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OVERPOPULATION: MITIGATION AND NORMATIVE DIFFUSION BY JORDAN ROYAL A Thesis Submitted to the Division of Social Sciences New College of Florida In partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Frank Alcock Sarasota, Florida May, 2013
nTable of Contents Glossary of Acronyms and List of Figures........... ................................................... ...........iv Acknowledgements................................... ................................................... .......................vi Introduction....................................... ................................................... ................................1 Chapter One: Population Dynamics................... ................................................... ...............4 Environmental Problems Associated with Population Growth...............................9 Historical Account of Population Growth Perception s and Mitigation.................13 Chapter Two: Normative Diffusion................... ................................................... .............19 Chapter Three: Global Conferences on Population and Development..............................26 Chapter Four: Population Policy Development, Indone sia................................................ 40 Chapter Five: Population Policy Development, Bangla desh.............................................57 Chapter Six: Conclusions, Challenges, and Recommend ations........................................70 Norm Diffusion in Domestic Setting-Case Studies... ............................................76 Conclusions and Recommendations................... ................................................... 81
nGlossary of Acronyms ARH-Adolescent Reproductive Health BKKBN-National Family Planning Board CPR-Contraceptive Prevalence Rate ESP-Essential Services Package FYP-Five Year Plan GDP-Gross Domestic Product Gt-Gigatons HPSP-Health and Population Sector Program ICPD-International Conference on Population and Dev elopment ICPD+5-United Nations General Assembly on the ICPD (1999) IDHS-Indonesian Demographics and Health Survey IEA-International Energy Agency IUD-Intrauterine Device IUSSP-Union for the Scientific Study of Population JPP-Jakarta Pilot Project NCPC-National Council for Population Control NGO-Nongovernment Organization NPC-National Population Council NPP-New Population Policy MCH-Maternal and Child Health MDG-Millennium Development Goals MOH-Ministry of Health MR-Menstrual Regulation
nMVA-Manual Vacuum Aspiration PoA-Program of Action STDs-Sexual Transmitted Diseases TFR-Total Fertility Rate UNFPA-United Nations Population Fund USAID-United States Agency for International Develo pment WHO-World Health Organization List of Figures Figure One......................................... ................................................... ...............................8
nAcknowledgements Professor Alcock, thank you for your unrelenting pa tience throughout this process. Professor Brain and Professor Harley, thank you for helping guide my environmental studies education and for participating in my final step as an undergraduate. Lucy, I love you. Thanks for being the best cat eve r.
rnIntroduction The following thesis concerns the global matter of overpopulation. Human overpopulation is considered one of the dominant is sues facing humanity because it impacts every aspect of the environment and threate ns our own species survival. Influenced by social norms and processes of globali zation, which encourage both rapid population growth and environmental exploitation, s taggering increases in population size and corresponding increases in consumption hav e resulted in a damaging, selfreinforcing relationship between population pressur es and environmental degradation. As the population grows, environmental resources decli ne in quality and availability. In turn, environmental degradation sustains population press ures. If the environment fails to meet the needs of existing populations, both the populat ion and the environment suffer as every new child is born; the new human life represe nts an additional burden on the environment and momentum in continued growth. The importance of population control thus plays a central role in reversing environmenta l degradation. In an effort to reverse the environmental degradation associated with overp opulation, it is imperative that humanity stabilize population growth and create a s ustainable relationship between the population and the environment. This thesis is also about norms. More specifically, it is about the diffusion of norms regarding gender roles and the relationship b etween womens rights, family planning, and population control. Because norms con cerning ideal family sizes and family planning vary due to cultural and religious values and social structures as well as institutions, norms are a key component to populati on reduction efforts.
nThere are two distinct approaches to controlling po pulation growth: a top-down approach in which objectives focus on reducing fert ility rates by meeting targets to stimulate economic and development progress; such a n approach often encompasses coercive elements wherein individuals are ill-infor med or forced into participation. The bottom-up approach emphasizes empowerment; objectiv es focus on improving the rights of individuals in an effort to stimulate value chan ges in support of smaller families and reproductive liberties. This thesis will argue that a distinctive shift has taken place with respect to the preferred approach of the internatio nal community. The shift reflects the normative diffusion of ideas about reproduction, ge nder equality, and womens rights in population reduction efforts. The shift can be thou ght of as a change from supporting topdown fertility control approaches to bottom-up empo werment efforts. Such a shift has occurred in spite of the effectiveness of top-down coercive initiatives. This thesis will explore the extent to which womens empowerment nor ms have spread both internationally and domestically in two Muslim coun tries, Bangladesh and Indonesia. More specifically, this thesis will use a framework developed by Martha Finnemore and Kathryn Sikkink to assess the stages of norm diffus ion observed to date. The initial chapter of this thesis provides an over view of population trends and projections, highlights the problems associated wit h population pressures, and provides some historical context on perspectives of how to m itigate population growth. The second chapter provides the framework for understan ding normative diffusion, which Finnemore and Sikkink describe as a three-phase pro cess. In the first phase norms emerge and actors begin to adopt them. Once a critical mas s of actors accepts the new norms, they reach a critical threshold point. The threshol d is followed by norm cascade in which
nactors begin to adopt new norms at an accelerated r ate. At the far end of norm cascade, norms may become so widely accepted that they are i nternalized1. The third chapter introduces international conferences on population and development, displaying changes in the international approach to population control and family planning. The fourth and fifth chapters are case studies on the population p olicy development in Bangladesh and Indonesia. Both countries are two of the most popul ous, dense, and majority Muslim countries in the world. The sixth chapter assesses normative diffusion at both the international and domestic level. nnrn rnn !"n ##$%&'rnn(r #)r*+((,--./''..01-,02n2n
nChapter One: Population Dynamics Human population growth has been a familiar topic w ithin population studies since the 18th century, when the global population hit its first billion individuals. Thomas Malthus introduced concerns regarding the potential implications of human population growth on society, the economy, and the environment2.The relationships he described have continued development and undergone persistent debate. In addition to controversy surrounding the problems associated with population growth, proposed solutions are as varied and complex as the problems themselves. The following chapter is devoted to illustrating the dynamic relationship between the h uman population and the environment in an effort to understand the processes which have led to current circumstances. Understanding the relationships between population and environmental pressures is essential to reversing or adapting to environmental changes. Reducing both the causes of population pressures and subsequent impacts are nec essary because future sustainability is dependent on the manner in which these issues ar e mitigated. The following section provides an overview of population trends and proje ctions, information on the environmental problems associated with population g rowth, historical context on perceptions of population growth as a problem, as w ell as what to do about it. It is important to note that the factors influencin g population growth are multifaceted, inextricably interconnected matters t hat vary cross-culturally over time. (234n nr 5r$66(7 (1r,0-.54#%r54n
nConsidering the global population rose to 7 billion individuals in 20113.these issues not only demand global attention, but also global actio n. Overpopulation is a condition in which a population s size exceeds its environments carrying capacity, resulting in adver se impacts affecting both the population and the environment. Carrying capacity c an be thought of as the maximum populous an environment can sustainably support. Ex act carrying capacity is difficult to calculate because it is determined by natural const raints and human choices, which alter over time. Often, overpopulation is considered a lo calized condition that is related to population density4. This narrower perspective, however, neglects the global environmental resources that local populations have access to and how resources are managed and distributed5 For this reason, both population density and env ironmental resources available to these populations are consid ered necessary components for estimating carrying capacity and identifying overpo pulation. Homo sapiens have existed on earth for roughly 200, 000 years. Hunters and gatherers until about 8,000 B.C., humans lived noma dic lifestyles. During this time, populations remained low and dispersed. Over the pe riod of about 5,000 years, increasing numbers of humans shifted to relying on cultivated crops and domesticated animals for their subsistence. Tools and skills had advanced su fficiently for cultivating peoples to support towns. "Far more than the domestication of plant and animal species was involved in this revolution, which was accompanied by massive changes in the structure 8nrn9nn!:,,+9r'n0 4nn8(nnnn nn'$;;999(;'';n9;'
nand organization of the societies that adopted agri culture and by a totally new relationship with the environment6. Although the creation of agriculture and civilizations increased the size of the human popul ation, threats from diseases to climate fluctuations kept life expectancy short and death r ates high. The global population remained relatively stable until the Industrial Rev olution in the 18th century, when the population began an exponential ascent7. Reaching 1 billion individuals in 1804, the global population doubled a little over a century l ater (1927). In less than 50 years, the population doubled again, achieving 4 billion in 19 74. Since then, the global population has increased by another 3 billion, totaling 7 bill ion individuals in 20118. This information suggests that the human population is e xponentially increasing, advancing in a geometric ratio. The rate of population increase suggests potential environmental strain because a growing population increases demand on finite natur al resources, which do not increase as the population grows or as technology advances. Events of episodic decreases in population size have historically had little effect on the inexorable upward acceleration in population size due to the nature of exponential gr owth. Although the global fertility rate has decreased over time, the absolute population si ze is larger. This suggests continued growth. Experience with other species, however, dem onstrates how resource limitations 2(n+nDn@n4(n,--F5E( nn$n9n'nCnn n2+((n#+n3n n+rCnrnnn6n%n!::BE('($2nn&E#n (nn,"Cn4n!::B$B:!* F"./ ,,0!1,,0 G$,:,,!F;nn,:..FF H8nrn'n#%r+## $'(C'(%n rInn'$;;n(;9'';n1 #;#J>J,
nand or environmental degradation will eventually fo rce the human population curve to approach an asymptote (carrying capacity)9. The quantitative factors influencing human populati on growth are linked to social and political factors. History shows that human cul tural development is related to population growth and changes in the natural enviro nment10 ; successful advances in agriculture, technology, and medicine induced major surges in population size and have contributed to the worldwide trend of declining mor tality rates. Human influence on the environment, however, has increased at a faster rat e than the human population size has grown11. For example, the global population quadrupled fro m 1860 to 1991, while the use of inanimate energy increased from 1 billion megawa tt*hour/year to 93 billion12,13. D@n,-..E('(#% n'nCn'(rnCn'n 3nCn9,"(''nn$'(r3n(n )nnnn(2r'',--1!,: (4nr4$'((n)DnnrD52(n,--!E('( @9r@45r18n;Cn n+(3nCn9#%rn !B''B-1F,(4nr4$+(3nCn9n6n%KE('Knn!F*,-/$B",4r'B",nnn$nnrnCnr#n4( r('9nrnn'9n
n Figure One14 The distribution of the population across countries by age and sex provides some insight into where the population is headed and how The shape of the graph in figure one illustrates the population growth of developed coun tries as nearly stable. Represented in its rectangular shape, the graph suggests that deve loped countries are meeting population replacement levels and seldom waiver. Developing co untries populations, on the other hand, are displayed as being dominated by youth. Th e number of youth includes many women in their reproductive years, indicating rapid and aggressive growth in developing countries for the near future. The momentum exempl ified by the graph suggest that population growth will continue to grow most rapidl y in less developed regions. Population growth projections vary considerably bec ause they depend on assumptions about future natural constraints and hu man choices15.Uncertainty is imbedded in projections, suggesting that estimates be treated as warnings that the '(@9CnE(E!::F '$;;9994n(nr(;4n!;(n ;n(n;(L'';(L''> 'n6n%n!::B'B",
npopulation is entering a zone where limits have bee n anticipated and may be encountered16. Models used to compute projections, therefore, es tablish a framework from which to interpret the dynamic relationship be tween population growth and carrying capacity, providing a range in projected growth. Fo r example, in 2004, the United Nations provided three scenarios of possible growth The low projection estimated that by 2050 the global population could be 7.4 billion. In alternative projections the population could reach 8.9 billion or be as high as 10.6 billion17. In 2011, the United Nations claimed that the global population would re ach 10 billion by 2100 if fertility in all countries convergences to replacement level18. Although fertility rates are expected to gradually fall, population growth could almost doub le before the lower fertility rates can take effect on the growth rate. Thus, it is imperat ive that projections are not static and consider changing aspects of society. Environmental Problems Associated with Population G rowth: Overpopulation is often considered to be the paramo unt ecological issue because it increases processes of environmental degradation and impacts natural processes. As the population increases, demand, resource extraction, production, consumption, pollution and waste also increases. For example, pollution fr om automobiles decrease air quality and contribute to global CO2 emissions19. Global carbon-dioxide emissions from fossilfuel combustion reached a record high of 31.6 gigat ons (Gt) in 2011, according to ('''(r(4$'n'n Cn#nnrn nrnr4+(rn3'3rn59nnnnn D41rn' -)r''(!B::8nrn'n #%r+##'( C!::"',,08nrn3nnn!:,,)r'( n,:44!,::#n (nCnn3n'nn5nCn',10DnIC+D929nCnn' 4#'$+'n 'Cn4nn%n!:,: B.-''". F1".F-
rnestimates from the International Energy Agency (IEA ), representing an increase of Gt by 3.2% since 2010. Coal accounted for 45% of total en ergy-related CO2 emissions in 2011, followed by oil (35%) and natural gas (20%)20. Forests and oceans are carbon-sinks. They remove CO2 buildup through processes of sequestration21. Due to levels of pollution and depletion, forests and oceans struggle to absorb increasing emission22. Extraction and manufacturing procedures increase processes of biodiversity loss, deforestation, soil erosion, acid rain, and destruction of the ozone layer. Practices which damage the soil or dep lete forests affect photosynthesis and the nitrogen cycle, as well as contribute to CO2 buildup23. Such processes have created a damaging self-reinforcing cycle in which population pressures result in environmental degradation, which in turn exacerbates population p ressures. For example, most indicators of the state of biodiv ersity (species population trends, habitat extent and condition, and community composition) show declines without significant reductions in rate. Indicators of press ures on biodiversity (resource consumption, nitrogen pollution, overexploitation, and climate change impacts), however, show increases. Such pressures can be attr ibuted to human processes of deforestation and habitat degradation. The correlat ion between biodiversity and its pressures suggests that the rate of biodiversity lo ss is not slowing24. Biodiversity n%+M)r%n(!:,,N%;%+!:,,8rnr%Cn(J(E 4rn8Cnn,--01!:,:(n7nCn$nn'nrnn(% n@nn,--0rn ',.,('$2nn&r(3nC(( E9n+D5C5E(n5C ,---1!:,:%'B@4DrCn$r#3nnnn (ED()'nDnn+ Cn6O)n3(rn% ++r6%DnDDr nD96D(n%'nn
rrnregulates many ecosystem-level processes, including services essential to human sustenance25. If biodiversity continues to decline then natural systems and services will also decline. This would result in adverse impacts on the populations health as well as economic and social circumstances. Population pressures also increase pressure on wate r resources. Because the global water consumption rate is double the rate of population growth, pressures on water resources contribute to aquifer exhaustion, agricul tural cutbacks, and food scarcity. In 2009, the World Water Development report suggested that almost half of the global population will be living in regions of high water stress by 203026. This situation is exacerbated by the fact that many developing countr ies, already experiencing water and food stress, often have the highest population grow th rates. As the global population and consumptive levels continue to grow, these issues w ill become increasingly visible. The environmental impact of human population growth can be observed through the following equation: (I=PAT) Impact is equal to Population size, multiplied by per capita consumption (Affluence), multiplied by a mea sure of the damage done by the Technologies chosen to supply each unit of consumpt ion27. Population growths adverse environmental impacts are thus tied to consumption patterns and economics. Countries @nnCPCn6n+nn6 nnCrnnn n+nr@6n@9n@ nCn3r@nE nn'6n15J(n5nCn6 5nrn+@n5(n 3n+EnQrn2 %%r#nrn((n R(rnn3nCn63(nDnI 'n9n1 (+rnn2nn22n6n1 'nSr3n) nn!.!:,:$B!.* -.!/,,F"1,,F.(4nr n!-+'!:,: G$,:,,!F;nn,,.0 ,!HrnDrn66%n(##+rn9@n Cr8E'nnn n+9nKDrCnr '(K(n".F0":,*!:,!/$ -1F0'(r)n'((n!:,:' ,%,--:
rntend to be highly pollutive during early stages of development because they often adopt inexpensive, inefficient technology. As incomes ris e, consumers place higher value on environmental quality and have the ability to pay f or it. Often, however, when countries reach a certain level of increased income and popul ation size, excessive consumptive behavior outcompetes with prices paid to protect th e environment28. Human induced environmental degradation advances cl imate change impacts, contributing to the rising sea-level and more frequ ent and severe natural disasters. As the population grows and impacts of climate change beco me more visible, the urgency in addressing risks and vulnerabilities associated wit h population pressures will increase. Considering the worlds most economically vulnerabl e populations are located in highrisk environments, these populations will be most s everely impacted by climate change. To accommodate at-risk populations needs as enviro nmental changes occur, population pressures must be addressed with regard to current and future social, economic, technological, and environmental conditions. There is some debate about how to decrease climate change vulnerabilities by channeling population control. The British Charity Population Trust frames family planning as a cheaper method of reducing future emi ssions of CO2 than many low-carbon technologies. By investing in family planning, they presume that the global carbon footprint will decrease. In 2007 David Shearman, an assessor for the Intergo vernmental Panel on Climate Change, also suggested top-down enforcement to redu ce population growth in an effort to nnr2(n,--!
