INSTITUTIONEN FÖR BIOLOGI OCH

MILJÖVETENSKAP

SWEDISH PUBLIC VIEWS ON FACTORS

INFLUENCING THE TOTAL FERTILITY RATE IN
DEVELOPING COUNTRIES, COMPARED TO A
SCIENTIFIC OVERVIEW.

Nordhild Siglinde Wetzler

Uppsats för avläggande av naturvetenskaplig kandidatexamen med huvudområdet biologi

BIO602 Biologi: Examensarbete 15 hp
Grundnivå Kandidat
Termin/år: Vt 2022
Examinator: Staffan Andersson vid Institutionen for biologi och miljövetenskap
Table of contents
Abstract.............................................................................................................................................2
Introduction.......................................................................................................................................4
Human impact on the living world...............................................................................................4
Purpose of survey in Sweden........................................................................................................6
Background.......................................................................................................................................7
Population growth.........................................................................................................................7
What influences population growth?...........................................................................................9
The Total Fertility Rate.............................................................................................................9
Method............................................................................................................................................16
The question............................................................................................................................16
The response categories...........................................................................................................17
The analyses............................................................................................................................19
Results.............................................................................................................................................19
Overall.........................................................................................................................................19
Age..........................................................................................................................................22
Discussion.......................................................................................................................................23
Survey and gender...................................................................................................................23
Survey and education..............................................................................................................24
Survey and age.......................................................................................................................25
Conclusions.............................................................................................................................26
References.......................................................................................................................................28

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Abstract
The human population has increased substantially since the late industrial revolution, from one to
almost eight billions in only 200 years, and our needs and demands today are threatening the
climate, biodiversity and the welfare of all species. Human population growth as an issue was
taken seriously up to about 1995 when public attention turned away from the topic. Fertility rates
in developing countries have since continued to be high and the world population has steadily
kept growing. Despite Sweden’s great attention to environmental concerns, little to no attention is
given to the pressing issue of overpopulation. In this study, a Novus survey was conducted with
1010 participants from Sweden to find out what citizens today think is the most important factor
in lowering fertility rates in developing countries. Each answer was sorted into categories and
differences were tested with Chi-Square tests. The results revealed differences in opinion
between men and women, age groups, and levels of education. The largest difference was
between genders; men focused more on economy and women more on contraceptives and female
rights. Whereas many studies point to family planning as one of the most important factors in
lowering fertility rates in developing countries, this was the category with the least amount of
respondents. In contrast, nearly half of the participants thought that increased living standard or
GDP was the main reason for falling fertility rates, while research shows that lower birth rates
precede rather than follow an increase in economic growth. Over 20% of all participants either
said they did not know the answer or misunderstood the question completely. This study
concludes that there is a large knowledge gap between todays scientific standing and the
understanding of Swedish citizens about what influences the fertility rates of human populations,
and that more work is needed to close this gap.

Befolkningen har ökat markant sedan industriella revolutionen, från en till nästan åtta miljarder
människor på endast 200 år, och våra behov är idag ett hot mot klimatet, biodiversiteten och
välfärden av samtliga arter på jorden. Den mänskliga befolkningsökningen togs på allvar tills runt
1995, när den offentliga uppmärksamheten vände sig bort från ämnet. Sen dess har fertiliteten
fortsatt att vara hög i utvecklingsländer och befolkningen har stadigt fortsatt öka. Trots att
Sverige lägger stor uppmärksamhet på miljöfrågor finns det nästintill inget intresse för
ämnesområdet överpopulation. I denna studie genomfördes en Novusundersökning med 1010
deltagare från hela Sverige för att ta reda på vad medborgare idag tror är den viktigaste faktorn
för sjunkande fertilitetstal i utvecklingsländer. Varje svar sorterades in i en kategori och
skillnaderna testades med Chi-Square tester. Resultaten avslöjade signifikanta skillnader i åsikt
mellan kön, ålder och utbildningsnivå. De största skillnaderna fanns mellan könen; männen

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fokuserade mer på ekonomi och kvinnor mer på preventivmedel och jämställdhet. Många studier
däremot pekar på att familjeplanering är en av de viktigaste faktorerna för sjunkande fertilitet och
ändå var detta den minsta svarskategorin. Nästan hälften av alla deltagare trodde att höjd
levnadsstandard eller BNP var huvudanledningen för sjunkande fertilitet, trots att studier visar att
lägre födelsetal föregår ekonomisk tillväxt. Över 20% av deltagarna sa antingen att de inte visste
eller missförstod frågan helt. Sammanfattningsvis drar den här studien slutsatsen att det finns ett
kunskapsglapp mellan dagens vetenskap och svenska folkets förståelse om vad som påverkar
fertilitetstal och att mer arbete krävs för att sluta den klyftan.

