(ominous music)
- [Narrator] In the elementary school of Oguchi, Japan,
the silence is more striking than the voices of children.
In a spacious classroom commanding
the undivided attention of his teacher,
11-year-old Daiki Sato sits alone.
Since kindergarten he's been the only student
in his class because of a startling
decline in birthrates.
By the end of the century Japan's population is expected
to shrink by half, with one out of every three
people retired.
And Japan is not alone.
Over the next 50 years
Europe is projected to lose 63 million
people while Russia shrinks almost 20%,
as elders over 60 outnumber children
under four, the economic and social changes
will be wrenching.
- But we're talking about a society in the future that's
never existed in past, one that is you know
literally an old folks home so we know
that the decline of many industrial
countries is already written in stone.
- [Narrator] Yet rising longevity is not just
transforming the industrialized world,
more children in developing countries
are surviving than ever before.
Today the largest generation of youth in
history is entering their reproductive
years igniting an explosion of births.
As global population climbs from six to nine billion,
the social and environmental strains will be enormous.
Our world is now careening into completely different
directions as youthful nations reel from
rising numbers while old ones grapple with decline.
- You see a huge generation gap across
countries emerging that's going to
translate into a more polarized world
society and those disparities are
potentially very destabilizing.
Join us for a journey across four continents as
we peer into the demographic divide
reshaping our world and confronting us
with stark choices for the future.
World in the Balance, The People Paradox.
Up next on Nova.
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sponsor of the Goldman Environmental Prize
and the William and Flora Hewlett Foundation,
major funding for Nova is
also provided by the Corporation for Public Broadcasting
and by PBS viewers like you, thank you.
(calming music)
- [Narrator] Deep in the heart of India,
towers the Taj Mahal a lavish mausoleum built to
honor a queen who died giving birth to
her 14th child.
It's a haunting symbol for a country
that will soon surpass China as the
world's most populous nation with over
a billion and a half people.
Beyond its walls lies the urban sprawl
of India's fastest growing state,
Uttar Pradesh with more people than all but
four nations in the world.
Its population of 177 million is crammed into an area
the size of Colorado.
Every three years its numbers swell by another 10 million
yet the rapid growth here masks a
stunning success across India where
fertility has plummeted from an average
of six children per woman to three,
this trend offers hope that India's
population might stop growing this century.
But the outcome depends on whether
the northern states can repeat the success
of the south where birthrates are
almost as low as Europe's.
- And the south of India of course is very educated
however the opposite is the case in the
north and that's where India's
demographic future really lies.
In a state like Uttar Pradesh where women
average about five children each in their
lifetime and they have very high levels
of illiteracy this is where the real
battle for India's future is going to be fought.
- [Narrator] If this battle isn't won within two
decades India's population instead of
stabilizing could nearly double by 2050.
With US support Dr. Ravi Anand has
organized a network of doctors across
Uttar Pradesh to offer healthcare and family planning.
- I would say this is a
window of opportunity if we do not take
all the measures that we can in every
possible manner to check the population
now then India will never be able to tackle this problem.
- [Narrator] Yet Ravi is well
aware that if progress is going to be
made the lives of women here must improve.
In the nearby slum she checks on
a 30-year-old mother named Gooday who
almost died delivering her eighth child,
she was rushed to the hospital
unconscious after three days of obstructed labor.
- [Translator] So now tell me, I hear
you had great problems with this birth.
- [Translator] Terrible problems the midwife that
delivered my other babies came but when
she touched my belly she said this
baby's life is in danger you must find
the money to get to the hospital.
- [Narrator] After delivering a baby girl
Gooday begged doctors to be sterilized
but she was overruled by her
mother-in-law and husband.
- She said she's
petrified of another pregnancy and
childbirth and she doesn't want to have
another baby but she's the one who's
least involved in this decision making
and that is why we counsel the husband
and the mother-in-law because we call
them the gatekeepers to the health services.
- [Translator] So I hear you want a second son.
- [Translator] I need at least one more.
- [Translator] If you have only one son,
and isn't one son good enough for you?
- [Translator] He's 40 years old
and he is the only son left alive.
- [Translator] And daughters?
- [Translator] I have three daughters but
they have gone to live with their husband's families.
- [Translator] Listen today one son
is just as much as you may need.
- One of the major reasons for the family size to
be really large in Northern India is the
son preference because it's the son who
stays with the family and he's expected
to look after his old parents and girls
are always considered as somebody else's asset, not mine.
- But the point is the strategy of
survival demands that you must have one
or two sons otherwise you will be left
high and dry, not only no old age throughout your life.
- [Narrator] Having a second son
raises the odds for Gooday that at least
one boy will survive,
especially since one in 10 children in
Uttar Pradesh dies before age five.
Gooday has lost three infants.
Ravi urges her to bring her children to the
clinic for vaccinations,
if the family trusts their son will survive the
pressure to bear another may ease.
- Women in India really don't have control over
their reproductive lives because all
sexual reproductive health decisions are
essentially made by men and you can't
deal with an issue like population by
itself, you have to look at the ratio of
infant mortality or literacy or women's status
because it's all very interlaced.
This is a patriarchal society and I
think gender lies at the heart of the problem really.
- [Narrator] On the edge of the Deccan Plains
barefoot children walk towards their
school in the rural village of Saswad.
The daily rhythm of life here masks an
unusual event unfolding in the heart of the village.
Newly married couples play
games to get to know each other as they
wait to have their wedding portraits taken.
The gathering has been organized
by social worker Manisha Gupta to help
young men and women bridge India's stark gender divide.
