myth 1
Too Little Food, Too Many People
[MYTH:] Food-producing resources are already stretched to their limits, and in many places there's just not enough to go around. More people inevitably means less for each of us. So continuing population growth, which could lead to several billion more people by mid-century, is a major crisis. To end hunger today and to have any hope of preventing ever-greater hunger in the future, we must stop population growth.
[OUR RESPONSE:] "Too many people pressing on too few resources" is perhaps the most common and intuitive explanation for continuing hunger. But sometimes our intuitions just don't line up with the evidence. The world produces more than enough food today. And, given the striking decline in population growth in recent decades, there's every reason to believe it is possible to halt population growth before we overshoot the Earth's capacity.
Let's begin by probing more deeply the extent of hunger that many assume to be evidence of too little food for too many mouths. How we measure hunger turns out to be trickier than we'd long assumed.
In our opening essay we noted that the UN Food and Agriculture Organization (FAO) defines hunger only in terms of calorie deficiency, and reports about 800 million hungry people.[1] In this widely used measure, the FAO explained to us, those who lack calories for many months at a stretch-say, between harvests or jobs-do not register if their calorie supply averaged over a year is minimally sufficient. Yet, medical authorities tell us that even short-term calorie deficiency can have devastating effects, especially on children and anyone weakened by disease.[2]
Appreciating the inadequacy of this single measure, in 2013 the FAO began to emphasize a "suite of food security indicators" that includes not only the adequacy of available protein and calorie supplies but also stunting and factors such as grain-import dependency and access to safe water and sanitation that signal vulnerability to hunger.[3] The FAO also added an assessment tool called Voices of the Hungry, drawing on self-reported experiences of food insecurity.[4] We applaud these efforts to gain a truer understanding of the depth of hunger.
Still, only [one] hunger measure-that of calorie deficiency-reaches the broad public, even as this measure increasingly fails to capture nutritional well-being.
Why do we say "increasingly"?
Because the quality of food in many parts of the world is degrading, so more of us can be suffering from lack of nutrients even when our calories are more than sufficient. For example, take India, where one in seven people is "hungry" by the current calorie measure, yet at the same time four in five infants and toddlers and half of all women suffer from iron deficiency, with potentially deadly consequences.[5]
From 1990 to 2010, unhealthy eating patterns outpaced dietary improvements in most parts of the world, including the poorer regions, reports a 2015 [Lancet] study. As a consequence, "most of the key causes" of noncommunicable diseases are diet-related and predicted by 2020 to account for nearly 75 percent of all deaths worldwide, the study emphasizes.[6] By 2008 nearly four-fifths of deaths from cancer, heart disease, and other noncommunicable diseases were not in the Global North, long associated with these largely diet-related ailments, but rather in "low-and lower middle-income countries," according to the World Health Organization (WHO).[7]
In these alarming trends, [The Lancet]['s] study implicates "transnational marketing and investment."
This widening disconnect between calories and nutrients has another devastating outcome: Worldwide, roughly one in eight people is now obese, and thus at risk for heart disease and diabetes among other ailments.[8] Almost two-thirds of obese people live in the Global South.[9]
These realities hit us when a doctor working in a rural Indian clinic serving two thousand impoverished farmers each month described a major change in his practice over the last few decades: "My patients get enough calories, but now 60 percent suffer diabetes and heart conditions."[10]
Clearly, the world urgently needs a more meaningful primary indicator of the nutritional crisis than one based on calories alone-a measure of what we call in this book "nutritional deprivation" that captures both calorie and nutrient deficiencies. Since we don't yet have one, let's review the indicators we do have and then see where we stand.
In addition to the calorie-deficiency measure, arriving at about 800 million people worldwide in 2014, another is "stunting," estimated by the WHO in collaboration with UNICEF and the World Bank.[11] In children under five, stunting is diagnosed when a child's height is significantly below the median compared with the "reference population."[12] To most ears, "stunting" merely suggests being unusually short; but it actually indicates a set of medical problems including a depressed immune system and impeded cognitive development.[13]
One-quarter of the world's children are stunted, report these agencies, with many factors conspiring to cause the problem, including too little food and nutritionally poor food for pregnant women and children, along with other deprivations.[14] New research underscores that poor sanitation also contributes to poor nutrition, and thus perhaps to as much as one-half or more of stunting, even when a child is well fed, because repeated bacterial infection associated with unsafe water interferes with nutrient absorption.[15]
Stunting remains "disturbingly high," notes the FAO. Without China, the global decline in stunting since 1990 would be significantly less than the decline in calorie deficiency-to us more evidence of a widening gap between calories and nutrition.[16]
Evidence grows that the consequences of stunting commonly last a lifetime, including cognitive impairment and a weakened immune system, as noted; and, for females, reproductive problems. All show up in reduced educational and economic achievement. Thus, we believe, because stunting typically brings lifelong harm, individuals designated as stunted during childhood should be counted throughout their lives among those suffering the consequences of nutritional deprivation.
