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Henry Phipps

Development, Population Growth and the Mortality-Fertility Link

Many people express the concern that population growth is a barrier to development

 . Different mechanisms have been postulated as to how population growth could impede development. For instance, when parents have large families they may be less able to invest in their children, whether this be by providing them adequate nutrition, healthcare or schooling. [1] [2] [3]The effects of this lack of investment are thought to undermine development.

Sometimes these concerns are raised regarding charities that save lives through medical interventions, with some claiming that money would be better spent limiting population growth. What’s more, if limiting population growth is an objective for development, then saving lives might at first glance seem to run counter to this goal.

One popular response is to argue that saving lives does nothing to increase population growth and in fact actually decreases population growth

 . The Gates Foundation and Gap Minder have both claimed that reducing mortality causes the fertility of the population (the number of children per woman) to decrease. The long-term effect of this is will be to reduce population growth. [4][5]

There are biological reasons for supposing high levels of mortality will not constitute a barrier to population growth. The death of an infant will lead to a cessation of breastfeeding meaning that the mother is able to fall pregnant again sooner than if the child had survived. [6]Further, if a large family size is desired for cultural or economic reasons, parents may take into account high levels of mortality by having more children in order to ensure that they reach their desired family size. [7]

Reducing mortality may actually decrease population growth. We might think that parents choose to have large numbers of children because they rely on at least some of their children surviving to provide for them in old age and carry on the family lineage. If mortality is high then parents will choose to have more children to try to increase the odds that at least some of them reach adulthood. However, if mortality is lowered, parents will have more confidence that their children will reach adulthood. Therefore they will have less of an incentive to conceive more children. [8]

If the above arguments are sound, then we have a strong response to concerns about population growth. By saving lives we also reduce population growth. But is this always the case?

In this report I look at the link between mortality reduction and population growth. I find that 

we should not be confident that reducing mortality will always reduce population growth

Methods other than reducing mortality seem more effective in reducing population growth.

A Strong Correlation Between Mortality and Decreased Fertility

Since 1950 we have seen extremely strong correlations between reductions in mortality and reductions in fertility. [9] [10]A recent review states that:

“A ‘folk regression’ of the fertility trend on the mortality trend would conclude that saving one life prevents two births.” [11]

no country has ever experienced a fall in fertility without first experiencing a fall in mortality

 . Contrary to popular belief, it does not look like we are heading towards an ever increasing population. Across most of the world, we have seen dramatic reductions in fertility accompanying drops in mortality. In Europe and North America the number of children per family has fallen to between 2 and 3 children, which keeps the population at its current size. In Latin America and Asia, we have also seen rapid convergence to lower fertility rates, with many countries that were once characterised by large families now near the fertility rates of the richest countries. [12]

If family size remained at around 2 children we would see dramatic population growth over the next few decades due to decreased mortality, but ultimately by 2100 the population size would stabilise. [13]

But correlation does not mean causation. 

The drop in mortality since 1950 took place alongside many other developments such as economic growth, increasing levels of education, female empowerment, and provision and acceptance of family planning services.

 Although we might expect all of these trends to lead to decreased fertility, identifying the relative effect of each of these factors is extremely difficult. [14]

For one, it is plausible that there are complex causal relationships between each of these factors. Maybe a combination of increased education and decreasing mortality is needed to see any significant impact on fertility. Also, the desire to limit family size might struggle to translate into drastically lower fertility without widely available modern methods of contraception.

That reductions in mortality are not always the best way to reduce population growth can be seen by comparing the fertility rates of different countries. Both Bangladesh and Niger have traditionally had large family sizes. Bangladesh has now reached a fertility rate of 2.4 children per women whereas Niger has a fertility rate of over 7 children per woman. It does not look like a high level of mortality is the main issue preventing Niger from reaching lower levels of fertility. In Bangladesh child mortality fell at a steady rate from 198.4 out of 1000 in 1980, to 143.7 out of 1000 in 1990. During this time total fertility dropped from 6.4 children per woman to 4.6 children per woman. Contrast this with recent developments in Niger: over a ten year period between 1998 and 2008, Niger experienced an even more dramatic fall in child mortality than was seen in Bangladesh, from 245.2 per 1000 to 141.4 per 1000, yet total fertility only fell from 7.8 to 7.6. [15]

