Rethinking the IMF Response The world is just emerging from the Asian financial crisis, perhaps the most cat event to affect global capitalism since the Great Depression. While the United States emerged from this event unscathed--some might argue that it even benefited from the crisis as plummeting commodity prices reduced domestic inflationary pressures--many developing nations were not so lucky. Whereas the Great Depression induced a great deal of soul searching about capitalism's basic principles, the seemingly quick global recovery from the financial crisis and its limited effect on industrial countries have brought a more mixed response--self-congratulation on the part of some, renewed criticism of the impacts of globalization by others. In both instances, however, the global economic arrangements were clearly inadequate. The international financial institutions and arrangements established at the end of World War II to guard against another global economic depression are widely viewed as incapable of managing the modern global eco nomy. The International Monetary Fund (IMF), in particular, has failed to perform the tasks for which it was designed. Today, the institution requires serious reform to ensure a more stable global economic environment. Beggar Thy Self The IMF's philosophy has moved far away from its roots. In this past financial crisis, the IMF provided funds under the explicit condition that countries engage in more contractionary fiscal and monetary policies than they might desire. The money went not to finance more expansionary fiscal policies but, instead, to bail out creditors from the more industrialized countries. The beggar-thy-neighbor policies that were so widely condemned gave way to even worse policies, with disastrous effects both for the home country and for its neighbors. The downward spiral in the region accelerated as declines in domestic GDP led to cutbacks in imports, thereby reducing regional exports. The beggar-thy-neighbor policy at least had the intention of making the nation's own citizens better off. No such benefits resulted from the IMF's beggar-thy-self policies. A country was told to build up its foreign-currency reserves and improve its current-account balance; this meant that it either had to increase expor ts or decrease imports. But exports could not rise overnight--in fact, as the country's neighbors' incomes plummeted, the prospects for increasing exports were even bleaker. Thus imports had to be reduced without imposing tariffs and without further devaluation. There was only one way that imports could be reduced in these circumstances: by reducing the consumption and investments that relied on imports. The immiseration of those at home was thus inevitable. There is a further irony in the policies that the IMF pursued: while the IMF was created to promote global economic stability, some of its policies actually contributed to instability. There is now overwhelming support for the hypothesis that premature capital and financial market liberalization throughout the developing world, a central part of IMF reforms over the past two decades, was a central factor not only behind the most recent set of crises but also behind the instability that has characterized the global market over the past quarter century. The Indictments There is now widespread agreement that the IMF response to the Asian crisis was a failure. Although exchange rates stabilized, interest rates dropped, and the world eventually emerged intact from the crisis, none of this turnaround can be attributed to the IMF when we judge the success of its policies by whether the downturn was unnecessarily long or imposed unnecessarily high costs on workers. Of the four crisis countries in Asia, Indonesia remains in deep depression. The political turmoil there has proven a nearly insurmountable obstacle, but there is little doubt that the magnitude of the economic downturn contributed to the severity of the social and political unrest, that the turmoil was anticipated, and that IMF policies contributed to the magnitude of the economic downturn. …

This article discusses the impact of Complex Humanitarian Emergencies on the delivery of humanitarian aids. Complex emergencies were the results of long-term political and social disputes. Its impact brings about public health crises like epidemics, malnutrition, and even widespread desperation. In fact, there are four aspects of these crises which complicate public health programs: 1) emergencies are long and recurring; 2) access to the most vulnerable population is often restricted; 3) restructuring health systems in complex emergencies can be futile; and 4) complex emergencies often result in mass forced migration. What makes matters worse is the breakdown of health networks which collapse early in complex emergencies, leading to extensive losses of human health resources. Not only that, health facilities and transportation, infrastructure are often decimated in complex emergencies, and regional hospitals, district health posts, laboratories, and primary care outposts are similarly abandoned or destroyed. Moreover, because it is difficult to predict the course of these emergencies, ascertaining the optimal time to intervene and to invest in materials and facilities that could be lost to renewed fighting can be impossible. To solve this problem requires a coordinated effort. It should also focus on resources, early warning systems, preparedness measures, ongoing career training of relief workers, and prepositioning of relief supplies.

