TY - JOUR T1 - Taking Exception. Reduced mortality leads to population growth: an inconvenient truth JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 135 LP - 138 DO - 10.9745/GHSP-D-14-00062 VL - 2 IS - 2 AU - James D Shelton Y1 - 2014/05/01 UR - http://www.ghspjournal.org/content/2/2/135.abstract N2 - Reduced mortality has been the predominant cause of the marked global population growth over the last 3/4 of a century. While improved child survival increases motivation to reduce fertility, it comes too little and too late to forestall substantial population growth. And, beyond motivation, couples need effective means to control their fertility. It is an inconvenient truth that reducing child mortality contributes considerably to the population growth destined to compromise the quality of life of many, particularly in sub-Saharan Africa. Vigorous child survival programming is of course imperative. Wide access to voluntary family planning can help mitigate that growth and provide many other benefits. The 2014 Gates annual letter, “3 Myths That Block Progress for the Poor,” makes many valid points about development, and, commendably, it strongly supports family planning.1 However, in arguing against what it termed a “myth”—that saving lives leads to overpopulation—ironically, it succumbs to a common misunderstanding about reduced mortality and population growth. The letter's basic proposition is: “When children survive in greater numbers, parents decide to have smaller families.” The inference is that reduced child mortality will somewhat automatically produce a corresponding and largely compensatory reduction in fertility levels, with little appreciable overall impact on population growth. This concept, sometimes termed “the child survival hypothesis,” was discussed and researched considerably, particularly during the 1970s. It has some intuitive credence and demographic support, because often historically when death rates began to fall, declines in birth rates followed.2 However, such an association does not prove causality. Indeed, historically sometimes the 2 rates have declined fairly concurrently, and there are many examples where birth rates began to fall before death rates.3 Notably, the very intensive province-by-province “Decline of Fertility in Europe” analysis found that while there was some weak association between child mortality and fertility decline, … ER -