Mixed Results Mark Asian Family Planning

FOR more than a decade now, the Western image of China has been colored by news reports of coercive measures used by the Beijing government to prevent couples from having more than one child.

But such reports have obscured a troubling demographic reality. Despite the rhetoric devoted to one-child families, average family size in rural areas is still close to three children.

Two reports issued yesterday by the Population Crisis Committee (PCC) say that unless China, and its Asian neighbor India, substantially improve their family-planning programs there will be little chance of stabilizing world population at a tolerable level.

"India and China, but especially India, will face enormous population growth over the next several decades unless they take immediate steps to improve the way they deliver family-planning services," says Sharon Camp, senior vice-president of the Washington-based group.

In its worst-case estimates, the United Nations Population Fund predicts that today's population of more than 5 billion could quadruple by the end of the next century. Whether more optimistic estimates can be met will depend to a large degree on the performance of the two Asian giants that have a combined population of 2 billion.

China launched its family-planning program in 1971, calling for delayed marriage, smaller families, and wider use of contraceptives. The results were dramatic: Contraceptive use rose while average family size dropped by more than half.

Still dissatisfied, the government initiated its controversial "one-child" campaign in 1979, using a combination of rewards and penalties to convince the reluctant.

Although family-planning efforts have been successful by developing world standards, tens of millions of rural Chinese couples still do not have access to adequate family-planning services. Those who do often have to deal with poorly trained staffs overburdened by the demands of the overly ambitious goals set by the government, according to one of the two PCC reports, "China's Family-Planning Program: Challenging the Myths."

Matters are worse in India, where the government has been slow to recognize the problem and where energies have been focused on a method of contraception, female sterilization, that appeals primarily to women who have already had a number of children.

Under increasing demographic pressure, the government has developed a model plan for limiting excessively high birth rates, says the other study, "India's Family-Planning Challenge: From Rhetoric to Action." But it has yet to be implemented. One casualty of inaction is the growing number of Indians - up to one-third of the population - who are malnourished.

The experience of at least two Indian states confirms the report's emphasis on the correlation between improved education and economic status for women and increased contraceptive use. The result has been the attainment of the low fertility rates needed to eventually stabilize the population.

Both reports call on the United States and other countries to do more to help improve the quality of family-planning services in countries like India and China.

The reports credit both countries with establishing comprehensive family-planning networks.

The existence of a family-planning infrastructure, however, is offset by poor staff training, a limited choice of contraceptives, and the absence of the kind of counseling needed to penetrate the layers of fear, ignorance, and superstition that attend the use of contraceptives in many developing countries.

One big difference between the two countries is that local authorities in China have much greater responsibility for the direction of family-planning programs. The reports say India would profit by emulating the strong support the Chinese government has given to family planning and the effective public relations campaign it has waged to promote the idea of smaller families.