753 



incidence of both malnutrition and diarrhea. But there should 

 be no underestimating the awesome difficulties of searching 

 for the best answers among such tangled relationships. The 

 number of children in a family may al-ready be at insupport- 

 able levels, and another life saved would depress even more 

 the amount of food-money per child. Indeed, the study re- 

 vealed the desperate efforts of these people to limit the num- 

 bers of their children. But acting in ignorance, their efforts 

 were often futile or tragic. 



It is important to recoa^nize that while health services have 

 contributed to increased rates of population growth, they 

 also have an essential role in limiting population growth. 

 Walsh McDermott has described a fertility-mortality cycle 

 in which high fertility leads to large numbers of children, 

 often crowded into a setting of poverty and ignorance with a 

 resulting high childhood mortality, which in turn sustains 

 hi^h fertility. He argues that reducing the death rate in small 

 children is a necessary precondition for reducing fertility. 

 McDermott's thesis has historical support. Fertility and in- 

 fant mortality have always been highly correlated, and in- 

 creasing evidence indicates that a lowered infant mortality 

 must antedate lowered fertility. * * * Itwproved health if< 

 a precond'/tion to reduced ferfilHy}^^ [Emphasis supplied.] 



Moreover, Bryant goes on to say — 



The hsue mu!<t remri'm unmhtahahly clear — tt is morally 

 ufiacceptahle to the people of the countries involved to allow 

 continued high mortality as a means of population control. 

 Myrdal states this issue forcefully in the context of the prob- 

 lem of South Asia : "In facing up to their population prob- 

 lems and striving to formulate an appropriate policy, the 

 South Asian countries are bound by one rigid value premise, 

 which has important practical consequences: any attempt to 

 depress population growth is restricted to work on the fer- 

 tility factor. Complacency about or even tolerance of a high 

 level of mortality because it slows population growth is sim- 

 ply not permissible. As a value premise, this is indisputably 

 the basis for public policy in South Asia as it is elsewhere 

 throughout the civilized world. All that can reasonably be 

 done to combat disease and prevent premature death must 

 be done, regardless of the effect on population growth * * *. 

 As a moral imperative, this valuation is absolute. But as 

 with all other categorical norms of ethics, it becomes a more 

 relative precept when for its realization it must compete 

 for scarce resources and then be placed in an order of 

 priorities." ^®^ 



^ In backward countries today, taken as a whole, [he con- 

 tinues] birth rates are rising, not falling; in those with popu- 

 lation policies, there is no indication that the government is 



w Bryant, "Health and the L>e%-eloping World." op. cit.. pages 100. 102-3; Also described 

 In : John H. Br.vant. '"The Gap between Modern Biomedical Technology and Health Needs 

 m Developing Countries.' In "Science and Technology in Developing Countries," (Cam- 

 bridge Univpisity Press, 1969 ) . 



"•Bryant, "Health and the Developing World," op. clt., pages 99-100. 



