Chapter 6

With a population of more than 261 million, the United States is the third largest country in the world. As a result of natural increase, defined as the difference between births and deaths, and immigration, the U.S. population is growing by 3 million people each year, or 1 percent annually -- more than twice the annual growth rate in most of Europe and in most industrialized countries, but far less than in developing countries. The U.S. Census Bureau projects that if current demographic trends persist, the U.S. population will reach 350 million people by the year 2030, and almost 400 million by the middle of the 21st century. [1] To put these numbers in perspective, under current trends, the United States is adding the equivalent of Connecticut's population every year and of California's every decade.

Production and consumption in the United States together form the critical link between population and sustainability. National quality of life derives in large part from the unprecedented scale of U.S. production and consumption. Production and consumption account for the throughput, or total mass of materials and energy that is used and makes its way through the economy, resulting in a U.S. gross domestic product (GDP) of more than $6.4 trillion in 1994. [2]

This high standard of living is also reflected in a high level of consumption -- a level amplified by growth in population. The United States consumes more than 4.5 billion metric tons of materials annually to produce the goods and services that make up its unparalleled economic activity. (See figure 12.) One example of U.S. consumption patterns can be found in the energy sector. The United States has 5 percent of the world's population but accounts for approximately 25 percent of global energy use on an annual basis. There is greater opportunity for improvements in energy efficiency in the United States than in other industrialized nations; U.S. energy use per unit of GDP is approximately 36 percent greater than in Germany and 79 percent greater than in Japan. Use of petroleum feedstocks is seven times the world's per capita average. In 1994, the United States used 19.9 million barrels of oil per day, while the remaining 24 Organization for Economic Cooperation and Development countries collectively used 23.8 million barrels per day. The United States is also the world's leading producer of garbage and industrial wastes. [3]

There is nothing inherently wrong with a population -- even a large one -- meeting its material needs by consuming resources and creating wastes. Problems arise when the numbers of people and the scale, composition, and pattern of their consumption and waste generation combine to have negative effects on the environment, the economy, and society. Together, the size of the population and the scale of consumption impinge significantly on American society's ability to achieve sustainability. There is relatively little concrete information about the long-term consequences of choices made by consumers, but such information will be essential in order to change patterns of consumption in the United States; it should be developed and made available.

Because the United States has the world's third largest population and the largest economy, with an unparalleled scale of per capita consumption and waste generation, even slight changes in U.S. consumption patterns or population size can have a significant impact on sustainability. Annual per capita gains in reducing wastes, improving resource efficiency, and promoting economic growth must exceed I percent to translate into real reductions in environmental impact and real growth in the American standard of living. Thus, unless some technological change substantially reduces the scale of resources needed to maintain the current quality of life in the United States, continued population growth steadily makes more difficult the job of mitigating the environmental impact of American resource use and waste production patterns. Based on current trends, efficiency in the use of all resources would have to increase by more than 50 percent over the next four or five decades just to keep pace with population growth.

Managing population growth, resources, and wastes is essential to ensuring that the total impact of these factors is within the bounds of sustainability. Stabilizing the population without changing consumption and waste production patterns would not be enough, but it would make an immensely challenging task more manageable. In the United States, each is necessary; neither alone is sufficient.

Sustainable development explicitly recognizes the obligation of the current generation to future generations. Taking this obligation seriously means examining the difficult issues and hearing divergent views to make informed decisions about what best serves the interests of America. As recognized at the International Conference on Population and Development in Cairo in 1994, all nations have responsibility for managing population growth. The United States must provide leadership by setting an example.

Involving as it does such difficult issues as personal childbearing decisions, contraceptive methods, teenage sexual behavior, and the high rate of abortion in America, as well as legal and illegal immigration trends, the subject of U.S. population growth is complex and controversial. It raises a variety of moral and ethical concerns. The Council believes that these issues can be approached forthrightly and must be addressed with great care, full respect, and in a way that is consistent with the various religious and ethical values and cultural backgrounds of the American people. The discussion and recommendations in this chapter focus on family planning, personal responsibility, and voluntarism. The Council has not discussed nor do its recommendations relate to or take a position on the issue of abortion.

