Foreword.(international family and reproductive health status)

Few women or men would not sacrifice their life to save that of their child. For most adults, the birth of a child is a wondrous occasion, and nurturing their children is their most precious and rewarding activity. Yet, as has always been true, some men and women are eager to escape the responsibilities and consequences of parenthood. Men, for example, may abandon their children under the stress of poverty and ignore offspring they have fathered out of wedlock. Women in desperate situations often choose to risk their lives to avoid having a child; many perish in the attempt.

These apparent contradictions do not negate the universal recognition of the joy, hope and sense of continuity--some would say immortality--that children bring to our lives. Nor do they negate the bonds of support, affection and intimacy that have characterized families, whatever form they have taken over the millennia or take in today's diverse world. Rather, these contradictions illustrate the powerful effects of societal and personal circumstances on individuals' desire to have and care for a child and on their need for a family. Certainly, culture, tradition, religion and economic conditions play important roles in these matters. So, too, do the educational, economic and social standing of individual men and women and their perceptions of the opportunities and options available to them and their children.

Nowhere is this better illustrated than in the revolution in childbearing aspirations that has occurred throughout the world during the last century. In the industrialized countries, the spread of education, the slow but steady improvements in health conditions and the improved status of women gradually led to substantial reductions both in the number of children individuals want and in the actual size of their families.

In the less-developed world, by contrast, the pace of change in desired family size has been dramatic in its swiftness and scope. Although fertility has just begun to decline in some countries and regions of the world--usually the poorest and most troubled--and population growth rates in many countries remain alarmingly high and are a cause for both national and global concern, the trends are clear: Individuals want fewer children, and birthrates are declining.

These changes are occurring not because men and women value children and families less now than they did in the past. Indeed, it may be just the opposite. Caught in the throes of massive economic and social changes, they have concluded that it is not only in their best interest, but also in the best interest of their ...