A gaunt young mother with an infant on her back, a toddler at her heels and several other small children trailing behind. This is a familiar sight on the streets of most Asian cities but one that is gradually disappearing from Taiwan. The island's family planning program-considered one of the world's most effective among countries with high rates of population increase---is having a visible effect.
Back in 1948, when the Joint Commission on Rural Reconstruction was established, family planning was not widely accepted and, in fact, faced a large measure of hostility. JCRR nevertheless stood behind the program from the outset. Dr. Chiang Moulin led JCRR in the initial undertakings of family planning. When he died in 1964, Dr. T. H. Shen took over the leadership and in 1968 saw family planning endorsed as a national policy of the Republic of China.
The China of old knew three powerful regulators of population growth-disease, famine and war. These were quickly brought under control in the Taiwan of the postwar years. Medical science and public health increased the life span and reduced infant mortality. Agricultural advance assured plenty of food for all. Although the confrontation with Communism continued, the island's political situation was stable.
Population figures began to soar out of sight. The crude birth rate went up from 38 per thousand in 1947 to 50 in 1951. The death rate dropped from 18 to 11 per thousand in the same period and the rate of natural increase almost doubled from 20 to 38.
JCRR's first family planning effort was a "Happy Family" booklet explaining how children can be spaced by using the rhythm method of birth control. Demographic data and understanding were lacking in Taiwan at that time. Family planning had too few proponents and too many opponents. Demographic study was undertaking with financial and technical assistance from the Rockefeller Foundation and Princeton University. JCRR expanded the research. One finding was that the bigger the family, the higher its mortality rate and the larger the number of children put out for adoption.
By 1954, government leaders began to understand the seriousness of the Taiwan population explosion. JCRR was asked to help in starting a control program. The result was establishment of the China Family Planning Association under a charter from the Ministry of the Interior. Leaders came from civil, military, political and cultural circles. Dr. S. C. Hsu, JCRR rural health chief who was to win a Magsaysay award in 1969, undertook what was virtually a one-man drive for funds. Shuttling between the government and U.S. aid officials, he finally obtained backing for a program of "Pre-Pregnancy Health".
Progress was slow. In 1959, Dr. Chiang Monlin warned that Taiwan was populating "another Kaohsiung" (then a city of 400,000) every year and that this would inevitably outstrip the food-producing capability of the island. By 1963, about a third of the 361 local health stations had pre-pregnancy health workers to teach family planning by traditional methods. In 1965 the Taiwan Population Studies Center was established with financial assistance from the Population Council of the United States and the University of Michigan.
Dr. Hsu drew up plans for an islandwide family health program at the request of K. T. Li, then the Minister of Economic Affairs. In May of 1968 the government lined up behind the population control movement with promulgation of the Regulations Governing Family Planning in Taiwan.
The Institute of Family Planning recently reported a drop in the crude birth rate from 3 per cent in 1964 to 2.3 per cent in 1969. This is still high when compared with the most developed countries, however, and demographers are worried about the years just ahead. Babies born during the early postwar years are reaching the marriageable age. The population of girls aged 20 through 24 will increase by 60 per cent during the next five years.
Family planners urge the taking of their message into the schools and armed forces. The goal is not to reduce the population, they say, but to slow the rate of increase to an acceptable figure. Another objective is the enhancement of child and maternal health. In numerical terms, demographers and planners would like to get the size of the average Taiwan family down to five, which means three children. This would provide an annual growth rate of 1.2 per cent, higher than the rates for the United States and many European countries but for Taiwan a giant step toward population stability.
Dr. L. P. Chow, director of the Chinese Center for International Training in Family Planning, has devised a "five 3's" formula to dramatize the case for reduced family size. He suggests that couples have their first child three years after marriage and then two more at intervals of three years—the process to be completed when the time the wife reaches the age of 33.
Taiwan family planning methods are entirely voluntary and do not include abortion, which is legal only for medical reasons. The most common methods are the Lippes loop and the oral pill. The loop is the more widely used. In 1964, the Committee of Family Planning of the Taiwan Provincial Health Department sent extension workers into the countryside to introduce the idea of the loop. They were followed by doctors of medicine under contract with the Maternal and Child Health Association of China.
