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Demographic entrapment
TRANSACTIONSOF
THE ROYAL SOCIETYCIFTROPICALMEDIC~NEAND
Demographic Maurice
King
Hwx~~(l993)
87, SUPPLEMENT
1,23-28
S1123
entrapment Academic Unit of Public Health Medicine,
University of Leeds, 20 Hyde Terrace, Leeds, LS2 9LN, UK
Abstract
Demographicentrapment is a situation in which a population exceedsthe carrying capacity of its own ecosystemand its ‘connectedness’to other ecosystems.It can be looked upon as a disorder of the demographictransition which presentsseriousethicalproblemsin that there areoccasionson which there is a conflict betweenthe interestsof the child and the community. Reasonsare given for the aid agencies’ recognizing the existence of entrapment, which presently they do not. Since there are at present considerableobstaclesto their doingthis, wemust accepta periodof ‘legitimatedouble-think’ meanwhile. Introduction
There is an increasingconsensus that the world hasultimately only 2 problems. One is that the industrial world is imperilling the climate of the entire globe. The other is that many communitiesin the developingworld are growing so fast that they are likely to exceedthe carrying capacity of their ecosystems.These problems arelinked and both are ecological.Entrapmentis largely taboo, in that when United Nations(UN) agenciescome to problemsof carrying capacity and sustainability,they quickly move to the next item on the agenda.My purposeis to remove that taboo, to exposethe ethical dilemmasthat it hides,to easethe tensionsthat resultfrom entrapment, and to encouragethe developmentof improved policies. A population is demographicallytrapped if it hasexceeded,or is projectedto exceed,the combinationof: (i) the carrying capacity of its own ecosystem,(ii) its ability to obtain the products, and particularly the food, producedby other ecosystems except asfood aid, and (iii) its ability to migrateto other ecosystems in a mannerwhich preserves(or improves)its standardof living (voluntary migration). Items (ii) and (iii) describethe links that a populationhaswith other ecosystems, and arecrucial, so they are discussedhere under the headingsof ‘connectedness’andits opposite,‘disconnectedness’. The end result of entrapmentis that peopledie wherethey are, migrate in misery to someurban slum (forced migration), or hopeto be supportedindefinitely by food aid. For the purposesof this paper an ecosystemis that supported by a particular area of land. Entrapment is thus a disorderof the carrying capacityof one’sown ecosystem,and of one’sconnectionto other People’s.The carrying capacity of an ecosystemis the maximumnumWHEN CARRYING CAPACITY IS EXCEEDED there are several passibilities
The
ber of a given speciesthat it can support indefinitely without causingenvironmentaldegradation.In the case of humanpopulations,2 important qualificationshave to be added:with a given technologyand consumptionpatterns. A population can, however, exceed the carrying capacityof its ecosystemtemporarily, but asit doessoit consumes its ecosystem’s biologicalresourcebase,sothat the carrying capacity of the ecosystemfalls even as the populationit supportsrises.Sincethis cannot go on for ever, there comesa time when the ecosystemcollapses, so that peopleeither die or migrate. The point at which they do this is their Malthusian ceiling, but they usually start migratingwell beforethey reachit. The scaleof this migration is already substantialin that the United Nations Fund for PopulationActivities (UNFPA, 1991)reports that half a billion (5x log) peopleare moving from their fragile and marginal lands to the cities. UNFPA (1991)alsoreports that governmentsarehaving increasing difficulty feedingthesecities. Connectedness Economic connectedness Economic connectedness
determines
the economic
links that the community supportedby a particular ecosystemhaswith other ecosystems.In practice, few communitiesare completelyisolated,andmostare connected with other ecosystemsand other communities to a greater or lesserdegree.The principal connections,or flowsin and out, are food, peoplemigrating (‘mouths to eat the food’), and the goodsand servicesthat are exchangedfor food and other products. The result of these connections is that most communitiesare ableto live off own and the product of more than oneecosystem-their other People’s.Thus Singaporeis not trapped even though it haslong exceededthe capacity of its tiny island, whereasNepal, havingalmostnothing to exchange, probablyis. Connectedness, or rather the lack of it-disconnectedness-is thus crucial to the considerationof entrapment. ‘Economicopenness’is one of connectedness.It is also closelyparallelby equity. Unfortunately for the measure-
world
TWO WORLDS All food 1s derived from the energy of
Fig. 1. Carrying capacity and connectedness. All food is ultimately derived from the sun’s energy. The energy arriving and the efficiency with which it can be converted into food sets a limit to carrying capacity. If the community of country A exceeds the carrying capacity of its ecosystem, it is dependent on its connectedness with the rest of the global ecosystem. The alternatives are for people to emigrate, or for goods and services to be exported in exchange for food from elsewhere in the world. If these fail the alternatives are indefinite food aid or death from starvation.
ecOnOmically -co”“ecfed” equitable
open
ecanomicall”
closed
-di*CO”“ectedll inequitable
Fig. 2. Two worlds. If the population of the perfectly connected, open and equitable world on the left were to exceed its carrying capacity, everyone would starve slowly, equally and simultaneously. In practice, in the world on the right, disconnectedness, economic closure and inequity ensure that some people will starve early and unequally.
S1124 ment of entrapment, there is no single unit of connectedness, as there is (persons per hectare) for carrying capacity. The flows of people and food, etc. have all to be estimated and projected separately. The complex nature of this connectedness, and the difficulty of measuring and predicting it, is sometimes used as an excuse for denying that entrapment exists. To take the extreme case, if the population of a perfectly connected, open and equitable world were to exceed its carrying capacity, everyone would starve slowly, equally and simultaneously. In practice, disconnectedness, economic closure and inequity ensure that some people will starve early and unequally. Migratory connectedness
In the definition of entrapmentgiven earlier, a population is not consideredtrapped until it is expectedto exceedor hasexceeded‘.. .its ability to migrate... in a manner which preserves(or improves)its standardof living’. Sahelianpeasantsmigrating to the hovels of Ouagadougou may have savedtheir lives, but they have not, alas, preservedtheir standardof living. Migration towardsa deteriorating culture and lifestyle will be referred to as forcedmigration. Although migration of both kinds is of increasingglobal importance,not in Africa, India or Chinais it practical to think about moving communitieson a sufficient scaleadequately to equilibrate the carrying capacity of one district with that of another. The political, cultural and other difficulties are too great. For example, although there is likely to be much migration, there is also likely to be much ‘non-migration’or fixednessof populations, which will prevent migration from adequatelyrelieving entrapment. kcttrorder
of the demographic
transition-the
time
All populationsenteredthe modernperiodwith a high birth rate anda deathrate which approximatelymatched it, and thus with a low and approximatelystablepopulanon. The death rate then fell, and sometimes,particularly in Africa, the birth rate alsorose,dueto a declinein breastfeeding, and weakeningof the taboo on sexualintercourseafter delivery. Since the birth rate was now
higher than the death rate, the population startedrising. If the community wasfortunate, asindeedhave beenall communitiesin the developedworld, the birth rate then fell until it approximatelymatchedthe death rate, sothat the populationstabilizedagain,but at a higher level, the whole processtaking about a hundred years. Such communitieshave successfullycompletedtheir demographic transitions.Many communitiesin the developingworld arenot beingsosuccessful. The first stageof this transition is stablein that, since its populationis stable,a community canremainin it indefinitely, without harm, and sois the last stage.Unfortunately, the middle stageis unstable,in that if a community staysin it too long becauseits birth rate doesnot fall? its population continuesto increaseto the point at which it may exceedthe carrying capacity of its ecosystem, and ultimately reach its Malthusian ceiling. This ceilinghasbeenshownin Fig. 3 asa zig-zag line to indicate variationsin agricultural output from year to year, with ‘good’yearsand ‘bad’ years. A population is likely to reachits Malthusian ceiling when it is already nearit, andencountersa bad year, or seriesof bad years. ‘A populationis demographicallytrapped if it hasexceeded,or is projectedto exceed,the.. . carryingcapacityof its own ecosystem.. .‘. Whether or not it doesexceedit dependsin part on the population’ssize.Sincethis is determined by births, deaths,and migration occurring over time, the time factor is crucialin determiningwhat hasalready happenedto the relationshipbetweena population andits ecosystem, andwhat isgoingto happento it. In default of adequateconnectedness,all populations are going to have to remain within the carrying capacity of their ecosystems.Since there are no extra-terrestrial connections,the world asa whole is going to have to do so too. Where breachesof carrying capacity cannot be compensated for by adequateconnectedness, birth rates areeither goingto have to fall, or deathrateswill rise. So far, birth rateshave come down enough, or connectednesshasbeenadequate,for there to have beenno recent rise in the death rate attributable to entrapment, apart from thosein the Saheland Ethiopia. In somecountries the birth rate has fallen with remarkablespeed.Thus, whereastotal fertility in the USA took 58 years to drop from 6.3 to 3.5, the samedecreasetook 15 yearsin Columbia, 8 in Thailand and only 7 in China (KHANNA et al., 1992).