By this reasoning stunting affects not just one-quarter of our children but one-quarter of our whole population, or 1.8 billion people. We know this approach breaks with conventional wisdom, but we ask you to weigh it seriously.
One might counter by observing that not every child diagnosed as stunted experiences significant harm as an adult, so isn't applying the same percentage to a whole population bound to overstate the problem? Unfortunately, no. Because stunting afflicted prior generations as well, this measure actually undercounts many adults born when stunting was even more common. Those in their 30s today, for example, were themselves under five years old at a time when stunting was much more widespread than it is today.[17]
Beyond calorie deficiency and stunting, are there any additional indicators that might help us to grasp the magnitude of the nutritional crisis?
A third is WHO's estimate that [two billion] of us have a deficit in at least one nutrient essential for health-a deficit often causing great harm. Vitamin A deficiency, for example, means blindness for as many as half a million children each year, and iron deficiency is linked to one in five maternal deaths.[18]
So taking into consideration these three indicators, with considerable overlap-calorie deficiency at about 800 million, stunting at 1.8 billion, and nutrient deficiency at 2 billion-arguably at least one-quarter of the Earth's 7.3 billion people suffer from nutritional deprivation. That's roughly twice as many as are "hungry" measured by calorie deficiency.[19]
We've chosen "nutritional deprivation" to define the crisis this book addresses, mindful that it isn't a common term. With this background, we can now clarify its meaning. Here and throughout our book nutritional deprivation means being so deprived of healthy food-and the safe water needed to absorb its nutrients-that one's health suffers. It thus captures both calorie and nutrient deficiency. "Being deprived" in this definition refers to the result of inequities in power relationships, such as those we touched on in the opening essay, that block people's access to food and to santitation. It therefore conveys a social malady-not simply being in a state of deficiency but the widespread harm caused by being actively deprived.
The implication of all of this?
We'll say it again: [In a world of abundant food resources, at least one in four of us suffers from nutritional deprivation], yet humanity still lacks a comprehensive measure of this crisis[.]
In our opening essay, we described hunger as painful, universal human emotions that arise from feelings of powerlessness to protect ourselves and our loved ones, and here we stress that hunger must be measured not only as calorie and nutrient deficiency but also as the resultant, ongoing impairment and disease. Hunger means all of this, and it affects all of us.
Because the word "hunger" carries such powerful emotion, we will continue to use it. We hope that you do, too. Still, we want to be clear that for us hunger means not only calorie deficiency but the much broader, and often more devastating, dimensions captured in "nutritional deprivation." In this sense, "hunger" is no longer understood primarily as an uncomfortable, even painful experience; it is a condition creating great and often lasting harms that we can all be part of ending.
Now let's tackle head-on the premise that scarcity explains the widespread misery of not being able to secure a healthy diet. Does scarcity hold up as an explanation in light of the facts?
BEHIND THE SCARCITY SCARE
Global population more than doubled between 1961 and 2013, but world food production grew even faster. So today there's about 50 percent more food produced for each of us.[20] In fact, the world produces enough food to provide every human being with nearly 2,900 calories a day.[21] That's enough to make many people chubby!
Plus, those 2,900 calories are just from the "leftovers"-what's left after we've diverted about half of the world's grain and most soy protein into feed for livestock and nonfood uses.[22] Worldwide, 9 percent of major crops is now used to produce ethanol-what we call "agrofuel" to remind us of its agricultural roots-and for other industrial purposes.[23]
Nor do the 2,900-and-climbing calories for each of us include much of the breathtakingly large amount of food we waste each year, about one-third of all edible parts of food, amounting to 1.3 billion tons in 2009.[24] As a result, we lose one out of every four calories produced.[25] Consumers in industrialized countries waste almost as much food as the net food production of sub-Saharan Africa.[26]
Beyond the vast abundance represented by these numbers are the uncounted but sizable quantities of food that 1.6 billion people living in or near forests secure for themselves from herbs, animals, fruits, nuts, and berries.[27] A sense of the richness that's not counted in the world's food supply is suggested in a finding of the National Academy of Sciences that "most of Africa's edible native fruits are wild-rarely cultivated or maintained or improved."[28]
While we hear from longtime food analyst Lester Brown that scarcity is the "new norm," the UN agency responsible for forecasting our future food supply, the FAO-even after taking into account expected population growth-forecasts global calories available per person in 2050 to be even slightly higher than the generous supply we have today.[29]
[Abundance, not scarcity, best describes the world's food supply.]