rncombat climate change. Shearman called for obligato ry rules at either the collective level, through carbon trade with penalties, or at the indi vidual level. He suggested that this would first require an effort to persuade all gover nments that curtailing the right to have children is an essential component to combatting cl imate change29. Agreeing on the terms of such rules, however, may prove to be diffi cult because some developing countries with rapidly growing populations still ha ve lower emission levels than many developed countries. This suggests that the use of coercive population interventions as a means of mitigating climate change impacts may not be a defensible approach. Given the immense investigation of the environment al impacts associated with population growth, debate about how to mitigate bot h the causes and implications of population pressures have been debated. In response to increasing pressures, governments and organizations have pursued efforts to decrease population growth in the hopes of achieving a sustainable relationship with the envir onment. Historical Account of Population Growth Perceptions and Mitigation Perceptions of the salience of population problems and how to address them have varied significantly over time. In 1798, Thomas Mal thus introduced his theory on population growth. He argued that the human populat ion would outstrip available food because the population increased geometrically, whe reas food production could only increase arithmetically. Malthus also argued that a system of preventative and positive checks on the population slowed its growth and woul d keep it from growing exponentially for too long. While positive checks i ncluded war, famine, and disease, Crn!::0nn'nnn& (rn#n%Cn +(
rnMalthus considered preventative checks those that d irectly affect fertility rates including marrying at a later age, abstaining from procreatio n, and birth control. As a religious man, Malthus supported delaying marriage until one was financially able to support a family. He considered birth control a threat to the moral order of society30. Malthus notions of population pressures on food av ailability were echoed by another prominent figure in population studies. In 1968, Garret Hardin expressed population concerns in terms of food production, le vels of consumption, and environmental impacts associated with unrestrained growth in Tragedy of the Commons31. Hardins basic solution suggested abandoning the commons system in reproduction, and instituting various restraints an d incentives to decrease population growth. To Hardin, individuals should not have the freedom to choose to have infinite numbers of children, adding to the burden on finite resources. He proposed a top-down approach to reducing growth through the utilization of coercion, encouraging individuals to sacrifice the liberty to reproduce without restr aint in an effort to preserve more essential freedoms, which would otherwise be lost32. Prior to Hardin, Arthur Miller also discussed the i mplications of overpopulation on liberty in his 1960 piece, Some Observations on the Political Economy of Population Growth. Miller argued that population growth is th e leading factor causing a trend toward greater need for organization, which results in further enhancements of group rather than individual values33. The growing population enhances organizationalism n(,0-.Er@n2n2nr#nnn,F !$,!"B10,-F.4r',!"Fn+(Kn4nCn% #'(@9K59r n''4n! B*,-F:/$F,"1F!-
rnbecause the organization, not the individual, is pr oductive in an industrial system. Miller argued that certain aspects of human liberty must b e restricted in order to retain a desirable future. Similar to Hardin, Miller claimed that population control would provide more freedom than possible in societies subsisting at saturation levels. He recommended restricting population growth in an effort to limit resource degradation. Miller wanted to ensure balance between population and environmental resources because, inevitably, this relationship determines population survival. Propos ing that rules of behavior are necessary for our civilization to survive, he sugge sted the lesser evil is population control. Miller foresaw two possible outcomes, both resultin g in more societal control: Either control will be developed rationally with re gard to the preservation of democratic values, or affairs will be allowed to drift into co nditions approaching authoritarianism. Miller believed, however, that an open society coul d persist if population policies permit the flourishing of conditions which lead to the enh ancement of individual integrity. Miller suggested approaching population issues thro ugh education coupled with government intervention through the imposition of t ax penalties for large families, elimination or modification of programs and selecti ve services encouraging population growth, and legalizing birth control methods includ ing abortion34. Both Hardin and Miller both suggested utilizing top -down coercive methods to reduce population growth, advocating for individual s to surrender the right to reproduce without constraint to allow for other freedoms. The se early ideas, advocating top-down population control approaches, seemed most influent ial from the 1960s to the 1980s. 4r'F!:
rnDuring this time population mitigation emerged in i nternational and domestic policy initiatives. Early initiatives often involved progr ams based on target objectives, incentivizing or forcing participation on the lower class.Such programs aimed to accelerate the demographic transition by changing n orms surrounding family size by also providing married couples with information about bi rth control and contraceptives35. During the 1980s, numerous activists and researcher s in women's health, population control, and reproductive health began a dvocating a shift in the mitigation of population growth36. They believed that a reproductive health framewor k with a broader programmatic focus could bring needed attention to such issues of sexually transmitted diseases, infertility, abortion, reproductive cance rs and women's empowerment37. Other contemporary perspectives on how to solve pop ulation problems are contrary to Hardins and Millers notions of popula tion control and individual liberty, suggesting that women should have the ability to ma ke strategic life choices through reproductive rights and an elevated social status. According to the World Health Organization (WHO), ensuring access to preferred co ntraceptive methods for women and couples is essential to securing the well-being and autonomy of women, and supports the health and development of communities. They believ e that a womans ability to space and limit her pregnancies has a direct impact on he r health and well-being. as well as on the outcome of each pregnancy, suggesting that wome n with access to contraception, in addition to opportunities in family decisions, have the ability to choose to have smaller @4''('$#''(n 'r(Cn Dn%n+n(4'!::"Dn?C!::"Dn2($+@(rnn&( r3n'r(CnEnr3K2n nn54:,n'n4n!::":"!:,B5r'F nnTnrn(nB-(n-Cn 4n,--"n,B:BU,B,"''( n'r(Cnn$+nn'n rr5n
rnfamilies than women without such opportunities. Con temporary ideas about population growth suggest that providing adequate education ab out family planning services and contraceptives is more effective than enforcing top -down government policies. Even if women are not initially receptive, they believe it is better to provide them with the means, rather than wait for them to change their minds38. The womens movement and many NGOs have contributed to inspiring initiatives for womens empowerment. Initiatives utilize a holi stic approach to address womens empowerment issues, focusing on improving womens s tatus in all walks of life and combatting power relations which obstruct such prog ress at various social levels39. Such programs believe that addressing the needs and rights of women and girls across the globe is essential to alleviating povert y, achieving social justice, and accelerating progress in achieving global developme nt goals. Programs attempt to improve women's access to economic resources, remov e legal impediments to their participation in public life, and raise social awar eness through education and communication. They suggest that by improving women s status, their decision-making capacity increases, especially in regard to sexuali ty and reproduction40. The transition from high fertility to replacement-level fertility has been associated with a gradual increase in gender equity primarily within the fami ly. In contrast, the spread of low fertility is associated with a rapid shift toward h igh levels of gender equity in institutions '$;;9999;nrnn;#nn;#B ,;n; !:,Bn()n7%'9nn$+nn#n@n rn1nnrnCn'nrn&rn @nrn%'9nnn(n6(#E(nCn'n 6J(nnT)n (n"(nB!::Bn '$;;999(#(r;919n1r;(n;9n1r1' '(; ))n$)nr'(!:,!8nr (r
rnsuch as education and employment41. Thus, reproductive empowerment is currently considered an essential component for longterm su ccess in population programs. It is important to note that the perceptions of ho w to mitigate population growth and its impacts are based on norms. Over time, appr oaches to population reduction efforts have varied with respect to norms of gender equalit y, womens rights, and individual liberties. In the following chapter, Martha Finnemo res and Kathryn Sikkinks interpretation of normative diffusion is provided. Their analysis is later used as a framework for understanding normative change in pop ulation reduction initiatives, which encompass norms of family planning and womens righ ts and empowerment. nnr@nrn%J(2nn#n2 '(rnCn'n3nCn9 (n!F(nB'"!0U"B-n'n4n!:::
rnChapter Two: Normative Diffusion Finnemore and Sikkink define norms as standards of appropriate behaviors which produce social order and stability, directing and s tandardizing behavior, often constraining actors by limiting their range of choi ce.42 Norms are described as continuous, rather than dichotomous entities vary ing in strengths, with different norms commanding different levels of agreement43. To understand the agreement process of normative changes authors, Martha Finnemore and Kathryn Sikkink, examine norm life cycles, describing international norm diffusio n as a three-part process: norm emergence, norm cascade, and norm internalization. This brief chapter provides an examination of Finnemores and Sikkinks understand ings of norm origins, motivations, and life cycles. Additionally, aspects of norms whi ch make them more or less likely to be adopted by the international community are highligh ted. This information provides insight into understanding how new norms have been successfully diffused internationally, and if used effectively, harbor th e potential to accelerate agreement processes in the future. This information will late r be applied to international conferences on population and development, displaying how norms regarding reproductive rights and the acceptance of family planning came to be. The primary apparatus of norm emergence is the pers uasion of norm entrepreneurs, attempting to convince a critical m ass of states to accept new norms44. Two common elements are highlighted in the successf ul creation of most new norms: nnr,--.'.-"4r'.-!4r,--.'.