Figure 12

On the issue of population, the emphasis of the Council's recommendations is on enabling parents to decide freely and responsibly the number and spacing of their children, based on the strongly held and unchallenged conviction that voluntary decision-making lies at the heart of all American family planning. The Council also recognizes that the issue of immigration is potentially explosive and urges that legal and illegal immigration be addressed with great sensitivity and recognition of long-standing American traditions of fairness, freedom, and asylum. Finally, while the Council encourages realization of its goals and recommendations throughout America, it wants to make clear that it seeks to move toward voluntary population stabilization at the national level, recognizing that the population of any state or region will ebb and flow according to the choices of individuals and families about where to live and work.

This report as a whole covers various aspects of consumption in the United States -- from the recommendations on extended product responsibility and sound fiscal policies to the promotion of sustainable communities and encouragement of collaborative approaches to managing natural resources. Because much of the report deals with issues involved in responsible consumption, this chapter recommends complementary policies that would move the United States toward voluntary population stabilization and sustainable development.

Expanding Reproductive Health Services

Unintended pregnancies are associated with higher rates of low birth weight and infant mortality, high rates of abortion, increased need for welfare, more teens forgoing education, and more children raising children -- all of which contribute to the deterioration of American families. These pregnancies affect people in all socioeconomic strata but are most common among younger and poorer women. National family planning efforts are critical to preventing unintended pregnancies before they occur and to achieving national health and social aims. Currently, the principal program providing comprehensive public family planning services to low-income women and men is under Title X of the Public Health Service Act of 1970 .6 Title X does not provide funding for abortion. The family planning services it does provide are estimated to prevent an average of 1.2 million unintended pregnancies and about half that number of abortions a year. [7]

The nation's family planning assistance efforts -- whether under Title X or any other program -- must provide education and outreach to prevent unintended pregnancies. In general, reproductive health services are targeted to women, but outreach needs to include men as well, so they can play an equal role in safeguarding their own reproductive health and that of their partner and in making sound family planning and contraceptive choices. Years of experience with Title X and other subsidized family planning programs show that few men use these services without special outreach, counseling, education, and other efforts to make them feel at ease. Special programs should reach young men before they become sexually active to help them build the skills and strategies needed for sexual health and responsibility. Clearly, the importance of the relationship between national family planning assistance efforts and population must be recognized as the nation goes forward. For example, funding for Title X fell by more than 70 percent in real dollars between 1980 and 1992 and has not been reauthorized by Congress since 1984. [8] Because of this, the ability of Title X to provide services to high-risk individuals and underserved or hard-to-reach populations becomes problematic. Reducing unintended pregnancies in the United States depends on the empowerment and participation of both men and women.

Public and private health insurance coverage of comprehensive reproductive health services is another essential means of preventing unintended pregnancies. For example, Medicaid is the largest public funder of family planning services, but because eligibility is tied to welfare eligibility, fewer than half of poor women are covered by Medicaid. In 1986, the federal government expanded Medicaid coverage to pregnant women and infants with incomes 133 percent of the poverty level, regardless of whether they meet other welfare requirements. But coverage under this extension does not include family planning services until after childbirth, and then only for 60 days. Thus, Medicaid in its current form is not an effective source of services for preventing first pregnancies among these women, nor for ensuring that future pregnancies are planned ones.

As noted above, the rate of unintended pregnancies is higher among poor and low-income women, but women from all social and economic backgrounds experience unintended pregnancies. Therefore, private insurance coverage for reproductive health services also needs to be considered in examining the effectiveness of services to women for the prevention of unintended pregnancies. Almost two-thirds of women of reproductive age in the United States do not rely on publicly provided family planning because they have insurance provided through employment in the private sector. But private insurance does not uniformly offer adequate coverage for family planning services. Up to 85 percent of insurance policies and health maintenance organizations cover sterilization and abortion, but fewer than half of typical plans cover the major reversible contraceptive methods: in fact, these methods are covered by only 15 percent of plans. [9] Expanding private insurance to cover the full range of reproductive health services should be explored.

In summary, then, an effective way to reduce the number of unintended pregnancies and births in the United States is to expand access to family planning, education, and related reproductive health services, particularly for at-risk individuals. Family planning is highly cost-effective compared with the social and public costs of unintended pregnancy, and it helps ensure that every child is a wanted child.

POLICY RECOMMENDATION 1

GREATER ACCESS TO AND AVAILABILITY OF SERVICES Expand access to and availability of the family planning and reproductive health services needed to prevent unintended pregnancies and ensure that all Americans have the information and services they need to decide freely and responsibly the number and spacing of their children.

