OOOOOCTOBERCTOBERCTOBERCTOBERCTOBER, 1997, 1997, 1997, 1997, 1997

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ASSESSING THE POLICY ENVIRONMENT:WHAT INFLUENCES POPULATION POLICY?

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POPTECH provides consulting support to USAID on designs andevaluations of USAID funded population and reproductive healthprojects. The POPTECH Tool Series is comprised of several analytic�tools� designed to support and enhance the expertise of POPTECHconsultants, promote consistency and quality across reports, andprovide assistance to the Global Bureau and Mission staff. Thesetools include checklists and papers that focus on issues central tothe design and evaluation of family planning and reproductivehealth projects. Assessing the Policy Environment: What Influencesthe Population Policy Process? is the first tool in the series.

AAAAABOUTBOUTBOUTBOUTBOUT THETHETHETHETHE A A A A AUTHORUTHORUTHORUTHORUTHOR

Dr. Susan Adamchak has extensive experience in internationalpopulation policy and reproductive health program developmentand support activities. She has a Ph.D. in sociology from BrownUniversity, where she focused on population studies and economicdevelopment. She has participated as a demographer and policyanalyst on numerous population sector assessments and programevaluations. A POPTECH key consultant since 1994, Dr. Adamchakhas worked on a variety of POPTECH assignments including theZimbabwe Population Sector Assessment, the final evaluation of theGhana Family Planning and Health Project, the final evaluation ofthe Uganda Busoga and East Amkole Diocese Community FamilyPlanning Projects, and the evaluation of USAID�s cooperativeagreement with the Population Reference Bureau. Her work on thenature of the population policy environment builds on earlierresearch she carried out on the influence that the environmentexerts on institutional decision making. The framework advanced byDr. Adamchak in this POPTECH Tool shows how qualitative, oftenintangible forces shape organizations� policy setting and actions.

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Introduction...................................................................................................

Using this Tool...........................................................................................

The Policy Environment Framework............................................................

Legal Environment....................................................................................

Direct Legal Influences..........................................................................

Indirect Legal Influences.......................................................................

Family Law Influences............................................................................

Political Environment.................................................................................

National Political Influences..................................................................

International Political Influences...........................................................

Economic Environment.............................................................................

National Economic Influences..............................................................

International Economic Influences.......................................................

Demographic Environment......................................................................

Demographic Influences.......................................................................

Ecological Environment.............................................................................

Ecological Influences.............................................................................

Cultural Environment.................................................................................

Norm/Belief Influences.........................................................................

Family Organization Influences............................................................

Media Influences...................................................................................

Other Cultural Influences......................................................................

Technological Environment.......................................................................

Technological Influences......................................................................

Conclusion.....................................................................................................

Appendix 1: Illustrative Policy Issues, Impacts, and Strategies for Change.

Appendix 2: Data Sources for the Seven Policy Environment Elements...

Appendix 3: Population Policy Environment Assessment Matrix...............

Appendix 4: Defining Population Policy......................................................

Appendix 5: Population Policies: Changing Perspectives...........................

Bibliography...................................................................................................

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This POPTECH tool describes a framework for assessing thepopulation policy environment. The policy environment continuouslyaffects the decisions, actions, and efficacy of those involved in thepopulation policy process, so it is important to identify the array offactors that influence and shape that environment. The purpose ofthis tool is to provide, in one source, a comprehensive list of factorsthat characterizes the environment within which population policiesare developed1.

The tool can be applied in a variety of policy and program contextsand will benefit users by identifying fundamental areas of support orresistance that can be targeted for specific project interventions. Itcan also be used in carrying out a population sector assessment andin designing and developing population and reproductive healthprograms. Using the checklists included here, country program staffor consultants can review key elements of the environment andidentify factors that either facilitate or discourage the formation ofeffective population policies and reproductive health programs.

Drawing on studies of organizational behavior (Hall, 1991), the toolidentifies seven elements of the policy environment and provides anoverview, an illustrative checklist of key issues, and at least one country-specific example for each. The seven environmental elements are:

u Legal u Demographic

u Political u Ecological

u Economic u Cultural

u Technological

Several of these elements are similar to the environmental factorsspecified by Bertrand et al., (1994). The list includes two notableadditions that are not usually specified in studies of the policyenvironment: technological and ecological elements.

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The following sections discuss each element of the policyenvironment and its implications for the population policy process.The illustrative checklists2 can be used to identify influences on thepolicy process.

While an effort has been made to be comprehensive in selectingitems for the checklists, they are not exhaustive. Other influentialfactors may emerge in different country contexts. Also, the fieldconsultant should not expect to investigate every factor listed. Theprimary purpose of this tool is to provide a summary and overview of

1 See Appendix 3 on defining population policy, and Appendix 4 on changing perspectivesrelated to population policy.2 Checklists were developed in part by consulting materials such as Bertrand et al., 1994;Kenney 1993; and Knowles et al., 1994.

IIIIINTRODUCTIONNTRODUCTIONNTRODUCTIONNTRODUCTIONNTRODUCTION

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issues to consider in conducting a population policy assessment orin designing a new program. A secondary purpose is to provideguidance for local research, taking into consideration programmaturity and priorities, data availability, time constraints, etc.

Defining the policy environment in terms of the seven elements isone way to specify the broad range of factors that may exert eitherdirect or indirect effects on population and reproductive healthprograms. The framework presented here forces the user to considerobvious and easily observed influences, such as key leaders beingopenly supportive of family planning, as well as more subtle forces,such as national and international migration patterns, that may exertas great an influence but be less readily recognized.

The purpose of using this tool in the field is to identify elementswithin each policy environment category that have a discernibleimpact on the program, determine how to promote change in eachelement, and propose strategies for reform.3 A subsequent stage ofactivities, not described here, is to identify individuals or institutionsto target for reform; identify actors to carry out the strategy; anddefine specific actions to take, a time frame, and needed resources.

To complete the checklists for a specific country application, theuser needs to gather information from a variety of sources, includingboth published and unpublished documents and interviews withlocal authorities and key informants. Appendix 2 lists suggestedsources for checklist items, grouped by environmental element.Some items on the checklists specify quantitative responses, whileothers call for informed, qualitative judgments. Simple yes/noanswers suffice for many items, but the tool also encourages morein-depth analysis to accommodate the context of individualcountries. Using the checklists in their entirety is an ambitiousundertaking, so users must determine what level of detail is best fortheir circumstances.

