Chapter 1: Population Issues

In the 1960s, people began to examine critically the notion that all population growth is desirable. Several public interest groups were established and population issues joined environmental and social issues on the public agenda.

In 1969, President Nixon issued to Congress a "Message on Population." Referring to the expectation of the time that the U.S. population might exceed 300 million by the year 2000, he said:

This growth will produce serious challenges for our society. I believe that many of our present social problems may be related to the fact that we have had only fifty years in which to accommodate the second hundred million Americans. In fact, since 1945 alone some 90 million babies have been born in this country. We have thus had to accommodate in a very few decades an adjustment to population growth which was once spread over centuries. And now it appears that we will have to provide for a third hundred million Americans in a period of just 30 years.

THE CREATION OF TITLE X
One result of Nixon's message was passage in 1970 of Title X of the Public Health Service Act, providing family planning services for low-income women and men. Another was the creation of the Commission on Population Growth and the American Future, chaired by John D. Rockefeller III, which released a multivolume study of U.S. population growth and its impacts in 1972.

The Rockefeller Commission's most widely cited recommendation reads:

Recognizing that our population cannot grow indefinitely, and appreciating the advantages of moving now toward the stabilization of population, the Commission recommends that the nation welcome and plan for a stabilized population.

CONFUSION OVER FERTILITY AND ZERO POPULATION GROWTH
Public concern for population growth in the United States waned sharply when news of the drop in fertility was confused with achievement of zero population growth. Yet below-replacement fertility rates do not translate into zero population growth until all age groups in a population are approximately the same size-even with zero migration.

In fact, the huge U.S. baby-boom generation entered childbearing age during the 1970s and 1980s. As described above, such a large generation produces an enormous total number of babies even though the average family has only two children. Thus, the number of births has exceeded the number of deaths in the United States throughout the period-and U.S. population has grown significantly even without taking immigration into account.

FORMATION OF THE TASK FORCE
Between 1972 and the 1994-95 work of the Population and Consumption Task Force of the PCSD no sustained official conversation about U.S. population growth has taken place. Most citizens- and most government officials-assumed incorrectly that below-replacement fertility automatically means immediate zero population growth and that U.S. population is no longer growing.

In contrast, immigration has received considerable attention. Several national commissions have reviewed immigration issues, including illegal immigrants and refugees, and published reports and recommendations. The most recent effort, which was chaired by the late Barbara Jordan, is the U.S. Commission on Immigration Reform. Its work is still under way.

Rapid population growth elsewhere in the world has received regular attention, especially at three United Nations international meetings in 1974, 1984, and 1994. At the most recent meeting, a broader consensus emerged on a new approach to population concerns than has occurred at these meetings before.

THE CAIRO CONSENSUS
The Plan of Action negotiated in September 1994 at the International Conference on Population and Development (ICPD) in Cairo is grounded in a comprehensive, woman-centered commitment to health, development, and empowerment. It recognizes the complex context in which decisions about childbearing are made.

Nations at the Cairo conference reached broad agreement that development (poverty alleviation, education, basic health care, and economic opportunity) and family planning each are important for reducing population growth rates-but that they work best when pursued together. Similarly, the consensus recognized that population growth is not the only driving force behind environmental concerns, and that consumption patterns also play an important role. Finally, it was widely agreed that family planning should be provided as part of broader primary and reproductive health initiatives, and that population policy should encompass economic opportunity for women and the elimination of legal and social barriers to gender equality.

The United States actively participated in the Cairo process, provided important leadership, and is part of the broad consensus that now exists worldwide for this approach to stabilizing world population.

DEMOGRAPHIC TRENDS

Annual growth figures of 0.7 and 1.0 percent may seem small, but they are not. Persistent 1.0 percent growth translates into a doubling time-the time it takes a population to double in size--of 70 years. This is an enormous increase when the population that is doubling is the United States, the third largest country in the world. Also, given the numeric size of the country, even apparently small percentage increases produce large increases in numbers.

The United States is today the only major industrialized country in the world experiencing population growth on a significant scale.

In 1994, the United States added nearly 2.0 million people to the population from the excess of births over deaths and, it is estimated, at least 1.0 million people from net migration into the country. This scale of growth adds another Connecticut in population each year, and another California each decade. Only a handful of countries, all of them developing, contribute more to their populations annually.

