Abstract
This chapter looks at the evolution of population policies in Latin America and the Caribbean during the last six decades. Policies in the region reflected discussions on population trends and issues at the global and regional levels, and particularly about the interactions between demographic changes and the social, economic, and political transformations of Latin American countries in this period. The initial efforts in the 1960s and early 1970s are considered as one of the most fascinating moments of the introduction of modern contraception, as for many countries, this happened when women and couples’ expectations about family size were changing. This success, which was considered limited at that time, was significant because it happened in spite of the initial opposition of some political and religious leaders. When the 1994 United Nations International Conference on Population and Development (ICPD) in Cairo brought the issue of reproductive health to the center of the population arena, Latin America and the Caribbean became one of the regions most involved in the design and implementation of this new paradigm. This was followed by the even newer approach brought by the Montevideo Consensus, which offered a more holistic view of key issues involving reproductive and sexual rights, including women’s equality and of a full range of social, cultural, and ethnic inequalities. Although this is a major achievement, we are still in a battle to make sense of what could be a comprehensive framework for population policies, in the new low to very low fertility regime that characterizes most of Latin America. What seems clear is that the current demographic context calls for a renovated vision based on an open and unbiased discussion of the goals, policy objectives, and interventions that help to place population dynamics in the framework of sustainable development. Indeed, this was always the aspiration of Carmen Miró.
Carmen Miró has been recognized as a pioneer in advancing population and development agenda in Latin America, pushing hard for the need to frame family planning in a population policy framework. She received her Ph.D. in Demography at the London School of Economics in the late 1950s and continued her work and contributions for at least four more decades.
The author wants to thank George Martine and Monica Villarreal for their support in the preparation of this chapter.
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Notes
- 1.
Among the factors that have contributed to the widespread use of family planning in Latin America, Bertrand et al. (2015a, b) have identified the following: “1. The development of strong NGOs that pioneered the family planning movement, tested new FP methodologies, and continue to tackle politically sensitive issues 2. A socio-political environment at the macro level that gradually supported family planning 3. Sustained external support in financial and technical assistance from USAID and other donors 4. Synergistic coordination among governments, external agencies, NGOs, and civil society 5. The development of local expertise in key programmatic, policy, and management areas 6. Improvement in the availability of information as a tool to drive decision making and open doors to new thinking and new approaches 7. Strategically designed, wide-reaching communication activities to support change in individual behavior and social norms 8. Mechanisms to ensure program financing that evolved to fit the times 9. Effective advocacy to achieve major political gains 10. Significant investments in contraceptive commodities and security” (Bertrand et al., 2015a, b: xi).
- 2.
Micklin (1994: 2) considers that for a national population policy to be viable, the government must officially make explicit its intentions to alter one or more demographic variables. Additionally, “it must satisfy four other conditions. First, necessary information must be available… . Second, institutional structures must exist or be created … Third, the necessary resources must be provided … Finally, the government must show sufficient political will …”.
- 3.
In his Annual Message to the Congress on the State of the Union of January 12, 1966 (Congress on the State of the Union, 1966), the U.S. President, Lyndon B. Johnson, said “I will also propose the International Health Act of 1966 to strike at disease by a new effort to bring modern skills and knowledge to the uncared-for, those suffering in the world, and … to help countries trying to control population growth, by increasing our research – and we will earmark funds to help their efforts.” Some months later, on October 18, 1966, he received the Margaret Sanger Award in World Leadership for his “vigorous and far-sighted leadership.” He was presented as someone who “… has been the major force in shaping a virtual revolution in government thinking to help to meet the global population crisis” in the Pittsburgh Post-Gazette – October 11, 1966; see https://news.google.com/newspapers?id=ViwNAAAAIBAJ&sjid=wmwDAAAAIBAJ&dq=margaret-sanger-award+johnson&pg=2359,1440141, accessed on January 5, 2022. Under his mandate, “… the U.S. Agency for International Development began providing contraceptives in its overseas development programs. President Johnson placed the prestige and influence of his office behind legislative and administrative actions to increase funding and staffing for voluntary family planning services for those who need them most, here and around the world” (see Planned Parenthood website https://www.plannedparenthood.org/about-us/newsroom/campaigns/ppfa-margaret-sanger-award-winners#Johnson, accessed on January 5, 2022).
- 4.