ACTION 1. Congress should authorize and sufficiently fund national family planning programs to ensure that all women and men, regardless of income, have access to family planning and related reproductive health care options. In addition, these efforts should be strengthened to enhance information, education, and outreach capabilities -- particularly for men and underserved or hard-to-reach populations. ACTION 2. Through families, social institutions, and community-oriented, peer-based, and adult-mentoring programs, education can be increased and appropriate services provided for adolescents. Programs can be initiated to encourage parents and other caregivers to fulfill their role as the primary provider of values and information. Abstinence and strategies for discouraging adolescents from engaging in sexual activity can be encouraged. In addition, access to appropriate services should be provided to adolescents who are sexually active. ACTION 3. The public and private sectors can reform health insurance coverage to ensure that all recipients are afforded choices among the broadest range of safe, voluntary reproductive health services. The Medicaid program also should be reformed to help ensure that recipients who become eligible as a result of pregnancy have access to family planning services for an extended period after birth to encourage birth spacing and discourage future unintended pregnancies. ACTION 4. Congress should fund -- through federal medical research laboratories, public-private partnerships, and other innovative arrangements -- increased research in both basic and applied reproductive health sciences, including research on alternative birth control technologies to expand the range of medically safe contraceptives available to women and men. Particular attention should be given to women-controlled barrier methods and methods that protect against sexually transmitted diseases, post-ovulatory methods, and improved male methods. Consideration also should be given to strategies that address product liability concerns that impede contraceptive research and product development by the private sector.

The Council recommends that both the public and private sectors endeavor separately and in partnership to deal with socioeconomic conditions that are closely related to high rates of teen and unintended pregnancy. The public sector has a role to play in developing laws and regulations to level the playing field in society, encouraging greater equity, and enhancing opportunities for disadvantaged Americans. The private sector can play an important role by voluntarily taking the initiative to break down barriers to women's advancement in the workplace. In addition, by providing jobs, employment training, and economic opportunity, as it does in the normal course of business, the private sector can create opportunity for disadvantaged segments of society. Finally, all Americans -- as parents, community members, and civic leaders -- have roles to play in promoting personal responsibility and common values, which will also support stronger families. Following are representative strategies offered by the Council for realizing these objectives.

POLICY RECOMMENDATION 2

EXPANDED OPPORTUNITIES FOR WOMEN Create partnerships to enhance opportunities for women, giving special attention to socioeconomic factors that result in disproportionately high levels of unintended and teen pregnancy among disadvantaged segments of society.

ACTION 1. National, community, and religious leaders can foster in all Americans the shared values involved in personal responsibility and the strengthening of the family, the most important unit of society. ACTION 2. The public and private sectors should work in partnership to ensure that women are not disadvantaged by decisions to bear and raise children, in terms of educational, employment, and professional opportunities and advancement. ACTION 3. Opportunities for women to participate in political and leadership positions should be expanded at all levels of society, in both the public and private sectors. ACTION 4. The public and private sectors should expand opportunities for women to participate in the workplace, ensuring pay equity, enhancing the availability of capital for women-owned enterprises, and promoting women into leadership positions in business. ACTION 5. The public and private sectors should enhance efforts to provide educational, economic, and social opportunities for women, particularly teens. ACTION 6. The public and private sectors and religious community can encourage innovative community and peer-based counseling efforts for disadvantaged youth and women to encourage these at-risk groups to abstain from early sexual activity and realize their full economic, educational, and social potential. ACTION 7. The public sector and religious community can encourage ment to take greater responsibility in child-rearing and family life.

Through the Immigration Act of 1990, Congress established the U.S. Commission on Immigration Reform to review immigration issues and strategies.[15] The commission has initiated a comprehensive review of current U.S. immigration policy; the review should be complete by the end of 1997. The thrust of the commission's work has been consistent with the Council's beliefs that policymaking in the United States should aim toward participatory, collaborative, and reasoned decisionmaking.

The Council has not examined the full range of difficult and sensitive issues associated with immigration in the United States. Little information on the effects of immigration on various aspects of American society and sustainable development is available. The Council supports the kind of expert, participatory process established by Congress to address immigration matters. We also support the creation of policies that recognize both the nation's historic acceptance of immigrants as well as the need to limit population growth. In this context, there is broad agreement that one of the most undervalued strategies related to immigration involves the promotion of broadly based international policies-- such as trade and international economic policy, foreign policy, and international environmental policy -- to address economic, political, and social conditions that influence an individual's decision to emigrate.

