II. NORMATIVE APPROACHES

Population policies raise profound questions of ethics. Is China justified in using coercion to enforce its policy of one child per couple? Is it legitimate for government officials and community peers in Indonesia to apply strong pressure to promote birth control? Should U.S. judges be free to require the insertion of Norplant, a long-lasting, subdermal contraceptive, when sentencing women they consider unfit to be mothers (Feringa et al.)? Do the wealthiest nations of the world have a moral obligation to accept refugees from poor countries?

Answers to such questions require ethical principles applicable to population policies across all countries and cultures. Principles that reflect the standards of only one country or region, such as the United States or Europe, may not persuade leaders and peoples of other countries.

Three schools of thought have guided debates on these principles. The first argues that government programs of any kind must respect human rights as stated in the Universal Declaration of Human Rights adopted by the United Nations in 1948; the International Covenant on Economic, Social, and Cultural Rights (1976); the International Covenant on Civil and Political Rights (1976); and many related U.N. statements (Nickel; Claude and Weston). A second school holds that the morality of population interventions must be determined by the country that carries them out, for it has the problem and best understands how to deal with it. This school accepts no universal standards of human rights. It considers attempts by others to impose such standards to be infringements on national sovereignty. The third school recognizes some or all of the human rights affirmed by the United Nations, but claims that when population growth or density create desperate economic or social problems for a country, its government has the right to limit individual reproductive freedom for the common good.

This article develops a framework of ethical principles based on the Universal Declaration of Human Rights, later U.N. statements on human rights, and regional declarations on the same subject, particularly the European Convention on Human Rights. It then applies those principles to population policies. It concludes by contrasting this approach with another ethical framework known as "stepladder ethics."

Five Key Principles

Ethical evaluation of population policies requires five principles to guide decisions as well as criteria for determining when one principle can be sacrificed for another.

Life heads the list, for without it people cannot benefit from the other four principles. Article 3 of the Universal Declaration of Human Rights states: "Everyone has the right to life, liberty and security of person." The International Covenant on Civil and Political Rights is more specific: "Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life" (Part III, Article 6).

Life means not only being alive, but enjoying good health and having reasonable security against the actions of others that cause death, illness, severe pain, or disability. Policies on fertility control, migration, and refugees threaten this principle when they take no action to assist people facing starvation or slaughter and when they create incentives for female infanticide (Aird; Brown and Shue). Policies endanger health when they promote methods of fertility control, such as sterilizations, oral contraceptives, the intrauterine device (IUD), or injections, that can pose grave risks to physical well-being. Among such risks are cardiovascular diseases, tubal infertility, pelvic inflammatory disease, and septic abortion (National Research Council, 1989; Schearer). Fertility-control programs may also damage the health of users when they overlook sexually transmitted diseases, such as gonorrhea, or other reproductive-tract infections, including genital herpes, chancroid, genital warts, vaginal infections, and infections of the upper reproductive tract (Dixon-Mueller and Wasserheit).

Freedom is the capacity and opportunity to make reflective choices and to act on those choices. Freedom requires knowledge about the choices available, such as options for fertility control or migration; a chance to make choices without coercion or strong pressure from others; awareness that one is making choices and of the issues at stake in each; and the possibility of taking action to carry out the choices made (Warwick, 1982, 1990; Veatch). Restrictions on any of these conditions, such as ignorance of options, decisions made while an individual is being tortured, or barriers to acting on choices made, void or limit freedom.

U.N. statements strongly endorse freedom. According to the Universal Declaration, everyone has the right to freedom of thought, conscience, and religion (Article 18); freedom of opinion and expression (Article 19); freedom of peaceful assembly and association (Article 20); freedom from slavery and servitude (Article 4); and freedom from arbitrary interference with privacy, family, home, or correspondence (Article 12). Both the International Covenant on Economic, Social, and Cultural Rights and the International Covenant on Civil and Political Rights open with this statement: "All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social, and cultural development" (Part I, Article 1, in both covenants). In the World Population Plan of Action developed at the World Population Conference in 1974, delegates agreed to the following statement on reproductive freedom: "All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so …" (World Population Conference, p. 7).