Paxman et al. (1993) describe that in Chile in 1960, almost 60,000 women were hospitalized due to abortion complications, which constituted 24 percent of all obstetrical admissions to hospitals.
- 5.
“In 1965, the Cornell International Population Program decided to determine the extent of attention to population problems and family planning in Latin American newspapers and began to collect newspaper clippings on these topics. Through the services of the Burrelle’s Press Clipping Bureau, a surprising total of six thousand clippings was obtained in 1965 and over eight thousand were gathered in 1966. Approximately three-quarters of these articles explicitly mentioned birth control or contraceptive methods” (Mayone Stycos, 1967: 67).
- 6.
Harewood (1968: 882) says that in the case of Haiti, “(t)he IPPF reported that while the government had announced plans in 1964 to absorb the FPA within the health services, little action had been reported by July 1967.” After that date, there was some progress and the country started receiving strong support from USAID (Ward et al., 2015a).
- 7.
“The traditional sources of opposition have considerably reduced their antagonism. Excellent examples are the attitude and action of the Roman Catholic church which, while retaining its opposition in principle to certain forms of birth control, has accepted the idea of planned and responsible parenthood, and is represented in the body responsible for organizing the national family planning program in the Dominican Republic, Trinidad and Tobago, and Curaçao” (Harewood, 1968: 892).
- 8.
See Weaver (1978: 431).
- 9.
Argentina and Uruguay were exceptions, having experienced their fertility transition much earlier, following the experience of Europe (Pantelides, 1996).
- 10.
Based on United Nations estimates, in 1960, half of the population of Latin America and the Caribbean (49.4%) was already living in urban areas and this figure increased to 65% by the end of the 1970s (United Nations, 2018). The same source shows that by 2020, the percentage of population living in urban areas in Asia only reached around the level of Latin America in 1960, while the African continent is expected to reach that value around 2033.
- 11.
It is clear that urbanization has undoubtedly had a major effect on fertility reduction in the Latin American region as well. Research into Brazil’s rapid fertility decline, for instance, suggests that urbanization was a major vehicle in promoting a variety of social changes that affect the fertility transition. It finds that urbanization not only has a direct impact on fertility behavior, but that it also has an important influence on its other major social and economic determinants. This would make the argument that the ongoing process of massive urbanization is one of the most important structural changes of this century (Martine, 2021).
- 12.
In spite of the political position of Latin America, it has also been recognized that “(a)lthough not all [Latin American] governments came to Bucharest explicitly supporting family planning and the use of contraceptives, all came with a least official tolerance towards family planning activities and most with publicly supported contraceptive programs” (Weaver, 1978: 435).
- 13.
It explicitly “… (r)ecommends that the couple and the individual should be allowed full freedom to choose in a responsible manner the number and spacing of their children. For the exercise of this basic human right of really being able to choose, it is necessary for States to respect these decisions by appropriate measures of assistance and information” (United Nations, 1975: 46).
- 14.
It says that “(c)ountries which consider that their present or expected rates of population growth hamper their goals of promoting human welfare are invited, if they have not yet done so, to consider adopting population policies, within the framework of socio-economic development, which are consistent with basic human rights and national goals and value” (United Nations, 1975: 9).
- 15.
This was a big change in its politics because until 1972, the government from Mexico had a “strictly pronatalist population policy” (Rodriguez-Barocio et al., 1980: 3).
- 16.
These institutions are: the Secretaría de Salubridad y Asistencia (SSA)-the Ministry of Health; the Instituto Mexicano del Seguro Social (IMSS)-the Mexican Social Security Institute; and the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), which is the government Employees’ Institute for Social Security and Social Services.
- 17.
About 40% of the world’s population participated in the first global initiative to collect data on fertility and family planning. From Latin America and the Caribbean, twelve countries participated (Mexico, Colombia, Costa Rica, Dominican Republic, Ecuador, Guyana, Haiti, Jamaica, Panama, Paraguay, Peru, Trinidad and Tobago, and Venezuela).
- 18.
These ups and downs of the “Mexico City Policy” have been directly linked to whichever party, Democrats or Republicans, wins the presidential election of the United States: “The [Reagan] policy was rescinded by President Bill Clinton and reinstituted and expanded by President George W. Bush to include State Department activities. In January 2009, President Barack Obama rescinded the policy. It was reinstated and expanded by President Trump in January 2017” (Congressional Research Service, 2020: 1). In January 2021, President Biden has rescinded the Mexico City Policy.
