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World in the Balance: The Population Paradox It took all of human history until the year 1804 for our population to reach its first billion. Now a billion new people .

(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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- [Man] We see an inventor,

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- [Man] Funding for World in
the Balance is provided by

Marguerite and Jerry Lenfest,

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T. MacArthur Foundation,

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sponsor of the Goldman Environmental Prize

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major funding for Nova is

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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.