- In traditional Indian society
95% of marriages still are
arranged marriages and most often than
not the bride and the groom are
strangers to each other and one would
say that there's a 50% chance of things
going wrong in a rural marriage where
it's arranged and she's barely 15 or 16
and he's not much older and they're
talking of really adolescence you know,
building a life and having children, it's not an easy job.
- [Narrator] Social taboos pushed
aside girls and boys in separate groups
hear frank talk about sex and how to use birth control.
The stakes are enormous.
The age structure of India's population
resembles a pyramid with vast numbers of
youth at its base, half the country
mirroring the world at large is under 25
and reaching reproductive age.
If couples in this generation have only
two children in effect replacing
themselves population growth will soon halt.
Yet for Manisha it's far from clear
if India's youth will follow this
radical trend and throw off the shackles of tradition.
As they pose for their
portraits she asked them how many
children they want
if the gender matters and how they feel
about birth control.
- A lot of the couples
said that they'll be happy with two
children and we said what gender and
they said it doesn't matter it's very
nice of them to say, 10 years ago people
wouldn't have even said it but I'm not
really sure that that would happen in
the household if there were just two daughters.
- [Narrator] Daughters are seen as an
economic liability because parents must
provide a dowry of cash or gifts to
marry them off.
A common Hindu wedding blessing praised
that a wife will bear eight sons,
but if she doesn't have any there could be a
price to pay,
and that's why Manisha tries to intervene early.
The most shocking proof of what can go
wrong are the brides who've been doused
in kerosene and set ablaze by angry
in-laws or husbands,
an estimated 25,000 women are killed or maimed each year
over dowry and domestic disputes or even
their failure to produce a son.
- Bride burning is common in India and
since women are so dispensable and these
young little girls you know between
the age of 15 to 24 are the most vulnerable,
girls would get burned they would get
poisoned and so therefore a girl in the
husband's house at least for the first
10 or 15 years always walks on a tightrope.
- [Narrator] Gender discrimination takes
place even among the wealthy.
Upper-class parents committed to a two-child family
have sonograms to make sure they've
conceived a son although this doctor
refuses to reveal a fetus's sex not
everyone is as ethical.
Millions of females are aborted leaving
India with 35 million fewer women than men.
- There was an article saying that
better dead than burned okay meaning that
it's better that you have sex determination
rather than be burned in
your in-laws household and the newspaper
asked me to write a rejoinder and I
wrote a rejoinder saying neither dear nor burned.
- India wants to reduce
population growth but it certainly
doesn't want to reduce it through sex
selective abortion in fact it is
actually illegal now to test to see what
the gender of a fetus is but I think that the
single most important thing India can do
today, demographically, is to somehow
make the birth of a girl child
as welcome as the birth of a boy child
because the goal of most developing
countries is to reach this magical two child family.
- [Narrator] Abidi Shah, a social worker has seen that
when women have greater access to
education and job training their status rises.
16 years ago she visited a village
on the outskirts of New Delhi,
dismayed by the plight of young girls there she
decided to act.
- There wasn't any sense among the girls
of the adolescence because they had lost
their childhood already they had to look
after the younger brother and sister
they had to cook the food they have to
clean the house they had to fetch the
drinking water, no education for them, no
food for them, no clothing for them.
- [Narrator] First Abidi convinced a skeptical community
to let her teach vocational and health
classes to adolescent girls,
next she had to show the girls themselves how
education could improve their lives.
- I just said do you want same life as you
are living here they said no I want
better life what sort of life you want,
the life I see on the TV the life you
are living so I said then what will you do,
we can't do anything, that's our luck,
that's our destiny,
I said no this is not your destiny you can
change your life.
- [Narrator] One young woman who
attended the program was Bimla,
at age 13 her father had arranged her marriage and
forced her to drop out of school.
- [Translator] I already had two daughters when Abidi
arrived at our house she saw that I was
hungry and exhausted and she asked me
why don't you use birth control,
I didn't know anything about it
but I knew I didn't want any more children.
- [Narrator] Bimla was just the kind of girl
Abidi wanted to reach,
she told Bimla that she could legally
use the pill even without her family's permission.
(speaking foreign language)
- [Translator] I was talking with my friend
and my mother-in-law was
listening from behind the door as soon
as she left my mother lost started
yelling you must have a son stop taking
the pills, although she tried to beat me
into submission I was sure I didn't want
any more children, I could see that large
families were often poorer their
children didn't have clothes to wear or
food to eat but they played in the dirt
and they didn't get an education.
- [Narrator] With help from a Abidi,
Bimla learned tailoring,
soon she had enough money to
help her husband buy a new house and
send their children to school.
- The reality in India is that many many women
are very empowered but the majority are
disempowered so when women want to
change the way their roles are defined
they cannot do that if they are
economically vulnerable and dependent.
Because the price then is that if you're
left destitute if you're abandoned if
you're thrown out of the house you have
no way to survive if you have no income
so I strongly believe that one way
forward to increase the momentum of
social and cultural change is to allow
women to have employment opportunities.
- [Narrator] Yet these opportunities may be hard to
come by, even as change sweeps across India.
To keep pace with its growing population
the country must create six million new
jobs a year,
but even its dazzling economic growth
of 8% is not enough to prevent
unemployment, already widespread, from rising
and a new problem is looming as
population pressures confront vast
numbers of towns and villages with
chronic water shortages.
- In India water tables are now falling in
most states including the Punjab which
is the breadbasket of India and this is
making it more difficult to expand food
production at a time when population is
projected to grow by another half
billion by 2050.