A matrix can be used to organize information gathered throughusing the checklists (sample shown in Appendix 3). Within the matrix,obstacles and facilitators can be grouped by environmental elementand �ranked� as strong or weak influences based on the data collected.The relative weight of each item rests with the expert determination ofthe individual or team carrying out the assessment because no twocountries will present the same environment profile. The user shouldkeep in mind that in some instances the absence of an influence is justas important to note as more overt factors. For example, thenonexistence of restrictions on contraceptive product advertising canbe categorized as a facilitating influence, as it allows for use ofcommunication channels that affect the market for family planning.

3 Appendix 1 shows a matrix with examples from each element, identifying a key issue,describing its impact, and suggesting a reform strategy.

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LEGAL ENVIRONMENT

Statutory, judge-made, common, customary, and religious law playvarying roles in different settings. The importance of statutory, judge-made, and common law in population and reproductive healthissues depends on the degree to which the rule of lawpredominates and the judiciary is independent and strong.

At the very least, the legal environment sets operating conditionsthat may range from regulation to prohibition (Hall, 1991). Theseinclude many of the laws and regulations often identified as directbarriers to family planning program implementation: import tariffson contraceptive products, advertising regulations on familyplanning products, and prohibitions against the supply of particularmethods.4 Other legal restrictions may have an indirect effect onpopulation issues and the appeal of family planning, for example taxor housing benefits for families with many children. Conversely,there may not be any legal backing to a stated population orreproductive health policy, thus limiting its perceived importance.

Of particular significance for individual and family fertility decisionmaking are laws that govern the rights of women in marriage,divorce, property ownership, inheritance, and child custody, as wellas laws that require men to assume an equitable share of the cost ofchildren and child support. For example, laws that limit theinheritance rights of the extended family may lead to strengthenedbonds between spouses and fewer births conceived as old-agesecurity for widows.

Another example of laws that can facilitate or hamper policyefforts is legislation that increases the age at marriage. Later age atmarriage results in a later age of childbearing, which in turn slowspopulation growth by increasing the generational span. The level ofadolescent pregnancy will also be reduced, as will the maternal andinfant mortality associated with early childbearing.

While legal change can benefit policy efforts, it is not alwayssufficient since laws are often not enforced. For example, manycountries have established minimum ages of marriage that areeither circumvented or ignored. In sub-Saharan Africa, in particular,legal change is often made more complex by the existence of duallegal systems: statutory law based on the codes of former colonialpowers, and customary law derived from ethnic or religioustraditions (McCauley et al., 1994). As Scribner (n.d.) notes: �Lawsregarding marriage, land tenure, or succession of property are key todetermining women�s legal status, and this is where the two legalsystems typically come into conflict.�

Although Ghana has had apopulation policy since 1964,there was no law or legislativeinstrument that gave backingto the policy or to its recentrevision until 1995. TheCabinet decision to establish aNational Population Councilinitially was not endorsed by agovernment decree, andprogress on implementationwas slowed becauseadministrators did not believethey had official authorizationto act upon the policy(Population Impact ProjectMarch 1995).

4 See Kenney (1993) and Bertrand et al., (1994) for a comprehensive listing of legal andregulatory barriers to family planning programs.

TTTTTHEHEHEHEHE P P P P POLICOLICOLICOLICOLICYYYYY E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT F F F F FRAMEWORKRAMEWORKRAMEWORKRAMEWORKRAMEWORK

The Zimbabwe Legal Age ofMajority Act (1982) sets 16 asthe minimum age of marriage.However, under the existingdual legal system manymarriages take place undercustomary law and minimumages are not enforced. The Actalso sets the age of majority at18 for both men and women;this emancipates women fromthe authority of their fathersin matters of marriage.

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DIRECT LEGAL INFLUENCES

u Are legal instruments in place to support population or familyplanning policies and their implementation?

u Is there prescription regulation of contraceptive methods?

u Are family planning services restricted to physicians as providers?Are they restricted to obstetrician/gynecologists as providers?

u Are there any restrictions on private practices of doctors ormidwives?

u Are there price controls on private sector family planning servicesor products?

u Are there restrictions that affect nonprofit organizations� ability tocharge fees for sales of donated commodities, services, etc.?

u Are any contraceptive methods prohibited?

u Is abortion legally available?

u Are there restrictions on access to family planning, particularlyrelated to age, marital status, or parity?

u Do public sector contraceptive subsidies hinder private sectorsupply?

u Are there duties and restrictions or quotas on contraceptiveimports?

u Are there taxes on domestically produced contraceptives?

u Are there commercial regulations pertaining to approval,licensing, and registration of contraceptives?

u Are there commercial regulations pertaining to promotion andadvertising of contraceptives?

IIIIINDIRECTNDIRECTNDIRECTNDIRECTNDIRECT L L L L LEGALEGALEGALEGALEGAL I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Are there tax incentives or disincentives related to family size?

u Do any labor laws pertaining to wages, employment benefits,pensions, female employment, and maternity leave discriminateagainst women in formal employment (restricting their access toalternative roles)?

u Is employment of minors legal?

u Do women have restricted access to credit?

u Do women have the right to enter into independent contracts?

u Are there restrictions on immigration, emigration, and/or internalmigration?

u Have land reform laws improved accessibility for small-scalefarmers, making migration or urban wage earnings lessnecessary?

Although the Penal Code ofBrazil does not explicitlyprohibit sterilization, theprocedure is often regarded asa form of aggravated assault,and is viewed as illegal.Punishment for aggravatedassault may range from threemonths to one year ofdetention, with more severepenalties if physical harmresults from the procedure. Atthe same time, the governmentappears to permit sterilizationin some cases, performed aftera “judicious medicalevaluation” when a woman’slife is at risk. Differenthospitals set different criteriafor performing sterilizations,seemingly indicating it is notillegal if performed to save thelife of the woman or to preventhealth problems. Efforts toreform the law are underway(Center for Reproductive Lawand Policy, 1995).

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u Is there a dual legal system in the country? If so, what are themain areas of authority of each legal system?

u Does marriage require the formal consent of the bride?

u Is there a minimum age of marriage, and is it enforced?

u Is polygamy permitted, and if allowed, is the number of wiveslimited?

u Do women have equal rights to divorce?

u Do women have rights to community property in divorce?

u Do inheritance laws discriminate against widows?

PPPPPOLITICOLITICOLITICOLITICOLITICALALALALAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

In a recent review of family planning policies and programs,Mauldin and Sinding (1993) summarize lessons learned in a dozenkey categories. They describe political commitment as being helpfulto program success but not essential, suggesting that politicalcommitment increases in importance as the social setting becomesless conducive to economic development and the adoption offamily planning.

