Challenging the claim that saving kids lives reduces population growth

A leading aid and development expert is challenging a popular claim made by Bill and Melinda Gates, health statistics wizard Hans Rosling and others in the humanitarian community often cited to counter the concern that saving kids lives in poor countries will exacerbate global population growth.

It is sometimes described as the ‘virtuous cycle’ because it shows how preventing child deaths actually reduces birth rates! Here’s Rosling making the case in his always entertaining style:

The gist here is that as you reduce childhood mortality rates in poor communities, families have less kids. Birth rates go down and, over time, the economic well-being of these communities rises along with other health indicators. Put another way, when poor families see fewer of their kids dying young, they stop having 10 kids if they only need five to work the farm and provide for the family.

Melinda Gates cited this phenomenon in this year’s annual letter from the Bill & Melinda Gates Foundation:

Melinda Gates
Gates Foundation

The fact is that a laissez faire approach to development—letting children die now so they don’t starve later—doesn’t actually work, thank goodness. It may be counterintuitive, but the countries with the most deaths have among the fastest-growing populations in the world.

Melinda cited evidence for this trend in both the wealthier countries, Thailand, Brazil, much of Latin America and Southeast Asia. In all these places, she noted that improvements in reproductive health and family planning services were accompanied by significant reductions in child mortality rates and birth rates.

The Gates and Rosling are hardly outliers. This virtuous cycle has become almost axiomatic within the aid and development community.

Now, a spoilsport named David Roodman, formerly with the Center for Global Development (and, briefly, an economics advisor for the Gates Foundation), says in a new analysis that the claim lacks sufficient evidence.

Roodman, who did his analysis at the request of GiveWell, an organization that vets philanthropic organizations and efforts, found no evidence to support the claim that reducing child deaths leads to a reduction in population growth. In fact, his analysis suggests (perhaps not surprisingly) that reducing child mortality initially causes a spike in population numbers.

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 … The impact of mortality drops on fertility will be nearly 1:1, so population growth will hardly change.

This certainly doesn’t mean that reducing child mortality causes an increase in population, as the Malthusian over-population worry warts claim.

“I’m suggesting that where family planning is the norm, which is an increasing fraction of the earth, saving lives should reduce births by about as much,” Roodman told Humanosphere in an email. “I also think that there’s strong evidence that family planning promotion really has worked in places, and that falling fertility is one of the great successes in development, even if most of it is not a domino effect from falling mortality.”

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.