To cite another example, Ethiopia and Uganda have similar levels of child mortality. In 2010, under 5 mortality was 75.6 per thousand in Ethiopia and 78.4 per thousand in Uganda. Both countries had seen large drops in child mortality since 1990 when under 5 mortality stood at 205 per thousand in Ethiopia and 178.7 in Uganda. Yet total fertility in Ethiopia presently stands at 4.8 children per woman as opposed to 6.2 children per woman in Uganda. It doesn’t look like it is high levels of mortality that are preventing Uganda from reaching Ethiopian levels of fertility. [16]

A recent review of the literature relating mortality to decreased fertility and population growth by David Roodman came to the following conclusion:

I think the best interpretation of the available evidence is that the impact of life-saving interventions on fertility and population growth varies by context, above all with total fertility, and is rarely greater than 1:1 [rarely enough for the fertility decline to exceed the mortality decline in terms of effect on population size]. In places where lifetime births/woman has converging to 2 or lower, family size is largely a conscious choice, made with an ideal family size in mind, and achieved in part by access to modern contraception. In those contexts, saving one child’s life should lead parents to avert a birth they would otherwise have. The impact of mortality drops on fertility will be nearly 1:1, so population growth will hardly change.

we should be wary of supposing that further decreases in mortality in high fertility countries will lead to decreased population growth

 . Indeed, as the above extract claims, in some contexts decreasing mortality may be increasing population growth as the impact of declining fertility on population growth may be less than the contribution of more people living long enough to start families of their own. The above review claims that in certain countries, such as Niger and Mali, for every six children that do not die in infancy, only 3 or 2 fewer children will be born. Here, saving lives can be expected to increase population in the short-term. [18]

Nonetheless, it is important to remember that the causal pathways relating mortality to population growth are complex and difficult to assess. In some contexts high levels of mortality might well have been the chief barrier to decreasing fertility. Additionally, although the effect of mortality decreases on fertility might be weak in isolation, it might be that in some contexts decreasing mortality alongside other interventions may be necessary to reduce fertility and limit population growth. This belief is evidenced in another review of the literature:

“If a consensus emerges at all from the wealth of past studies on mortality and fertility declines, it would be that while a direct, independent effect of mortality change on fertility change is often found to be weak, ‘child survival and family planning programs play important complementary roles’.” [19]



It seems fair to say that 

we cannot assume that decreasing mortality is an effective means of reducing population growth. The impact of reduced mortality on population growth will depend on the specific context in which the reduction takes place

Those who are concerned with the effects of population growth on development should predominantly be concerned about Sub-Saharan Africa. Whereas other regions of the world have converged on or are about to converge on average fertility rate of just over two children per family, fertility declines in Sub-Saharan Africa have lagged behind the rest of the world. [20]This lag in declining fertility rates is projected to lead to high levels of population growth in Sub-Saharan Africa. [21]

A particular extreme example is that of Niger, where the population has tripled since the 1970s and is expected to triple again before 2030. [22] Fertility declines have begun later and been slower in Sub-Saharan Africa than in other regions. [23]In part this might be due to the fact that declines in mortality took place later than in other regions. But it appears that there are other factors which are preventing a more rapid decline in fertility.

Some of these are regional-specific factors that lead to a desire for large families, including religious beliefs, marriage practices and communal land ownership. [24]However, many of these factors - such as low levels of female education and a lack of governmental enthusiasm for family planning - have been faced in other areas. [25]

The success of some African countries in dramatically lowering fertility has been attributed to the provision of family planning programmes. This is the case in Ethiopia [26], Kenya [27(which reached a fertility rate of 4.6 in 2010), and Rwanda [29], which has seen a particularly dramatic decline in fertility from 6.1 in 2005 to 4.6 in 2010.

We have good reason to suppose that decreasing child mortality in Sub-Saharan Africa will lead to decreases in fertility. But we also have good reason to think that in many instances falls in mortality may in fact lead to population growth in the short term, as the decrease in fertility may be outweighed by the increasing number of people who survive to have families of their own.

Comparing countries in Sub-Saharan Africa to one another as well as to countries from other regions indicates that factors other than the level of mortality are the major impediment to decreasing fertility and population growth. We have good reason to believe the conclusion of a recent UN report that suggests that 

the most effective means to achieve decreases in fertility and population growth in Sub-Saharan Africa would be to invest in family planning services and female education.