Others have cited government action as a motivating factor inchanging perceptions about fertility. Cleland writes that if �legitimacyof birth control is a determinant of the timing of fertility decline,then government action to popularize and promote family planningmay be a catalyst for change in reproductive behavior� (1990).Caldwell et al., (1992) contend that �government activity in thepopulation field and its appeal to women as well as men havechanged the earlier society where the only legitimized authority formaking reproductive decisions was the husband and his family oforigin� (1992). Freedman and Freedman (1989) include �political andother supports for the idea of the legitimacy and the personal andsocial value of family planning� among important programelements.

Actions by public officials in developing countries tend to carrymore immediate impact than those of their counterparts in themore developed countries. Often, governments are highlycentralized, more insulated, and play a more intrusive role in thenational economy (Porter and Hicks, 1994). Political solutions toproblems are often proposed by actors closely linked to government.Azefor (1988) notes that political commitment to family planningpolicies and programs is especially important in Africa, due to thehighly centralized nature of the state.

Porter and Hicks (1994) write that �... political events move at theirown pace and by their own dynamics and rules....[they] can move asubject onto or off of a government agenda....[A]nalysis of thepolitical costs and benefits� of considering a policy may influence adecision more than analytic and technical studies of a problem (seealso Finkle and McIntosh, 1985; Coleman, 1990). In addition, �the

Early marriage remainsprevalent in India, eventhough the governmentpromulgated the ChildMarriage Restraining Act in1929. The Act sets theminimum age of marriage at18 for girls and 21 for boys,and makes marriages for thoseyounger punishable byimprisonment or fines.However, the Act does notinvalidate marriages thatcontravene the statute(Center for Reproductive Lawand Policy, 1995).

In Ghana, every governmentsince 1969 has accepted (ordid not reject) the populationpolicy. Only the currentgovernment under PresidentJerry Rawlings has shownstrong commitment topopulation as an importantelement of nationaldevelopment strategies.During the 1960s and 1970s,Ghana witnessed repeatedchanges of government, eachwith their own priorities inaddressing national problems.Changing political leaders alsoresulted in changingadministrative decision makers,causing the population policyto remain unimplemented. Nostrong advocate emerged, soinadequate financial andmanpower resources wereallocated. Without strongpolitical backing,administrators were unable totap external funding sourcesfor support (Social SectorPolicy Unit, 1991).

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institutional and political venues in which political problems andsolutions come to be defined and debated are crucial to agendasetting� and the strategies pursued (Porter and Hicks, 1994). Strongpolitical pressures may lead to either crises or opportunities forpopulation policies. Shifts in the existing system or alliances of keyactors may result in different priorities or resource allocations.

International politics may also affect the environment for apopulation policy. The rapport with other countries in the region andperceptions of cooperation or aggression can temper pro- or anti-natalist orientations. Among developing countries, the degree ofinfluence exerted by donors and lenders may affect the seriousnesswith which government approaches population policy planning anddevelopment.

NNNNNAAAAATIONALTIONALTIONALTIONALTIONAL P P P P POLITICOLITICOLITICOLITICOLITICALALALALAL I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Is there a formal population policy (strategy with objectives suchas national and local demographic targets)?

u Is there an implicit population policy, as evidenced bygovernment pronouncements and strategies?

u Is the government politically stable?

u Are national leaders considered legitimate?

u Are key leaders visibly supportive of population issues?

u Is the government committed to economic and socialdevelopment, manifested both in frequent, influential, publicpronouncements, and in action and achievement?

u Are there strong and cohesive interest groups�women, medicalprofessionals, land owners, ethnic groups, key age cohorts�thatinfluence government policies?

u Does the influence (or lack thereof) exerted by special interestgroups affect content of a policy, its targeted goals, plan forimplementation, and actual follow-up?

u To what extent do increased democratization and a more vocal,unfettered media contribute to more open debate about theissues contained in a population policy?

u Are the developments implied in a population policy associatedwith an opposition party or faction, causing polarization on theissues?

u Is there policy regarding redistributing the population (i.e.,promoting internal migration, urban/rural migration policies)?

IIIIINTERNANTERNANTERNANTERNANTERNATIONALTIONALTIONALTIONALTIONAL P P P P POLITICOLITICOLITICOLITICOLITICALALALALAL I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u What are the political relationships with neighboring countries?

u What are the population policies of neighboring countries?

u What degree of influence do donors and lenders have on politicalleaders and local decision making?

The Philippine Medium-TermDevelopment Plan for 1993-98 recognizes the role of rapidpopulation growth inconstraining socioeconomicprogress. The Plan has anexplicit objective of reducingthe population growth rateand fertility “through widerrecognition of the benefits ofsmall family size and thepromotion of more responsibleparenthood. It states that thefamily planning program willbe implemented vigorously toreduce population growth(Herrin and Costello, 1996).

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It is essential to review the economic environment of a countrybecause population policy efforts and the programs they entail areoften justified on economic grounds. It is frequently argued thatpopulation growth must occur at a pace slower than, or at aminimum equal to, that of national economic growth. The state ofthe economy affects competition for resources, and allocation ofhuman, monetary, and infrastructure resources to populationactivities may be controversial because it diverts resources fromother national priorities.

Economic decision making also comes into play at the level ofindividuals and households. Children may be looked at as anadditional source of household income. Local conditions can affectdecisions about labor migration, both within national borders andinternationally. Migrant pay remittances contribute substantially tothe support of households and communities in many countries.

A number of the legal changes discussed earlier are closely linkedto economic policy. Policies that increase women�s earning powerinclude �...deregulating economies, increasing the demand for labor,removing barriers to women�s participation, and allowing womenequal access to productive resources. These economic policies leadto rising women�s incomes and altering attitudes about the role ofwomen� (Scribner, n.d.).

NNNNNAAAAATIONALTIONALTIONALTIONALTIONAL E E E E ECONOMICCONOMICCONOMICCONOMICCONOMIC I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u What are key economic indicators (i.e., gross domestic product(GDP), unemployment rates, inflation rates, distribution ofwealth)?

u Is there a recognition of the interaction between populationgrowth and availability of natural and economic resources?

u Is population change considered important enough to merit asuitable allocation of public resources?

u Are there government subsidies of social services (i.e., education,housing, health care)?

u Are fiscal resources scarce or readily available for local investmentin human resources and infrastructure?

u How much control does the public sector exert over the nationaleconomy?

u What is the strength, degree of development, and power of theprivate sector?

u What is the relationship between the public and private sectors?

u To what extent does the national economy depend on agricultureor other primary production industries?

u If there is a reliance on agriculture, is there equitable access toland for all population segments?

u What are the prevalent wealth flow patterns (are children a sourceof family income)?