The target set in 1964 was acceptance of the loop by 600,000 women in five years and reduction of population growth from 3 to 2 per cent in a decade. As of November, 1969, women who had used the loop totaled 620,000.and 90,000 were taking the pill. Neither method is certain. Many users of the loop become pregnant for one reason or another. The pill is sometimes discontinued. Family planners say that motivation is the key to the success of either method.
Specially trained nurses sponsored by JCRR have been sent to villages. They live with farm families while they teach family planning. The armed forces are providing recruit education in the essentials of family planning. More than 100,000 young men and women are reached annually.
Working on plans for a comprehensive family planning education program is Dr. Julia J. Tsuei, director of the family planning division of the Department of Obstetrics and Gynecology of New York University's School of Medicine. She came to Taiwan in December of 1969 under a year's agreement with the National Defense Medical Center. She is working on the plan of education while serving as head of the NDMC Obstetrics and Gynecology Department and director of the Maternal and Child Health Center at the Veterans General Hospital. Her goal is a varied program of education and services that will be useful at all stages of life. She believes that family planning instruction should be incorporated in the curricula of public education.
With an area of less than 14,000 square miles, and only a quarter of that arable, Taiwan has the world's highest population density in terms of agriculturally useful land. Only Holland has a higher density in terms of people to total land area. Family planning is helping to show the island's more than 14 million people that a continued high rate of population growth will make further gains in the standard of living difficult, if not impossible.
Discussing the population problem in late January, the China News said editorially:
"DDT will be banned in Taiwan beginning July 1. Taipei is seeking ways to prevent the burning of soft coal in the hope of cleaning up the air. The city traffic problem is growing worse as more people become prosperous enough to buy motor vehicles.
"Such problems of tills middle-sized island of 14 million people are a microcosm of those to be found elsewhere. Man's numbers and materialism are upsetting the ecological balance of the world.
"Awareness of a poisoned environment is widespread. Recognition of polluted air and traffic snarls is inescapable. What man seems not to have understood is the role of population growth in this process.
"World population has doubled to nearly 4,000 million in the last 70 years and has increased by five times since the mid-1600s. At present rates of growth, the population of a hundred years from now is unthinkable. Life might be possible but not as we know it today.
"Only a decade or two ago mankind was divided on the question of population control. The matter of control is no longer at issue. Today's differences involve the means of control: natural versus artificial, free choice versus regimentation. Nearly everyone agrees that man cannot permit his numbers to go on increasing at the present rate.
"Family planning is encouraged in Taiwan and the rate of population increase has been substantially lowered. The loop has been widely distributed. A growing number of women are taking the pill. Members of religious groups that forbid artificial means of control are supporting the rhythm method.
"The world has only another generation or two to stop population growth voluntarily. If it does not, government will step in, abhorrent as that may be to most of us. Family size might be limited with a progressive tax on children. More forceful methods are not outside the realm of possibility.
"Voluntarism in family planning is difficult to promote. So far the trend toward smaller families is largely the result of free choice on the part of women, who prefer not to be burdened with too many children. Men have never had the same concern about family size that women do. No state in the world has actively supported small families except by making birth control information and devices easily available.
"Old ways of thinking about family size are rooted in agrarian societies with high mother and child mortality rates. The family with only a child or two is thought of as too small. Some societies still point with pride to the family of ten or more. A family of four or five is thought of as wholly acceptable and not too large, although if this were the average size, the world's population would double to 8,000 million by about the year 2000 (as it very well may).
"In the time that remains for free choice, governments and people need to do a lot more thinking and talking about the population problem. Not only ecology is involved. How much freedom and democracy will be possible in a world of 20,000 million people, a figure that could be easily reached by the mid-2000s? What will be the value of life when men live in anthills?
"If voluntary population control is to be effective, most of the people of the world will have to be persuaded that limitation is in their self-interest and also an inescapable responsibility to their species and their descendants. Mencius held that not to have sons was the supreme unfilial behavior. In his time, he was quite right. For our world, to have too many sons—or daughters—may be a quick way of ending not only the individual line but homo sapiens as well."