Welfare means a standard of living adequate to provide food, clothing, housing, healthcare, and education. Affirmed in Articles 25 and 26 of the Universal Declaration, this standard was both repeated and broadened in the International Covenant on Economic, Social, and Cultural Rights. That statement spoke specifically about the right to continuous improvement in living conditions; the steps needed to protect the right to be free from hunger; the right of everyone to the highest attainable standard of physical and mental health; the widest possible protection and assistance for the family; special protection for mothers before and after childbirth; and protection of children and young persons from social and economic exploitation, including work that threatens their lives or is harmful to their morals and health. The World Population Plan of Action of 1974 also explicitly tied population policies to human welfare: "The principal aim of social, economic, and cultural development, of which population goals and policies are integral parts, is to improve levels of living and the quality of life of the people" (World Population Conference, p. 7). Population programs, therefore, should not aim only to raise or lower fertility, reduce mortality, or control migration, but to be instruments for promoting human welfare.

Fairness refers to an equitable distribution of the benefits and harms from population policies. It does not require an equal distribution of benefits and harms, but it does demand that one individual or group should not receive disproportionate advantages or disadvantages from a given policy. The Universal Declaration strongly endorses fairness in Article 1: "All human beings are born free and equal in dignity and rights." Article 2 continues: "Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status." The 1967U.N. Protocol Relating to the Status of Refugees established principles for determining fairness in refugee and immigration policies.

In 1972, Ugandan President Idi Amin Dada ordered the expulsion of between 40,000 and 50,000 Asians living in Uganda. His action is an extreme example of the unfairness seen when the costs of population policy are borne by a single ethnic group. India's use of coercion to promote sterilization among beggars and other poor people between 1975 and 1977 was another case of unfair policy implementation (Gwatkin). Other examples include the testing only in low-income areas of contraceptives designed for all women (Holmes et al.), and failing to tell uneducated candidates for sterilization how this operation is carried out, what it means for fertility, and what medical risks and side effects accompany it. In each of these cases the political, economic, social, and medical harms of population interventions fall more heavily on one group than another.

Truth telling requires accurate information about population policies and avoiding lies, misrepresentations, distortions, and evasions about their content, implementation, and consequences. Though truth telling is not explicitly stated in U.N. declarations of human rights, it is a prerequisite for the other four principles cited. Lies about policies of fertility control, migration, and refugees can jeopardize human life when they involve fatal risks, such as death from infections or from being shot in enemy territory. They limit freedom by depriving individuals of the knowledge necessary to make an informed choice, such as information about the side effects of sterilization. Lies harm welfare when they cause risk to one's income, education, or job prospects, and they violate fairness when they are more likely to be told to one group, such as the poor or an ethnic minority, than to others.

Life, freedom, welfare, fairness, and truth telling can conflict with each other. Faced with what they see as excessive population growth, government officials may claim that the common welfare demands restrictions on reproductive freedom and allows distortions of the truth, such as not disclosing the medical risks of contraceptives, in order to make birth control seem attractive. Also citing the national interest, political leaders may decide to exterminate members of a specific religion, such as Jews in German territory during World War II; expel an entire ethnic group from the country, as happened in Uganda; or put severe limits on the entry of immigrants they define as hostile to the national interest, as happened when the U.S. government used ships to block the entry of Haitian refugees in the early 1990s. All three policies subordinate fairness toward religious and ethnic groups to local definitions of the common welfare. Are such policies justified, or are there some principles that cannot be sacrificed to promote others?

The Universal Declaration puts no relative weights on the many rights it endorses. However, later agreements do set priorities among rights. In Article 15, the European Convention on Human Rights states that even in national emergencies, governments cannot use murder, torture, degrading punishments, slavery, or servitude. These rights thus hold the highest rank. Nothing, including government concerns about the damage due to population growth, can override them. The International Covenant on Civil and Political Rights, drafted after the European Convention, accepts all the rights that the Convention declares immune to being overridden and adds others, particularly freedom of thought, conscience, and religion. Henry Shue (1980) and James Nickel (1987) suggest comparable criteria for weighing human rights while Sissela Bok (1978) discusses the value of truth telling and the conditions under which it may be suspended.

Application to Population Interventions

The viability of any framework of population ethics depends on its ability to illuminate right and wrong in specific policies, strategies, and sets of actions. Policies set the directions for population interventions, strategies show the broad plans for following those directions, and actions indicate what happens in the field, whether intended or not. The ethics of the three are not necessarily the same. Policies may be stated in humane terms and yet be accompanied by strategies that are coercive. Strategies can be expressed in benign language but, through deliberate initiatives or neglect, lead to field actions that compromise truth, limit freedom, damage human welfare, and in extreme cases, threaten life. Ethical analysis must pay close attention not only to official statements of policies and strategies, but also to how the programs they generate are carried out.