nnorm entrepreneurs and an organizational platform f rom which entrepreneurs work45. Norm entrepreneurs call attention to and strategica lly frame issues to emphasize problems with existing norms, and encourage adoptio n of new norms. This framing is an essential element for entrepreneurs because, if don e successfully, it aids the broader publics understanding of issues and acceptance of new norms. Because norm entrepreneurs introduce norms differing from existi ng ones, they often come into direct competition with strongly held domestic norms, and alternative perceptions of appropriateness and interest. To challenge existing ideas, entrepreneurs may behave explicitly inappropriately as a tool to frame an is sue or send a message46. At this stage of the norm life cycle, raising logic of appropriatene ss to explain a behavior is complex because standards of appropriateness are precisely what is being challenged47. All norm entrepreneurs at the international level r equire an organizational platform from which they promote their ideas. Often entrepreneurs work from an existing organization with an agenda other than promoting th e norm alone. This agenda may influence the content of the norm; however, many or ganizations use of expertise and information have positive influences on changing be havior of other actors48. No matter the platform, entrepreneurs and associated organiza tions usually need to secure stateactor support to endorse new norms and make norm so cialization an agenda topic. The size of the organization and the weight of the stat es they are attempting to persuade is a major factor in determining entrepreneurs approach49. Empathy and moral beliefs are 4r'.-F4r'.-04r'.-.4r'.--4r'-::
rnoften used as tools of influence, because the ultim ate goal is to challenge what is appropriate. In these cases, information via media and access to important audiences is often provided by organizational networks50. For an emergent norm to move onto its next life cyc le stage, it must reach a threshold: acceptance of a new norm among a critica l mass of states. Often this requires the institutionalization of the norm in sets of int ernational rules and networks. Such institutionalization is beneficial for potential no rm cascade because it clarifies what the norm is and what constitutes violation. Institution alization is not necessary prior to a norm cascade, however, and may follow rather preced e it51. Typically a threshold has been met once 1/3 of the total states embrace the n ew norm. Which states adopt the norm is a crucial factor prior to achieving norm cascade because some states are critical to the adoption of a new norm. Critical states are those t hat are directly affected by the acceptance of a new norm, and without which the ac hievement of substantive norm goal is compromised52. Because states also have varying normative weight s, these calculations differ from issue to issue. Although c ascades require some support of critical states, agreement among them is not essential. Little normative change occurs prior to the thresho ld without significant domestic support for such change. Following the threshold, h owever, more countries begin to adopt new norms even without domestic pressure to d o so. At this point, contagion occurs in which international or transnational norm influe nces become more important than n4r'.--4r'-::4r'-:,
ndomestic politics for effecting norm change53. Domestic influences, thus, are strongest at the early stage of a norm life cycle, and lessen si gnificantly once a norm has become institutionalized in the international system54. The primary device of norm cascade is the active pr ocess of socialization at the international level intended to prompt norm violato rs to become followers. Socialization is thus the dominant mechanism of norm cascades, oc curring in various forms including emulation, praise, and ridicule. Networks of entrep reneurs and international organizations act as agents of such socialization, pressuring nor m violators by monitoring and publicizing compliance with international standards Two reasons related to states identities as members of the international communit y help explain how this works and what makes states comply: recognition that state i dentity fundamentally shapes state behavior and that state identity is, in turn, shape d by the cultural-institutional context within which states act55. Part of state identity, as a member of a social c ategory, includes certain norms to follow. When a threshold occurs, new norms redefine appropriate behavior for the state identity. In re lation to states identity as part of the international community, socialization in the form of peer-pressure occurs. Motivation for responding to such peer-pressure inc ludes legitimation, conformity, and esteem. States desire international legitimation because it influences domestic perceptions of legitimacy held by a state s own citizens56. Domestic legitimation is essential because it promotes compl iance with government rules. This 4r'-:!4r'.-B4r'-:!4r'-:B
nimplies that international legitimation reflects ba ck on domestic bases of legitimation and ability to stay in power. Conformity and esteem sim ilarly involve perceptions of states and their peers. Compliance represents social proof that states are part of the group. Leaders also want to think highly of themselves as much as they want others approval57. Theories of cognitive dissonance provide insights i nto the motivations for conforming behavior, because dissonance is primaril y stimulated when actors realize the adverse impacts of their behavior that cannot be ea sily resolved. This usually leads actors to reduce discord by changing behaviors or attitude s. Because norm promotion often points to inconsistencies between words and actions and holds actors personally responsible for adverse consequences of behaviors, norm entrepreneurs can be thought of as providing information that provokes cognitive di ssonance among norm violators in an effort to change behaviors. At the far end of a norm cascade, norm acceptance m ay become so diffuse that international actors internalize them. Norms, thus, achieve a taken-for granted quality that makes conformance almost instinctive. Internalized norms, for this reason, can be both powerful and hard to differentiate. Internalization is powerful because behavior according to the norm is not questioned, but hard to discern because conforming to the new norm may not be seriously discussed58. When norms become internalized in actors, they no longer choose to conform in a meaningful way, becau se alternative behaviors are not considered59. As governments and organizations become more prof essionalized, policy may gradually become more reflective of the normati ve biases of the professions that 4r'-:B4r'-:"4r'-,B
nman decision-making agencies. Behavior and habit ma y also be powerful mechanisms contributing to the universalization of norms after norm cascades, suggesting that routes to normative change may be similarly indirect and e volutionary as changes in behavior and habit: procedural changes that create new poli tical process can lead to gradual and inadvertent normative, ideational, and political co nvergence60. The framework of normative diffusion delivered by Finnemore and Sikkink provides some insight on population mitigation, whi ch encompasses norms of family planning and individual liberties. More specificall y, norms embedded in population efforts include issues of gender equality and women s empowerment. Early initiatives focused on increasing contraceptive prevalence rate s by targeting women, often through coercive measures and incentives61. Norms supported the subordinate role of women in society, treating them as objective through which f ertility reduction could be achieved. A shift in government approaches to population cont rol included international efforts to diffuse norms about family planning and womens rights and role in society. Through the partial diffusion of norms regarding ge nder equality and womens empowerment via international conferences on popula tion and development, initiatives have experienced success. However, the internationa l community has maintained sovereignty norms in population policy agreements. Such norms have implications for program implementation and may affect process of ac tive normative diffusion. For example, cultural and religious norms that support large families and womens subordinate role in society and the household delay new norms in the process of n4r'-: E,-' 0
nbecoming prevailing norms. The following chapter pr ovides information on international approaches to population control. The focus and fin al agreements of each conference display a process of normative shift within the int ernational community in support of womens empowerment norms.
nChapter Three: Global Conferences on Population and Development Since 1960 USAID has been a major funder of Third W orld population control, providing half of the money for internationally fun ded birth control programs and family planning services, including the Pill, Intrauterine Device (IUD), and sterilization62. In the 1970s, population reduction efforts became a salien t international issue. The historical account of international population conferences and the various population policy approaches are examined in the following section. C onference motivations, objectives, controversies, and final agreements are highlighted displaying normative changes in international population politics regarding reprodu ctive rights and womens empowerment. The first international conference on population or ganized by the United Nations was held in Rome, Italy in 1954. The purpose of the conference was to exchange scientific data on population variables, their dete rminants and their implications. At the conference, experts agreed to generate fuller infor mation on the demographic situation of the developing countries and to promote the creatio n of regional training centers, which would help address population issues and prepare sp ecialists in demographic analysis63. The second international population conference was held in 1965 in Belgrade, Serbia by the International Union for the Scientific Study of Population (IUSSP) and the United Nations. The focus of the conference was to analyze fertility as part of a policy for development planning. The Belgrade conference was h eld at a time when studies on the ''nnr(rnnnK2n3r+4 K91'nnE(5#n3nCn9 ,--.T)n,---3nCnrrn&'rnr!::!V nnrn!::0'N ,--.1!::04nnE9%(nr'( 5nr+4%&'nn n'Cn2n)r'(#nnn3n,"2 #n(#+(n!B ,..*,"1 F/''!F!1!F0(4nr4$4rn8 Cnn
n population aspects of development coincided with th e establishment of population programs subsidized by the United States Agency for International Development (USAID)64. The third international conference on population wa s held in 1974 in Bucharest Romania. The conference inspiration came overwhelmi ngly from the United States and a small group of Western European and Asian nations c oncerned with the implications of global population trends on development65. In an effort to stimulate international determination in dealing with these issues, a Progr am of Action (PoA) was drafted. Conference aims included recognizing the social, ec onomic, cultural, and developmental positions of all countries, accepting population po licies and objectives as integral elements of socio-economic development policies, an d acknowledging that population and development are interdependent variables, which varied across nations as a result of these interactions66. Challenged both empirically and culturally, the dra ft purpose, to affect population variables by limiting growth through th e implementation of population and social welfare policies, which would directly affec t fertility, was replaced in the final document purpose-statement, to help coordinate pop ulation trends and the trends of economic and social development,67. The changes in the PoA language, from draft to adoption, provide insight on how the fundamental co nflicts of interest that engaged 8nr!:,!(n'( '$;;999(;n;rnCn'n;rnCnr;''( 65nD4Dn2n#D( n$'(nCn'nrnn9 n%rn'(rnCn'n 3nCn9'((,,n' ,-0 .01,,"@nn)nn,-)3nE''nnr '$;;999#;n;!::.;:.;::!191n 1''nnr111,,n,-0 .-
nattention at the conference surpassed and subsumed the population issue68; North-South issues of economics and influence took center stage at Bucharest. The significance of the Bucharest conference was th e politicization of population in the contemporary context of struggle over the di stribution of resources and power between industrialized nations and the Third World69. Population problems were redefined in the context of the political and econo mic aims of the nations in attendance70. Due to negotiation struggles, the final document wa s much different than its draft. The majority of amendments came from Third World countr ies that felt that other issues were more salient to their interests than curbing popula tion growth. Population problems were seen as symptoms of imbalances in the development p rocess, consequences of the international economic system71. By using population as a vehicle to advance Third World goals of establishing a New International Eco nomic Order, demographic considerations were subordinated to political inter ests72. The final document encouraged countries to develop their own population policies, reduce infant mortality, make family plan ning education and services available to all, promote regional and rural development poli cies in an effort to reduce urban pressure, improve national population and developme nt planning, and promote womens legal status, education, employment, and equality73. n,-0 '.-n4r'.04r'..4r',:!8nr9r''(#nnnVD(n ,-0"$)r'(#++(( ,-0F
nA product of strained compromise, the PoA neither s ynthesized nor fully reflected the different positions that initially divided dele gates74. Without international consensus on a strategy to reduce population growth, the docu ment was approved primarily because it included explicit safeguards of national soverei gnty and refrained from prescribing particular population policies to member government s. The document encouraged recommended policies be formulated and implemented without violating, and with due promotion of, universally accepted standards of hum an rights75. Although womens empowerment and human rights were advocated at Bucharest, countries were not bound to implement measures that would satisfy such aspects of the final agreement by international standards due to s overeignty protections. The watereddown compromise gradually helped legitimize family planning and acceptance of population targets as part of a development policy, though such targets were not set76. The purpose of the Mexico City Conference on Popula tion in 1984 was to review developments made since Bucharest and to make recom mendations for the future implementation of the World PoA77. Although the conference reaffirmed the PoAs principles and objectives, substantial changes in t he worlds development conditions necessitated strengthening the document for the nex t decade. Technical and scientific basis for recommendations were sought to further ag reement development78. By 1984, most developing countries believed it was in their own interest to reduce fertility and address population issues as part of their developm ent strategies. The Third World no n,-0 ',:"4r',:-4r'-:8nrn#nnn'( n&F1,B+((,-."@nnD9 (rn, F,-."'! -F1B:!'((D9,-."!-F
nlonger considered international assistance racist o r imperialistic, nor did they accuse the West of advocating for population control as a subs titute for foreign aid. A consensus was made that problems must be addressed with or wi thout transforming the world economy. Improvements in human welfare were observed, howeve r constraints in stagnating economies and absolute poverty levels were less enc ouraging. Although the population growth rate decreased, the world population increas ed by 770 million during the decade between conferences (1974-1984). 90% of such growth occurred in developing countries. Womens status had also somewhat improved, yet ineq uality persisted, remaining evident in higher incidence of poverty, unemployment, and i lliteracy79. Unsatisfied with efforts to export contraception to the Third World, which freq uently met resistance on moral, cultural, and medical grounds, the United Nations b ecame increasingly supportive of abortion as a means of family planning and populati on control80. Conference conversation focused on population growt h, high mortality and morbidity, family planning, maternal and child heal th, aging populations, migration, the interrelations of population, social, and economic development, and the role of NGOs and governments in addressing problems. Population and development policies were framed as mutually reinforcing when responsive to i ndividual, family, and community needs. Improving womens status was introduced as a n important goal in itself, but also one that would positively influence family planning81. 4r'!-Fn)nn,-D9,-."'!-F
