About Growth

No one as yet has tried to stick a label on the seventies, but it is certain that it will be a far cry from the "soaring sixties"; not so much because the opening year saw the economy in a state of stagnation, but because growth to many has become a dirty word. In the search for the root cause of the things that ail us, which are increasingly lumped under the giant umbrella-word "environment," anything that increases is suspect; proof is required to remove the presumption of guilt.

Prominent suspects are population and the economy. Zero population growth (ZPG) has been joined by zero economic growth (ZEG), though the latter has as yet failed to assume the proportions of a movement. While ZPG has edged its way into the language one would have trouble using ZEG without an explanatory footnote.

Nor do the differences stop there. During 1970 the ZPG movement became more sophisticated, demonstrated its capacity to assimilate the facts of life, and encountered no serious opposition, in the sense that cessation of population growth is generally considered to be not only a desirable but an inevitable condition for mankind's survival. There is no such agreement on economic growth, even in the long run.

Omitting the effects of migration, there are two ways to bring about ZPG: by raising mortality or by lowering fertility. In 1969 the U.S. crude death rate was 9.5 by 1,000, and the crude birth rate 17.7. Therefore, one would have almost double the death rate or almost halve the birth rate to get zero growth. The first is unthinkable on ethical grounds alone. It is true that the size of a nation's health budget is flexible, so that the death rate is not nearly as immune from public policy decisions as one might think; but that is a far cry from setting as a policy target a rise in the death rate. This leaves the birth rate as the factor to be manipulated—a point that is as obvious to the ZPG movement as to everyone else. Where differences crop up are (a) evaluation of changes in the rate and the effect on number 0 births, (b) how well along we might already be on the road, and (c) what means of getting there are effective and acceptable.

A piece of research published in late 1968 but receiving widespread attention only last year has helped give perspective to the first of the three problem areas. In the November 1968 issue of Population Studies Tomas Frejka showed three important things:

First, to stop population growth now, births would, on the average, have to be held to 1.2 children for the entire span of women's childbearing period. The violence of that proposition can be measured against statistics of actual fertility. As of 1965, the latest age cohort of women that had statistically reached the end of childbearing—i.e., women born in 1919-20—had given birth to 2,777 children per 1,000. Of those who had not yet completed childbearing, the latest cohort to reach age 40 had given birth to 2,937 children per 1,000 and even those who had just reached age 25 by 1965 (and thus had not yet reached the median age of birth giving which lies just below 28 years) had already had 1,629 children per 1,000. Obviously, the target of 1,200 per 1,000 is unrealistic.

Second, what are the implications of an immediate transition to a completed fertility rate of 2,110 children per 1,000 women, the rate calculated to result in an exact replication of the number of women in the childbearing age groups? Given the heavy weight of these age groups in the U.S. population now and for some time to come, the population would continue to grow for another 70 years and end up nearly 40 percent larger than it is now. Even the less drastic assumption appears unrealistic; in recognition of this, ZPG's original slogan "Stop at two" has been extended by the words "One will do"—a tribute to realism concerning what is needed if not on what can be expected.

Third, what would happen under the further-relaxed but still-demanding assumption that, while women who have already entered childbearing age will complete the historic pattern of more nearly three children, those entering from now on would stop at two? The total population to be expected in the United States at specified future dates then would rise to a realistic minimum of some 260 million by the end of the century and a final stationary one of about 300 million by mid-21st century.

Calculations such as these are useful in disclosing the preconditions for a variety of outcomes. They help measure the distance to whatever goal is found desirable. Thus it is important to note that fertility rates among younger women have indeed been falling: 1,000 women born in 1939-40 had by 1959-60 accumulated 487 births, the highest for the 20-year age group in at least the preceding 40 years; but the same rate for women born 1944-45 had (by 1964-65) dropped to 399, and it continued to decline for the women born still more recently. A similar phenomenon holds true for older women. Only those aged at least 35 by 1965 continued to show increases in total fertility over comparably aged women in earlier years.

Whether the drastic reduction in the number of children born so far to the youngest of the country's mothers reflects merely postponement or is the result of a more profound change in reproductive behavior is a question whose answer holds the key to the size of the U.S. population in the next 25 years.

Recent research by demographers Bumpass and Westoff suggests that the number of children wanted is substantially smaller than the number actually produced. The provision of family planning services and facilities as a means of sustaining and accelerating these trends has received great emphasis, most recently in the passage of the Family Planning Services and Population Research Act of 1970.

