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Population policy and contraceptive choice - Population, Fertility and Family Planning: Contraceptive Method Mix in Asian Countries By Aditi KUNDU & Bhaswati DAS New Delhi: Rawat Publications, 2019. 248 pp. Hardcover $45.00

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Population, Fertility and Family Planning: Contraceptive Method Mix in Asian Countries By Aditi KUNDU & Bhaswati DAS New Delhi: Rawat Publications, 2019. 248 pp. Hardcover $45.00

Published online by Cambridge University Press:  20 April 2021

Sayak Dutta
Affiliation:
Jawaharlal Nehru University
Nandita Saikia
Affiliation:
Jawaharlal Nehru University
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Abstract

Type
Book Review
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Asian Journal of Law and Society

The book is a gust of fresh wind within the crowd of demographic literature. The authors successfully took a rather niche topic of contraceptive use and expanded the scope to incorporate an interdisciplinary approach by fusing the politics of family planning to the choice of contraceptives, at the level of a continent. The book comes at a crucial moment when, perhaps for the first time since 1965 Belgrade conference, the world is contemplating the necessity for population control. Footnote 1 It is this style of historical narrative to gaze into the legacy of Asian family-planning programmes that makes this book such a captivating read.

Contrary to the popular discourse, population numbers have not stopped being a challenge to the policy-makers. Even as the two giants, India and China, approach replacement level and much of the former USSR is experiencing a sustained negative growth, the world population continues to grow at an alarming rate. Footnote 2 With improving standards of living and per-capita resource utilization in South and East Asian countries rising to match the Western standards, one would be terrified to anticipate the consequences of the ecological strain on the planet to be brought about by humankind. Footnote 3 More worrying, however, is the spatial disparity in the projected growth rate. Even for all the globalized activities, our political order remains territorially entrenched, and differential population growth is already showing symptoms of the calamities that it is about to bring along. If the present trend continues, fracture zones between high- and low-population countries are looking at a bleak future of refugee crises, cultural conflicts, and armed struggles. Footnote 4 Being the poster child for planned fertility transition, discussions on population policy have traditionally been centred on Asian countries and, while those countries are by and large on the verge of approaching replacement level, much of Africa is staring down the barrel of an impending population explosion. Footnote 5 Couple this with the fact that, from the development of the Bucharest conference to the cafeteria approach of the Cairo conference and beyond, international rationales of contraceptive choice are in a constant flux; the formulation of effective family-planning programmes in African countries would require all the past experiences it can get. Footnote 6 A carefully organized understanding between a state’s activity and couples’ choice as undertaken in this work can provide significant insights into a nascent population programme.

Right from the outset, with the opening phrase “Ever since antiquity till the recent times,” the authors make their intention clear to accord history a centre stage in their analysis. Indeed, the first section of the first chapter presents a nostalgic hindsight into population transition and family-planning programmes, shortly discussing antiquity until the early modern period before delving into the European population decline and finally the planned programmes of the developing countries. Hereafter, however, the focus shifts almost exclusively to contraception, starting with an excellent historical review of evolving contraceptive methods, from “jumping backwards seven times after sexual act” to the development of Depo Provera, laid out in a temporal narrative. Although there is a short discussion on variables affecting contraceptive use, the work draws its primary theoretical justification from Bulatao’s model of contraceptive-method choice.

The book adopts an elaborate conceptual framework to link the couple’s reasoning to use a specific method with a state’s motivation for approaching family-planning policies. Although aesthetically pleasing, the framework leaves several questions unanswered. The couple’s choice part of the structure is firmly grounded in the previous discussions of method-choice literature, but the state’s rationale and implementation of family-planning programmes that assume such a vital role in future analysis appear to have been embraced with an intuitive logic devoid of any substantial theoretical justification. The collation of method-mix data from multiple sources to construct a repository is a commendable effort that is sure to aid future researchers. The descriptive statistics that follow and graphical representations of country-level method-mix numbers in all their spatial variability lay the groundwork for the upcoming policy reviews. The authors make it absolutely clear that, through the flurry of tables and illustrations, their aim is only to present a picturesque pattern of the existing situation and not to undertake any analysis. This, to a large extent, negates the significant difference between the data-collection years (2005 for Japan to 2015–16 for India and Armenia) across the selected countries. However, even with their strong historical focus, the authors conspicuously restrict themselves to the most recent data for each country. A foray into the historical pattern of method mixes and associating them with momentous policy decisions would have been a worthwhile venture.