But Don't Price Spikes Prove Scarcity?
On average, global food prices in 2014 were 45 percent higher than a decade ago, after adjustment for inflation, a huge increase in a short time.[30] And they are predicted to rise further as climate change affects agriculture.
But are shortages really the cause?
From time to time, the world experiences price spikes in grains and other agricultural commodities-accompanied by experts blaming food "shortages." The most recent and deadly price spikes occurred in 2008 and 2011. But such spikes often do not reflect a real shortage of food: Over the decade that included this food-price crisis, global per capita agricultural production continued, with one tiny dip, its steady growth of the previous decade.[31] Rather, these spikes are "bubbles" generated in large measure by commodity speculators whose gambles transform small declines in forecasted supply into [much] higher prices.[32]
Unfortunately, for impoverished people increasingly dependent on imports, international price swings bring harsh consequences, as we examine in Myth 6.[33]
Beneath the Big Picture: What About the Hunger Zones?
All well and good for the global picture, you might be thinking, but doesn't such a broad stroke tell us little? What about countries we tend to associate with widespread hunger-those in the Global South, especially in Africa?
Are not food supplies scarce there?
Food output per person in what are called "low income, food deficit" countries increased almost 30 percent between 1990 and 2012.[34] If we look more closely at areas that account for most of the world's hungry people, scarcity cannot explain hunger.
[India.] Over 190 million Indians do not get enough to eat-that's almost one-quarter of the world's calorie-deficient people.[35] Yet, over the years from 1990 to 2012, food production per person in India has outstripped population growth by about a third, while the number of undernourished Indians-almost one in seven-declined by just 10 percent.[36] India not only exports grain, but in 2012 it had the world's second-largest grain stockpile after China. In that year, India's stockpile alone could have provided one cup of cooked rice to every Indian every day plus almost 50 loaves of bread for everyone that year, and bursting granaries often force the government to store wheat outdoors under tarps, exposed to rot and rats.[37]
Despite all this, India is home to 38 percent of the world's stunted children, and stunting brings lifelong impairment and vulnerability to disease.[38] As already noted, new research suggests that poor sanitation, by exposing children to pathogens that interfere with nutrient absorption, likely plays a huge role in this lost potential.[39]
Scarcity of food, however, is not to blame.
[Africa.] When most people in industrial countries think of hunger, no doubt images of Africa come to mind first. Yet food production on the African continent outstripped population growth between 1990 and 2013 by 22 percent, not that far from the global average of 29 percent.[40]
South of the Sahara, since 1990 the number of Africans suffering from long-term, severe calorie deficiency has increased by 22 percent.[41] But during the same period, food production per person rose almost 10 percent, even though the region includes countries with the world's highest population growth rates.[42]
Roughly 2,300 calories are available per person every day in sub-Saharan Africa. That's somewhat above the "basic minimum nutritional requirement," of 2,100 calories a day, as defined by the United Nations Development Programme. Thus, if food available within sub-Saharan Africa were equitably distributed, [all] Africans could meet their basic caloric needs.[43]
In rethinking scarcity in Africa, also note that almost a dozen sub--Saharan countries-some with high levels of undernourished people-export more food than they import. The Ivory Coast, for example, uses prime land to grow cocoa and coffee; this makes it a net food exporter, yet 30 percent of its young children are stunted, a proportion higher than the world average.[44]
Despite its production gains, sub-Saharan Africa's food output for local consumption remains far below its potential. This reality of unrealized potential isn't surprising given the range of forces that over centuries have thwarted and distorted the region's agricultural development:
[Foreign interests take over agricultural lands.] Colonial seizures of land in the nineteenth century continued into the twentieth. They have displaced peoples and pushed agricultural production from good soils into less fertile areas, with the best land dedicated largely to export crops.[45] In new forms, these seizures continue today as China, Saudi Arabia, Kuwait, Qatar, and South Korea, among others, are busy buying up or leasing vast tracts of land to provide food-not for local people but for their own consumers-as well as to produce crops for fuel. While reliable data are hard to come by because the companies involved are secretive, a UN report nevertheless includes this dramatic estimate: Up to two-thirds of all of what are now called "land grabs" are to grow crops for fuel. Since 2000 in Africa, land grabs so far total an area as large as Kenya.[46]
[Governments underinvest in agriculture-failing to put resources into farm credit, local market roads, and crop storage facilities.] That's true even though agriculture engages at least 70 percent of the African workforce.[47] Tanzania is just one example where "the main reasons farmers do not produce more," observes the FAO, are "difficulty in accessing markets and a lack of infrastructure."[48] Forty African governments recently committed publicly to devote 10 percent of their budgets to agriculture, but by 2014 only nine of them had achieved this goal.[49]
[Government resources tend to back agricultural exports more than staple foods of small farmers.] The colonial era's focus of public resources-from research to credit-on export crops has continued after independence.[50]
[Foreign aid policies have often reinforced this emphasis on exports]. Much official foreign assistance has bypassed Africa's small farmers and pastoralists in favor of expensive, large-scale projects, backing export-oriented, elite-controlled production.[51] (We explore U.S. foreign aid in Myth 8.)