- India faces really huge
environmental problems from rapid
population growth it might have a hard
time growing enough food for itself on
the other hand you've becoming a center
of software so if it makes a transition
to becoming more of a high-tech
knowledge-based society then it probably
could feed itself it has huge numbers of
very smart well-educated people.
- So we have got such a large number of intellectuals
in every field that you cannot
write of India and say well, population growth
will finish, this country will be doomed
there will be no drinking water, no housing
no nothing, no jobs, absolutely unreal, unscientific
it is drama.
- [Narrator] India is poised on a knife-edge
headed in the right direction it will
still take years to reach the coveted two
child family and what if the average
family size turns out to be slightly more?
- Suppose in India they really did achieve
two children per couple in let's say 15
years then they would rise to about
1.6 billion by 2050 but the key is if
couples have say on average about
two and a half children India would get its
second billion by the middle of this century.
- [Narrator] And the same is true for the world,
if global fertility stays even
slightly above this magical two child number,
by mid-century our population
could nearly double from six to 11 billion.
- We're dealing with unprecedented numbers
in terms of their magnitude and the
result could be huge rates of
unemployment, great political instability,
strife and a complete unraveling of
economy and society, and human ingenuity
may well find a way to deal with these
numbers it has in the past,
human ingenuity is wonderful but it's also,
like demographics, highly uncertain.
- [Narrator] Around the world in Japan the population
is careening in the opposite direction
of India's,
300 children once studied here in the elementary school
of Oguchi,
but once this lone fifth grader
graduates no new students will fill his
place because of a startling decline in birthrates.
- Never before in human
history has fertility fallen so far
so fast, so deep and so unexpectedly,
and no one should doubt that it is a revolutionary change.
- If you go back and you look in the 1960s there all these
horrendous titles books you know like
The Population Bomb and many more and you
find out that the primary source of
concern in the intellectual circles about
population was and in some places
continues to be the population explosion
and in all of the industrial countries
our overreaction potentially to this
this concern now has left us with just
the opposite problem.
- [Narrator] With crowded streets and packed trains
Japan hardly seems to be in need of any more people,
but if fertility stays at its low rate
of 1.3 children per woman by the end of
the century Japan's population of
126 million will shrink in half.
The impending decline has become a
national crisis with blame targeted
against the soaring numbers of unmarried youth,
called parasite singles they live
with their parents while pursuing
careers and other interests besides marriage.
- Japanese women in the 70s felt
that 25 was your last chance to get
married if you were 26 you'd be
a Christmas cake because December 25th is
the last day when a Christmas cake can
be sold and after that you're leftovers.
Now a woman will often delay marriage
until you know the last possible time
before she can have her first child this
is now seen by some as a kind of female
selfishness but I think women in general
are trying to do different things with their lives.
- [Narrator] Tomoko Omuro is a leading
television journalist,
at age 29 she became one of Japan's first female anchors.
(speaking foreign language)
- I think there are two doors for women.
One door has a ladder for promotion,
and the other one doesn't really have anything,
and you just stay on the same level forever.
And lots of women end up taking copies and serving tea.
And I didn't want to have that kind of work,
and I was looking for a good lifetime career.
- [Narrator] By age 37, Tomoko had become
an editor-in-chief, supervising a team of producers
and reporters.
Her husband of nine years often asked her
when they might start a family.
- Many companies in Japan still consider women
with children as a burden.
So, I was so scared to have a baby,
because I thought I would just drop out of the race.
So, I kept on just postponing it.
But when I turned 37 or so,
I started feeling like something was missing in my life.
- [Narrator] At 41, Tomoko gave birth to their daughter,
Asumi.
Her initial ambivalence about motherhood
is becoming increasingly common.
- [Translator] When I get married,
it might be better to have kids, but I don't worry about it.
- [Translator] If I get married,
I might think about having kids in my 30s.
- [Translator] If I am working, I can live on my own.
In the older times, marrying, for Japanese women,
was like a dependency.
It's not like that any more.
- [Narrator] But besides wanting careers,
there's another crucial reason that more women are working.
- In Japan, the economy since '89, '90
has been in a recession.
Japanese women often have to work to keep
their families middle class.
One income doesn't work for many families,
especially in terms of the costs of children's education.
It's an exceptionally expensive task to raise
a successful child in Japan.
- [Narrator] There's a saying that Japanese men live
at the office and commute to home,
often catching the last train, at midnight.
Now as more women join their husbands at work,
they're discovering that the long hours required
by most employers make having a family,
certainly a large one, difficult.
(speaking foreign language)
For Tomoko, it was a tough challenge to find
a daycare center that could look after Asumi
for 13 hours a day, given the unpredictable hours
of the newsroom.
For six months, her mother moved to Tokyo to help.
Now that she's gone, Tomoko agonizes at the thought
that her daughter may be asleep by the time she's picked up.
- If you are an executive, you can't say,
"Well, it's five o'clock, I'm leaving."
If there's work, you have to complete your work.
Right now I'm trying to figure out how to work with
my full ability, and at the same time just save
the time for my baby.
My husband, I know he's busy, maybe busier than I am.
Japanese people tend to work for long hours
and unless we change that kind of idea,
the declining birth rate is going to continue.
- [Narrator] Three hours from Tokyo,
near the elementary school of Oguchi,
one can glimpse the flip side of the country's
falling birthrates.
By 2050, one in three Japanese will be over the age of 65.
In Oguchi, this is already the reality.
Mr. and Mrs. Ohno's house was once packed
with three generations.
