State of World Population 2023 - 8 Billion Lives, Infinite Possibilities

Publication date: 2023

ISSN 1020-5195 ISBN 9789211014730 Sales No� E�23�III�H�1 E/500/2023 United Nations Population Fund 605 Third Avenue New York, NY 10158 Tel� +1 212-297-5000 www�unfpa�org @UNFPA state of w orld population 2023 8 B illion Lives, Infinite P ossibilities: the case for rights and choices Ensuring rights and choices for all 8 Billion Lives, INFINITE POSSIBILITIES the case for rights and choices Printed on recycled paper State of World Population report 2023 This report was developed under the auspices of the UNFPA Division for Communications and Strategic Partnerships� EDITOR-IN-CHIEF: Ian McFarlane EDITORIAL TEAM Senior editor: Rebecca Zerzan Production editor/creative direction: Katie Black, Katie Madonia Features editor: Richard Kollodge Features writers: Leyla Alyanak, Janet Jensen, Richard Kollodge Editorial support and guidance: Jacqueline Daldin, Tara Jayaram, Lisa Ratcliffe, Catherine Trautwein Digital edition manager: Katie Black Digital edition adviser: Enes Champo Fact checker: Ines Finchelstein SENIOR RESEARCH ADVISER: Silvia E� Giorguli EXTERNAL RESEARCHERS AND WRITERS Daniel Baker, Nikolai Botev, Ann Garbett, Stuart Gietel-Basten, Gretchen Luchsinger, Rishita Nandagiri, Rebecca Sear, Tomas Sobotka UNFPA TECHNICAL ADVISERS Alanna Armitage, Satvika Chalasani, Jens-Hagen Eschenbaecher, Michael Herrmann, Sandile Simelane, Rachel Snow COMMISSIONED ORIGINAL ARTWORK Cecilie Waagner Falkenstrøm of ARTificial Mind Studio MAPS AND DESIGNATIONS The designations employed and the presentation of material in maps do not imply the expression of any opinion whatsoever on the part of UNFPA concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries� ACKNOWLEDGEMENTS UNFPA thanks the following people for sharing glimpses of their lives and work for this report: Amsalu, Ethiopia; Ardit Dakshi, Albania; Diana Donțu, Moldova; Josephine Ferorelli, United States of America; Irina Fusu, Moldova; Emmanuel Ganse, Benin; Gelila, Ethiopia; Hideko, Japan; Pela Judith, Madagascar; Meghan Kallman, United States of America; Saori Kamano, Japan’s National Institute of Population and Social Security Research; Gibson Kawago, Tanzania; Khaled, Yemen; Pat Kupchi, Nigeria; Joseph Mondo, Papua New Guinea; Ki Nam Park, Korea Population, Health and Welfare Association; Natsuko, Japan; Paul Ndhlovu, Zimbabwe; Jelena Perić, Serbia; Rama (name changed), Syria; Said (name changed), Oman; Norbert Safari, Democratic Republic of the Congo; Senad Santic, Bosnia and Herzegovina; Senad Santic, Bosnia and Herzegovina; Sawako Shirahase, United Nations University; Yeon Soo, Republic of Korea; Jonathan Stack, United States of America; Idil Üner, Türkiye; Volatanae, Madagascar; Ibrahim Wada, Nigeria; Shannon Wood, Johns Hopkins University; Ivana Zubac, Serbia Chief of the UNFPA Media and Communications Branch, Selinde Dulckeit, provided invaluable insights to the draft, as did UNFPA Technical Director Dr. Julitta Onabanjo, and members of the Office of the Executive Director, including Teresa Buerkle, Sam Choritz, Saturnin Epie, Alana Ngoh, Pio Smith and Anne Wittenberg� UNFPA colleagues and others around the world supported the development of feature stories and other content or provided technical guidance: Samir Aldarabi, Adolfo Ballina, Jacob Enoh Eben, Jens-Hagen Eschenbaecher, Rose Marie Gad, Lilian Landau, Nouran Makhlouf and Julia Novichenok� UNFPA Population and Development experts provided data in the indicators section of this report, as well as overall technical guidance� They include Alessio Cangiano, Sabrina Juran, Mengjia Liang, Rintaro Mori and Fredrick Okwayo. Author Ann Garbett led the analyses of both the YouGov survey results and the Inquiry data; further analysis of the YouGov survey results can be found at Print and interactive design: Prographics, Inc� The editors are grateful for the contributions of partners, including experts at the Population Division of the United Nations Department of Economic and Social Affairs, in particular Giulia Gonnella, Vladimíra Kantorová, Vinod Mishra, Karoline Schmid and Guangyu Zhang; experts at the International Organization for Migration, in particular Marie McAuliffe; experts at YouGov, particularly Tanya Abraham; experts at the Brown Institute, particularly Vrinda G� Bhat, Mark Hansen, Michael Krisch, Katherine R� Watson and Katharina Tittel; and Aditya Bharadwaj, an expert on reproductive health and technologies. A NOTE ON ART The artwork for this report was created by award-winning artist and founder of the art-tech studio ARTificial Mind, Cecilie Waagner Falkenstrøm� Cecilie’s art, which utilizes artificial intelligence, machine learning and other cutting-edge technologies to provoke reflections about our engagement with technology, represents the core themes of this year’s report: the perils and promise of a not-so-distant future, the fears which spring from those unknowns, and the infinite possibilities within reach when rights and choices for all are ensured� In its ability to bridge the gap between the real and the imagined, this year’s artwork encapsulates the anxieties and opportunities that future holds, and, most importantly, underlines how we are co-creators of it� Ensuring rights and choices for all 8 Billion Lives, INFINITE POSSIBILITIES the case for rights and choices Our Human Family, 8 Billion Strong page 10 FEATURE: It’s not about the number, it’s about the quality of life � � � � � � � � � � � � � � � � 28 IN FOCUS: Too many, too few: the long history of population debates � � � � � � � � � � 30 Too Many? page 34 FEATURE: Young people forge new paths � � � � � � � � � � � � 40 FEATURE: With covert contraceptive use, women challenge men’s power over childbearing decisions � � � � � � � 56 FEATURE: Family planning: a climate change survival strategy � � � � � � � � � � � 59 IN FOCUS: The fallacies of aiming for replacement-level fertility � � � � 60 Too Few? page 64 FEATURE: Wooing Balkan repats � � � � � � � � � � � � � � � � � � � � 76 FEATURE: Expectations about women’s roles at work and at home drag marriage and fertility rates to new lows � � � � � � � � � � � 80 FEATURE: Family-friendly workplaces to support demographic resilience � � � � � � 86 IN FOCUS: Migration is part of the solution � � � � � � � � � � � � � 96 Chapter 1 Chapter 2 Chapter 3 CONTENTS FOREWORD � � � � � � � � � � � � � � � � � � 4 EXECUTIVE SUMMARY � � � � � � � � � 6 The State of Reproductive Choice page 98 FEATURE: Needs of infertile couples can be overlooked in a world fixated on population growth � � � � � � � � � � � �104 FEATURE: Imagining a better future � � � � � � � � � � � � � � � � � � �110 FEATURE: Viewing vasectomy as an empowering act of love � � � � �120 IN FOCUS: A look at the most vulnerable: early adolescent pregnancies and the violation of rights � � � � � � � � � � � � � � � � � � � � � �124 Rights Are the Key page 126 FEATURE: For accurate and credible data, participation and trust are key � � � � � � � � � � � � � �134 Chapter 4 Chapter 5 INDICATORS � � � � � � � 151 TECHNICAL NOTES � � 170 REFERENCES � � � � � � � 175 In November 2022, the world population eclipsed 8 billion people. For many of us, it represented a milestone that the human family should celebrate — a sign that people are living longer, healthier lives and enjoying more rights and greater choices than ever before. The relationship between reproductive autonomy and healthier lives is an uncontested truth: as women are empowered to make choices about their bodies and lives, they and their families thrive — and their societies thrive as well. Yet that was not the message heard by much of the world. Instead, many headlines warned of a world teetering into overpopulation, or that whole countries and regions were ageing into obsolescence. Somehow, when the human numbers are tallied and population milestones passed, the rights and potential of individuals fade too easily into the background. Over and over, we see birth rates identified as a problem — and a solution — with little acknowledgement of the agency of the people doing the birthing. This story was supposed to have changed. In 1994, the Programme of Action of the International Conference on Population and Development (ICPD) recognized that advancing gender equality and the empowerment of women and ensuring women’s ability to control their own fertility must be at the heart of population and development- related programmes. This vision was articulated, in large part, because women’s movements saw both the violations that can occur when family planning is used as a tool for “population control” and what empowerment and autonomous family planning can help secure for individuals. Today, the 2030 Agenda for Sustainable Development expressly acknowledges that sexual and reproductive health and gender equality are essential for unlocking a more prosperous and sustainable future. Why, then, are so many women still deprived of their bodily autonomy? The most recent data from 68 countries show that an estimated 44 per cent of partnered women are unable to make decisions over health care, sex or contraception. The result? Nearly half of all pregnancies are unintended, an abrogation of women’s basic human right to decide freely and responsibly the number and spacing of their children. FOREWORD 4 Foreword Today, climate change, pandemics, conflicts, mass displacement, economic uncertainty and other issues fuel concerns about over- and under-population. Yet human reproduction is neither the problem nor the solution. This State of World Population report, produced by a group of external advisers, researchers and writers, working alongside UNFPA technical staff and editors, explores how broadening our understanding of population can lead to new solutions that build demographic resilience and help shape a more equitable and prosperous future. Advancing gender equality is an often- overlooked solution to many of these concerns. In ageing, low-fertility countries with labour productivity concerns, achieving gender parity in the workforce is considered the most effective way to improve productivity and income growth. In high-fertility countries, empowerment through education and family planning is known to yield enormous dividends in the form of economic growth and human capital development. That is why UNFPA is calling for expanded efforts to realize bodily autonomy and support sexual and reproductive health and rights for all — the foundation for full equality, dignity and opportunity. Every member of our human family has the right to make free and informed choices about their health, bodies and futures. This right should be the starting point for all conversations about population. Population is, after all, about people, about creating the conditions for all 8 billion of us to live freely and fully, equal in dignity and rights, on a healthy, safe and prosperous planet. When we invest in people and their potential, in their rights and choices, all of humanity benefits. Dr. Natalia Kanem Executive Director United Nations Population Fund 5STATE OF WORLD POPULATION 2023 Ours is a world of hope and possibility, a world where the human family is larger than ever before. It is a world in which we are collectively living longer and, on balance, enjoying better health, more rights and broader choices than at any other point in human history. Ours is also a world of anxieties: the tensions of everyday life are rapidly accumulating amid economic uncertainty, the existential question of climate change, the still-rising toll of the COVID-19 pandemic and the ongoing ravages of conflict. In November 2022, the United Nations announced that the human population had surpassed 8 billion people, and also that two thirds of people were living in places where fertility rates had fallen below the so-called “replacement level” of 2.1 births per woman. These trends offer a nuanced look at demographic transition — the shift from higher to lower mortality and fertility — as it unfolds EXECUTIVE SUMMARY in different countries and contexts. But the subtleties of this story were very often lost. “Too many” people will overwhelm the planet, many pundits proclaimed, even as others warned that “too few” people would lead to civilizational collapse. Every population trend seems to invoke its own vision of catastrophe. Too many young people? Destabilizing. Too many old people? A burden. Too many migrants? A threat. To be sure, there are many valid and pressing concerns related to population, such as the complex links between population size, affluence and fossil fuel consumption, and the challenges of budgeting for infrastructure, health services and pension programmes. But when we flatten out the nuance, we obscure the very problems we need to address, burying them beneath layers of hyperbole and blame. Fertility rates that deviate from 2.1 are widely treated as red flags, predictive of either impending overpopulation or catastrophic depopulation. The solutions, it is often said or implied, should therefore be fertility related. Fears and fixes begin to take the form of a woman’s body. This alarmism poses real risks: 6 Executive summary one, that population anxiety will distract us from serious but solvable problems, and two, that population anxiety will become a rationale for denying the rights and bodily autonomy of women and girls. Population matters The State of World Population report is produced by a panel of external advisers, researchers and writers, who work alongside UNFPA technical staff and editors, bringing the insights of leading independent experts together on issues related to the UNFPA mandate. This report explores how people — the general public, policymakers, academics and others — understand current population trends, and how those views can impact sexual and reproductive health and rights. Make no mistake: population trends are real and enormously impactful. They affect culture and social relations, economies and political discourse. They influence how we approach climate change, allocate resources, respond to shifting workforces and more. But it is precisely because population trends are so important that we must move past the tendency to reduce all of humanity to the threat of a population “bomb” or “bust”. These alarmist narratives persist in part because they offer easy talking points and can be used to justify simple but fallacious “fixes”, like setting fertility targets to “correct” a population size. Research for this report found a notable recent uptick in governments adopting policies aimed at raising, lowering or maintaining fertility rates. Further, the share of countries with policies to increase fertility has grown, while the share of countries without fertility policies has diminished. Policies to influence fertility rates are not necessarily coercive — they can take many forms — but in general, the analysis finds that efforts to influence fertility are associated with diminished levels of human freedoms. In reality, there is no perfect population size, nor any reliable way to achieve a specific population size. Fertility rates fluctuate for a wide variety of reasons that stretch far beyond the reach of targets and State policies. At times, efforts to manipulate population even defy logic. Responding to an ageing population by encouraging people to have more babies, for example, ignores the fact that this will do little to relieve shortages of workers and pension burdens in the short term, and in fact will increase the need for other large investments like education long before the babies become productive, tax-paying workers. STATE OF WORLD POPULATION 2023 7 Yet such approaches remain palatable in many places — and not only among policymakers but among politicians, commentators and community members as well. It may seem more achievable to focus on population numbers and to convince women to have more or fewer children than to tackle the climate crisis through reducing emissions or increasing sustainable consumption and production, or to make the public investments needed to ensure equitable access to quality education, employment, health coverage and social protection. In this way, women’s and girls’ bodies are treated as instruments to enact population ideals, a notion made possible by their still subordinate status, socially, politically and economically. Of course, good intentions are often also at work; implementing family-friendly conditions for those who want to have children and providing contraceptives for those who don’t are critical efforts that support reproductive rights and gender equality. But a view of the world in which high-fertility rates mean contraceptives are needed, while low-fertility rates mean family-friendly policies are needed, is also too simplistic. Infertility is widespread in high-fertility contexts, just as unmet need for contraception is prevalent in low-fertility ones, and a full range of reproductive health services and gender- equality protections is needed in all settings. Moreover, there is a risk that those who craft or implement fertility policies will come to see directing fertility rates as their main goal. We know that when this happens, it can undermine women’s exercise of choice and diminish their rights. The most recent Sustainable Development Goals data reveal that, out of 68 reporting countries, an estimated 44 per cent of partnered women are unable to make decisions over health care, contraception or sex (UNFPA, 2023). The most vulnerable have only a tenuous grip on their bodily autonomy, if they can exercise autonomy at all; this fact obliges us to prioritize their needs, rights, choices and dignity – including in population policies. Towards rights and resilience It is clear that the old prescriptions for managing population change do not work, and in the worst cases they lead to violence and harm. The same is true of despair, which may lead us to compromise on agreed rights. How often have we seen fear used to separate populations into “us” versus “them”? Why should we work together towards a better future if all we can imagine is a worse one? Fortunately, countries are beginning to put aside fear, responding to the challenges with new solutions in order to foster truly successful, thriving populations. In planning for unfolding demographic changes, they are not setting targets but aiming for demographic resilience. This approach means that social and economic systems stay attuned to what people themselves say they want and need to flourish, in times of both prosperity and peril. Starting down this path means broadening our understanding of population, investing in the data collection and analyses needed to look at — and also look beyond — total population sums and fertility rates. A more accurate perspective may emerge, for instance, from considering age structure, migration, mortality trends and age at childbearing. Data could factor in shifting social and gender norms and fertility intentions. They could better define demographic intersections with gender equality, as in a recent United Nations study, which found that greater gender parity in the labour force would do much more to sustain economies in ageing, low- fertility societies than a return to higher fertility (UN DESA, 2023a). Equally important are the questions we ask when using this information. Instead of asking, for instance, whether a fertility rate is too high or too low, we might ask whether people are able to realize their sexual and reproductive rights, and if not, what is required to fill the gaps? How well is the space for choice protected? Is it protected equally for all, with no exclusions in principle or practice, as human rights standards require? Are diverse voices steering the process of inquiry and deciding the directions it takes and the conclusions it reaches? The 1994 International Conference on Population and Development was a landmark shift away from population control ideologies and towards sexual and reproductive health and rights. This was largely due to the powerful advocacy of women’s movements and the willingness of policymakers to listen to their case for rights and choices. It is time to listen again. This means hearing the voices of concern, voices represented by the stories in this report. It means heeding the voices of those advocating for sexual and reproductive justice, which considers not just stand-alone factors like contraceptive access but all the conditions needed for rights and choices, from economic security to a clean and sustainable environment to liberation from violence and discrimination. These are calls for action arising from the belief that a better future is possible, if all of us act in concert to make it so — and that requires action not just from policymakers and parliamentarians, but also young people, older persons, activists, the private sector and civil society groups. Together, we must create a world where everyone can exercise their rights, choices and responsibilities. This is essential for building a more sustainable, equal and just world for all 8 billion of us. A future of infinite possibilities. The time for action is now. 9STATE OF WORLD POPULATION 2023 Our Human Family, 8 Bil- lion Strong Our Human Family, 8 BILLION Strong CHAPTER 1 STATE OF WORLD POPULATION 2023 11 Our human family now has 8 billion members, a milestone to celebrate. It represents historic advances for humanity in medicine, science, health, agriculture and education. More newborns make it through the precarious first months of life (WHO, 2022). Children are more likely to grow to adulthood (Small Arms Survey, 2022), and people live longer, healthier lives. These gains are the result of progress in public health, nutrition, education and more, and growing numbers of people are able to enjoy these benefits. In recent decades, these advances have been amplified by commitments to human rights, universal health, sustainable development and gender equality — made by governments, non-governmental movements, the private sector and many more. They include the global Sustainable Development Goals (SDGs), which are at the heart of a transformative international agenda for development for all people by 2030. The international community has, through not only the SDGs but also many preceding decades of agreements, legal instruments and evolving social norms, assured every individual has an equal right to life, and to the highest attainable standard of health and dignity. Every human being sharing our planet today is owed these human rights and the possibilities that human rights can help them unlock. Yet humanity has reached this population of 8 billion at a moment of multiple, overlapping and escalating crises. The COVID-19 pandemic has, to date, killed more than 6 million people (with estimates as high as 21 million) (Msemburi and others, 2022; The Economist, 2022; WHO, 2022a). The climate catastrophe (UNEP, 2022), weakened economies, conflict, food and energy shortages, and technology-driven disinformation pose threats everywhere in the world. The future can seem bleak; according to the 2022 Human Development Report, more than six in seven people globally say they feel insecure (UNDP, 2022). Amid these fears, it is all too easy to interpret the biggest demographic headlines of the moment — 8 billion people on Earth alongside historically low-fertility rates in many countries (UN DESA, 2022) — as signs of impending disaster. People are seeking answers, and “population” can be an appealing scapegoat for many problems. This tendency poses risks, including laying blame on people who look different or live differently. We see this concern unfolding right now. It is expressed as fears about “overpopulation” — the perception that there are more people than the planet can sustain. At the same time, particularly in lower-fertility countries, it is expressed as concerns about “underpopulation”, worries about diminishing labour forces and the “collapse” of communities or countries. In many places, both fears are playing out simultaneously. Media headlines tell part of this story. “Planet Earth: 8 billion people and dwindling resources”, one syndicated headline (AFP, 2022) announced as the milestone figure was reached in November 2022. “Young women are turning their backs on marriage and children while elderly numbers boom”, another news item exclaimed (Zhang, 