Today's annual immigration to the United States is high by historical standards, matching levels achieved during the peak years of 1901-1910. And fertility has risen in recent years. In 1989, the average number of children born per woman in the United States exceeded 2.0 for the first time in 17 years, after remaining between 1.7 and 1.8 for 15 years. After reaching 2.1 children per woman on average for a year or two, the rate is now again 2.0. This means that current U.S. fertility matches birth .rates in less wealthy countries such as Ireland and Malta, rather than the birth rates of European and Asian economic peers.

CENSUS BUREAU PROJECTIONS
The U.S. Census Bureau projects that if current mortality, fertility, and immigration patterns persist, U.S. population will reach 350 million people by the year 2030 and nearly 400 million people by 2050, continuing to grow indefinitely. (This is the "medium projection.")

If fertility and immigration fall slightly, U.S. population will still increase until about 2030, when it will reach about 290 million people. In another decade, a slow decline in numbers would begin. (This is the "low projection.")

The opposite assumption-involving rises in fertility and immigration -would produce 500 million Americans by the year 2050, with continued growth inevitable and no stabilization in sight. (This is the "high projection.")

Continued population growth in the United States, particularly on the scale envisioned by the medium and high projections, has enormous implications. Coupled with the technologies and resource consumption patterns that underlie the U.S. standard of living, population growth in America produces an environmental impact unparalleled by any other country at this time.

Continued population growth also has the potential to overwhelm efficiency and productivity gains, negating technology-based efforts to reduce U.S. environmental impact. Population growth also challenges industry's best efforts to provide new, higher quality jobs for all Americans and to improve real wages for American workers-which have been stagnant for 22 years. It similarly adds to the nation's needs to reduce poverty, improve education, and provide health care for all Americans. In short, the United States is already severely challenged by the need to provide better opportunities for millions of disadvantaged citizens, and continued population growth will exacerbate those challenges.

THE IMPLICATIONS OF SLOW GROWTH
Economic theories about the relationship between population growth and economic prosperity vary across the full spectrum of possible opinions-and conclusions depend strongly on the assumptions. A series of conferences and studies of the economic effects of low fertility, however, conducted during the late 1970s and early 1980s in both Europe and the United States, concluded that even slowly shrinking populations have little negative economic impact.

Demographer Geoffrey McNicoll, summarizing the consensus, writes that "the effects of low fertility on labor supply, technological change, and investment and consumption appear relatively slight."

The Rockefeller Commission examined several aspects of the relationship between population and prosperity in its 1972 report, comparing the effect of an American population with a two-child family average with that of a three-child family average. Essentially, the Commission analyzed the difference between a growing and a stable U.S. population. "The nation has nothing to fear from a gradual approach to population stabilization," the report said. "From an economic point of view, a reduction in the rate of population growth would bring important benefits." The report also cited the testimony of the chair of the Atlantic-Richfield board of trustees, who testified at a hearing convened by the Commission:

There is a habit of thinking in some segments of the business community that population increase is something essential to the maintenance of vigorous demand and economic growth, just as there is an instinctive reaction against any new cost factors being added to the processes of production and distribution. But our economy has already, and in many ways, shown its tremendous adaptability to new social demands and necessities. I have not the slightest doubt that it can meet this new challenge.

Many analysts express concern that countries with low fertility will eventually have trouble financing public old-age pensions as the ratio of workers to elderly people falls. It is possible, however, that rising costs of supporting the elderly may be offset by declining costs of supporting children. The precise calculation for each country depends on the exact age structure of the population, the social security system, and immigration patterns. In any case, population policy is a crude tool for making social security policy, and it makes little sense to endure high levels of unwanted fertility and environmental degradation from continued population growth in the hope of helping a program with many other problems.

For decades, Americans have not had a desire for an ever-larger population. This is suggested by polls over the years. In 1974, 87 percent of respondents to a Roper poll said they did not wish the country had more people. A 1971 poll by the U.S. Commission on Population Growth and the American Future found that 22 percent felt U.S. population should be smaller than it was then, which was close to 200 million. As long ago as 1947, when U.S. population was 140 million, Gallup found that 55 percent of Americans believed the country would be "worse off' with more people.

FINDINGS AND POLICY RECOMMENDATIONS

FERTILITY

POLICY RECOMMENDATION 1
Information and services to prevent unintended pregnancies	Governments at all levels should increase and improve educational efforts and public outreach related to contraceptive methods and reproductive health, and expand access to-and availability of-the services individuals need to freely and responsibly decide the number and spacing of their children.