It is, however, the failures that concern us here, not the successes. There are 78 million people in countries whosetotal fertility is over 7, and 708 million whereit is over 6. For thosecountrieswhich are projectedto exceed their carrying capacity, will fertility fall fast enoughfor themto remainwithin it? For thosecountrieswhich have alreadyexceededit? can fertility fall fast enoughfor them to return below it? Unfortunately, the demographic momentumof a young populationis sogreatthat a fall to replacementfertility will not return a severely trapped population to within the carrying capacity of its ecosystem. For suchpopulationsthe only alternativesare onechild or, theoretically, no-child families. Neglect of the time factor is one of the flaws in UNICEF’Sargument that by ‘saving young lives we alsoreduce the populationgrowth rate’ (GUARDIAN,1990)and by implication always do so, and do so immediately, sinceexceptionsand delay are never mentioned. There areat least2 questionshere. (i) Do interventionsto lower child mortality lower the birth rate? (ii) How quickly do they do this?If a community is not trapped, even a seriously delayedresponseis unimportant; if it is trapped, even moderatedelay is critical, sinceinterventions for child survival increasepopulationpressure,makeentrapFig.3.Threehuman populations. A, thepopulation remained withinits ment worse, and causethe disturbing conflict between carryingcapacity.B, thepopulation rose,but increased its carrying interestsof the child and the community that is decapacity asit didso,andremained withinit. C, thepopulation exceeded the scribedbelow. its carryingcapacity, andin doingSOdestroyed itsbiological support The UN Department of International and Economic system, SOthat thecarryingcapacity fell. Ultimately thepopulation Affairs, in an impartial UN statementof the position, is reached itsMalthusian ceilingandalsofell.TheMalthusian ceiling is shown asawavylinetoindicate goodyears andbad years. much moreguardedin respectof both thesequestions:it
s1125 states that ‘. ..improvements in child survival typically precede sustained fertility decline. This observation, however, cannot lead to the automatic conclusion that policy interventions to improve the health of children will be immediately [my italics] followed by a decline in the birth rate...’ (UN, 1987). By admitting that fertility decline may not be immediate, this statement admits of delay. In practice there are many communities which have seen a major fall in their child mortality with little or no change in their fertility rate, so that delay is open ended, in that the expected change in fertility has yet to occur. The extreme example is Oman, with a childhood mortality of 49 per thousand and a total fertility of 7.3. Jordan, Iran and Syria have a similar child mortality, and fertilities of 5.8, 5.0 and 6.5. Less extreme is UNICEF’S entire group of very high child mortality countries with a median child mortality of 189 (less than half its likely original value of about 500) and a total fertility of 6.6. For these countries, most of which are in sub-Saharan Africa, the critical question is: will fertility fall fast enough to escape entrapment?-assuming that they are not trapped already, which some of them may be. Which communities are trapped? There are 3 ways of determining the existence and severity of entrapment, and all have serious limitations. (i) By calculation. The necessary data include projections of population growth and migration of either kind, estimates of food produced locally and imported by trade (connectedness), the probability of technological breakthroughs in agriculture, and the effect of epidemic diseaseLparticul&ly the acquired immune deficiency syndrome (AIDS). In view of the difficulties inherent in the data, and particularly in making projections, calculation is difficult, but it is important none the less, because it appears to be the only way of determining the earlier stages of entrapment. (ii) By observing ecological degradation, either directly or through decreased productivity forcing people to emigrate. Ecological degradation (see above) is a late sign and indicates that carrying capacity has been exceeded. By the time it is severe, the community supported by that ecosystem has either migrated or died, or is fed by food imported from elsewhere. Although ecological degradation may be relatively easy to estimate, it is only one of the determinants of entrapment. Disconnectedness, the other, is much more difficult. (iii) From the opinions of external observers in the aid agencies. Interestingly, these are surprisingly consistent, although there is a natural reluctance for any given executive to name publicly any given country as being trapped. The countries commonly considered to be trapped are parts of the Indian subcontinent, Kenya and Nigeria. To these some would add Nepal, parts of China, eastern Indonesia, and the Philippines. India is sometimes considered more trapped than Bangladesh. Rwanda and Malawi are also sometimes mentioned. What these observers base their opinions on is not clear; it is presumably a combination of increasing population densities, progressive immiseration and pessimistic views of food supplies. Although none of them indicate the stage of entrapment, the fact that early entrapment can be determined only by calculation and projection makes it likely that they are recognizing its later stages. Whatever the difficulty of calculating entrapment, the extent of ecological deterioration, and the consistency of the opinions of experienced observers encourage the suspicion that entrapment is both real and massive. Entrapment of particular communities The Indian subcontinent Although entrapment appears to be severe in other parts of the region, only India will be considered here. India’s 843 million people appear to have all but exhausted the potential of its ‘first green revolution’, in that
the rate of increase of food production is now slowing down due to decreased fertilizer productivities and longterm mining of soil minerals (UN, 1992). There is grave cause for concern in that current nutritional levels are not adequate even at the present time, and yet India can expect almost another billion ( 109) people before its population is assumed to stabilize at 1.7 billion (1.7~ 109) in 2060 (PREMI, 1991). If India is to feed its expected population, and avoid a population crash, the following conditions must be met. (i) There must be a second generation green revolution involving multiple technological productivity breakthroughs in its non-irrigated monsoon-fed ‘dry’ coarse grain agriculture, which has not yet had a green revolt&on, and where ~water shortage is a major oroblem. (ii) These breakthrounhs must be disseminated widely, rabidly and efficiently.“(iii) They must be taken up by the villagers. (iv) There must be no serious snags. (v) They must eventually feed nearly another billion people. (vi) They must be implemented quickly enough. (vii) They must start becoming effective immediately. (viii) They must be sustainable. Concurrence of all these conditions seems unlikely. This gloomy prognosis is supported by BORLAUG (1992). the Nobel Laureate who develooed the rice strains that produced the first green revolution. In 1970 he warned that these had given India 30 years of grace. In 1990, with 10 years left to go, he said he saw no reason to change his mind. It is also reported that several nongovernmental organizations are expecting severe starvation in India and Africa in the 1990s. This would put India’s Malthusian ceiling at about a billion ( 109), which is its expected population in the year 2000. Its carrying capacity can only be guessed at, and is likely to be substantially less than this. The likely scenario for disaster is a bad year, or series of bad years, in India, some time in the next 10 years, accompanied by similar bad years in the North American grain belt which reduce world grain stocks, and thus the possibility of substantial food aid. Aftica Entrapment here follows a different pattern from that in India, since there is much less connectedness between its communities than there is in India. Parts of Ethiopia and the Sahel have already progressed through all the stages of entrapment, and have had their population crashes. People have either died or migrated. The most ambitious attempt ever made to measure carrvine canacitv was the FAOUNFPA nroiect ‘Land Resources for Populations of the Future’ -(LRPF; HIGGINS et al., 1982). This confirmed the general consensus that food supply is no problem globally, and argued persuasively that human carrying capacity had already been exceeded in parts of sub-Saharan Africa. Crop yields, per caput food output, environmental damage and breaches in-carrying capacity have already reached crisis proportions in the drier Darts of West Africa and the highlands of East Africa (M~HAR, 1988). Although there isno immediate overall problem with carrying capacity in Africa as a whole, even with low technology methods, disconnectedness places daunting obstacles in the way of making areas in potential surplus feed those in deficit. The need to improve carrying capacity by improving agricultural technology is acute in many areas. Global entrapment The limit on the global food production is the limit on what connectedness can do to diminish global entrapment. It is not proposed to discuss the vexed question of whether the world could feed a oonulation that will double and could triple, except to refer to the LRPF proiect above. and to auote the aeronomist Willem Beets who wrote”Yes the &anet can pyoduce 2 or 3 times more food, even under a medium level of technology. But the potential cannot be exploited on account of unsurmountable human, institutional and political constraints’. This