Mortality, Population Growth and Aid: Some Conclusions

Decreasing mortality may have an important role to play in moving to a low fertility society. Nevertheless, we cannot assume that reducing mortality in a particular instance will lead to decreases in fertility that are significant enough to outweigh the direct contribution to population growth caused by reduced mortality.

the major barrier to decreasing fertility and population growth in Sub-Saharan Africa today is not high mortality but factors such as the low levels of female education and lack of family planning programmes

 . If reducing population growth is of overriding concern, it seems that the most effective means to do this would be to attempt to implement the above programmes rather than trying to further reduce mortality.

reducing population growth is but one concern amongst many when deciding which interventions to support in low income countries

 . Just how damaging population growth is for development is unclear and there is dispute as to whether it is particularly damaging at all. Even if population growth does significantly impede development, 

it is still plausible that donating to charities that directly save lives and reduce morbidity confers more valuable benefit than donating to charities that try to reduce population growth.

Finally and most importantly, the historical record shows us that 

we are able to massively reduce fertility and thus (in the long-term) population growth whilst also dramatically reducing mortality

 . Additionally, over the long-term it is plausible that these processes are mutually supporting. Concerns about population growth at worst may give reason to move marginal dollars from health interventions to interventions supporting other causes such as family planning, but they certainly do not give any reason to abandon the process of attempting to reduce mortality and morbidity in low income countries.

[1]Health and Economic Growth, Wile pp. 656-657 

http://www.sciencedirect.com/science/article/pii/B9780444535405000033#





[2]When Does Improving Health Raise GDP?, Ashref et al p. 8





http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860117/





[3]Copenhagen Consensus 2012 Challenge Paper on Population Growth, Kohler p.50



[4]Gates Foundation Annual Letter 2014





http://www.gatesfoundation.org/Who-We-Are/Resources-and-Media/Annual-Letters-List/Annual-Letter-2014





[5]Will saving poor children lead to overpopulation?





https://www.youtube.com/watch?v=BkSO9pOVpRM





[6]Mortality Decline and the Demographic Response: Toward a New Agenda, Montgomery pp 5-6.





http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.175.9555&rep=rep1&type=pdf





[7]Ibid



[8]Will saving poor children lead to overpopulation?





http://blog.givewell.org/2008/08/03/infant-mortality-and-overpopulation/





[10]Macroeconomics and Health: Investing in Health for Economic Development, Sachs pp. 35-38.



[11] 

http://davidroodman.com/blog/2014/04/16/the-mortality-fertility-link/

https://www.youtube.com/watch?v=FACK2knC08E





[18]Ibid



[19]Demographic pressure, economic development, and social engineering: An assessment of fertility declines in the second half of the twentieth century. Heuveline p.389.



[20]How Exceptional is the Pattern of Fertility Decline in Sub-Saharan Africa? Bongaarts pp. 1-4.



[21]Don’t Panic









[23]How Exceptional is the Pattern of Fertility Decline in Sub-Saharan Africa? Bongaarts pp. 1-4.



[24]Ibid pp. 1-2.



[25]Ibid.



[26]Ibid p.11



[27] 





[28]The Effects of Improved Survival on Fertility: A Reassessment, Cleland pp. 84-85





http://www.jstor.org/stable/3115250?loginSuccess=true&seq=1#page_scan_tab_contents





[29]How Exceptional is the Pattern of Fertility Decline in Sub-Saharan Africa? Bongaarts p.11

Mark Barnes

Smart Legacy Giving

I have recently taken the Giving What We Can 

 and in doing so I have been looking into efficient ways of donating money to charity. Giving What We Can have a very helpful page on their website detailing the 

 of charitable giving. However, I recently had cause to change my Will and in doing so I found a very tax-efficient way to give. The effect is that 

some UK taxpayers can quadruple their donation to charitable causes, through Will giving, at no cost to themselves.