Fertility rate
Since 1989, the U.S. fertility rate has been 2.0, the highest fertility experienced in the United States since 1972 and exceeding current fertility rates among European and Asian economic peers of the United States. Americans achieve this fertility rate with high levels of unintended pregnancies and births and high levels of induced abortion.

Pregnancies
In 1992, 6.6 million women became pregnant in the United States. Of these pregnancies, 57 percent were unintended-either the pregnancy occurred before the mother was ready (it was 94 mistimed") or the woman did not wish to have the pregnancy at all (it was "unwanted").

Unintended pregnancies can have disturbing consequences. They are associated with higher rates of low birthweight and infant mortality than are planned pregnancies. It is estimated that eliminating unintended pregnancies would reduce U.S. infant mortality by 10 percent and the incidence of low birthweight babies by 12 percent. Also, half of all unintended pregnancies in the United States that do not end in spontaneous miscarriage end in abortion. If all pregnancies were planned, demand for abortion would be scant indeed.

Women of all ages and income levels experience unintended pregnancies, but teens, women over 40, and poor women do so more often than others. Four in five adolescent pregnancies are unintended, and for women over 40 more than three-quarters of pregnancies are unintended. Women with family incomes below the poverty level also report three-quarters of their pregnancies as unintended.

Births
Of the nearly four million U.S. births annually, three in 10 are mistimed and one in 10 is unwanted. The incidence of unintended births has risen in the past decade, after falling between the 1960s and early 1980s.

Unintended births can have significant economic consequences for families. For example, 39 percent of new entrants onto the welfare rolls in any given year are the result of a first birth to an unmarried woman. More than half the teens who give birth receive welfare within five years- although not all of these are unintended births. While women of all ages and incomes experience unintended births, mistimed births are highest among young women, and unwanted births are highest among older women. Poor women have the highest percentage of both.

If all U.S. births were wanted, their number would fall by 10 percent-to 3.6 million a year. Population growth from the excess of births over deaths would fall to 1.6 million. Delaying currently mistimed births, through better access to contraceptive services, education, and economic opportunities, would also reduce total births-significantly so. Demographers have not made this calculation for the United States, but estimates for other populations have found that even slight delays reduce fertility a great deal.

Contraceptive Services
Unintended pregnancies--and the unintended births that follow--occur because contraceptives are not used at all, because of less-than-effective use of available contraceptive methods, and because progress is lacking on new contraceptives.

Contraceptive failures are not entirely failures of technology. Contraceptives fail more often among U.S. women who are single, younger, and poor. And Americans experience higher contraceptive failure rates than their European counterparts. Variations such as these suggest that human behavior contributes to contraceptive failure.

Of the estimated 62 million women of reproductive age (15-44) in the United States in 1990, an estimated 55 million were sexually experienced. Of these, 25 million were pregnant, had just given birth, were attempting to become pregnant, were protected from pregnancy by contraceptive sterilization--either of themselves or their partners--or were sterile for other reasons. The rest-some 30 million American women-were estimated to be technically at risk of an unintended pregnancy. It is estimated from surveys that approximately four or five million of these women did not use contraception, and just over half of all unintended pregnancies (53 percent) occurred to them. The remaining unintended pregnancies occurred to the 25 million women who used a contraceptive method other than sterilization, but for whom the method failed.

The risk of unintended pregnancy is exaggerated for 15 million women who need subsidized family planning and reproductive health care. The poor are overrepresented in the ranks of these women. An estimated 56 percent of low-income women and 69 percent of sexually active teenagers in need of family planning services do not receive medically supervised contraceptive care.

Title X
The principal program providing comprehensive public family planning services to low-income women is Title X of the Public Health Service Act. Title X monies fund contraceptive supplies, information on contraceptive methods, counseling, cancer screening, screening for HIV/AIDS and other sexually transmitted diseases, infertility services, other features of reproductive health care, and information, education, and research activities that support service provision.

Some 4,000 clinics and other agencies nationwide will receive $193.4 million in fiscal year 1995 and provide services to more than four million clients. More than 60 percent of Title X clients are under 25 years old, 30 percent are adolescent, and 85 percent are low income. Although the numbers seem large, Title X reaches fewer than half of those eligible for the services it provides. In particular, men, teens, substance abusers, and the homeless are populations that under-use Title X services.

Though they are not able to provide universal access to services for poor women-in part because funding for Title X fell by more than 70 percent in real dollars between 1980 and 1992-Title X is estimated to prevent an average of 1.2 million unintended pregnancies-and about half that number of abortions-a year. It does this at a cost of about $200 per woman for comprehensive family planning services. In comparison, an ordinary, nonsurgical birth without complications cost $6,400 in 1992.