rnExpecting the sanction to abortion in the name of f amily planning, population control advocates were defeated82. The conference was dominated by conflict over the United States position, taking the opportunity to advance its own political ideology. At Mexico City, the United States, under President Ron ald Reagan, instituted the Mexico City Policy, which required organizations receiving federal funding to refrain from performing or promoting abortion services as a fami ly planning method. The policy directed USAID to expand this limitation and withho ld funds from NGOs that use nonUSAID funds to engage in providing advice, counseli ng, or information regarding abortion, or lobbying a foreign government to legal ize or make abortion available83. The agreement had an influence on the agreement outcome ; abortion was excluded as a legitimate method of family planning84. The Mexico City conference produced the Declaration on Population and Development. Eighty-eight recommendations were agre ed upon aimed to increase the integration of population development planning, inc rease efforts toward eradicating mass hunger, illiteracy, unemployment, achieve adequate health and nutrition levels, and improve the status of women. Development strategies to achieve these ends were also recommended. Strategies included integrating women in all aspects of the development process, improving womens legal rights and status, providing the measures for women to attain equality, and ensure equal opportunity for w omen in the labor force85. Recommendations were also made to strengthen the ro le of national and international )nn,-n&1('(nr( #nnn#n 2n+r#n8nrn+n#n nCn'nD4!::-D9,-."!-.4r'!-0
nefforts to achieve objectives including increasing self-reliance, monitoring, evaluation systems, administrative and managerial capacity, us e of international assistance, and involvement of community in implementation. The fin al report also stated that abortion services were not a legitimate means of population control86. This decision and the United States Mexico City Policy had serious financ ial repercussions for UN programs. A review of the Declaration and its progress was sc heduled to occur in 198987. The most dramatic change from Bucharest was the str engthening and improvement of the language of the PoA document to emphasize the importance of family planning programs and development efforts, w hereas prior to Mexico City, delegates were uncertain or opposed to family plann ing interventions88. Delegates came to the consensus that it is a basic human right for people to decide the number and spacing of births. The Declaration constituted an u ndertaking by nations and international organizations to respect sovereignty, combating all forms of social, economic, development challenges, and upholding human rights and individual freedoms89. Inadequate commitment and resources in addition to ineffective coordination and implementation, however, limited the effective impl ementation of national population policies. The Mexico City Policy enacted by Reagan in 1984, w as rescinded by Clinton in 1993, reinstituted by Bush in 2001, and rescinded a gain by Obama in 2009. Clinton suggested that the policys broad implications on g rants and assistance undermined )nn,-D9,-."!-04r'!-.4r'!--
nefforts to promote safe and efficacious family plan ning programs in foreign nations. He committed to funding abortion at any stage of pregn ancy. Because the policy reduced overall funding provided to NGOs, it negatively aff ected their ability to distribute birth control, leading to increased birth rate, unintende d pregnancies, and unsafe abortions. Framing the right-to-abortion a fundamental right o f women, Clinton pledged to use federal money to improve family planning efforts in US aid programs. Given the shift in the USs political position on abortion rights, a r adical change in the US population policy agenda was expected to be delivered at Cairo90. Norms regarding womens rights and empowerment were emphasized in Mexico City. Liberty was not the focal point of the confer ence, however, but rather a side note to family planning and development objectives. The inc reasing prevalence of womens empowerment needs in international discussions stim ulated increasing support at the domestic level. During the 1980s, women worldwide b egan channeling their reproductive demands through NGOs and political networks91. Women expressed concerns regarding government attempts to achieve fertility reduction targets directed at them. Combining intensive persuasion, widespread family planning se rvices, and small-scale incentive schemes, instances of coercion have often raised ch arges which violate individual rights92. Experts began doubting the efficiency of maintain ing stringent demographic objectives, specifically when government actions we re contrary to the rights and needs of individuals. Many family planning programs were ca ught between two potentially n)nn,-Dn?C!::"Dn2($+@(rnn&( r3n'r(CnEnr3K2n nn54:,n'n4n!::":"!:,B5r'F&1(nn3('('T9n7 $2#n'r(Cnnnn (4n,--B',-
nconflicting mandates: promoting the achievement of demographic objectives and meeting individual health and welfare needs93. Through coordination among experts and grassroots representatives, a requirement prior to the International Conference on Population and Development (ICPD) was laid down: a shift in the focus of population initiatives was necessary. From primarily focusing on fertility reduction, mitigating growth by achieving quotas, population objectives w ere shifted to focus on the reproductive and sexual rights of individuals94. The needs and rights of women, thus, became a focal point on the international populatio n agenda. Beginning in the 1970s, international population an d development conferences were dominated by devoted population-control advoca tes arguing against staunch resistance on economic and cultural bases95. At the ICPD held in Cairo Egypt in 1994, it was made clear that the UN wanted to abandon the to p-down approach previously adopted by many governments to control population g rowth, and instead wanted to focus discussions on the conditions of the individual, sp ecifically women96. Not only were human rights the core of discussions and action to follow, but women were centrally involved in the debate. Though packaging population and development issues as interrelated factors remained a common theme, the c onference content shifted to focusing on concerns of carrying capacity, gender equality, womens empowerment, and reproductive rights. Acknowledging the challenges o f continuing current population D(n6(r(rnnnn#nJ(# n$'n#n9(rn# '!,!*,--:/$F,1-,'FB5r!::"'F)nn,-5r!::"'"
ninitiatives, world leaders came together to negotia te the Cairo Program of Action (PoA), which would set the foundation for global populatio n programs for the next 20 years. The lengthy process of the PoA negotiations can be attributed to controversies over the documents language. Prior to the conferen ce, Pope John Paul the 2nd distributed a document reflecting his opposition to the drafted PoA97. The Pope identified the drafts central ethical errors, defined moral alternatives, and set in motion a wide-spread resistance movement. Although the United States ple dged support for abortion-ondemand prior to the conference, Vice President Al G ore gave a speech declaring that the US has not sought, does not seek, and will not seek to establish any international right to abortion, contrary to the draft documents definiti on of reproductive health care as including pregnancy termination98. Other countries also expressed reservations about t he agreement. Most reservations were the result of discomfort with cer tain words and phrases related to sexual and reproductive health and rights issues. S ome countries also felt that the wordings were in conflict with their national law, and thus unable to accept them. The Vatican and some Muslim countries opposed wording s uch as responsible sexual behavior, sexual activity, and other words that might imply extra-marital sex99. These states consider sexual activity acceptable only wit hin the bounds of marriage, and that abstinence should be exercised at all other times100. Controversy surrounded key words that could be interpreted to include the right to a bortion, suggested that unmarried people )nn,-5r!::"' )nn,-nn5r!::"'"
nshould be included in reproductive and sexual healt h and rights, or eluded to the acceptance of alternative family dynamics101. Through deliberations over proposed abortion language, the Vatican and conservative cou ntries had a major impact on the final document: in no case should abortion be promoted a s a method of family planning. The document also states that countries retain sovereig n rights in PoA implementation, with respect for different religions and cultures. The ICPD became the first international conference explicitly to recognize reproductive rights as human rights, emphasizing th e role of women in achieving population and development objectives, and declarin g womens ability to access reproductive health and rights the cornerstone of h er empowerment and a key to sustainable development102. The agreement committed members to an increase in family planning activity funds, from $6 billion to $17 bil lion by 2000, paid for by increased contributions to United Nations Population Fund fro m the wealthiest countries and cutbacks in other UN-sponsored efforts103. Delegates agreed on four qualitative and quantitative goals. Universal primary education was to be achieved by 2015. To accomplish this objective, the PoA urged wider acce ss to secondary education for women and girls. Infant, child, and maternal mortality ra tes were agreed to be drastically reduced, as well as disparities in maternal mortali ty rates within countries between geographic regions, socioeconomic, and ethnic group s. Access to reproductive and sexual health services were to be provided, including fami ly planning, counseling, pre-natal care, safe delivery, post-natal care, prevention an d appropriate treatment of infertility, n)nn,-nn#nnn'(rnCn'n '$;;999(#';'(4;'r;n)nn,-
nprevention of abortion, management of abortion cons equences, treatment of reproductive tract infections, STDs and other reproductive healt h conditions, education, counseling on human sexuality, reproductive health and responsibl e parenthood, HIV/AIDs services, delivery of services, and active discouragement of female genital mutilation104. The most significant development at Cairo was the s hift in focus from population control to the empowerment of women, top-down enfor cement to bottom-up efforts. Through the clash of moral visions, the final docum ent endorsed voluntary measures of population control. Although the shift in the appro ach to family planning was agreed upon at Cairo, the PoA was not necessarily implemen ted uniformly. Without additional guidelines to achieve goals, population targets the mselves seemed to require the same coercive government intervention schemes the confer ence aimed to eradicate. The United Nations General Assembly in 1999 (ICPD+5) convened five years after the 1994 ICPD to review the implementation of the PoA adopted at Cai ro and to identify key actions for further implementation. The PoA, along with benchmarks added at the ICPD+5 review, were integrated in the eight Millennium Development Goals (MDG) derive d from the Millennium Summit in 2000105. Together these guidelines instruct the United Nat ions Population Fund (UNFPA) in its efforts to support education, reprod uctive health and rights, and advance nn#nnn'(rnCn'n1 1n#+ +;,0,;,B;3nC,113n'#nn#nn n'(rnCn'n8+ ,-n '$;;999(#';'(4;'r;
n gender equality, and focus development priorities f or governments, donors and practitioner agencies, serving as time-bound instru ctions106. The ICPD+10 Review in 2004, the 10th Anniversary of the ICPD, marked the halfway point of the 20-year PoA, offering the oppo rtunity to reflect on progress made since Cairo and to acknowledge and address challeng es ahead. The UNFPA conducted an in-depth, country-by-country analysis of success, c onstraints, and approaches towards full implementation of the ICPD PoA. The 10th Anniversar y also provided the opportunity to demonstrate how ICPD achievement would advance the Millennium Development Goals107. The outcomes of the ICPD+10 global and regional r eviews demonstrated that countries made progress in implementing a reproduct ive health approach, strengthening efforts to improve gender equality, equity and the empowerment of women, addressing adolescent reproductive health, establishing new pa rtnerships with civil society and the private sector, and promoting the integration of po pulation into development planning and policymaking. Review outcomes also revealed tha t major challenges to the full implementation of the Cairo agenda remained, includ ing addressing HIV/AIDS more effectively, incorporating culturally sensitive app roaches into programming and strengthening data collection and analysis systems108. As the 20th anniversary of the ICPD 2014 and the de adline for the MDGs (2015) approach, governments have renewed their commitment to the ICPD PoA. UNFPA has been tasked with conducting a global review of achi evements, gaps and challenges in nn+#n(n'nn#nn #+#n11W '$;;999(#';'(4;n;n';'r;n 1#nnn11'(1r1 nCn'n; 1n1n '$;;999(#';'(4;'r; n4r
n delivering promises made at the ICPD and ICPD+5 and ICPD+10. A review of progress towards Millennium Development Goals is also being undertaken. The results of both reviews will lead to a new understanding of develop ment109. The succession of United Nations sponsored populat ion conferences displays a shift in the international governments approach to population reduction and liberty. Over time, international initiatives strayed away from t op-down target-driven population control efforts towards contemporary, bottom-up fam ily planning programing aimed at empowering women. Notions of how liberties influenc e initiative success also shifted. Rather than revoking individual rights to reduce po pulation growth, newer ideas suggest providing individuals with more rights, specificall y women, to achieve sustained population reduction. Both Bangladesh and Indonesia have had much success in fertility reduction efforts through population programs, yet both remai n in the top ten most populace and dense countries world-wide. In light of shifting in ternational approaches to population policies and programs, it is helpful to examine the transfer of shifting approaches at the domestic level to determine whether or not internat ional influence has played a role in altering domestic population policies, programs, an d norms. The following chapters provide a case-study analysis on the population pol icy development of Bangladesh and Indonesia in an effort to gain a more holistic unde rstanding of shifting approaches of population mitigation at the domestic level. n4r
nChapter Four: Population Policy Development, Indone sia Population control efforts in Indonesia began durin g colonization. The Dutch forced transmigration, relieving overpopulation by relocating people in the densest regions to less dense islands. Due to concern about the distribution of the population and economic prospects, the new government established the Transmigration Office in 1950, which became an independent department in 1984. By 1989, the program had successfully relocated more than 2 million people110. In 1956, USAID funded Indonesian doctors training i n family planning techniques because President Sukarno refused to con sider internal government support for family planning111. The Ministry of Health ended its prohibition agai nst the distribution of contraceptives in 1960s, joining ef forts of nongovernment family planning organizations including the recently established Vo luntary Indonesian Planned Parenthood Association, a private non-profit organi zation offering contraceptives to a network of largely urban clients112. At the time there was little public support for f ertility reduction efforts, in part because local traditions encouraged large families. The idea of family planning was not popular among religious or community leaders, whom expressed distress over family planning efforts. Islamic lead ers declared that inhibiting conception was against Islamic doctrine and that contraceptive use was allowed only in cases of emergency. In 1969, Nahdlatul Ulama, Indonesia's la rgest orthodox Islamic organization, stated that family planning was permissible only fo r spacing, not the prevention of births, n'(D(n,-00CVB!*F/$,1 !rn7 #'$(nrnn E(2EE(64(3r!:,!',B4r',B
rndeclaring a prohibition on abortion and sterilizati on. Faced with religious and cultural opposition, in the midst of establishing a national family planning program, the government decided to engage religious leaders and modify policies in response to their concerns. Thus it was decided early that abortion o r sterilization would not be promoted as part of the program. Due to continued discussion with religious leaders, concerns were eased, eventually resulting in religious family pla nning support other than permanent methods. In 1967, under the New Order, President Suharto sig ned the World Leaders Declaration on Population, committing Indonesia to dealing with development problems originating from rapid population growth. This agre ement set stage for the establishment of the National Family Planning Board, also known a s BKKBN. To Indonesias benefit, the international political position was conducive to the idea; donors offered aid to help establish the program. Suharto established the BKKBN in 1970, adopting a c linic-based approach to contraceptive provision113. During the programs primary years, the government made a commitment to reduce the total fertility rate of 5. 8 children per woman by half by 2005. The BKKBN was given the mandate to coordinate all f amily planning activities performed by both government and nongovernment orga nizations. Its mission was to directly reduce the fertility rate by providing mar ried couples with contraception information and services. The program also aimed to indirectly reduce the fertility rate through institutionalizing the idea of family plann ing. Early program activities included 2n(#r3n'r(CnEn rn+rEn8+U 3%@+5852+2+rn #+rrnnnn.1,: nn4n!:,:D2r'!