[Low prices for farmers stifle production]. With an eye to preventing urban unrest and meeting the desire of the better-off for meat and dairy products, African governments have often maintained low prices for food and feed. One result is that their own small farmers earn so little that their capacity and incentive to produce are undermined.[52] Plus, some countries, including the United States, "dump" their food surpluses in African markets-that is, sell them below their cost of production. The net effect has been to depress local production.[53] (More on this also in Myth 8.)
[Corporations based in the industrial countries have shifted urban tastes]. Thirty years ago, for example, only a small minority of urban dwellers in sub-Saharan Africa ate wheat. Today bread is a staple for many, and bread and other wheat products account for a large portion of the region's grain imports;[54] U.S. food aid and advertising by global food companies ("He'll be smart. He'll go far. He'll eat bread.") have helped mold African tastes to what the industrial countries have to sell.[55]
Thus, beneath scarcity as the diagnosis of Africa's hunger problem lie many human-made and therefore reversible causes. Throughout our book, we share highlights of Africans' progress in overcoming this legacy.
Lessons from Home
In reflecting on the relationship between hunger and scarcity, we should also never overlook the experience of the United States. In 2006, the U.S. government chose to abandon the word "hunger" and replace it with "food insecurity" in the official count of the food-deprived. The U.S. Department of Agriculture defines food security as access "at all times to enough food for an active, healthy life."[56] Thus "food insecurity" is the lack of such access, affecting, as noted, one of every six Americans.[57] But would anyone argue that there is not enough food in the United States?
Surely not.
The United States is the world's leading agricultural exporter. For U.S. farmers, "overproduction"-which knocks down prices-is a persistent worry.[58] Plus, over a third of this country's enormous corn harvest, used for fuel, feeds no one.[59]
In the United States, just as in the Global South, hunger is an outrage precisely because it is profoundly needless.
Behind the headlines, the media images, the superficial clichés, we can learn to see that hunger is real; scarcity is not. Scarcity is a human creation.
With this clarifying evidence of food sufficiency along with vast, wasted potential, let's now turn to the other side of the equation: the number of people who need to eat. After virtually every public talk on hunger we've given over more than forty years, there's been one question we've had to be ready to answer: "What about population growth-isn't it the [real] problem?"
Clearly, many people who appreciate that there is more than enough food today still worry that, if population continues to grow, very soon there will not be.
So let's ask:
WHAT [IS] THE POPULATION PROBLEM?
As we examine the relationship between population and hunger, let's first register the obvious but often-overlooked absence of any link between population density and the extent of hunger.
Scanning the globe, we see population density in the European Union at about twice the world average; but the region has the least hunger. Now consider two regions that are home to most of the world's hungry people: India and sub-Saharan Africa. India's population per square kilometer of 416 is many times the world average of 54, while sub--Saharan Africa's density of 39 per square kilometer is considerably below the average.[60] Now imagine this comparison: Bangladesh's density is equivalent to half the entire U.S. population living in an area the size of Alabama, [yet] the total calories in its food supply could meet the needs of every citizen.[61]
Of course, in localities where people have been pushed off their land and forced to settle on fewer acres of less fertile land, the number of people per unit of land is likely to contribute to hunger. But in no way does such local injustice explain global hunger.
