was progressively delayed to a later age and singlehood (as well as out-
migration) increased. In contrast, in the developing countries, the pace
of mortality decline was incomparably quicker, while economic and social
development did not immediately bring about late nuptiality. In fact,
quite the opposite occurred. For example, in several Latin American
countries that experienced rapid economic growth in the 1950s and the
1960s (Brazil, Colombia, Mexico and Venezuela), rapid urbanization,
employment opportunities in industries and services, and social mobility
led to a marriage boom. Higher nuptiality, together with reduced
maternal morbidity and mortality, caused an increase in marital
fertility.
26. The Group observed that it was not until modern contraceptive
methods (e.g., the pill, intra-uterine devices (IUDs) and sterilization)
were widely made available in the mid-1960s that fertility began to
decline in the developing countries. The Group agreed that there was a
positive correlation between the rapidity by which fertility declined and
the dissemination of contraceptive methods. The Group further agreed
that fertility trends in countries such as Costa Rica and Sri Lanka or in
the Indian state of Kerala showed that fertility might decline, even in
the absence of significant economic growth, with social development. On
the other hand, there was ample evidence that fertility remained high in
countries that had experienced low economic growth and limited social
development.
27. Declines in birth rates had recently been observed among the least
educated and poorest social groups, including in rural areas, in
countries such as Colombia, the Dominican Republic, Brazil and, possibly,
Indonesia. Those declines had not been primarily associated with
improvements in the welfare of households but rather had been induced by
worsening living conditions. In this context of poverty, resort to
contraception - often, to sterilization - was made by older women who
wished to cease reproduction even though the first part of their
reproductive life had followed a traditional pattern: early nuptiality,
closely spaced and uncontrolled births. The Group agreed that this
fertility transition was driven by the large supply of free contraceptive
means that were made available to the poorest groups under health and
family-planning programmes. Some participants suggested that mass media -
particularly radio and television - contributed to fertility decline by
diffusing among the poorest social groups the consumption patterns and
family models of the urban middle class and that rapid urbanization had
disrupted the traditional social structure, of which the poor were a
part. In addition, it was noted that such fertility decline was only
observed in those countries that had adequate medical and administrative
infrastructures and enjoyed minimum civil order. The Group was of the
opinion that, although reduction in fertility among the poor indicated
that birth control had now found wide social acceptance in several
countries of Asia and Latin America, a durable reduction in fertility
required improved standards of living of the poorest social groups.
28. The Meeting was informed that the demographic transition in Latin
America occurred in a context of rapid urbanization. There was some
evidence of patterns of urbanization and of internal migration
influencing the magnitude and timing of demographic changes.
29. With the exception of Argentina and Uruguay, which followed a
European-type pattern of demographic transition, fertility declined first
in two countries that had experienced early urbanization and had
relatively well-developed social security programmes: Chile and Cuba.
Subsequently, fertility fell among the urban population of countries that
had large urban concentrations such as Brazil, Colombia and Mexico.
Later on, fertility started to decrease among the rural populations of
those countries, as well as in the urban areas of other Latin American
countries. A comparison of patterns of fertility decline in Latin
America also suggested that countries having an interlinked network of
modern cities such as Argentina, Brazil, Colombia and Mexico would tend
to go through the demographic transition much quicker than countries
having only one mega-city, and even more quickly than those that had only
small and traditional towns.
30. Studies on demographic changes in Brazil showed that large flows of
high-fertility migrants from the north-eastern region initially resulted
in a slow-down of fertility decline in the metropolitan areas of the more
advanced southern and south-eastern regions. Similarly, migrants to the
new agricultural areas of frontier regions had higher fertility than the
native populations in both the regions of origin and destination.
However, there was also evidence of rapidly falling fertility of migrants
from poorer regions to urban areas after arrival, thereby contributing to
the overall fertility decline. It was further suggested that return
migration might have been influential in changing values and attitudes
towards fertility in places of origin.
D. Demographic and health transitions
31. The participants observed that, during the demographic transition,
the decline in mortality was associated with a shift from a high
prevalence of deaths owing to infectious and acute diseases at a young
age, to a morbidity and mortality dominated by chronic and degenerative
diseases of older adults. In a paper entitled "Demographic and
epidemiological trends affecting health policy in developing countries",
the participants were informed that the pattern of epidemiological change
associated with the demographic transition varied greatly among and
within developing countries.