Family planning is dramatically cost-effective. For every dollar spent on publicly funded family planning services of any kind, $4.40 is saved that the federal government would otherwise be obliged by law to spend on medical care, welfare benefits, and other social services.

In addition to Title X, three other federal programs fund contraceptive services and supplies: the Maternal and Child Health Block Grant, Medicaid, and the Social Services Block Grant (Titles V, XIX, and XX of the Social Security Act, respectively). Funds are targeted specifically for family planning only in Title X; block grants can be used for many different purposes.

Medicaid
Medicaid is the largest public funder of family planning services, but because eligibility is tied to welfare eligibility, fewer than half of poor women are covered by Medicaid. The federal government generally funds prenatal care and delivery services for women eligible for Medicaid, as well as the full range of contraceptive methods for all eligible women, but does not fund abortion except under restricted circumstances.[3]

In 1986, the federal government expanded Medicaid coverage to pregnant women and infants with incomes 133 percent of the poverty level, regardless of whether they meet other requirements for welfare. But coverage under this extension does not include family planning services until after childbirth, and then only for 60 days. Thus, Medicaid is not an effective source of services for preventing first pregnancies among these women.

Private Insurance
Almost two-thirds of women of reproductive age in the United States do not rely on publicly provided family planning because they have private-sector, employment-related insurance. But private insurance does not uniformly offer good coverage for family planning services. Up to 85 percent of insurance policies and health maintenance organizations cover sterilization and abortion, but fewer than half of the typical plans cover the five major reversible contraceptive methods-IUDs, diaphragms, Norplant, Depo-Provera, and oral contraceptives. Only 15 percent of plans cover all five reversible methods.

Thus, an important strategy for reducing the number of unintended pregnancies and births in the United States is to expand access, particularly for poor women, to contraception and related reproductive health services. Contraception is cost-effective, assists women in having the number of children they want when they want them, prevents abortions, and works toward the goal of having every child born in the United States be a wanted child.

Related Strategies
Other strategies also make sense for reducing unintended pregnancies and births: expanding the range of contraceptives available; broadening the participation of men in contraceptive and childbearing decisions; enlisting the media to convey messages about reproductive responsibility; and attempting to foster mature discussion and education related to sex, sexuality, and contraceptive issues.

Both private and public support for contraceptive research has declined sharply in the last 25 years. In 1970, 13 major drug companies were involved in the development of new contraceptives worldwide, nine in the United States. Today, four are involved and only one is based in the United States.

Support of research by the National Institutes of Health and the U.S. Agency for International Development, the two principal federal sources of funds for contraceptive research, has waned significantly. Analysts identify political factors and the withdrawal of federal support during the 1980s, as well as standards of legal liability for harm from contraceptives, as leading causes of the decline.

Emergency Contraception
Not all opportunities for new contraception require new research. Emergency post-coital contraception, which uses already packaged oral contraceptives in a different combination and intensity from ordinary use, is available now and is used in emergency rooms for rape victims, in universities, and in some family planning clinics.

Of the more than 50 brands of oral contraceptives currently approved in the United States, six are effective for emergency post-coital use. These are not labeled as approved by the Food and Drug Administration for such use, however, and physicians and other medical personnel either do not know about the legality of this use or are not at ease with it. Furthermore, pharmaceutical companies are not permitted to market drugs for uses that are not labeled. Yet, it is estimated that wider use of emergency contraception could reduce unintended pregnancies by 1.7 million and abortions by 800,000 annually.

The Role of Men
Though a male participates in every pregnancy that occurs, he often plays a far from equal role in doing what's needed to safeguard reproductive health, in making sound family planning and reproductive health choices, and in using contraception. This is especially true of young men.

Twenty-five years of experience with Title X and other subsidized family planning programs shows that few men use these services without special outreach, counseling, education, and other efforts to make them feel at ease.

Special programs are also required to reach young men, before they become sexually active, to build the skills and strategies required for sexual health and responsibility. Reducing unintended pregnancies in the United States will require the empowerment and participation of both men and women; special programs to improve men's participation are an integral part of achieving this goal.

Contraceptive Failure
Inquiry into why Americans experience higher rates of contraceptive failure and unintended pregnancy than Europeans has found, among other things, that Americans are distinctly of two minds about sex and sexuality.