Here’s how it works. Usually an estate pays inheritance tax of 40% on the ‘net value’ of the estate. The ‘net value’ is the value of the estate after deducting for debts, liabilities, reliefs, exemptions (e.g. anything left to spouses) and anything below the inheritance tax threshold (which the government has just raised). However the UK government incentivizes individuals to give in their Wills. If 10% of the ‘net value’ of the estate is left to charity then the estate only pays 36% inheritance tax. Thus for example if the ‘net value’ of the estate is £100k then usually £40k is paid in tax and £60k can be bequeathed to beneficiaries. However, if the Will states that £10k should be given to charity then the remaining estate is taxed at 36%, which results in £32.4k being paid in tax and £57.6k going to beneficiaries. Hence by reducing the benefit to one of your beneficiaries by £2.4k, you can give £10k to effective charities. Thus, if you qualify for inheritance tax, you can effectively quadruple your effective giving by changing your Will to donate 10% to charitable causes.

| Net Value of Estate | £100k | £100k | | Left to Charities | £0 | £10k | | Inheritance Tax Rate | 40% | 36% | | Inheritance Tax Paid | £40k | £32.4k | | Left to Beneficiaries | £60k | £57.6k |

There is however a caveat to this. By giving £10k to charity you are also reducing government receipts by £7.6k and so you must make sure that you are doing more good than the government would otherwise be doing with those receipts. I suspect that Giving What We Can members should be able to convince themselves that by giving to recommended charities, which can save a life for around £2.5k, they are in fact satisfying that requirement.

Finally, it may well be the case that many of you do not have estates that would attract inheritance tax. Only about 3 to 5% of estates do. However, even if you would not qualify for inheritance tax, it may be the case that your parents would. If they intend to leave money to you, and you intend to leave that money to effective charities, it would be significantly more effective if they left it directly to the charities on your behalf. Thus instead of receiving £2.4k as a beneficiary of the Will, you would be donating £10k to effective charities and therefore quadrupling the good you could do. It may be a difficult conversation to have with your parents, but it could also be very beneficial. I have changed my Will accordingly and intend to have that conversation with my own parents shortly.

Larissa Hesketh-Rowe

EA Global Oxford: Figure out the most good you can do and then do it

Last weekend I attended the Effective Altruism Global conference in Oxford. This was the third in a series that saw events in Melbourne and at the Googleplex in California. These events were the biggest in Effective Altruism’s short history.

Even a week later my mind is still buzzing with all of the fascinating things I learnt, my inbox and Facebook feed are going crazy with messages from the great people I met and I’m trying to keep up with all the exciting projects I could make a difference in.

This means I could probably write at least another ten blog posts based around things I got out of the conference. But today I want to share with you a simple yet powerful message. If you care about helping others and making a positive impact in the world then what you need to do is quite straightforward.

All photos by Lauryn Vaughan of [Not Purple. Creative](https://www.facebook.com/notpurple23)

Michelle Hutchinson, the Executive Director of Giving What We Can, provided the perfect opening to the conference by summarising the simple assumptions that bring us all together.

And when we say help people we mean anyone and everyone.

This means we expand the circle of people and issues we care about until we realise that everyone, all around the world has similar hopes and fears.

Michelle shared a personal story. I will do the same.

I’ve had a lot of experiences with cancer in my family. We’re very fortunate that my mum survived breast cancer, although it was hardly easy and I’m not sure I was much help being a sullen teenager at the time. My dad has had a scare and my grandad died of cancer a few years ago. So I have taken part in several fundraisers to beat cancer; night walks around London, my first 5k, bake sales and many more.

What I eventually came to realise however is that it’s not the cancer in of itself that is the evil here, it’s the suffering and loss. Strokes can cause heartache and pain. So can malaria. So can starvation.

I don’t want the people I care about to suffer any of these.

I would only wish to swap one condition for another in any of my loved ones if I thought it would bring them less pain and keep us together longer. So now I try to just tackle as much suffering I can. I raise to beat suffering and loss in whatever form.

Having had this realisation it didn’t take me long to realise if I cared this much about my mum, other people probably care just as much for their mothers. And for their fathers, brothers, sisters, grandparents, children and friends. People everywhere, from the north of the UK suffering from leukemia to in a village in Malawi fighting against malaria. They all care and feel this pain just like I do. So I want to help them, whoever or wherever they are.