S1126 has the ring of truth since, unfortunately, it is a very human world. Two questionshaveto be askedaboutglobalfood supply. (i) How much food could the world produce if it were farmed ontimallv? The answerhere is reassurina. (ii) How much food i’; it actually going to produceand distribute, whennecessaryfree, given all the constraints, esoeciallv the human ones?This is the kev auestion which trappedcommunitiesmust askthemselves’, andto which the answeris not so hopeful. Planshave to be made,not on the basisof what ought to happen,but on what Drobablv will haDDen.The indefinite suDDortof large iopulatibns which-can no longer feed themselves, and have nothing to buy food with, seemslikely to be a major concernof the internationalcommunity in the not too distantfuture. Ethics The ecologicalconstraintson mankindtake no account of our ethics. This grim fact is behindmostof the ethical dilemmasthat ariseduring the processof entrapment. Thev concern both fertilitv (esDeciallvthoserelating to abortion and one-child familiesj and mortality, par&ularly child mortality, in that there is a conflict between the interestsof the presentchild andits community, and betweenthem and its future community (and its future children). Thesedilemmaschangeduring the processof entrapment.There is alsoa conflict betweenthe interests of the Dresentchild andthat child savedfor the moment. but only for malnutrition and an early death. Is the child’s life really worth savingif this is so soonto be its fate? This is the child vividly describedby SCHEPERHUGHES(1991). Not surprisingly, the dilemmas(apart from the particular ‘UNICEFdilemma’ mentioned in ‘Ethical stagetwo’,, below) are at their greatestwhen child mortality is high, either early or late in the process of entrapment. Most importantly, they exist at all for an aid agencyonly if it is assumed that ‘we’, the aid agency, do the deciding, and it is expected that what the aid agency does will have a significant effect in lowering child mortality. The alternative, which is to give great weight to the premissof local autonomy, and to let the local community make the decisions,is the position taken by the Savethe Children Fund and is described elsewhere(KING, 1992[seealsopp. 29-31 of this Supplement]).
Ethical stage two, low child mortality As LITHELL et al. (1992)correctly pointed out, by the
time child mortalitv hasfallento about 140Derthousand. the present Indian rate, depressingit further barely raisesthe population trajectory. Thus halving India’s child mortality would add only an equivalent-of about 11% of the DresentDoDulationto its DoDulationin 25 yearstime. At this stage;not doingeverything possibleto savechild life thereforehaslittle demographiceffect. Should,however, a populationbe in dangerof entrapment, there is anotherseriousdilemmain this stage,particularly for UNICEF. It is betweenthe opportunity costs of, say, trying to halve child mortality with technical ‘fixes’ for child survival, and an urgent programmeof ‘emergencydisentrapment’in a desperateattempt to avoid the next stage.This is partly a matter of priority in the allocationof resources,andpartly of priorities for the ‘UNICEF publicity machine,’which is far strongerin UNICEFthan in the other agencies.Otherwise the dilemma level in this stageis low. Ethical stage three, on the way up to the Malthusian
ceiling
As a population approachesits Malthusian ceiling, its death rate, particularly its child death rate, rises. The long-term trajectory-influencing factors of earlier stages no longeroperate,and introducing family planning, even one-childfamilies,is too late. Assuminga constantor decreasingfood supply, there is acute pressureon food, suchthat onemore (child) mouth to feedmeanslessfood for someoneelse.To the extent that child survival interventions are possibleat all, they increasethe dilemma. Once this stageis reached,it is arguablewhether withholding public health measuressuchasoral rehydration makesmuch difference, since food is likely to be the limiting factor. There is needfor studiesin specificcommunities.The length of this phaseis uncertain, but there areunhappyindicationsthat it may not alwaysbe short. Ethical stage four, the population crash
The community has now partly or completely destroyed the carrying capacityof its ecosystem,sothat its populationis crashingto a lower level. To the extent that it is possibleto prevent this crash, the dilemmabetween the interestsof the presentchild and the community is acute. Once a population is safely disentrapped,and is stableagainbelowthe carrying capacity of its ecosystem, this painful setof dilemmasends.
Ethical stage one, the early modern period
All communitiesentered the modern period with a child mortality rate which wassometimesashigh as500 per thousand,a commonlyquoted African figure (MORLEY, 1963).It washigh enoughfor a reduction, by whatever means,markedly to raise population trajectories. Complexandonly partly predictableand quantifiableinteractionsbetweenthe child deathrate and the birth rate start in this stageand continue into the next one, such that Preston (personalcommunication)wasable to say that ‘In my guesssizeablefertility declinein this stage and the next would have beensmallerwithout earlierdecline in child mortality’. As discussedearlier, the effect of mortality on fertility is not invariable and can be delaved bv severaldecades.This delav is unimDortantif a country’ is not trapped, but is seriousif it i’s. It would therefore have beenin the future demographicinterests of a community which subsequentlybecametrapped, though not, alas,of its then children, to have reducedits child mortality only just enoughto have triggereda fertility decline. No country remainswith a child mortality rate of 500, but someare sufficientlv near it for the dilemmaof this stageto remainin some-degree. Thus Malawi hasa child mortality of 253 and a total fertility of 7.6. Halving its child mortality would add the equivalent of 30% of its presentpopulation to its populationin 25 yearstime-a seriousincreasein population growth for a country in potential dangerof entrapment.
Does loweringthe child death rate lower the birth rate?
What, if it doesnot, or if it doesnot do it fast enough, are the ethical consequences in respect of the dilemma betweenthe interestsof the child and the community?If a community is not trapped there is no ethical consequence. If it is trapped, the directly population-raising effectsof lowering the child death rates(which are greatest when the death rate is high) have to competewith the indirectly population-loweringeffect of what a lowered child death rate might do to lower the birth rate, riven enoughtime. This effect is sodifficult to measure and predic; that it can only be guessedat in a given circumstance.However, it canbe delayed,and, asindicated above,time to entrapmentcanbe critical. Resolving the dilemmas of entrapment MACINTYRE (1987) observedthat western liberalism,
the contemporyinternationalculture, hasinherited a collection of ethicalpremisses from its cultural pastthat are in conflict with one another within our own minds and betweenus, andthat there is no logicallv irrefutable wav of determiningthat one premissispreferable to another. This is distressing.in that there isno assurance of ethical certainty, but it 7sat the sametime reassuringaswe at leastknow where we are. The weighting to be given to particular premisses,when theseconflict in the making of a given decision,is decidedby the socialprocessof ethical argument between those who hold opposing
S1127 views. Hence the interminable nature of such argument. Hence also its immense importance, since only if there has been thorough discussion in society can an aid agency executive make decisions that cause the minimum stress between the conflicting premisses that are held by his or her own society, and those in which those decisions operate. The premisses that particularly concern entrapment are those of the interests of the present child, the present community, the future community, and its future children. It would hardly be possible to have any more disturbing dilemma for aid agency executives than a conflict between the interests of these groups-which is present only if a community is trapped. Hence the extreme stress it produces in them and their wish to see it repressed. The main problem of these executives seems to be the difficulty of making decisions in the presence of dilemmas involving these conflicting premisses. The only way to assist them is to ‘derepress the trap’, to remove the taboo on it, and thoroughly to air the dilemmas it produces, so that when decisions have to be made, they can be based on some consensus-preferably among those most involved. This means that the dilemmas have to be discussed bv the public. For this to happen they have to be reported by- the media. So far this has not been adeauatelv done bv the British media. It has been done much betier in Holland and Sweden. The awareness of entrapment: cies recognize it?
