Behind the Numbers: The PRB blog on population, health, and the environment

by Farzaneh (Nazy) Roudi, program director, Middle East and North Africa

Iran stands out for lowering its fertility in a short time without coercion or abortion. The total fertility rate dropped from 6.6 births per woman in 1977 to 2.0 births per woman in 2000, and to 1.9 births per woman in 2006. The decline has been particularly impressive in rural areas where the average number of births per woman in one generation dropped from 8.1 births per woman to 2.1 births per woman. 

But now President Ahmadinejad wants to reverse this demographic trend and boost population growth by offering families a financial incentive to have more children. Will he succeed? I don’t think so. Here’s why:

1. Today, Iranians’ decision on whether to bring a child into this world is more complicated than just involving a bit of financial incentive. Under this new plan each child born in the current Iranian year, which began March 21, will receive a $950 deposit in a government bank account. They will then continue to receive $95 every year until they reach 18. Parents will also be expected to pay matching funds into the accounts. Then, children can withdraw the money at the age of 20 and use it for education, marriage, health and housing. But Iranian parents, with their daily economic struggle to make the ends meet, know that this amount is not going to go far. This reminds me of when I was in Iran about 10 years ago, a few months after Dr. Marandi, former Iranian minister of health, received UNFPA’s annual award for his contribution to improving maternal and child health in Iran. When I told relatives and friends about Dr. Marandi’s award and the drop in fertility, they all had a similar reaction. They would laughingly say, “Why did HE receive the award? You only need to go to a grocery store and check prices and you can see for yourself why families don’t want to have more children.” And today, prices are even higher than 10 years ago.
2. While my friends and relatives made a legitimate point about economic hardships Iranian families were going through, one could not deny the government’s success in expanding its basic health care uniformly and universally. The Iranian constitution stipulates that the government is responsible for providing basic health care (which includes family planning services) and education to all its citizens for free. One would expect that family planning services will remain as part of basic health care package.
3. Most modern methods of family planning are produced in the country, making Iran pretty much self-sufficient. For example, the only condom factory in the region is in Iran which exports condoms to other countries in the region and Eastern Europe. And since private businesses are involved in the production of contraceptives, one would expect them to continue their operations and to promote their sales.
4. Iranian women and men have gotten used to exercising their reproductive rights and would expect to be able to continue to do so. Today, 74 percent of married women ages 15 to 49 practice family planning; 60 percent use a modern method; one-third of the modern contraceptive users have relied on permanent method—female or male sterilization.
5. Iranian families have learned to value quality of children over quantity of children. Small family size—one child or two children—is now the norm. In today’s Iran, three children is considered a large family. This reminds me of the reaction of my Egyptian colleague (a medical doctor working in population and reproductive health) with whom I traveled with to Iran. She said that something has happened to the Iranian psyche that has not yet happened in Egypt—Egyptians also have universal access to family planning services, but their fertility has plateaued at around 3 births per woman for about a decade.  

Iranians have been progressive in reproductive rights. Iranian women live a modern lifestyle that is often not seen in Western media that show women covered head to toe in black, as if they belong to centuries ago. Elementary school enrollment is universal; the gender gap in secondary school enrollment is almost closed; and more girls are enrolled in universities than boys. And more important, the educational system is modern and only a very small percentage of students attend religious schools—contrary to what is happening in some neighboring countries. In short, Ahmadinejad’s argument—rejecting family planning as a Western and secular plot – is not going to be bought by Iranians. Despite continued international economic sanctions and political isolations, secular ideas are pouring into the country through satellite TVs and the Internet. Iranians have the second-highest rate of Internet use in the Middle East and North Africa region, after the United Arab Emirates.  

While I don’t see much reason for Ahmadinejad’s new policy to influence country’s overall fertility, the crude birth rate in Iran is going to increase for a decade or so, as the baby boomers go through their childbearing years. So one should not rush to judgment and attribute future increases in the number of births to the success of Ahmadinejad’s policy. Today, a significant portion of Iran’s population are in their 20s and early 30s (prime ages to marry and have children), born during the high-fertility era around the 1979 Islamic revolution and 1980s. 