32. On a regional basis, the "epidemiological transition" was most
advanced in Latin America and the Caribbean and cardiovascular diseases
had become the principal cause of death in a majority of Latin American
countries. In Africa, especially in sub-Saharan Africa, health
improvements had lagged behind those of other major regions of the world.
However, there were indications of increasing prevalence of
cardiovascular disease, respiratory tuberculosis, accidents and violence
in many African countries. Epidemiological change had been most rapid,
albeit diverse, in those countries of East and South-eastern Asia that
had experienced a swift demographic transition (e.g., China and the
Republic of Korea).
33. The Group noted that, in the midst of the health transition,
developing countries faced a complex epidemiological situation that put
additional stress on the health system. While chronic and degenerative
diseases emerged as a serious problem among urban upper- and middle-class
adults, the prevalence of infectious and parasitic diseases remained high
among the rural and poor sectors of society. Studies had shown that
there was a striking overlap of stages in the epidemiological transition
in some Latin American countries, which were characterized by large
social and economic inequality. Marked differences in morbidity and
mortality had sometimes also been observed between ethnic groups. In
some cases, there was also evidence of increasing morbidity associated
with pre-transition diseases, for example, malaria, dengue fever or
cholera, that had resurfaced after an initial period of control.
34. The Group observed that while the epidemiological transition
resulted in an overall decline in most age- and cause-specific mortality
rates, the development process often brought about an increase in deaths,
owing to accidents and violence. Changes in the number and proportions
of the different age groups of the population also altered the morbidity
profile of the developing countries. As large cohorts reached adulthood,
maternal mortality tended to increase, often as a result of induced
abortions. In addition, there was some evidence of sexually transmitted
diseases spreading with the growth of the sexually active population.
Furthermore, as population aged, rate of disability was likely to
increase. For example, the application of currently observed gross
disability rates to the projected population of the Philippines showed
that the projected increases in the number of disabled persons were of
concern in terms of future service and care requirements. Still, it was
unclear whether rates of disability would increase as societies
modernized in the developing world as they did in the developed
countries.
35. The Group agreed that a major challenge for health policy in the
developing countries arose from the coexistence of problems associated
with all stages of the epidemiological transition. The participants
noted that studies on the cost-effectiveness of alternative strategies of
disease intervention strategies pointed to the comparative advantage of
prevention of chronic diseases in the developing countries. The
participants further noted that implementation of preventive measures was
often hampered by skepticism about the efficacy of educational programmes
and political preference for short-term demonstrable results, and by the
fact that it required interventions beyond the control of health
ministries.
36. The Group agreed that a new challenge for health policy recently
emerged with the spread of the human immunodeficiency virus (HIV)
infection in many countries of Asia and Africa. The Group observed that
it was estimated that two thirds of the total number of HIV-infected
individuals in the world, that is, some 7 to 8 million individuals, lived
in sub-Saharan Africa. While most of the HIV-positive individuals in
Africa currently lived in relatively low population countries of Eastern
Africa, there was evidence of rising numbers of HIV cases in Western
Africa, particularly in Nigeria, whose population accounts for one
quarter of the total sub-Saharan population.
37. In a paper entitled "Demographic and development consequences of the
AIDS epidemic in Africa", the participants were informed that the
epidemiology of the acquired immune deficiency syndrome (AIDS) in Africa
was characterized by a male-to-female ratio of infection of approximately
1:1 in most countries and by high prevalence rates among adults aged 20-
40 and children under five years of age. There was also evidence that
the major risk factors associated with the spread of the disease were
multiple sexual partners, sex with commercial sex workers and record of
sexually transmitted diseases. Studies had also shown that extra-marital
sexual activities, which were commonplace in much of sub-Saharan Africa
and which were, in the past, mostly accommodated within the extended
family, had increasingly been directed to prostitutes. In addition, it
had been suggested that economic difficulties experienced in most sub-
Saharan African countries had had a significantly negative impact on
sexual behaviour, for example, an increasing number of young women, many
of whom were migrants to urban areas, had turned to offering sex for
payment. The Group was in agreement that, in the absence of a cure for
HIV/AIDS, change in sexual behaviour was the only way to prevent the
transmission of HIV. The Group was further in agreement that, in the
African context, changes in sexual behaviour required vigorous action to
promote and improve women's control over their sexuality.