The five ethical principles will now be applied to three examples of interventions begun by population policies. In each case the aim will be to lay out the key principle or principles involved and to indicate how apparent tensions among principles might be resolved.

THE "POPULATION PROBLEM." Population policies usually begin with some notion of a problem. For strong advocates of fertility control, such as Paul Ehrlich and Anne Ehrlich (1990), the problem is captured in phrases such as "the population bomb" or "the population explosion." According to others, particularly Julian Simon (1981), population growth brings many benefits to society, including the stimulation of human creativity. And for some, fertility, migration, and refugees are complex phenomena that must be carefully studied and that may produce no catchwords that draw public attention.

Any definition of a population problem, or a statement that there is none, must be governed by the principle of truth telling. Those claiming a problem exists should indicate the good promoted or the evil created by fertility, migration, and refugees. What, precisely, has population done to make it qualify as a problem or a nonproblem?

Statements of a problem should also give a fair summary of the evidence bearing on the subject and its limitations. If the findings are drawn from simulations, or cover a small sample of the countries in the world, those points should be disclosed. Scholars violate truth telling when they say or imply that simulations done through a hypothetical model of reality are equivalent to data on what people or organizations actually do. Further, when scholars who write on population work for or are funded by organizations promoting or trying to prevent action on population, such as the World Bank or a right-to-life committee, can it be determined whether they have remained objective or have taken on the advocacy role of their sponsors? If scholars have merged research and advocacy, do they indicate where research stops and advocacy begins? Truth telling requires that all relevant information be presented, even when it may harm one's active endorsement of a policy.

Claims that a problem exists must next show the specific connection between research evidence and the good or evil that makes it a problem. That connection often proves elusive. Data showing that the poorest nations of the world have the highest fertility and the wealthiest nations the lowest fertility may seem to establish a link between population growth and economic development. Indeed, such data are commonly used to support claims of a "population bomb." Yet many studies have failed to show that rapid population growth holds back economic development in the industrialized or developing countries, and a few suggest that it may have advantages (Boserup; National Research Council, 1986). To meet the standard of truth telling, scholars should not, as often happens, cite only those studies that support the view of a population problem to which they subscribe and omit contrary evidence.

USING COERCION. China has used coercion to force some of its citizens to limit fertility. Coercion means using or threatening to use physical force or severe deprivation in order to make people do things they would not normally do. Governments apply physical force when they order armed police or military officers to take citizens against their will to clinics that perform abortion or sterilization, or when they credibly threaten with torture couples who have more than two children. They use severe deprivation when they require that poor citizens be sterilized before they can obtain a job or receive food supplies necessary for their own and their family's welfare; warn that parents with more than a certain number of children will be put in prison or have their houses demolished; or use other threats that carry serious risks to life, health, and welfare.

China has relied on coercion to carry out its one-childper-couple policy (Aird). The Chinese government claims that its policies are voluntary, but its pressure on field workers to meet their targets, particularly in cities, has led to coercive implementation. According to Tyrene White: "Beijing's penetration to the household is awesome. In 1979 mobilization campaigns for 'voluntary' sterilizations, abortions, and adoption of contraceptive measures were widespread, and the fine line between persuasion and coercion was crossed frequently" (p. 315). Two other scholars comment: "During 1979 and in some subsequent years, in some urban areas and provinces, women pregnant with a second or higher order child were required to abort the pregnancies. Instances of mandatory sterilization were also reported" (Hardee-Cleaveland and Banister, p. 275).

China's use of coercion and heavy pressures to reduce fertility has, from indications, led to female infanticide and adoption (Johansson and Nygren). In traditional China, men had the basic duty of continuing the descent line of their fathers by having a son. This boy could carry on the family name, support his parents in their old age, and inherit their property. Failure to have a son showed ingratitude to one's ancestors and discredited men in their own communities. This tradition has continued to the present. If a man's only child is a daughter, he and his neighbors may feel that he has not fulfilled one of his most basic duties in life. Yet a successful one-child policy would mean that many males could not have a son. Demographic analysis strongly suggests a clash between a couple's normal desire to keep and raise their daughters and the limits on having sons imposed by the country's policies on fertility control.