As it has grappled with issues of population policy, the international community has emphasized that women's reproductive rights are human rights. Scholars have also acknowledged that the right to reproductive health care exists within the scope of international human rights treaties and conventions and that gender equality, nondiscrimination, and freedom from government interference in marriage and family life are also guaranteed. Further protections extend to counseling and health information and referral. The Programme of Action of the 1994 International Conference on Population and Development continues this trend by emphasizing the importance of human rights for attaining population and development objectives, calling on governments to focus their efforts on improving the quality of life for individuals, and endorsing the notion that reproductive rights are universal human rights. Reproductive health care options are also influenced by sovereign laws that restrict availability of contraception, sterilization, or abortion. However, universal rights and unrestricted access must be complemented by other factors controlled by domestic laws to guarantee reproductive choice. Such laws cover issues like marriage age, divorce, marital property, child support, maternity benefits, day care, sex discrimination, eligibility for insurance, confidentiality, spousal consent, rape, and sexual abuse. Countries must modify restrictive national laws and promote laws protecting women's rights.

In Mexico, a 40 year period of political stability and economic advancement, hailed for its high rates of growth in income per capita, rapid urbanization, and impressive gains in indicators of health and education, seemed to come to a halt in the early 1980s. Since the early 1970s, fertility has declined sharply in chronological association with a new population policy and the implementation of a national family planning program. If in 1940 there was no apparent reason for the Mexican state to have much interest in limiting fertility, such was no longer the case by 1970. The General Law of Population that had been passed in 1947 was laced with the expansionist ideology that dominated demographic issues for more that a century; its pro-natalism had been reinforced by health regulations prohibiting the sale and use of contraceptives and by a penal code that made abortion a crime. Between 1970 and 1981 the total fertility rate fell by about 39%. Since 1975, change in contraceptive practice accounts for the bulk of the measured fertility decline. Between 1976 and 1982 there was a 66% increase in contraceptive prevalence. The government's involvement in family planning activities helped to: 1) develop an effective contraceptive distribution system; 2) circulate extensive information, education, and communication publicizing fertility and images of the small family; and 3) mobilize health practitioners in public institutions to counsel and persuade their clients to accept and practice contraception. The emerging debate over population policy in Brazil may well prefigure debates in other Latin American countries; the recent democratization in Brazil is the vocalization of a demand from women's groups and the left for government provided family planning services. Overall, Mexico's willingness to take the long view tackle the birth rate issue head on is likely to remain an exception in Latin America.

International population assistance in the UN is a relatively recent development; it is only since 1966 that a broad-based technical assistance program in population was authorized by the General Assembly. The desire of developing country members for accelerated economic growth ultimately brought about a change in the views on population. In 1967, the Secretary General established a trust fund for population activities, later renamed the United Nations Fund for Population Activities (UNFPA). 3 principles have guided UNFPA work since its inception: 1) national sovereignty in population matters is to be resspected and adhered to at all times, 2) individuals and couples are to be provided the information and services necessary to determine freely and responsibly the number and spacing of their children, and 3) population goals and policies are integral parts of socioeconomic defelopment. The areas of assistance by the UNFPA consist of 1) family planning, 2) communication and education, 3) population dynamics, 4) basic data collection, 5) population policy formulation and implementation, and 6) special programs such as those for women and the aging population. In 16 years, the UNFPA has received about $1.4 billion for transfer to developing countries as population assistanceand has financed 4373 population projects in 149 countries and territories. The relation between the US government and UNFPA is tenuous and likely to remain so as long as the US cannot resolve its own domestic controversies over famly planning, foreign population assistance, abortion, which, ironically, is legalin the country. There will always be some sort of domestic controversy over population; the UN has overcome domestic difficulties by framing the arguments properly within the demographic, social, economic, ecological, and political concerns of countries and applying the fundamental principles of national sovereignty, freedom of individual choice, and the link of population and development,to reconcile differences.