38. The Group observed that the AIDS epidemic was likely to have
dramatic implications for the African family system. The participants
noted that there was evidence of the HIV epidemic challenging the
universality of marriage in African societies. In Uganda and Zambia, it
was estimated that one third of the victims were unmarried and increasing
divorce rates were reported among the seropositive. The participants
further noted that the HIV epidemic was also disrupting the
intergenerational transfers and support system. For example, in Uganda,
it was estimated that 13 per cent of the population under age 18 had been
orphaned by AIDS. Furthermore, in the communities worst hit by the
epidemic, the majority of survivors were elderly people and young
children and an increasing number of families were headed either by the
eldest child or by an elderly member. The Group was concerned that, as a
result of the AIDS epidemic, the responsibility for caring for an
increasing number of children and elderly would be transferred from the
family to society at large in countries that already lacked the most
basic social and economic resources.
E. Population growth and employment
39. The participants were in agreement that a major challenge faced by
the economies of developing countries was the creation of sufficient
employment opportunities in the modern sector to absorb their rapidly
growing labour force. The participants observed that the labour force
had grown rapidly during the 1980s in most developing countries and would
continue to grow rapidly during the 1990s. This included many countries
that had experienced a decline in the growth rate of their population
because of the existence of a 10- to 25-year lag between a slow-down in
population growth and its effect on the supply of labour. The
participants further observed that the increase in labour supply was
particularly dramatic in urban areas because of the high level of rural-
to-urban migration.
40. The Group was in agreement that the policies necessary to generate
employment operated on the demand side of the labour market. A paper
entitled "Population growth, employment expansion and industrialization:
lessons from the NIEs and Latin American countries", provided the
participants with a comparative analysis of demographic and employment
trends, and discussed the extent to which the macroeconomic policies that
had been implemented over the past 30 years in Latin America and East
Asia had been successful and consistent in meeting the needs of a rapidly
growing labour force.
41. The participants noted that full employment and steady growth of the
proportion of wage workers employed in the modern sectors had
increasingly characterized the labour market in the newly industrialized
countries (NIEs) of East Asia since the 1960s. In contrast, in most
Latin American countries, jobs creation had slowed down considerably in
the manufacturing sectors during the 1970s and 1980s leading to an
increase in employment in the informal sector and to growing numbers of
self-employed, underemployed and unemployed workers.
42. The participants were in agreement that, to a large extent, the
contrasting performances of labour markets in East Asia and Latin America
were a reflection of the respective macroeconomic policies adopted in the
1960s. The industrialization strategies followed by the NIEs, that is,
outward economic orientation and preference given to labour-intensive
technologies in industries and in agriculture, had resulted in a gradual
sectoral shift in output which had greatly contributed to the absorption
and sectoral reallocation of the growing labour force. On the other
hand, the preference given to capital-intensive technologies during the
stage of import-substitution and the extension of this import-
substitution strategy to the production of durable and capital goods had
eventually limited the growth of employment in both the rural and the
manufacturing sectors below the increase in the labour force in Latin
America. The limited impact of structural adjustments policies adopted
in the 1980s on the wage and sectoral composition of the Latin American
labour markets also pointed to institutional rigidities slowing down the
shift in the output mix from non-tradable to tradable sectors and
generating informal employment.
F. Social changes and the elderly in developing countries
43. The Group noted that in the developing countries the family was the
traditional caregiver and was expected to continue to provide care for
the elderly. In considering the support roles of the family, the
participants underscored the necessity of taking into consideration the
demographic, social and economic factors that influenced the size and
structure of families and the relationships between generations.
44. The shift from family enterprise to wage employment that resulted
from industrialization was singled out as one of the most fundamental
economic changes that might affect intergenerational relationships. It
was observed that the authority the family elderly traditionally had over
young family members through control of key productive resources became
less important when alternative means of employment were available. The
participants noted that industrialization, urbanization and increasing
education also provided expanding opportunities for women to be engaged
in wage employment outside the home. Consequently, women tended to be
less available to care for the young and the old in the household. In
fact, development of the formal sector was likely to reduce opportunities
for the elderly to be engaged in productive work, while resources tended
to shift from the hands of the parents to the younger generation.
45. The Group noted that concerns with the implications of these
changes, for the burdens of younger people and the quality of support and
care given to the elderly, had been expressed in many countries.
However, the participants noted that in Japan many elements of
traditional family life were retained despite the advanced urban economy
and the existence of public income support programmes for the elderly.
The participants also observed that there was evidence in all cultural
settings of the elderly looking for autonomy and independence and that
relying solely on family support might be counterproductive.