Terence Hull (1990) shows that in 1987 the sex ratios in China—the number of males per 100 females—were nearly 111, compared to an earlier reference norm of 106. Using comparable data, Sten Johansson and Ola Nygren (1991) estimate that from 1985 through 1987 the average number of missing girls (those normally expected to be in the population but, in fact, missing from it) was about 500,000 per year or 1,500,000 for those three years alone. These authors and others writing about the many millions of missing girls in China attribute this phenomenon to the one-child-per-couple policy. They offer four possible explanations: infanticide caused by deliberate actions of the parents or neglect leading to fatal illnesses; a higher proportion of abortions for female than male babies; births not properly registered with the authorities, usually because they were beyond the local quota for couples; and the practice of offering female children for adoption. The evidence offered by Johansson and Nygren suggests the presence of excess female infant deaths, whether from infanticide or other reasons; unregistered babies; and female adoption.

China's coercive policies show the severe tensions between limiting population for the common good and life, freedom, and fairness. If, in response to the one-child norm, Chinese couples have used female infanticide to raise their chances of having a son, compulsion clashes with the infant girl's right to life. Government officials may say that they never intended to encourage infanticide, but that statement does not absolve them of responsibility for the deaths that take place. A full ethical analysis of policies must take account not only of official declarations and intentions, but also of the actions to which they lead. If, as seems to be the case, the policy of one child per couple has led to infanticide, by U.N. standards of human rights this sacrifice of life cannot be justified by the argument that China's overpopulation demands stringent control of fertility. In social policies, life holds such a high value that it cannot be traded off for even the most compelling public claims.

Coercive policies also put unjustifiable limits on human freedom. Unlike life, freedom can be and often is restricted for the common good. Laws, tax regulations, and many other policies indicate what individuals and groups must and must not do. But forcing citizens to undergo sterilizations or abortions that they do not want, as has happened in China, violates the principles of liberty and human dignity endorsed in all U.N. declarations of human rights. The moral question is not whether individuals should be totally free to set their family size—which they are not in any country or culture—but whether some limits on reproductive choice violate human rights. Using force to promote small family sizes does violate those rights.

China's population interventions further raise the question of fairness. Policies leading directly or indirectly to female infanticide, the abortion of female children, or female adoption put a far heavier burden on girls than boys. Abortion and infanticide mean that, through the decisions of their parents, girls stand a lower chance than boys of being born or of surviving to be adults. With adoption, young girls survive but do not have the same opportunity as male children to be raised by their parents. All three outcomes violate fairness by providing more benefits to boys than to girls and more harms to girls than to boys.

INADEQUATE MEDICAL SUPPORT. Fertility control programs in low-income countries sometimes lead to a conflict between efficiency in delivering services and healthcare for those receiving the services. To raise efficiency, program managers may insist that field workers meet the targets set for them and threaten with severe punishments those who do not comply. During India's birth-control campaign between 1975 and 1977, which relied heavily on forced sterilization, the Chief Secretary of the state of Uttar Pradesh sent this telegraph to his subordinates: "… Failure to achieve monthly targets will not only result in the stoppage of salaries but also suspension and severest penalties. Galvanise entire administrative machinery forthwith and continue to report daily progress by … wireless to me and secretary to Chief Minister" (Gwatkin, p. 41).

Managers and staff working under such pressures often provide little or no health support for those receiving their services. In India during the period mentioned, hundreds of men died from infections that developed after hastily performed sterilizations with no medical follow-up (Gwatkin, p. 47). Other health hazards caused by fertility-control methods include severe, and sometimes fatal, upper reproductive-tract infections among women not properly screened for the intrauterine device; medical complications produced by using the Dalkon shield and high-dose oral contraceptives in developing countries when their risks were well-known in the United States and Europe; reproductive-tract infections among thousands of women in poor countries; and disruptions of the menstrual cycle, heavy bleeding or spotting, weight gain, depression, headaches, dizziness, fatigue, bloating, or loss of libido among women using the injectable contraceptive Depo-Provera (National Research Council, 1989; Schearer).