2022), adding, “demographer says the issue has potential to be elevated to a national security level”. Versions of these messages appeared worldwide: “As climate change worsens, Egypt is begging families to have fewer kids” (O’Grady and Mahfouz, 2022). “South Korea spent $200 billion, but it can’t pay people enough Our Human Family, 8 Billion Strong12 to have a baby” (Hancocks, 2022). “‘Without enough Latvians, we won’t be Latvia’: Eastern Europe’s shrinking population” (Henley, 2022). “A demographic time bomb is about to reshape our world. The planet’s population is soon expected to peak. What comes next will be unrecognisable” (Shute, 2022). Both the tone and the language of such claims fail to reflect the complexities of population trends and the rights and autonomy of individuals (see box, “Using the language of rights”). And this is not unique to the media. From policy discussions to radio chat shows to conversations among > More newborns make it through the precarious first months of life. > Children are more likely to grow to adulthood. > People live longer‚ healthier lives. _ _ _ STATE OF WORLD POPULATION 2023 13 friends, there is widespread acceptance of the idea that countries or the world should work towards an ideal population size or composition or fertility rate. In some cases, public policies articulate such goals, even though history repeatedly shows the perils of population targets. Population targets are often implicitly coercive, pushing people towards reproductive choices that they might not otherwise make themselves. This process unfolds along a spectrum, from public campaigns and persuasion, to subtle or overt discrimination, and even to the forced use or denial of contraception and other sexual and reproductive health services. Numbers in support of rights All human beings have the right to make choices about when (or whether) to have children, how many children to have and with whom to have them. Their right to bodily autonomy means just that: free and informed choice, unhindered by requirements to live in service to any broader demographic, economic, social, political, environmental or security claims. This is not to say that population numbers do not matter; they do, because every human being matters. Population data offer some of the most reliable, forward-looking information on the > A history of ups and downs Population fluctuations are not new. Archaeological evidence indicates that there have been periods of rapid population growth followed by population declines throughout human history (Shennan and Sear, 2021) — but most historical population busts were driven by periods of mass early mortality, induced by events such as war, famines or epidemics. Indeed, the COVID-19 pandemic and the ongoing HIV/AIDS epidemic remind us that disease can continue to impact demographic trends on a large scale� Still, almost all current cases of falling population size are attributable to declining fertility and emigration rather than mass mortality events — trends that are a testament to advances in science, technology and peacebuilding� Today, most experts agree: population changes are normal, and population sizes are neither good nor bad; what is needed are resilient systems that can respond to the needs of a population, no matter what its size� Likewise, rising and falling fertility rates are neither good nor bad; they should, however, be an expression of the reproductive rights and choices of individuals. Our Human Family, 8 Billion Strong14 needs that communities may have 5, 15 and even 50 years into the future. Cohorts of infants will require investments in health care and schooling, for instance. How these cohorts age, how they will likely affect labour markets and pension funds, how needs compare among cohorts within and across communities — all of this information offers policymakers a forecast of the possible future and of future possibilities. These data can enable policymakers to better prepare for impending changes, whether that means investing in systems that support large numbers of students, job seekers or retirees. Population numbers are also critical in steering policies and programmes to achieve the SDGs, including their inherent commitment to leave no one behind. Population data provided by the United Nations Population Division are used to monitor around a quarter of the 231 SDG indicators, for example (UN DESA, n.d.). Particularly relevant for this report, population data can be used to quantify persistent and ubiquitous violations of reproductive rights. Since 2015, as part of SDG Target 5.6.1, countries have submitted data on bodily autonomy, which show that unacceptably large populations of partnered women and girls continue to be denied their fundamental right to make decisions about whether to seek health care, whether to have sex and whether to use contraception. In 2023, 68 countries have reported 5.6.1 data, showing that 24 per cent are unable to say no to sex, 25 per cent are unable to make decisions about their own health care and 11 per cent are unable to make decisions specifically about contraception. Together, this means that only 56 per cent of women are able to make their own decisions over their sexual and reproductive health and rights (UNFPA, 2023). The needs and rights of individuals may be challenging to reconcile with the number of people now sharing our planet. Much anxiety circles around the world’s current megatrends, tectonic shifts not only in population size but also in the climate, emerging disease threats and more. But no matter the vastness of our human family, every member has non-negotiable rights and value. The international community has repeatedly recognized and affirmed — in agreements ranging from the 1994 International Conference on Population and Development (ICPD) Programme of Action to the 2030 Agenda for Sustainable Development — that human rights and gender equality are bedrock necessities for a more peaceful and prosperous future for all. > Their right to bodily autonomy means just that: free and informed choice‚ unhindered by requirements to live in service to any broader demographic‚ economic‚ social‚ political‚ environmental or security claims. _ _ _ STATE OF WORLD POPULATION 2023 15 Perspectives from the public to policymakers To learn more about perceptions and anxieties around population in a world of 8 billion, this report undertook original research in the form of a general public survey and analysis, as well as a secondary analysis of a routine United Nations survey of government policies. Public survey The public survey, commissioned by UNFPA and conducted by YouGov, asked a representative sample of 7,797 people across eight countries (Brazil, Egypt, France, Hungary, India, Japan, Nigeria and the United States) for their views on population issues (see Technical note on page 172 for more information). The findings suggest that population anxieties have seeped into large portions of the general public. In every country surveyed, the most common view among respondents was that the global population was too large. In six countries (all except Japan and India), the most common view was that the global fertility rate was too high (Figure 1). Between 47 per cent (Japan) and 76 per cent (Hungary) of adults believed that the current world population was too high while between 26 per cent (Japan) and 60 per cent (France) believed the global fertility rate of 2.3 children per woman was too high. Still, many people did not share this view, and there was variety among and within countries. Between 13 per cent (France) and 30 per cent (Nigeria) believed the global population was about right. Every country had appreciable numbers of respondents who did not have an opinion and who believed population and fertility were too low. In Hungary and Japan, To this end, we must aim for a world in which the consequential act of bringing a child into the world — including the timing and circumstances of each birth — is an act of agency, an affirmation of choice and an expression of hope. Decision makers can better build resilient populations not by setting targets and stifling choices but by pursuing policies that enable individuals to realize their own reproductive ideals and broader well-being, including through education, health care, clean water, opportunities and more. Our Human Family, 8 Billion Strong16 the two countries with the lowest fertility rates of those surveyed, the majority of adults felt domestic fertility rates were too low. Another notable finding was that exposure to messages and rhetoric about the world’s population — whether via media, general conversation or other modes of communication — appeared to be linked to greater concern about population size, fertility rate and immigration. In all countries, those who reported being exposed to media or conversations about the world’s population in the past 12 months were substantially more likely to view the global population as being too high. This trend was starkest in Japan, where 68 per cent of those with media or messaging > FIGURE 1 S ource: UNFPA/YouGov survey 2022. Views on global fertility rate held by survey respondents France Hungary NigeriaBrazil Egypt India USAJapan 20% 40% 60% 80% 100% Too high Too low About right Don’t know > Exposure to messages and rhetoric about the world’s population appears to be linked to greater concern about fertility rate and immigration. _ _ _ STATE OF WORLD POPULATION 2023 17 exposure believed the world population was too high while only 29 per cent of those without messaging exposure believed the same. In every country, those who had not seen any media coverage or messaging about the population were more likely to report “don’t know” when asked if the population was too big, too small or just right. Similarly, those exposed to rhetoric or media messages about global or domestic population size were more likely to say the global fertility rate was too high. Although it’s not possible to ascertain a causal relationship (rhetoric may contribute to population anxiety, for example, but people with population anxiety may also better recall or more actively consume Our Human Family, 8 Billion Strong18 trends. A notable uptick is evident in the number of countries adopting fertility policies with an express purpose to raise, lower or maintain fertility rates. Countries that state an intention to raise fertility through policy and those with no stated fertility intention have similar levels of human development. But tellingly, those countries without policies seeking to influence fertility rates have much higher scores on human freedom, as measured by the Human Freedom Index, compared to those with fertility targets (regardless of whether the goal is to raise, lower or maintain fertility). These global averages mask subnational diversity and variation among individual countries, but generally speaking they suggest that countries without fertility targets do better in prioritizing people’s rights. (For more information, see Technical note on page 173.) While the most recent Inquiry survey, from 2021, does not report on governments’ fertility policies, it does allow governments to report on whether they have any laws or regulations that guarantee access to certain reproductive and sexual health services, including maternity care and various family planning services, and whether access to these is limited by contradictory plural legal systems or other restrictions based on age, marital status or third- party authorization (e.g., spousal, parental, medical). The analysis finds no connection between countries’ fertility rates and the accessibility of their sexual and reproductive health services. In other words, countries reporting greater restrictions on sexual and reproductive health and rights are no more likely to have higher- or lower-fertility rates. information about population), what is clear is the value of ensuring that rights and choices remain central in dialogue and messaging around population issues. One particularly crucial finding arose when respondents were asked to identify what issues were of greatest importance to them when thinking about population change within their own countries. In all countries except Japan, issues related to policies on sexual and reproductive health and rights, as well as other human rights, were a significant concern for many (see page 46 for more information). The centrality of rights rarely finds its way into discourse about “over-” and “under-” population as expressed by politicians and the media, but it appears that rights and policies are present in the public’s mind, as are concerns about the economic and environmental impacts of population change. Secondary analysis The secondary analysis looks at data submitted by governments to a United Nations survey of government policies, the Inquiry Among Governments on Population and Development, which has been routinely conducted since 1963. These data offer the only comparative view into the perspectives of governments on national populations, an utterly unique set of data showing how governments describe and approach critical aspects of population change and international migration within their borders. The analysis focused on responses from 2015, 2019 and 2021, predating the announcement that humanity has reached 8 billion people. Still, the responses seem to indicate a rise in anxiety among governments when it comes to their populations and fertility STATE OF WORLD POPULATION 2023 19 commonplace. Similarly, countries with lower income levels were not found to have more restrictive access to contraception and maternity care than higher-income countries, suggesting that political choices, not resources, explain differences in access. This analysis, along with the research elaborated throughout this report, indicates that when sexual and reproductive health services are viewed, even rhetorically, as tools to achieve fertility goals, the results can be counterproductive. However, these data also show there is a concerning connection between restrictions in one sexual and reproductive health domain and those in others (Figure 2). For example, countries curtailing access to maternity care also tended to have more constrained access to contraception. Greater limits on contraception correlate with more barriers to abortion and post-abortion care. This suggests that, while fertility rates do not seem to be reflective of restrictions in reproductive health services, the restrictions certainly reflect gender-unequal norms. Further, these norms remain tragically > FIGURE 2 Sou rce: United Nations Inquiry Among Governments on Population and Development, 2021. For information on restrictions, see Technical note on page 174. Correlations between restrictions to access in sexual and reproductive health and rights services 1 2 3 4 5 6 7 8 0 4 8 12 16 Av er ag e re st ri ct io ns to a bo rt io n an d po st -a bo rt io n ca re Av er ag e re st ri ct io ns to m at er ni ty c ar e Number of restrictions to accessing contraception Number of restrictions to accessing contraception Number of restrictions to accessing contraception Av er ag e re st ri ct io ns to m at er ni ty s er vi ce s 1 2 3 4 5 6 7 8 7 8 0 4 8 12 16 1 2 3 4 5 6 0 4 8 12 16 Our Human Family, 8 Billion Strong20 Hope in an age of anxiety People cannot have too many or too few children under any definition but their own. What can be extraordinarily good or disastrously bad, however, are the ways we respond to population numbers and trends. Extraordinarily good outcomes can happen when policies are evidence-based and human rights are affirmed, and disastrously bad outcomes happen when we react to the real challenges of population change by prescribing fertility solutions that undercut human rights — or by ignoring population change altogether. In many ways, population anxiety may be an understandable reaction to the world’s many uncertainties. But despair only diverts attention away from the problems that need addressing and saps motivation to manage challenges associated with demographic change — and these challenges can, indeed, be managed. Countries and people can thrive in a world of demographic change. While people have never been more numerous than they are today, and total population numbers will continue to grow for several decades, the latest United Nations projections suggest that the rate of global population growth has fallen, and has been at less than 1 per cent since 2020 (Figure 3). This is largely due to declining fertility; around two thirds of people live in a country or area with a total fertility rate at or below 2.1 children per woman (widely considered the “replacement fertility” rate, also called “zero-growth fertility” rate, an idea explored on page 60). In some cases, falling populations will be due to higher emigration (UN DESA, 2022a). The population growth > FIGURE 2 Sou rce: United Nations Inquiry Among Governments on Population and Development, 2021. For information on restrictions, see Technical note on page 174. Correlations between restrictions to access in sexual and reproductive health and rights services 1 2 3 4 5 6 7 8 0 4 8 12 16 Av er ag e re st ri ct io ns to a bo rt io n an d po st -a bo rt io n ca re Av er ag e re st ri ct io ns to m at er ni ty c ar e Number of restrictions to accessing contraception Number of restrictions to accessing contraception Number of restrictions to accessing contraception Av er ag e re st ri ct io ns to m at er ni ty s er vi ce s 1 2 3 4 5 6 7 8 7 8 0 4 8 12 16 1 2 3 4 5 6 0 4 8 12 16 STATE OF WORLD POPULATION 2023 21 that remains largely stems from the inbuilt momentum of current numbers of people and improvements in life expectancy, not fertility rates. This report explores the mix of fears and anxieties arising from these trends. Chapter 2 considers the view that there are simply “too many” people, leading to climate change and environmental destruction. The Intergovernmental Panel on Climate Change has described growth in per capita gross domestic product (GDP) and population growth as the strongest drivers of emissions from fossil fuel combustion in the last decade. Yet these projections are not purely about population numbers. Growth in per capita GDP is outstripping gains in efficiency, underlining the critical role of consumption patterns in emissions (IPCC, 2022). Typically, those who are well-off and able to consume more produce more emissions and have a much greater impact on climate change. And they are a minority of the human family. Out of 8 billion people, around 5.5 billion do not make enough money, about $10 a day, to consume much and contribute much to emissions, if anything at all (Kanem, 2017). So while population numbers are essential to > FIGURE 3 World population growth rate, 1950–2021 0.5 1.0 1.5 2.0 2.5 4 2 6 8 10 12 1950 1960 1970 1980 1990 2000 2010 2020 A ve ra ge a nn ua l c ha ng e of p op ul at io n si ze (p er ce nt ag e) Population, billions Number of persons Growth rate Source: UN DESA, 2022. Our Human Family, 8 Billion Strong22 understanding climate concerns, fixating on numbers alone can obscure the actions that all countries need to take to meet these challenges, from cutting emissions to financing the efforts of poor communities to adapt to climate change. Chapter 3 addresses anxiety over shrinking populations, fears that are increasingly common in places where fertility is low and where concerns either about nations disappearing or being “taken over” by minority or migrant groups have risen. Movements in some European countries and elsewhere have pushed to stop the “great replacement” supposedly posed by increased migration, and have called on women to have babies to shore up population numbers instead (Goetz, 2021). Yet history repeatedly shows that neither restrictions on reproductive freedoms nor cultural exhortations for women to have more children are effective in reversing fertility declines or increasing population numbers overall. A related concern addressed in Chapter 3 is population ageing, a phenomenon taking place everywhere but felt most acutely in low- fertility countries. The fact that people are living longer and healthier lives than at any time in human history should be seen as a > FIGURE 3 World population growth rate, 1950–2021 0.5 1.0 1.5 2.0 2.5 4 2 6 8 10 12 1950 1960 1970 1980 1990 2000 2010 2020 A ve ra ge a nn ua l c ha ng e of p op ul at io n si ze (p er ce nt ag e) Population, billions Number of persons Growth rate Source: UN DESA, 2022. 23 > Using the language of rights This interdisciplinary report brings together scholarship from a variety of fields and, in doing so, finds incongruities in how various academic traditions, practitioners and political actors speak about and understand population issues — and in particular how they speak about fertility trends and patterns� The very same words can communicate different meanings depending on who is talking and who is listening. At the “macro” level, where many demographic experts and policymakers operate, fertility is often approached as simply one of three components of population change (along with mortality and migration), and calls to “reduce” or “boost” it are common. Policies designed to increase or decrease fertility are seen not only as beneficial to societies but often also as rights affirming and empowering for individuals, especially when accompanied by the caveat that such policies must avoid coercion. But heard from the perspectives of people who have historically been — or currently are — denied reproductive autonomy, this same language conspicuously fails to account for the agency of individuals. For decades, feminist academics, among others (Hartmann, 2016; Smyth, 1996), have noted with concern that family planning programmes have been used, even promoted, as tools for fertility reduction rather than tools by which to secure women’s and girls’ autonomy� In this view, neglecting to specify reproductive rights and choices as the foremost objective of any population policy necessarily opens the door to pressure, coercion and abuse. It is possible to bridge these gaps when we talk about fertility rates and population policies, by making reproductive rights the starting point rather than an assumption or afterthought� This is not a rejection of the seriousness of population concerns, which require rational, evidence- and human rights-based population policies� Such policies must be designed and explained with care, understanding that language is an instrument of power and that real lives are at stake� This report uses the following terms with the following definitions: population control – the practice of intentionally controlling the growth, size or distribution of a human population (this term is widely associated with measures that violate human rights, such as forced sterilization programmes, but in some contexts it continues to be used to describe family planning programmes without any negative connotation [Sari and others, 2022]). demographic anxiety – fear, whether founded or unfounded, arising from population size, population change, population composition or fertility rates� Our Human Family, 8 Billion Strong24 demographic resilience – the quality or state of being able to adapt and thrive amid demographic changes (see box on page 27). population targets – numbers or number ranges of people that are the goal of any given population policy� fertility targets – fertility rates or fertility rate changes that are the goal of any given population policy� population policies – policies concerning a range of population issues, including population size and growth, population distribution by age, fertility and marriage, reproductive health and family planning, health and mortality, spatial distribution and urbanization, and internal and international migration� These policies are often not comprehensively contained within a single framework, ministry or programme but rather touch upon the work of many different agencies and divisions within governments� fertility policies – policies related to fertility, most notably those related to reproductive health services; however, in this report “fertility policies” refers specifically to policies which countries themselves have identified as intending to influence fertility rates (whether to maintain, reduce or increase) in their responses to the Inquiry Among Governments on Population and