The crux of the book is organized in Chapters Three, Four, and Five, as the 38 selected countries are conveniently divided in three groups of 13, 15, and ten based on their total fertility rate, after other criteria such as geographical contiguity or sociocultural similarity have been found to be of little relevance. This turned out to be a positive design choice, as countries at a certain level of their fertility transition often had similar policy imperatives, although they cannot be considered uniform by any stretch of the imagination. The lack of a family-planning programme in Syria or Jordon on account of political disorder and lack of productive will stands in stark contrast to Japan or Armenia with a pro-natalist approach with a policy to increase the population. The way in which population policy shapes the method choice is also noticeably different. Throughout the journey across 38 countries, the authors excavated the literary sources to unearth the most probable explanation for the observed patterns to a staggering variability amongst the countries. From geographical obstacles to regulatory frameworks, incentive mechanisms to subsidization, and a disparity between the activities of state and donor agencies, the multitude of explanations thoroughly rebuffs the “one-size-fits-all” paradigm for any family-planning programme.

Overall, the authors found compelling evidences of a state’s influence through overt or covert policy decisions to explain the prevailing country-level variation in the method mix. To their credit, they are able to investigate a staggering variability within the selected 38 countries and distil their narratives into eight simple yet elegant highlights. Their concluding points do a fantastic job in elucidating how state intervention may persuade a couple’s rationale, but have, to a certain extent, failed to incorporate the state’s rationale within their motif.

Even after making casual reference to governmentality a couple of times, the authors never really paid homage to Foucault and investigated the dynamics of power relations. This restricts their enquiry on a superficial level without really scrutinizing the deep structures of the institutional assertion of state authority. At this, one has to lament a missed opportunity to go slightly deeper into the biopolitics of family planning. Footnote 7 With evidences from 38 Asian countries and a ton of bibliographic references, the book is a great addition to the burgeoning archives of demographic literature. Their analysis to relate the contraceptive-method mix to family-planning programmes, however, is lacking on multiple fronts. With a lengthy discussion on method-choice theories and conceptual frameworks, the study shapes up very structurally, and yet writings in later chapters are in the mould of a narrative analysis. For instance, the eight key points presented in the conclusion have not been included in the analytic structure and exist only as a suggestive corollary to the observations from country-level analysis. Although this is stylistically congruent with the three policy chapters and with the authors’ claim of it being an “explorative study” and “not all-encompassing,” its discord with the first couple of chapters is quite glaring. It is this epistemic dissonance between a structural and a narrative form of analysis that prevents a truly harmonious synthesis.

The book is an explorative study; examined exclusively with literary sources, it attempted to find the causal link between contraceptive choice and population policies. To what extent it has succeeded in that pursuit is debatable, but its value as an introductory read is undeniable. Although not groundbreaking in its findings, a comprehensible narrative style and a lucid prose largely devoid of academic jargon make it a preliminary read not just for demographers, but also for a wide array of practitioners and researchers in the fields of population and health studies and science policy, bureaucrats, and policy-makers for both state and non-state organizations, and even for a larger audience not directly related to academia.

Footnotes

1 Finkle & McIntosh (Reference Finkle and McIntosh2002).

2 Gerland, Rafter, & Ševčíková (Reference Gerland, Rafter and Ševčíková2014).

3 Pimentel & Pimentel (Reference Pimentel and Pimentel2006).

4 Kaplan (Reference Kaplan2000).

5 Cohen (Reference Cohen2003).

6 Caldwell & Caldwell (Reference Caldwell and Caldwell2002).

7 Krause and De Zordo (Reference Elizabeth and De Zordo2012).

References

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