Ethical Responsibilities of Fertility-Control Programs

Given these risks to life and health, officials responsible for fertility-control programs face three questions of ethics. The first question concerns the amount of information about the hazards of a particular method that should be disclosed by program staff to their clients. With heavy pressure from their superiors to meet their targets, field workers often emphasize the benefits of a method and conceal its risks. This practice violates the principle of freedom, which requires that clients have reasonable information about risks and benefits to make an informed choice about fertility control. Even when clients cannot grasp sophisticated explanations of medical hazards, they can be told what is at stake in language that they understand. When the risks not disclosed are serious, clients may also face threats to their life, their health, or their welfare.

The second ethical question concerns the adequacy of health services to deal with the hazards created by methods of fertility control. Some argue that, given the severity of the population problem, governments are morally justified in operating fertility-control services well ahead of health-support services. Others, particularly groups supporting the rights of women in family-planning programs, claim that this strategy not only violates human rights but produces a backlash against birth control. Clients who have not been told of any possible side effects or complications from the methods offered and who then suffer poor health can retaliate in many ways. They may discontinue the methods they have started, accept a method but not use it, start rumors about the physical dangers of birth control, stay away from family-planning clinics and field workers, enlist religious leaders or political parties to make fertility control a political issue, vote against the government in the next election, or, if they are truly angry, riot against the government in power. Many of these reactions followed India's use of coercion between 1975 and 1977.

The third ethical question is fairness in the distribution of medical harms and benefits among individuals and groups. This issue arises in the testing as well as the distribution of fertility-control methods. Beginning with the contraceptive pill, whose main evaluation was carried out in Puerto Rico, drug companies have often tested new methods of fertility control on poor individuals in developing countries. Government regulations on testing in those countries have been far less strict than in the United States. Moreover, the low-income individuals chosen for the testing asked few questions about what was being done and were unlikely to mount political protests or begin lawsuits to receive compensation for damage to their health. During the distribution of fertility-control methods, poor individuals in many countries likewise have received less adequate explanations and suffered more health hazards than those with higher incomes. As one example, for many years the U.S. government, citing health risks, banned the domestic use of the injectable contraceptive Depo-Provera. But it saw no problem including Depo-Provera as part of the contraceptive services in poor nations supported by U.S. foreign aid.

Four ethical guidelines help to resolve these conflicts. First, no program should knowingly threaten the life of its clients by using methods that can cause death or by failing to provide health services. If, as happened in India, sterilized males apply animal dung to areas of pain, and if that folk remedy proves fatal, fertility-control programs must take all possible steps to prevent its use.

Second, programs must offer healthcare for all users of methods with serious medical risks. In its villages, Indonesia has developed a simple system of healthcare often located in the home of the village head or another resident. Should clients show symptoms that cannot be treated there, they are referred to the nearest health clinic or hospital.

Third, clients must be told, in words they understand, about the risks as well as the benefits of fertility-control methods. To deny potential users information about risks unjustifiably limits their freedom of choice. Explanations need not be elaborate to be accurate, but they must be given.

Fourth, the distribution of risks and benefits from fertility-control programs should be fair, though not necessarily equal. Poor persons should not be the main candidates on whom fertility-control methods are tested, nor should some groups of citizens receive adequate health support while others receive little or none.

To promote user freedom and welfare, program designers and field workers can be trained to adopt the standards of quality suggested by Judith Bruce (1990). Quality care requires technical competence that gives accurate information to users in language they understand; informed consent that shows sensitivity to concerns about modesty among women and girls; pain management; and continuous rather than one-time service to clients. Instead of aiming only to avoid violations of human rights, which might attain that goal but result in mediocre care, staff can be taught to seek high client satisfaction with fertility-control services.

Stepladder Ethics: A Contrast

Ethical principles based on internationally accepted standards of human rights contrast sharply with the stepladder ethics proposed by Bernard Berelson and Jonathan Lieberson (1979). Berelson was president of the Population Council, a visible center of research, training, and advocacy on population policy, and Lieberson was a philosopher who served as adviser to the Population Council and taught at Columbia University. These two authors commanded attention and respect, and their article was the first and last systematic analysis of ethics to appear in Population and Development Review, the leading journal on population policy.