Yes, Iran is facing an aging population and the country needs to prepare for it. This may well be in the mind of Ahmadinejad as he encourages women to have more children. But one may also see other motives: boosting his image as a populist; trying to psychologically calm people about current economic crisis in the country; and trying to push women back to stay home, raising children and not participating in public life. Iranian women who have achieved their reproductive rights are at the forefront of democracy movement in Iran, demanding more rights.  Will Ahmadinejad be able to change all this by throwing money at people? No, I don’t think so.

by Mark Mather, associate vice president, Domestic Programs

With the 2010 Census enumeration winding down, we demographers are getting excited about data. The census happens just once every 10 years and no one knows exactly what the results are going to show. If the Census Bureau’s latest population estimates correctly foretell the 2010 Census count, then the official tally for April 2010 should come in around 309 million. 

But there’s a lot of wiggle room around that number, and the final count could come in several million people higher or lower than we expect. Back in 2000, the official census tally, at 281.4 million, was nearly 7 million people higher than expected based on intercensal population estimates. That’s like missing the entire population of Arizona. 

Why is there so much uncertainty? After all, the population balancing equation is pretty straightforward: Just add births, subtract deaths, and add net international migrants (immigrants minus emigrants) to last year’s population to get the population for the current year. 

One of the challenges is getting reliable estimates of net international migration. Immigrants are a diverse population, consisting of legal immigrants, refugees, unauthorized migrants, temporary migrants (such as students or temporary workers), and migrants from Puerto Rico (see the table here for more detail). Of these groups, unauthorized migrants are by far the most difficult to track, and their migration flows can change in response to short-term social, economic, or political factors. The Migration Policy Institute has linked a decline in unauthorized immigrants to the recent recession, but we do not have any hard numbers on this trend. 

Here is another challenge:  U.S. population estimates are only as good as the decennial census counts on which they are based. You can think of annual estimates as hands on a clock. Every 10 years we reset the clock to the “correct” time based on the decennial census enumeration. Then, over the next 10 years, we move the hands of the clock forward (or backward) based on the estimated numbers of births, deaths, and net international migrants. Part of the challenge is setting the hands to move at the right speed. But arriving at the correct time in 2010 also assumes that we set the clock to the right time back in 2000. In many ways, the 2000 Census was considered to be one of the most accurate in history, but there were still millions of people who were missed and millions more who were counted twice. To the extent that the Census Bureau corrects these erroneous omissions and duplicates in 2010, the population could come in significantly higher or lower than expected. 

The first official national and state population counts from the 2010 Census, which are used to apportion seats in the U.S. House of Representatives, must be delivered to the President of the United States by December 31 of this year. What will the data show? I’m going to put the U.S. population as of April 1, 2010 somewhere between 304 million and 314 million. And if I had to pinpoint a number, I’d put the final tally at around 307 million, slightly below the Census Bureau’s current estimate. What do you think the official count will be?

by Karin Ringheim, senior policy adviser, International Programs

Nature provides a nearly equal distribution of male and female children at birth – about 105 boys for every 100 girls. A high sex ratio at birth (108 boys to 100 girls or higher), such as in China, Taiwan, South Korea and parts of India and Vietnam, provides strong evidence that nature is being overridden by a preference in these societies for male children. The imbalance in the sex ratio that results from son preference is accentuated as fertility declines: The fewer children women have, the more pressure there is in some cultures for them to have at least one son. China’s “One-Child” policy, for example, precipitated its rising and imbalanced sex ratio.

Prenatal sex detection with ultrasound followed by abortion of female fetuses is now a common practice in countries where sons are preferred. Prohibiting the use of ultrasound for this purpose has proven difficult to enforce. South Korea has long prohibited the practice, but sex selective abortion continues. While South Korea’s sex ratio has fallen from a high of 116 boys to every 100 girls in 1990, it remains above the normal range. The persistence of sex selection despite legal sanctions points to the need to address the cultural factors that drive son preference, especially undervaluation of girls by their parents and their societies.

The status of girls within the household rises as they are educated and better able to contribute to the economic well-being of their families. However, girls in most developing countries are caught in a trap: they have less opportunity for schooling and job training than boys, which perpetuates their low economic and social status. Parents do not see the connection between denying their daughters access to education and mourning the birth of another daughter, or aborting her because she will be economically burdensome.