Yet we all must take seriously the continuing growth of the human population. For who would look forward to our species so dominating the planet that other forms of life were squeezed out, and all wilderness was subdued, and the mere struggle to feed and warm ourselves would keep us from more satisfying pursuits? Plus, of course, the size of the human population is one of the key variables in dealing with climate change.
The population question is so vital that we can't afford to be the least bit fuzzy in our thinking. So here we will focus on the most critical questions: Is human population growth "out of control"? And what are we learning about the link between halting population growth and ending hunger?
In the early 1950s, the global total fertility rate was 5. That's the average number of children a woman would bear if she were to live out her childbearing years and have children in line with the current age-specific fertility rates. This total fertility rate of 5 was well more than double the "replacement rate"-the point at which a population begins to level off and stops growing over time.[62]
Then, the 1968 best seller [The Population Bomb] by Paul Ehrlich delivered this frightening verdict: "The battle to feed all of humanity is over. In the 1970s the world will undergo famines-hundreds of millions of people are going to starve to death."[63] A few years later, ecologist Garrett Hardin called for a "lifeboat ethic," in which we must let some starve if the majority is to survive.[64]
People got really worried.
[And so what has happened?]
Food per person, as we've seen, kept climbing while at the same time, by the mid-1990s, the global fertility rate had dropped from 5 to 3. By 2010, globally, it reached 2.5. (The replacement rate is now 2.1.) More specifically:
In the "more developed" regions as a whole, fertility rates-with major exceptions, including the United States-had dropped to 1.7 by 2010, well below the replacement rate.
In Asia and Latin America, fertility has fallen steadily from around 5 in the mid-1970s to about 2.3 in 2010.[65]
In Africa, the rate of fertility decline has been considerably slower, falling from more than 6.7 in the mid-1970s to 4.7 in 2012.[66] That's about where South Asia and Latin America stood forty years earlier, just as their accelerated fertility declines began.[67]
TOWARD A "DEMOGRAPHIC TRANSITION"
FOR A SUSTAINABLE WORLD
All of this lines up neatly with the concept of "demographic transition," first observed in what are today's industrial countries over the two centuries preceding 1950. It works like this: As public health and living standards improve, mortality falls and population grows fast. But over time, fertility rates drop, and overall population growth slows, then stops.[68]
Demographers have observed a similar pattern in countries in the Global South as well. The two most populous countries on the planet, China and India, have experienced dramatic declines in their fertility rates. From the 1950s to 2010, China dropped from 6.1 to 1.7, and India from 5.9 to 2.5.[69]
Thus, the population transition in the Global South as a whole, again with exceptions, has occurred much faster than it did in the Global North.
[And what about the future?]
Can we get to replacement level fertility, while healing the Earth from our current damaging practices, without overwhelming food-growing resources?
Here's what the United Nations lays out: According to its "medium" projection, global population will grow to 9.6 billion people by 2050, or about a third more of us than in 2015. At that point the world fertility rate is predicted to be 2.2. But even at that level, our population would add another billion-plus people by 2100. By then, while estimates vary, the medium projection suggests we'd have reached an average fertility rate of roughly replacement level-2.0 births per woman.[70]
This big picture is vitally important to absorb, but when we think only in terms of "world population," we miss a lot. For example: Already almost half the world's people live in countries where fertility rates are below replacement levels.[71]
Even more dramatic: If the UN projections pan out, just [eight] countries, six of them in sub-Saharan Africa, will account for more than half of all population growth worldwide to 2100. Those eight are Nigeria, India, Tanzania, the Democratic Republic of the Congo, Niger, Uganda, Ethiopia, and the United States.[72] (The U.S. population increase is expected largely to reflect immigration.) And, within India, the population growth is occurring, not throughout the country, but primarily in nine states that are home to only about half the country's population. Already, eleven Indian states are at or below replacement level.[73]
Thus, we see that more than half of the increase in world population is actually occurring in just seven countries, plus nine states in India-together representing just a fifth of the world's population.[74] Beyond this group, the picture among low-income countries is extremely mixed but, overall, encouraging: Among 156 countries categorized as "less developed" and with at least ninety thousand people:[75]
32 have reached below-replacement-level fertility.
