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BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1194-7.World population reached 5 billion on July 11, 1987. Current UNFPA projections predict world population stabilization at 10 billion by 2050. However, the current population is already exerting a tremendous amount of pressure on the carrying capacity of the planet. Ozone depletion, global warming, and acid rain are all the result of human activity at a level of half the current projection. World food production stabilized in 1988 and fell 5% in both 1987 and 1988. In both those years, world population grew 3.6% annually. Every year 14 million tons of grain production are lost to soil erosion, irrigation damage, poor land management, air pollution, flooding, acid rain, and increased ultraviolet radiation. Controlling population growth is not an easy task because of the complexities involved. Increasing female literacy and reducing infant mortality rates are very powerful means of controlling growth. China has served as the best example by reducing its growth rate from 4.75 in the early 70s to 2.36 in just 10 years. They accomplished this in a homogeneous society by making population control a civic duty. They provided rewards for small families and penalties for large ones. Family planning need is still very high, although it ranges from 12% in the Ivory Coast to 77% in the Republic of Korea. The UNFPA goal is to make family planning available to 59% os the world is couples by 2000. To do this, an additional US$9 billion needs to be spent which is a tiny fraction of total development aid to the 3rd world. In 1990 .9% of the total amount of development aid went to population and family planning programs.
TEMAS DE POBLACION. 1991 Jun; 1(2):51-5.This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only source of security is to have many children, a significant proportion of whom will not survive. In rural Bangladesh, where chronic hunger and unemployment are rife, the incentives and the pressures of family planning and health workers were sufficient to persuade many persons to undergo sterilization. Payment of commissions to workers to promote sterilization has discouraged them from supplying adequate information about sterilization for fear of losing clients. Population from other donors and wide publicity about the abuses in the sterilization program and the high rates of regret among women undergoing sterilization only for the incentives have led to some modifications, but the World Bank has continued to exert pressure on the Bangladeshi government to develop fertility-control programs. The damaging effects of World Bank population programs can also be seen in Indonesia, Nepal, and other developing countries.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.