Author: Amy Tsui, John Hopkins University

Some five to six decades ago, between 1951 and 1965, a rather remarkable chain of events took place in Asia, the Pacific and the Middle East: countries began to use family planning programs to address rapid population growth, and many subsequently experienced extraordinary economic growth.

India, Pakistan (then including Bangladesh), the Republic of Korea, China, Fiji, Egypt, Singapore, Sri Lanka (then Ceylon), and Turkey all implemented family planning programs. By 1976, the governments of Indonesia, the Philippines, Thailand, Vietnam and Nepal had also declared their population growth and fertility rates too high and provided direct support for contraceptive access. Government after government declared support for national family planning programs, and formed inter-ministerial coordinating boards, councils and commissions to address population concerns and organised the top-to-bottom provision of family planning services. The supervising boards or commissions were frequently administered under prime ministers’ offices.

Family planning efforts were linked to fertility reduction and in turn to slowing population growth — policy goals that aimed to enhance a country’s prospects for economic development. As well as attempting to control fertility, governments sought to lower child mortality, eradicate infectious diseases, increase education levels, improve nutritional status and food security, modernise agriculture and expand their economies with manufacturing and industrialisation.

Not many now see family planning as a central element to national economic development. Rapid population growth is no longer considered a global or local risk, fertility reduction is not politically correct, and family planning has been absorbed into a larger pantheon of reproductive health needs for human, rather than economic, development. The Millennium Development Goals — first adopted in 1990 — only addressed family planning when universal access to reproductive health was adopted as a target for maternal health in 2005. But for Asia, the development perspectives that prevailed in the 1960s and 1970s saw family planning and fertility decline as necessary steps to facilitate economic growth.

At that time, the region saw robust and in some places quite rapid fertility declines — particularly in China, South Korea and Thailand — and, as a consequence, changed population age structures. With fewer births, higher ratios of persons of working age (those aged 15–59) to those of dependency age (those aged 0–14 and 60-plus) emerged. Take South Korea as a typical example. There the proportion of the population under 15 was 42 per cent in 1970. It dropped by half to 21 per cent in 2000, while the proportion of working age people (15–59 years) rose from to 52 to 68 per cent in the same period. The ratio of workers to youth went from 1.24:1 to 3.24:1. The total fertility rate dropped from 4.5 to 2.4 in this time and the proportion of childbearing-aged married women practising contraception rose from 24.5 per cent to 79.3 per cent.

This scenario was replicated in many countries, and as a result the region began to experience the ‘demographic dividend’. This term, coined in 2003 by David Bloom and David Canning, refers to the economic growth that results from changes in population age structure as a result of a fertility decline. Lower fertility rates produce smaller youth cohorts, and the government is then able to spend relatively less on basic health care, education, food and housing for the young, and invest relatively more in business, infrastructure, job skills training and the economy.

Estimates by economist and demographer, Andrew Mason, co-director of the National Transfer Accounts project, suggest that in the mid-2000s the demographic dividend in East and Southeast Asia contributed as much as 1.9 per cent of an annual growth of 4.32 per cent in GDP per consumer (weighted for age-related consumption). For South Asia, he estimated that the dividend contributed 0.79 per cent of 1.88 per cent of actual economic growth. The economic growth resulting from balanced age structures has been substantial. Moreover, the demographic dividend’s economic benefits have been enduring. While it is popular to despair of countries’ ageing populations, Dr. Mason and his NTA colleagues show that with proper financial mechanisms encouraging worker savings and investments in property, businesses, pension funds or other assets, the demographic dividend can continue to pay out as Asia ages. If private, especially family, transfers to the elderly can be built up, people will rely less and less on government support.

Today, partly thanks to the demographic dividend, 49 per cent of women in Asia are in the labour force, compared with 80 per cent of men. In 2010 the per capita GNI (by purchasing-power-parity) in East and Southeast Asia ranged from US$3070 in Vietnam to US$31,110 in South Korea, and to US$58,700 in Singapore. The average human development index value is a strong 671 out of 1000 for the region. The average number of children expected per childbearing-aged woman is near or just below 2.0 and three-quarters of couples use contraception.

In the late 1960s, when India established its Ministry of Health and Family Planning, or in 1970, when Indonesia established its National Family Planning Coordinating Board, it was impossible to foresee a day when contraceptive use would become routine health behavior, much like vaccinating children. Today, while some couples may obtain their contraceptive care from government clinics, most seek private sources and pay for these services through health insurance or out of pocket. Such a situation of contraceptive security, enjoyed at the individual couple level, is one that remains out of the reach of some 222 million women and their partners in low-resource settings in sub-Saharan Africa and parts of South Asia. The 2012 London Summit on Family, co-sponsored by the Bill & Melinda Gates Foundation and the UK Department for International Development, declared a goal of ensuring 120 million women and their partners, in 69 low-income countries, have access to contraception by 2020. The lessons of Asia’s economic development plans and benefits of the demographic dividend in the region may be a source of inspiration for these countries. As the UN begins to frame global development goals for beyond 2015 they would do well to consider demography and family planning.

Amy Tsui is Professor at the Bloomberg School of Public Health, Johns Hopkins University and Director of the Bill and Melinda Gates Institute of Population and Reproductive Health.

This article appeared in the most recent edition of the East Asia Forum Quarterly,‘Demographic Transition’.