Only 31 still have high fertility rates-5 or above-but these fast--growing countries constitute only 9 percent of the world's population.[76]
Of the remaining 93 countries among those "less developed," only 11 show increasing fertility, while 88 percent-82 countries-show declining fertility rates.[77]
Combined, these trends lead to projections that all regions except sub-Saharan Africa will reach replacement level fertility by 2050.[78]
Globally, the United Nations predicts a doubling of the number of countries with below-replacement-level fertility by the middle of this century. If this prediction unfolds, by 2050 more than three-fourths of people on our planet, or 7.1 billion, will live in countries with below-replacement-level fertility rates.[79]
Taking all this in, we suddenly see not a "world" population crisis but, rather, a challenge in specific areas of our world-areas with high fertility rates where people are experiencing poverty, hunger, the oppression of girls and women, and other human rights violations. Think of the implications.
Roughly four in ten pregnancies worldwide in 2012 were unintended and almost a quarter of all births were unplanned. Three-quarters of these births occurred in Africa and Asia.[80] Thus, working toward a world where all families have access to contraception and the knowledge and power to avoid these births can move us toward a stable world population that our Earth can support.
Is this not further, powerful evidence that the population challenge is not about stifling an innate drive to reproduce-a daunting task!-but rather about achieving what people truly want: an end to poverty and powerlessness, and therefore the opportunity for real choice.
UN Predictions, Which Choices, Our Choices?
The UN projection taking us to 9.6 billion by mid-century is the one typically referenced in the media. It is the in-between estimate, neither the most pessimistic nor the most hopeful. In the next chapter we explore how humanity can ensure that food supplies continue to be ample if this projection unfolds.
But nothing here is set in stone. Note that population projections before have turned out to be too high because human beings changed things. Case in point? The medium estimate of 9.6 billion forecast for mid-century is a lot lower than the medium estimate of 11.2 billion projected by the United Nations forty years ago.[81]
Now, let's look at the United Nations' "low" projection-8.3 billion people at mid-century-and what it might take to get there.
Getting there is desirable for a slew of reasons. It would make more likely the possibility of halting humanity's destruction of the natural world and that core human rights, including access to food and reproductive choice, would be fulfilled. The good news is that we have clear evidence of what it takes to halt population growth, because it's already worked in most of the world. So the question is only whether humanity will step up and apply these clear lessons to the root causes of the remaining population growth.
[Proven Pathways to Bringing Population into Balance with the Earth]
To act wisely, as so many people want to, we need to identify the specific social conditions linked to movement toward ending population growth.
What are they?
A short answer is the expansion of basic human rights. They include education (particularly for women) and economic opportunity, as well as access to food, health care, and contraception.[82]
One health factor associated with fertility is the rate of child death. Understandably, women who experience the death of a child will on average give birth to more children.[83] And progress in avoiding the tragic loss of a child can be speedy: In Myth 6 we note the experience of a large Brazilian city that cut child deaths by 72 percent in only a dozen years.[84]
That women's education is associated with improved child survival also makes intuitive sense. For this and other reasons, it's no surprise that female education is associated with lower fertility rates, as indicated by a 2011 survey in Uganda: Women with no formal education have on average 4.5 children, whereas those with even a few years of primary school have three. Women with one or two years of secondary school average 1.9 children, and with more years of schooling, the number falls further.[85]
All of these advances interact, of course.
The relative powerlessness of women subordinated within the family and society is, arguably, one factor in high birthrates. Men make reproductive decisions in many cultures, research finds.[86] But, it's important also to consider the wider context in which such imbalance exists: Within societies characterized by extreme inequality, many men who hold power over women are themselves part of subordinated groups. As long as society's economic and political rules deny men sources of self-esteem and decent income through productive work, it is likely some will cling tenaciously to their superior status vis-à-vis women, and one manifestation will be more births than women would themselves choose.[87]
Thus, it is not surprising that greater gender equality is associated with lower fertility rates.[88]
"Schools for Husbands"
Among gender-equity concerns are the protection of women's health and the responsibility for the use of contraceptives. On these counts, consider what's happening in Niger, a West African nation ranking near the bottom of the UN Gender Equality Index, with both its fertility rate and its rate of maternal death among the world's highest.[89]
Just eight years ago, only 5 percent of couples there used modern contraceptives.
Since then, villagers have created 137 groups they call [écoles des Maris] (Schools for Husbands) that are already making a difference. Members are chosen by a local social-benefit organization because they are trusted by their communities and their wives use local health services. The men meet twice monthly to discuss problems and solutions, then "become guides and role models within their own family and among others in the community," reports the UN Population Fund.[90]
The "schools" were launched in 2008 in response to the Population Fund's survey identifying "men's dominance and attitudes to be one of the major obstacles to women taking advantage of reproductive health care."