nadvocacy and broad information programs on marriage counseling, infertility therapy, and birth spacing clinics, in an effort to achieve the objectives of the Population Declaration. Suharto eventually declared population control and family planning key elements of the New Order, formalizing and national ly supporting the program. The BKKBN became responsible for further developing the program and managing foreign aid provided for this purpose114. Its well-established framework became amenable t o the diffusion of the current official policy regarding population planning115. These efforts indicate the importance the government placed on th e rapid diffusion of family planning and a small family norm among the populace. The programs early success derived from strong pre sidential support which included generous resources, financial assistance a nd political leverage116.Prior to the establishment of the BKKBN, Ali Sadikin was the fir st political leader to commit Suhartos resources to meeting population reduction objectives. Serving as governor of Jakarta from 1966 to 1967, Sadikin established the Jakarta Pilot Project (JPP). The JPP was the first government funded community oriented family planning program, aimed at assessing the publics attitudes toward family plan ning and exploring alternative approaches to providing services117. The government assisted program activities, givin g speeches at clinic openings, holding seminars, and encouraging the integration of family planning services and activities. Later programs ci ted the Pilot Project as proof that En!:,:'!3r!:,!',BEn!:,!'!n'n'(rrn*nn4 rn/2nnnEE(%J(& (4!:: '!:
nstrong responsive leadership could overcome problem s of religious opposition and community inflexibility118. Concentrating on the actions of individuals like Su harto and Sadikin prevents an understanding of the environment in which the famil y planning debates took place and the changing attitudes of the broader community. Th e narrow scope of the Jakarta example displays how important the political factor was in the development of family planning in Indonesia. One key activity leading to the establishment of the official family planning program was the compilation and publicatio n of a pamphlet titled Views of Religions on Family Planning in 1968. Before the p amphlet was released, government representatives and religious leaders participated in a panel discussion. The pamphlet was purposed to document the general acceptance of fami ly planning principles by four officially recognized religions including Islam, Pr otestant Christianity, Catholic Christianity, and Balinese Hinduism. The discussion and resulting pamphlet represent vital social change, in which consensus on the mora lity of birth control turned from strongly negative to positive119. Vigorous government efforts to recruit religious le aders to support the program process were a key element to its success. Because acceptance of family planning by Muslim leaders was critical to persuading Indonesia s majority Muslim population to support the program, the BKKBN initiated a sustaine d talk, resulting in leaders supporting the use of contraceptive methods other t han permanent methods. To help build consensus about the acceptability of family plannin g, religious leaders were asked to 3r!:,!',"4r',"
ninclude family planning messages in their weekly se rvices. According to the head of BKKBNs center for International Training and Colla boration, about 90% of the Muslim community now supports family planning. Aware of potential conflict with the minority Catho lic community, special efforts were also aimed at constructive dialogue with the C atholic hierarchy. Though the Catholic Church supports family planning, it neithe r actively endorses the use of contraceptives, nor opposes it. Dialogue between th e state and Catholic Church has been made easier by the relative independence of the In donesian Catholic church.120 The church perceives family planning as a matter of mor al choice by the individual, exercised based on information. The churchs liberal attitude toward family planning is evident in its approval of the distribution of the government family planning booklet titled Building a Prosperous and Responsible Family: the Catholic Perspective, which includes 11 pages of a detailed description of vari ous methods of artificial contraception121. New contraceptive users increasingly preferred cont raceptive methods that required continuous resupply and reminders to conti nue its use. Recognizing the slow progress in contraceptive use and availability, BKK BN officials decided that a new program configuration was required. Given geographi c fragmentation of Indonesia, in 1977 the village family planning program was establ ished, which included door-to-door outreach by fieldworkers. Although this program exp ansion led to more rapid contraceptive use, it was not until 1984 that all p rovinces had family planning services n4r',F4r',F
nthrough clinics. Clinics not only served as contrac eptive providers, but also supplied subtle forms of social pressure directed at married women, encouraging them to begin and sustain contraceptive use. The program became a mass movement. Innovative orga nization at the village level sustained the programs momentum; field worke rs promoted the idea of a small, healthy, prosperous, and happy family, posting Tw o children are enough signs and imprinting circles on the houses of residents who w ere practicing contraception. The successful expansion of village level family planni ng groups was majorly due to the BKKBNs innovations appealing to women, incentivizi ng limited births. The program integrated income-support programs and made micro-c redit available, providing funds with low interest to groups for micro-credit purpos es, requiring family planning use for a specific period of time before loans were accessibl e. Working as motivation to use family planning methods, the intervention also stre ngthened the government-society link122. By the mid-1980s, Indonesia had nearly achieved uni versal primary education, a feat made possible by the successful birth control program which slowed population growth123. The total fertility rate declined from 5.6 births per woman per lifetime in 196570 to 3.4 births in 1985-90124. Suhartos role in the formation of the family pla nning program, support during its implementation, and the programs success were internationally recognized in 1989 when the United Nations awarded Suharto with its Population Award. The reward was received for havin g the most outstanding 4r', 4r',B8!::-
ncontribution to the awareness of population questio ns or to their solutions. Although Suharto significantly contributed to the success of the program, the details surrounding the governments initiation of the program provide insight into the difficulties of overcoming government inertia and hostility toward family planning during a time when government structures were undergoing significant r enovations125. The family planning policy implemented in the 1970s was practically forced126. Suhartos authoritarian New Order government establ ished a highly centralized state apparatus which reached down into villages and tole rated no organizational opposition127. Program counselors were instructed to meet a weekly target number of families to join the program, going door-to-door encouraging women to use contraceptives128. During the late 1980s, prior to East Timors separation fr om Indonesia (2002), the Indonesian government initiated covert sterilization efforts i n the region, injecting young girls with unknown substances they thought to be vaccinations that had prolonged effects on their menstruation and health129. According to the Urban Poor Consortium, a nongove rnment organization based in Jakarta, if women refused to take contraception, they were chased down and threatened with, among other punishments, forced transmigration to rural areas of Indonesia. In addition, civil servants with more than two children were denied the education tuition subsidies which were part of thei r employee packages130; without this 3r!:,!',"4r',0En!:,!'B3r!:,!',0r%,--0Kn+n$ #)n73n'r(Cnrn&( 3%2K%2E(3nn n4(n+(n3r!:,!',0
nbroader political administration system, it is hard to believe the BKKBN could have expanded and coordinated the family planning progra m so effectively131. From the 1970s to 1995, the New Order government ma intained political stability and impressive economic growth, factors also contri buting to people wanting smaller families. The dramatic decline in fertility was due to a combination of many factors, though program effort contributed significantly to the timing and quick pace of the fertility decline and the rapid expansion in family planning services132. Despite criticism of the harsh government tactics used to enforce the two-child limit and the basic suspension of womens reproductive rights-couples w ere not allowed to select the form of contraception that best suited their needs-Suhar tos family planning program was extremely successful at reducing fertility. Indones ias fertility rate dropped from 5.6% in the 1970s to 3% in 1991. From declining birth rates it is possible to infer that Indonesia has developed a successful family planning programs although coercive measures were used. The BKKBN has been hailed one of the worlds best family planning programs by various international organizations, suggesting tha t Indonesia is a model for other countries with booming populations. By 1994 the total fertility rate had fallen to arou nd 2.86 children per woman, and the average annual growth rate declined to about 1. 66%. Although population initiatives in Indonesia were credited for successfully declini ng fertility at the time of the ICPD, demographers suggested that broad social and econom ic changes would be conducive to E(,-00',"En!:,:'B
nestablishing a new norm of having smaller families133. Prior to the ICPD, Indonesias population policies were implemented as tools for p opulation control, making certain types of contraception widely available and emphasi zing birth-spacing versus permanent forms of contraception. Target-orientation was the key component of Indonesias machine model family planning program, resulting in severely limited contraception choices, the use of authority and coercion, and the toleration of poor quality services, which undermined health service delivery and obscur ed the causes of afflictions perpetuating poverty and racial and ethical tension s134. Due to the inconsistent availability and superficial depth of services prov ided by the top-down, target-driven population program, individuals were inadequately i nformed about contraceptives and poorly provided for in terms of preferences and nee ds. Ill-informed participants, unable to give truly informed consent, represent only a porti on of the human rights violations Indonesians experienced135. As discussed, the 1994 ICPD represented a shift in family planning ideology away from an approach oriented toward population co ntrol and demographic targets towards a client-oriented reproductive health appro ach emphasizing quality services and grounded in human rights136. During negotiations, Indonesia expressed cultural and religious concerns about the wording of the PoA wit h respect to its predominately Islamic population, creating a barrier to family planning p ractices. Because Islamic and cultural traditions supported the dominant role of husbands in decisions regarding the family, Indonesia had reservations about phrases within the PoA that suggested womens E,-'0B4r'0 &1(nn,--B',-En!:,:',,
nindividual right to reproductive health. Indonesia s main obstacle in continued success, however, was not traditional values, but the availa bility of contraception. Although Indonesia adopted the ICPD PoA it has done so with reservations. For example, it only committed to implementing the PoA and guaranteeing reproductive rights if they are not contrary to cultural and rel igious beliefs and values in Indonesia. Although Cairo did not spell the end of Indonesias national family planning program, it posed a dilemma for the BKKBN. Established as a sta nd-alone agency within the central government, the BKKBN was charged with taking the l ead on population control. Because family planning was seen as a health and ge nder issue under Cairo, that meant handing over responsibility for family planning pol icy to the Ministry of Health (MOH). The BKKBN was reluctant to do so. However, the prog ram was unable to move forward and fully embrace ICPD because it required acknowle dging family planning first and foremost as a matter of reproductive health, belong ing to the mission of the MOH. The BKKBN chose not to redefine their central missi on explicitly in Cairo terms, though it adopted many of its elements. As a result neither goals of the governments family planning program nor the explicit contributi ons of BKKBN to the nations development objectives were defined with the same c larity and conviction that they were during the 1970s and 80s137. Although the program seemed to be on track to sta bilize the population by 2015, per suggestion of the IPCD, dur ing the 90s, the program first appeared to be losing focus and stalling; potential ly due to changes in the institutional context which BKKBN operates138. For the past 15 years, the program has been unabl e to 4r',,4r',:
nfocus on how its business has evolved a part from t ackling other formidable challenges regarding the international agenda, domestic decent ralization, and government reform. Because government-sponsored national family planni ng programs have finite life-spans, the central governments responsibility will change in the long-term. Many Asian countries at or below TFR/replacement have already or are considering disbanding their family planning programs. Since 1994, the program has focused on integrating family planning into a broader development effort to improve the welfare o f mothers and children. The program no longer broadly targets married women in their re productive years, but instead has specific objectives for various demographic and ins titutional divisions of society. For example, women 20-29 years old are encouraged to ha ve no more than two children, while women 30+ years are advised to have no more c hildren. In addition, parents are urged to implement new family values, teaching thei r children about the importance of family planning. In 1997, half of women between the ages of 25 and 4 9 years were married at 18.6 years, while the age of first married had risen to 19.2 years from 2002 to 2003. On average, women are either pregnant or a mother by a ge 21. In 1998, the Department of Health began coordinating functional guidelines on the implementation of the Essential Reproductive Health Package at the basic health car e service level. In 2002, the Health Department established the Commission on Adolescent Reproductive Health, involving various departments, the private sector, media and NGOs, aiming to improve adolescent reproductive health (ARH). The BKKBN has also estab lished Empowerment Centers for ARH in all districts. In an effort to express messa ges of ARH, BKKBN and the
rn Indonesian Planned Parenthood Association are in th e process of producing documents related to the empowerment of ARH. Although the ARH program has been ongoing, young and single people have yet to benefit from th e services provided, mainly because cultural and religious values inhibit it. Women's empowerment is still in the process of impl ementation. Currently, 40 cities have Women Empowerment Agency offices. In so me cities, the agencies have been effective, but confusion over what gender mainstrea ming is hinders many others. Lacking the authority or functioning structures that could aid agencies in wielding more influence also poses challenges to this initiative. Urban women continue to have fewer children. 60.3% of currently married women were using contraception in 2003. Injectables and oral contraception methods are the most widely used forms. IUDs are also prevalent though their popularity is decreasing. Permanent methods such as sterilization are also low, as is condom use. Womens reasoning for choosing a particular contrac eptive method is dependent on side effects, convenience, and the desire a more effecti ve method139. Surveys show that women who would prefer to avoid pregnancy but do no t use contraception do so because of constraints in access to and quality of family p lanning services, shortages, unreliable supplies, method failure, health concerns, and side -effects, lack of information, family, community, or husband opposition, and risk of pregn ancy. Still, the total demand for family planning is 70%, 88% of which is currently s atisfied. According to the United Nations, fertility has decreased to 2.06 in 2010140. 3r!:,!',Fn4r',F
nCurrent issues in the National Program include chan ging demographics, political decentralization, and the changing International ag enda141. As a country goes through its demographic transition the demographic profile of i ts population changes, in turn resulting in changes in demands for family planning and reproductive health services, which require program responsiveness. The recent p lateauing of Contraceptive Prevalence Rate (CPR) does not pose a threat to fut ure population growth because the balance of evidence suggests that Total Fertility R ate (TFR) has declined to a point close to the replacement level; however, such plateauing is also associated with continuing unmet contraceptive needs142, which is defined by the Department of Health Serv ices as the percentage of currently married women who eith er do not want any more children or who want to wait before their next birth, but who a re not using any method of family planning143. The plateauing of the CPR around 60% is not consi stent with government stated policy objectives of ensuring that family pl anning services are available to all married couples who need them144. Slow progress in CPR, however, does not mean family planning is static; new trends suggest metho d mixing including a shift away from IUDs to injectables. Family Planning Program experts argue that it may b e difficult to reach the high levels of CPR required to attain long-term populati on stabilization if programs rely heavily on short-term re-supply methods, which ma ke the program especially vulnerable to disruption (e.g. transitioning to dec entralization)145,146. The changing En!:,:'"4r'"4r'. 4r' n3!::B
