Recommendations

Ensuring more balanced age structures, especially among developing countries with very young and youthful populations, requires strong international partnerships, comprehensive policies and adequate funding to address those populations' needs. In particular, policies must focus on significantly increasing assistance for programs that improve access to modern contraception and other sexual and reproductive health services, expanding educational opportunities for girls, increasing women's participation in government and throughout society, and enhancing employment opportunities for youth. In the minority of developed countries confronting rapid population aging, programs that work to balance women's professional and family responsibilities and increase men's involvement in childrearing, as well as other innovative approaches, should be considered.

Given the profound impact of demographic trends on countries' economic and social well-being that this report documents, governments should implement programs that can influence the shape of those demographic trends in the future. A number of interventions, especially in the area of health and social services, can significantly influence a country's age structure. Such steps include the following:

1. Expand access to family planning services and improve sexual and reproductive health as a means to achieve balanced age structures.

In countries that retain high birth and death rates, particularly those with very young and youthful age structures, demographic research and experience demonstrate that a range of social interventions can spur lower birth and death rates. Predominant among these are increased availability of voluntary family planning and sexual and reproductive health services, improvements in girls' education and income-generating opportunities for women, maternal and child health programs, and prevention and treatment of sexually transmitted infections, including HIV/AIDS.

Greater political commitment and more funding, both from international donors and countries themselves, are needed to expand programs that enable women and couples to choose for themselves the timing and frequency of childbirth, that promote maternal and infant survival, and that protect reproductive-age adults from HIV and other sexually transmitted infections. For example, African health ministers recently developed a plan to take the continent forward towards the goal of universal access to comprehensive sexual and reproductive health services in Africa by 2015. The plan recognizes that sexual and reproductive health encompasses many elements: adolescent sexual and reproductive health; safe motherhood and newborn care; abortion care; family planning; prevention and management of sexually transmitted infections including HIV/AIDS; prevention and management of infertility; prevention and management of reproductive cancers; addressing mid-life concerns of boys, girls, men and women; health and development; reduction of gender-based violence; interpersonal communication and counseling; and health education.¹

While policies and programs in family planning and reproductive health are generally under the purview of donors of development assistance and health and social service agencies and ministries, non-traditional actors such as the military can play important roles as well. For example, military commands should be prepared to lend logistical and organizational support, with proper training and carefully defined roles, to organizations working to provide reproductive health care. Such cooperation is particularly needed in rural areas and post-conflict environments where the logistical and distributional challenges--and lack of access to health services--are the most acute.

In recent years, support for family planning and sexual and reproductive health programs from international donors has fallen victim to funding reductions, ideologically-based policy restrictions and competing priorities in international development.* As a result, unmet need for family planning and sexual and reproductive health care in developing nations remains high. More than 200 million women in the developing world who want to delay or end childbearing are unable to access the services and supplies to do so.

Rather than limiting their funding or tying it to policy restrictions, donors should create and promote development assistance policies that support universal access to voluntary family planning and sexual and reproductive health care, with gender issues fully mainstreamed. For example, the Danish International Development Agency has developed a policy stating that Denmark gives high priority to multilateral cooperation with organizations that strive to eliminate violence against women and ensure women's sexual and reproductive rights as well as their access to resourcesÉDenmark stresses the importance of promoting gender equality in the areas of peace, security, refugees and humanitarian assistance as well as in regional political dialogues and assistance.²

Countries with transitional age structures have already benefited from policies and programs that encourage demographic development. But as mortality and fertility rates decline from critical levels, their continued progress is not guaranteed unless governments make deliberate efforts. Access to a broad range of sexual and reproductive health services, such as contraceptives, should be expanded to make them universally available and affordable. Programs to improve educational attainment and economic opportunities for women should reach full scale.

With their low fertility and mortality rates symbolizing the end of the demographic transition, countries with a mature age structure generally have high economic and governance standards and are more stable and less prone to conflict than countries with other age structure types. Governments of these countries tend to be concerned about the future social and economic impact of their populations' aging. To that end, a variety of more generous family-friendly policies (such as expanded family and maternal leave policies) could encourage greater equity for women and, possibly, higher fertility in aging nations. However, efforts to encourage childbearing should be based on the rights of individuals and couples to decide for themselves the timing and number of childbirths.