46. The participants noted that the availability of direct family
support for the elderly was strongly reduced, at least temporarily, when
rural-to-urban or international migration physically separated the
generations. The Group also noted that, in many developing countries,
large numbers of families that lived in poverty and did not have adequate
housing could not provide the care and support for their elderly that
they were expected to give. The elderly who currently lacked the most
basic support and care were those whose families lived in shanty towns
next to large urban agglomerations, who belonged to single-parent
families and were destitute in rural South Asia.
47. One recurrent theme of the discussion was the need to address ageing
issues from a gender perspective because of the large proportion of
females in the elderly population and the existence of significant
differences in the social and economic status between elderly males and
females.
48. In a paper entitled "Role and status of adult women and social and
economic conditions of elderly women: a cohort approach", the
participants were informed that significant changes in educational
attainment and marital, employment and health histories of the successive
cohorts entering old age were expected.
49. The participants observed that the elderly were both providers and
receivers of care and agreed that increased literacy and education among
the elderly, while enhancing the contributions of the elderly to
development, would also generate new needs and put additional demands on
society.
50. The Group noted that, although the proportion of elderly was still
low in most developing countries, the number of elderly was increasing
rapidly. The Group further noted that the process of ageing would be
very rapid in the developing countries as compared to the developed
countries because fertility decline was faster in the developing
countries than in the developed countries.
51. The Group observed that the Governments of many developing countries
were neither aware of ageing issues in their countries nor of the fact
that the elderly represented important human resources that could be
tapped for development. The Group noted that issues arising from
population ageing could be anticipated well ahead of time. Therefore, it
encouraged the Governments of developing countries to incorporate an
ageing component into their long-term planning that would allow the
timely development of appropriate societal responses to the changing
needs of the elderly.
G. Social development and ageing in developed countries
52. The participants noted that, while ageing was usually defined as an
increase in the proportion of the elderly, most of the economic
consequences of ageing and related policy implications required reference
to absolute numbers of the aged. Studies on the economic implications of
ageing had mainly focused on impacts on consumption, the labour market
and public expenditures. There was ample evidence from the literature
that ageing had a limited effect on overall consumption. Whereas it had
often been argued that ageing might have significant effects on certain
individual consumption sectors (e.g., medical goods), some participants
observed that intersectoral transfers owing to population ageing were
small in comparison with transfers driven by income growth and that there
was no need for policy intervention because adjustments were made through
market mechanisms.
53. The participants observed that labour market responses to the ageing
of the labour force had been markedly inadequate because of individual
preferences and institutional rigidities. The decline of the labour
force participation rate of the population aged 65 or over in the
developed countries between 1950 and 1990 was estimated at two thirds for
males and three fourths for females, on average, while in the age group
60-64, corresponding figures were approximately two fifths and one third.
No reversal in trends was to be expected during the last decade of the
twentieth century and the decline was expected to continue, albeit at a
slower pace. One participant noted that current and prospective
retirement preferences in the developed countries were on a collision
course with the lack of supplies of labour-intensive inputs that would be
required to provide needed upper-age health care and institutional,
social and home-care services in the forthcoming decades.
54. The Group agreed that the decline in economic activity at older age
would compound the stress that population ageing put on the financing of
social expenditures by further increasing the ratio of inactive to active
populations. The Group was also in agreement that, while reforms of
national pension and health systems were made necessary by population
ageing and behavioural changes in all developed countries, the adequacy
of providing care for the elderly would eventually be determined by the
rate of economic growth in the coming decades.
55. The participants observed that the recent dramatic decline in
mortality at older age had resulted in a rapid growth of the very old
both in absolute and relative terms in the developed countries. The
participants further observed that there were major background and
behavioural differences between the younger and the older elderly
members. Numerous studies had shown that the proportions of women and of
persons living alone or institutionalized were higher among the very old
than in any other age category and that the very old exhibited lower
levels of education and income and higher levels of disability. The
Group recognized that, although the older segment of the aged population
comprised numerous examples of successful ageing, the very old were often
in need of assistance in their activities of daily living because of
increasing impairments associated with their declining health status.