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Introduction

Human impact on the living world

The current era is characterised by strong human impact on virtually every part of the planet. The
massive effects of people on global ecosystems, climate and geosphere have led to the proposal
that we now enter a new geological epoch called the Anthropocene. Research shows that a
growing human population is contributing substantially to rapid loss of biodiversity, global
political unrest and the changes in climate, (Crist et al., 2017; Foley et al.,2011). There are many
ways in which humans impact the world, below I will focus mainly on the production of our most
important resource- food, to more in detail motivate my study.
Food production today is arguably the greatest culprit when it comes to using up more and
more of the earth's former forests, wetlands and freshwater resources, not to mention overfishing,
(Our World In Data, 2022). Although modern technologies with pesticides, fertilisers, genetically
modified crops and advanced farming equipment have increased the productivity of land, more
people mean an increased demand for further expansion of the already overused farmable soil.
Agriculture occupies about 50% of the planet's habitable land and of that area, 77% is used for
meat and dairy farming. In fact, livestock makes up 94% of the global mammal biomass, not
counting humans. That leaves only 6% for wild mammals, (Our World In Data, 2022).
Further, more than one fifth of human caused global emissions are released by global food
production. (Crist et al., 2017; Our World In Data, 2022). As food requirements rise, natural
forests give way to arable land or tree plantations, and local wildlife is often replaced by
livestock, (Foley et al., 2005). In fact, meat and dairy have, on average, the largest environmental
impact of all, no matter whether one compares land use or carbon emissions, (Our World In Data,
2022). The production of livestock alone is responsible for the largest global emissions of the
powerful greenhouse gases methane and nitrous oxide, (Bailey et al., 2014), which has given
some incentive to reduce the consumption of animal products in especially western countries.
However, with a rapidly growing global middle class in many developing countries, who so far
have lived modest lifestyles compared to the West, the demand for animal products is rising
steadily, (Crist et al.,2017). According to Bailey et al.,(2014), global demands will see an
increase of dairy and meat production by 65% and 76% respectively until 2050. One could argue
for an increased effectiveness in animal farming but this would result in an even greater violation
of animal welfare than today, (Crist et.al.,2017).
Agriculture impacts the environment by eliminating and disturbing wildlife and by the use of
much freshwater, such as for irrigation, so called “green water”. Fertilizers leaking into streams

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and groundwater reduce water quality in many areas. (Bennett et al., 2001). Excess nutrients such
as nitrogen and phosphorous as well as pesticides are carried far by waterways. This can then
cause eutrophication and oxygen deficiency, increased cyanobacteria growth, the spread of
diseases and extensive death of aquatic organisms. The phosphorous stored within terrestrial and
freshwater ecosystems is 75% higher than it was at preindustrial times, (Bennett et al, 2001).
Because of irrigation, many lakes and rivers contain much less water now than they used to,
and some occasionally dry up, (D`Odorico et al., 2018). For instance the Colorado river and the
Rio Grande no longer reach the ocean due to overconsumption by farmland and cities. Food
production alone stands for nearly 86% of the global freshwater use, (D`Odorico et al., 2018).
Since water is the greatest limiting factor to agriculture in most parts of the world, (Falkenmark
& Rockström, 2006), increasing farmland area creates a negative feedback loop in which more
extreme measures to obtain water are needed to achieve the same productivity.
Wildlife greatly depends on clean freshwater for survival. Wading birds and amphibians have
been especially hurt by the draining and farming of wetlands as well as rerouting and damaging
of streams and rivers. Wetlands and riparian areas have the highest amount of endangered
species, (McRae et al., 2017), and even if the water itself often is renewable, the damage to
freshwater ecosystems and their species can be irreversible, (D´Odorico et al, 2018).
Agriculture uses roughly 50% of our planets liveable land, (Our World In Data, 2022). Atleast
10 million hectares were lost annually due to soil degradation since before the 1990s, a number
that is growing. Thus, each year new farmland has to be added, taken primarily from the worlds
remaining forests, (Pimentel et al., 1994), and tropical regions which are important biodiversity
hotspots, (Foley et al., 2011). It seems unlikely that both the need to conserve biodiversity and
food requirements of a growing population can be met, (Crist et al., 2017). Predictions
concerning the future call attention to increasing difficulties with supplying enough food and
clean water. Climate change together with degradation of land and water resources increase the
risk for more frequent crises such as famines and droughts, (Foley et al.,2011), in turn leading to
conflicts. If we think the current levels of strain upon the ecosystems of the earth are bad, we can
only imagine what at least 3 billion more people would mean, (see projections of United Nations,
2019).
Biodiversity in and of itself is not enough. Care must be taken to ensure that remaining species
have enough living space to maintain healthy metapopulations, genetic variation as well as enable
migration and other natural behaviours. Demands that cannot be met with a growing human
population, (Crist, et al., 2017).