- 19.
The government of Rodrigo Carazo, President of Costa Rica between 1978 and 1982, clearly stated that it would not support expanding family planning programs (Holl et al., 1993).
- 20.
United Nations, 2019.
- 21.
After 2020, other countries joined the list of ‘graduated’ countries (Costa Rica, Dominican Republic, Ecuador, El Salvador, Jamaica, Mexico, Nicaragua, Panama, Paraguay, and Peru). Source: USAID Technical Issues Brief: Latin American and the Caribbean: see https://www.usaid.gov/global-health/health-areas/family-planning/resources/issue-briefs-latin-america-caribbean, accessed on October 8, 2021.
- 22.
Jason Finkle and Alison McIntosh stated that “In the aftermath of Cairo, the population movement finds itself in a quandary. Stated in the simplest terms, governments, intergovernmental bodies and non-governmental organizations have been committed to a greatly expanded mandate without assurances of increased resources. Even before the conference itself, participants in the ICPD process were aware that the proposed programs would be expensive” (Finkle & McIntosh, 1996: 110).
- 23.
An excellent evaluation conducted in 1999 by ECLAC (CEPAL, 1999) described what happened with population institutional arrangements in the region after ICPD. Ecuador is mentioned as one of the countries that eliminated the Population Unit established before the ICPD (three others countries did the same in this period). Since 1978, the National Development Council of Ecuador covered population Issues. In 1982, a population unit was created within this Council. Between 1984 and 1992, this Unit then evolved to the level of Direction including a dozen of staff. But by mid-1990s, this Direction was reduced to only one person, who was then transferred to the General Direction of Social development without responsibility for population policies (CEPAL, 1999).
- 24.
That’s why in the final outcome of the Conference, it was recognized that in spite of some advances towards integrating population issues into public policies and programs, many challenges still remain in their design, formulation, and implementation (ECLAC, 2013b).
- 25.
“Approximately 400 civil society representatives attended the conference and many governments had progressive civil society voices within their delegations … The large presence and strong voices of youth, feminist, lesbian, gay, bisexual and trans activists (LGBT), Afro-Latino, indigenous and sex worker organizations have decidedly contributed to counter the pressures made by conservative governments, such as Guatemala, Honduras and Jamaica” (Abracinskas et al., 2014: 3).
- 26.
Francisco Alba (2014) considered that given the changes in the population age structures that were taking place in the region, there was a need to create a new paradigm based on what he called ‘a new population governance’ that framed the policies and the economic, social, and political parameters in order to boost human capital. See also Chap. 19: Policies Needed to Capture Demographic Dividends of this Handbook (Turbat, this volume).
- 27.
See https://www.cepal.org/en/eventos/conferencia-regional-intergubernamental-envejecimiento, accessed on October 8, 2021.
- 28.
Sandra Huenchuan (2016) mentions that countries of the Caribbean (The Bahamas, Jamaica, and Saint Kitts and Nevis) were the pioneer in the creation of institutions dealing with the elderly in the 1960s and 1970s.
- 29.
United Nations (2018).
- 30.
Faria and others claimed that even if Brazil has never endorsed a national family planning policy, some of the government policies in the area of social and economic development had a direct or indirect effect on fertility, acting as ‘implicit population policies’ (Martine, 1996).
- 31.
ECLAC (2019) warns about the need to implement the legal frameworks that have been developed and assuring that this progress is not lost for political or cultural reasons.
- 32.
United Nations (2019).
- 33.
At the same time, eleven countries still wanted to reduce their fertility level, most of them (seven) were also interested in reducing their rate of population growth.
- 34.
Family policies are defined by the International Encyclopedia of the Social & Behavioral Sciences as the “…state policies oriented to the welfare of children and the support of family as an institution or way of life. Most widely, family polices concern themselves with demographic matters, the financial and other resources.”
- 35.
Lutz (2008: 18).
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Guzman, J.M. (2022). Population Policies in Latin America and the Caribbean: From Carmen Miró to the Montevideo Consensus. In: May, J.F., Goldstone, J.A. (eds) International Handbook of Population Policies. International Handbooks of Population, vol 11. Springer, Cham. https://doi.org/10.1007/978-3-031-02040-7_10
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