But since their parents died and their children
left for careers in the city,
life for this 80-year-old couple has become lonelier.
- [Translator] In the old times,
it was normal for a daughter-in-law to look
after her in-laws.
So that's why I took care of my father-in-law
until he died, at 83.
- [Translator] Our children have grown up
and gone to live in Tokyo.
They've all gotten married and have to worry
about sending their children to school.
That is their place now.
They have to work, and they can't afford to
come back here and look after us.
- The governmental query now is,
"Who cares for our elders?"
In essence, though, the government really feels that
families are responsible and society isn't.
And ultimately, when you say family, you mean women.
- [Narrator] But with more women working,
there's often no one at home to care for the elderly.
The stress on families is mounting,
especially since neither the government
nor private industry has been able to fill the gap.
If the Ohnos should get sick,
the only nearby nursing home is full.
To ensure their security in old age,
the Ohnos had counted on profits from their forest,
but as globalization brought in cheap timber
from the Philippines, they were unable to sell their trees.
- [Translator] I can't depend on my children,
so I don't know what to do.
It would be great if the government builds lots
of nursing homes and takes care of us,
but I don't have high expectations.
Staying healthy is the best thing,
but we can't stay healthy forever.
- [Narrator] Japan's population pyramid looks
like India's turned upside down,
reflecting how the elderly dramatically outnumber the young.
The Japanese now live longer than anyone else,
with men averaging 78 years and women 84.
- And with increasing education,
we find that disability rates among the elderly
have been dropping steadily. That is fabulously good news.
It's a revolution in human demography.
It means that people of 60 have the function
of people of 40 at the beginning of the century.
- [Narrator] But this good news is tempered by
a sobering reality in aging countries.
There will soon not be enough young people
entering the work force to support those retiring.
Not only will there be fewer workers,
but as the population declines,
there will be fewer consumers.
- It's going to be extremely hard for businesses to make
a profit.
And when businesses don't make a profit,
they don't pay taxes.
And when taxes don't get paid, you can't support
the welfare state.
And so the older countries face such
a huge problem financially that they really
could undermine the global economy.
- [Narrator] To keep its workforce from shrinking,
an aging country like Japan would need to take
in 600,000 immigrants a year.
Yet the Japanese resist, obsessed by preserving
their own ethnicity.
In stark contrast, America's workforce continues
to grow as a result of immigration.
- American fertility has been below replacement for about
35 years, but just barely below.
But we take in about a million immigrants a year.
And in the next 50 years, they and their children
are going to help America grow by about
a 100 million people, so we will be the only one
of the modern countries that will be growing,
and growing substantially.
- [Narrator] The United States is now the third
most populous nation, and will remain so for
the next 50 years, as our numbers climb from around 300
to 400 million people.
Economically, this growth keeps us vibrant.
Yet our productive economy also uses more resources
than any other nation and generates one quarter
of the greenhouse gases contributing to global warming.
In fact an American child will consume
and pollute more over a lifetime
than 30 children born in India.
Although population growth is delaying aging in the U.S.
our ranks of seniors will also increase as
the baby boom generation, one in four Americans, retires.
- No other country will see as large a percentage
increase in the elder population as the United States will,
because our baby boom was larger than anybody else's.
And yet we will continue to have lots and lots
of young people to support them, not enough to
keep Social Security solvent, but certainly enough
to make us a younger country compared to
the other developed countries.
- [Narrator] Across the industrialized world,
the average family size is now at or below two children.
This stunning change has slowed population growth,
yet it also signals the advent of global aging.
Confronted by the prospect of shrinking populations,
many countries now encourage couples to have more children.
Ironically, they're finding that it maybe easier
to cut fertility than it is to raise it.
A startling demographic divide now confronts us
as older societies shrink and age, while youthful ones reel
from rapid growth.
Nowhere is the contrast starker than in sub-Saharan Africa.
With families averaging around six children each,
it's one of the fastest growing regions in the world,
despite high death rates from AIDS.
- AIDS mortality is having a huge effect on population size.
Nevertheless, the age structure in sub-Saharan Africa
is so young that there will be so many people that still
need to pass thorough their reproductive ages,
that sub-Saharan Africa, even if it put the brakes
absolutely, today, on fertility rates,
its population would nearly double over this century.
- [Narrator] In 1950, sub-Saharan Africa had one third
as many people as Europe.
By 2050, this African population will be
triple the size of Europe's.
- Rapid population growth poses a real challenge to nations.
It taxes their educational system,
their infrastructures, their health system,
so, as a whole, it becomes a heavy burden on
an economy and a governmental system
that is not strong enough.
- And what does it mean for these countries?
It means falling per capita incomes,
it means deteriorating social services,
and it means conflict.
And these will create tremendous pressures to emigrate.
- [Narrator] Africa's population pressures will
not just create economic refugees, but environmental ones
as well.
To meet rising demands for food, fuel and shelter,
the continent's forests are disappearing
at the fastest rate in the world.
As countries struggle to obtain a decent standard of living,
natural environments are increasingly strained.
The degradation not only threatens Africa's unique wildlife,
but creates hardships for people who live off the land.
- And roughly a third of the people in the world still
earn their living not on a job,
but by growing things or catching them,
or by picking them up off the ground.
So if those ecosystems go down, those people are
in very bad shape.
And so that's the real risk, is that we're going
to degrade ecosystems past the point where
they can sustain life as we know it.
- [Narrator] Many African states have now embraced
family planning.
One of the oldest and most successful programs is in Kenya.