Since the [écoles des Maris] began, the "use of family planning services has tripled [and] the number of childbirths attended by skilled health personnel has doubled." Still, few couples in Niger use birth control. But change is under way: "When the schools started, only 5 percent of women in Niger reported using contraception. Now that figure is up to 13 percent."[91]
The People-to-People Effect
The Schools for Husbands tap a force for change identified by collaborating researchers in southern India and Bangladesh. They came up with another key variable in lowering fertility after discovering that certain fertility rates didn't line up with widely recognized economic and educational-status fertility determinants.
People accept contraceptive use, the researchers found, based on the "sum total of… interaction within the community." They tracked a number of indicators mentioned above and noted the "sudden decline in fertility in [the Indian states of] Tamil Nadu and later in Andhra Pradesh without significant improvement in female literacy or decline in IMR [infant mortality rate]." Strongly associated with lower fertility, however, was what these researchers call "diffusion."[92]
So what is [diffusion]?
It is the people-to-people effect. Fertility rates fall when norms change as women participate in groups of all sorts, including micro-credit groups, or self-help groups more generally. Meeting together, the women absorb one another's experience and exchange useful information about contraception. In the early 2000s, notes the report, the southern Indian state of Andhra Pradesh (now divided into two states) had four hundred thousand micro-credit groups, almost 40 percent of all such groups in India.[93] Today, its fertility rate is 1.8 and its poverty rate is less than 10 percent, both far below India's overall averages.[94]
In other words, what matters most to our reproductive behavior, these researchers posit, may be the influence of others in close social circles. Through social connections, women gain a greater sense of their own power over the most intimate matters of reproduction. This finding reinforces observations that self-empowerment through learning in groups can be transformative. Research on small self-help groups of women in Bangladesh, for example, suggests that members' lower fertility rate reflects not just greater economic security but the influences of being in a group, which helps to bring independence from control by family members.[95]
The population question is indeed complex. Even in a few low-income societies with great economic inequality, one can find low fertility rates. Examples in Latin America include Brazil and Costa Rica, both of which are at below-replacement-level fertility; and Argentina and Mexico, where rates are relatively low.
But lest we leave our readers imagining that the lowering of birthrates in the Global South invariably represents a positive transition--including progress for women-consider the experience of China and India.
When Pressure to Lower Birthrates Puts Women at Risk
First, China. Its "one-child" policy, most stringently enforced from 1979 to the late '80s, continues in some form to this day.[96] At its height, women were forced to abort second pregnancies, and those who gave birth to females, who were less favored, were sometimes scorned by their families. Because female fetuses were disproportionately aborted, today China faces a highly uneven sex ratio at birth of 118 boys for every 100 girls.[97]
Then consider India. Although it is home to 17 percent of the world's people, more than a third of female sterilizations worldwide occur there. In fact, female sterilization accounts for two-thirds of the country's contraceptive use.[98]
Sterilization can be a good choice-when it is a [choice].
In India, however, "choice" gets murky when at least some government health workers must meet sterilization quotas or risk having their salaries cut, and when very poor women are paid or offered gifts if they agree to sterilization.[99]
In 2014, at least thirteen women died and many others were sickened in India's "sterilization camps." At one, the doctor performed eighty-three operations in six hours. It was "nearly impossible to limit the number because recruiters generated such a crowd," noted a doctor quoted by the [New York Times] editorial board. Each woman was paid 1,400 rupees, roughly $22, to undergo the procedure.[100]
"I did it out of desperation," a twenty-five-year-old mother of three told a Bloomberg News reporter in 2013, as she lay recovering from the procedure on a concrete floor.[101]
Interestingly, in the 1970s it was a public outcry over forced male sterilization that led to a spotlight being put on female sterilizations.[102] So, while studies report that male sterilization by vasectomies is both less risky and less costly, in India today only 1 percent of men are sterilized, compared with 37 percent of women.[103]
On all sides of the population question, there is a lot to learn. But one clear pattern stands out:
Neither population density nor population growth is the cause of hunger. Rather, the two often occur together because they have similar roots in extreme power inequalities. So, let's now turn to a few examples of the rapid slowing of population growth as societies evolve to correct those imbalances by securing basic economic and social rights.
Lessons from Country Successes
Some of the earliest and most spectacular fertility declines occurred in the context of broad-based improvements in nutrition, health, and education. Let's look at some of those examples.