should
the UN agen-
Although it is argued that entrapment is already in progress,-the scale-on which it is presently obvious makesit iust oossiblefor the UN agenciesto maintain the illusion that it doesnot exist. Sometime during the next 10-15yearsthis will probably no longerbe possible. For example, reasonshave been given above for the thinking that India may be ascloseasthis to its Malthusianceiling. The Food and Agriculture Organizationand UNFPA are sufficiently unthreatenedto be able to discusscarrying capacity, and sometimeseven population projectionsin relation to it, but stopshort of considering what happenswhen the relationshipis unfavourableand adequatemigrationimpossible.Entrapmenthas,it seems, beenmentionedonly oncein the entire UN literature, by the World Health Organization (WHO, 1988).There is, however, reported to be much private discussionon entrapment by WHO staff. More than five thousandrequests were received for the issueof the ,journal Nu devoted to entrapment (HOFVANDER, 1991), many of them from international agencies.Interestingly, a long correspondencewith Carl Taylor, formerly chairmanof the Division of International Health at TohnsHoukins University, hasfailed to convincehim that it exist; Another of UNICEF'S advisors,William Foege, director of the Carter Center, is reluctant to discussit. Sincethere is an effective tabooon the discussionof entrapmentby the UN agencies,this is hardly surprising.Nor is it surprising that it was never mentioned at the United Nations Commission on Environmentand Development(UNCED) conferenceheld in 1992in Rio de Janeiro. There are good reasonswhy the UN agenciesshould discussentrapment. (i) There can be no escapefrom what happensto be the unhappy truth; only if the truth is recognizedcan anything be doneabout it. (ii) Denying entrapment deniescommunitiesand the world a critical stimulusfor effective action. (iii) Failure to decidethe dilemmasactively, merely decidesthem by default. (iv) Even the intelligentsiain a trapped community are unaware of its entrapment. (v) Recognizing entrapment would be a great stimulusto ordinary family planning, both by encouragingaid for family planning by the northern countries and promoting its uptake in the south. By definition, this would not disentrap the severely trapped, but it would at least amelioratetheir plight. For thosecountrieson the borderlineof entrapment more ordinary family planning might be all that
wasnecessary,sothat the importanceof recognizingentrapment is critical for this reason alone. (vi) There might be somecommunities, Indonesia for example, which would acceptone-child families. (vii) Hopefully, the realization that parts of the South were trapped would encouragelifestyle changesin the North. (viii) As a samplepanel from the developing world, a classof postgraduates in Leedswasaskedif they thought entrapment shouldbe recognized.They wereunanimousthat it shouldbe. UNICEF
It was apparent early that UNICEF was particularly threatenedby the discussionof entrapment. It wasalso apparent that there wasa subtle convention that it was not proper to criticize UNICEF in print. UNICEF, by insisting that entrapmentis meaningfulonly for the world asa whole (EDITORIAL, 1992, and Dr Poore’sreport to this meeting,pp. 29-31 of this supplement)and by expecting migration to solve any problemsthat there might be, deniesthe existenceof disconnectedness. If the arguments that entrapment exists are sustained, UNICEF deniesreality. The International
Planned Parenthood Federation
Halfdan Mahler, director of the International Planned ParenthoodFederation (IPPF), the co-ordinating body for all the world’s family planning organizations,wrote that, after consultationwith ‘a.Herculeanpanelof soothsayers’he hasdecidedto ‘opt out of all the traps’. The soothsayerswere presumably the international public healthestablishment,and it is significantthat theseconsultations,which were ‘Herculean’, were not madepublic, nor washis decisionofficially reported or ratified by the family planning associationsIPPF represents.It is mostunlikely that there would havebeenHerculeandiscussions about somethingwhich doesnot exist. Sinceone of the most convincing reasonsfor recognizing entrapment is the impetus it would give to ordinary family manning,and sincethis is the businessof IPPF, it is to be regretted that the world, and particularly’ IPPF’s member organizations, were not party to these discussion. Legitimate ‘double-think’
Are the dilemmasto be decidedby default becausethe ‘soothsayers’ opt out, and becausethe agencieschooseto deny the.existenceof entrapment?Or, are they to be resolvedby open discussion,and particularly by the communitiesmostinvolved? Unfortunately, the political tensionssurroundingentrapmentareat presentsogreatthat agencyexecutivesmust not be pressuredto recognizeentrapment. Yet, since there seemsto be no reasonable doubt that entrapmentexists, the rest of us have to recognizeit. We are therefore in for a period of legitimate ‘double-think’. Legitimatebecausewe have to recoanize it, and double-think becausewe have to accept tha?the agencies cannotyet recognizeit. Countries of the northern hemisphere
Meanwhile, mainly asthe result of early economicdevelopment, the birth rates of the high resource-consuming northern nations, and those countries of the south with successfuleconomies,have fallen to near or even below their death rates. They have not destroyedtheir ecosystems (at least partly at the expenseof helping in the destructionof other people’s),they have stayedclear of their Malthusian ceilings, and they have escapedthe demographictrap. Their challengeand their dilemmais the extent to which they are preparedto reducetheir resourceconsumptionand sharetheir resourceswith the trapped,especiallyin the form of ‘free’ foreign exchange. But the situationis worsethan this. There aregrounds for thinking that the industrial economywhich takesthe environmentfor granted,both asan infinite resourceand an infinite sink, is alsorelentlesslydestroying the inte-
S1128 grity of the family and the community and particularly the ‘contain& moral context of the communitv’ (DALY & COBB, 19807. One of its most evil demons is thkscientifically-directed advertisement-driven race for ever more unsustainable material standards of living. This is so powerful and persuasive as to be seemingly unstoppable. References Borlaug, N. E. (1992). Population: A Challenge to Contemporary Developmenr Strategies. New Delhi: Family Planning Foundation for India, section 17. Daly, H. E. & Cobb, J. B. (1990). For the Common Good. London: Greenprint, The Merlin Press. Editorial (1992).Pressure on the eco-seams. Lancet, 339, 12651267. Guardian (1990). The Guardian (London), 22-23 September 1990, p. 48. Higgins, G. M. et al. (1982). Potential Population Supporkg Capacities of Lands in the Developing World, the LRPF Project. Rome: Food and Agriculture Organization. Hofvander, Y., editor (1991). Nu-nutt om u-landshalsovard, 1 (10) (Uppsala University: International Child Health Unit). Khanna, J., Van Look, P. F. A. & Griffin, P. D. (1992). Reproductive Health: a Key to a Brighter Future. Geneva: World Health Organization. King, M. H. (1992). The demographic entrapment of mankind. In: The Demographic Trap, Strenseth, S. C. (editor). Oslo, Norway: Centre for Development and Environment,
University of Oslo. Lithell, U.-B., Rosling, H. & Hofvander, Y. (1992). Children’s deaths and population growth. Lancet, 339,377-378. Macintyre, A. (1987). After Virtue. London: Duckworth. Mahar, D. J. (1988). Population growth and human carrying capacity in sub-Saharan Africa. In: World Population Trends and their Impact on Economic Development, Salvatore, D. (editor). Westport, Connecticut: Greenwood Press. Morley, D. C. (1963). A medical service for children under five years of age in West Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene. 57, 79-88 & 392. Premi, M. K. (1991). Idia’s Population Heading Towards a Billion: an Analvsis of the 1991 Provi6onal Census Resula. New Delhi: DKpublishers, p. 80. Scheper-Hughes, N. (1991). Social indifference to child death. Lancet, 337,1144-1147. UN (1987). Family building by fate or design: a srudy of relationships between child survival and fertility. New York: United Nations Department of Economic and Social Affairs, mimeographed document no. STIESAISER.RI74. UN (1992). Administrative Committee on Coordination-Report of the Subcommittee on Nukion. New York: United Nations. [Draft version. J UNFPA (1991). State of World Population 1991. New York: United Nations Fund for Population Activities, p. 4. WHO (1988). From Alma-Ata to the Year 2000. Reflections at the Midpoint. Geneva: World Health Organization.