The increasing cost of livingand rising competition forjobs, exacerbated by twosuccessive crippling droughts,are spurring a new wave ofmigration among Zimbabweanworkers, who are much indemand in neighboringcountries. There is anecdotalevidence that people living inthe provinces that borderSouth Africa and Botswanamaintain their residence inZimbabwe while workingoutside the country,commuting home weekly ormonthly with their highersalaries and less expensiveconsumer goods.

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u What are the most common sources of women�s income?

u Is the employment situation such that workers seek employmentbeyond the country�s borders?

u How does migration affect the local tax base?

u How affordable are contraceptives for various income levels?

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u How badly is foreign currency needed to service debt or purchaseimport commodities?

u Is the government willing to allocate foreign exchange for thepurchase of needed family planning supplies and equipment?

u What is the current level of donor assistance in the populationsector?

u Will policy change result in fiscal transfers from donors,particularly if policy change is tied to grants?

DDDDDEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHIC E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

The demographic environment is important because of itspotential to influence political decision making. McIntosh and Finkle(1985) suggest that attitudes about policy decisions are ofteninfluenced more by real experience with the consequences ofpopulation change than by exposure to population data.Nonetheless, influential technocrats and cadres can play animportant role in exposing policy makers to demographic data andincrease the chance that the data will affect their decisions.

Policy makers should have access to data such as rates ofpopulation growth, patterns of migration, maternal and infantmortality, and life expectancy. Unfortunately, in situations wherepolitical control is tied to the numeric supremacy of a particularreligious or ethnic group, policy makers are more likely to disguise oravoid frank examination of demographic trends.

Fertility is usually considered the key demographic variable bywhich to effect change in the population, mainly by reducing birthsthrough the widespread use of contraception. This can only be doneif contraceptive services and commodities are widely available andeasily accessible for users. Surveys and service statistics provideinformation on family planning use patterns. Surveys also offer dataon the levels of awareness, demand for and use of contraceptiveservices. Among contraceptors, it is worthwhile to study use patternsfor the various methods available, by type of method (temporary vs.long-term and permanent methods).

The demographic impact of HIV and AIDS must be taken intoaccount in the policy process. The mortality effects of AIDS shouldbe incorporated in population estimates and projections. Themorbidity associated with HIV and AIDS will take a toll on nationalhealth services, as well as reduce the economic capacity of theincome-earning age groups. The demand for contraceptive

Fertility reduction throughcontraceptive use has beensuccessfully promoted througha large public program inZimbabwe. Demographic andhealth surveys conducted in1984, 1988, and 1994 provideinformation on contraceptiveuse, maternal and childmortality, and otherindicators. Taken together,they offer a valuable timeseries of demographic trendsin the country. The data havedrawn attention to anexcessive reliance on oralcontraceptives and have led toprogram efforts to modify themethod mix and diversifymodes of service delivery(Zimbabwe Demographic andHealth Survey, 1984, 1988,1994).

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commodities, may rise if these commodities are increasingly used toprevent transmission of HIV/AIDS.

DDDDDEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHIC I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Are census, survey, registry, and service data collected, analyzed,and compiled in accurate, timely, and useful ways?

u What are the values for key demographic indicators such aspopulation size and distribution; population growth rate; agedistribution and dependency ratios; migration patterns; fertility,morbidity, and mortality rates; educational levels; and ethnic orracial composition?

u Are these values within acceptable international standards,5 or dothey place an undue burden on the country?

u Do national plans take into account anticipated changes in theage structure of the population?

u What is the nature of urban development, and is the countrydominated by a primary city?

u Have attempts been made to redistribute the population byinvesting in less-populated regions, and if so, how successful havethey been?

u Is there frequent rural-urban migration? Is it temporary, cyclical, orof long duration?

u What are the leading causes of death among different segmentsof the population?

u What is the HIV infection rate nationally, and among high-riskgroups?

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Hall uses the term ecological environment to refer to the �socialecology� of an organization, that is, the number of organizationswith which the focal organization has contact, their relationships,and the environment in which they are located (Hall, 1991). In thecontext of the population policy environment, we may refer torelationships held by one country with others in the region andglobally. Participation and alliances in international organizationsmay influence population policy development at home.

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u Is the country an active participant in regional or internationalbodies such as the Organization of African Unity (OAU) and theNon-Aligned Movement (NAM)?

u Does the government participate in international public fora likethe International Conference on Population and Development?

Zimbabwe has been aconsistent advocate ofsustainable populationgrowth. Its participation ininternational meetings includebeing a signatory of theKilimanjaro Programme ofAction, hosting the All-AfricaParliamentary Conference onPopulation and Development,and leading participants at the1984 World PopulationConference in calling forbalancing population growthand national capacity. Mostrecently, Zimbabwe chairedthe Africa-Middle Eastparliamentary interimcommittee at the InternationalPopulation Conference ofParliamentarians on Populationand Development held inconjunction with theInternational Conference onPopulation and Developmentin 1994. This public supporthas been influential in makingpopulation and family planningfrequent media topics, and hascontributed to local supportfor programs, fostering thedevelopment of a populationpolicy (Zimbabwe ChairsRegional Committee, TheHerald, 5 September 1994).

5 Such as targets of Health for All 2000; standards expressed by WHO, UN, World Bank, etc.

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u Is it a signatory to relevant declarations emerging frominternational meetings? If so, to what extent have suchinternational statements influenced the development oramendment of domestic policy?

u To what extent are policy makers and administrators willing toobserve and learn from the experiences of other countries inshaping policy components and programs?

u Do nongovernmental organizations (NGOs) play an active role inpromoting population issues? What is the nature of cooperationwith the government?

u To what extent do bilateral donor and multilateral lendinginstitutions exert particular influence over domestic policydevelopment?

CCCCCULULULULULTURALTURALTURALTURALTURAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

Cultural influences may be more ephemeral and elusive andhence more difficult to measure, than other environmentalinfluences. Values and norms change over time, with impact filteredthrough the behavior of individuals. The culture experienced bypresent-day policy makers affects their development of strategies forthe future (Schneider, 1989).

Azefor (1989) argues that the lack of attention to cultural,religious, and social factors in sub-Saharan Africa causedplanners to overlook local priorities and thus contributed to lownational commitment to population policies.

It is relevant to consider local norms, mores, and beliefs aboutbirth, death, and migration. Policy makers must understandexpectations concerning the value of children and their educationand labor contribution to the family. The role and influence ofmatrilineal or patrilineal family systems and different forms of marriageshould be specified, and their effects on female autonomy clarified.