In the '70s and '80s, this East African nation was
the poster child for runaway growth.
But two decades of family planning cut fertility
from around seven to four children per woman.
- The number of children per woman has dropped dramatically,
partly as a result of their individual choices,
and partly because people have thought to provide
reproductive health services to make it possible for them.
- [Narrator] According to demographic models,
Kenya's falling fertility places it on
the threshold of a profound transition.
All countries start in stage one,
where high death rates from disease make high birth rates
a necessity to keep a population from being decimated.
- But then, as modernization begins,
the death rate falls but the birth rate does not.
So you have a large excess of births over deaths,
and the so-called population explosion.
- [Narrator] The challenge for every country
is to pass rapidly through this second stage,
and bring birth rates back into balance with death rates,
allowing the population to stabilize.
- Because if countries can't get through that stage quickly,
then the pressures of population growth may begin to
undermine their prospects of breaking out.
And if they don't break out, then the chances are that,
eventually, things will start breaking down.
- [Narrator] Just as Kenya stands ready to reap the benefits
of falling birth rates, the country is facing a stunning
demographic reversal.
For the first time in modern history, death rates are rising
not falling.
Six to nine percent of all Kenyans are infected with
HIV-AIDS, causing life expectancy to plummet from
65 to 49 years.
In Kenya, AIDS and population growth
have become tragically linked.
Nowhere is this more evident than in the slums of Nairobi.
Here, 21-year-old Florence Akinyi lives with
her relatives in a one-room corrugated shack.
What's surprising about her family is that
all six members are orphans.
At 16, Florence was thrust into taking care
of her four younger siblings after
their parents died of AIDS.
Then the disease killed her sister,
and Florence took in her three-year-old nephew.
- In fact, at times I always feel that it is a lot of
burden, but because I knew there is no one to take care
of them, I have just to do the duty now.
- [Narrator] Florence dropped out of school
and searched for ways to support her family.
But with few skills, her options were bleak.
- What happens with these young women when they
are forced to drop out of school,
very often with very basic elementary education,
they wind up on the streets.
And they sell their bodies in order to fend for themselves.
It is not uncommon to find that young women have
had sex with older men for something as simple as a meal,
something as simple as a bag of what we call chips.
- I always feel so bad because in order to get money,
from this, that is, you have to sleep with them,
and they pay you more when you don't use the condom.
And I needed money to survive.
- [Narrator] Eventually, Florence had to break the
news to her family that she, too, was infected
with the deadly HIV virus.
With treatment beyond her family's means,
her plight echoes a death sentence ringing across
sub-Saharan Africa.
Adults between the ages of 20 and 60 are being wiped out,
contorting the population pyramids of countries ravaged
by AIDS into a haunting shape,
with large numbers of children at the base,
disappearing adults in the middle,
and the few surviving seniors on top.
- AIDS is cutting a huge swath through
sub-Saharan Africa's strongest resources, its people,
its working-age people.
And that is imposing a huge burden in those countries.
There are currently 11 million orphans
in sub-Saharan Africa.
Never before in history have we seen such
a colossal burden as the number of orphans that will
overwhelm the capacity of the usual social institutions
that we have to deal with them.
- Africa is living in an utter catastrophe right now:
millions and millions of people dying of preventable
and treatable disease, millions of
children becoming orphaned.
Impoverished people can't face these challenges
on their own.
- [Narrator] Today the epidemic is spreading fastest
among women.
In fact, an African woman's greatest chance
for getting infected is within marriage
where condoms are rarely used when families
are hoping for children.
- Right now, a woman has to make a choice between having
a child or putting herself at risk of HIV infection.
And because of that, it is clear that
a prevention strategy for them is crucial.
- [Narrator] There may soon be a breakthrough that will
save women's lives.
At the Population Council in New York City,
scientists have discovered compounds that prevent
the HIV virus from infecting human cells.
Called microbicides, the hope is that they will
chemically block or kill the virus during intercourse.
The goal is to develop a vaginal gel that can protect
women from disease if their partners fail to wear a condom.
- Some of these products may also have the ability
to be contraceptive.
But I think the main issue is that a woman has control
over its use, she can decide when to use it.
- As we've seen in the family planning world,
it is women who primarily take responsibility
for protection, and if microbicides were actually
then made available to women, even if they
were 60% efficacious, not 100% efficacious,
even 60% efficacious, they could avert
millions of infections.
- [Narrator] In several sub-Saharan African countries AIDS
has reversed population growth.
But in most, births far exceed deaths partly because only
19% of women here use birth control,
in contrast to 61% of women worldwide.
Although more young people than ever will need family
planning, funding has not kept pace.
To complicate matters, the United States has blocked support
to clinics offering abortion related care or counseling,
even if U.S. funds are not used for these services.
As a result, many have closed.
- It is a tragedy because birthrates are not just
coming down just on their own, they're coming down
because women are accessing family planning services.
And when women can use contraception,
they do not need to have abortions.
- [Narrator] The toll of unwanted pregnancy can be seen
in the wards of Kenyatta National Hospital.
Half of all adolescent girls in the country bear children
by age 19.
Many don't have the means to care for their babies
and attempt illegal abortions.
- We've heard of young women using coat hangers,
knitting needles, detergent, overdosing
on anti-malarial medication.
By the time the young women show up at
a public health facility, very often they're bleeding,
they're septic, and they're traumatized.
- [Narrator] But the doctors here stress that there's
an obvious solution to this problem.
- Let's look at adolescent pregnancy,
let's look at abortion, and let's look at AIDS.