First, Americans are reluctant to discuss these issues as either parents or children and are sometimes ambivalent about having them taught by professional educators. Only 10 percent of American students receive comprehensive sexuality education, for example, although 73 percent of U.S. parents support sexuality education in the schools. It appears that many would rather deny the need for family planning and reproductive health services, particularly for young people, and allow the punishing consequences, than address the need for prevention forthrightly.

Second, media images in advertising, television, and movies are laden with sex and especially sex without consequences. It is perhaps not surprising that conversations and knowledge about reproduction and contraception-both required for effective contraception and fully planned pregnancies-are rare, when the media provides few models for this behavior.

Financial Incentives
Many observers of population and fertility dynamics in the United States think immediately of financial incentives as ways to encourage the use of contraception, delayed childbearing, or smaller families. Tax deductions for two children, but no more, and linking welfare payments to family size, are proposals that surface from time to time.

Several factors suggest that reliance on such financial incentives is not appropriate, with limited exception, in a wealthy country with as much unintended fertility as this one. People already want fewer children; the difficulty is matching outcomes with intentions. Broader access to family planning services and more education about sexuality and contraception seem more appropriate than financial incentives.

It is undeniable that financial incentives related to fertility and family planning have a bad reputation. In poor countries, incentives tend to be offered in isolation from broader reproductive health services. Even small payments (such as clean clothing or travel costs to a clinic) carry the risk of being so large in a poor individual's eyes that they override individual judgment, becoming so attractive that they destroy meaningful choice. In short, they coerce.

Developing country experience might seem irrelevant to the United States except for another factor. Programs to promote childbearing in wealthy European countries, where the costs of raising a child reach to several hundreds of thousands of dollars, have found that a financial incentive has to be quite large to be effective. Such incentives not only cost a great deal, but, more importantly, they also run the risk of amounting to coercion of the poor in a wealthy country.

What About Tax Breaks?
One of the most common suggestions from activists interested in financial incentives is limiting the federal tax deduction for dependents to two children only. It is unlikely that this would affect childbearing by acting as an authentic financial incentive, in part because of the extent of unintended fertility. But such an action could have symbolic value; the federal government would be stating an official, rhetorical preference for small families by adopting such a provision.

The Task Force has not reached consensus on whether limiting tax deductions at the federal level to two children would be a useful symbol, but in general believes that financial incentives at the federal level are not advisable.

Fighting Poverty

People in poverty are disadvantaged in childbearing at a number of levels: they have less access to contraceptives; they use them less effectively; they are more likely to have an unintended pregnancy; and they are more likely to give birth if they have a pregnancy. If more generous and authentic economic opportunity for the poor can be called a financial incentive for small families, it is reasonable to discuss financial incentives in those terms.

When asked in one of the Task Force's roundtables to name an effective financial incentive for deferring early teen pregnancy, Margaret Pruitt Clark of Advocates for Youth replied, "A job."

A scholarship to college could also be a meaningful incentive for some Margaret Pruitt teens to delay childbearing. This approach has been used successfully by the "I Have A Dream" foundation and in the Children's Aid Society program in New York. Some adolescent fertility programs have succeeded with small payments to teens for staying "unpregnant." Denver had a program for some years called "a dollar a day," in which teens reported to the program site each day to collect a dollar. The human contact and the sense that someone was paying attention to them was probably as important as the dollar, but experience suggests that there is room for considering carefully prescribed financial incentives in the context of teen fertility.

Any such incentives should not be administered through the federal welfare system, however. For that system to encourage fertility behavior of any kind is inappropriate. The current system of welfare and federal family planning and health services in fact does encourage childbearing, but not in the sense that welfare critics of the day suggest. It does so, not by encouraging women to have children to gain welfare coverage, but by failing to fund the full range of reproductive health services, while paying for pregnancy- and birth-related services.

The constellation of federal welfare and family planning services should not inadvertently operate as an incentive for or against childbearing. Federal services should neither coerce poor women into childbearing, punish women for childbearing, nor punish the children born by denying them welfare benefits.

POLICY RECOMMENDATION 2
Adolescent Pregnancy Prevention	Education and services for adolescents should be increased through various school-based, community--oriented, peer-based, and adult mentoring programs.

Adolescent Fertility
In general, everything said in the previous pages about unintended fertility applies to adolescent fertility, because more than 80 percent of teen pregnancies are unintended. But adolescent fertility is also a special case requiring programs designed specifically for young people.