ndemographics of Indonesia as it completes its demog raphic transition are placing growing pressure on family planning program managers to pro vide additional services for the growing proportion of population that is currently unmarried. A family planning program that continues to restrict itself to providing serv ices almost exclusively to married couples will necessarily miss a vital, and increasingly lar ge, part of the action147. There is also a trend of clients shifting to the pr ivate sector, a trend accelerated by the Asian Financial Crisis. The trend in privatizat ion is broadly consistent with the governments objectives; the policy of self-reliant family planning was introduced in 1989. With privatization, however, a number of fact ors must be accounted for to ensure prolonged success; consequences of increased costs of services on the poor, enough regulation to ensure minimum standards of service, and the ability to provide a choice of methods. There are also concerns about how self-rel iant the private sector actually is and how much relies of it on indirect and or hidden gov ernment subsidies148. Another concern of program managers includes region al and socio-economic differences in family planning practices among the population; the poor still generally want more children than the more affluent. These di fferences relate to concerns about the targeting of subsidized family planning services an d supplies; Even among the extremely poor more women rely on the private than the public sector for source of supply, while among the non-poor just over 25 perce nt use the public sector149. These En!:,:'F4r'04r'.nn'nCn(nB, (4nBn'n4n!:: n'Cn8n +nrn6(nn
nstatistics suggest that the governments subsidized FP services are not benefiting the poor in the way intended150. Although Indonesia has experienced success in incre asing contraceptive awareness, use, lower fertility rates, lower infant and child mortality, slower rate of population growth, it is not guaranteed that sustai ned population reduction will be established. Unless progress is accompanied by acce ptance and continued use of effective methods, progress is limited. The BKKBN appears to have lost the innovation and c oordination it displayed in the 1970s and 1980s. Overall goals of the program h ave remained stable since its launch in 1970. Expansion followed through the 1980s as ne w approaches were tested to increase coverage and institutionalized family plan ning became a social norm. By the 1990s, most couples were practicing some type of fa mily planning; their commitment was demonstrated through continued use during suppl y disruptions in the height of the Asian Financial Crisis in 1997151. The Indonesia Demographic and Health Survey (IDHS ) showed that in the early 1990s, the CPR for current ly married women aged 15-49 had reached 50%, plateauing around 60% in the early 200 0s, suggesting the program may be losing steam. The challenges the program has faced since the 1990s are more complex than any one indicator can suggest152. In 2004 most of the program administration authorit y was transferred to hundreds of autonomous districts. Much of the BKKBNs respon sibility for developing family planning policy is now shared with regional governm ents. The BKKBN engaged in nEn!:,:'-4r'-4r'B
nefforts to ease the transfer, developing a list of essential services with regional governments and the Ministry of Home Affairs, which districts would be legally obligated to provide in addition to performance ind icators for monitoring153. The BKKBN also secured government funds to continue pro viding subsidized contraceptives to districts upon request. Other proactive initiati ves include the Early Warning and Rapid Response System established to identify emerging pr oblems quickly and work with districts to resolve them. The system ensures that the BKKBN and stakeholders still receive information, at least from a national persp ective, on program performance if routine monitoring fails in the early years of dece ntralization. Decentralization, apart from being a restraint, cou ld also be viewed as a supporting factor to program success, as each regio n can develop programs in harmony with local conditions, while improving local potent ial. Following decentralization family planning program officials at all levels face new c hallenges including: obtaining consistent resources, planning program activities, recruitment, managing personnel, range of authority in policy formulation, need for advoca cy, relationships with other government and NGO units, reporting on performance, finances, and performance evaluations. Because decentralization involves both administrative and political dimensions, family planning program officials canno t resolve all administrative issues before politicians resolve outstanding issues regar ding distribution of authority across all levels of government154. 4r',B4r',B
nThe BKKBN has been relatively successful in control ling population growth. However, its focus on the promotion of contraceptiv e use, rather than equity or freedom of choice, individuals right to reproductive choic e have not always been respected. The fact remains, however, that Indonesia has been able to attain its objectives through this path. National leadership proved to be an essential component of successful family planning in Indonesia. Suharto was the first nation al leader to recognize rapid population growth as a national concern, though his leadership was problematic, being responsible for numerous human rights violations155. Suharto focused on the constraints of an unrestrained population growth on development possi bilities. Concerned with long-term progress, Suharto provided high-level political wil l to plan for the future. Undoubtedly due to government intervention, Indonesias populat ion growth rate and fertility rates have dramatically declined. However, the nation is still unsuccessfully accommodating the reproductive rights of women. As a result, impr ovements to womens empowerment and reproductive health appear to be slow. It is difficult to accept the governments coercive approach as a valid, humane form of governing. It is uncertain whether or not I ndonesia would have experienced such rapid progress in reducing population growth withou t the governments top-down approach; therefore I do not believe Indonesias po pulation control programs should be used as a model for success, but rather a framework in need of modern norms and advanced programing devoted to womens rights. 3r!:,!',
nChapter Five: Population Policy Development, Bangla desh In the 1950s, the first private family planning ass ociation in Bangladesh was funded abroad. Initiatives were voluntary and limit ed to small-scale distribution services in urban areas, mostly at hospitals and clinics, le d by social and medical workers156. In 1960, the National Family Planning Board was establ ished157. The government sponsored a clinic-based family planning program, opened fami ly planning centers at every hospital and rural dispensary, and set a target of providing services to 6-7% of eligible couples158. With the objective of controlling population growth as a strategy to achieve economic development, in 1965, a field-based family planning program was launched as a priority. Full-time field-staff and part-time midwives were r ecruited to provide motivation and services closer to rural populations, offering limi ted clinical and non-clinical methods of contraception159. Although the national government was in favor of population control, citizens resisted the idea especially without adequ ate information on contraceptives or consistent services. The combination of services pr ovided, counter to the needs and preferences of locals, and the governments coerciv e approach to population control led to popular backlash, contributing to the government s collapse in 1968. Population initiatives were at a standstill during the Liberation War in 1971. From independence to 1974 the Maternal and Child HealthFamily Planning Program, an integrated health and family planning program, emer ged. The administrative process for decision-making shifted from an autonomous family p lanning board and council to the %n3rn3nCn9'" '(n!:,!DnE3n'r(Cn3r)$2n@ 4#'(,-(%rn''!!"3r!:,!' 4r'
nMinistry of Health and Family Planning. Although mi dwives were no-longer provided, family planning services were functionally integrat ed at the field level. The oral pill was also introduced as a method of contraception160. Following the 1974 Bucharest conference on populati on (1974), a widespread famine elevated concerns about demographic pressure s on national resources and economic development. At the time women of Banglade sh had six or more children on average combined with poor nutrition and lack of ac cess to quality health services. This high fertility rate jeopardized womens and childre ns health, posing constraints on economic development and social progress. With rega rd to the potential political conflict that could result from government attempts to influ ence personal family decisions, a new program was implemented with complimentary public-s ector actions addressing constraints. At the onset of implementation, the ne w program faced a number of challenges including low levels of education about family planning, prevailing beliefs that a large family is best, womens low status in society, and lack of access to services among rural populations, especially women with limi ted mobility161. Over the next five years the Maternal and Child Hea lth (MCH)-based Multisectoral Program was created. A separate Directorat e of Family Planning and an independent Division of Population Control and Fami ly Planning in the Ministry of Health were also established. A central coordinatio n committee was formed to coordinate implementation and review progress of multi-sectora l population activities under various ministries. n4r' 4r'B"
nIn 1976 the government recognized rapid population growth as the countrys number one problem, approving a National Population Policy Outline in which rural Bangladesh became a strong focus162. Realizing its constitutional responsibility to en sure that citizens receive basic needs and benefit from socio-economic development, the government began pursuing several long-tern policie s focused on population and development. The Outlines objectives include impro ving the standard of living through enhanced reproductive health status and reduction o f population growth rate, with special attention paid to poor and vulnerable populations. Since the Outlines creation it has been reflected in policy emphasis in all successive Five -Year-Plans and programs. Having acknowledged the momentum of population growth due to the large population base of youth, the government began attempts to curb growth in the long-run by pursuing population influencing policies through ministry co ordination163. From 1980 to 1985 the Functionally Integrated Progr am took shape164. Delivery of MCH-FP services were integrated with lower level s, becoming a function of health officials. The National Population Council (NPC) wa s reconstituted into a high-powered National Council for Population Control (NCPC), hea ded by the president of the Council of Ministers. An executive committee headed by the Minister for H ealth and Population was also formed. A unified command was established through the Health Ministry and the Population Control Ministry merger under one se cretary of Ministry of Health and Population Control165. 4r' #Enr)n#n1@Cnn#nn 'nM3n'(4#Drn$ Drn'(n4n!::01:.3r!:,!'F4r'F
nFollowing the Mexico City Population and Developmen t Conference in 1984, the Intensive Family Planning Program was developed. Th e broad-based multi-dimensional intensive MCH-FP program was launched and branches of the National Council for Population Control were established in each distric t. Satellite Clinic, an outreach activity, was also introduced to deliver services to remote a nd rural areas. Education and community activities were program components intend ed to stimulate norm changes regarding family size and provide information about contraception options166. The reduction of rapid population growth through in tensive service delivery and communication participation occurred from 1990 to 1 995167. Intensified propaganda campaigns intended to establish population program objectives as a social movement168, promoting family planning as an integral part of de velopment activities through intersectoral collaboration, community support, and part icipation mobilization. Service delivery expanded as resource allocation for progra m implementation increased. Increased involvement of NGOs and the private secto r supplemented and complimented government efforts169. Up to 1996, population policy in Bangladesh was gui ded by objectives and strategies presented in the 1976 Population Policy Outline170. The implementation of the target-driven family planning program focused on re ducing fertility rates. The MCHbased service delivery system was developed, contra ceptive availability and use expanded as field workers were deployed to provide to services at homes, and multi4r'04r'FE,-'!B-3r!:,!'Fn18+'nnn!BDrnM'($% n(nr((n+nr
rnsectoral collaboration was promoted171. The total fertility rate declined from 6.3 births per woman in 1970-1975 to a rate of 3.3 births per woma n by 2000. The fertility rate decreased 48% in 25 years. A number of Bangladeshs early population program e lements contributed to its success in fertility rate reduction. In addition to the services previously articulated primary program elements have included coercion, in centives, propaganda, and development of clinics in rural regions. Throughout program expansions, both international and domestic incentives and intimidat ion were used to ensure widespread participation172. For example, as sterilization rates began declini ng, the World Bank expressed concern, suggesting that short term contr aceptive options were less costeffective than more permanent methods. In response, the Bangladesh army launched a campaign of compulsory sterilization in the norther n district, Mymensingh, in 1983173. Efforts in the mid-80s displayed indications of suc cess. Population growth declined from 3% to 2.3% between 1961 and 1981 as contraceptive p ractice increased. Sterilization was the most commonly sought method of contraception in government plans until 1990. Villagers with three or more children were listed, brought to clinics, and forced to give consent to sterilization. Women who refused to part icipate were threatened and or withheld United Nations World Food Program aid174. In 1993 population propaganda amplified in an effort to recruit more acceptors of sterilization services; 1/3 of contraceptive users were targeted to be sterilized175. Although international organizations 4rE,-'!!B4r'!B:4r'!B:4r'!BB
nand aid agencies pressured Bangladesh to meet targe ts, consequences raised issues of human rights. Early messages of family planning campaigns, a smal l family is a happy family, were unsuccessful. Although almost all women were i n favor of family planning, market researchers found that women were prohibited from u sing contraception if their husbands were adverse to the idea176. Because men were recognized as the primary obstac le in expanding contraceptive use, a mass-media campaign was designed to appeal to male audiences. Television, radio, movies, and mobile-va ns urged men to talk with their wives about contraceptive options. Media was also used t o address the harassment of outreach workers facing threats of violence. Two of Banglade shs renowned writers were asked to write a storyline displaying the value of outreachworker efforts in urban and rural environments. The soap-opera heroine, Laila was created about a family planning outreach worker. The show served as an entertainmen t platform conveyed messages about family planning as well as the importance of outreach workers177. Another element of the program which aided fertilit y decline included clinics established in rural areas. Facilities provided med ical contraception services, to which outreach workers could refer clients who wished to use long-term or permanent methods of contraception. Such clinics brought services to rural populations, easing access barriers. The family planning program demonstrated success in reaching objectives of informing couples about contraception, increasing u se, and decreasing fertility rates. In 1991, a contraception prevalence survey found that almost all women had some 3r!:,!'F4r'0
nknowledge about modern contraception methods. Betwe en 1975 and 1997 the proportion of married women who had ever used contraception in creased five-fold: 14% to 70%. In spite of its early success, Bangladeshs populat ion program began stagnating in the early 1990s178. During the ICPD planning process, the program cli mate in Bangladesh was in the process of change; Bangladesh became com mitted to revamping its family planning program with emphasis on quality of care, expanding access, and developing sustainable systems. The government recognized the importance of pursuing family planning goals to achieve the long-term demographic target of reaching replacement fertility by 2005. Influenced by demands for improv ement in the quality of services provided, Bangladesh recognized that its population program had reached a crossroads. In order to progress, changes in emphasis and appro ach were sought. The ICPD PoA reflected many of the changes that Bangladesh consi dered pre-ICPD. The final agreement provided a framework that tied together the pre-ICP D work of the MOHFW to identify priority concerns and a possible agenda for action. During negotiations reservations on the part of Ban gladesh government representatives were expressed, accompanied by a nu mber of other predominately Islamic nations, regarding specific terms used in t he original PoA which could be interpreted in ways that went against religious and cultural values. Abortion was the central debate. Although Bangladesh provided menstr ual regulation (MR) services since the 1970s, this service was delivered in a conserva tive legal setting;MR is a procedure that uses manual vacuum aspiration (MVA) to safely establish non-pregnancy after a missed period. MR procedures are provided up to ten weeks after a womans missed '(D,---'!