The reason why we say this is the common denominator
there is unsafe sex.
And this sexual activity is occurring in the absence
of accurate and reliable information,
and in the absence of services that would enable
them to deal with the consequences.
- And we know that there is an unmet need for family
planning, and that this will only grow.
Add to this that you now have more and more young people
entering their reproductive years,
and you can see that we're sitting on a time bomb.
- [Narrator] In contrast to most African nations,
Kenya has started its demographic transition.
Its fertility rates have fallen to around four children
per woman, although not yet as low as India's average
of three.
With fewer babies being born, a changing age structure
has opened up a rare window of opportunity
for both countries.
- India and Kenya have a huge population that's just getting
ready to enter the labor force,
the prime working years, the prime reproductive years.
If India and Kenya can keep fertility down,
those resources that would have otherwise gone to
children can be devoted to building up
the productive capacity of the economy.
- [Narrator] This strategy transformed the once poor nations
of South Korea, Taiwan, Singapore and Hong Kong.
As fertility fell, these governments took money once
spent on children and created jobs for young adults
entering the work force.
The economic gains of these Asian Tigers stunned the world.
- Economic growth in East Asia was not miraculous at all.
It was, fundamentally, a demographic phenomenon, and it's
a demographic phenomenon that can be repeated in other
countries like India and Kenya.
If they keep fertility down and invest in their
young working age people, India and Kenya have
an opportunity to escape the poverty trap that
have ensnared them for centuries.
- [Narrator] It took until 1800 for global population
to reach its first billion.
In two centuries, the numbers increased six-fold.
Our world is now headed towards a day of reckoning.
If fertility drops just below two children, by mid-century,
global population could stabilize
at around nine billion people.
- The key is the education and, really,
the liberation of women.
When women have more control over their lives,
then they'll have the number of children they want.
And all the evidence is that women want fewer children.
- Nevertheless, if women have even, on average,
half a child more than our expectation,
population could nearly double over the next 50 years.
And that would involve an increase of over five billion
individuals, which is historically absolutely unprecedented.
It took us over 200 years to add the last five billion
people and that could happen again, in less than 50 years,
going forward.
- [Narrator] With projections uncertain,
what will the demands for energy, food and water be
in the future?
How will the other species with whom we share
the planet fare?
The next few decades will be a critical time to ensure
the trend to smaller families and plan realistically
for global aging.
- Yes, there are huge challenges,
but the biggest risk we face of all is inaction.
We are not spectators to a world coming apart at the seams.
If we mobilize our skills and our incomes and our wealth,
even to a modest extent, we can help shift the world onto
a path that is one of shared prosperity,
that is one of environmental sustainability.
In the end, the choice is ours.
(calming music)
- [Narrator] On Nova's website delve deeper into the
issues raised in this program hear more
from the experts test your understanding
of global trends learn how you can get
involved and more find it on PBS.org.
(triumphant music)
Nova is a production of WGBH Boston,
major funding for Nova is provided by
the Park Foundation dedicated to
education and quality television
- [Man] we see teacher of the year, we see kids reaching
their potential it's what inspires us to
create software that helps you reach yours.
- [Woman] Science it has given us the
framework to help make wireless
communications clear, Sprint is proud to support Nova.
- [Man] Funding for World in the Balance
is provided by
Marguerite and Jerry Lenfest,
the John D. and Catherine T. MacArthur Foundation,
the Richard and Rhoda Goldman Fund
sponsor of the Goldman Environmental Prize
and the William and Flora Hewlett Foundation.
Major funding for Nova is also provided
by the Corporation for Public Broadcasting
and by PBS viewers like you, thank you.
(ominous music)
- [Narrator] In the elementary school of Oguchi, Japan,
the silence is more striking than the voices of children.
In a spacious classroom, commanding the undivided attention
of his teacher, 11-year-old Daiki Sato sits alone.
Since kindergarten, he's been the only student in his class,
because of a startling decline in birthrates.
By the end of the century, Japan's population is expected
to shrink by half, with one out of every three people
retired.
And Japan is not alone.
Over the next 50 years,
Europe is projected to lose 63 million people,
while Russia shrinks almost 20%.
As elders over 60 outnumber children under four,
the economic and social changes will be wrenching.
- We're talking about a society in the future that's never
existed in the past,
one that is literally an old folk's home.
So we know that the decline of many industrial
countries is already written in stone.
- [Narrator] Yet, rising longevity is not just transforming
the industrialized world.
More children in developing countries are surviving
than ever before.
Today, the largest generation of youth in history is
entering their reproductive years,
igniting an explosion of births.
As global population climbs from over six to nine billion,
the social and environmental strains will be enormous.
Our world is now careening in two completely different
directions as youthful nations reel from rising numbers
while old ones grapple with decline.
- You see a huge generation gap across countries emerging,
that's going to translate into a more polarized world
society, and those disparities
are potentially very destabilizing.
- [Narrator] Join us for a journey across four continents
as we peer into the demographic divide reshaping
our world and confronting us with stark choices for
the future.
World in the Balance, The People Paradox.
Up next, on Nova.
(triumphant music)
- [Man] Major funding for Nova is provided by,
the Park Foundation dedicated to
education and quality television.
- [Woman] Science, it's given us the framework to help make
wireless communications clear.
Sprint is proud to support Nova.
- [Man] We see an inventor,
at Microsoft your potential inspires us
to create software that helps you reach it,
your potential, our passion.