2  Support improvements in the legal, educational and economic status of women.

Countries in which most girls attend secondary school and most women are employed in the formal labor sector have better maternal and child health indicators and lower fertility rates. When couples choose to have smaller families, more children--especially girls--attend school and more women are able to work and increase their families' income. Governments and donors benefit through greater per capita spending on health and education, and through increased savings and investment in the economy. Improving women's status can influence social environments, help change cultural norms and, ultimately, speed demographic transition. The World Bank has recognized this connection between women's roles and development: Women's lack of economic empowerment not only imperils growth and poverty reduction, but also has a host of other negative impacts, including less favorable education and health outcomes for children and a more rapid spread of HIV/AIDS.³

Policies should encourage social and political reforms that help girls stay in school and strengthen school curricula. Income-generating opportunities for women should be promoted, and women should be fully protected from gender-based violence. Women should have a full and equal role in the political process, ranging from the right to vote to greater representation in parliament and high levels of government.

Governments should promote the judicial oversight of women's and family legal disputes in civil courts of law and, where applicable, their removal from the purview of religious courts or customary law. Where the decisions of religious or customary courts have framed family law, on balance, women have made little progress. In some cases they have lost ground in securing equal rights to custody of their own children, to divorce, to access to sexual and reproductive health services, to inheritance and land title, and to protection in schools and in the workplace.

Countries and regions with disproportionately low levels of female children as a result of neglect and sex-selective abortion may face future repercussions. Societies are less stable when there are large numbers of men unable to marry, due to unbalanced sex ratios or economic challenges in establishing a home or paying a dowry. There are no easy prescriptions for the dismal status of females in societies in which skewed demographic disparities in favor of males are actively promoted. Governments and civil society in such countries should pursue policies that promote equal status of women and men and discourage norms and actions that eradicate naturally occurring gender balance.

3 Consider population trends when setting societal priorities.

Population age structure can have significant impacts on countries' stability, governance, and social well-being. However, demography is not monolithic or entirely predictable, and the demographic situation and potential of geographically or culturally similar countries can be very different. Policymakers and program managers should focus greater attention on the nature and impact of demography and age structures, both regionally and in specific countries. The United Nations Millennium Project has noted the relationship between demographics and the broad development objectives of the Millennium Development Goals (MDGs): The achievement of the MDGs is influenced by population dynamics such as population growth, fertility and mortality levels, age structure and rural-urban distribution. Each developing country has its own unique combination of demographic factors that affect the prospects for progress toward the MDGs.⁴

Demographic data, in the form of statistics, case studies and trend analysis, should be incorporated into research and publications on security, economic and development issues. Policymakers should seek to emulate in developing nations the successful role that programs that impact age structures--including voluntary family planning, girls' education, and women's empowerment--have had in countries that have progressed further along the demographic transition.

* In the case of the United States as an international donor, such restrictions have included the Mexico City Policy and components of the President's Emergency Plan for AIDS Relief (PEPFAR). The Mexico City Policy, sometimes called the Global Gag Rule, denies U.S. family planning assistance to foreign organizations that use their own non-U.S. funds to provide legal abortion, counsel or refer for abortion, or lobby for the legalization of abortion in their country. In addition to forfeiting U.S. financial assistance, foreign organizations also lose valuable technical assistance and U.S.-donated contraceptives, including condoms. PEPFAR mandates that a minimum of one-third of U.S. bilateral HIV/AIDS prevention funds (20 percent of the $3 billion authorized annually) be dedicated solely for abstinence-until-marriage programs. PEPFAR also includes a requirement that organizations receiving U.S. HIV/AIDS assistance have an official policy explicitly opposing prostitution and sex trafficking as a condition of eligibility for funds. Both of these provisions limit the ability of organizations working on HIV/AIDS prevention to address the critical health needs of married women, sex workers, intravenous drug users, and other highly vulnerable populations.