Summary

The chapter covers a wide range of issues, and there is a lack of detail in some of the arguments. We have to think of priorities across as well as within issues, and this chapter puts forward five thematic priorities.

There is a fundamental issue of applying benefitcost analysis to reducing fertility because this takes no account of the well-being of those potentially born. This is probably an insoluble philosophical problem, but we also have the more mundane issue that people like to have children, and this benefit is not included in the analysis. People value children, and the proper place for decision making should be at the household level. I would prefer to see targets based on access to family planning rather than contraceptive use. On the benefit of maternal and child health, much of the benefit of family planning comes from better birth spacing and timing, rather than number of births. Births before the mother is 18 or less than 36 months after the previous birth are very high risk to both mother and child.

The largest impact of family planning appears to be through rising per capita income, which I do not see as a measure of welfare. National income accounting does not, for example, include leisure time. Similarly, the value to parents of having children does not appear in the national income accounts.

When families make decisions, there is a strong case for giving more power to women, particularly in male-dominated societies, as husbands almost always want more children than their wives, but it is the wives who bear the costs of higher fertility.

Improvement in healthy life span has contributed as much as economic growth to improvements in human welfare since 1960. The problem of an aging population is that it can lead to a rise in the old age dependency ratio. But this does not have to be so. If the old save for their retirement needs, including healthcare, they are not dependent. A simple way to achieve this is to force savings out of earnings into private accounts to meet retirement needs, supplemented by a basic pension to avoid poverty. In this way, there are only minimal transfers between generations, which means the age dependency issue is not really a problem. Population aging is incompatible with the current institutions and work and pension arrangements in many countries.