Societies will ultimately pay a price for son preference, which will have long-term repercussions for the workforce, marriage markets, and the status of women in these societies. But whether those consequences ultimately benefit women by rendering them more valuable remains doubtful. The relatively rarity of women in male-dominated societies may also lead to greater oppression of women. (Think of forced reproduction in the Handmaid’s Tale!) Programs and policies that highlight the value of the girl child and the necessity of investing in girls’ futures are important, both in rapidly expanding Asian economies where son preference is in evidence, and in sub-Saharan Africa and other countries where a preference for sons is not evidenced by sex selective abortion, but through economic and social deprivation. If the inherent value of girls is not yet apparent to their parents, at least girls must be given a chance to prove their worth.

by Ashley Frost, senior policy analyst

In June 2010, 16 individuals who are leading the way in Population, Health, and Environment (PHE) programs in East Africa gathered in Nairobi to participate in one of PRB’s highly acclaimed policy communications workshops. Through this training, participants learned how to better communicate information about effective PHE interventions and advocate for policy change that promotes PHE linkages and integrated approaches to policymakers in their home countries. 

Since 2005, PRB has partnered with the National Coordinating Agency for Population (NCAPD) based in Nairobi, to facilitate these workshops. While the workshop provided participants with a number of take-home messages, three of the main principles of the workshop were: know your audience, use empirical evidence to support your message, and provide specific recommendations that encourage policymakers to act. Workshop activities showed participants how to implement these principles in written formats, when communicating in person, and when providing formal presentations. It was an intensive week-long experience; participants attended panel sessions and group meetings during the day and worked on individual exercises at night. 

This year’s workshop, not unlike workshops in years past, brought together a remarkable group of professionals. The participants were from Kenya, Tanzania, and Uganda and they worked on a diverse range of PHE issues, including public health and endangered wildlife, HIV/AIDS and environmental linkages, and reproductive health advocacy as a conservation strategy. Given the incredible resumes and experience of our participants, I was curious to see how they would respond to the workshop activities. Would the experience meet participants’ diverse needs? Would it be challenging to even the most seasoned professionals? And lastly, would it leave participants more confident in their abilities and energized to reach out to decisionmakers? 

The answer to all of these questions was yes. Despite the numerous qualifications and years of experience that participants possessed, the workshop still provided a unique opportunity to spend a concentrated period of time thinking about and practicing communication techniques with constant feedback from policy communication experts and their peers in the field. They learned new skills, built new connections, and reinvigorated their enthusiasm to share evidence and findings with decisionmakers.  

On the last day of the workshop, each participant gave a formal presentation to the group. Despite the level of comfort that comes from spending a week together, for some participants, the presentation was still nerve-wracking. The presentations were filmed so that participants could see their own strengths and weaknesses as communicators, and the feedback from the group was honest. Still, every participant rose well beyond the challenge, proving that policy communications is a critical skill that can be cultivated, and that good mentoring, peer support, and hard work pay off. The participants also demonstrated that the process of growing as a communicator is never done. We all can continue to challenge ourselves to be strong policy communicators, and learn new techniques to improve the success of our messages, regardless of where we are in our careers.

Two participants share their thoughts on the workshop:

by Eric Zuehlke, editor

Also posted on End the Neglect, the Global Network for Neglected Tropical Disease blog

The damaging effects of HIV/AIDS and malaria on individuals, families, and communities in developing countries are well-documented. Public advocacy campaigns highlight the millions of deaths each year that can be prevented through basic immunizations that are taken for granted in developed countries. But did you know that 13 parasitic and bacterial infections, mostly worms and trachoma known as the “neglected tropical diseases,” are the most common afflictions of the world’s poorest people? “Neglected” tropical diseases affect about 1.4 billion people worldwide, mostly in rural areas of developing countries. Unlike AIDS and malaria, they aren’t fatal, but they are disabling, leading to lost income from missed work and lower IQs. A recent post on the Discovery magazine blog highlights recent research from the University of New Mexico that hypothesizes that the prevalence of these parasitic infections is the “most powerful predictor of average national IQ” – more than GDP, literacy rates, and school enrollment. The post questions whether correlation is causation and is skeptical about these diseases having effects on the IQ of entire countries: 

“…a link between infections and IQ tells us nothing about whether infected people grow up to be less intelligent, or whether intelligent people are less likely to become infected. Intelligence, after all, could affect one’s understanding of what a disease is, how to avoid it, and how to seek help for an infection.”