Berelson and Lieberson offered this pivotal statement about population ethics: "Employ less severe measures where possible and only ascend to harsher measures if the problem at hand, as a matter of (established) fact, is clearly grave enough to warrant it" (p. 596). They continued: "… The degree of coercive policy brought into play should be proportional to the degree of seriousness of the present problem and should be introduced only after less coercive means have been exhausted. Thus overt violence or other potentially injurious coercion is not to be used before noninjurious coercion has been exhausted" (p. 602). Their moral stepladder involves beginning with voluntary policies and, if they fail, moving up the scale of pressure on people to the point justified by the seriousness of the population problem. They do not mention fertility-control measures involving threats to life, but, by their logic, governments facing exceptionally severe problems from population growth would be allowed to use those methods as well.

The authors state that they are writing out of a Western, individualistic mode, and recognize that other countries draw ethical principles from different philosophical and political traditions. They do not mention U.N. declarations on human rights, or the widely varying views of the world's religions on methods of fertility control. They apply their Western code to the strategies adopted by countries whose local standards are very different from their own. Leaders in countries populated by Catholics, Buddhists, and Muslims, for instance, might vigorously challenge the principle of allowing governments to use any form of coercion in limiting fertility. Stepladder ethics provides no means of developing cross-national ethical principles whose morality derives mainly from religion or from assumptions that differ from those of the authors, including human rights.

Stepladder ethics thus differs greatly from principles based on universally accepted human rights. Norms such as life, freedom, fairness, and welfare provide a basis for developing ethical guidelines for population policies that apply to every society. Like all ethical principles, those norms need clear definition and are often violated in practice, but they open the way for discussion among persons from diverse political systems and religious traditions and beliefs.

Conclusions

To be applicable to the hundreds of countries and cultures across the world, population ethics must be based on widely shared norms. Principles drawing on the assumptions of a single society or culture will often be rejected by those from other backgrounds. Moreover, to be viable in helping decisions about population policies, the principles chosen should have priorities assigned to them. They must be able to answer one of the most challenging questions in ethics: Is it morally acceptable to sacrifice one principle, such as life, for another, such as the common welfare?

This entry proposes four principles based on international declarations of human rights: life, freedom, welfare, and fairness. It adds truth telling as a fifth principle valuable in itself and necessary in reaching the other four. When these principles clash, life receives first priority. In contrast to stepladder ethics, which grants no human rights, the ethical framework proposed here bans any method of population control with serious risks of death or those relying on torture, slavery, servitude, or other degrading punishments.

If adopted, this ethical framework would have the same advantages and limitations as all universal codes of human rights. The main advantage is that it can be used to educate policymakers and field workers on what is and is not morally acceptable in population programs. When a program violates its standards, U.N. organizations, including the Commission on Human Rights, or private groups, such as Amnesty International, could document the abuses of human rights and demand more humane policies or practices. As has already happened, universal codes can also stimulate geographic regions, such as Europe and Latin America, or major religions to examine human rights from other perspectives. S. M. Haider (1978) and his associates, for example, found many parallels and some differences between Islamic teaching and the Universal Declaration of Human Rights.

The key drawback to this framework is that, like other declarations of human rights, it might be viewed as noble in the abstract but unworkable in practice. Critics could say that it embodies foreign rather than national standards and takes no account of the difficulties with population control that face an overcrowded nation. Even so, it would give local and international advocates of human rights criteria that could be used to develop political and moral pressure to end abuses such as forced sterilization and abortion. And it would avoid the charge, leveled against stepladder ethics, that its ethical standards derive from one country or region, such as the West.

A normative framework based on internationally accepted standards of human rights offers no simple answers to the complex ethical difficulties found in population programs. It does, however, provide a foundation for discussing morality among those who hold widely different views about politics, religion, ethics, and culture. Without that foundation there will never be any serious analysis or lasting agreement about what should and should not be done in population policies and programs.

donald p. warwick

SEE ALSO: Abortion; Adoption; Coercion; Embryo and Fetus: Religious Perspectives; Eugenics and Religious Law; Genetic Testing and Screening; Infanticide; Feminism; Fertility Control; Freedom and Free Will; Harm; Infanticide; Informed Consent; Justice; Life; Natural Law; Race and Racism; Rights, Human;Sexism; and other Population Ethics subentries

BIBLIOGRAPHY

Aird, John S. 1990. Slaughter of the Innocents: Coercive Birth Control in China. Washington, D.C.: AEI Press.

Berelson, Bernard, and Lieberson, Jonathan. 1979. "Government Efforts to Influence Fertility: The Ethical Issues." Population and Development Review 5(4): 581–613.