THE ROYAL SOCIETYCIFTROPICALMEDIC~NEAND
Demographic Maurice
King
Hwx~~(l993)
87, SUPPLEMENT
1,23-28
S1123
entrapment Academic Unit of Public Health Medicine,
University of Leeds, 20 Hyde Terrace, Leeds, LS2 9LN, UK
Abstract
Demographicentrapment is a situation in which a population exceedsthe carrying capacity of its own ecosystemand its ‘connectedness’to other ecosystems.It can be looked upon as a disorder of the demographictransition which presentsseriousethicalproblemsin that there areoccasionson which there is a conflict betweenthe interestsof the child and the community. Reasonsare given for the aid agencies’ recognizing the existence of entrapment, which presently they do not. Since there are at present considerableobstaclesto their doingthis, wemust accepta periodof ‘legitimatedouble-think’ meanwhile. Introduction
There is an increasingconsensus that the world hasultimately only 2 problems. One is that the industrial world is imperilling the climate of the entire globe. The other is that many communitiesin the developingworld are growing so fast that they are likely to exceedthe carrying capacity of their ecosystems.These problems arelinked and both are ecological.Entrapmentis largely taboo, in that when United Nations(UN) agenciescome to problemsof carrying capacity and sustainability,they quickly move to the next item on the agenda.My purposeis to remove that taboo, to exposethe ethical dilemmasthat it hides,to easethe tensionsthat resultfrom entrapment, and to encouragethe developmentof improved policies. A population is demographicallytrapped if it hasexceeded,or is projectedto exceed,the combinationof: (i) the carrying capacity of its own ecosystem,(ii) its ability to obtain the products, and particularly the food, producedby other ecosystems except asfood aid, and (iii) its ability to migrateto other ecosystems in a mannerwhich preserves(or improves)its standardof living (voluntary migration). Items (ii) and (iii) describethe links that a populationhaswith other ecosystems, and arecrucial, so they are discussedhere under the headingsof ‘connectedness’andits opposite,‘disconnectedness’. The end result of entrapmentis that peopledie wherethey are, migrate in misery to someurban slum (forced migration), or hopeto be supportedindefinitely by food aid. For the purposesof this paper an ecosystemis that supported by a particular area of land. Entrapment is thus a disorderof the carrying capacityof one’sown ecosystem,and of one’sconnectionto other People’s.The carrying capacity of an ecosystemis the maximumnumWHEN CARRYING CAPACITY IS EXCEEDED there are several passibilities
The
ber of a given speciesthat it can support indefinitely without causingenvironmentaldegradation.In the case of humanpopulations,2 important qualificationshave to be added:with a given technologyand consumptionpatterns. A population can, however, exceed the carrying capacityof its ecosystemtemporarily, but asit doessoit consumes its ecosystem’s biologicalresourcebase,sothat the carrying capacity of the ecosystemfalls even as the populationit supportsrises.Sincethis cannot go on for ever, there comesa time when the ecosystemcollapses, so that peopleeither die or migrate. The point at which they do this is their Malthusian ceiling, but they usually start migratingwell beforethey reachit. The scaleof this migration is already substantialin that the United Nations Fund for PopulationActivities (UNFPA, 1991)reports that half a billion (5x log) peopleare moving from their fragile and marginal lands to the cities. UNFPA (1991)alsoreports that governmentsarehaving increasing difficulty feedingthesecities. Connectedness Economic connectedness Economic connectedness
determines
the economic
links that the community supportedby a particular ecosystemhaswith other ecosystems.In practice, few communitiesare completelyisolated,andmostare connected with other ecosystemsand other communities to a greater or lesserdegree.The principal connections,or flowsin and out, are food, peoplemigrating (‘mouths to eat the food’), and the goodsand servicesthat are exchangedfor food and other products. The result of these connections is that most communitiesare ableto live off own and the product of more than oneecosystem-their other People’s.Thus Singaporeis not trapped even though it haslong exceededthe capacity of its tiny island, whereasNepal, havingalmostnothing to exchange, probablyis. Connectedness, or rather the lack of it-disconnectedness-is thus crucial to the considerationof entrapment. ‘Economicopenness’is one of connectedness.It is also closelyparallelby equity. Unfortunately for the measure-
world
TWO WORLDS All food 1s derived from the energy of
Fig. 1. Carrying capacity and connectedness. All food is ultimately derived from the sun’s energy. The energy arriving and the efficiency with which it can be converted into food sets a limit to carrying capacity. If the community of country A exceeds the carrying capacity of its ecosystem, it is dependent on its connectedness with the rest of the global ecosystem. The alternatives are for people to emigrate, or for goods and services to be exported in exchange for food from elsewhere in the world. If these fail the alternatives are indefinite food aid or death from starvation.
ecOnOmically -co”“ecfed” equitable
open
ecanomicall”
closed
-di*CO”“ectedll inequitable
Fig. 2. Two worlds. If the population of the perfectly connected, open and equitable world on the left were to exceed its carrying capacity, everyone would starve slowly, equally and simultaneously. In practice, in the world on the right, disconnectedness, economic closure and inequity ensure that some people will starve early and unequally.
S1124 ment of entrapment, there is no single unit of connectedness, as there is (persons per hectare) for carrying capacity. The flows of people and food, etc. have all to be estimated and projected separately. The complex nature of this connectedness, and the difficulty of measuring and predicting it, is sometimes used as an excuse for denying that entrapment exists. To take the extreme case, if the population of a perfectly connected, open and equitable world were to exceed its carrying capacity, everyone would starve slowly, equally and simultaneously. In practice, disconnectedness, economic closure and inequity ensure that some people will starve early and unequally. Migratory connectedness
In the definition of entrapmentgiven earlier, a population is not consideredtrapped until it is expectedto exceedor hasexceeded‘.. .its ability to migrate... in a manner which preserves(or improves)its standardof living’. Sahelianpeasantsmigrating to the hovels of Ouagadougou may have savedtheir lives, but they have not, alas, preservedtheir standardof living. Migration towardsa deteriorating culture and lifestyle will be referred to as forcedmigration. Although migration of both kinds is of increasingglobal importance,not in Africa, India or Chinais it practical to think about moving communitieson a sufficient scaleadequately to equilibrate the carrying capacity of one district with that of another. The political, cultural and other difficulties are too great. For example, although there is likely to be much migration, there is also likely to be much ‘non-migration’or fixednessof populations, which will prevent migration from adequatelyrelieving entrapment. kcttrorder
of the demographic
transition-the
time
All populationsenteredthe modernperiodwith a high birth rate anda deathrate which approximatelymatched it, and thus with a low and approximatelystablepopulanon. The death rate then fell, and sometimes,particularly in Africa, the birth rate alsorose,dueto a declinein breastfeeding, and weakeningof the taboo on sexualintercourseafter delivery. Since the birth rate was now
higher than the death rate, the population startedrising. If the community wasfortunate, asindeedhave beenall communitiesin the developedworld, the birth rate then fell until it approximatelymatchedthe death rate, sothat the populationstabilizedagain,but at a higher level, the whole processtaking about a hundred years. Such communitieshave successfullycompletedtheir demographic transitions.Many communitiesin the developingworld arenot beingsosuccessful. The first stageof this transition is stablein that, since its populationis stable,a community canremainin it indefinitely, without harm, and sois the last stage.Unfortunately, the middle stageis unstable,in that if a community staysin it too long becauseits birth rate doesnot fall? its population continuesto increaseto the point at which it may exceedthe carrying capacity of its ecosystem, and ultimately reach its Malthusian ceiling. This ceilinghasbeenshownin Fig. 3 asa zig-zag line to indicate variationsin agricultural output from year to year, with ‘good’yearsand ‘bad’ years. A population is likely to reachits Malthusian ceiling when it is already nearit, andencountersa bad year, or seriesof bad years. ‘A populationis demographicallytrapped if it hasexceeded,or is projectedto exceed,the.. . carryingcapacityof its own ecosystem.. .‘. Whether or not it doesexceedit dependsin part on the population’ssize.Sincethis is determined by births, deaths,and migration occurring over time, the time factor is crucialin determiningwhat hasalready happenedto the relationshipbetweena population andits ecosystem, andwhat isgoingto happento it. In default of adequateconnectedness,all populations are going to have to remain within the carrying capacity of their ecosystems.Since there are no extra-terrestrial connections,the world asa whole is going to have to do so too. Where breachesof carrying capacity cannot be compensated for by adequateconnectedness, birth rates areeither goingto have to fall, or deathrateswill rise. So far, birth rateshave come down enough, or connectednesshasbeenadequate,for there to have beenno recent rise in the death rate attributable to entrapment, apart from thosein the Saheland Ethiopia. In somecountries the birth rate has fallen with remarkablespeed.Thus, whereastotal fertility in the USA took 58 years to drop from 6.3 to 3.5, the samedecreasetook 15 yearsin Columbia, 8 in Thailand and only 7 in China (KHANNA et al., 1992).