Development� high fertility – in this report, the term “high fertility” is used in a comparative sense rather than as a fixed fertility threshold tied to a specific total fertility rate. While the term, as used in the report, generally points to fertility rates that lead to population growth — those above approximately 2.1 children per woman (see page 60) – it recognizes that perceptions of what constitutes high fertility are subjective and context specific. low fertility – likewise, “low fertility” in this report is used in a comparative sense rather than as a fixed fertility benchmark tied to a specific total fertility rate. While the term, as used in the report, generally points to fertility rates that do not contribute to population growth — those at or below approximately 2.1 children per woman (see page 60) — it recognizes that perceptions of what constitutes low fertility are subjective and context specific. STATE OF WORLD POPULATION 2023 25 major accomplishment, yet fears about ageing populations are common — including worries of diminishing national power, unsustainable public budgets and weakening economies. Experience shows that many of the issues associated with decreasing population size and ageing can be managed. One of the most impactful solutions, in fact, is the empowerment of women (UN DESA, 2023a). Chapter 4 illustrates why women’s empowerment and bodily autonomy belong at the centre of population conversations. Too many women around the world are unable to achieve their reproductive aspirations. In broad strokes, many women in high-fertility countries report having more children than desired while many women in low-fertility countries report having fewer children than desired. Yet to assume that all women in certain settings desire fewer children while those in other settings desire more is to erase crucial complexities. For example, there is a tragically high prevalence of infertility in low-income, high-fertility countries, including in sub-Saharan Africa (Inhorn and Patrizio, 2015). In contrast, there are persistently high levels of unmet need and low levels of satisfied demand for modern contraception in many low-fertility countries, including countries in Asia and Eastern Europe (Haakenstad and others, 2022). Moreover, many patriarchal assumptions about women’s reproductive wants and roles are counterproductive for both families and individuals. Chapter 5 offers solutions aimed at using family planning and gender-equality programmes not as tools to achieve population goals but as goals in themselves. Instead of focusing on whether fertility rates are “too high” or “too low”, leaders might more productively ask whether people are able to choose, freely and responsibly, the number and timing of their children, if they are able to exercise reproductive choice and bodily autonomy, and if they can access health services with confidentiality and dignity. When reproductive rights are undermined, which people are most affected? How can their needs be met, their voices heard and their rights upheld? Inclusion is a core solution, at every level, spanning a more expansive vision of what families are and can look like, a comprehensive array of reproductive health services, a holistic definition of what population is, and an inclusive vision of who is counted and who belongs. This chapter also highlights the importance of looking at solutions beyond fertility and reproduction. Beyond alarmism, towards empowerment We have the tools and frameworks to move beyond alarmist debates over “too many” or “too few”. One example is the international call for sexual and reproductive justice, which requires addressing the diverse forms of discrimination and injustice that people face in realizing their rights. Applying it, as has already been done in countries such as South Africa (McGovern and others, 2022), implies putting aside fertility targets and ensuring that people, with no exceptions or exclusions, have the best chances to make their own choices. This means providing quality and affordable health services, a liveable income, a clean environment, and safety from violence and stigma, among other core elements. Our Human Family, 8 Billion Strong26 would be one that avoids putting human bodies in the service of economic, political, security or any other national goals, and instead upholds human rights and advances human well-being so that all members of a society have choices about how to live and thrive. In the end, population anxiety is an easy way to avoid the complexities of the challenges we face. For some, it offers the comfort of clinging to the status quo. But indulging in it will do little to move our human family forward. Progress requires us to imagine the world not as it is but as it could be, one in which every individual can realize their full potential, one in which the most consequential reproductive choices of a person’s life — whether, when and with whom to have a child — are made freely and responsibly. That world is a future within our reach; the path there is ours to make. Another important approach is the movement for demographic resilience, a new view of population policies and actions where societies anticipate changing demographic trends and adapt and harness opportunities accordingly, all while keeping human rights at the centre of any intervention. This is a more balanced, positive and comprehensive approach than piecemeal concerns about fertility levels or population numbers (Armitage, 2021). In Cairo in 1994, at the ICPD, governments agreed that the aim of any population policy should be to ensure the reproductive rights, choices and sexual health of people, rather than to achieve demographic targets. Fertility targets should not become goals in and of themselves; rather, very high- or low-fertility rates are often a symptom of widespread loss of bodily autonomy and reproductive choice. A more stable and productive social contract > Demographic resilience Demographic resilience describes the ability of a system to adapt to, anticipate and thrive amid demographic changes. As populations inevitably fluctuate, there is a growing call for States to better understand these changes to ensure they have the skills, tools, political will and public support to effectively mitigate potentially negative effects for individuals, societies, economies and the environment, and harness the opportunities that come with demographic change for people, prosperity and the planet� In contrast to reactive approaches to population change, which seek to manipulate or control natural trends, an approach which centres on demographic resilience attempts to prepare for such changes to ensure that the needs and rights of everyone in a society are adequately met, regardless of its make-up� Population change is something to be planned for, not feared� A toolkit to help countries promote resilience amid demographic change can be found on page 132� STATE OF WORLD POPULATION 2023 27 It’s not about the number, it’s about the quality of life The world’s population reached 8 billion in November 2022. What does the general public think of this record number of people on the planet and how does this milestone affect them as individuals? How does it affect their communities and nations? Interviews were conducted with several individuals from the Arab States, a region where a higher- than-average fertility rate (2�8 births per woman compared to the world’s average of 2.3) is occurring in the context of water scarcity concerns, accelerating desertification (Abumoghli and Goncalves, 2019) and frequent humanitarian crises� Have these trends affected people’s perceptions of population growth or influenced their decisions about having children? One woman, Rama (name changed), said yes. “I don’t want to give birth to a child while living in these times,” the 30-year-old Syrian explains� “There are too many things to worry about today: safety, security, economic security�” In her opinion, the population of Syria is too large for the level of services that are available� Conflict has weakened the social safety net� She adds that many people facing hardship today are having children without the means to care for them� “It’s everyone’s right to have a child, but maybe it’s best to wait for the right conditions.” Rama hopes to one day adopt one of the country’s many children who have been orphaned or abandoned� Said (name changed), 45, says that the population of Oman may seem small compared to other countries in the region, but it’s growing fast, and it seems that people with fewer means are the ones having larger families� This is not a problem, he believes, so long as the country’s economy remains strong enough to provide jobs, especially for unskilled labourers� “I worry about what will happen if one day the economy takes a downturn and people lose their jobs,” he says� “And I worry about what a lot of unemployed young people will mean for stability�” FEATURE Our Human Family, 8 Billion Strong28 A key theme that emerged is that anxieties about population size are more often than not anxieties about being able to provide a good quality of life for everyone� Khaled, 51, says that the problem in his country, Yemen, is that population growth is outpacing “development growth”� He says Yemen has a large and rapidly growing working-age population right now, and the country could, in his opinion, see faster economic growth if young people were educated, in good health and able to find good jobs. He says women in particular need to participate more in the country’s development� “So our population can be a positive thing,” he says� Anxieties about population size are more often than not anxieties about being able to provide a good quality of life for everyone. © cloverphoto Photo by Jimmy Conover on Unsplash Photo by Nihal Karkala on Unsplash Photo by Nattalia Nunez on Unsplash STATE OF WORLD POPULATION 2023 29 IN FOCUS Interest in population size dates to antiquity. But no matter if populations were seen as too large or too small, there has been one consistent thread: disregard for the rights and choices of women and girls, and the exercise of power by some people over others. Early philosophers, including Confucius, Plato and Aristotle, contemplated how the number of people might influence the power and prosperity of a State (Charbit, 2011). Ancient Rome penalized childless women over the age of 24 by barring them from wearing precious metals, and imposed a tax on men who remained single (The Economist, 2020). In Europe, the end of the feudal system spurred interest in populations as a source of wealth, political power and military strength. Jean-Baptiste Colbert, an influential French statesman, promoted populationisme — a doctrine favouring population growth through high fertility or immigration (Pal, 2021). This era saw an emphasis on controlling and subjugating women as obedient reproducers of the workforce. Social norms stressed their roles as dutiful wives and mothers and discouraged protest. The transatlantic slave trade took off, forcibly moving people from Africa to the Americas and elsewhere; their bodies were counted as literal assets (Federici, 2004). At the end of the eighteenth century, declining living conditions in Britain spurred concerns around population growth. T. R. Malthus advanced his influential theory that unchecked population growth results in poverty, misery and war. His “population pessimism” still echoes in thinking today (Economics Online, 2021). In France, a century later, alarmism flared in the opposite direction when population decline became the scapegoat for the defeat in the Franco-Prussian war. Policies to encourage childbearing were put in place. Such views spilled over into the growing number of colonies held by European powers. British Governor of Bombay Sir Richard Temple promised his superiors in London that he would “increase the number of his Majesty’s subjects in India” (Randeira, 2018). After the independence of most Latin American countries in the first half of the nineteenth century, the new governments shared a pronatalist view, summarized in Juan Bautista Alberdi’s phrase “to govern is to populate”. Promoting population growth was seen as needed to protect the emerging countries from outside threats, from possible invasions from neighbouring countries and as a way to increase the number of workers and production. This pronatalist view lasted uncontested during the first six decades of the nineteenth century (Sánchez- Albornoz, 2014). By the twentieth century, the birth control movement had emerged in some parts of the world (MacNamara, 2018; Engelman, 2011; Fisher, 2006; Klausen, 2004; Grossmann, 1995; McCann, 1994; Reed, 1984), driven by ideas foundational to the suffragist struggle, including bodily autonomy and full and participatory citizenship (Prescott and Thompson, 2020). When mass-produced contraceptives became widely available in the 1920s, advocacy for contraception in India, then a British colony, became a moment to exert a sense of agency and a right to self-rule (Hodges, 2016). Healthy mothers were seen as the basis for a self-sufficient Too many, too few: the long history of population debates Our Human Family, 8 Billion Strong30 nation, and contraception was part of entering a new age of science, innovation and progress. In that same period, the Soviet Union became the first country to legalize abortions on medical and social grounds, among other advances. But by the 1930s, faced with slumping population growth, Joseph Stalin reversed these policies and arrested the statisticians behind the 1937 census because it showed a population decline (Arel, 2002; Blum, 1998). Declining fertility rates in Western Europe and the United States of America in the early twentieth century shaped the emergence of eugenics, an ideology thought to improve the “quality” of populations. It encouraged fertility among those with “desirable” traits and discouraged fertility among those with “undesirable” traits. “Inferior” groups typically were socioeconomically disadvantaged and/or marginalized minorities and persons with disabilities. Ideas of racial supremacy were also invoked in the evil ideology and policies of Nazi Germany and the horrors which were perpetrated; notions of “racial purity” culminated in the Holocaust. Some of these ideas were adopted in Latin America in the early twentieth century at a moment when immigration was seen as a way to increase the size and the “quality” of the population. Migration policies excluded individuals who were considered by governments to “represent a racial, moral or political risk”. Under these ideas, immigration from Western Europe was encouraged and preferred over the arrival of other groups such as immigrants from Africa, Asia, Eastern Europe or the Middle East (Yankelevich, 2020; Sánchez-Albornoz, 2014). The second half of the twentieth century saw many countries gain independence, the emergence of diverse movements to claim human rights, and family planning programmes and population policies oriented around reducing fertility around the world (Klancher Merchant, 2017). UNFPA and many other population-focused organizations and family planning programmes were founded as leaders reacted both to fears over the “population bomb” and to the potential of contraception to drive development and prosperity for the poorest communities. Popular narratives at the time typically gave little prominence to the reproductive desires of women; it was often assumed that women would want (or could be convinced to want) smaller family sizes, with development benefits for their broader communities. India established the first national programme to control population growth through family planning in 1952. This achieved limited success in slowing birth rates but also resulted in instances of excessive and even forced sterilization (Hartmann, 2016); it would take until the early 1990s for leaders to shift from a target- driven family planning programme to one based on women’s health and rights. Mixing national and international ideas about population control as a road to development, China, in 1956, adopted a policy to regulate population growth “for the protection of women and children, better educating and rearing offspring and bringing about national prosperity” (Yu, 1979). The notion that high population growth would impede development eventually culminated in the one-child policy in 1980 (Jackson, 2012). Some developing countries pushed back against the idea of population control, with ministers arguing, “Development is the best contraceptive” (Sinding, 2000). In other words, overall economic development would result in higher levels of education and health, including greater use of contraception, leading to lower- fertility levels. In Africa, mounting international pressure to institute policies to control population growth, including through development aid, was initially met with widespread resistance. African thinkers argued that the problem was not the size of their populations but their distribution. Low population STATE OF WORLD POPULATION 2023 31 density complicated efforts to develop infrastructure, for instance. Only six African nations had population policies in place by the early 1970s, but by 1990, all but two African governments had established policies with elements of population control, often emphasizing contraception. This took place as countries struggled to gain the means to advance their economies, develop their extensive and poor rural areas, and empower women (Pearce, 1994). In Latin America, the implementation of population policies based on birth control and the definition of growth targets started in the late 1960s and spread after the Population Conference of Bucharest in 1974. Within the region, debate concentrated on the way population policies were aligned or not with general social, health, educational and economic policies and on how demographic variables were integrated into national development strategies. Almost all countries implemented some type of family planning programmes, with variations in the emphasis, resources and relevance given by governments, and the participation of the public and private sectors (Miro, 2022, 1971). Different tendencies operated in countries under the Soviet Bloc. By the middle of the last century, many were concerned not about too many people but about too few. Some responses aimed at exerting a devastating control over women’s bodies, most notably in Romania. In 1966, the Ceaușescu regime severely restricted abortions and access to contraception to force more women to have babies (Socialist Republic of Romania, 1966). The population never reached a planned target of 30 million, however, peaking at 23.2 million in 1990. Until the policy was dropped in 1989, Romania saw spiking maternal and child mortality, and higher rates of malnourishment and severe physical disabilities (Kligman, 1998). Marginalized groups have been especially vulnerable to population control policies (Jean-Jacques and Rowlands, 2018). Federally sponsored mass sterilization campaigns in the United States had affected up to 42 per cent of Native American women by the 1970s (University of Rochester, 2019). In Japan, a 1948 forced sterilization policy for people with disabilities (Hovannisyan, 2020) remained in place until 1996, when the Government of Japan compensated victims of it. In the 1980s, Singapore briefly introduced incentives for highly educated women to have children and disincentives for women with lower levels of education (Wong and Yeoh, n.d.). Despite pronatalist policies in State-socialist countries, Roma minorities in Central and Eastern Europe were the target of antinatalist programmes and forced sterilization between the 1950s and the 1980s (Varza, 2021). Underlying ideologies around population control echoed throughout international talks on population in the latter half of the twentieth century, although acceptance of the human right to decide on the number and spacing of children gained ground, driven by the growing strength of women’s rights movements. First enshrined in the 1968 Teheran Proclamation, and propelled by mounting evidence of abuses and gaps in family planning services, this vision was most powerfully and successfully advanced by feminists and rights advocates, including civil society groups supported by UNFPA, at the landmark ICPD in Cairo in 1994 (UNFPA, 1994). The ICPD transformed the global consensus on how to approach population policy, moving it from numbers and targets to a central emphasis on human rights. Contraception was seen as integral to broader efforts to improve women’s health and empowerment (Hardon, 2006). Our Human Family, 8 Billion Strong32 Since then, although some governments have maintained population targets to increase or decrease fertility rates, many others have shifted the focus to ensuring sexual and reproductive rights and health. Still, old habits die hard, and the language and tools of the past continue to be used, even in countries that have disavowed target-based population policies. Measures continue to be designed and implemented to coax individuals to increase or decrease the number of their children towards a fixed notion of an ideal population size. STATE OF WORLD POPULATION 2023 33 CHAPTER 2CHAPTER 2 Too Many? STATE OF WORLD POPULATION 2023 35 threats. It erases from public imagination the steps needed to address such issues, including policies to promote sustainable consumption and production or to reduce inequality and poverty. It obscures the responsibility of systems and societies to find solutions to these complex and interconnected problems while upholding human rights. Many real challenges are waved away with a simple, nihilistic verdict: if global catastrophes are the result of too many people, the logical assumption that follows is that the number of people must be reduced, that some unknown number of people should survive and reproduce while others should not. “Too many” people. This phrase is uttered every day. It can be heard among drivers sitting in traffic. It may be spoken by shoppers in long queues for groceries and by consumers of news about the plunder of natural resources and rising global temperatures. From their perspectives, a world of 8 billion human beings is one bursting at the seams. “Too many” is a convenient summary, a tidy way of explaining away overloaded infrastructure, the climate crisis, biodiversity losses, economic instability, hunger and security There is ample evidence from history that the fears stirred by this false narrative lead to horrors and inhumanity (for more, see “Too many, too few” on pages 30-33). But there is another peril, too — the risk that in focusing on whether and how to subtract human beings from the planet, we will neglect entirely the root causes of so many global crises. Inequality, violations of human rights and lack of sustainable development are key drivers of the ill health, environmental degradation, poverty, hunger and tragedy so often blamed on “overpopulation”. “Too many” is also a deterrent to political action, in that it leaves citizens to lament the perceived inevitability of overpopulation, which is often predicted to lead to mass mortality events and draconian restrictions on human freedoms (Gerbrands, 2017). This thinking erodes the optimism required for voters and consumers to call upon governments, industries, distribution systems and infrastructure developers to respond productively and in good faith to the pressing challenges related to population growth. What else is lost with the ringing alarm of “too many”? The real and powerful story of progress, and the lessons of that progress. We start to see human survival as a problem rather than an achievement, and we retreat to ancient divisions — us versus them — instead of seeking common ground and solutions through solidarity and innovation for the common good. Yes, the choices ahead are complex and difficult. There are real concerns, real catastrophes to mitigate and avert — urgent and existential issues that will not be solved when they are expressed as problems of “too many”. This chapter shows that fears of “too many” are indeed pervasive, and it emphasizes how the real problems fuelling fears of overpopulation cannot be solved by efforts to manipulate population size or composition. It will highlight some solutions and how we can move forward, with