The costs of adolescent pregnancy in the United States are incalculable: in impaired health of the teen mothers and their infants; in the stunted lives of the families created; and in lost educational, economic, and social opportunities. Yet every year, more than one million teens become pregnant, a number that represents 11 percent of all teenaged women and 20 percent of sexually active teenaged women. Half a million of the four million births in the United States annually occur to teenaged mothers. Birth rates among teens appear to be rising. Also, the pregnancy rate among U.S. teens is at least twice as high as in Canada, England and Wales, France, and Sweden, and more than nine times as high as in the Netherlands. This is so despite similar levels of sexual activity.

Causes of Teen Pregnancy
U.S. teens become pregnant for a complex set of reasons, and programs to prevent teen pregnancy must take all of them into account. Among the causes most often identified are inadequate health care, lack of access to family planning, lack of knowledge about sexuality, poverty, poor schools, sexual abuse, parental neglect, and lack of hope for the future.

While both higher-income and lower-income teenage girls become pregnant, poverty is an important predictor of adolescent pregnancy. Only slight differences exist in levels of sexual activity among adolescents from lower- and higher-income families; yet young women from poorer circumstances are less likely to use contraceptives, more likely to become pregnant even if they do use a method, more likely to give birth if they become pregnant, and less likely to marry if they give birth.

The younger a girl is when she first engages in sexual activity, the more likely it is that the activity was pressured, if not coerced, either by a family member or a significantly older male. Nearly 70 percent of children born to teenaged girls are fathered by men 20 years of age or older. Usually the younger the mother, the greater the gap between her age and that of the father: one study has found that girls 11 to 12 years old were impregnated by men on average 10 years older.

Programs for Teens
It is widely agreed that the best strategy for preventing teen pregnancy is always-and always has been-to urge adolescents to postpone sexual activity: to say "No." Programs must then train teenagers in the negotiating skills required to say no. But programs must also build reasons for saying no--individual self-esteem, alternatives to sexual activity and childbearing, and hope for the future.

As important as the promotion of abstinence is to preventing teen pregnancy, it cannot be the only strategy. Approximately one-third of American 15-year-olds have had sexual intercourse at least once. At age 18, the percentages are 56 for girls and 73 for boys. Effective teen pregnancy prevention programs, then, must acknowledge the reality of sexual activity among teens and equip young people to behave responsibly.

Such programs can be school- or community-based. They should educate young people in reproductive health, contraception, and sexuality; they should involve males as well as females; and they should be built on the successes observed around the country.

Successful programs include: the Meharry Medical College "I Have A Future" program in Nashville; the Harriet Tubman Express adolescent pregnancy prevention program in Chattanooga; the New York Children's Aid Society pregnancy prevention program; and the Grady Memorial Hospital "Human Sexuality, Postponing Sexual Involvement" program in Atlanta. At the same time, we also need to better understand the elements of successful teenage pregnancy prevention programs.

POLICY RECOMMENDATION 3
Improve the Conditions Affecting Individual Decisions	The public and private sectors should work in partnership to reduce poverty and provide greater economic, social, and political opportunities for all Americans, particularly women.

Women, Poverty, and Opportunity
It has already been said that poverty is an important thread running through the tapestry of unintended pregnancies and births in the United States, both for adult and teenaged women. Unintended pregnancy becomes yet another negative consequence of poverty. Women should more than their share of the burden of U.S. poverty-almost two-thirds of all poor adults are women, and more than half of all poor families are headed by a single mother. And poor women shoulder more than their share of the burden of unintended pregnancies because they have less access to contraceptive services and fewer resources to use in achieving their desired family. These programs are all logical responses to the need to reduce unintended pregnancies: programs that improve access to reproductive health care for women; that work to keep girls, pregnant or not, in school (one-fifth of people with eight or fewer years of formal education are employed more than two-thirds of high school graduates are); and that work to expand economic opportunities for women.

Beyond poverty, a variety of other conditions can affect childbearing decisions-most notably hope for the future, a sense of self-worth, and the expectation of a job and career. Even in a country as advanced as the United States, significant room remains for improving educational, social, economic, and political opportunities for all Americans, and particularly for women and minorities.

Empowering Women
Creating conditions that empower women is especially important in the context of fertility. Improving high school completion rates for adolescents at risk of pregnancy; encouraging high school completion even for those young women who bear children; further progress toward ensuring equal opportunities for women in the workforce; and providing women with equal pay for equal work-these all create conditions that enable women to avoid unintended pregnancies, as well as to care for the families they have. The same is true of eliminating institutionalized discrimination against women and expanding their participation in public policy and public office.