India and China contain more than 40% of the world's population, yet in India it is painfully clear that the political commitment necessary to tackle India's greatest problem is not there in full measure. India's present per capita income is less than $300, and nearly 65% of the people live below the poverty line. The average Indian woman produces 5 children; even if the Indian government's efforts to reduce family size to 2 children is successful by the year 2040, India will have a population of 2.5 billion. The possibility that India will succeed in reducing average family size to 2 children appears remote. 30 years ago, India became the 1st developing country to formally make family planning a matter of national policy. In the early years of the national family planning programs, practitioners had access mostly to sterilization and condoms. Over the years, theIndian government persuaded the US and other western donors to give $2 billion to population control programs. Still, the population continues to grow annually at the rate of 2.1%. Government statistics reflect the ups and downs of national population control policies; thenumber of new family planning users increased from 4.3 million in 1974-1975 to 12.5 million in 1976-1977, due largely to a dramatic increase in vasectomies. Tge number of new contraceptive users fell to 4.5 million after the "emergency" was lifted in 1977. The present Indian generation is far more receptive culturally as well as sociologically to the concept of population control than most other developing countries. What is needed now is renewed political committment by the Gandhi adminiostration. India cannot afford to replicate the Chinese way of tackling overpopulation without inflicting human abuses and without undermining its painstakingly cultivated democratic system.

This article suggests some of the principal factors behind the decisions by an increasing number of countries deciding that the achievement of their national objectives required a policy for population, and the way that they are likely to work out. By 1983, 35 developing countries had an official policy to reduce their population growth rate, and in 34 others, the government supported family planning activities--usually for reasons of health or as a human right. The number is remarkable given the many compelling reasons that governments have for not attempting anything so difficult as to modify demographic trends. The future results of population programs, in social and economic terms, are very difficult to quantify, thus defying cost-benefit analysis of the desirability of investing resources in this area, rather than in something else. There are also powerful political reasons why a government might well hesitate before embarking on a policy to reduce the nation's fertility. At the very least, it implies government interference in the most private and personal of human relations, an invasion of human rights, and a disturbance of the traditional patterns of society and behavior. For many countries that are pursuing a policy to limit population growth, the decision has been taken only after the grievous consequences of not having such a policy have already become manifest. The critical question is how soon a government will make the connection among political disobedience, economic and social distress, and the population explosion, and adopt a population policy. Although the number of developing countries that have officially proclaimed a strongly pro-natalist population policy is relatively small, many have Marxist governments. Overall, governments have several strategies at their disposal: 1) improving the accessability and the quality of the service; 2) promoting population education and family planning motivation (with the assistance of the media, folk art, and personal persuasion); and 3) applying a judicious mixture of incentives and disincentives.

Since the 1st oil crisis in 1973, the economies of sub-Saharan Africa have barely kept pace with their burgeoning populations. Women in Sub-Saharan Africa give birth more often than women in any other region of the world, with an average of more than 6.5 live births each. The region's natural increase average 2.5% a year in the 1960s, 2.7% in the 1970s, and in the mid-1980s, it is 3.1% per annum--a rate that will double the regions population in 22 years. National leaders in Sub-Saharan Africa were slow to consider population policy as a key component of the social and economic development effort. The neglect of population issues is reflected in the limited scope of public or private family planning programs in the sub-continent. Donor countries and institutions play an important role in developing the information base by providing technical training to government staff, supporting research, and disseminating information to a broad spectrum of political actors. Some examples of policy reconsiderations in Nigeria, Zambia, Liberia, and Niger are given. These countries are starting to give active consideration to population policies to reduce fertility and high rates of population growth by expanding family planning services, raising the age of marriage, improving the status of women, providing family-life education, and incorporating economic incentives for smaller families into the provision of social services. The highly centralized nature of African governments dictates that the acquiescence of the governmental elite must be obtained before any policy can take hold. Overall, high population growth rates in combination with a stagnating social and economic development effort throughout the region have provided the catalyst for a new look at Sub-Saharan Africa population policy. The ability of African nations to implement policies that reduce fertility is more open to question; no African nation has as yet done so, and the socioeconomics factors contributing to high fertility remain strong.