clear eyes and hard evidence, to achieve a better future. Modern Malthusians Concerns about overpopulation have deep roots, most famously expressed by T. R. Malthus. In this view, the appetites of humanity will inevitably outstrip scarce resources. Today, in an age of uncertainty, these old beliefs are rising once again to the fore. When overpopulation alarmists talk about the needs of the planet, they are generally careful to avoid identifying who exactly they believe is reproducing “too much”, but for many listeners, the question of “who?” hangs in the air, unspoken. The idea that fewer people would automatically relieve pressures on the planet and allow ecological restoration is persistent (Cafaro and others, 2022). For example, one Western group of academics puts population “at the root of grave global environmental problems, from climate change to mass species extinction”. Its answer: limit human numbers. It argues, “Excessive family size sends tens of millions > What else is lost with the ringing alarm of “too many”? The real and powerful story of progress‚ and the lessons of that progress. _ _ _ STATE OF WORLD POPULATION 2023 37 of children to bed hungry each night in the developing world, where rapid population growth stresses scarce water, food and space resources beyond safe limits” (The Overpopulation Project, n.d.). Proponents of such thinking often link human population size to food insecurity, soil degradation, biodiversity loss, plastic pollution, the increased chances of pandemics, overcrowding, joblessness, deteriorating infrastructure, bad governance and conflict. These views call for “difficult conversations about population growth” among other policy measures like reining in consumption patterns, in order to avoid a “ghastly future” (Bradshaw and others, 2021). These claims have gained traction throughout the broader world. Famous broadcaster and naturalist David Attenborough’s statement in 2020 that humans have overrun the planet unleashed volumes of subsequent social media commentary (Manavis, 2020). A survey of Twitter comments found that the vast majority agreed with his overpopulation claims. The few dissenters mostly took the chance to deny climate change (Manavis, 2020). Yet there is surprisingly little evidence to link demographics and conservation efforts. “There is not, and never has been, a single, evidence- based model that has successfully calculated or predicted the global environmental impact of human numbers alone,” one expert writes (Sasser, 2018), a point acknowledged even by many proponents of the view that humankind is overpopulated (Cafaro and others, 2022). The rhetoric around overpopulation is not harmless. Even when calls for limiting human reproduction are accompanied by caveats about respecting human rights (Crist and others, 2022), the overarching logic continues to allocate responsibility for reversing global scarcity, environmental degradation and climate change to those who have had the least chance to access opportunities, have contributed less to these problems given lower levels of consumption, and whose rights are most easily undermined. Women and girls in particular see their bodies repeatedly invoked as the problem and the solution to “overpopulation”. CNN editor Eliza Anyangwe pointed out that “identifying population growth as the problem logically presents population control as the solution. This automatically transforms wombs into legitimate sites for climate policy. In other words, women’s rights to contraception and education are weaponized: they are no longer tools that help women access greater choice, but instead this gender equality goal is hijacked to impose someone else’s agenda” (Anyangwe, 2021). Additionally, marginalized communities, such as people living in the least developed countries and those who have experienced the worst poverty and dislocation, tend to find themselves on the losing side of the implied demographic “solution”. When high rates of population growth are identified as the problem, it becomes impossible to ignore that it is the poorest countries that tend to have the highest fertility and population growth rates. In other words, when viewed through a global lens, much of the “problem” of global population growth is being attributed to the bodies of impoverished sub-Saharan Africans and Asians who make the most minimal 38 Too Many? contributions to global environmental destruction and climate change (Bhatia and others, 2020). This dynamic exists within borders as well; in some countries with low-fertility rates, poor and marginalized communities have long been described as reproducing recklessly and prolifically (Brooks, 2021). Yet even immediate declines in fertility would not prevent population growth, demographers indicate. “Two thirds of the projected increase in global population > Women and girls in particular see their bodies repeatedly invoked as the problem and solution to “overpopulation”. _ _ _ 39 About one in six people in the world today are between the ages of 15 and 24, and the ranks of young people are growing rapidly, especially in sub-Saharan Africa� Some policymakers view this trend with alarm, seeing nothing but potential for political upheaval and violence� Persistent negative stereotypes about youth frame them as a problem to be solved and a threat to be contained, according to The Missing Peace, an independent progress study on the United Nations Youth, Peace and Security agenda (Simpson, 2018). But rather than being the problem, young people around the world today are increasingly part of the solution� Through their creative actions and “unapologetic advocacy”, young people are challenging the status quo in many sectors, according to the United Nations study� Youth creativity has reshaped culture and the arts� Youth movements have championed diversity and human rights� Energetic activism has offered an antidote to despair� “The momentum surrounding the global youth agenda is larger than ever before,” says Idil Üner, who, at age 24, manages a flagship initiative of the Office of the Secretary- General’s Envoy on Youth to recognize exceptional young leaders for the SDGs� Young people everywhere are making a difference, even though they rarely have a seat at the table where policy decisions are traditionally made, Üner explains� While almost half of the world’s population is under age 30, the average age of political leaders is 62 (Office of the Secretary- General’s Envoy on Youth, 2022). In some countries, the minimum age to run for public office is 40. Thus, most laws are enacted by people with a world view fundamentally different from those who have grown up in the fast-moving, crisis-beset, Internet-fuelled world of 8 billion� “For generations before us, power was something exclusive� It was hierarchical, bureaucratic, formal and institutional,” Üner adds� But for most young people today, she says, “Power means transparency not secrecy� Power is fluid, not hierarchical. Power is in mobilization… In many ways, young people are already designing their own futures by reimagining the way our systems operate and by demanding true power-sharing within those systems�” Gibson Kawago, for instance, a 24-year-old climate entrepreneur, radio personality and youth mentor in the United Republic of Tanzania, says, “Every young person should identify a problem in their own society and come up with a solution� That is the easy way for us to create solutions for the future�” At age 14, he created a solar battery to help members of his unelectrified village. Later, with the help of a business incubator, he started his own company, WAGA TANZANIA� The company recycles lithium-ion batteries and produces durable and affordable battery-powered products� Young people forge new paths FEATURE Too Many?40 Since 2019, WAGA has recycled over 3,100 lithium-ion batteries and created 32 jobs, all while keeping hazardous materials out of the environment. On top of that, Kawago’s can- do spirit and empowering messages reach a radio audience of some 12 million� Another youth leader, 24-year-old Paul Ndhlovu, from Zimbabwe, has an outsize influence. At Zvandiri (meaning “As I am” in the local language), an organization that provides peer-led support to HIV- positive young people, he has produced around 100 radio shows reaching an estimated 180,000 people over a recent 10-month period� Ndhlovu has seen policy changes informed by the show and by the group’s advocacy� “It’s all a collective effort,” he stresses� These stories suggest the scope of what young people can accomplish when their talents are supported and when they are included in decision-making� “Ultimately we are the ones most impacted by the choices we make, or fail to make, today,” Üner points out� “ In many ways, young people are already designing their own futures by reimagining the way our systems operate and by demanding true power-sharing within those systems.” For Idil Üner, young people everywhere are making a difference despite rarely having a seat at the table� Image courtesy of Idil Üner STATE OF WORLD POPULATION 2023 41 through 2050 will be driven by the momentum of past growth that is embedded in the youthful age structure of the current population,” the 2022 United Nations World Population Prospects report highlights (UN DESA, 2022). “Such growth would occur even if childbearing in today’s high-fertility countries were to fall immediately to around two births per woman. Given that most population increases until 2050 will be driven by the momentum of past growth, further actions by governments aimed at reducing fertility would do little to slow the pace of growth between now and midcentury.” Overall fertility is projected to fall to 2.1 births per woman — considered to be the approximate level required for long-term zero growth in a context of low mortality — by 2050 (for more on the limits of this 2.1 fertility rate, see page 60). Focusing only on the “problem” of high fertility, moreover, obscures the fact that population growth is driven in significant part by declining levels of mortality. Global life expectancy reached 72.8 years in 2019 — an increase of nearly 9 years since 1990, and it is expected to reach 77.2 years by 2050, even after considering the effects of the COVID-19 pandemic on mortality (UN DESA, 2022). The African Development Bank notes increased survival, with mortality declining more quickly than fertility, as a key contributor to population growth in sub- Saharan Africa (African Development Bank Group, 2014). In fact, even while mortality rates remain unacceptably high in the region, sub-Saharan Africa has seen transformative gains in human health and longevity since the end of colonialism (see Figure 4). > FIGURE 4 Comparison of crude death rate in sub-Saharan Africa with global crude death rate, 1960–2020 Source: UN DESA, 2022. 5 10 15 20 25 1960 1980 2000 2020 World Sub-Saharan Africa D ea th r at e pe r 1, 00 0 pe op le 42 Too Many? Further, the group Survival, which works with Indigenous peoples to protect their land rights, notes that Africa is only a fraction as densely populated as the United Kingdom, for example, and that the average person in the United States consumes 40 times as much food, energy, consumer goods and so on as the average African (Corry, n.d.). It has pushed back against a global drive to make 30 per cent of the Earth’s territory a “protected area”, stressing that this will continue a long colonial history of pushing Indigenous communities off their land, despite consistent evidence that these communities are highly sustainable custodians of natural resources (Maffi and Woodley, 2010; Pretty and others, 2009; Gadgil and others, 1993). > Extreme scenarios at work A harmful and disturbing version of “too many” people being the problem has emerged with the coupling of fascist movements and environmentalism, layered with White supremacism� One of the parents of ecofascism was Finnish writer Pentti Linkola who, in 2009, called for the “controlled pruning” of the human population and opposed reductions in infant mortality� He suggested genocide as a solution to both environmental and cultural destruction� Ecofascism’s deadly ambitions erupted in mass shootings in 2020 in both New Zealand and the United States, as only two recent examples� Both killers issued manifestoes listing environmental and White supremacist grievances (Amend, 2020). An analysis of 22 European far-right parties that sat in the European Parliament from May 2014 to September 2019 detected a discourse labelled “ecobordering”, which treats immigration as a threat to the local or national environment� Borders then become a form of environmental protection� Ecobordering depicts migrants, especially non-White migrants, as environmentally irresponsible “hordes” that have exhausted their own natural resources, and that threaten destination countries due to an absence of “belonging” to or “investment” in a local area (Turner and Bailey, 2022). In the United States, anxiety over non-White immigrants has fuelled racist conspiracy theories dubbed the “great replacement” (discussed further in Chapter 3), which largely skips any environmental reference points in favour of calls for immediate, violent action� “I think of America, the great assimilator, as a rubber band, but with this — we’re at the breaking point,” said the general counsel of a think tank in the state of Minnesota� “These aren’t people coming from Norway, let’s put it that way. These people are very visible” (Darby, 2019). STATE OF WORLD POPULATION 2023 43 > FIGURE 5 Respondents’ views on fertility rate and population size across eight countries surveyed France France Hungary Hungary Nigeria Nigeria Brazil Brazil Egypt Egypt India India USA USA Japan JapanFrance France Hungary Hungary Nigeria Nigeria Brazil Brazil Egypt Egypt India India USA USA Japan Japan 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% Too high Too low Don’t know About right Country fertility rates Global fertility rates Country population World population Source: UNFPA/YouGov survey, 2022. Views from the population How pervasive is the view that the world’s population is “too high” or that fertility rates are “too high”? In the representative YouGov survey of 7,797 people, across eight countries, the most commonly held view was that the current world population was too large (Figure 5). In six of the eight countries surveyed (Brazil, Egypt, France, Hungary, India and Nigeria), a majority of people — 53 to 76 per cent — held this perspective. In the two remaining countries (Japan and the United States of America), this view was held by the largest share of respondents, amounting to just under half of all people (49 and 47 per cent, respectively). Similarly, in six of the eight countries, the most commonly held opinion about the global fertility rate was that it was too high. Of course, this does not mean that the majority of those surveyed believe that the planet is overrun by people, nor does it mean respondents 44 Too Many? > FIGURE 5 Respondents’ views on fertility rate and population size across eight countries surveyed France France Hungary Hungary Nigeria Nigeria Brazil Brazil Egypt Egypt India India USA USA Japan JapanFrance France Hungary Hungary Nigeria Nigeria Brazil Brazil Egypt Egypt India India USA USA Japan Japan 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% 20% 40% 60% 80% 100% Too high Too low Don’t know About right Country fertility rates Global fertility rates Country population World population Source: UNFPA/YouGov survey, 2022. believe fertility rates are a tool for solving such a problem. In fact, views about respondents’ own population sizes were much more varied: in Brazil, Egypt, India and Nigeria, the most commonly held opinion was that the population in their own country was too large and fertility rates were too high, while in France, Hungary, Japan and the United States, the most commonly held opinion was that their own country’s population size was “about right”. In France and the United States, the most commonly held opinion was that the domestic fertility rate was about right, while in Hungary and Japan, the most commonly held view — representing more than half of adults in both — was that the fertility rate was too low. Some of these views may be unsurprising. For example, all four countries that view their domestic populations as too large have indeed experienced significant growth — more than quadrupling in size since 1950. But the survey also shows that population concerns cannot be reduced to simple or single factors. They are much more context specific. Interestingly, five out of the eight countries (Brazil, France, Hungary, Japan and the United States) had more respondents saying the size of the world’s population was too high compared to saying the same thing about the size of their own country’s population. This was particularly dramatic in Hungary and Japan. Respondents in two countries (India and Nigeria) were more likely to say their domestic population was too high than to say the global population was too high. In Egypt, respondents were equally likely to say that the population was too high on both a national and global level. When asked about the impact of potentially higher global fertility or higher domestic fertility, only France, Hungary, Japan and the United States (all members of the Organisation for Economic Co-operation and Development [OECD]) had more respondents viewing higher global fertility as harmful than viewing higher domestic fertility as harmful. > Forced sterilization Sterilization without full, free and informed consent has been variously described by international, regional and national human rights bodies as an involuntary, coercive and/or forced practice, and as a violation of fundamental human rights, including the right to health, the right to privacy, the right to information, the right to decide on the number and spacing of children, the right to found a family and the right to be free from discrimination (OHCHR and others, 2014). Numerous human rights bodies have recognized that forced sterilization is a violation of the right to be free from torture and other cruel, inhuman or degrading treatment or punishment (United Nations General Assembly, 1998). STATE OF WORLD POPULATION 2023 45 Respondents were also asked to identify which 3 out of 20 issues were of greatest importance to them when thinking about population change in their countries. After the authors classified these issues into 8 thematic categories, it was found that approximately two thirds or more of adults named various economic issues as top concerns for population change (Figure 6). Environmental concerns were the second most commonly cited priority in all countries except Hungary (where sexual and reproductive health and rights policies ranked as the second most commonly selected concern, followed by environmental concerns). Concerns over sexual and reproductive health and rights policies and over human rights generally ranked as the third most commonly selected priority in the aggregate, while issues of culture, the impact of ethnic groups and concerns about racism took fourth priority in the aggregate (see Technical note on page 173 for more.) Surveys in eight countries are not sufficient to generalize views for all the world. Still, the responses do make the case that demographic anxiety is real and, in those countries surveyed, widespread. They show that environmental > FIGURE 6 Source: UNFPA/YouGov survey, 2022. Note: Proportions add up to more than 100% because respondents identifi ed their top 3 concerns out of a list of 20 options (plus “don’t know” and “none of these”). Authors classifi ed these into the 8 broad categories above. More information available at Concerns about possible changes to population in countries surveyed 77% 60% 66% 77% 63% 62% 80% 66% 41% 34% 48% 28% 46% 47% 55% 42% 20% 31% 15% 33% 30% 40% 30% 22% 19% 36% 21% 20% 27% 31% 23% 20% 17% 26% 21%19% 22% 31% 17% 15% Brazil Egypt France Hungary India Japan Nigeria USA Economic Environmental Sexual and reproductive health policies and human rights Culture, ethnicity, racism Conflict and tensions Slums and urban sprawl Population decline Other/don't know 46 Too Many? concerns are indeed among the top causes of population anxiety — which might make people vulnerable to the claims of “too many” or indicate that alarmist rhetoric about “overpopulation” is influencing people’s views. The responses similarly highlight how differently people view their own country’s population and fertility rates, and those of the world at large. At the same time, there is enormous diversity in what people regard as their top concern. One takeaway lesson is that more research is needed to understand people’s concerns and that better communication about population issues is needed to ameliorate these concerns. Another is that members of the general public can and do hold nuanced and complex views about population, and they are disserved by simple narratives like “too many”. Sexual and reproductive health and rights, and human rights more broadly, are indeed at the front of many people’s minds when population issues are discussed, and therefore rights can and should have a central place in these conversations. Views from policymakers The United Nations Inquiry Among Governments on Population and Development, in its 2015 and 2019 iterations (the eleventh and twelfth Inquiries), asked, “What is the policy of the Government concerning the present level of fertility?” with the optional responses “raise”, “maintain at current levels”, “lower” and “no official policy”. Despite widespread anxiety about “overpopulation”, countries with the most wealth — those with the highest adjusted net income per capita (gross national income minus consumption of fixed capital and natural resources depletion) and highest gross national income per capita — tend to say they have no policies to influence fertility in one way or another (Figure 7). When countries reporting an intention to raise domestic fertility are grouped together, they represent the next highest level of wealth. Both groups of countries — those without policies to affect fertility and those intending to raise fertility — have very high per capita environmental impacts, as measured by carbon dioxide emissions per capita, material > FIGURE 6 Source: UNFPA/YouGov survey, 2022. Note: Proportions add up to more than 100% because respondents identifi ed their top 3 concerns out of a list of 20 options (plus “don’t know” and “none of these”). Authors classifi ed these into the 8 broad categories above. More information available at Concerns about possible changes to population in countries surveyed 77% 60% 66% 77% 63% 62% 80% 66% 41% 34% 48% 28% 46% 47% 55% 42% 20% 31% 15% 33% 30% 40% 30% 22% 19% 36% 21% 20% 27% 31% 23% 20% 17% 26% 21%19% 22% 31% 17% 15% Brazil Egypt France Hungary India Japan Nigeria USA Economic Environmental Sexual and reproductive health policies and human rights Culture, ethnicity, racism Conflict and tensions Slums and urban sprawl Population decline Other/don't know > FIGURE 7 Relationship between fertility policies and net national income per capita Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. 5,000 10,000 15,000 20,000 25,000 Lower Maintain Fertility policy Raise No policy N et in co m e pe r ca pi ta STATE OF WORLD POPULATION 2023 47 footprint per capita and consumption-adjusted carbon dioxide emissions per capita (Figure 8). In other words, countries with the highest levels of wealth and consumption are either agnostic about their own fertility rates or actively seeking to increase those rates. This pattern is also seen when looking at countries’ actual fertility rates, rather than their government-specified policy intentions. Countries are not asked in the United Nations Inquiry survey for their views on the size of the global population. Without these data, there are two possible interpretations of the above fertility policies: countries with high levels of development and affluence are perhaps not deeply concerned about “overpopulation”, or they are concerned about it but not about their own country’s contributions to it. In countries experiencing the highest levels of fertility, governments do indeed express concerns over population growth. The United Nations Inquiry response data show countries with high-fertility rates overwhelmingly reporting an intention to use policy measures to reduce fertility rates. When looking at circumstances within these countries, it seems likely that policies to reduce fertility rates are largely in response to concerns > FIGURE 8 Area marked in green indicates 3 tonnes of CO2 per capita or less; many believe sustainable consumption requires a per capital emission rate within this range. Dots in the fi gure are scaled to country population size. Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. Correlation between total fertility, fertility policy and consumption- adjusted carbon dioxide emissions per capita and population size To ta l f er ti lit y ra te Tons CO2 per capita Lower Maintain No policy No response Raise 1 2 3 4 5 6 7 0 5 10 15 20 25 30 35 40 45 Countries with the highest fertility rates tend to be the lowest per-capita emitters of carbon dioxide� 48 Too Many? > FIGURE 8 Area marked in green indicates 3 tonnes of CO2 per capita or less; many believe sustainable consumption requires a per capital emission rate within this range. Dots in the fi gure are scaled to country population size. Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. Correlation between total fertility, fertility policy and consumption- adjusted carbon dioxide emissions per capita and population size To ta l f er ti lit y ra te Tons CO2 per capita Lower Maintain No policy No response Raise 1 2 3 4 5 6 7 0 5 10 15 20 25 30 35 40 45 Countries with the highest fertility rates tend to be the lowest per-capita emitters of carbon dioxide� around being able to afford the needed investments in education, health and social services that would lead to improved welfare and broader economic prosperity. Countries with higher-fertility rates see a strong correlation with lower female life expectancy (Figure 9). Many of the drivers behind curtailed life expectancies are directly related to reproductive health care: people in countries with weaker health systems experience higher barriers (including financial and logistical) to accessing contraceptive information and services, higher rates of unintended pregnancy, and higher risks of maternal, neonatal and under-5 mortality (Starrs and others, 2018). > FIGURE 9 To ta l f er til ity r at e Lower Maintain No policy No response Raise Births per 1,000 adolescents Adolescent birth rate 1 2 3 4 5 6 7 8 0 50 100 150 200 Years Life expectancy, female 1 2 3 4 5 6 7 8 40 50 60 70 80 90 Years Healthy life expectancy, female 1 2 3 4 5 6 7 8 40 50 60 70 80 90 Deaths per 100,000 live births Maternal mortality rate 1 2 3 4 5 6 7 8 0 500 1,000 1,500 Correlation between total fertility rate, fertility policy and other development indicators For information on healthy life expectancy and life expectancy, see Technical note on page 174. Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. > Countries with the highest levels of wealth and consumption are either agnostic about their own fertility rates or actively seeking to increase those rates. _ _ _ STATE OF WORLD POPULATION 2023 49 The reciprocity between fertility and mortality rates plays out most starkly in settings with the highest fertility: higher- fertility rates very strongly correlate to higher maternal death rates and higher adolescent birth rates (which also carry a higher risk of maternal injury and death), while higher overall mortality rates could incentivize higher fertility. For instance, one respondent to a Kenyan questionnaire on contraception explained, “Young men say that they want to have many children first, then do [family planning] later. They wonder, suppose they get only two children and the two die, what will happen next?” (NCPD, 2014). According to the 2021 World Population Policies report, 69 countries have population policies to lower fertility; just over half are in sub-Saharan Africa (UN DESA, 2021). In these countries, the report notes, raising the age of marriage or union formation, raising the age of the mother at the time of her first birth and increasing the interval between successive births “are considered to be effective means to improve sexual and reproductive health and to help reduce fertility levels”. All of these are important policy and development efforts to be applauded; they are known to support the health, rights and empowerment of women and girls, with value well beyond their impact on national fertility rates. But problems can and do arise if such efforts are tied to a fertility target — either expressly in the text of policies, or implicitly as interpreted by local officials or service providers — rather than specifically intending to help individuals secure their sexual and reproductive rights. When rights and choices are secondary To critique concerns about “too many” as overbroad and alarmist is not the same as dismissing concerns related to population growth or high rates of fertility. Many concerns are valid, including those around the impacts of population growth when it takes place without investments in sustainable development and advances in human well-being. Family planning can help address these worries and support declining fertility, yielding “a demographic dividend by reducing the dependency ratio, increasing women’s participation in the paid labor force, and allowing increased investments in human and physical capital” (Liu and Raftery, 2020). This paradigm has been well known for decades. In fact, the goals of both those concerned with “too many” and advocates of reproductive and human rights are aligned in most respects. Both call for greatly expanding access to high-quality contraceptive services and information. Both call for investing in girls’ education and women’s economic empowerment. Both highlight the development benefits that accrue to societies and countries more broadly when individuals are able to responsibly plan their families, secure an education and invest in their children. Both also note the broad development gains that can be achieved in the years following fertility decline (Mayhew and others, 2020; Janetos and others, 2012). Where these two camps diverge is in decision- making. Who is exercising agency and reproductive choice? This question cannot be 50 Too Many? answered unless we ask what individuals want for themselves. Overpopulation anxiety can lead to proposals to manage, or even control, human populations (Cafaro, 2012), which, in the worst cases, can lead to forced, top-down population policies. But even when the most coercive practices are eschewed, the belief that populations can or should be calibrated by experts leads to a kind of “soft” targeting through persuasion and incentives — “non- coercive population control” is a term sometimes used (Cafaro, 2012). These targets seek to convince people of the “benefits of investing in smaller families…[and] the ways that a shrinking population contributes to securing the best lives possible for future generations everywhere” (The Population Dimension, 2021). Promoting family planning in this way, with reproductive agency as a secondary consideration, may actually undermine the acceptance of contraception and the commitment to reproductive rights (Nandagiri, 2021; Senderowicz, 2020). Marginalized groups, particularly those in developing countries that receive donor funds for family planning programmes, have long expressed concerns about contraception being imposed by government actors for shadowy purposes. These fears see a connection between historical policies of eugenics (Thorburn and Bogart, 2005), colonialism (Kaler, 2003), genocide and modern reproductive health initiatives. “Too close an identification of the family planning programme with foreign donors can lead to accusations of intended genocide,” warned a 2012 publication directed towards programme implementers (Bongaarts and others, 2012). These fears — that family planning is a foreign imposition — continue to find expression within communities (Mwaisaka and others, 2020; Thorburn and Bogart, 2005), academia (Bendix and others, 2020; Wilson, 2018) and even among state leaders (Anon, 2022; Yeginsu, 2014). They are exacerbated when policymakers in more affluent countries frame family planning programmes as a means to fix concerns about “too much” fertility and population growth in other countries. For example, an official from one country noted that aid for family planning programmes would — in addition to supporting women’s and girls’ autonomy and health — also help to reduce high population growth rates in Africa, and therefore migratory pressures on Europe (BBC, 2017; ReliefWeb, 2017). This latter objective was widely circulated in the media (BBC, 2017; Bergin, 2017), as it echoed old narratives alleging that family planning was a STATE OF WORLD POPULATION 2023 51 tool of the “population control lobby” imposing Western values on non-Western communities (BBC, 2017; Pearce, 1994). Both global and national family planning programmes are still often evaluated mainly by their ability to increase contraceptive uptake and reduce fertility. Even if programmes fully embrace the language of rights and empowerment, there is a risk of coercion if their ultimate goals are understood — by administrators, service providers or others — to be the steering of people’s choices. Studies of contraceptive provision in low-income countries have found women reporting biased or directive counselling, misinformation, limited contraceptive choices, method denial, a refusal to remove implanted contraceptives and non- consensual provision of long-acting methods (Senderowicz and Kolenda, 2022; Tumlinson and others, 2022; Senderowicz, 2019). Family planning targets can also obscure gender- based and other forms of discrimination. In India, when some states proposed a two-child policy in 2021, including financial incentives for sterilization as well as penalties, in the form of lost benefits and debarment from certain government jobs and local elected office, for those who exceeded the target family size (Nagabhushana and Sarkar, 2022; Ellis-Petersen, 2021; Government of Assam, Health and Family Welfare, 2017), commentators pointed out some of the deleterious effects of such policies: “sex- selective abortion, preference for male children, denying the paternity of female children, prenatal sex determination, and violence against women for giving birth to girl children will be on the rise” (Mishra and Paul, 2022). Other commentators noted that such policies would disproportionately affect vulnerable sectors of society (Tyagi, 2021) and members of religious groups with higher birth rates (Rao, 2022; Dash, 2021; Ghosh, 2021). Emphasizing its opposition to coercion in family planning, the national government stated in several forums, including in Parliament, that it did not condone such policies, noting that they would prove to be “counter-productive” (Government of India, 2021). In 2012, doctors in Uzbekistan spoke out about the use of sterilization to reduce the population rate, which included relying on arguments to poorer patients that they could not afford more children (Holt, 2012). None of these concerns undermines or invalidates the importance of voluntary family planning programmes, which have been foundational to many health and rights advances in recent decades. Family planning programmes have cut maternal mortality rates, averting an estimated 150,000 maternal deaths in the past year alone (FP2030, 2022), and they are strongly associated with reductions in adolescent pregnancy (UNFPA, 2020) and improved educational attainment (Stevenson and others, 2021). Declines in fertility, including in countries that once had high rates, largely represent the fact that more people have the means and opportunities to exercise their rights and choices. Indeed, economic and development gains are worthy reasons for promoting family planning efforts in aggregate, and may even serve as more compelling incentives for donors or leaders than human rights alone. But while economic and development benefits of family planning programmes are powerful and laudable, they should not be secondary to the essential goal of empowering women and 52 Too Many? Additionally, it is important to acknowledge that family planning can encompass much more than contraceptive information and care; it can include supporting those who want to become pregnant, a desire that is no less valid when it takes place in a country with a high- fertility rate. In fact, researchers have long noted that developing countries with high-fertility rates often have the paradoxical experience of high rates of infertility (ESHRE Taskforce on Ethics and Law, 2009), representing a loss for those unable to realize their reproductive goals (see page 137 for more). Putting people at the centre Historically, the links between economic outcomes and population were issues of debate (Sinding, 2009) — population growth was alternatively seen as a benefit, an obstacle and even irrelevant in terms of economic growth (Fox and Dyson, 2015). Some evidence suggests that the association depends on different periods in time, pointing to how a buoyant global economy in the middle of the last century obscured negative consequences from high population growth. While the balance of studies today shows that demographic transitions — the movement from high to low fertility — offer a powerful opportunity to generate an economic and developmental gain in the form of a so-called “demographic dividend” (UNFPA, 2018; Lee and Mason, 2006: Bloom and Williamson, 1998), the crux of this gain is not mechanical. It is human. Family planning programmes must be accompanied by other advances to human welfare, such as increased equality, the expansion of education and more stable employment, to girls to exercise choice over their own bodies and futures. Experience shows that when contraceptives are viewed as tools for something other than promoting individual health and empowerment, women and girls are vulnerable to harmful consequences. In the case of one community in the United States in the 1960s, fears around “Black genocide” led male leaders to reject Government-funded contraceptive services, a decision forcefully opposed by the women of the community (Caron, 1998). Similarly, injectable contraceptives were banned in post-colonial Zimbabwe due in part to the fact that the method was closely associated with colonial population control strategies — despite the high popularity of the method among women, who often saw the injectable contraceptive as a means of regulating their own fertility without interference from partners and relatives (Kaler, 1998). And reproductive rights advocates in the United States have warned that overzealous and targeted promotion of long-acting reversible contraceptives could paradoxically reduce choice for the most marginalized women (Gomez and Wapman, 2017; Gomez and others, 2014). Male opponents of contraception often see it as undermining their own authority over their partner’s sexuality and reproduction (Kabagenyi and others, 2014; NCPD, 2014). The most recent SDG data find that, in 68 reporting countries, just 56 per cent of partnered women are able to make decisions about health care, contraception and sex (UNFPA, 2023). Given these low levels of bodily autonomy, family planning programmes must exercise care to ensure that decision-making power over a woman’s body is not simply relocated from her partner to the State or vice versa. STATE OF WORLD POPULATION 2023 53 maximize benefit (Fletcher and others, 2014) and to continue the trend of global progress. Family planning alone, without improving the low status of women and girls around the world, will likely have only a limited impact on broader economic and social development. In fact, the world has made great progress in making contraceptive services and information more available. While lack of knowledge about contraceptives was the most commonly cited reason for non-use in the 1980s, it is now among the least common reasons, a heartening trend (Sedgh and others, 2016). Still, research shows that, in 2023, 41 per cent of partnered women are not using modern contraception (UN DESA, 2022c), highlighting the importance of creating environments that enable women to achieve their reproductive goals. That means doing more than distributing contraceptive commodities but also providing comprehensive sexuality education (inclusive of facts about human rights and gender equality), health services that provide gender-responsive care and the broadest possible contraceptive method mix, and — critically — overall improvements in gender equality to overcome opposition to contraception that is driven by patriarchal norms (Abbing, 2017). The case for hope In today’s world of unease and uncertainty, we need to talk about population issues. But we must do so in new ways that uproot current biases and avoid perpetuating harmful discriminatory norms and myths. Malthus himself offers a case in point. He forecast that a growing population would outstrip the food supply, but missed how rapidly agricultural productivity improved. In the end, this left his prophecy unrealized (Ojeda and others, 2020). Malthus also overlooked the critical issues of disparities in resource consumption and inequalities, which lie at the heart of crises such as famines as well as the climate emergency today. In the end, the mantra of “too many” risks reinforcing, even unintentionally, old notions of who is “valued” and who is not. And it does not grapple with the broader questions of agency, autonomy, rights or justice that surround two core population issues: reproduction and migration (the issue of migration is addressed in chapter 3). Contrary to the alarm bells about exploding numbers, population trends everywhere point to slower growth and ageing societies (see Chapter 3). Just eight countries will account for half the projected growth in global population by 2050 — the Democratic Republic of the Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, the Philippines and the United Republic of Tanzania — while two thirds of people now live in a country where lifetime fertility corresponds with zero growth. The World Bank points out that “demography need not lead to disaster”, referring to these trends. In countries experiencing a demographic transition — where fertility rates decline, life expectancy rises and workforces grow — human capital investment can trigger a demographic dividend, not only through greater economic productivity but also from more health, education and empowerment (all of which are also associated with declining fertility rates) (Gorvett, 2022; Canning and others, 2015). 54 Too Many? Other evidence has shown that higher levels of human capital can offset environmental impacts while improving productivity and economic growth. In China, one study found that a steady flow of people into urban areas has increased environmental pressures but educational achievements, rising at the same time, have moderated the impact (Ahmed and others, 2020). Since urbanization is central to economic growth, the study suggested not stopping it but making urban sustainability central to environmental policies. Necessary elements include urban planning, well-orchestrated investments in green labour markets and industries, and workforce training to continue building human capital. Moving towards realistic, rights-based and effective responses to current challenges requires reframing how we talk and think about population, justice, development, climate and the relationships connecting these things. Sexual and reproductive rights have been defined and agreed in the ICPD Programme for Action and various regional instruments, such as the Montevideo Consensus and the African Protocol on the Rights of Women. Realizing these rights will support other forms of human progress. But rights cannot be used mainly to meet fertility targets or accelerate economic growth or curb climate change. Nor can they be shunted aside under varying conditions. The real issue may not be so much a “ghastly future” but emerging from a “ghastly past” that made people and environmental resources subordinate to economies and powerful factions of society — rather than the other way around (Bluwstein and others, 2021). Advocates have long called for the provision of contraception, reproductive health care and social policies, such as maternity leave and so on, for reasons beyond fertility targets (Senderowicz, 2020). These efforts should continue, and can form part of broader modern efforts to place population, development and human rights under a framework of sexual and reproductive justice (Ross and Solinger, 2017). This framework encapsulates the right to have or not have children as well as the right to parent one’s children in safe and sustainable environments, and the right to sexual autonomy and gender freedom. Sexual and reproductive rights are at the core of the framework, but it also recognizes and calls for action on the conditions surrounding reproduction, including the diverse inequalities and intersecting forms of economic, social and environmental discrimination that systematically limit sexual and reproductive choices. These barriers operate and intersect at the community, country, regional and global levels. They are worse for people caught at the intersection of multiple forms of vulnerability and marginalization (McGovern and others, 2022). In 2015, the Cabinet of South Africa included sexual and reproductive health and rights as a population policy priority, which has led to broad consultations across sectors, looking at issues of governance, service delivery, migration and mobility, tradition, culture and language, poverty, inequality and demography. In 2023, a national conference is planned to highlight priorities requiring intensified interventions. In Nepal, after a landmark case affirming women’s reproductive rights and right to self- determination in all reproductive functions, the Supreme Court ordered the Government of Nepal to make necessary legal and policy changes to ensure that all women can realize these rights, including those who are marginalized and STATE OF WORLD POPULATION 2023 55 On her rounds in rural Ethiopia, health-care extension worker Amsalu goes door to door, delivering contraceptives to women who would otherwise not have access to them� The husbands of most of her clients know about the contraception — but a few do not� “These women are already mothers with three or four kids,” says the 36 year old, who began doing this work 14 years ago� “They hide contraception because the husband wants more children but she has had enough or just wants to take a break.” An estimated 7 per cent of married women who use contraception in Ethiopia are using it covertly (PMA Ethiopia, n.d.). Covert use is not unique to Ethiopia, however� It happens in many countries, with recent estimates from sub-Saharan Africa ranging from about 5 per cent in Kano, Nigeria, to more than 16 per cent in Burkina Faso (Sarnak and others, 2022). Women typically resort to covert use in response to their husbands’ opposition� Some men think that a woman’s use of contraception means she is having an affair. Others object to contraception because they believe it can harm their wives’ health� Some say it goes against their religious beliefs� Still others want their wives to keep having children� In many countries, women tend to have less power in health-care decisions (Smith and others, 2022). That means when a man forbids his wife from using contraception, her only options may be to go without or to use covertly� Amsalu says that women in her area prefer injectable contraceptives because they last for three months and are not visible� In the capital of Ethiopia, however, women who hide contraception from their husbands prefer implants and intrauterine devices, according to Gelila, a family planning services provider� “We can be asked to hide the scars from implants so their husbands don’t see them,” she says� “Women hide contraception because they are afraid,” she adds� They are dependent on their husbands and fear what might happen to them if they are caught� The consequences can include With covert contraceptive use, women challenge men’s power over childbearing decisions FEATURE Too Many?56 everything from violence to divorce� “I remember one time, a man brought his wife into the clinic and demanded that I remove her implants then and there,” Gelila says� Despite the risks involved, some