IMMIGRATION
The United States has been called "a nation of immigrants." It is obvious, but true, that only the 2.2 million Native Americans living in the United States today are not immigrants or their descendants. The United States has a strong tradition both of fueling population and economic growth with immigration and of acting as a haven for oppressed and persecuted peoples from all over the world.

POLICY RECOMMENDATION 4
Immigration	Develop comprehensive and responsible immigration and foreign policies that reduce illegal immigration and mitigate the factors that encourage immigration. Increase research on linkages between demographic change, including immigration factors, and sustainable development.

Immigration in U.S. History
Large-scale immigration to the United States has occurred in four waves, each, except the last, ended by war and followed by a period of reduced immigration. The movement of predominantly British and western European people to the New World to settle what became the United States constituted the first immigration wave, ending with the Revolutionary War. The second wave began in 1820, was dominated by Irish and German migrants, and came to an end with the Civil War.

During the third wave, which began in 1880 and ended with World War 1, southern and eastern Europeans migrated to the Midwest, and Chinese, Japanese, and other Asians migrated to the West, joining the western and northern Europeans. The fourth wave of large-scale immigration began in 1965 and is still under way: Latin Americans and Asians outnumber Europeans in this most recent migration stream.

Immigration Policy
In earlier decades, U.S. immigration policy and law were set to develop vast open spaces and to favor some nations' immigrants over others. More recently, the principles of reunifying immigrant families, whatever their national origin, and adding needed skills to the workforce have guided immigration policy. The two most recent immigration laws are the Immigration Reform and Control Act (IRCA) of 1986 and the Immigration Act of 1990.

The 1986 law, attempting to change the conditions that draw illegal migrants to the United States, addressed illegal or undocumented immigration by creating sanctions against employers who knowingly hire them. The law granted legal resident status to certain illegal immigrants who had been living in the country for some time and also included antidiscrimination measures.

The 1990 law changed the composition of-and raised the numerical ceiling on-legal immigrants, placing a greater emphasis on work-related migration than previous laws had done. It also established a program to diversify the sources of legal immigration. Both laws have worked to increase numbers of immigrants; IRCA with its amnesty program, in the short term, and the 1990 law with its numerical ceiling, in the long term.

Current Immigration
During fiscal 1994, the Immigration and Naturalization Service (INS), acting under these two laws, admitted 830,000 legal immigrants to the United States. The INS estimates that about 300,000 illegal immigrants also entered the country, intending to remain on a long-term or permanent basis. Seventy percent of legal immigrants settle in six states: California, Texas, Florida, Illinois, New York, and New Jersey. Among illegal immigrants, 85 percent settle in these six states. Thus, the impacts of immigration, both legal and illegal, are concentrated on a few localities and regions.

Congress established the U.S. Commission on Immigration Reform, and charged it with exploring a number of issues related to immigration, including the effect of immigration on natural resource use, the environment, and U.S. demographic conditions. The executive director of the Commission, Susan Martin, testified before the Population and Consumption Task Force that not enough is known to allow valid, detailed conclusions about the effects of immigration on job displacement and creation; on working conditions, wages, and income levels of resident U.S. workers; and on the parts of the U.S. population that are already disadvantaged, The environmental impacts of immigration are not fully understood, either. Thus, it is not possible today for immigration policy to be guided in detail by fine-grained understanding of economic and environmental impacts. The Commission is working to change this limitation, however.

Illegal Immigration
While the Task Force's work was under way, the Commission on Immigration Reform was examining certain aspects of illegal immigration. It was particularly interested in addressing the causes of illegal immigration in sending countries. Some of the issues in Mexico-one source of illegal immigration-include: identification of specific communities in Mexico with high levels of emigration; design of programs to affect the conditions causing migration in those communities; and creation of economic opportunities for the women left behind when men and older boys depart.

The Population and Consumption Task Force endorses the Commission on Immigration Reforrn's work in general, and agrees specifically with the need for better information and research findings; the need to reduce illegal immigration but to do so with sensitivity to the human and civil rights of those affected; and the need to create conditions in sending countries that provide meaningful economic opportunity and development for people who live there.

The deliberations of the Task Force concluded before the Commission issued its findings on legal immigration in the summer of 1995. While that work was underway, the Task Force urged the Commission to consider larger demographic conditions-specifically the need to move toward population stabilization-in developing its recommendations.