Gage and Njogu (1994) highlight the gaps in social assumptionsunderlying family planning programs and local realities. They citeBleek (1987), who observed that the family planning program inGhana was criticized for disregarding the complex nature of familyorganization, particularly the matrifocal tendencies in childrearing.The initial program was based on implicit assumptions that fathersare household heads, marriages are stable, and that marriage is themain context for procreation, thus excluding a focus on premarital orextramarital pregnancies. More careful consideration of culturalrealities resulted in program changes that now focus greaterattention on the needs of sexually active adolescents. A socialmarketing program makes contraceptives available to consumersregardless of age or marital status.

Policy planners must also consider the role of the media in culturalchange. Images and ideas from around the globe are now readilyavailable through music, videos, movies, news magazines, andtelevision. The desire for improved living conditions, fostered

For many people inZimbabwe, having a largenumber of children is still seenas a means of ensuring futuresecurity. Girls are considered asource of wealth, as theirfuture spouses will pay“lobola,” a bride price, to thefamily. Women’s status remainslinked to the number ofchildren they bear, and manyenter marriage early to starthaving children. In responseto government policy thatprovides universal primaryeducation, school enrollmentof girls has risen but still lagsbehind rates for boys. Girlsoften drop out of school tomeet household demands forchild care or labor, or due toearly pregnancy.

1414141414

through awareness of conditions in other societies, may modifyexisting ideas about family size and composition. The effects ofopenness to outside knowledge, and the influence of religion andgender relations on fertility change are all important in the short term(Cleland, 1990).

NNNNNORMORMORMORMORM/B/B/B/B/BELIEFELIEFELIEFELIEFELIEF I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Are there religious beliefs that affect women�s status or fertilitybehavior?

u Are arranged marriages and payment of bride price or dowrypracticed? How do they affect the status of women?

u What are norms and sanctions concerning extramarital andpremarital sexual activity?

u What are considered to be appropriate marriage ages for femalesand males?

u Is there a strong belief that a new wife must bear children rightaway?

u Are there strong sex preferences for children? Do attempts toachieve a child of the desired sex lead to frequent pregnancies,selective abortions, or infanticide?

u Are there social sanctions against the use of abortion?

u Are there social sanctions against the use of contraception?

u Is female circumcision practiced? Among what proportion of thepopulation? Is there a campaign to eradicate the practice?

FFFFFAMILAMILAMILAMILAMILYYYYY O O O O ORGANIZARGANIZARGANIZARGANIZARGANIZATIONTIONTIONTIONTION I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Does society permit polygamous marriages? What proportion takethis form?

u Do newly married couples live with the husband�s parents?

u How are important decisions made within the family? Whoinfluences these decisions? Does the extended family play a role?Is the mother-in-law influential?

MMMMMEDIAEDIAEDIAEDIAEDIA I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u What proportion of the population is literate?

u What proportion of the population has access to print media,radio, television, or video?

u Are reports from external media sources widely available?

u Are population issues discussed in the media?

OOOOOTHERTHERTHERTHERTHER C C C C CULULULULULTURALTURALTURALTURALTURAL I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Do ethnic or religious rivalries exist, and are they salient enoughto interfere with population programs?

u Are there ex-colonial influences that linger beyond those implicit inlegal systems, as discussed in section 2.1?

Catholic Bishops and layleaders in Zimbabwe publiclyvoiced their opposition to theagenda of the 1994International Conference onPopulation and Development.Their media campaign in theweeks prior to the conferencesparked public debate aboutreproductive rights, the role ofthe family, and adolescentsexuality (Bishops Hit Out atPopulation Agenda. The DailyGazette, 17 August 1994, 7and Population ConferenceSlammed, The Herald, 1September 1994, 11).

1515151515

TTTTTECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICALALALALAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

The technological environment includes developments affectedby science, engineering, research, practice, serendipity, and theintroduction of personnel with new ideas. Changes in technologycan trigger changes in organizations, or in this context, in policy.

Technological changes that pertain specifically to family planningand family planning programs are also important in theimplementation of population policies. These include contraceptivedevelopment and modifications in accessibility that affect bothinitial acceptance and resupply of contraceptives.

Contraceptive development may affect ease of administration,user compliance, effectiveness, and predictability of method failurerates. Limiting side effects makes methods more amenable to wide-scale distribution and use and has important implications for wideraccessibility. Accessibility may be improved by expanding outreachservices, setting up community-based development (CBD) programs,allocating or building more facilities in rural areas, hiring morepersonnel, changing the division of labor among medical andparamedical personnel, and increasing the role of the private sector(Scribner, n.d.). Improved transportation systems have the potentialto dramatically contribute to accessibility.

Awareness-raising efforts may be improved by innovations incommunications technology, such as interactive computer modelsor use of shared information on the Internet.

TTTTTECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICALALALALAL I I I I INFLUENCESNFLUENCESNFLUENCESNFLUENCESNFLUENCES

u Is there access to technological developments in computers,media, and transportation to facilitate sharing experiences fromdifferent regions, countries, and contexts?

u Are improved techniques of data collection, analysis, andinterpretation of results, as well as software and modeling,available and applied?

u Is there restricted access to survey results (formal or informal)?

u Are there any effective communication and awareness-raisingefforts that clarify and make salient population issues, relate themto other sectors, or project the costs of different interventions?

u Are new contraceptives added to the local method mix as theybecome available globally?

u Are nurses, paramedical staff, and community-based distributorsable to distribute contraceptives based on the technologicalcomplexity of each available method?

u What is the quality of the existing transportation infrastructure?Have there been creative adaptations of service delivery methodsto improve access and compensate for difficult travel?

Ghana has made extensive useof computer tools such as theRAPID Model6 to illustratethe impact of populationchange on different economicand social sectors. The modelis updated as new data becomeavailable and has been shownwidely to both technical andnontechnical audiences toalert them to the implicationsof population growth.

The Zimbabwe Drugs ControlCouncil approved registrationof the female condom in 1996,and a shipment of 100,000units was sent to the countryin April 1997 marking the firsttime the method will beavailable to women there(Network, 1997).

6 The RAPID (Resources for the Analysis of Population and its Impact on Development) Model wasdeveloped by The Futures Group International in collaboration with Research Triangle Institute.

1616161616

u Has the availability of ultrasound equipment and prenatal testing ledto an increase in sex-selective abortion?

CCCCCONCLUSIONONCLUSIONONCLUSIONONCLUSIONONCLUSION

This POPTECH tool describes a practical framework for assessingthe population policy environment. The framework consists of sevendiscrete elements that each focus on one segment of theenvironment. The illustrative, but not exhaustive, lists of factors thatinfluence each environmental element can be used to assess therelative impact of each element on the policy process. The tool canhelp an analyst identify key elements within which to target policyreform. Prioritizing their likelihood of change, and the effortsrequired to do so, will permit specification of an appropriate policyimplementation strategy.