[Sri Lanka.] Significant decline in the fertility rate began from the time of Sri Lanka's independence in 1948 to 1978. Over those thirty years, the government supported citizens' access to basic foods, notably rice, through a combination of free food, rationed food, and subsidized prices. Since then, continued fertility decline has been associated with increased availability of contraception and the rise in age of marriage, linked to longer female schooling. In the early 1980s, the fertility rate was 3.2, but by the late 2010s it stood at 2.3, just above replacement level.[104]
[Cuba.] From the start of the revolution in 1959 till the acute economic crisis of 1989, rationing and price ceilings on staples kept basic food affordable and available to the Cuban people. All citizens were guaranteed enough rice, beans, oil, sugar, meat, and other food to provide them with 1,900 calories a day.[105] As health care and education also became available to all, Cuba's fertility rate fell from almost 4.2 in 1955 to 1.5 in 2010.[106]
[Two States in India-Himachal Pradesh and Kerala.] In the small northern state of Himachal Pradesh, 90 percent of the population is rural; yet its per capita income and education levels are among India's highest. "Strong community involvement," notes a World Bank study, with high levels of female participation and local accountability, have helped the state's health and other services reach even "far-flung villages."
Among the roots of the state's success are "land reforms in the 1950s and the 1970s [that] laid the early foundations for social inclusion," adds the report. Today, almost eight in ten rural households in Himachal Pradesh own some land.[107] And its fertility rate? On a par with Denmark's, at 1.7.[108]
At the opposite end of the country is Kerala, also a small state and one of India's most densely populated; yet judged by measures of well-being, including infant mortality and life expectancy, Kerala is superior to most low-income countries as well as to India as a whole.[109]
The state's 1969 land reform law "abolished tenancy in both rice land and house compound plots," notes Kerala analyst Richard Franke, who adds that the reform's major consequences include the "abolition of landlord and tenant classes, reduction in inequality of land ownership and income as measured by the Gini index, and reduction in caste inequality."[110] Kerala's female literacy rate is over 90 percent, and its fertility rate of 1.6 is below that of the United States.[111]
Some critics downplay the state's progress, noting that it is facilitated by large remittances sent home by Kerala citizens working abroad. What makes Kerala impressive to us, however, is what its citizens have chosen to do with their resources.[112]
In addition, Thailand and Costa Rica deserve our attention. In both, health and other social indicators offer clues as to why they experienced early declines and now have fertility rates below replacement. Infant death rates are relatively low, especially in Costa Rica, and life expectancy is high-for women, it is eighty-two.[113] Perhaps most important, in Costa Rica an unusually high proportion of women are educated, and in Thailand proportionately more women work outside the home than in most countries in the Global South.[114]
The experiences of these countries confirm that advances in nutrition, health care, and health outcomes, as well as education and employment for women, typically are associated with a decline-sometimes quite rapid-in fertility rates.
THE CHALLENGE AHEAD
In this chapter, we've outlined what we believe are critical points too often muddled in discussions of food availability and population:
Today, the world produces more than enough for everyone to thrive, yet roughly one-quarter of the world's people suffer nutritional deprivation; and at the same time we waste a quarter of all calories.
In no country does population density explain hunger.
Continuing population growth is a critical challenge, but it is not the root cause of today's hunger. Most often it is-like hunger-an outcome of inequities that deprive the majority, especially poor women, of basic human rights to food, security, economic opportunity, health care, and education.
Fertility and population growth rates have dropped dramatically. More than half of all remaining growth is occurring in just seven countries plus nine states in India. Together they represent one-fifth of the world's population.
Countries with high fertility rates-of 5 or more-are home to only 9 percent of the world's total population; and most of the "less developed" countries show declining fertility rates.
All of these trends lead to the (medium) projection that by 2050 the world as a whole will reach a fertility rate of 2.2, on the path to a replacement level of 2.1.
Fertility rates decline as women gain access to education, health care, and employment. They also fall as women participate in social groups in which they acquire a range of attitudes, skills, and knowledge from each other and gain resources that enable them to make more independent choices.
The biggest lesson we take from these points is this: Precisely because population growth is such a critical problem, we cannot waste time with approaches that do not work. To be serious about bringing human population into balance with the natural world and with our food--producing resources, we must address the unfair structures of economic and political power-from the local to the global level-that lie at the root of the crisis.
To attack high birthrates without attacking the causes of poverty, hunger, and the disproportionate powerlessness of women is fruitless.
It is a tragic diversion our small planet can ill afford.