It is, however, the failures that concern us here, not the successes. There are 78 million people in countries whosetotal fertility is over 7, and 708 million whereit is over 6. For thosecountrieswhich are projectedto exceed their carrying capacity, will fertility fall fast enoughfor themto remainwithin it? For thosecountrieswhich have alreadyexceededit? can fertility fall fast enoughfor them to return below it? Unfortunately, the demographic momentumof a young populationis sogreatthat a fall to replacementfertility will not return a severely trapped population to within the carrying capacity of its ecosystem. For suchpopulationsthe only alternativesare onechild or, theoretically, no-child families. Neglect of the time factor is one of the flaws in UNICEF’Sargument that by ‘saving young lives we alsoreduce the populationgrowth rate’ (GUARDIAN,1990)and by implication always do so, and do so immediately, sinceexceptionsand delay are never mentioned. There areat least2 questionshere. (i) Do interventionsto lower child mortality lower the birth rate? (ii) How quickly do they do this?If a community is not trapped, even a seriously delayedresponseis unimportant; if it is trapped, even moderatedelay is critical, sinceinterventions for child survival increasepopulationpressure,makeentrapFig.3.Threehuman populations. A, thepopulation remained withinits ment worse, and causethe disturbing conflict between carryingcapacity.B, thepopulation rose,but increased its carrying interestsof the child and the community that is decapacity asit didso,andremained withinit. C, thepopulation exceeded the scribedbelow. its carryingcapacity, andin doingSOdestroyed itsbiological support The UN Department of International and Economic system, SOthat thecarryingcapacity fell. Ultimately thepopulation Affairs, in an impartial UN statementof the position, is reached itsMalthusian ceilingandalsofell.TheMalthusian ceiling is shown asawavylinetoindicate goodyears andbad years. much moreguardedin respectof both thesequestions:it
s1125 states that ‘. ..improvements in child survival typically precede sustained fertility decline. This observation, however, cannot lead to the automatic conclusion that policy interventions to improve the health of children will be immediately [my italics] followed by a decline in the birth rate...’ (UN, 1987). By admitting that fertility decline may not be immediate, this statement admits of delay. In practice there are many communities which have seen a major fall in their child mortality with little or no change in their fertility rate, so that delay is open ended, in that the expected change in fertility has yet to occur. The extreme example is Oman, with a childhood mortality of 49 per thousand and a total fertility of 7.3. Jordan, Iran and Syria have a similar child mortality, and fertilities of 5.8, 5.0 and 6.5. Less extreme is UNICEF’S entire group of very high child mortality countries with a median child mortality of 189 (less than half its likely original value of about 500) and a total fertility of 6.6. For these countries, most of which are in sub-Saharan Africa, the critical question is: will fertility fall fast enough to escape entrapment?-assuming that they are not trapped already, which some of them may be. Which communities are trapped? There are 3 ways of determining the existence and severity of entrapment, and all have serious limitations. (i) By calculation. The necessary data include projections of population growth and migration of either kind, estimates of food produced locally and imported by trade (connectedness), the probability of technological breakthroughs in agriculture, and the effect of epidemic diseaseLparticul&ly the acquired immune deficiency syndrome (AIDS). In view of the difficulties inherent in the data, and particularly in making projections, calculation is difficult, but it is important none the less, because it appears to be the only way of determining the earlier stages of entrapment. (ii) By observing ecological degradation, either directly or through decreased productivity forcing people to emigrate. Ecological degradation (see above) is a late sign and indicates that carrying capacity has been exceeded. By the time it is severe, the community supported by that ecosystem has either migrated or died, or is fed by food imported from elsewhere. Although ecological degradation may be relatively easy to estimate, it is only one of the determinants of entrapment. Disconnectedness, the other, is much more difficult. (iii) From the opinions of external observers in the aid agencies. Interestingly, these are surprisingly consistent, although there is a natural reluctance for any given executive to name publicly any given country as being trapped. The countries commonly considered to be trapped are parts of the Indian subcontinent, Kenya and Nigeria. To these some would add Nepal, parts of China, eastern Indonesia, and the Philippines. India is sometimes considered more trapped than Bangladesh. Rwanda and Malawi are also sometimes mentioned. What these observers base their opinions on is not clear; it is presumably a combination of increasing population densities, progressive immiseration and pessimistic views of food supplies. Although none of them indicate the stage of entrapment, the fact that early entrapment can be determined only by calculation and projection makes it likely that they are recognizing its later stages. Whatever the difficulty of calculating entrapment, the extent of ecological deterioration, and the consistency of the opinions of experienced observers encourage the suspicion that entrapment is both real and massive. Entrapment of particular communities The Indian subcontinent Although entrapment appears to be severe in other parts of the region, only India will be considered here. India’s 843 million people appear to have all but exhausted the potential of its ‘first green revolution’, in that
the rate of increase of food production is now slowing down due to decreased fertilizer productivities and longterm mining of soil minerals (UN, 1992). There is grave cause for concern in that current nutritional levels are not adequate even at the present time, and yet India can expect almost another billion ( 109) people before its population is assumed to stabilize at 1.7 billion (1.7~ 109) in 2060 (PREMI, 1991). If India is to feed its expected population, and avoid a population crash, the following conditions must be met. (i) There must be a second generation green revolution involving multiple technological productivity breakthroughs in its non-irrigated monsoon-fed ‘dry’ coarse grain agriculture, which has not yet had a green revolt&on, and where ~water shortage is a major oroblem. (ii) These breakthrounhs must be disseminated widely, rabidly and efficiently.