56. The Group noted that there was wide evidence that the vast majority
of frail elderly were currently receiving assistance from informal family
helpers, for example, spouse or daughters. Studies also suggested that
the elderly and their families only turned to formal care as a last
resort and that formal care usually did not completely substitute for
informal care but rather tended to supplement it, thereby increasing the
total level of care. The Group was concerned that the availability of
informal care was declining as a result of increasing geographical
mobility, employment of women, singlehood and divorce, as well as
decreasing fertility and the rising complexity and changing nature of
family relationships. The Group recommended that research efforts and
policy analysis be undertaken on the physical and human resources needed
to accommodate the growing number of very old people and on the
appropriate combination of social and family support.
II. RECOMMENDATIONS
A. Preamble
The World Population Plan of Action, adopted at Bucharest in 1974,
and the International Conference on Population, held at Mexico City in
1984, note that demographic inertia leads to an increasing population for
many decades to come. In the 1990s, the issues of population size,
growth and distribution remain major challenges to the revitalization of
economic growth and social development in the developing countries, and
to the preservation of the environment.
In the coming decades, patterns of fertility and mortality decline
will be crucial determinants of the size of the world population and will
affect the balance between human numbers, use of resources and pace of
development. Thus, a slowly declining pattern of fertility could more
than double the size of the world population in the long run as compared
to a more rapid decline. As affirmed by the International Development
Strategy for the Fourth United Nations Development Decade, such doubling
will exacerbate the strains on the social situation, economic growth, the
environment and the use of natural resources. The speed of fertility
decline will depend on the extent to which economic and social
development goals are achieved, particularly in the relatively less
developed countries. Recent experience also shows that fertility may
decline with social development.
The World Population Plan of Action also notes the importance of
population ageing and draws particular attention to the acceleration in
the ageing of the populations of developing regions. In addition, the
International Plan of Action on Ageing (l982) stresses the centrality of
population ageing in social and economic development. Not only are the
numbers and proportions of the elderly increasing rapidly in many of the
developing countries, but the social and economic conditions facing the
elderly are undergoing a profound transition. The demographic transition
is bringing about substantial changes in the family, notably its
composition and intergenerational relationships, as well as in society,
in particular the age structure, and the intergenerational solidarity
between older and younger age categories.
The Expert Group Meeting on Population Growth and Demographic
Structure, having reviewed the available research and discussed various
policy and operational implications, proposes the following
recommendations.
B. Recommendations
Recommendation 1
Noting that the size, growth and age composition of the population
may play an important role in achieving sustained economic growth in the
developing countries, and recognizing the efforts and progress made to
date in many developing countries, the Expert Group urges the Governments
of all developing countries to increase their political commitment to
human resources development and population programmes that have impacts
on population trends and characteristics, such as population growth,
morbidity and mortality, reproduction, population distribution, internal
and international migration and population structure, while respecting
the freedom of choice of individuals, and to adopt integrated approaches
to social and economic development that incorporate population
considerations at all levels of decision-making and in resource
allocation.
Recommendation 2
Noting that mortality and fertility rates in the least developed
countries are among the highest in the world and that the economies of
those countries are the weakest, the Expert Group urges the international
community to increase its assistance to population and development
programmes in those countries.
Recommendation 3
Noting that, in addition to the least developed countries, other
developing countries and regions within those countries also experience
rapid population growth, the Expert Group urges the international
community to also extend assistance to population and development
programmes in those countries.
Recommendation 4
Noting that widespread poverty and social inequality exacerbate the
consequences of rapid population growth, the Expert Group urges
Governments to adopt comprehensive and consistent economic and social
strategies to alleviate poverty and reduce social inequality in both
rural and urban settings.
Recommendation 5
Although rapid progress in the provision of social and health
services has occurred in many regions of the world, the services are
unevenly distributed between urban and rural areas, within cities and
among socio-economic groups. Accordingly, Governments are urged to give
high policy priority to spatial, social, age and gender equity in the
allocation of resources and in access to services that are likely to
result in reduced mortality and low levels of fertility.
Recommendation 6
The Expert Group recognizes that the population momentum will ensure
a continued increase in the school-age population in many developing
countries into the twenty-first century, and that higher educational
levels are a major factor in reducing mortality and fertility and in
increasing individual earnings. In the light of the importance of a
skilled labour force in an increasingly competitive world, the Expert
Group urges Governments to give high policy priority to education
programmes benefiting all children, irrespective of gender, by increasing
the enrolment rates and reducing the drop-out rates, through the
assurance of resources to those programmes that would increase teaching
quality and the provision of educational materials and facilities.