The new act marks a turn in federal strategy from research to action or at least support of action. It provides nearly $400 million over the next three years in support of establishing or extending family planning services, research, manpower training, and information. At present there are no family planning services in well over half the counties in the United States; in over 80 percent of the counties that did have such services (in hospitals or elsewhere) fewer than 100 patients were served per year; and 90 percent of the country's nonprofit, general-care hospitals—typically the ones accessible to low-income mothers—do not have a family planning program.

The act is written to remedy this situation, as well as to stimulate research on reproductive biology, contraception, etc. In organizational terms, its principal contribution is the establishment of an Office of Population Affairs in HEW, directly under the Deputy Assistant Secretary for Population Affairs (who assumed his duties in May 1970). This has occasioned some unhappiness because the freezing of organizational lines in an Act of Congress is not necessarily helpful.

One can look to the new office to promote consolidation of the many units now scattered throughout HEW, a condition illustrated by the fact that the $106 million requested in fiscal year 1971 for the department's population and family planning activities was split among six major arms of the department and within these among some 18 centers, services, and programs. The National Center for Family Planning Services, established in October 1969, presumably will be a prime beneficiary of the 1970 act, reportedly with a good chance of being adequately staffed even in a period of squeezed budgets. The Maternal and Child Health Service, also part of the Health Services and Mental Health Administration and operating largely through grants for assistance to clinics and infant care projects, probably will have a relatively declining role in family planning. The Center for Population Research, established in August 1968 as part of the National Institutes of Child Health and Human Development, is another likely recipient of added funds.

Even though he is armed with full authority to speak and act for both the Assistant Secretary for Health and Scientific Affairs and the Surgeon General, is supported by a formal public advisory committee, and is to be strengthened by two special assistants, the new Deputy Assistant Secretary for Population Affairs faces a formidable task in launching this program whose budget has just about quintupled in the last four years.

Even the question of how success will be measured is not simple. Indeed, it seems tied to the number of women who want family planning services but cannot now get them, estimated at around 5.5 million. Derived, with some adjustments, from the number of women of childbearing age estimated to be in income classes defined as below the poverty line, this figure has over the past three years given rise to a lively debate among students of population growth. Some contend that the estimate greatly exaggerates the number who both need and want family planning services and thus leads to overemphasis on the latter as a path to reduced population growth. Passage of the 1970 act thus has given the previously scholarly controversy some very practical implications. Since the legislation was heavily inspired by the "birth control gap" (or, given its aversion to abortion, more accurately the "conception control gap"), success may come to be defined in terms of the number of women availing themselves of newly established or expanded services. Reaching anything short of 5 million or so might then be considered less than success.

This would be lamentable; not only because the estimate of 5 million women may be too high, but also because there may be large-scale shifting about of women who have in fact not lacked access but who, for a variety of reasons, are changing the dispensing agency. Finally, truly successful family planning can be expected to produce women no longer in need of continued service. These "graduates" are often counted as "defectors," while in fact they might be the truest testimonial to success.

One would hope that any numbers game could be avoided. The services now being launched are moving in a desirable direction, and support an existing trend. Whether there are 5 or 3 million women that are in need of them is less interesting than beginning to narrow an enormous gap in services.

Between the recently observed trend toward lower fertility among young women, the increased availability of contraceptive devices, and support for more research, the emergence of ZPG in the earlier rather than the latter part of the 21st century becomes a feasible goal. If in addition more states should abandon their antiabortion laws, one would move from conception control to birth control. This would provide a true measure of people's desire to limit births. The prospects on that score are still uncertain and the state-by-state picture is mixed, but a number of events in 1970 have opened up the subject not only to frank discussion but to action.

As of the beginning of 1970, ten states had liberalized their abortion laws in conformity with the Model Penal Code of the American Law Institute, permitting abortion in specified circumstances—to protect the mother's life, physical or mental health; to terminate pregnancies resulting from rape or incest; and upon indication of grave mental or physical defects in the child. Two other states—South Carolina and Virginia—adopted the same principles during the year. But New York, Alaska, Hawaii, and Washington have gone beyond reform to repeal of antiabortion laws. New legislation makes abortion a matter to be decided between the expecting woman and her physician. However, conditions under which abortion may take place vary widely among these states regarding stage of pregnancy beyond which it is prohibited, residency requirements, need to perform it in a licensed hospital or clinic, and consent of persons other than the pregnant woman.

