Chapter 1: Population Issues
History of the U.S. Population Issue
The notion that America s best interests may not lie in continued
population growth has been widely discussed only since the 1960s. Before
then, population growth was generally viewed
not only as necessary and inevitable but desirable.
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
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
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
When President Nixon transmitted his message to Congress in 1969, U.S. families averaged
between two and three children-the total fertility rate was 2.5-so that parents more than replaced
themselves, and generation numbers were growing ever larger. By the time the Commission
released its report in 1972, the total fertility rate had fallen to two children, or replacement level.
The following year, it fell below two children per family, where it
stayed until 1989.
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
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.
The United States is today the only major industrialized country in the
population growth on a significant scale. The U.S. population grows at
0.7 percent annually when
immigration is not taken into account, compared to an average annual
growth rate (also without
counting immigration) of not more than 0.2 percent in all of Europe.
The U.S. population grows at
approximately 1.0 percent when immigration is taken into account.
|Annual growth figures of 0.7 and 1.0 percent may seem small,
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
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
||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
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
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.
The Commission report goes on to state, "In short, we find no convincing economic argument
for continued national population growth."
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
Important findings presented in the roundtables, combined with the
expertise of Task Force
members, shaped the Task Force's policy recommendations on population matters. Principal
findings on fertility, immigration, and population distribution are summarized below. Before
each section, the relevant policy recommendations are stated. For the
full policy recommendation, including specific actions, see Chapter 4.
|POLICY RECOMMENDATION 1|
|Information and services to prevent
||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.
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.
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.
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.
Unintended pregnancies--and the unintended births that follow--occur
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
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
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 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.
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.
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.
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
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.
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.
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
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.
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.
| 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
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."
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|
|| Education and services for adolescents
should be increased through various school-based, community--oriented,
peer-based, and adult mentoring programs.
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
TEENS TEACHING TEENS|
Approximately 30 percent of America's 15-year-olds have
had sexual intercourse at least once. At age 18, the percentages are 56
and 73 for boys. Effective teen pregnancy prevention programs should
encourage teens to abstain from sexual activity, equip them to behave
responsibly, and provide appropriate services. Such programs can
school-based: they should educate young people in reproductive
health contraception, and sexuality, they should involve mates as well
females; and they should be built on successes demonstrated around
country. At the same time, the elements of successful teenage pregnant
prevention programs need to be better understood. As important as
promotion of abstinence is to preventing teen pregnancy, it cannot be
The key to one of the most successful pregnancy
prevention programs in the United States is "Teens Teaching Teens.'Started
the Atlanta public schools and the Grady Health System, the
program helped hundreds of Georgia teenagers avoid unwanted pregnancies.
Eighty-three percent of all teenagers giving birth come
from families who live below the poverty line, the Council was told
during a Task
Force roundtable discussion. Yet the Atlanta program "manages
to reach even the hardest of hard-to-reach youth," according to Marie
Mitchell, program manager for teen services at the Grady Health System
Center. A Ford Foundation study confirms her view. It found that students
from low income families who participate in the Atlanta program are less
sexually active than those who do not participate. By the senior year
high school, although participants' abstinence rates drop, their
use of birth control practices is significantly higher than among those
students that did not participate in the program.
Each summer, some 60 to 70 juniors and seniors from the Atlanta
public schools train to become student leaders in the Grady
Health System program. Then, for five sessions during eighth-grade health
class, the older teens encourage the younger ones to postpone sex. Mitch
says explained, "It's so successful because it's a teenage-led
support is created for the notion that you don't need to be sexual
involved. Teens provide models to other teens showing that it
is something you can do."
While the program's purpose is to reach younger students,
the student teachers, who must be former participants in the program,
also learn from their experience. "Not only does it help them manage their
own sexuality, it also helps them develop more confidence, leadership
skills, and public speaking experience," Mitchell
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
||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.
|NEW ECONOMICS FOR WOMEN|
Casa Loma is an apartment complex located in one of the poorest
sections of downtown Los Angeles. It is also the site of the cornerstone project
of New Economics for Women (NEW), a nonprofit development corporation
fully owned and operated by women dedicated to improving the lives of poor
single parents and their families.
When Anna Rodriguez, a single parent of four boys aged two to 14,
arrived at Casa Loma, she was on welfare and sewed at home to supplement
her income. Weary of being dependent, Rodriguez, with support from the Casa
Loma project, first obtained a minimum-wage job as a seamstress in a nearby
shop. Then she heard about a new garment factory opening in the San
Femando Valley, 30 miles away. Despite the distance, she went to pick up an
application, but was told it was too late: the deadline had passed. The Casa
Loma director made a telephone call on her behalf. The following Monday,
Rodriguez reported to work as an $8.50-an-hour seamstress. Just two weeks
later, she was promoted to second designer at $20 per hour.
"Casa Loma has been an incredibly successful public-private
partnership because we have facilitated and strengthened opportunities for women to
empower themselves,' says Beatriz Olvera Stotzer, NEW president and
founder. 'Anna is a perfect example of empowerment. She was afraid of
leaving her children at home for fear she would not be a good mother and was
ashamed of being on welfare. We provided the environment and assistance for
her to empower herself."
The Casa Loma project, which relies on private donations as well as
public funds, combines housing with an aggressive agenda of on-site educational, social, and business programs. The programs focus on matters that
deeply affect impoverished families: infant and child care in a safe environment,-
after-school activities for latchkey kids; training for adults and children in areas
ranging from adult literacy to word processing and mathematics; and life skill
courses in budgeting, finance, job placement assistance, and micro-enterprise
development. Parenting magazine gave NEW and the Casa Loma project its
1994 Parenting Achievement Award for making the world a betterplace for children. The U.S. Department of Housing and Urban Development considers
Casa Loma a national housing model for the 21st
Beyond poverty, a variety of other conditions can affect childbearing
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
social, economic, and political opportunities for all Americans, and
particularly for women and
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
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
as well as to care for the families they have. The same is true of
discrimination against women and expanding their participation in public
policy and public
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|
||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
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
began in 1965 and is still under way: Latin Americans and Asians
outnumber Europeans in this most recent migration stream.
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
The 1990 law changed the composition of-and raised the numerical
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.
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
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.
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.
|POLICY RECOMMENDATION 5|
||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.
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.
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
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
CONCLUSIONS ON POPULATION ISSUES
The Population and Consumption Task Force's findings have led it to a number of
conclusions. To enable individuals to make responsible fertility choices, it seems particularly
important to focus on the following goals:
- 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
- A broadened range of contraceptive options, including emergency
- 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 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