POLICY RECOMMENDATION 3

IMPROVED IMMIGRATION POLICIES Encourage the Commission on Immigration Reform to continue its work, and support research to promote the implementation and fair enforcement of responsible immigration policies.

ACTION 1. Congress and the relevant federal agencies should review and address the appropriateness of recommendations presented by the Commission on Imigration Reform with respect to American traditions of fairness, freedom, and asylum as well as the aim of sustainable development. Priority attention should be given to implement and enforce national policies on illegal and legal immigration policy. ACTION 2. The federal government should fund research on the environmental and economic effects of migration to the United States and population growth in general to inform immigration and other demographic policies. ACTION 3. U.S. foreign policy and international economic policy should deal comprehensively with the causes of migration to the United States. An effective strategy to prevent unlawful migration should be based on international policies that directly or indirectly address the factors that encourage people to leave their home countries, including lack of employment; poor working conditions; political, social, and religious oppression; and civil conflict.

[2] Statistical Abstract of the United States 1994, p. 446.

[3] General consumption data are from World Resources Institute, World Resources 1994-95, prepared in collaboration with the U.N. Environmental Program and the U.N. Development Program (New York: Oxford University Press, 1994), p. 15. Energy consumption data are from U.S. Department of Commerce, Bureau of the Census, World Population Profle: 1994 (Washington, D.C.: Government Printing Office, 1994), p. 9, fig. 6; and U.S. Department of Energy, Energy Information Association, International Energy Annual: 1993, DOE/EIA-0219(93) (Washington, D.C.: Government Printing Office, 1995), p. vii. International comparisons are from Organization for Economic Cooperation and Development, OECD Environmental Performance Review -- Netherlands (Paris, 1995), p. 69, fig. 3.4; World Resources 1994-95, p. 16, table 1.9, and p. 341, table 21.6; and U.N. Environment Program, Environmental Data Report 1993-94 (Oxford: the Alden Press, 1993), pp. 347-48, table 8.2.

[4] Institute of Medicine, The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, S. Brown and L. Eisenberg, eds. (Washington, D.C.: National Academy Press, 1995).

[5] Data derived by subtracting deaths from births using vital statistics compiled by the National Center for Health and Human Services in 1992. See U.S. Health and Human Services, "Advance Report of Final Mortality Statistics, 1992," Monthly Vital Statistics Report 43, no. 6 (Hyattsville, Md.: National Institute for Health Statistics, 1994); and U.S. Health and Human Services, "Advance Report of Final Natality Statistics, 1991," Monthly Vital Statistics Report 43, no. 5 (Hyattsville, Md.: National Institute for Health Statistics, 1994).

[6] Public Health Service Act of 1970, 42 U.S.C. Subchapter VIII, Title X, 300 et seq. (1988).

[7] The Alan Guttmacher Institute, "The U.S. Family Planning Program Faces Challenges and Change," Issues in Brief (Washington, D.C., 1995).

[8] D. Daley and R. Gold, "Public Funding for Contraceptive, Sterilization, and Aborton Services, Fiscal Year 1992," Family Planning Perspectives 25, no. 6 (December 1993): 248; and "The U.S. Family Planning Program Faces Challenges and Change."

[9] The Alan Guttmacher Institute, Uneven and Unequal: Insurance Cover and Reproductive Health Service (Washington, D.C., 1994).

[10] The Alan Guttmacher Institute, Sex and America's Teenagers (Washington, D.C., 1994), p. 20.

[11] Information presented by Jacqueline Forrest of The Alan Guttmacher Institute to the President's Council on Sustainable Development, Population and Consumption Task Force, Roundtable Discussion on Fertility and Migration, The George Washington University, Washington, D.C., 27 October 1994.

[12] Patricia Donovan, The Politics of Blame: Family Planning Abortion and the Poor (Washington, D.C.: The Alan Guttmacher Institute, 1995), p.9.

[13] Statistical Abstract of the United States 1994, pp. 9-10, tables 4-6.

[14] Information presented by jennifer Day of the U.S. Bureau of the Census to the President's Council on Sustainable Development, Population and Consumption Task Force, Rountable Discussion on Fertility and Migration, the George Washington University, Washington, D.C., 27 October 1994.

[15] Immigration Act of 1990, Pub. L. 101-649, 104 Stat. 4978.

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