I think the author misses the point here. The issue isn’t that intelligence may lead to greater knowledge and prevent infection. How does intelligence help in seeking treatment in the poorest rural areas in the world, with little or no medical care or resources to treat these diseases? In addition, lower IQs can have huge lifelong ramifications in terms of educational attainment and employment. Young children are often afflicted by these conditions, delaying mental and cognitive development. A wide body of research has shown that deficiencies in the first years of life have lifelong effects. Nutrition shortfalls have also proven to detrimentally affect IQ. For example, deficiency in iodine, an element that we take for granted in the United States, can lead to impaired cognitive development and is the leading cause of mental retardation worldwide. Given the sheer prevalence and disabling nature of these diseases, you would think there would be more discussion of their effects on productivity, economic development, and social stability. They are a major hidden root cause of poverty. Of course, lack of education and employment opportunities, weak markets for goods and foods for poor farmers, trade imbalances, and conflict over scarce resources are all major contributors to poverty, but without a foundation of good health, how can the other issues be overcome?

I recently interviewed Dr. Peter Hotez, research professor and the chair of the Department of Microbiology, Immunology, and Tropical Medicine at George Washington University about the effects of these diseases on economic development and the interesting potential for “vaccine diplomacy.” He’s also the president of the Sabin Vaccine Institute, an organization working to reach the millions of people affected by neglected tropical diseases. A “rapid impact package” of drugs that eliminate the seven most common tropical diseases can be administered for just 50 cents a person per year. Whether or not the neglected tropical diseases are the single “most powerful predictor of national IQ,” they are a major contributor to poverty.

by Marissa Yeakey, policy analyst, International Programs

PRB’s offices feel a lot quieter this week, now that our 16 2010 Population Policy Communication Fellows are no longer sitting among us. For the last two weeks, this group of outstanding PhD students from Africa, South Asia, and the Middle East were stationed in our conference room, learning PRB’s principles of policy communication, and putting these principles into immediate practice by writing sample policy briefs and preparing policy presentations based on their own dissertation research. saglikli konularmakyaj kozmetik

The Policy Fellows program is one of PRB’s longest-standing programs, dating all the way back to the mid-1980s. Every June, a new group of bright young students, the people who will become tomorrow’s leading researchers and academicians, descends upon PRB for a two-week workshop on how to translate their research into policies and programs. At the heart of all of these Fellows’ research is a commitment to social change; they are researching topics ranging from gender inequality in community-based health insurance to the impacts of childbearing and life expectancy on economic growth. Findings from studies such as these can have profound impacts on policies and programs – but only if the data and findings can be effectively communicated to decisionmakers. A desire to understand this process, and a commitment to seeing research lead to more than just academic publications, is a large part of what drew this group together.

The Policy Fellows come to PRB at the peak of their educational career; on the whole, they are about to dive into data collection and analysis for their dissertations. This type of academic creativity sweeps through PRB’s office during the workshop, as the excitement and potential of research permeates the discussions and activities of the group. This is one reason why the Policy Fellows program can also be a challenge; it’s not easy to completely shift gears, mid-dissertation, and craft key messages and recommendations for policy and lay audiences. But this is what we ask the group to do – to set aside the world of their academic communities, and think and communicate in terms of policymakers and program managers. This year, as in every other, we saw the group rise to our challenge. Over the final two days, the participants delivered their presentations, communicating their findings with a passion and clarity fit for Parliament briefings, not conference sessions.

Effectively communicating research is not something that can take place in a vacuum over two weeks; as many of us know, it is an ongoing, sometimes laborious process. This group took the first step during the June workshop They are beginning a journey as researchers, one that we hope will lead to positive impacts on policies and programs for reproductive health.