For many people, myself included, this also extends to animals. Many studies have shown 

 and even without that we can certainly see that 

 much as newborn babies can, so we should worry about their suffering too. One thing that I was impressed by at the conference was that there was such an emphasis on vegetarian and vegan food because so many people there cared about animal welfare. Never before have I been to a conference where the organisers felt the need to put a note to say they were sorry that the biscuits were not vegan – and I’m an event coordinator, I go to a lot of conferences!

It was lovely to be at an event where everyone wanted to help as many people and animals as they could, as much as they could.

Using reason, conducting research and analysing statistics.

The more we understand what causes these and many other problems the more we can do to help. This means we need to measure impact, look at statistics and explore areas no one else is looking at.

Toby Ord gave a fascinating example. Research has demonstrated how effective antiretroviral drugs are in tackling HIV Aids. But in terms of preventing deaths from the disease, promoting the use of condoms is many times more effective. And, thinking again of wanting to prevent suffering rather than any one disease, we can save many more lives again by tackling malaria. Treating malaria providing anti-mosquito bed nets through the Against Malaria Foundation is the best intervention we have found.

So we can use research and scientific reasoning to help more people, to figure out how to do 

Reason doesn’t just help us identify the most effective causes but also biases in our own thinking that might cause to focus more on evidence that supports our existing viewpoints.

To help us with finding these things out there were some really interesting workshops at the conference run by the 

 on how to find biases in your own thinking and how to better understand very different points of view. One workshop I particularly enjoyed was learning to argue from an opposing point of view to see where you might be wrong.

One stand out message of the conference was the importance of humility.

Changing your mind just means you’ve learnt something new. When you think like this it is easier to learn and be accepting of others.

Shared community and acceptance was a really powerful feeling of the conference for me. In many ways the people there were very different. People from countries, working in very different areas (from computer engineers based in the USA to health workers working in the global south) and focusing on different causes (from animal welfare to helping people become more rational). All united in trying to do the most good possible.

Unfortunately I will say a more general diversity was still lacking. The audience was predominantly white collar, white males between the ages of 18 and 30. This was an open topic of discussion at the conference. Particularly, does this lead to biased optimism on things like getting into politics or running start ups?

That said, the atmosphere was very supportive and inclusive. Although the the sessions were intense, it felt like a very safe space. Everyone was on your side.

The conference had the strange feel of a group interview day - but much more friendly. On the one hand I met lots of people, many of whom were hiring into Effective Altruism organisations, looking to collaborate on new projects or giving advice on how to make an impact. And yet instead of pushing personal skills and hoarding contacts, everyone was sharing tips and contacts, and offering to volunteer to support promising ideas.

For me this community feeling was optimised by the lovely delegation from Norway letting me crash with them when I missed the last train to where I was staying one night. I think I was too engaged in discussing how to make an impact through politics and learning about the latest developments in computer science!

Figuring out how to do the most good doesn’t stop with finding a more effective cause.

Maybe you can help find the most effective ways of treating malaria. Or maybe you can come up with a model of how to stop diseases spreading through populations.

Maybe you can influence governments to put more money into research or into tackling malaria or into building the health infrastructure needed in the countries where malaria is prevalent.

Or maybe you can persuade more people of the amazing impact they can have on so many people’s lives if they just think about how to do the most good. Maybe you persuade some people to fund anti-malaria bednets, some people who can influence government policy and some who can research how to do all of these things even more effectively.

I attended a fantastic workshop with Giving What We Can’s own Jonathan Courtney, Director of Outreach, where I collaborated with people from around the world who run local groups. We try to reach out to people in our own towns and cities so that we can discuss together how we can do the most good and then support each other in doing it.

This is one of the ways I feel that I, personally, can make an impact.

Once you've worked out what cause area you can have the biggest impact in and how, it's just a case of doing it.

 of things to do after the conference, whether you attended or not. And 

 you can find small steps anyone can take to get started.

One of my big learns was you don't need to have all the answers now. Don't stall on doing something good because you're not sure it's the best thing. 

Blog

Development, Population Growth and the Mortality-Fertility Link

Smart Legacy Giving

EA Global Oxford: Figure out the most good you can do and then do it

Is tobacco control a "best-buy" for the developing world?

An Update on Project Healthy Children

An Update on Project Healthy Children — Part II

Doing Good Better: Review

The SDGs - could we become the generation that eliminates extreme poverty?

My Journey to Taking the Giving What We Can Pledge

Words and Deeds