Recommendation 7
Recognizing that persistently low levels of female education and
female participation in the formal labour force and low wages paid to
women severely hamper the demographic transition, the Expert Group
recommends that high priority be given to investments and expenditures
aimed at increasing women's access to education, training and credit, as
well as to economic policies that increase their opportunity to
participate in the formal labour force.
Recommendation 8*
In recognizing the rights of couples and individuals to choose the
number and spacing of their children, the Expert Group urges Governments
and the international community to give high priority to increasing the
quantity and quality of comprehensive reproductive health-care programmes
(including, for example, family planning, maternal and child health care
and the prevention and treatment of infertility in an integrated manner),
which constitute an essential component of efforts to improve health and
reduce fertility.
Recommendation 9
Recognizing that the economic contribution of women is undervalued
and that the key role it can play in demographic change is rarely
recognized, the Expert Group urges Governments to take measures to remove
barriers that limit women's social, economic, legal and political rights
and to undertake steps to ensure their economic independence.
Recommendation 10
As the rapid demographic and epidemiological transition under way in
both the developed and the developing countries is producing great
changes in their morbidity profiles, the Expert Group recommends that
health-sector priorities be reassessed to adapt to these new situations
in order to ensure the selection of the most cost-effective and efficient
means of providing health care to all.
Recommendation 11
The Expert Group urges Governments to increase public awareness of
potential demographic and socio-economic consequences of AIDS, to
integrate these potential consequences in the national planning process
and to devise appropriate responses to address the prevention of AIDS and
to mitigate the socio-economic problems that are likely to arise.
Governments should also be encouraged to develop comprehensive health-
care strategies for preventing and curing sexually transmitted diseases,
with a view to minimizing the effects of HIV infection and the spread of
AIDS.
Recommendation 12
Recognizing that in many countries pension and social security
programmes for the elderly are inadequate, have low coverage or do not
exist at all, the Expert Group recommends that high priority be given to
establishing a "safety-net" for the elderly in such countries. Long-term
planning to anticipate the changing needs over time of the young, elderly
and working-age populations should be encouraged to ensure that adequate
resources are available when and where they are needed.
* Three participants expressed regret that they were unable to
associate themselves with the adoption of this recommendation.
Recommendation 13
The elderly, a heterogeneous and active group, are first and
foremost an important human resource for development. Recognizing that
the interrelationships between social, cultural, political, economic and
demographic patterns have a profound impact on family, kinship and
household structure, which, in turn, are crucial determinants of the
well-being of the elderly, the Expert Group recommends that Governments
keep these factors in mind when formulating long-term development
policies.
Recommendation 14
Recognizing that rapid demographic change, including population
ageing, is occurring in many areas, the Expert Group recommends that
research efforts and policy analysis be undertaken on intergenerational
equity in the allocation of both public and private resources, on the
appropriate combination of public, community-based and family support of
the elderly and on the physical and human resources needed to accommodate
the growing numbers of elderly persons.
Recommendation 15
Recognizing the heterogeneity of the elderly population and the
changing needs of individuals as they age, the Expert Group urges
Governments to address the particular requirements of the very old, who
in many societies are the fastest growing segment of the total
population. Special efforts should be made to enable very old people to
remain in their own homes and community by ensuring that adequate support
is available.
Recommendation 16
In planning for economic and social development, Governments are
urged to monitor population characteristics and trends both as accurately
and comprehensively as possible and on a regular basis, in order to
anticipate likely changes in demographic and socio-economic
characteristics of various population subgroups. The collection of data
to enable cohort and longitudinal analyses is especially encouraged.
Recommendation 17
Valuable lessons could be learned from studying the
interrelationships between demographic, social, economic and
environmental changes in a comparative perspective that encompasses
countries experiencing varying rates of economic development. The Expert
Group urges international organizations to cooperate and avoid
duplication in their efforts to gather and share comparable data relevant
for comparative analysis.
Recommendation 18
Recognizing that summary measures of population growth and
demographic structure are important and meaningful indicators of the
general demographic conditions of national, regional and world population
aggregates, the Expert Group recommends that policy-relevant, social,
cultural, age-specific, ethnic- and gender-specific subnational data be
more systematically collected, analysed and disseminated during the next
decade in order to capture the vast demographic heterogeneity masked by
aggregate statistics.
Recommendation 19
Recognizing the diversity of demographic issues and the need for
trained professionals to deal with such and related issues, the Expert
Group urges Governments and the international community to support and
strengthen high-level training courses in demography and related fields
in the developing countries.
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