POPULATION DISTRIBUTION

POLICY RECOMMENDATION 5
Population Distribution	The President and Congress should authorize and appoint a national commission to develop a national strategy to address changes in national population distribution with negative impacts on sustainable development, while respecting individuals' freedom of choice in where to live.

Historical Trends
Population in the United States is unevenly distributed and always has been. The concentration on the eastern seaboard has been a familiar feature of U.S. population distribution since the original 13 colonies. The ten most densely populated states in 1987 occupied a line from Massachusetts in the north to Florida in the south, skipping only the southern states from Virginia to Georgia.

Additions to the U.S. population are also unevenly distributed. Between 1980 and 1990, the West grew by more than 22 percent; the South by 13 percent; the Northeast by 3.4 percent; and the Midwest by just 1.4 percent. More than half the country'.s total population growth took place in California, Florida, and Texas.

An additional trend is deconcentration, or "exurbanization," the spread of settlement beyond cities and suburbs into formerly rural areas. A recent analysis has found that "exurban" counties were the fastest-growing component of the American demographic scene and accounted for 30 percent of U.S. population growth between 1960 and 1985.

Between 1970 and 1990, population along the southeastern Atlantic seaboard grew by 74 percent. In all, more than 40 percent of the nation's 263 million people live in coastal areas. Population densities exceed 192 people per square kilometer in 20 percent of coastal counties. Densities in the urban cores of some of these areas exceed 3,800 people per square kilometer. Government studies indicate that a 15 percent increase in coastal population over the next two decades is likely, with growth concentrated in California, Florida, and Texas.

Local Impact
The impacts of domestic migration and rapid growth are felt most concretely at the local level. All over the country, from small towns in New England and the West, to cities such as Los Angeles and Miami, localities are struggling to manage rapid growth so they can enjoy the economic prosperity that often comes with growth while preserving the character of their communities that they value so highly. Many areas that aggressively sought growth in the past are finding that they cannot sustain it either economically, environmentally, or socially.

Uneven population distribution exacerbates all these effects of rapid local growth. The uneven distribution and movement of people also has important national implications. The destruction of coastal areas, the massing of population in areas that would suffer from rising sea levels and severe storms due to climate change, the loss of prime farmland, and concentrated stress on scarce water resources are all issues of interest to the national government.

While unevenly distributed economic activity is at the root of uneven population distribution- both as a cause and an effect-other factors are also at play. These include perceptions about quality of life in various locales and government policies whose operation and effects are not well understood. Further, the narrow range of policy tools available to the multiple governments affected-federal, tribal, state, county, municipal-are largely untried, and a broader range of tools remains unexplored.

At the same time, the right to move anywhere is a constitutionally protected right for Americans, and derives from some of the most strongly held beliefs in American culture. Indeed, the freedom of mobility is nothing less than the basis on which the country was founded and built, and it needs to be protected.

We are clearly at an early stage in our understanding of uneven population growth and of intense population impacts on the local level. We are similarly at an early stage in the development of policy tools for dealing effectively with these dimensions of the population issue in the United States.

CONCLUSIONS ON POPULATION ISSUES

• Elimination of unintended pregnancies and births by means of expanded access to comprehensive family planning services, including information and education, particularly for the poor, teens, men, and other underserved populations;
• A broadened range of contraceptive options, including emergency contraception;
• Carefully framed programs aimed specifically at teens and designed to postpone sexual activity and childbearing; and
• Use of the media and advertising to promote sexual responsibility.

The two most important external conditions affecting fertility decisions appear to be poverty and the specific features of women's low status that inhibit access to reproductive health care and meaningful economic opportunity.

With regard to immigration, the Task Force recognizes the comprehensive work being done by the U.S. Commission on Immigration Reform and has identified aspects of the Commission's work that it supports and areas where more needs to be done.

The Task Force finds the following facts important with regard to immigration:

• Immigration into the United States is as high as it has ever been and contributes a third of annual U.S. population growth;
• Better research and information on immigration are required, because it is not possible to fine-tune policy based on current knowledge of immigration's economic, social, or environmental impact; and
• Efforts to improve conditions in sending countries are more humane and likely to succeed in the long term than efforts to punish immigrants for coming to the United States or to intensify border enforcement.

Finally, with regard to the uneven U.S. population distribution, the Task Force concludes that a good deal of research and fact-finding are needed in order to understand the implications for sustainability and to develop the policy tools that can deal effectively with population distribution concerns.