Bok, Sissela. 1978. Lying: Moral Choice in Public and Private Life. New York: Pantheon Books.

Boserup, Ester. 1990. Economic and Demographic Relationships in Development. Baltimore: Johns Hopkins University Press.

Brown, Peter G., and Shue, Henry, eds. 1981. Boundaries: National Autonomy and Its Limits. Totowa, NJ: Rowman & Littlefield.

Bruce, Judith. 1990. "Fundamental Elements of the Quality of Care: A Simple Framework." Studies in Family Planning 21(2):61–91.

Claude, Richard Pierre, and Weston, Burns H., eds. 1989. Human Rights in the World Community: Issues and Action. Philadelphia: University of Pennsylvania Press.

Dixon-Mueller, Ruth, and Wasserheit, Judith N. 1991. The Culture of Silence: Reproductive Tract Infections among Women in the Third World. New York: International Women's Health Coalition.

Ehrlich, Paul R., and Ehrlich, Anne H. 1990. The Population Explosion. New York: Simon & Schuster.

Feringa, Barbara; Iden, Sara; and Rosenfield, Allan. 1992. "NORPLANT: Potential for Coercion." In Norplant and Poor Women, pp. 57–63, ed. Sarah-Ellen Samuels and Mark P. Smith. Menlo Park, CA: Henry J. Kaiser Family Foundation.

Gwatkin, Davidson R. 1979. "Political Will and Family Planning: The Implications of India's Emergency Experience." Population and Development Review 5(1): 29–59.

Haider, S. M. 1978. Islamic Concept of Human Rights. Lahore, Pakistan: Book House.

Hardee-Cleaveland, Karen, and Banister, Judith. 1988. "Fertility Policy and Implementation in China, 1986–1988." Population and Development Review 14(2): 245–286.

Holmes, Helen B.; Hoskins, Betty B.; and Gross, Michael, eds. 1980. Birth Control and Controlling Birth: Women-Centered Perspectives. Clifton, NJ: Humana Press.

Hull, Terence H. 1990. "Recent Trends in Sex Ratios at Birth in China." Population and Development Review 16(1): 63–83.

Johansson, Sten, and Nygren, Ola. 1991. "The Missing Girls of China: A New Demographic Account." Population and Development Review 17(1): 35–51.

National Research Council (U.S.). Working Group on the Health Consequences of Contraceptive Use and Controlled Fertility. 1989. Contraception and Reproduction: Health Consequences for Women and Children in the Developing World. Washington, D.C.: National Academy Press.

National Research Council (U.S.). Working Group on Population Growth and Economic Development. 1986. Population Growth and Economic Development: Policy Questions. Washington, D.C.: National Academy Press.

Nickel, James W. 1987. Making Sense of Human Rights: Philosophical Reflections on the Universal Declaration of Human Rights. Berkeley: University of California Press.

Schearer, S. Bruce. 1983. "Monetary and Health Costs of Contraception." In Fertility Regulation and Institutional Influences, pp. 103–122. Vol. 2 of Determinants of Fertility in Developing Countries, ed. Rodolfo A. Bulatao and Ronald D. Lee. New York: Academic Press.

Shue, Henry. 1980. Basic Rights: Substance, Affluence, and U.S. Foreign Policy. Princeton, NJ: Princeton University Press.

Simon, Julian L. 1981. The Ultimate Resource. Princeton, NJ: Princeton University Press.

Veatch, Robert M., ed. 1977. Population Policy and Ethics: The American Experience. New York: Irvington Publishers.

Warwick, Donald P. 1982. Bitter Pills: Population Policies and Their Implementation in Eight Developing Countries. New York: Cambridge University Press.

Warwick, Donald P. 1990. "The Ethics of Population Control." In Population Policy: Contemporary Issues, pp. 21–37, ed. Godfrey Roberts. New York: Praeger.

White, Tyrene. 1987. "Implementing the 'One-Child-per-Couple' Population Program in Rural China: National Goals and Local Politics." In Policy Implementation in Post-Mao China, pp. 284–317, ed. David M. Lampton. Berkeley: University of California Press.

World Population Conference. 1975. Report of the United Nations World Population Conference, 1974, Bucharest, 19–30 August, 1974. E/CONF.60/19. New York: United Nations.