1717171717

AAAAAPPENDIXPPENDIXPPENDIXPPENDIXPPENDIX 1 1 1 1 1

IIIIILLUSTRALLUSTRALLUSTRALLUSTRALLUSTRATIVETIVETIVETIVETIVE P P P P POLICOLICOLICOLICOLICYYYYY I I I I ISSSSSSUESSUESSUESSUESSUES, I, I, I, I, IMPMPMPMPMPACTSACTSACTSACTSACTS, , , , , ANDANDANDANDAND S S S S STRATRATRATRATRATEGIESTEGIESTEGIESTEGIESTEGIES FORFORFORFORFOR C C C C CHANGEHANGEHANGEHANGEHANGE

POLICYELEMENT

INFLUENCE COUNTRY ISSUE IMPACT SSSSSTRATRATRATRATRATEGYTEGYTEGYTEGYTEGY FORFORFORFORFOR C C C C CHANGEHANGEHANGEHANGEHANGE

Legal

Political

Economic

Demographic

Ecological

Cultural

Technological

Direct legal

National

National

Norms/Beliefs

Zimbabwe

Peru

Ukraine

Uganda

UnitedStates

India

Chad

1971 Midwives PracticesAct limits authorizedactivities to prenatal,birth, and immediatepostnatal care

An NGO-sponsoredconsensus process toidentify adolescent policyand program needsincluded mid-levelofficials from Ministries ofHealth, Women andEducation who were notin decision makingcapacity

Despite commitment ofgovernment to provideFP services, no financingis provided in thenational budget

Hard hit early by theAIDS epidemic, levels ofinfection climbed toamong the highest in theworld

US foreign policy onpopulation relied heavilyon the promotion offamily planning as astrategy for modifyingpopulation growth rates

A strong preference forsons persists, influencingcouples’ fertility decisionmaking

Insufficient technicalcapacity, inadequatecomputer infrastructureimpeded ability toconduct a populationcensus

Midwives wishing to startprivate practices areconstrained in RH servicesthey can offer

There has been noindication from theministries that they arecommitted to integratingrecommendations into theirpolicy and plans

The National FamilyPlanning Program is an“unfunded mandate” to theOblasts (local government);some use discretionary fundsto provide services that varywidely in scope and quality

Tens of thousands ofchildren orphaned; adultseconomically active died

Family planning programswere frequently contentious,targets of criticism frombilateral partners, narrow inscope addressing onlytargeted women ofreproductive age

Continued preference forsons contributes to bothwanted and unwantedfertility, raises rate of sex-selective abortion

One of the last Africancountries to conduct acensus, resulting in no dataon population size,distribution, or composition

Engage Zimbabwe NursesAssociation and MOH indrafting new legislation; lobbyParliamentarians; involvemedical aid (insurance) andpractitioners in process

NGOs need to involve publicofficials who are in a position tomake commitments for change,and involve them early in policyand program efforts. Undertakeadvocacy efforts; harness NGOconstituents to build widespreadgrassroots support for policy andprogram

Conduct cost-benefit analysis todemonstrate cost savings andreductions in abortion resultingfrom FP services; carry outadvocacy activities with decisionmakers to increase allocation ofresources to RH and FP

An aggressive educationcampaign set out to increasemonogamy, reduce number ofsexual partners, encouragecondom use, and delay sexualdebut

Following ICPD the USmodified its policy to recognizegender equality and respect forrights of individuals within aframework of life-longreproductive health. This neworientation now shapes bilateraland multi-national discussionswith partner countries

Education and employmentopportunities must be providedfor women. Mass mediacommunication about the valueof women for the family andsociety, alternative roles forwomen can help improve status

Decision to process census onmicrocomputers set standard forother countries; provided datafor decision making within oneyear of census field work

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DDDDDAAAAATTTTTAAAAA S S S S SOUROUROUROUROURCESCESCESCESCES FORFORFORFORFOR THETHETHETHETHE S S S S SEVENEVENEVENEVENEVEN P P P P POLICOLICOLICOLICOLICYYYYY E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT E E E E ELEMENTSLEMENTSLEMENTSLEMENTSLEMENTS

LLLLLEGALEGALEGALEGALEGAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Law reports and reviews l Statutory instruments and legal acts l Import tariff controls l Commercial regulations l Tax codes l Codification of customary law l Health system regulations: service delivery guidelines l Provider surveys

PPPPPOLITICOLITICOLITICOLITICOLITICALALALALAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Content analysis of major media reports l Existence of explicit national population policy l Charter or law authorizing implementation of population policy l Meeting minutes l Interviews with key informants l Observation l Analysis of speeches, official proclamations

EEEEECONOMICCONOMICCONOMICCONOMICCONOMIC E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l National economic reports l United Nations, World Bank reports l Content analysis of major media reports l Government regulations l National accounts data l Health budgets l Family planning/reproductive health program records l Donor accounts

DDDDDEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHICEMOGRAPHIC E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Census, vital registry, family planning program reports l Population-based and special survey data l Ministry of Health annual reports l United Nations, World Bank reports l Population distribution policies l Ministry of Local Government reports

AAAAAPPENDIXPPENDIXPPENDIXPPENDIXPPENDIX 2 2 2 2 2

1919191919

EEEEECOLOGICCOLOGICCOLOGICCOLOGICCOLOGICALALALALAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Media reports l Proceedings of international conferences l Presence, visibility, range of activities of nongovernmental

organizations l Reports, key informants of bilateral donors and multilateral lending

organizations l Observation l Text of speeches l Official documents

CCCCCULULULULULTURALTURALTURALTURALTURAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Women�s journals, research, media reports l Current anthropological studies l Customary law l United Nations, World Bank reports l Survey reports l Key informants l Media content analysis l Focus groups l Official documents

TTTTTECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICECHNOLOGICALALALALAL E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT

l Survey data l National reports l Data collection program and report publication l Ministry of Health, private and NGO program guidelines l Observation l Information on medical infrastructure

2020202020

AAAAAPPENDIXPPENDIXPPENDIXPPENDIXPPENDIX 3 3 3 3 3

PPPPPOPOPOPOPOPULULULULULAAAAATIONTIONTIONTIONTION P P P P POLICOLICOLICOLICOLICYYYYY E E E E ENVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENTNVIRONMENT A A A A ASSSSSSESSESSESSESSESSMENTSMENTSMENTSMENTSMENT M M M M MAAAAATRIXTRIXTRIXTRIXTRIX

POLICY GOAL(S):

INFLUENCESENVIRONMENTAL

ELEMENTS FACILITATORSOBSTACLES

LEGAL

POLITICAL

ECONOMIC

DEMOGRAPHIC

ECOLOGICAL

CULTURAL

TECHNOLOGICAL

STRONG STRONG

WEAK WEAK

A matrix can be used to organize information gathered throughusing the checklists. Within the matrix obstacles and facilitators canbe grouped by environmental element and �ranked� as strong orweak influences based on the data collected. The relative weight ofeach item rests with the expert determination of the individual orteam carrying out the assessment because no two countries willpresent the same environment profile. The user should keep inmind that in some instances the absence of an influence is just asimportant to note as more overt factors. For example, thenonexistence of restrictions on contraceptive product advertisingcan be categorized as a facilitating influence, as it allows for use ofcommunication channels that affect the market for family planning.