women still choose covert use in response to “pregnancy coercion”, according to Shannon Wood, a Johns Hopkins University researcher who studies the social determinants of women’s health, gender- based violence, and adverse reproductive and sexual health outcomes� An estimated one in five Ethiopian women aged 15 to 49 have experienced pregnancy coercion, which can take the form of a husband forbidding family planning, taking her contraceptives away, threatening to leave her if she doesn’t become pregnant, or beating her for not agreeing to get pregnant (Dozier and others, 2022). Even though covert use persists in the capital of Ethiopia and in rural areas, Gelila and Amsalu say they are seeing less of it today than they did a decade or two ago� “Nowadays, men are more open and understanding,” Amsalu says� “Ideally, a couple would discuss using contraception,” Gelila says� “But if that doesn’t work, a woman may take action and use it even if her husband disagrees� It’s empowering for her to do what she has to do to time or space her pregnancies�” An estimated one in five Ethiopian women aged 15 to 49 have experienced pregnancy coercion. Women typically resort to covert contraceptive use in response to their husbands’ opposition� Pictured is an Ethiopian health extension worker who counsels women on family planning� © UNFPA/Mulugeta Ayene STATE OF WORLD POPULATION 2023 57 impoverished (McGovern and others, 2022). The Montevideo Consensus on Population and Development, approved in 2013 at the Economic Commission for Latin America and the Caribbean Regional Conference, offers another powerful example in which population policies are centred on human rights, particularly sexual and reproductive rights, gender equality, the inclusion of minorities and efforts addressing inequality (UN ECLAC, 2013). A sexual and reproductive justice approach can also help us understand more clearly the relationship between climate catastrophe and population. It can point to how “too many” masks the gender and racial dimensions and the starkly unfair results. Women are already on the front lines of climate change, struggling to cope with fewer assets and resources, deficits in food, jobs, education and health care, and the horrors of gender-based violence (Anon, 2022a). The idea that their reproductive capacities can be harnessed to solve environmental degradation and loss is both wrong and ineffective because it assumes “there is no fundamental power imbalance between the rich and the poor or contradiction between placing disproportionate blame for the world’s problems on poor women’s fertility and advocating for reproductive rights and health” (Hartmann and Barajas- Román, 2011). The continued refrain of “too many” suggests we must re-emphasize and build upon the work of the ICPD Programme of Action, perhaps by raising its central message — about the importance of individual reproductive health and rights to collective human development — in new spaces. We see this happening, to some extent, when environmental and social justice activists and ecofeminists frame all environmental issues as reproductive issues, since sustaining ecosystems makes all life possible and enables the processes of production and reproduction on which all communities depend (Di Chiro, 2008). Such approaches would move beyond focusing on human numbers to look at human experiences (Ojeda and others, 2020). Indigenous scholars have led the way in articulating an environmental reproductive justice situated in diverse kinships, including not just the human family but the natural world we depend upon (Lappé and others, 2019). Many scholars argue that rebalancing inequitable economic, social and political systems can go much further in addressing current concerns — indeed, this is at the heart of the 2030 Agenda for Sustainable Development. Rather than reducing the number of people, our focus should be on investing in education, quality health care, measures to resolve food insecurity, clean and affordable energy, and gender equality in all areas of life, among other fundamentals. The Union of Concerned Scientists echoes these ideas in pointing out: “A misplaced focus on population growth as a key driver of past, present and future climate change conflates a rise in emissions with an increase in people, rather than the real source of those emissions: an increase in cars, power plants, airplanes, industries, buildings, and other parts of our fossil fuel dependent economy and lifestyles.” Half of all emissions come from the richest 10 per cent of the world’s population, it notes (Union of Concerned Scientists, 2022). Sustainable development depends on factors inclusive of, but extending well beyond, demographics. The counting of human numbers should advance, not undermine, our collective humanity. 58 Too Many? For some women, family planning can be a question of life and death� When there is no money to feed additional children, keeping families small is one way for women to cope� That is the case for Pela Judith, who lives in the Grand Sud, or Great South of Madagascar, a region now facing its most acute drought in 40 years (Kouame, 2022). “I used to cultivate cassava and other grains,” she says� “The children went to school while we were in the fields.” It’s a life the 25 year old barely remembers� “The droughts have changed many things� Now everything has become expensive — food, water. We had to stop schooling for two of the children�” The drought has caused severe food shortages for more than a million people� For Pela Judith, it coincided with another tragedy: her husband fell ill and became partly paralysed� The family sold their land to pay for treatment and moved to the city to find work� Pela Judith is now the sole breadwinner, washing clothes or carrying water for money� For her, contraception is a necessity� “I am not even able to feed my four children, so giving birth to another child is not in my plans anymore�” Pela Judith is not alone; many women are choosing to limit their family size in response to climate catastrophe (Staveteig and others, 2018). But not everyone makes the same choice� Some evidence shows that, while some women in Bangladesh and Mozambique preferred not to have children because they could not ensure their survival, others wanted to increase their family size by at least one son, which was seen as helping the family’s security (IPAS, n.d.). For Volatanae, 43, reliance on a man was never an option� She works as a street hawker in the Madagascan city of Majunga, more than 1,500 kilometres away from her four children, who live with her parents� Abandoned by her children’s father, Volatanae alone shoulders the responsibility for making money to send home so her children can eat� In Majunga, she got into a relationship with a man who turned out to be abusive� “He kept beating me� Because of this, I can’t hear with my left ear, I can’t hear very well with my right ear either, and I can’t see very well with my left eye�” The injuries have left her struggling to make ends meet� For her, contraception is essential — for her own future and for her children’s� “With the droughts, how will I be able to feed another child? It’s already very difficult for me to feed my four children� Since the droughts, I am really afraid of getting pregnant again… Thank goodness family planning is still available where I am�” Family planning: a climate change survival strategy FEATURE STATE OF WORLD POPULATION 2023 59 It is clear that there are widespread concerns about fertility rates and trends. But how are governments deciding whether their country’s fertility rate is “too low”, “too high” or “just right”? Period total fertility rate — an indicator of the average number of children that would be born alive to a woman during her lifetime — has become the measure of choice in evaluating fertility trends and differences between countries and population groups (Sobotka and Lutz, 2011). In highly developed countries with very low infant and child mortality and natural sex ratios at birth, replacement-level total fertility rate is close to 2.1 children per woman. This number, 2.1, has become a gold standard for many policymakers, even if their population policies do not expressly state it (Sobotka and others, 2019). But a tunnel-vision focus on period total fertility rate is problematic: it can lead to a distorted view of population prospects and, consequently, ill-conceived policies. For one, period total fertility relies on numerous assumptions. The 2.1 threshold assumes natural sex ratios at birth and very low mortality, neither of which is universally prevalent. For most countries, the replacement- level fertility rate falls somewhere between 2.05 and 2.12. But there are 18 countries, all in sub-Saharan Africa, that have a replacement- level total fertility rate between 2.30 and 2.65 (with Somalia, South Sudan, Chad and Nigeria ranking the highest) (Figure 10) (UN DESA, 2022). Sex ratios at birth can also be strongly affected by son preference and sex-selective > FIGURE 10 Global variation in replacement-level total fertility rate, 2020 Source: computations from World Population Prospects 2022 (UN DESA, 2022). 2.65 2.61 2.53 2.50 2.44 2.36 2.33 2.32 2.30 2.26 2.23 2.21 2.20 2.19 2.17 2.16 2.15 2.12 2.11 2.10 2.09 2.08 2.07 2.06 2.00 2.25 2.50 2.75 Nigeria Chad South Sudan Somalia Central African Republic Democratic Republic of the Congo Niger Côte d'Ivoire Burundi Angola Pakistan Kenya Uganda India Rwanda China Indonesia Algeria Iran Thailand Brazil Poland Sri Lanka United States 2.05Qatar The fallacies of aiming for replacement- level fertility IN FOCUS 60 Too Many? abortion. While a natural sex ratio at birth is around 106 boys per 100 girls born, a global assessment identified 12 countries and regions with systematically distorted ratios over the last three decades, including Armenia, Azerbaijan, China, India and Viet Nam (Chao and others, 2019). The UN estimated that in 2021 the highest such ratio was 113 boys born per 100 girls in Azerbaijan and 112 boys per 100 girls in China (UN DESA, 2022). When factoring in skewed sex ratios at birth, the threshold of replacement-level total fertility rate changes; a sex ratio at birth of 113:100 implies that total fertility rate would need to be 7 to 8 per cent higher to reach replacement. Period fertility rates also respond strongly to external shocks and changing societal conditions. Economic crises, political upheaval, epidemics (including the COVID-19 pandemic) and changes in family policies can lead to sizeable swings in the total fertility rate. These changes are often temporary and fuelled by fluctuations in the age at childbearing or in birth spacing, rather than by overall changes in family sizes. In many countries with low-fertility rates, the trend of later parenthood means fewer babies are born in each period: a number of children who would be born today if childbearing age remained stable might be born instead one, two or many years later, increasingly to parents in their late 30s or early 40s. This trend skews conventional indicators of period fertility (Bongaarts and Sobotka, 2012; Bongaarts and Feeney, 1998). Researchers have developed indicators of fertility that adjust for the impact of changes in the age at childbearing, or the “tempo effect”. For instance, in the European Union, a tempo-adjusted index of period fertility was 1.72 in 2018, about 0.2 above the conventional total fertility rate (VID, 2022). In the United States, this tempo-adjusted number stood at 0.33 above the conventional total fertility rate of 1.73 in 2018 (VID, 2022). > FIGURE 11 Period total fertility rate (1960–2021) and completed cohort fertility rate (CTFR, women born 1930–1980) in Czechia Source: Czech Statistical Offi ce (2022), Human Fertility Database (2022). Notes: Cohort fertility at later childbearing years (41+) for women born in 1975–1980 was partly estimated. In the fi gure, fertility in each year is compared with cohort fertility of women who were in mid-reproductive years (age 30) in that year. 0.50 1.00 1.50 2.00 2.50 1930 1950 1970 1960 1980 2000 2020 Pe ri od T FR a nd co m pl et ed fe rt ili ty Period TFR Completed cohort CTFR Year of birth Year These seemingly small differences can have long-term implications. When changes in the timing of births stretch over long periods, total fertility rate can be very different from the actual family sizes seen among women of reproductive age. In Czechia in 1999, a period of economic and social change, the total fertility rate fell to 1.13, which might suggest the country was awash with single- child families; yet, when looking at the family sizes of women born in 1970 (who were in their prime childbearing years in 1999), the average was close to 1.91 births (Czech Statistical Office, 2022; Human Fertility Database, 2022) (Figure 11). Looking at total fertility rate as the reproduction level required to replace a generation also means assuming a closed population without migration. However, very few countries experience almost no international migration. Both outmigration and immigration impact population growth, as well as the age and sex structure of the population. In countries and regions with positive net migration — including most of the European Union, North America and Australia, but also many middle-income countries — migration partly or fully compensates for the fewer births seen with low-fertility rates. By contrast, in countries with significant outmigration, including most countries in Eastern and South-Eastern Europe, migration accelerates the impact of low fertility on population decline and can contribute to faster population ageing. When accounting for migration, the picture of replacement fertility looks very different (Parr, 2021; Preston and Wang, 2007). Countries such as Australia, Norway and Singapore could have extremely low fertility and still achieve population growth in the long run. Population age structure also casts a shadow from the past on current and future demographic trends. Populations with many people in the young and reproductive age brackets may experience decades of continuing growth, even with very 62 Too Many? low fertility and no significant immigration — this legacy impact of population age structure is termed “population momentum”. By contrast, older populations may experience population declines despite higher fertility rates. The use of total fertility rate is even more problematic when looking at population age structures because replacement and above- replacement fertility levels do not lead to the stabilization of age structures. Increasing longevity is the main driver of population ageing, not low fertility. Many governments have launched policies aimed at limiting or boosting fertility, which can violate reproductive rights and freedoms (Gietel-Basten and others, 2022), often basing these policies on biased assessments that use total fertility rate and the oversimplified concept of replacement-level fertility. A proper assessment of generational replacement and prospects for population growth should consider population age structure, migration, trends in mortality, sex ratios at birth and the tempo effect. In addition, the stated or implicit aim by many governments to achieve long-term population “stabilization” — and thus also zero population growth — is misguided and its rationale questionable. For one, government policies have only a limited impact on many population processes, including fertility and migration. But there is also no compelling evidence that a stable population would bring the highest levels of societal well-being and prosperity. (Some research suggests that moderately low fertility and a declining population are even beneficial for material standards of living, for example [Skirbekk, 2022; Lee and others, 2014].) Lasting solutions will not be found in oversimplified metrics. Instead, policymakers would do well to support the collection and analysis of more data and more complex data that capture shifting social norms, changing needs and evolving fertility intentions. STATE OF WORLD POPULATION 2023 63 Artwork by Rebeka Artim © UNFPA/Fidel Évora Too few? CHAPTER 3 STATE OF WORLD POPULATION 2023 65 with moderate growth, as well). At the local level, in areas of economic decline for example, concerns include maintaining infrastructure and services (e.g., schools, hospitals and public transportation) for the remaining populace. At the country level, these concerns are magnified to include fears about lower overall economic growth, possible reduced productivity because of ageing, difficulties in funding entitlement programmes such as pensions, the need to raise taxes to maintain infrastructure, and a loss of military and political strength (Coleman and Rowthorn, 2011). While population decreases may be nothing new, the global context is: an estimated two thirds of the world population are now living in a country or area with sub-replacement fertility. This fact, alongside the increasing number of States confronted by lower fertility numbers, is stoking concerns that, if this continues, whole countries or even the human population itself could “collapse”. Public responses to this phenomenon vary widely, from hopeful to concerned to deeply pessimistic predictions of an impending “population disaster” (Kassam, 2015), “birth crisis” (Zecchini and Jones, 2022) and potential threat to “national security” (Zhang, 2022). Some policy responses have taken the form of positively working to improve maternal health, encouraging gender equality and removing financial barriers to parenthood — in other words, programmes which support choice and rights — while others look to more directive policies that aim to reduce the availability of contraception and ban or limit voluntary sterilization (Gietel-Basten and others, 2022; Population Matters, 2021). The blame, in many In 2020, international media reported a “jaw-dropping global crash in children being born”(Gallagher, 2020) based on a study published in The Lancet by the Institute for Health Metrics and Evaluation (Vollset and others, 2020). This was mirrored in alarmist reports about specific countries, especially two of the largest: “The Great People Shortage Hits China: The Country’s Shrinking Population Is a Grim Omen for the Rest of the World” (Dettmers and others, 2023) and “America Is Looking Down the Barrel of Population Collapse” (Cooper, 2021). On the face of it, fears of an “underpopulation crisis” (Musk, 2022) may be surprising given that the global population has more than doubled in just 50 years. The global fertility rate remains above the so-called “replacement level” of 2.1 births per woman (see page 60 for more on the limitations of this measurement) (UN DESA, 2022), and there are informed predictions that the global population will continue growing to almost 10 billion later this century (Vollset and others, 2020). Yet concerns about “depopulation” are also ascendant. Historically, population decreases have taken place locally, nationally and even globally because of factors such as migration, war, famine, natural disaster and disease. Tragically, all of these drivers continue to exist today. However, at the national level, many of today’s falling populations are additionally fuelled by a drop in birth rates to below replacement levels, a trend that is informing much of the discourse and concern about decreasing populations. Indeed, there are well-documented issues that tend to arise with a slowed birth rate or a decreasing population (as there would be with a high-fertility rate or 66 Too few? contexts, is laid at the feet of women, who are often castigated for rejecting marriage and motherhood (He, 2022; Tavernise and others, 2021; Tramontana, 2021; Stone, 2018; Lies, 2014; Kelly, 2009), while encouraging a more submissive model of femininity that seeks to reinstate a so-called “traditional” family and gender dynamic (this is considered in more detail in Chapter 4) (Vida, 2019). Many countries have a mix of such policies and rhetoric (Gietel-Basten and others, 2022; Population Matters, 2021). Fertility rates are not the only mechanism affecting population size. In fact, below-zero growth fertility rates have existed in many parts of the world since the 1970s, without an attendant decline in population totals because many of these countries typically experience net immigration (Simon and others, 2012; UN DESA, 2001). This trend is currently projected to continue, United Nations demographers say. “Over the next few decades, migration will be the sole driver of population growth in high-income countries, as the number of deaths will progressively exceed the number of births,” notes the most recent World Population Prospects report (UN DESA, 2022). But this, too, is often viewed with concern, commonly revolving around economic and cultural fears. There are fears, for example, about labour market impacts, such as low-skilled migrants undercutting wages or “overqualified” migrants displacing domestic workers and increasing income inequality. In fact, there is no conclusive evidence on this matter (Orrenius and Zavodny, 2018), and from an international perspective, international migration may even decrease global inequality by increasing the wages of those at the bottom of the world’s income distribution (National Academies of STATE OF WORLD POPULATION 2023 67 Science, Engineering and Medicine, 2016). There are also concerns about rapidly changing social norms, and concerns about migrants’ integration or lack thereof. One frequently cited fear is that migration effectively imports criminality, a concern generally debunked by investigations into such allegations (Knight and Tribin, 2020; Hagan and others, 2008). All of these fears can fuel ethno-nationalist sentiment (Gietel-Basten and others, 2022; Vida, 2019), as they centre around who is counted as a member of the population, who “belongs” and who does not. Lower fertility also contributes to the phenomenon of population ageing. In simple terms, ageing is the foreseeable result of declining fertility rates and growing longevity, a process taking place at different rates worldwide but moving in the same general direction everywhere. When populations age, attendant concerns have been expressed around slowing economic activity and growing caretaking burdens on societies (Anon, 2021; Bauer, 2021; Turner, 2009). Just as with claims that there are “too many” people, the focus on “too few” portrays the common global experience of progress and achievement as one of catastrophe instead. Falling birth rates and rising lifespans are a hallmark of demographic transition, the trajectory of economic and social development observed by demographers for decades among countries moving from higher to lower mortality and fertility: since 1990 global lifespans have increased by nearly a decade (UN DESA, 2022). Worldwide, fertility has fallen from an average of 5 births per woman in 1950 to 2.3 births per woman in 2021, an indication of the increasing control that individuals — particularly women — are able to exercise over their reproductive lives (UN DESA, 2022). Together, these advances have resulted in the large-scale liberation of women and girls from repeated unwanted and unplanned pregnancies; the educational and economic empowerment they have achieved alongside that liberation has played a major role in increasing life expectancy for themselves and their children. These are gains, not losses. It is a march of progress that must continue. “Too few” of whom? Historically, fears about so-called “underpopulation” are closely linked to the view that there is “strength in numbers”. National security was seen as requiring the potential mass mobilization of the male population in times of war; in this view, large populations are necessary for economic and military power (Coleman and Rowthorn, 2011). Reproduction is a form of patriotic service to the state, this thinking held. “Men give to their country its swords and lances, but the women give to it its men,” argued a 1912 book (tellingly titled Race Suicide) (Iseman, 1912). In more recent years, this martial rationale for influencing population has been less often invoked, though interest in “demographic security”, the study of how demographic profiles can impact national security, remains an area of investigation by researchers and others. Today, the only region of the world expected to