Will the circle be unbroken?

• Position: Includes related article on population assistance to developing countries - Child survival programs and fertility decline

Everyone has the right to life, liberty and the security of person.

- Universal Declaration of Human Rights, Article 3

The demographic transition which has been under way in the developing countries since the middle of the twentieth century has shown much difference, both in its course and in the factors behind it, from the transition which started two centuries ago in countries that are now developed.

In the developed countries, the gradual improvement in living conditions accompanying industrialization and urbanization, coupled with broadening education and sanitation and a growing understanding of the principle of hygiene and nutrition, resulted in progressive gains in child survival and declines in mortality at all ages. These same forces of development were progressively changing attitudes towards reproduction, reducing the demand for children and lowering marital fertility.

In the developing countries, there have been unprecedented declines in mortality over a few decades since mid-century. Only sub-Saharan Africa as a whole Ires not yet entered into this phase of demographic transition to a significant extent. A distinguishing feature of this transition has been that declines in mortality and fertility were not accompanying major gains in economic development.

One major driving force behind these dramatic demographic changes has been the revolution in biomedical technology. After the Second World War, insecticides and antibiotics were introduced, followed by vaccines for poliomyelitis and measles, plus oral rehydration therapy, as well as a whole range of modern contraceptives. There is ample evidence that the success of child survival programmes may increase contraceptive practice and hence bring about fertility decline.

This observation raises the wider issue of the effects on fertility of decline in child mortality and the mechanisms through which those effects operate. It has been well established that child survival influences fertility levels. Improvements in child survival usually precede sustained fertility decline; interventions to improve the health of children will eventually be followed by fertility decline, depending upon the type of intervention and prevalent attitudes towards family size.

The desired family size is also important in studying the impact of child mortality on fertility. When parents become confident that their children will live and thus become more assured of the returns for physical and emotional...