- [Man] Funding for World in the Balance
is provided by Marguerite and Jerry Lenfest,
the John D. and Catherine T. MacArthur Foundation,
the Richard and Rhoda Goldman Fund
sponsor of the Goldman Environmental Prize
and the William and Flora Hewlett Foundation,
major funding for Nova is
also provided by the Corporation for Public Broadcasting
and by PBS viewers like you, thank you.
- [Narrator] Deep in the heart of India,
towers the Taj Mahal, a lavish mausoleum built to honor
a queen who died giving birth to her 14th child.
It's a haunting symbol for a country that will soon surpass
China as the world's most populous nation,
with over a billion and a half people.
Beyond its walls, lies the urban sprawl of India's fastest
growing state, Uttar Pradesh, with more people than all
but four nations in the world.
Its population of 177 million is crammed into an area
the size of Colorado.
Every three years, its numbers swell by another 10 million.
Yet the rapid growth here masks a stunning success across
India, where fertility has plummeted from an average of six
children per woman to three.
This trend offers hope that India's population might stop
growing this century.
But the outcome depends on whether the northern states
can repeat the success of the south where birthrates
are almost as low as Europe's.
- And the south of India, of course, is very educated.
However, the opposite is the case in the north,
and that's where India's demographic future really lies.
In a state like Uttar Pradesh, where women average about
five children each in their lifetime,
and they have very high levels of illiteracy,
this is where the real battle for India's future
is going to be fought.
- [Narrator] If this battle isn't won within two decades,
India's population, instead of stabilizing,
could nearly double by 2050.
With U.S support, Dr. Ravi Anand has organized
a network of doctors across Uttar Pradesh
to offer healthcare and family planning.
- I would say this is our window of opportunity.
If we do not take all the measures that we can,
in every possible manner, to check the population now,
then India will never be able to tackle this problem.
- [Narrator] Yet Ravi is well aware that if progress is
going to be made, the lives of women here must improve.
In a nearby slum, she checks on a 30-year-old mother named
Gooday, who almost died delivering her eighth child.
She was rushed to the hospital unconscious,
after three days of obstructed labor.
- [Translator] So, now tell me,
I hear you had great problems with this birth?
- [Translator] Terrible problems.
The midwife that had delivered my other babies came,
but when she touched my belly she said,
this baby's life is in danger.
You must find the money to get to the hospital.
- [Narrator] After delivering a baby girl,
Gooday begged doctors to be sterilized,
but she was overruled by her mother-in-law and husband.
- She says she's petrified of another pregnancy
and childbirth, and she doesn't want to have another baby.
But she's the one who's least involved in this decision
making.
And that is why we counsel the husband
and the mother-in-law, because we call them
the gatekeepers to the health services.
- [Translator] So, I hear you want a second son?
- [Translator] I need at least one more.
- [Translator] You have only one son?
And isn't one son good enough for you?
- [Translator] He's 40 years old,
and he is the only son left alive.
- [Translator] And daughters?
- [Translator] I have three daughters,
but they've gone to live with their husband's families.
- [Translator] Listen, today,
one son is just as much as you may need.
- [Translator] I already had two daughters
when Abidi arrived at our house.
She saw that I was hungry and exhausted, and she asked me,
"Why don't you use birth control?"
I didn't know anything about it.
But I knew I didn't want any more children.
- [Narrator] Bimla was just the kind of girl Abidi
wanted to reach.
She told Bimla that she could legally use the pill,
even without her family's permission.
- [Translator] I was talking with my friend,
and my mother-in-law was listening from behind the door.
As soon as she left, my mother-in-law started yelling,
"You must have a son. Stop taking the pills."
Although she tried to beat me into submission,
I was sure I didn't want any more children.
I could see that large families were often poorer.
Their children didn't have clothes to wear,
or food to eat, that they played in dirt
and they didn't get an education.
- [Narrator] With help from Abidi, Bimla learned tailoring.
Soon she had enough money help her husband buy
a new house and send their children to school.
- The reality, in India, is that many,
many women are very empowered, but the majority are
disempowered.
So when women want to change the way their roles are
defined, they cannot do that if they're economically
vulnerable and dependent, because the price then is that if
you are left destitute, if you're abandoned, if you're
thrown out of the house, you have no way to survive if you
have no income.
So I strongly believe that one way forward,
to increase the momentum of social and cultural change,
is to allow women to have employment opportunities.
- [Narrator] Yet these opportunities may be hard to come by,
even as change sweeps across India.
To keep pace with its growing population,
the country must create six million new jobs a year.
But even its dazzling economic growth of 8%
is not enough to prevent unemployment,
already widespread, from rising.
And a new problem is looming as population pressures
confront a vast number of towns and villages
with chronic water shortages.
- In India, water tables are now falling in most states,
including the Punjab, which is the bread basket of India.
And this is making it more difficult to expand food
production at a time when the population is projected
to grow by another half billion by 2050.
- India faces really huge environmental problems
from rapid population growth, and it might have a hard time
growing enough food for itself.
On the other hand, it's becoming a center of software,
so if it makes a transition to becoming more of a high tech,
knowledge-based society,
then it probably could feed itself.
It has huge numbers of very smart, well educated people.
- So we have got such a large number of intellectuals in
every field that you cannot write off India and say,
oh, population growth will finish this country.
We'll be doomed.
There'll be no drinking water, no housing,
no nothing, no jobs.
Absolutely unreal, unscientific, it is drama.
- [Narrator] India is poised on a knife edge.
Headed in the right direction, it will still take years
to reach the coveted two-child family.
And what if the average family size turns out
to be slightly more?
- Suppose in India they really did achieve two children
per couple in, let's say, 15 years.