2121212121

DDDDDEFININGEFININGEFININGEFININGEFINING P P P P POPOPOPOPOPULULULULULAAAAATIONTIONTIONTIONTION P P P P POLICOLICOLICOLICOLICYYYYY

There are many definitions of population policy. According to onerecent source:

A formal population policy, which is either a writtendocument or part of one, is an official statement of agovernment that establishes goals (and in come casestargets) for the population sector and includes astrategy for attaining them (Bertrand et al., 1994).

The population sector encompasses the size, distribution, andcomposition of the national population, as modified by threedemographic variables: fertility, mortality, and migration.

This definition focuses on �formal,� or explicit population policies.Often population policies may be informal or implicit, that is,�...those laws, regulations, and other directives which, although notnecessarily issued for the purpose of affecting population growth,distribution, or composition, have the effect of doing so� (Issacs andIrvin, 1991).

A formal population policy may not make much of a difference.According to Bertrand et al., (1994)

The adoption of a formal population policy is oftenseen as a key accomplishment in the area of policy. Itis important to keep in mind, however, that whatcounts most is its dissemination and implementation.It is also noted that many successful family planningprograms have been conducted in the absence of aformal policy (Bertrand et al., 1994).

This latter statement echoes arguments that �policy should beconceptualized as a set of actions rather than a statement of intent�(OPTIONS Evaluation, Appendix D). Emphasis should be placed onthe operational and implementation aspects of the policy process,rather than on public pronouncements that are made but notimplemented.

On the other hand, family planning program personnel mayinterpret the lack of a population policy as an indicator of latentopposition to the expansion of contraceptive services. However, thecase may be that the development and implementation of acomprehensive population policy may instead draw into sharp focusother sensitive issues pertaining to population, such as landdistribution or changes in the role of women, that threaten political

AAAAAPPENDIXPPENDIXPPENDIXPPENDIXPPENDIX 4 4 4 4 4

2222222222

and economic elites. The deferral of policy development in suchcases may be an indication of reluctance to confront other elementsin the policy environment. Indeed, �population policies should beviewed within the context of broader government policies, sincetheir intended outcome may depend on the influence of theseother policies� (Govindasamy and DaVanzo, 1992).

A key question is whether population policy is synonymous withfamily planning policy. For some analysts and policy makers theanswer is yes, because fertility reduction is seen as the easiest wayto moderate population growth. But is this the best consideration forcountries? Holding this perspective gives short shrift to otherdemographic and social issues, such as internal labor migration orland reform. An emphasis on family planning may cause technicalexperts to underestimate the sensitivity of other issues, and, hence,neither anticipate obstruction nor plan adequate strategies tocircumvent or accommodate other sectoral concerns. Cassen and Bates(1994) echo Bongaarts when noting that population policies shouldhave three conceptual components: reduce the unmet need for familyplanning by making services available and accessible; promote thesocial and economic development needed to reduce fertility desires;and address the implied future impact of population momentum bydelaying age at marriage and lengthening generations.

The starting point of the conceptual framework of family planningdemand and program impact on fertility is societal and individualfactors, that in turn affect both the value and demand for childrenand development programs (Bertrand et al., 1994). However, an evenbroader array of factors, particularly at the societal level, may affectthe perceived importance and relevance of a population policy.

2323232323

PPPPPOPOPOPOPOPULULULULULAAAAATIONTIONTIONTIONTION P P P P POLICIESOLICIESOLICIESOLICIESOLICIES: C: C: C: C: CHANGINGHANGINGHANGINGHANGINGHANGING P P P P PERSPECTIVESERSPECTIVESERSPECTIVESERSPECTIVESERSPECTIVES

For the past three decades, policies to address the relationshipbetween population and economic development rested on two basicassumptions: rapid population growth impedes development; andcontraceptive use, mainly by women, represents the best strategy toslow growth. Today the emphasis on contraceptive use is being widelychallenged, with critics stressing the need for multi-sectoral approachesthat include reform in health, education, and legal systems (Scribner,n.d.; Bongaarts, 1994; Sen et al., 1994; Dixon-Mueller, 1993). Raised by�an ad hoc coalition of researchers, policy makers, and advocates,�these challenges �have brought about a shift in the rhetoric if not yetthe practice of population policies� (Jacobson, 1994).

The new, stronger voices of women advocates have also focusedattention on policy. Many have criticized population policies as beingdriven by demographic goals, mindless of the individuals by whoseaction such goals are to be achieved. Advocates of the rights ofwomen have argued that population and family planning policies mustbe undertaken in a context of full human rights and must especiallyaccommodate the range of reproductive rights of concern to womenof any age and fertility status (see particularly Dixon-Mueller, 1993 andSen et al., 1994). Delegates to both the 1994 United NationsInternational Conference on Population and Development and the1995 Fourth United Nations World Conference on Women in Beijingendorsed simultaneous action on family planning and related healthmeasures and the promotion of human development.

Indeed, this turnabout in policy goals was presaged nearly 25 yearsago by a key demography scholar. Kingsley Davis wrote that the familyplanning approach �...limits the aims of population policy� (1971). Davisargued that

...while family planning may serve important purposes,such as the promotion of women’s rights, sole emphasison family planning in population policy is an “escapefrom the real issues” of the need for socio-economicchange.... The task of population policy, therefore,would be to create appealing alternatives to largefamilies and to supplement family planning withresearch on the socioeconomic measures affectingfertility (Davis, cited in Yount and Knowles, 1993).

AAAAAPPENDIXPPENDIXPPENDIXPPENDIXPPENDIX 5 5 5 5 5

2424242424

The late 1980s and early 1990s also witnessed an increasedemphasis on accountability and evaluation of population programs,both on the part of multilateral and bilateral donors and lendingorganizations and within individual national programs. This in turnresulted in a greater effort to define, operationalize, and measure allelements of family planning program impact, including the policyenvironment.