The office is quieter, now that the group has dispersed back to their homes and research institutions. But they’ve left their mark on me and the PRB staff; they always make me excited about the future of research, and the potential of that research to change the world.

by Zofeen T. Ebrahim, freelance journalist based in Karachi, Pakistan, and member PRB’s Women’s Edition 

They didn’t talk about maternal mortality and they didn’t talk about how it pays to invest in women. They didn’t talk about cost-effective solutions or that pumping another $12 billion a year can deliver for girls and women. No grim figures and no statistics were discussed.

So what were these women doing at Women Deliver, the largest-ever maternal and child health conference, held in Washington D.C. this week if they were not advocating for investing in women’s health and education, the theme of the conference? It was the second plenary of the first day of Women Deliver 2010, and these women in power talked about how they learned to cope with their successes.

These champions of women’s rights, who have worked tirelessly for women’s health issues, included Michelle Bachelet, former president of Chile; Helen Clark, administrator of  the United Nations Development Programme (UNDP); Ashley Judd, actress and board member of the Population Services International; and Valerie Jarrett, senior adviser to President Obama.

The four women spoke unabashedly about their fears, mostly about the fear of not meeting people’s expectations; the hard task of upholding the “superwoman” title that they never asked for in the first place, and how they dealt with criticism. They talked about their endless quest to find a balance, the juggling of responsibilities for those who had kids, and how those who chose not to have kids had to fight for that right. They talked about the importance of having alliances, of “trusting” friends who would tell them the truth for often when you are at the helm you “lose sense of reality.” Their discussion became all the more real because it was interspersed with real-life anecdotes. 

The room was cold and would have grown unbearably colder had it not been for the warmth exuded by the moderator, Arianna Huffington, editor-in-chief of The Huffington Post, who put her guests at ease — so much so that Judd took off her shoes and plunked herself comfortably in the chair and pulled her legs up. 

Huffington opened the discussion with what she claimed was a “trivial” subject — sleep – of which she had lately become “obsessed.” She said she needed seven and a half hours of sleep to be able to get her creative juices running smoothly. But more importantly, she pointed out that for many women, success meant driving themselves to the ground. “It’s not enough to be successful if there was no joy,” she said.

Bachelet, who was 22nd on Forbes 2009 list of 100 most powerful women, said women in power positions could make a difference. “I went into politics to be able to make people happy,” she said simply. Yet, she said it was not easy and she spent sleepless nights and anxious days because people were looking up to her, many for inspiration, others with aspiration. 

The key to surviving at the helm, said Jarret, was to “make room for yourself.” To which Clark added, “believe in yourself,” which was seconded by Bachelet who said “don’t be consumed by work.” But another piece of advice came out during the plenary: abstain from holding grudges. Each speaker said most women were so scared of criticism, they internalized it. “The trick is to get over it,” they said.

by Marlene Lee, senior research associate, Domestic Programs

In response to my earlier blog post on immigration and social security, researcher Dowell Myers makes the valuable point that considering immigration as a solution to the Social Security financing problem is not an “all or nothing” proposition. Immigration may be part of a solution, reducing the old-age dependency and helping to reduce the deficit of the Social Security program (see Social Security Advisory Board’s estimate of reduction). In his work, Myers estimates that feasible levels of immigration could reduce the old-age dependency ratio by 25 percent. Both Myers and Reich in their NPR interviews suggest that the policy solutions for Social Security should include immigration.

However, research suggests that increased immigration may have drawbacks for vulnerable populations that other policy options do not. George Borjas and other scholars provide evidence that immigration is most likely to hurt low-income workers. (For information on immigrant characteristics, see MPI report on immigrants and recession, and for a readable account of Borjas’ argument see NYT Magazine contributor Roger Lowenstein’s article “The Immigration Equation”)  If one accepts the premise that immigrants reduce job opportunities for low-income workers, particularly visible minorities—a big if —then a solution that includes high levels of immigration might well affect the Social Security earnings of low-income and minority workers. This is because individuals’ eligibility for and level of Social Security benefits are tied to their earnings history.