Then they would rise to about 1.6 billion by 2050.
But the key is, if couples have, on average,
about two and a half children,
India would get its second billion by the middle
of this century.
- [Narrator] And the same is true for the world.
A common Hindu wedding blessing prays that a wife will bear
eight sons, but if she doesn't have any,
there could be a price to pay.
And that's why Manisha tried to intervene early.
The most shocking proof of what can go wrong are the brides
who've been doused in kerosene
and set ablaze by angry in-laws or husbands.
An estimated 25,000 women are killed or maimed each year
over dowry and domestic disputes or
even their failure to produce a son.
- Bride burning is common in India.
And since women are so dispensable, and these young,
little girls, you know, between the ages of 15 to 24
are the most vulnerable, girls will get burned,
they will get poisoned.
And so, therefore, a girl in the husband's house,
at least for the first 10 or 15 years,
always walks on a tightrope.
- [Narrator] Gender discrimination takes place even among
the wealthy.
Upper class parents, committed to a two-child family,
have sonograms to make sure that they've conceived a son.
Although this doctor refuses to reveal a fetus's sex,
not everyone is as ethical.
Millions of females are aborted, leaving India
with 35 million fewer women than men.
- There was an article saying that better dead than burned,
meaning that it's better that you have sex determination
rather than be burned in your in-laws' household.
And the newspaper asked me to write a rejoinder,
and I wrote a rejoinder saying, neither dead nor burned.
- India wants to reduce population growth,
but it certainly doesn't want to reduce it through
sex-selective abortion.
In fact, it is actually illegal now to test to see what
the gender of a fetus is.
But I think the single most important thing India can do
today, demographically, is to somehow make the birth of
a girl child as welcome as the birth of a boy child,
because the goal of most developing countries is
to reach this magical two-child family.
- [Narrator] Abidi Shah, a social worker,
has seen that when women have greater access to education
and job training, their status rises.
16 years ago, she visited a village on the outskirts
of New Delhi.
Dismayed by the plight of young girls there,
she decided to act.
- There wasn't any sense among the girls of the adolescence,
because they had lost their childhood already.
They had to look after their younger brother and sister.
They had to cook the food.
They had to clean the house.
They had to fetch the drinking water.
No education for them, no food for them,
no clothing for them.
- [Narrator] First Abidi had to convince a skeptical
community to let her teach vocational
and health classes to adolescent girls.
Next, she had to show the girls themselves
how education could improve their lives.
- I just said, do you want same life as you are living here?
They said, no, I want better life.
"What sort of life do you want?"
"The life I see on the TV. The life you are living."
So I said, "Then what will you do?"
"We can't do anything. That's our luck, that's our destiny."
I said, "No. This is not your destiny.
"You can change your life."
- [Narrator] One young woman who attended the program
was Bimla.
At age 13, her father had arranged her marriage
and forced her to drop out of school.
- One of the major reasons for the family size
to be really large in Northern India is the son preference,
because it's the son who stays with the family,
and he's expected to look after his old parents.
And girls are always considered as,
somebody else's asset, not mine.
- But the point is the strategy of survival demands
that you must have one or two sons, otherwise you will
be left high and dry, not only in the old age,
throughout your life.
- [Narrator] Having a second son raises the odds for
Gooday that at least one boy will survive,
especially since one in 10 children in Uttar Pradesh
die before age five.
Gooday has lost three infants.
Ravi urges her to bring her children to the clinic for
vaccinations.
If the family trusts their son will survive,
the pressure to bear another may ease.
- Women in India really don't have control over their
reproductive lives because all sexual reproductive health
decisions are essentially made by men.
And so you can't deal with an issue like population by
itself.
You have to look at the issue of infant mortality, literacy,
or women's status, because it's all very interlinked.
This is a patriarchal society.
And I think gender lies at the heart of the problem, really.
- [Narrator] On the edge of the Deccan Plains,
barefoot children walk towards their school in
the rural village of Saswad.
The daily rhythm of life here masks an unusual event
unfolding in the heart of the village.
Newly married couples play games to get to know each other
as they wait to have their wedding portraits taken.
The gathering has been organized by social worker
Manisha Gupta to help young men and women bridge
India's stark gender divide.
- In a traditional Indian society,
95% of marriages still are arranged marriages.
And most often than not, the bride and the groom are
strangers to each other.
And one would say that there's a 50% chance of things
going wrong in a rural marriage where it's arranged,
and she's barely 15 or 16, and he's not much older.
And we're talking of, really, adolescents,
who are building a life and having children.
It's not an easy job.
- [Narrator] Social taboos pushed aside,
girl and boys in separate groups
hear frank talk about sex and how to use birth control.
The stakes are enormous.
The age structure of India's population resembles a pyramid,
with vast numbers of youth at its base.
Half the country, mirroring the world at large,
is under 25 and reaching reproductive age.
If couples in this generation have only two children,
in effect replacing themselves,
population growth will soon halt.
Yet for Manisha, it's far from clear if India's youth
will follow this radical trend and throw off
the shackles of tradition.
As they pose for their portraits,
she asks them how many children they want,
if the gender matters, and how they feel
about birth control.
- A lot of the couples said that they'd be happy with two
children.
And we said, "What gender?"
And they said it doesn't matter.
It's very nice of them to say it.
10 years ago our people wouldn't have even said it.
But I'm not really sure what would happen in
the household if there were just two daughters.
- [Narrator] Daughters are seen as an economic liability
because parents must provide a dowry of cash or gifts to
marry them off.