nperiod. Abortion is illegal except to save a mother s life179. Vigilant to maintain a distinction between menstrual regulations, the gove rnments stand on abortion in international conferences reflected the country law s and cultural values. The controversy over terms was eventually resolved by the previousl y mentioned nations right to sovereignty in implementing the PoA. The PoA had an important influence on Bangladeshs fifth Five Year Plan (FYP) (1997), the Health and Population Sector Program (H PSP) (1998), and the draft of the New Population Policy (NPP).180 Each plan and program stemming from the conference incorporated components of the ICPD document, thus inspiring Bangladeshs second phase of population policy development in 1997. Thi s period was characterized by a transition from target-driven reductions to a clien t-centered approach reflected in the fifth FYP, HPSP, and drafted NPP. The fifth FYP emphasis on population policy dealt with a broader range of reproductive health issues targete d at a large number of people, rather than addressing family planning needs alone. The HP SP (1998 to 2003) emphasized integrating health and family planning facilities a nd personnel to provide an Essential Services Package (ESP). The package included: maternal health (antenatal, delivery, and postnatal care) menstrual regulation, and post-abortion complicatio n care adolescent health family planning management and prevention of STDs and HIV/AIDS child health o an expanded program of immunization o acute respiratory infection o control of diarrheal diseases o prevention of malnutrition 4r'!n18+
nMoving away from family planning services delivery at homes, the HPSP provided ESPs at one-stop clinics. The NPP draft built on approac hes in HPSP and the fifth FYP. The NPP provided lists of objectives and strategies for providing comprehensive reproductive health and family planning services to a wider segm ent of the population181. The greatest contribution of the ICPD to Bangladesh was its timing and focus on a holistic approach to the dynamic changes already un derway in it population program182. Bangladesh adopted the ICPD definition of reproduct ive health and expanded population policies and programs through the effective use of technical assistance, which strengthened coordination within development sector s183. Due to the ICPDs introduction of an integrated approach to family planning, Bangl adesh set the goal of providing reproductive health to all through the provisions o f an essential services package. Growing from a small-scale, clinic based program to multi-sectoral nationwide program, initiatives shifted away from door-to-door delivery to clients obtaining services from fixed clinic-sites184. Although Bangladesh has experienced continued succe ss in achieving ICPD objectives, the new program faced challenges in set ting priorities, financing, and implementation. In addition, because the PoA is sub ject to individual nations interpretation, population issues regarding unmarri ed people, adolescents, and other controversial topics have been overlooked, posing a threat to the programs success and 4r'(4,---'B13n'r(CnEnnr$+' Cn(r#%(nn Ernn+95(n%n)n nr(nnnE ,--.Ernnn,--.
nperpetuating values in contradiction to addressing current population challenges185. Population growth also continues to constrain effor ts to raise standard of living. In this context, development problems include deforestation and reduction of cultivable land, onset of desertification, air and water pollution, scarcity of drinking water, unemployment, malnutrition, and slow progress in he alth and education sectors. Stabilizing population growth is an urgent national priority. However, factors that influence population stabilization efforts are spre ad across work of several ministries including Health, Education, Labor and Employment, Social Welfare, Women and Childrens Affairs, Youth, Rural Development and Co operatives, etc.186 Recognizing the relationship between population and development, the following objectives and implementation strategies have been formulated to address future challenges in the areas of population growth and ec onomic development: attain a Net Reproductive Rate, address causes of maternal and infant mortality, increase use of immunization to reduce child health problems, ensure population development links through coordin ation and implementation of population related activities acr oss ministries, encouraging births later, developing human resources, ensure the right to free access of reproductive inf ormation/facilities, ensure gender equity/womens empowerment, provide nutritional knowledge to prevent malnutriti on, ensure food security, etc.187 To achieve these objectives, a number of broad impl ementation strategies have been suggested. These include ensuring the provisio n of quality services that respond to client-needs, strengthening population and developm ent linkages, reducing gender n4n!::01!::.4r4r
ndiscrimination in service provisions with a priorit y on poor women and children, public policies relating to all sectors incorporation of p opulation factors in an effort to make society conscious of population problems and implic ations at every social level, using all to disseminate the small family norm, and introduci ng population and reproductive health education in the formal school system and sectoral training institutions. By upholding human rights standards and complying with prior com mitments, Bangladeshs national policies are geared towards stabilizing population growth188. Still there is an uneven application of family planning programs in rural ar eas, which happen to be the most populous. Other discrepancies between rural and urb an populations include rural women bearing one more child on average189. Marriage age is still young, but rising. While t he minimum age for men to marry is 21, the legal age f or women to marry has risen from 14 years to 18 years. In 2000, 50% of women in Banglad esh were married by the age of 15, down 10% since 1997. Among married women, 59% prefe r a two-child family, 22% believe three is ideal. Still, family planning is p racticed later in marriage and newly-weds continue to have children at roughly the same rate as did their predecessors190. Nearly half of contraceptive users discontinue use after one year due to concerns about health and side-effects. The high public awar eness and knowledge of family planning does not translate into an equivalent leve l of contraceptive use because there is still a preference for large families and male offs pring. Although abortion is illegal except to save a mothers life, illegal abortion is a majo r contributor to the high rate of maternal mortality. The public-sector remains the primary so urce of family planning from which 4r3r!:,!'.n4r'.
n64% of current contraceptive users obtain their met hod of contraception; 36% do so from a public facility and 28% do so from government fie ld workers. In 2000, 64% of pill users relied on government supplied brands, which a re distributed for free. Users among married women increased from 8% to 60% from the mid -1970s to 2004. Although social and economic improvements have played a major role in increasing demand for contraception, the provision of services and inform ation show to have an independent effect on attitudes and behaviors191. Although Bangladesh has been applauded for its succ ess in fertility decline, the governments ardent commitment to increase CPR in e arly fertility control efforts not only neglected human rights, but also diverted atte ntion away from providing a full range of health needs that met local demands. Early demog raphically-driven programs treated women as a means of achieving population control ob jectives, resulting in health services other than fertility control receiving less attenti on192. Throughout Bangladeshs population policy development, programs aimed at im proving standards of living and access to reproductive health services have been co upled with instances of government coercion and attempts to force sterilization. As in ternational agreements on population and development transitioned from promoting targetdriven population programs to client-oriented voluntary programs, domestic coerci on and forced participation in programs have decreased; international agreements, however, have always discouraged violations of human rights. Because Bangladesh has consistently updated its program objectives and expanded its reproductive services, it is unclear as to whether major international normative shifts impacted Bangladesh s population initiatives. It is possible 4r'.1-4r',:
nthat the program would have progressed to its curre nt point without international influence. It is clear, however, that the 1994 ICPD took place when Bangladeshs population program began stagnating and the country subsequently became committed to improving its services. Thus, the conferences timi ng and approach provided the framework from which Bangladeshs population progra m could progress.
nChapter Six: Conclusions, Challenges, and Recommend ations Overpopulation can be considered the defining envir onmental and developmental challenge of our time. Although population pressure s have global implications, addressing such problems can be thought of on the b asis of self-interest. For example, if the human population continues to grow exponentiall y, individual nations will not only suffer from the impacts of environmental degradatio n, but they will also suffer in terms of basic health and economic prosperity. By acknowl edging the domestic impacts of population pressures, nations recognize their selfinterest in addressing rapid population growth through population policies and programs. Su ch efforts, in turn, benefit global society. As previously discussed, there are two distinct app roaches to population control: top-down coercion and bottom-up empowerment. Within each approach, a set of norms exist as to what family planning services entail an d what womens role is in the success of fertility reduction initiatives. Acceptance of s uch norms is highly dependent on a number of inextricably combined variables including religious, cultural, and political values, womens role in society, and efforts to soc ialize citizens to new norms. Each factor plays an important role in both internationa l and domestic settings, affecting normative diffusion regarding womens empowerment a nd reproductive rights. In the 1970s, most nations experiencing population pressures recognized their self-interest in reducing fertility rates, partakin g in national population control initiatives. Early efforts often used coercive methods, targetin g women in an effort to increase contraceptive prevalence, sterilization, and someti mes abortion. In the 1990s, however,
rnthere was a shift in ideas about population control At the 1994 Cairo conference population initiatives were subsumed into broader n orms of gender equality and womens rights. This shift in ideology, based on new norms, had implications for domestic program structures. Such norms, however, were resis ted by conservative nations, specifically those with majority Muslim populations In the following section, Finnemores and Sikkinks interpretation of normative diffusion is used as a framework to analyze the dif fusion of norms regarding gender equality, family planning, and womens rights and e mpowerment at both the international and domestic level. The population programs of Indo nesia and Bangladesh, before and after Cairo, are also compared. The traditional nor ms in contrast to gender equality norms are highlighted, illustrating the resistance of con servative nations in accepting new norms regarding women and implementing programs in accord ance with such norms. This information is pertinent to the future acceptance o f norms regarding womens rights and empowerment and provides some insight into the chal lenges of overcoming cultural barriers in implementing international agreements. I conclude by providing personal projections and recommendations that I feel are nec essary to the success of future population programs. The succession of international population and deve lopment conferences displays an attempt, on behalf of the United Nations, to int roduce new norms about gender equality, family planning, and womens rights and e mpowerment. At each conference, new norm advocates met with cultural and religious opposition; most frequently, controversy regarded family planning language in dr afted programs of action. Because the United Nations advocated an overhaul of norms, which comprised controversial
nmethods of population control including abortion, t his objective met with domestic opposition that slowed the process normative change regarding womens empowerment. Inspiration for the 1974 Bucharest conference on po pulation came predominately from the United States and a small group of Western European and Asian nations. In coordination with the United Nations and nongovernm ent organizations, each acted as norm entrepreneurs, articulating new norms of gende r equality through the organizational platform of international conferences. At Bucharest disparities in delegate motivations shifted focus from population mitigation to solving economic concerns, overshadowing norms regarding womens empowerment. The Third Worl d advocated establishing a New International Economic Order to address developing countries ailments caused by NorthSouth inequalities. To the Third World, their popul ation problems were seen as symptoms of greater economic issues. Demographic co nsiderations fell short to political interests; emerging norm acceptance was lower on th e international agenda than reaching consensus on the final Program of Action, which encouraged countries to develop their own population policies promoting womens legal status and equality193. This suggestion is a clear instance of norm emergence among the int ernational community because womens role in population initiatives was acknowle dged.Although new norms emerged at the 1974 conference, they were contrary to the t raditional norms of conservative nations. Domestic resistance to new norms persisted at each successive international conference. 8,-0F
nFollowing the Bucharest conference, women worldwide began channeling their reproductive demands through NGOs and political net works194. The combination of international consensus on the 1974 Program of Acti on, which introduced new norms about womens rights, and increasing domestic press ure for governments to behave in accordance with the Bucharest agreement, led nation s to increasingly adopt new norms. This process catalyzed new norms to the next life c ycle phase, cascade, in which countries began to adopt new norms at an accelerate d rate even without domestic pressure to do so. By the time of the Mexico City conference in 1984, most countries believed it was in their interest to reduce fertility and addre ss population issues as part of their development strategies. Most countries had already established family planning programs, suggesting that domestic regions had begu n to accept family planning as a norm. In Mexico City, norms regarding womens right s, however, were dwarfed by political objectives and controversy surrounding po pulation control methods. Changing perceptions of self-interest and norm acceptance be gan to merge. Because the United Nations was unsatisfied with eff orts to export contraception and other family planning services to the Third Wor ld, they became increasingly supportive of abortion as a means of population con trol. Again, they met significant backlash on religious and political grounds from gl obal powers including the United States, Muslim countries, and the Vatican. Because each entity has considerable influence on the rest of the world, their position undermined normative change regarding womens rights other than the right to abortion; the intern ational community was significantly 5r!::"'F
nimpacted by the repercussions of the controversial Mexico City Policy, which revoked funding from programs that incorporated abortion se rvices. Womens empowerment became a secondary goal to the integration of famil y planning in development policies. The Mexico City conference represents the beginning s of an international norm cascade because delegates came to the consensus tha t improving womens status in society was an important goal in itself, implementi ng programs in accordance with the Program of Action which encouraged emerging norms. Because improving womens rights was a subordinate goal to family planning ob jectives, however, persistent cultural opposition at the domestic level prohibited normati ve diffusion regarding womens rights in many conservative nations. The conference was su ccessful in pursuing norms of family planning, the importance of maternal and chi ld health, and the basic human right of deciding the number and spacing of births throug h family planning education and services195. Through coordination among experts and grassroots r epresentatives, a requirement prior to the next international confere nce on population was established; a shift in the focus of initiatives was necessary to address program challenges. From primarily focusing on fertility reduction, mitigati ng growth by achieving quotas, population objectives shifted to focus on the repro ductive and sexual rights of individuals196. The needs and rights of women, thus, became a fo cal point on the international population agenda. At the 1994 ICPD i n Cairo, nations were encouraged to accept and implement new norms into population prog rams. However, conservative D9,-."'!-.5r!::"'F