“(iii) They must be taken up by the villagers. (iv) There must be no serious snags. (v) They must eventually feed nearly another billion people. (vi) They must be implemented quickly enough. (vii) They must start becoming effective immediately. (viii) They must be sustainable. Concurrence of all these conditions seems unlikely. This gloomy prognosis is supported by BORLAUG (1992). the Nobel Laureate who develooed the rice strains that produced the first green revolution. In 1970 he warned that these had given India 30 years of grace. In 1990, with 10 years left to go, he said he saw no reason to change his mind. It is also reported that several nongovernmental organizations are expecting severe starvation in India and Africa in the 1990s. This would put India’s Malthusian ceiling at about a billion ( 109), which is its expected population in the year 2000. Its carrying capacity can only be guessed at, and is likely to be substantially less than this. The likely scenario for disaster is a bad year, or series of bad years, in India, some time in the next 10 years, accompanied by similar bad years in the North American grain belt which reduce world grain stocks, and thus the possibility of substantial food aid. Aftica Entrapment here follows a different pattern from that in India, since there is much less connectedness between its communities than there is in India. Parts of Ethiopia and the Sahel have already progressed through all the stages of entrapment, and have had their population crashes. People have either died or migrated. The most ambitious attempt ever made to measure carrvine canacitv was the FAOUNFPA nroiect ‘Land Resources for Populations of the Future’ -(LRPF; HIGGINS et al., 1982). This confirmed the general consensus that food supply is no problem globally, and argued persuasively that human carrying capacity had already been exceeded in parts of sub-Saharan Africa. Crop yields, per caput food output, environmental damage and breaches in-carrying capacity have already reached crisis proportions in the drier Darts of West Africa and the highlands of East Africa (M~HAR, 1988). Although there isno immediate overall problem with carrying capacity in Africa as a whole, even with low technology methods, disconnectedness places daunting obstacles in the way of making areas in potential surplus feed those in deficit. The need to improve carrying capacity by improving agricultural technology is acute in many areas. Global entrapment The limit on the global food production is the limit on what connectedness can do to diminish global entrapment. It is not proposed to discuss the vexed question of whether the world could feed a oonulation that will double and could triple, except to refer to the LRPF proiect above. and to auote the aeronomist Willem Beets who wrote”Yes the &anet can pyoduce 2 or 3 times more food, even under a medium level of technology. But the potential cannot be exploited on account of unsurmountable human, institutional and political constraints’. This
S1126 has the ring of truth since, unfortunately, it is a very human world. Two questionshaveto be askedaboutglobalfood supply. (i) How much food could the world produce if it were farmed ontimallv? The answerhere is reassurina. (ii) How much food i’; it actually going to produceand distribute, whennecessaryfree, given all the constraints, esoeciallv the human ones?This is the kev auestion which trappedcommunitiesmust askthemselves’, andto which the answeris not so hopeful. Planshave to be made,not on the basisof what ought to happen,but on what Drobablv will haDDen.The indefinite suDDortof large iopulatibns which-can no longer feed themselves, and have nothing to buy food with, seemslikely to be a major concernof the internationalcommunity in the not too distantfuture. Ethics The ecologicalconstraintson mankindtake no account of our ethics. This grim fact is behindmostof the ethical dilemmasthat ariseduring the processof entrapment. Thev concern both fertilitv (esDeciallvthoserelating to abortion and one-child familiesj and mortality, par&ularly child mortality, in that there is a conflict between the interestsof the presentchild andits community, and betweenthem and its future community (and its future children). Thesedilemmaschangeduring the processof entrapment.There is alsoa conflict betweenthe interests of the Dresentchild andthat child savedfor the moment. but only for malnutrition and an early death. Is the child’s life really worth savingif this is so soonto be its fate? This is the child vividly describedby SCHEPERHUGHES(1991). Not surprisingly, the dilemmas(apart from the particular ‘UNICEFdilemma’ mentioned in ‘Ethical stagetwo’,, below) are at their greatestwhen child mortality is high, either early or late in the process of entrapment. Most importantly, they exist at all for an aid agencyonly if it is assumed that ‘we’, the aid agency, do the deciding, and it is expected that what the aid agency does will have a significant effect in lowering child mortality. The alternative, which is to give great weight to the premissof local autonomy, and to let the local community make the decisions,is the position taken by the Savethe Children Fund and is described elsewhere(KING, 1992[seealsopp. 29-31 of this Supplement]).
Ethical stage two, low child mortality As LITHELL et al. (1992)correctly pointed out, by the
time child mortalitv hasfallento about 140Derthousand. the present Indian rate, depressingit further barely raisesthe population trajectory. Thus halving India’s child mortality would add only an equivalent-of about 11% of the DresentDoDulationto its DoDulationin 25 yearstime. At this stage;not doingeverything possibleto savechild life thereforehaslittle demographiceffect. Should,however, a populationbe in dangerof entrapment, there is anotherseriousdilemmain this stage,particularly for UNICEF. It is betweenthe opportunity costs of, say, trying to halve child mortality with technical ‘fixes’ for child survival, and an urgent programmeof ‘emergencydisentrapment’in a desperateattempt to avoid the next stage.This is partly a matter of priority in the allocationof resources,andpartly of priorities for the ‘UNICEF publicity machine,’which is far strongerin UNICEFthan in the other agencies.Otherwise the dilemma level in this stageis low. Ethical stage three, on the way up to the Malthusian
ceiling
As a population approachesits Malthusian ceiling, its death rate, particularly its child death rate, rises. The long-term trajectory-influencing factors of earlier stages no longeroperate,and introducing family planning, even one-childfamilies,is too late. Assuminga constantor decreasingfood supply, there is acute pressureon food, suchthat onemore (child) mouth to feedmeanslessfood for someoneelse.To the extent that child survival interventions are possibleat all, they increasethe dilemma. Once this stageis reached,it is arguablewhether withholding public health measuressuchasoral rehydration makesmuch difference, since food is likely to be the limiting factor. There is needfor studiesin specificcommunities.The length of this phaseis uncertain, but there areunhappyindicationsthat it may not alwaysbe short. Ethical stage four, the population crash
The community has now partly or completely destroyed the carrying capacityof its ecosystem,sothat its populationis crashingto a lower level. To the extent that it is possibleto prevent this crash, the dilemmabetween the interestsof the presentchild and the community is acute. Once a population is safely disentrapped,and is stableagainbelowthe carrying capacity of its ecosystem, this painful setof dilemmasends.
Ethical stage one, the early modern period
All communitiesentered the modern period with a child mortality rate which wassometimesashigh as500 per thousand,a commonlyquoted African figure (MORLEY, 1963).It washigh enoughfor a reduction, by whatever means,markedly to raise population trajectories. Complexandonly partly predictableand quantifiableinteractionsbetweenthe child deathrate and the birth rate start in this stageand continue into the next one, such that Preston (personalcommunication)wasable to say that ‘In my guesssizeablefertility declinein this stage and the next would have beensmallerwithout earlierdecline in child mortality’. As discussedearlier, the effect of mortality on fertility is not invariable and can be delaved bv severaldecades.This delav is unimDortantif a country’ is not trapped, but is seriousif it i’s. It would therefore have beenin the future demographicinterests of a community which subsequentlybecametrapped, though not, alas,of its then children, to have reducedits child mortality only just enoughto have triggereda fertility decline. No country remainswith a child mortality rate of 500, but someare sufficientlv near it for the dilemmaof this stageto remainin some-degree. Thus Malawi hasa child mortality of 253 and a total fertility of 7.6. Halving its child mortality would add the equivalent of 30% of its presentpopulation to its populationin 25 yearstime-a seriousincreasein population growth for a country in potential dangerof entrapment.
Does loweringthe child death rate lower the birth rate?