experience an overall population decrease in the immediate term (between 2022 and 2050) 68 Too few? is Europe, where fertility has been below the replacement level since the late 1970s, and where a minus 7 per cent growth is expected, according to the 2022 World Population Prospects report. Other regions’ populations — in South-Eastern Asia, Central and Southern Asia, Latin America and the Caribbean, and North America — are projected to continue growing, but to reach their peak sizes before 2100 (UN DESA, 2022) (See Figure 24 on page 129). Yet fears over so-called “population collapse” are pervasive, very often with a subtext: a heightened degree of concern over whose numbers are declining. That is, anxieties about slowing or reversing population growth typically centre around the low birth rates of specific subgroups in the population — underlining that much of this concern is not simply about fertility but about immigration, ethnicity, race and the politics of who should reproduce. Narratives of “underpopulation” are often invoked by political actors at the level of the nation state. Some politicians consider “strategic demography” — the use of demography in policy — to be an effective tool to garner support (Teitelbaum, 2015). In fact, many countries are seeing political leaders, parties and movements solicit support by generating fears about demographic change and by emphasizing low and declining fertility either as a stand-alone concern or alongside the changes brought about by immigration (Gietel-Basten, 2016). While these anxieties are not necessarily ethno- nationalist, the response to these anxieties often is. Ethno-nationalism emphasizes a tight link between ethnicity and/or religion and nationality; such political movements can be found in different STATE OF WORLD POPULATION 2023 69 > Extreme scenarios at work One extreme form of ethno-nationalism in Europe and other majority-White nations, which transcends national boundaries, is the “great replacement” ideology� The terminology of “great replacement” was popularized by Renaud Camus, a French writer who claimed in 2011 that immigration from North Africa and the Middle East would inevitably result in the end of French “culture” (Camus, 2011). While Camus gave this viewpoint a name, the idea itself has been around for a long time, as shown by overt and covert discriminatory policies towards marginalized groups around the world� The focus of the “threat” is often expressly racialized in many places, with claims that the White “race” is in danger of being outreproduced by the higher fertility of Black and Brown “races” and its culture diluted by immigration by these “races” — the terminology of “White genocide” is used alongside “great replacement”� The theory is genetically (“races” cannot be genetically distinguished [AABA, 2019]), anthropologically (there is no single “White” identity, [Alba, 2018]) and demographically (the theory relies on particular demographic projections that are unlikely [Root, 2019]) unsound, but the ideology persists� While this ideology is perhaps most commonly associated with countries in Europe and North America (a 2021 poll suggested two thirds of respondents in France were concerned about “great replacement” [Anon, 2021a]), versions of it appear in different contexts throughout the world, drawing divisions not only among races but also among religions, ethnicities and other classes of belonging� Indeed, the use or misuse of population statistics to fuel societal divisions is widespread and longstanding� In India, for instance, the rise of nationalism during the early twentieth century was accompanied by rhetoric regarding the increasing fertility rate of the country’s Muslim population, which was linked to unfounded fears that the Hindu religion would be endangered (Mukerji, 1909). These concerns were influenced by a biased reading of demographic data collected during the previous censuses (Bhagat, 2012), illustrating how data can be misused� Dehumanizing and extremist rhetoric can, in the worst cases, lead to organized violence against groups of people, including genocide� More recently, researchers have begun to observe and investigate how such language can also incite violence by random and unknown third party actors, a concept termed “stochastic” violence (Amman and Meloy, 2021; DeCaprio, 2020). Given how easily demographic data can be politicized, some countries have chosen not to collect or release demographic data� Kenya did not release census data on ethnicity in 1999 because of fears over how the political allegiance of different ethnic groups could be used to sow division (Balaton-Chrimes and Cooley, 2022). Lebanon has held only one census, in 1932 (Faour, 2007), and has not held another for fear that demographic data on the population sizes of its different religious groups would upset the balance of power between those groups (Maktabi, 1999). Likewise, Belgium does not collect data on the number of speakers of the country’s official languages (Ronsijn, 2014; EFNIL, 2009). 70 Too few? regions of the world and in low-, middle- and high-income countries. They generate support by raising alarm about the decline of a particular ethnic or religious group, often invoking the lower fertility rates of one group compared with other groups, or making claims about fertility differentials where few to none exist (Jeffery and Jeffery, 2022; Parrado, 2011). In higher-income countries and regions with significant migrant inflows, such as Europe and the United States, ethno-nationalist actors also raise concerns over immigration, which is presented as an economic and cultural peril (Huntington, 2004; Sartori, 2002). In countries with lower immigration but with diverse populations, ethnic or religious minority groups are often portrayed as a “threat” — examples of political movements targeting subpopulations are all too widespread, both historically and now. Such tactics have been identified as generating or deepening divisions between different groups in some countries (Layton and others, 2021). Views from the population Anxieties about “depopulation” and “population decline” appear to be a minority view. The YouGov survey asked a representative sample of nearly 8,000 adults across eight countries whether they thought their domestic population size was too large, too small or about right (respondents could also select don’t know). In every country, more people said their national population size was too high or was about right than said it was too small. The highest level of respondents saying that their population was too small — 36 per cent — was seen in Hungary, but even there it remained a > FIGURE 12 Proportion of men and women in eight countries surveyed who believed the current population size of their country was too low Source: UNFPA/YouGov survey, 2022. 5 10 15 20 25 30 35 40 45 India NigeriaEgyptBrazil USAFrance JapanHungary Pe rc en ta ge Female Male STATE OF WORLD POPULATION 2023 71 minority opinion. (Hungary was also the only country surveyed that has seen consistently negative population growth over the past four decades.) An interesting gender difference emerged when looking at respondents who viewed their national population as being too small: these views were more likely to be held by men than women (Figure 12). In France, Japan and the United States, more men than women believed the country’s population was too low (in France the figures were 16 per cent men versus 10 per cent women; in Japan, 22 per cent versus 14 per cent; and in the United States, 11 per cent versus 5 per cent). A gender difference also emerged when looking at respondents who viewed their national fertility rate as too low. In most countries — and especially in Hungary, France, Nigeria and the United States — more women than men thought a lower fertility rate would have a neutral impact, while more men thought it would have a negative impact. In all countries, more men than women believed higher domestic > Declining sperm counts: a cause for worry? Concerns over population decline have popped up in surprising places, including academic research noting that sperm counts are declining� Indeed, there are reasons to believe increasing levels of microplastics, hormone-disrupting chemicals and carbon emissions may be altering human germplasm, potentially resulting in unexplained infertility� Some studies indicate that high levels of air pollution are beginning to affect sperm quality and viability (Zhao and others, 2022). This has prompted scientists to ask: is ambient air pollution a risk factor for fecundity (Pedersen, 2022)? Polluted water and river systems may be similarly shaping reproductive health (Brown, 2002). Moreover, there is now credible evidence that rising global temperatures are threatening health outcomes in terms of an increase in preterm births (Clougherty and Burris, 2022). This research has led some to declare the human race is “imperiled” (Swann, 2021). Still others point out, however, that while both environmental and lifestyle factors have likely contributed to decreased sperm counts, motility and morphology, these counts continue to be “above the normal reference limit for fertility by a significant margin” (Tong and others, 2022). As discussed in Chapter 2, the interplay between environmental degradation and fertility rates is reason for real concern, but caution and circumspection are needed� 72 Too few? fertility rates would have a positive impact (though in Brazil and India, the gender difference was within the margin of error). These findings raise the possibility that men may be more inclined to see smaller domestic populations and lower domestic fertility rates as problematic and to see increasing birth rates as a solution. Views on immigration, meanwhile, were highly varied. In all countries except Japan and Nigeria, the most commonly held opinion about immigration was that current levels in their own country were too high. In France, Brazil and the United States, more than half of adults thought that current immigration levels were too high. In every country except Hungary, exposure to rhetoric, messaging or media about global or domestic population size correlated to viewing immigration rates as too high. In Hungary, meanwhile, exposure to conversations and messaging about population correlated to viewing the population size as too low. Concerns related to population change were also variable across countries and ages. In Hungary, for example, population decline was considered a top-5 priority among older respondents but not younger respondents, while for environmental concerns the reverse was true. Together, these findings suggest that anxieties around low domestic population, low domestic fertility and rates of migration are subject to influence by social circumstances, including gender, age and exposure to media and rhetoric. > Exposure to rhetoric‚ messaging or media about global or domestic population size correlated to viewing immigration rates as too high — — — STATE OF WORLD POPULATION 2023 73 Views from policymakers Fertility policies versus migration policies Analysis of data from the United Nations Inquiry Among Governments on Population and Development shows that most countries express a desire to influence their fertility rates and most countries do not want to change their current migration rates (Figure 13). While there is an intricate and diverse mix of fertility and migration policy groupings, one pattern stands out: the largest policy grouping — with over one third of countries — seeks to influence current fertility rates (either raising or lowering) but not to change migration (either raising or lowering outmigration or immigration). The groupings become more complex when including the direction of change desired by the policies — whether to raise or lower fertility, raise or lower outmigration, or raise or lower immigration (see Technical note on response rates, page 173) — but the overarching trend suggests that policymakers are more inclined to treat fertility rates (i.e., women’s bodies) as tools for statist ends rather than embracing immigration or seeking to > FIGURE 13 Proportion of countries by policy groupings for fertility and migration 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Immigration Outmigration Pr op or tio n of c ou nt ri es Has policies to change migration rate but not fertility rate Has policies to change migration rate and fertility rate Has no policies to change migration or fertility rates Has policies to change fertility rates but not migration rate 28% 39% 23% 10% 37% 27% 25% 11% Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. Proportion of countries by type of immigration policy* 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pr op or ti on o f c ou nt ri es Lower Maintain No policyRaise 8% 44% 26% 22% Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. *Policies refer to legally permitted channels of migration. > FIGURE 14 74 Too few? encourage the retention of potential emigrants through increased domestic opportunities. While the YouGov survey findings indicate that perceptions of immigration among the general public, at least in the countries surveyed, seem to be influenced by population rhetoric, policymakers overall express much less concern about immigration in their responses to the Inquiry. Only about 8 per cent of responding countries reported an intention to lower immigration rates (that is, immigration through legally accepted channels) (Figure 14). Two thirds of countries responded that their policy was to maintain current immigration rates. The remaining countries (one quarter) wanted to raise immigration. However, the vast majority (69 per cent) of countries responding to questions about irregular migration stated that it was a major concern, a reflection, perhaps, that concerns are more about who is entering the country, and how, rather than the level of immigration (Figure 15). The Global Compact for Safe, Regular and Ordered Migration was adopted in December 2018, shifting conversations away from the size of migrant flows to the > FIGURE 13 Proportion of countries by policy groupings for fertility and migration 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Immigration Outmigration Pr op or tio n of c ou nt ri es Has policies to change migration rate but not fertility rate Has policies to change migration rate and fertility rate Has no policies to change migration or fertility rates Has policies to change fertility rates but not migration rate 28% 39% 23% 10% 37% 27% 25% 11% Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. Proportion of countries by type of immigration policy* 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pr op or ti on o f c ou nt ri es Lower Maintain No policyRaise 8% 44% 26% 22% Source: United Nations Inquiry Among Governments on Population and Development, 2019 and 2015. *Policies refer to legally permitted channels of migration. > FIGURE 14 > FIGURE 15 Source: United Nations Inquiry Among Governments on Population and Development, 2019. *Immigration policy refers to regular immigration; level of concern refers to irregular migration. Number of countries grouped by type of immigration policy and level of concern regarding irregular migration* While a majority of countries indicate irregular immigration is a major concern, less than 10 per cent of countries intend to reduce regular immigration (in pink). 20 40 60 80 Major Minor Not a concern N um be r of c ou nt ri es Level of concern regarding irregular migration Lower Maintain No policyRaise 20 40 60 80 Major Minor Not a concern N um be r of c ou nt ri es Level of concern regarding irregular migration Lower Maintain No policyRaise STATE OF WORLD POPULATION 2023 75 They’re called repatriates, or “repats” for short, people who move back to their home countries after having emigrated� Some parts of Central and Eastern Europe — under pressure from low birth rates and high outmigration (Armitage, 2019) — are working to convince emigrés to return home, hoping to see their populations grow and to develop demographic resilience� The Balkan diaspora, for example, is huge� With an estimated 53 per cent of the people born in Bosnia and Herzegovina, 45 per cent of those born in Albania, and 12 per cent of people born in Serbia living outside their countries (Migration Data Portal, 2021), government incentives to woo them back are no surprise� The “I Choose Croatia” scheme offers up to €26,000 in subsidies to Croatians who come home and start a business (Hina, 2022). Serbia has a sophisticated combination of tax relief, start-up help and attractive technology parks, and Moldova’s PARE 1+1 programme matches private investments into new businesses started by returnees (ODA, 2013). “I received help from three different programmes in Moldova,” says Irina Fusu, a dental surgeon who returned after five years in Russia. “It wasn’t just money. I’m a doctor, and I didn’t know management, so I was helped with business courses by the government�” Her Da Vinci dental clinic won the “best dental clinic” award in 2020� National governments are not the only ones helping people return� In Serbia, Returning Point is a non-governmental organization whose mission is to create a better climate for repats�“When I decided to return to Serbia, I reached out to Returning Point,” says Ivana Zubac, a financial controller who spent 20 years in Western Europe� “I took a chance to see what things were like here, and my quality of life is now much better�” Zubac now helps mentor other newly returned Serbians� Also returning to Serbia is Jelena Perić, a paediatric nurse who came back from Munich, where she had been working since 2011� She received support from yet another source: the German aid agency GIZ� “I wanted to help families learn about breastfeeding, which is not very popular in Serbia,” she says� Many countries are looking for longer-term solutions, as well� When people have a decent standard of living, secure and promising jobs, good education for their children, decent health care, and an enabling environment, there are fewer reasons for them to seek these abroad� Senad Santic says a stronger private sector also helps retain young talent� He runs ZenDev, an IT company in Mostar, Bosnia and Herzegovina, and believes job opportunities like the ones ZenDev and similar companies provide will help keep young people from leaving� “The idea,” says Santic, “is to have conditions at home that prevent people from wanting to leave in the first place.” Wooing Balkan repats FEATURE Irina Fusu, a repat from Moldova� Image courtesy of Irina Fusu Too few?76 ways those flows are managed, with human rights agreements at its foundation. Yet among countries seeking to lower (regular) immigration, the present secondary analysis finds a reduction in the number of reported mechanisms to safeguard migrant rights and protections in 2021 compared with 2019. In contrast, in countries seeking to maintain or raise immigration, the reported safeguarding mechanisms increased over the same period. This raises the question: are migrant rights, like reproductive rights, at risk of being eroded as countries seek to achieve their population goals? STATE OF WORLD POPULATION 2023 77 Fertility policies, development and human freedom There are clear correlations between countries’ self-reported fertility policies and other indicators of well-being (including and beyond the relationship to maternal health discussed in Chapter 2). Countries seeking to lower their fertility rate have the lowest levels of development as measured by the Human Development Index; countries seeking to maintain their level of fertility showed the second lowest level of human development; and countries seeking to increase their fertility and those with no fertility policy have similarly high levels of human development. These correlations align with the broader trends of demographic transitions, wherein development, lower fertility, and greater health and longevity go hand in hand. Less expected were the findings when comparing countries’ self-reported fertility policies against their scores on the Human Freedom Index and Democracy Index. As shown in Figure 16, countries with no professed policies to influence fertility have the highest average scores on the Human Freedom Index, while countries in all other policy categories (those seeking to lower, raise or maintain fertility) have almost identical and distinctly lower human freedom scores. Countries with no professed fertility policy also have the highest average scores on the Democracy Index, while countries with policies to raise fertility have by far the lowest average scores of any policy group. In fact, the average Democracy Index score of countries with no professed fertility policy is nearly twice as high as the average score of countries with policies to raise fertility. Countries looking to lower fertility, > FIGURE 16 1 2 3 4 5 6 7 8 Lower Maintain Raise No policy Lower Maintain Raise No policy Lower Maintain Raise No policy Democracy Index 2 4 6 8 10 Human Freedom Index 0.2 0.4 0.6 0.8 1.0 Human Development Index (HDI) Average Human Development Index, Human Freedom Index and Democracy Index scores among countries with matching fertility policies Countries with no policy to infl uence fertility rates have, on average, higher levels of human development, freedom and democracy� Source: United Nations Inquiry Among Governments on Population and Development, 2021, 2019, 2015. 