Teasing out the effect of policy on different population groups is always difficult. And certainly many economists would argue that to the extent immigrant workers contribute to small business growth and spend their earnings in the United States, they may ultimately increase job opportunities. In any case, other policy options such as raising the Social Security payroll tax or changing the rules so that high earners pay Social Security taxes on all earnings, not just the first $106,800, do not disproportionately affect low-income workers. Also, let’s not forget that part of the equation for Social Security solvency is the labor force participation rate. Increases in women’s labor force participation rates had a positive impact on labor force growth, thereby increasing contributions paid into Social Security. Certainly even with the same old-age dependency ratio, if women’s labor force participation rates had not risen over the previous four decades, the Social Security financing gap would be larger. But these rates have stabilized, and the women who helped fuel economic growth will be among those collecting Social Security in the next 30 years.

A high rate of labor force participation among immigrants is one of the reasons that more immigration might work as part of the answer to the gap in Social Security funding. Higher labor force participation rates among native-born minorities also have the potential to increase growth of the labor force and future contributions to Social Security, just as increased female labor force participation did. But, this potential solution is not often mentioned in the current debate, perhaps because it is not perceived to be as easy to achieve as expanding immigration.

by Marlene Lee, senior research associate, Domestic Programs

This year, for the first time Social Security will take in less in taxes than is paid out in benefits. And by most estimates, the Social Security Trust Fund—designed to cover exactly this type of shortfall—will be exhausted around 2037. A few weeks ago, Robert Reich, Secretary of Labor under President Clinton and Professor of Public Policy at the University of California at Berkeley, proposed immigration as an easy answer to the Social Security funding crisis, or at least as one factor in the combination of steps needed to address this crisis. Reich says that increased immigration would likely have a greater impact than any other proposed measures, such as raising payroll taxes and the age of eligibility for social security benefits. His argument rests on immigrants’ younger age than non-immigrants and on his attributing the Social Security funding crisis to the decreasing number of workers per retiree. According to Reich, logically and simply, increasing the number of immigrants will increase the number of workers per retiree because young immigrants will work for decades to come. 

Used under Creative Commons license from AFL-CIO.

But as many demographic studies suggest, the amount of immigration needed to produce the desired elderly dependency ratio (the retirement age population divided by the working age population) may not be desirable or achievable. In a PRB online discussion, Ronald Lee, a Berkeley economist and demographer, said he estimates that 395 million immigrants would be needed. UN estimates are even higher. Also, there is the question of how long it takes immigration to change a population’s age structure. Immigrants entering the United States will themselves age, some becoming eligible to participate in Social Security. Ken Johnson from the University of New Hampshire and Dan Lichter from Cornell University show that higher fertility among some immigrant groups fuels natural increase in areas where the population would otherwise have declined. But the impact of immigrant fertility on a population’s age structure takes a long time to manifest itself.

Finally, immigration may help close the financial gap in Social Security through its effect on economic growth. But economic growth depends on both the growth rate of labor and the growth rate of labor productivity. The effect of population aging on labor productivity is complex, particularly in an era of improved health among the older population and rapid technological progress.  Historically, changes in the amount of capital available per worker as well as the pace of technology and the experience of the workforce have been the main factors that affect labor productivity. Alan Greenspan recently concluded, “…it is heightened growth of output per worker that presents the greatest potential to boost the growth of gross domestic product. A significant rise in the growth of labor productivity will be necessary if the standard of living of retirees is to be maintained and that of workers is to continue advancing.”

The effect of immigration on labor force growth seems pretty obvious, if not quite as simple as Reich argues, but its effect on labor productivity seems less obvious. Immigration’s effect on labor productivity would depend on the composition of the immigrant population. In the United States, the immigrant population includes both low-skilled and highly skilled workers, but the global competition for skilled workers has increased, keeping some potential skilled immigrants in their home countries or drawing them to countries other than the United States.

by Karin Ringheim, senior advisor, International Programs

I first met Henry the Hand at the 2003 Global Health Conference in Washington, DC. Dressed as a giant plush yellow hand with a permanently happy face, Henry, alias Will Saywer MD, attended the annual conference to promote his handwashing message among global health professionals.  Will was an amiable presence, but as he attempted to cordially insert himself into conversations, some no doubt found his persistence about handwashing annoying. Weren’t there bigger fish to fry? AIDS, TB, malaria, reproductive health? Henry appeared to be better suited to a children’s fair.