npopulations, specifically Muslim nations, resisted such norms. Once again, the United Nations met cultural and religious opposition from countries concerned about reproductive rights including abortion. Although ab ortion controversy persisted, the conference focus on womens empowerment represents a normative shift in the international communitys approach to family planni ng and reproductive rights; the ICPD became the first international conference to explic itly recognize reproductive rights as human rights, emphasizing the role of women in achi eving population and development objectives. Consensus on the 1994 Program of Action suggests the progression of norm cascade because the worlds nations agreed that wom ens ability to access reproductive health and rights the cornerstone of her empowermen t and a key to sustainable development197. Although reproductive liberties were previously a cknowledged as keys to education, equity, and autonomy in international population politics, sustained commitment to the goals of Cairo was acknowledged a s a requirement for continued success198. The Cairo conference represents the international n ormative cascade and institutionalization of norms regarding womens rig hts. Post-Cairo conferences suggest persistent commitment on the part of domestic gover nments to pursue population program objectives; however, cultural and religious disparities continue to compromise agreements and hinder complete normative diffusion. As previously stated, new norms regarding womens r ights were resisted by Muslim nations like Bangladesh and Indonesia. Numer ous Muslim cultural and religious 8+Err!:,,
nnorms contrast norms promoting gender equality. For example, traditional norms set appropriate roles for women as subordinate to their male counterparts. Women are forbidden to make decisions that affect the family. New norms advocating equal access to contraception and womens reproductive rights are i n direct contrast with these traditional norms because supporting new norms woul d provide women with the ability to choose to take contraception with or without her husbands approval. Other wide-spread norms have also affected the diff usion of norms regarding womens rights. For example, the right-to-life norm supported by many conservative nations, is contrary to norms that encourage aborti on as a legitimate means of population control. Due to backlash at each international conf erence on population, each Program of Action explicitly prohibits abortion as a means of family planning. In addition, sovereignty norms, embedded in nearly every interna tional agreement, allow nations to implement policies and programs that are in accorda nce with cultural values and national laws. Nations resist stringent international contro ls, only allowing recommendations. The opt-out clause in every Program of Action from each international conference on population displays this norm. Each norm mentioned continues to have implications on the successful normative diffusion regarding women s empowerment and gender equality. Norm Diffusion in Domestic Setting-Case Studies Voluntary family planning was introduced in Banglad esh in the 1950s through the provisions of foreign assistance. International pow ers have thus influenced Bangladeshs domestic population initiatives even before interna tional meetings on population were
nheld. In 1960, when the government established the National Family Planning Program, initiatives were limited and lacked adequate infras tructure and personnel to provide services to meet the needs of individuals. The prog ram used coercive measures to encourage or force participation in family planning programs, often violating human rights standards. In the early 1970s, the government began providing maternal and child health services. Though womens empowerment was not the co re objective of the program, women became a central focus of population policies and initiatives, suggesting norm emergence regarding womens role in effective ferti lity reduction. Programs based on meeting fertility reduction targets were supported at Bucharest and were further developed following the conference. In response to the Mexico City conference in 1984, population initiatives expanded to include services for rural populations. Education and community activities were intended to stimulate nor m changes regarding family size and provide information about contraception options199. Although the programs focus on womens and childrens health and family sizes were similar to norms emerging at the international level, domestic initiatives did not e ncompassed womens empowerment or reproductive right enhancement as key components. T he establishment of family planning services, with a focus on women, however, suggests domestic norm emergence. In the early 1990s, propaganda campaigns intensifie d, intended to establish population program objectives as a social movement, promoting family planning as an integral part of development activities through int er-sectoral collaboration, community 3r!:,!'0
nsupport, and participation mobilization200. During the ICPD planning process, Bangladesh became committed to revamping its family planning program, expanding access, and improving quality of care. Changes that Bangladesh considered pre-Cairo were reflected in the 1994 Program of Action, sugge sting that domestic program changes were occurring simultaneous to international normat ive shifts. Following the 1994 conference, Bangladesh incorporated components of t he Program of Action in its policies and programs in support of new norms surrounding wo mens empowerment and family planning. For example, the establishment of Womens empowerment centers in Bangladesh suggests that norms have been implemente d in population programs. The program expansion in support of new norms represent s an instance of a domestic norm foothold. However, it is uncertain as to whether or not the community has accepted gender equality norms or if Bangladesh has implemen ted such programs in an effort to maintain aid relations based on self-interest. Population policies were first enacted in Indonesia during their colonial period. Transmigration policies prevailed until the 1970, w hen Indonesias National Family Planning Program was established. Voluntary family planning initiatives emerged in 1956, when USAID funded Indonesian doctors training in family planning methods, helping establish the Voluntary Planned Parenthood Association in Indonesia. At the time, there was little public support for such init iatives because traditional norms, in support of large families, were advocated by religi ous and community leaders. In 1967 the first government funded community orien ted family planning program, the Jakarta Pilot Project, was established The government supported efforts by nnE,-'!B-
nencouraging the integration of family planning serv ices and activities. Through government efforts to overcome religious and cultur al opposition to family planning, the project was used as a framework for establishing th e National Family Planning Program in 1970. Initiatives included advocacy and informat ion programs in support of norms regarding family planning. These examples represent domestic norm emergence of family planning. Throughout the 1970s and 80s, cont inued expansion of program services and delivery improved access and spread family plan ning acceptance. Instances of forced sterilization also aided fertility decline. By the time of the ICPD in 1994, Indonesias fertil ity rate declined to 2.86 children per women. At the conference, traditional values spurred controversy over the proposed agreement regarding reproductive rights an d womens empowerment. Although Indonesia adopted the Cairo agreement, it did so wi th reservations on cultural and religious grounds. Indonesias family planning prog ram has since undergone various institutional changes and implemented new program e lements in support of normative change. Womens Empowerment Agency offices, for exa mple, have been established, suggesting some progression in norm acceptance. There are a number of similarities between the popu lation programs in Bangladesh and Indonesia. In both countries, volunt ary family planning services began in the 1950s without government support. After acknowl edging the importance of population control measures in pursuing economic de velopment, both countries initiated conversations with religious leaders to gain suppor t, instituted national family planning programs, and experienced significant reductions in fertility rates. In both cases, there were instances of forced sterilization, contracepti ve use, coercion, and incentives. In both
ncountries, population programs also receive a dispr oportionate amount of money compared to what is spent on basic health care serv ices, clearly displaying government priorities. Family planning personnel, in early ini tiatives, lacked training and the ability to distribute adequate information to clients, unde rmining true consent to participation. Population control was perceived as a priority in b oth countries, but for different reasons. Bangladesh prioritized population control measures over increasing agricultural production, literacy, health care, and feeding the hungry, essentially proving that population growth could be reduced without also imp roving health, poverty, or social justice conditions. Bangladesh set a target that ov er 1/3 of contraceptive users be sterilized. Indonesia, on the other hand, institute d population control measures in an effort in increase economic prosperity, encouraging or forcing permanent methods of birth control. Since Cairo, both countries have ins tituted programs in accordance with the 1994 Program of Action in an effort to improve wome ns reproductive rights. The diffusion of this norm, domestically, however, has been a slow process that continues to be a challenge for programs due to cultural resista nce. In terms of case studies differences, Indonesia beg an family planning with an emphasis on birth-spacing versus sterilization, com pensating for potential backlash, before instituting a more heavy-handed program. Ind onesia pursued effective contraception methods including IUD, pill, injectio n, and mass insertion campaigns with high profile attendance. The Indonesian family plan ning program used coercion in all aspects, including mapping contraceptive users and targeting non-users through fieldworker outreach. While Indonesia has been successfu l in fertility declines and displays instances of norm emergence and cascade, coercion a nd lack of contraceptive options in
rnthe programs early years stigmatized family planni ng services. This is a challenge the program is still recovering from. In Bangladesh, va rious contraceptive options were available but service provisions lacked reliability Bangladesh became dependent on sterilization and other permanent or cost-effectiv e contraceptive options. With external pressure to raise contraceptive prevalence rates an d aggressive efforts, the program became more forceful at meeting targets through inc entives and coercion. Currently, both countries have established programs in accordance with norms of womens empowerment and gender equality. However, i t is uncertain as to whether or not norms have been accepted by the community or if the governments goals of maintaining aid relations overshadows any true norm acceptance. Conclusions and Recommendations Norms regarding population mitigation simultaneousl y emerged in both domestic and international communities. Norms regarding wome ns rights and empowerment, however, required more socialization at the interna tional level and increased domestic pressure to stimulate change. Religious and cultura l values have persistently influenced the progression of normative diffusion in both sett ings. The succession of international population conferences illustrates how new norms em erged, were observed and conflicted. The progression of norms up to the 1994 conference suggests that norms regarding womens rights and empowerment have achie ved a partial cascade, firmly embedded in the Cairo Program of Action. Although t he international community supports new norms, I believe that the pace of acce ptance at the domestic level is lagging; new norms have a ways to go before they can become prevailing norms, specifically
nbecause the social and religious dynamics of the co unties are contrary to norms of womens rights. Both Bangladesh and Indonesia have had great success in reducing fertility rates pre-90s due to program efforts. Pri or to the ICPD, however, program effectiveness began stagnating. New ideas of gender equality helped reshape domestic family planning programs. It is uncertain, however, whether or not international pressure to adopt and implement new norms was the primary in fluence on such adoption. This uncertainty persists because both countries experie nced rapid fertility decline utilizing top-down approaches to population control. Other th an program stagnation and international pressure to conform, neither country had a reason to address population growth from an alternative approach. I believe that both Indonesia and Bangladesh have experienced partial normative diffusion regarding w omens rights, however, further diffusion is dependent on domestic acceptance. The challenges posed to current population initiati ves are that of increasing efforts, awareness, responding to individual needs, and adjusting services to provide for changing demographic conditions. Development polici es and programs must reflect the inextricable links between population, environment, and development, which requires womens empowerment. Domestic governments should fo cus on improving womens status and opportunities in an effort to raise over all quality of life, economic prosperity, and environmental wellbeing. A central focus on the critical role of women and its broader applications are necessary to achieve devel opment objectives. Inequalities must be eliminated to empower women, increase sustainabi lity and access, and improve human capital. Education and job opportunities, especiall y for women, are essential components to alleviating poverty and gender inequality becaus e they allow women the choice to
nhave fewer children and the ability to invest more in each child. Education on the environmental and social costs of population growth should emphasize the benefits of small families, stressing that every person must be cared for within the constraints of the local and global environment. Social norms must shi ft away from stringent limitations on womens choice and should increase acceptability of opting to remain childless. Economic forces should also be considered in popula tion control policies. Gross Domestic Production (GDP) is the global measure of economic progress, which includes a built-in tie to population growth: more people me an more transactions. However, GDP can rise while median household income and wellbein g decline, suggesting that inappropriate measures set inappropriate goals. Bet ter economic policies in conjunction with slowing population growth can increase prosper ity. Progress measurements should, thus, incorporate measures other than economics to fully encompass development objectives. Recognizing the processes and challenges of normati ve diffusion at both the international and domestic levels is essential to o vercoming barriers in addressing the global implications of population pressures. Initia tives must be broad based and incorporate preparatory measures to deal with chang ing demographics, economic status, and environmental fluctuations. Because norms regar ding family planning, family size, and womens empowerment and rights are at the casca de phase of the normative life cycle, it is possible for such norms to become the prevailing norms if countries continue to socialize, not coerce, citizens to accept normat ive change by understanding the benefits of doing so.
nGiven the staunch cultural and religious opposition new norms have faced since their emergence, I predict that the current process of normative diffusion will not replace traditional norms for some time. In an ideal world, individuals would choose to have two or less children, recognizing the burden of exponen tial growth on society and the environment. Women would have equal rights and oppo rtunities to men with the ability and means to decide the number and spacing of birth s through access to high quality family planning and health services. Individuals wo uld spread new norms to future generations in an effort to sustain population grow th reduction and achieve a sustainable global population size. Each of these recommendatio ns would help relieve global problems of poverty, equality, and health. Through this thesis, I hope to have demonstrated th e importance of international and domestic bodies in normative diffusion. I belie ve that the barriers in successful diffusion have the potential to be overcome by util izing bottom-up empowerment efforts, contrary to top-down fertility reduction targets, w hich revoked liberties rather than provided them. It is essential for human rights sta ndards to be upheld in population initiatives because successful normative diffusion requires actors acceptance of norms before behavior shifts to support them. The mitigation of overpopulation is an important is sue to me because its success has direct impacts on the future and, more specific ally, my life. Throughout this process, my ideas about population control have drastically changed. Initially, I thought that every country should have Chinas one child policy becaus e population growth is so rampant that drastic measures were required. Now I realize that forcing individuals to comply with top-down demands negates human rights and the need to allowing people to choose what
nbest suits their lifestyle and preferences. I belie ve it is important to provide services to individuals even if they do not initially accept ne w norms, because it is necessary to provide services that encourage acceptance; eventua lly society will adapt and adopt new norms. With adequate information about the implicat ions of population growth, I believe humanity could make the best decision for both huma ns and the environment. If such changes do not occur soon, however, certain liberti es may need to be revoked. I do not believe in forced abortion or sterilization, but li miting the number of births per family may be a useful tool to curbing population growth.
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