On the other side of the ledger, seven state legislatures in 1970 failed to approve liberalized abortion laws; one (Maryland) passed the most liberal law of all, having no residency requirement and allowing abortion at any time during the residency; it was vetoed by the Governor. In four other states legislation repealing restrictive legislation was pending. A bill put into the congressional hopper by Senator Packwood that would free abortion from all restrictions had no chance of passage, with both legislators and the Administration content to let the subject be handled by the states. Indeed, the clause inserted by the House into the 1970 Act and agreed to by the Senate, under which funds cannot be ". . . used in programs where abortion is a method of family planning," clearly reveals at least the procedural preferences of legislators.

Passage of legislation, however, is in any event only the first step. "Abortion on demand," a popular slogan, neglects the matter of supply. Willing hospitals, clinics, doctors, nurses, etc. must be at hand if the demand is to be met under medically satisfactory conditions and on time. This is far from an accomplished fact, for instance, in all portions of the principal test state, New York. Since presumably no court of law can force a physician to perform an operation he is unwilling to carry out, one would guess that, as in any other area in which the laws permit actions but appropriate facilities are lacking, the remedy lies in local pressure for action. "Waiting lists" are surely not the answer; for not only does the threat to the mother's health rise as pregnancy advances, but the cutoff stipulated in most laws eventually cancels her eligibility. Court actions originating in nine states are pending which will test the constitutionality of restrictive abortion laws. Some have been filed by interested individuals or organizations. Others have arisen from abortions performed with the express intent to test the law in the hope that the litigation will reach the Supreme Court. At least one of them is scheduled to come before the Supreme Court early in 1971. A decision finding such laws unconstitutional would greatly accelerate what is otherwise likely to remain piecemeal revision. In the present atmosphere, a contrary decision probably would do no more than retard the movement that has begun on both coasts.

Thus, either suddenly, by a decision of the Supreme Court, or more slowly, by state legislation, legal abortion almost certainly will join contraception to provide parents with a complete arsenal of birth control measures. The much harder question might then arise: should the nation move from the kind of birth control in which the decision remains with the individual to a societal control, by which the government attempts to bring the number of children wanted by parents in line with the number deemed desirable for the well-being of society as a whole. It is a question we may not have to face if the 1970 Act works well through research, education, and services designed to make its own growth and size an important business of the nation.

Zero economic growth is as yet a far hazier topic than ZPG, although its rationale is easy to fathom: if we only produced less of everything or most things, would have less to handle, dispose of, worry over, and we could presumably turn more of our attention to nobler and more pressing pursuits than acquisition of possessions. Assuming, for the sake of argument, that a reduction in the volume of goods and services (GNP) is in fact a better route in the pursuit of happiness than is improved management of our production—distribution—consumption—disposal cycle, we are still faced with some unanswered questions.

(1) Since GNP is a product of man-hours and productivity, it can be reduced by cutting down one or the other. A deliberate reduction in Productivity, i.e., the attempt to accomplish the same things with greater effort appears a sufficiently perverse goal for society to be ruled out. A reduction in man-hours is quite possible, but hard to enforce on anyone who is not prepared to trade added income for leisure.

(2) A halt or reduction in the output of goods and services for society as a whole would bear most heavily upon the less affluent, unless accompanied by a major effort at income redistribution.

(3) While GNP reflects changes only in those goods and services that have a market price, we are not forever limited in considering society's output or growth solely in those terms. Once we have constructed appropriate measurements, it is quite possible for conventionally defined GNP to remain constant or even decline, while other "income" to society, derived from a better environment for example, grows. This raises a great many conceptual and technical problems, but failure to solve them—they have indeed been barely tackled—need not obscure the simple fact that a nation's production or income need not be defined by marketed goods and services to the exclusion of other items that society both desires and enjoys.

In short, to conclude now that growth of real GNP should cease is unwarranted in view of the present symptoms about which we complain and the remedies that probably are within our reach for dealing with them. At some time in the future, the problem of disposing of residuals and the problem of certain types of congestion may indeed become more and more pressing. As we proceed to deal with these difficulties, the effects of the measures taken will require a slower growth, and perhaps a reduction, in the production of those goods and services causing the trouble.

Suppose, however, that over time a series of corrective measures resulted in an economy in which quantity of residuals to be disposed of did not grow and measures were taken to stop all further increase of the various types of congestion. Then productivity increases of various types could permit a larger output of goods and services within the restriction of no increase in the total of residuals.

When and if we reach this stage, there will be an increased emphasis on the distribution of income, since one of the present avenues for improvement of the welfare of the poor will be restricted to a considerable extent. Along with greater emphasis on distribution will no doubt come a reexamination of what constitutes a satisfying life. We may find that we can do nicely without an increase in material goods great enough to aggravate the problem of disposing of residuals.