78 Too few? which otherwise see the lowest average health and development scores, have the second highest average Democracy Index scores, faring far better than countries with policies to raise fertility and slightly better than countries with policies to maintain fertility. In short, places where individual freedoms and rights protections are highest tend to not have any fertility policies. This does not mean that all countries with no fertility policy necessarily have high levels of development, democracy and human freedom — there are many countries that defy this trend. Indeed, much of the difference is driven by a cluster of countries that have no fertility policies and also have the highest levels of freedom, democracy and development. Still, the global averages are telling, and perhaps indicative of a tendency within freer, more democratic and developed countries to prioritize human rights in their citizens’ reproductive decision-making. When rights and choices are secondary The starting point for conversations about low fertility is, generally, what women are failing to do with their bodies and lives and what impact this will have on societies at large (Cronshaw, 2022). In fact, there have been headlines in some places that presume that women are overwhelmingly rejecting marriage and childbearing (Loh, 2022; Torgalkar, 2020), often with the implication that to do so is selfish. Missing from much of the conversation around low fertility is what individuals actually want for their own reproductive lives (discussed in more detail in Chapter 4). An ethno-nationalist view of demography often similarly negates the reproductive agency of the individual, embracing a gender ideology that subordinates women’s rights, particularly their reproductive rights, to the goals of an > Women’s bodies as problems and solutions Curiously, just as anxieties about “too many” people can lead to the subordination of women’s reproductive autonomy, anxieties about “too few” can do the same, even using the same language� As seen in Chapter 2, discourse about “too many” contributes to the view that contraception is a product of foreign influence. In low-fertility contexts, “anti- gender” rhetoric similarly views gender equality, LGBTQI+ rights, comprehensive sexuality education and reproductive autonomy as unwelcome imports from abroad (Human Rights Watch, 2019; Vida, 2019). STATE OF WORLD POPULATION 2023 79 “I’m willing to marry if I meet someone who has the same view about marriage as I do and respects me,” says Yeon Soo, a 35-year-old doctor in Gyeonggi-do, in the Republic of Korea� “But I don’t feel the need to get married if there isn’t anyone like that�” She is not alone� Fewer and fewer Koreans are marrying today. A survey of 30-year- olds by the Korea Population, Health and Welfare Association revealed that 30 per cent of women — and 18 per cent of men — said they would not get married in the future� Today, the marriage rate is about two thirds lower than it was in the 1980s (Ki Nam Park, personal communication). And those who are marrying are marrying later� In the 1980s, the average man and woman married at age 27 and 24, respectively� Today, the average ages are 33 and 31� What accounts for this trend? As Yeon Soo indicated, one reason is concern among women that they will have to forfeit careers and become stay-at- home mothers shouldering the full burden of housework and childcare� “I think the most important thing in marriage is whether my potential partner can fully respect and support my career,” she says� “Here in Korea, after marriage, a woman’s status can change� She is no longer a woman, but someone’s wife, a mother, a daughter-in-law�” Yeon Soo is not unlike thousands of Korean women who are rejecting long-standing views of marriage as an obligation, one that comes with responsibilities for raising a family, managing the home, and being an obedient daughter-in-law, and are increasingly seeing marriage as a choice, one that does not entail sacrificing university degrees or professional lives� An unstable labour market, where a large share of young people, but especially women, have part-time or short-term jobs, is partly to blame for fewer and later marriages, explains Ki Nam Park, Secretary-General of the Korea Population, Health and Welfare Association� “About 72 per cent of women have at least a college degree,” she says� “I think the increase in the age of first marriage Expectations about women’s roles at work and at home drag marriage and fertility rates to new lows FEATURE Too few?80 reflects a social trend in which young people are now investing more time in their academic background and job preparation and want to prioritize finding and holding onto a good job.” And with fewer and later marriages come fewer children. Unlike in many other developed countries, having children in the Republic of Korea happens almost exclusively within marriage, Park explains. So with marriage rates at a record low, in 2022 the country’s estimated total fertility rate of 0.81 was the lowest in the world (Yoon, 2022). The decline in births alarms some policymakers because it means the share of the population that is older is growing rapidly, and covering the costs of medical care and services for them “will be a huge burden on the younger generation,” Park says. “If the total population decreases, production and consumption will decrease, the economy will contract, and eventually the vitality of society will decrease.” The country’s falling marriage and fertility rates are intertwined with gender-unequal attitudes about jobs, child-rearing and housework. Gains in opportunities outside of marriage — in the labour market and in wider society — together with increasing costs associated with raising children today mean that the traditional “marriage package”, where the woman gives up her job, stays home and raises children while the man works long hours and devotes little time to housework and childcare, has lost its appeal for many young women, especially those with high levels of educational attainment, according to a recent OECD study on the Republic of Korea’s rapidly changing society (OECD, 2019). And because childbirth remains strongly associated with marriage, the study says, the barriers young people face even in finding a partner while establishing themselves in the labour market also contribute to declining fertility. The Republic of Korea is not the only country where fewer and later marriages go hand in hand with fewer children. In Japan, too, marriage rates have reached historic lows, and 25 per cent of women in their 30s say they have no intention of getting married (Government of Japan, 2022). Meanwhile, the average number of births per woman is about 1.3. Like their Korean counterparts, many young Japanese women are saying maybe — or maybe not — to marriage and to having children because they want to keep their careers and avoid being saddled with unpaid house and care work. “I want to be married one day, but only under certain conditions,” says Hideko, a 22-year-old office worker in Tokyo. “I would want to continue my job, and my partner and I would have to share the burdens of house chores and child-rearing,” she adds. For many women considering marriage, the opportunity costs are high, explains Sawako Shirahase, a social demographer and senior vice-rector of the Tokyo-based United Nations University. The usual choice women have to make is between only two options, she says. “It’s either A or B: keep your job or take care of your family.” But there are also economic reasons factoring into decisions about marriage and starting families, Shirahase says. Young people prefer not to marry or start a family until they can afford it, and that goal is becoming harder and harder to reach, with many  young people today finding themselves in precarious work situations. “Having kids and raising them are expensive in Japan,” Shirahase says. “The costs of sending children to good schools are often too high for single-income families.” But if both parents are working so the children can STATE OF WORLD POPULATION 2023 81 go to good schools, she adds, “Who will take care of the children and do all the housework? It’s traditionally the woman who is expected to take on all these family responsibilities by herself�” And for those couples who think they are ready to marry and have a family, it may be too late to have children� Nearly one in four couples in Japan has undergone testing or treatment for infertility, according to findings from the Japanese Fertility Survey (National Institute of Population and Social Security Research, 2022). In addition, some women in their 40s may never even have the chance to start a family because men may not want to marry someone they think won’t be able to have children� Policymakers in both Japan and the Republic of Korea have implemented tax credits and taken other measures, such as expanding access to affordable childcare, to make it easier for couples to have children, if they want them� But some of the obstacles to marriage and starting families may take generations to dismantle� In Japan, this will inevitably entail changing deeply embedded norms, as well as economic systems, to make them more gender equal and conducive to balancing families and careers, Shirahase says� Natsuko, a 32-year-old midwife in Yokohama, says that one day she’d like to spend her life with a partner and have children but adds that marriage and childbirth would greatly affect her career plan� “This would never happen to a man,” she says� Similarly, in the Republic of Korea, Dr� Park says that what’s needed is “a social atmosphere in which men actively participate in housework and childcare”� At the same time, gender discrimination in employment and wages are a big part of the problem, she adds� Saori Kamano, a sociologist at Japan’s National Institute of Population and Social Security Research, says that you can’t force people to get married and have children, so “you have to transform systems and institutions, as well as the norms”, starting with shifting attitudes about gender roles� “This will take a long time, but our recent National Fertility Survey shows there are signs of change�” “The increase in the age of first marriage reflects a social trend in which young people want to prioritize finding and holding onto a good job.” An unstable labour market is partly to blame for fewer and later marriages, explains Dr Ki Nam Park, Secretary-General of the Korea Population, Health and Welfare Association� Image courtesy of Dr� Park Too few?82 ethnic or political group. Examples include coercive reproductive policies (such as restricting abortion [Philbrick, 2022; Samuels and Potts, 2022] or contraceptive access [Council of Europe, 2017]) or policies that restrict women’s rights in other domains, such as in the workplace, in order to confine them to the domestic sphere. Ethno-nationalism may use rhetoric aimed at convincing both women and men to increase fertility; this was found to be the case, for example, in four Asian countries (Whittaker, 2022). Researchers point to anxieties about ethnic dominance as contributing to rising fertility in Sri Lanka (De Silva and Goonatilaka, 2021). In Türkiye, analysts point out that, although abortion was decriminalized in 1983, rhetoric encouraging women to have more children has been accompanied by diminishing access to contraception in the public sector (MacFarlane and others, 2016). Some of these views are tied to ethno- nationalism, but there are, of course, plenty of sociocultural norms that seek to subordinate the reproductive agency of women and girls to the desires of others. Many gender-unequal norms, widespread around the world, hold that a woman’s primary societal function is to become a mother and caretaker, while a man’s is to become a breadwinner for his family. This heteronormative model of the nuclear family is seen as both “traditional” and “natural” (EPF, 2018), even though definitions and manifestations of the family have varied widely over time and geography (see Chapter 4). Whether gender inequality is perpetuated through ethno-nationalist efforts or through pushback against changing gender norms, or both, the consequences for women’s reproductive health and fertility are dire. Generally speaking, contemporary policies like these are not coercive in the mould of the industrial-scale eugenics programmes seen in the twentieth century. Forced sterilization and forced pregnancy are universally recognized human rights abuses, rightly eschewed by all Member States. Still, by seeking to steer reproductive choices, some population policies elevate the fertility preferences of policymakers and politicians over the autonomy and choices of individuals. In their most benign form, these include incentives and disincentives, but for people facing multiple overlapping forms of vulnerability — poverty, stigmatization, discrimination, abuse — they can have the effect of eliminating choice all together. This is perhaps most obvious when access to reproductive and family planning services is reduced, a rollback of the commitments made in the 1994 ICPD Programme of Action. Heightened barriers to reproductive health care and services, including contraceptives and safe abortion, may be overcome by economically and socially empowered women, but others see their options > Whether gender inequality is perpetuated through ethno-nationalist efforts or through pushback against changing gender norms‚ or both‚ the consequences for women’s reproductive health and fertility are dire. _ _ _ STATE OF WORLD POPULATION 2023 83 disappear altogether. The quality of services more broadly can also decline. Limitations in family planning services in the public sector in Türkiye have led to “indebtedness of women through out-of-pocket payments” for sexual and reproductive health care (Dayi, 2019). Official 2018 data point to an increase in the unmet need for family planning to 12 per cent of currently married women, twice the rate recorded in 2013. In Poland, where abortion has long been legal only if a pregnancy is the result of a crime or if it poses an imminent threat to life, recent policy changes have included reducing access to emergency contraception (available now by prescription only) and limiting sexuality education (Human Rights Watch, 2019). In Iran, recent legislation has raised barriers to obtaining an abortion; the issue is now under the purview of the Ministry of Intelligence. Voluntary sterilization is banned, as is the provision of free contraception in public health facilities (Berger, 2021). Formal or informal restrictions to family planning services have been reported in many other parts of the world. Restrictions and barriers to reproductive health and rights are not always the result of harmful gender norms, ethno-nationalism or other efforts to manipulate demographic trends. Access to a service or commodity can be reduced for any number of reasons — budgetary or supply issues, for example. But in some cases, there is the suggestion of a link between demographic targets and reduced access to reproductive health services. Some countries, such as Romania (Benavides, 2021) and the United States, have seen abortion access plummet in recent years (Lazzarini, 2022) at the same time that there has been an uptick in “great replacement” rhetoric (Samuels and Potts, 2022). In some places, reproductive health restrictions disproportionately impact particular groups, such as in Malaysia, where migrant women lack access to reproductive health information and contraception, and where those who fall pregnant can be subject to deportation (Brizuela and others, 2021; Loganathan and others, 2020). Yet in many cases the connection to traditional gender norms or ethno-nationalist sentiment is overt. In one memorable example, abortion and contraception were identified as a “mass destruction weapon against European demography” (Scrinzi, 2017). Putting people at the centre Policies that seek to restrict choice are not the only tools available to policymakers. Many also implement policies to promote opportunities, empowerment and choice for women — funding parental leave programmes, offsetting the costs of child- rearing through payments or tax credits, or promoting gender equality in the workplace and home to lower the barriers to parenthood for women in the labour force, etc. Such programmes can be a model for improving conditions for families as they lower barriers to parenthood for those who desire it, improve parents’ ability to invest in their children’s health and futures, and support equality of opportunity and economic empowerment for women — to make it easier for people to realize their reproductive rights and to have the number of children they wish. 84 Too few? These policy responses promoting gender equality and women’s participation in the labour market are a reflection of inequalities and challenges that persist within low-fertility countries. For example, women in low-fertility countries spend, on average, more than twice as much time on unpaid domestic work as men, according to the United Nations Population Division (UN DESA, 2020). Efforts to remedy such inequalities have the potential to improve welfare for not just women but all of society. STATE OF WORLD POPULATION 2023 85 When Diana Donțu, in Moldova, found out she was pregnant with triplets, she asked her boss for flexible working arrangements. He agreed — these had become more familiar during the COVID-19 pandemic, and it made good economic sense to retain skilled employees. Donțu worked from home after the births and later went back to the office three days a week as executive director of Panilino, a cake factory� “Without these policies, I would have had to find another company, or stay at home,” she says� And as her children grew older, Donțu was able to send them to a new day-care centre on Panilino’s premises� “Now if something happens to one of my children while I am at work, I can simply go over and see them,” she says� Her experience is an exception rather than the rule in this region, where women often have to choose between career and family� A recent survey in Moldova revealed 9 in 10 women with children under 3 stay home (UNFPA and Ministry of Labour and Social Protection of the Republic of Moldova, 2022). The scarcity of family-friendly policies has had knock-on effects: people often have fewer children than they want, pushing birth rates down� In addition, businesses — already grappling with a shrinking pool of workers due to outmigration — fail to benefit from the skills of women who are unable to re-enter the labour force after giving birth� Through a programme funded by Austria that supports gender- responsive family policies in Moldova and the Balkans, UNFPA advised Panilino executives on how to develop family-friendly workplaces and provided a grant to help open the day-care centre� Evidence shows that such policies — both at the national level and those implemented by the private sector — are powerful tools to shift discriminatory gender norms and redistribute unpaid care work so that both men and women can realize their career aspirations without foregoing having children� While the principal aim is to allow more people to balance work and family life, it also helps ease the pressure on young people to seek job opportunities outside of the country� Albania is another country in the region adopting family-friendly policies, which include generous parental leave benefits — for women and men alike (UNFPA Albania and IDRA Research and Consulting, 2021). But even though paternity leave is now available, few men choose to take advantage of it� In South- Eastern Europe, only 3 per cent Family-friendly workplaces to support demographic resilience FEATURE Too few?86 of men say they have taken paternity leave (UNFPA and IDRA Research and Consulting, 2022). Ardit Dakshi’s experience suggests at least one reason why. His job as a systems engineer in Tirana made it easier for him to work from home when his wife gave birth to twins� “In the beginning, my co-workers laughed at me,” he says� However, he adds, “When my colleagues saw all the benefits, they started using paternity leave too�” The populations of many countries in Eastern and Central Europe are falling quickly (Kentish, 2020). Some governments are worried that without more births, and in the absence of immigration, their economies will falter, and there will not be enough young workers to contribute to social support systems on which their ageing populations depend� Some countries have resorted to government incentives to encourage people to have more children� Incentives vary widely and include payments to families who have more children, tax breaks for larger families, housing and car subsidies, and also awards for mothers with more than five children, and experience with “baby bonuses” shows that cash incentives or tax credits by themselves, particularly when they are modest, have a negligible impact on fertility rates in the long run (Stone, 2020). A more resilient approach helps couples reconcile work and family to have the number of children they want� Data and studies support the value of having workplaces that are family friendly and parental leave that is generous and equitable; in these conditions, women have more job opportunities and men share household tasks (Armitage, 2019). “Taking paternity leave and connecting with my daughters is the single most important thing I’ve ever done in my life,” says Dakshi� As Donțu takes a Zoom call, her son Alexandru climbs onto her lap� “He was a bit sick today so I brought him to the office. I could not do this without these family-friendly policies�” For Donțu and Dakshi, flexible and adaptable working conditions have made all the difference� Image courtesy of Diana Donțu Without family-friendly work policies, mother of triplets Diana Donțu explains that she would have had to find another company or stay at home� STATE OF WORLD POPULATION 2023 87 “Most governments of countries with low fertility, including those with no official policies to influence fertility levels, have adopted measures to incentivize childbearing, including paid or unpaid parental leave with job security, subsidised childcare, flexible or part-time work hours for parents, tax credits for dependent children, and child or family allowances,” the United Nations Population Division has observed (UN DESA, 2022b). Many of these measures are, in fact, standard social and welfare policies recommended irrespective of fertility concerns. But when these policies have as their primary objective influence over raising or lowering aggregate fertility, there are significant perils. Namely, the possibility that these policies will be reduced or even reversed when their aims are no longer considered politically or economically paramount. In fact, this report’s assessment of Inquiry data found that many countries actually 88 Too few? reported reducing the number of measures designed to support families and gender equality: 38 countries, between 2015 and 2019, reduced childcare subsidies, lump-sum payments for children and child or family allowances (policies that not only support children but also help women to remain in, or return to, remunerated employment). This raises an important question: if human rights and welfare were a primary incentive for implementing family-supportive policies, would these measures be less subject to abrogation? Then there are cases in which policymakers expressly set target fertility rates — even though the world has been moving away from focusing on specific demographic targets since the 1994 ICPD. In the past two decades such targets have been formulated by, among others, the governments of Belarus, Estonia, Japan, the Republic of Korea, Poland and Russia (Sobotka and others, 2019). For instance, the Government of Poland has recently published its “Demographic Strategy 2040”, which focuses, despite its title, exclusively on family policies and strategies aiming to increase birth rates, to reach a replacement level of period fertility around 2.1 by the year 2040, which would be an increase of 50 per cent from its current level of 1.4 (Government of Poland, 2021). In Iran, increasing fertility rates, decreasing the age of marriage and lowering divorce rates (to increase marital fertility) are core components of a target to increase the country’s population to 150 million (Ladier- Fouladi, 2022). In some cases, the preference for changing fertility rather than increasing immigration is made very explicit (see the box on “great replacement” on page 43) (Walker, 2020). Sometimes targets take the form of incentives provided to couples who produce a certain number of children — a kind of reproductive quota. Unlike schemes that provide support to every child, these incentive programmes allocate financial value based upon a government-set numerical goal. In Hungary, a policy offers a 10-million-forint loan (~$25,000) to young married couples. With every child born, the loan repayment is deferred. If the couple have three children within the required time frame, no final repayment is required (Walker, 2019). Indeed, it has recently been estimated that Hungarians planning to have three children can “receive up to HUF 42 million (EUR 116,713) in non-refundable grants and HUF 73 million in subsidized loans over the years for the purchase of a net HUF 100 million home” (Anon, 2021b). In the Russian Federation, the country rewards “mother heroines” who have 10 or more children with a payment of 1 million rubles (Anon, 2022b), or roughly $13,000. In Iran, a 2021 law provides incentives for childbirth and marriage, including financial incentives to reduce the age of marriage, with interest-free loans available to couples under 25 and women under 23 (Government of Iran, 2021). Some have even suggested pronatalist family policies that are punitive or exclusionary, such as taxing childless adults (Morland, 2022; Gao, 2018). In Hungary, newly developed national in vitro fertilization centres will offer free cycles for all women — apart from those over the age of 40 and lesbians. STATE OF WORLD POPULATION 2023 89 The case for hope Evidence shows us that there is no need to design policies to engineer population-wide fertility increases. Such policies, whether to meet targets or otherwise, do not have significant long- term effectiveness (Frejka and Gietel-Basten, 2016). Looking at the countries most recently associated with instituting such targets, there is very little discernible shift in the total fertility rate after adjusting for the tempo effect (i.e., some people may well decide to have children that they were planning to have in any case at a particular point in time in order to make the most of a new policy, but they do not increase their total planned family size) (see spread on page 60). This has been illustrated in the Russian Federation, the Islamic Republic of Iran, many countries in East Asia, and Thailand, among others (Gietel-Basten and others, 2022). Indeed, any increases that have occurred tend to be to period rather than cohort fertility — that is, they impact the timing of births, rather than the total number of births a woman might have over the course of her lifetime, which was the case

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