What, if it doesnot, or if it doesnot do it fast enough, are the ethical consequences in respect of the dilemma betweenthe interestsof the child and the community?If a community is not trapped there is no ethical consequence. If it is trapped, the directly population-raising effectsof lowering the child death rates(which are greatest when the death rate is high) have to competewith the indirectly population-loweringeffect of what a lowered child death rate might do to lower the birth rate, riven enoughtime. This effect is sodifficult to measure and predic; that it can only be guessedat in a given circumstance.However, it canbe delayed,and, asindicated above,time to entrapmentcanbe critical. Resolving the dilemmas of entrapment MACINTYRE (1987) observedthat western liberalism,
the contemporyinternationalculture, hasinherited a collection of ethicalpremisses from its cultural pastthat are in conflict with one another within our own minds and betweenus, andthat there is no logicallv irrefutable wav of determiningthat one premissispreferable to another. This is distressing.in that there isno assurance of ethical certainty, but it 7sat the sametime reassuringaswe at leastknow where we are. The weighting to be given to particular premisses,when theseconflict in the making of a given decision,is decidedby the socialprocessof ethical argument between those who hold opposing
S1127 views. Hence the interminable nature of such argument. Hence also its immense importance, since only if there has been thorough discussion in society can an aid agency executive make decisions that cause the minimum stress between the conflicting premisses that are held by his or her own society, and those in which those decisions operate. The premisses that particularly concern entrapment are those of the interests of the present child, the present community, the future community, and its future children. It would hardly be possible to have any more disturbing dilemma for aid agency executives than a conflict between the interests of these groups-which is present only if a community is trapped. Hence the extreme stress it produces in them and their wish to see it repressed. The main problem of these executives seems to be the difficulty of making decisions in the presence of dilemmas involving these conflicting premisses. The only way to assist them is to ‘derepress the trap’, to remove the taboo on it, and thoroughly to air the dilemmas it produces, so that when decisions have to be made, they can be based on some consensus-preferably among those most involved. This means that the dilemmas have to be discussed bv the public. For this to happen they have to be reported by- the media. So far this has not been adeauatelv done bv the British media. It has been done much betier in Holland and Sweden. The awareness of entrapment: cies recognize it?
should
the UN agen-
Although it is argued that entrapment is already in progress,-the scale-on which it is presently obvious makesit iust oossiblefor the UN agenciesto maintain the illusion that it doesnot exist. Sometime during the next 10-15yearsthis will probably no longerbe possible. For example, reasonshave been given above for the thinking that India may be ascloseasthis to its Malthusianceiling. The Food and Agriculture Organizationand UNFPA are sufficiently unthreatenedto be able to discusscarrying capacity, and sometimeseven population projectionsin relation to it, but stopshort of considering what happenswhen the relationshipis unfavourableand adequatemigrationimpossible.Entrapmenthas,it seems, beenmentionedonly oncein the entire UN literature, by the World Health Organization (WHO, 1988).There is, however, reported to be much private discussionon entrapment by WHO staff. More than five thousandrequests were received for the issueof the ,journal Nu devoted to entrapment (HOFVANDER, 1991), many of them from international agencies.Interestingly, a long correspondencewith Carl Taylor, formerly chairmanof the Division of International Health at TohnsHoukins University, hasfailed to convincehim that it exist; Another of UNICEF'S advisors,William Foege, director of the Carter Center, is reluctant to discussit. Sincethere is an effective tabooon the discussionof entrapmentby the UN agencies,this is hardly surprising.Nor is it surprising that it was never mentioned at the United Nations Commission on Environmentand Development(UNCED) conferenceheld in 1992in Rio de Janeiro. There are good reasonswhy the UN agenciesshould discussentrapment. (i) There can be no escapefrom what happensto be the unhappy truth; only if the truth is recognizedcan anything be doneabout it. (ii) Denying entrapment deniescommunitiesand the world a critical stimulusfor effective action. (iii) Failure to decidethe dilemmasactively, merely decidesthem by default. (iv) Even the intelligentsiain a trapped community are unaware of its entrapment. (v) Recognizing entrapment would be a great stimulusto ordinary family planning, both by encouragingaid for family planning by the northern countries and promoting its uptake in the south. By definition, this would not disentrap the severely trapped, but it would at least amelioratetheir plight. For thosecountrieson the borderlineof entrapment more ordinary family planning might be all that
wasnecessary,sothat the importanceof recognizingentrapment is critical for this reason alone. (vi) There might be somecommunities, Indonesia for example, which would acceptone-child families. (vii) Hopefully, the realization that parts of the South were trapped would encouragelifestyle changesin the North. (viii) As a samplepanel from the developing world, a classof postgraduates in Leedswasaskedif they thought entrapment shouldbe recognized.They wereunanimousthat it shouldbe. UNICEF
It was apparent early that UNICEF was particularly threatenedby the discussionof entrapment. It wasalso apparent that there wasa subtle convention that it was not proper to criticize UNICEF in print. UNICEF, by insisting that entrapmentis meaningfulonly for the world asa whole (EDITORIAL, 1992, and Dr Poore’sreport to this meeting,pp. 29-31 of this supplement)and by expecting migration to solve any problemsthat there might be, deniesthe existenceof disconnectedness. If the arguments that entrapment exists are sustained, UNICEF deniesreality. The International
Planned Parenthood Federation
Halfdan Mahler, director of the International Planned ParenthoodFederation (IPPF), the co-ordinating body for all the world’s family planning organizations,wrote that, after consultationwith ‘a.Herculeanpanelof soothsayers’he hasdecidedto ‘opt out of all the traps’. The soothsayerswere presumably the international public healthestablishment,and it is significantthat theseconsultations,which were ‘Herculean’, were not madepublic, nor washis decisionofficially reported or ratified by the family planning associationsIPPF represents.It is mostunlikely that there would havebeenHerculeandiscussions about somethingwhich doesnot exist. Sinceone of the most convincing reasonsfor recognizing entrapment is the impetus it would give to ordinary family manning,and sincethis is the businessof IPPF, it is to be regretted that the world, and particularly’ IPPF’s member organizations, were not party to these discussion. Legitimate ‘double-think’
Are the dilemmasto be decidedby default becausethe ‘soothsayers’ opt out, and becausethe agencieschooseto deny the.existenceof entrapment?Or, are they to be resolvedby open discussion,and particularly by the communitiesmostinvolved? Unfortunately, the political tensionssurroundingentrapmentareat presentsogreatthat agencyexecutivesmust not be pressuredto recognizeentrapment. Yet, since there seemsto be no reasonable doubt that entrapmentexists, the rest of us have to recognizeit. We are therefore in for a period of legitimate ‘double-think’. Legitimatebecausewe have to recoanize it, and double-think becausewe have to accept tha?the agencies cannotyet recognizeit. Countries of the northern hemisphere
Meanwhile, mainly asthe result of early economicdevelopment, the birth rates of the high resource-consuming northern nations, and those countries of the south with successfuleconomies,have fallen to near or even below their death rates. They have not destroyedtheir ecosystems (at least partly at the expenseof helping in the destructionof other people’s),they have stayedclear of their Malthusian ceilings, and they have escapedthe demographictrap. Their challengeand their dilemmais the extent to which they are preparedto reducetheir resourceconsumptionand sharetheir resourceswith the trapped,especiallyin the form of ‘free’ foreign exchange. But the situationis worsethan this. There aregrounds for thinking that the industrial economywhich takesthe environmentfor granted,both asan infinite resourceand an infinite sink, is alsorelentlesslydestroying the inte-
S1128 grity of the family and the community and particularly the ‘contain& moral context of the communitv’ (DALY & COBB, 19807. One of its most evil demons is thkscientifically-directed advertisement-driven race for ever more unsustainable material standards of living. This is so powerful and persuasive as to be seemingly unstoppable. References Borlaug, N. E. (1992). Population: A Challenge to Contemporary Developmenr Strategies. New Delhi: Family Planning Foundation for India, section 17. Daly, H. E. & Cobb, J. B. (1990). For the Common Good. London: Greenprint, The Merlin Press. Editorial (1992).Pressure on the eco-seams. Lancet, 339, 12651267. Guardian (1990). The Guardian (London), 22-23 September 1990, p. 48. Higgins, G. M. et al. (1982). Potential Population Supporkg Capacities of Lands in the Developing World, the LRPF Project. Rome: Food and Agriculture Organization. Hofvander, Y., editor (1991). Nu-nutt om u-landshalsovard, 1 (10) (Uppsala University: International Child Health Unit). Khanna, J., Van Look, P. F. A. & Griffin, P. D. (1992). Reproductive Health: a Key to a Brighter Future. Geneva: World Health Organization. King, M. H. (1992). The demographic entrapment of mankind. In: The Demographic Trap, Strenseth, S. C. (editor). Oslo, Norway: Centre for Development and Environment,
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