During the past two years, a number of important books,monographs, and articles were published, contributing to the newdebate on population policy. One such volume, Population andDevelopment: Old Debates, New Conclusions, was edited by RobertCassen for the Overseas Development Council. According toCassen�s summary of the collected authors� conclusions, rapidpopulation growth under conditions of high fertility has clear andnegative effects on individuals and households; it also constrainsthe ability of governments to provide education, health services, andemployment opportunities. He explains the title of a companionvolume, Population Policy: A New Consensus, as

...intended to register that there is a growingconvergence of views in a number of areas: on theconsequences of rapid population growth in developingcountries, both among students of population andamong most of the world’s governments; and onwhat should be the principal elements of populationpolicy (Cassen and Bates, 1994).

Cassen and Bates note that population policy is not simply familyplanning. Rather, they understand population policy �to encompassfamily planning and related health measures, as well as thoseaspects of economic development more generally that bear mostclosely on population, such as social or human resourcedevelopment� (Cassen and Bates, 1994).

In contrast, a collection of papers edited by Finkle and McIntosh(1994) reflect the belief that �...the old politics of population hasbeen replaced by the politics of family planning� (ibid). Theassumption is that family planning is the most direct way to affectpopulation change, and that this perspective has come to beaccepted worldwide.

One point of increased consensus is that family planning shouldbe closely integrated with comprehensive reproductive health care.However, although views are converging, they are not uniform byany means. Dixon-Mueller (1993) argues that population policiesshould be human rights policies and should emphasize a woman-centered reproductive policy �based on the concepts of sexual andreproductive health and women�s rights� (1993). She writes that

2525252525

The policy goal would be to empower women to gaincontrol over their own sexual and reproductivecapacities in the context of a broad program of socialtransformation that advances the freedom andsecurity of women of all social classes. Fertilityreduction is likely to result from thesetransformations, but it is not a primary goal (1993).

From a different perspective, Mason (1994) advocates retainingfamily planning programs and population policies that aim to slowpopulation growth as their primary goal. She acknowledges,however, that such programs can �best meet their demographicpurposes by use of approaches that preserve, and in some casesexpand, women�s human rights� (1994). This can be done both byimproving the quality of existing programs, and by assuring the fullrange of entitlements, including adequate health care, that havebeen denied many women up to today.

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Adamchak, Susan. 1995. Introducing Family Planning Benefits in aZimbabwean Medical Aid Society: A Case Study of FactorsInfluencing Change. Unpublished dissertation. Providence, RI:Brown University.

Azefor, Michael N.A. 1988. �Policies and family planning programs inAfrica: Evaluation and prospects.� Pp. 2.4.1-15 in Africa PopulationConference, Volume 1. Liege, Belgium: IUSSP.

Bertrand, Jane T., Robert J. Magnani and James C. Knowles. 1994.Handbook of Indicators for Family Planning Program Evaluation. TheEvaluation Project. Chapel Hill, NC: Carolina Population Center,University of North Carolina at Chapel Hill.

�Bishops Hit Out at Population Agenda.� The Daily Gazette, 17 August1994, 7.

Bleek, Wolf. 1987. �Family and family planning in southern Ghana.� Pp.138-153 in Sex Roles, Population and Development in West Africa.ed. Christine Oppong. London: Heinemann.

Bongaarts, John. 1994. �Population policy options in the developingworld.� Working Papers No. 59. New York, NY: The PopulationCouncil.

Cassen, Robert (ed.). 1994. Population and Development: Old Debates,New Conclusions. Washington, DC: Overseas Development Council.

Cassen, Robert with Lisa M. Bates. 1994. �Population policy: A newconsensus.� Policy Essay No. 12. Washington, DC: OverseasDevelopment Council.

Caldwell, John C., I.O. Orubuloye and Pat Caldwell. 1992. �The familyand sexual networking in sub-Saharan Africa: Historical regionaldifferences and present-day implications.� Population Studies, 46(3):385-410.

Center for Reproductive Law and Policy. 1995. �Women of the World:Formal Laws and Policies Affecting their Reproductive Lives.� NewYork, NY: The Center for Reproductive Law and Policy, InternationalProgram.

Central Statistical Office and Macro International Inc. 1995. ZimbabweDemographic and Health Survey 1994. Harare, Zimbabwe andCalverton, Maryland.

Cleland, John G. 1990. �Fertility decline in developing countries: theroles of economic modernization, culture, and governmentinterventions.� Pp. 126-145 in Fertility and Resources, edited by JohnLanders and Vernon Reynolds. Cambridge: Cambridge UniversityPress.

Coleman, David. 1990. �The relation between policy research andgovernment policy.� Pp. 57-73 in International Transmission ofPopulation Policy Experience. New York, NY: United Nations.

BBBBBIBLIOGRAPHYIBLIOGRAPHYIBLIOGRAPHYIBLIOGRAPHYIBLIOGRAPHY

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Davis, Kingsley. 1971. �Population policy: Will current programssucceed?� Pp. 211-227 in Global Ecology: Readings Toward a RationalStrategy for Man, John P. Holdren and Paul R. Erlich (eds.). New York,NY: Harcourt Brace Jovanovich.

Dixon-Mueller, Ruth. 1993. Population Policy and Women�s Rights:Transforming Reproductive Choice. Westport, CT: Praeger.

Finkle, Jason L. and C. Alison McIntosh (eds.). 1994. �The New Politics ofPopulation: Conflict and Consensus in Family Planning.� Populationand Development Review, Supplement to Volume 20. New York, NY:The Population Council.

Freedman, Ronald C. and Deborah S. Freedman. 1989. �The role offamily planning programs in fertility as a fertility determinant.� Paperpresented at the IUSSP Seminar on the Role of Family PlanningPrograms as a Fertility Determinant, Tunis.

Gage, Anastasia J. and Wamucii Njogu. 1994. Gender Inequalities andDemographic Behavior: Ghana/Kenya. New York, NY: The PopulationCouncil.

Govindasamy, Pavalavalli and Julie DaVanzo. 1992. �Ethnicity and fertilitydifferentials in peninsular Malaysia: Do policies matter?� Populationand Development Review, 18:243-267.

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Knowles, James C., Kenneth A. Bollen and Kathy Yount. 1994. �The policyenvironment of family planning programs: A literature review.� TheEVALUATION Project Working Paper, No. WG-P-01. Chapel Hill, NC:Carolina Population Center, University of North Carolina at ChapelHill.

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McIntosh, C. Allison and Jason L. Finkle. 1985. �Demographic rationalismand political systems.� Pp. 319-329 in International PopulationConference, vol. 3. Liege, Belgium: IUSSP.

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