5
Purpose of survey in Sweden

Sweden is one of the leading countries when it comes to environmental studies and political
policies to mitigate climate change. It is also a leading nation in giving foreign aid per capita. In
2020, Sweden was the single largest donor of official development assistance (ODA) per capita
in the world, closely followed by its neighbour Norway. Sweden donated 1,14% of its gross
national income (GNI) to ODA that year and has an overall goal of spending roughly 1% each
year. Compare this to the United States which, although being the world’s largest donor in
absolute terms, only spent 0,17% of its GNI that same year. Moreover, a large portion of
Sweden’s aid budget is intended for the environment and fighting climate change. They are one
of the largest per capita donors to organisations who help developing countries care for their
environment, such as the Green Climate Fund and the Global Environment Facility,
(Donortracker, 2022).
Reducing fertility rates is the best way to combat climate change and preserve biodiversity,
(Crist. et al, 2017). Since TFR is the highest in developing countries, aid and resources should be
targeted at reducing birth rates specifically. Sweden does have a strong commitment to
strengthening women’s rights abroad through its sexual and reproductive health and rights policy
(SRHR). Although this plan addresses fertility rates to some extent, the term family planning is
never mentioned in the strategy document for SRHR in Sub Saharan Africa for 2015-2019,
(Government offices of Sweden, 2015). The question is, Why is there not more discussion about
limiting population growth despite there being such a high awareness about environmental issues
as well as female rights. Could it be that the common public as well as policy makers are simply
not aware of overpopulation itself as a pressing issue which needs solving?
This study aims to quantify public awareness among Swedish citizens about what most
effectively reduces fertility rates in developing countries. It aims to see if there is a knowledge
gap between the science and the general public about the importance and details of
overpopulation and its solutions, as they are related to TFR. The thought behind this is that a
democratic government is a reflection of its citizens and if the citizens are poorly informed then
there can be no effective approach to aspects such as international aid (in Sweden, foreign aid has
a budget of roughly 54-58 billion Swedish crowns.). Adequate population policies depend on
accurate knowledge about which factors influence TFR, (Götmark&Andersson, 2022).
From the results I expect to see the following patterns:
1. A higher awareness about fertility issues among women compared to men since this is a
subject that affects women around the world more deeply.
2. Older people to be more informed than younger since they might remember when this was a

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publicly noticed issue in the past.
3. Higher educated people to be more knowledgeable than lower educated people.
The null hypothesis for all these is that there will be no difference between gender, age, education
level.

Background

Population growth
Since the industrial revolution the global human population has increased substantially, from 1
billion in 1808 to almost 7,9 billion in 2021, (Our World In Data, 2022). By 2100, the UN
projects our human population reaches almost 11 billion in their medium variant in which they
presume that fertility rates will decrease. If, however, fertility remains the same as today we may
reach a staggering 22 billion people, (United Nations, 2019). Contrast this number with an
ecologically sustainable number that, if the goal is to uphold a western living standard, would be
no larger than 5 billion, but rather closer to 1,5-3 billion, (Crist, et al., 2017).
Human population growth was once an important topic on the global agenda, for the reasons
mentioned above. The urgency of this issue was well recognised by both the public and
politicians, (Foreman, 2014). No less than three UN-population conferences were held, in 1974,
1984 and 1994 but none thereafter. Instead the interest for finding a solution to population growth
declined and by the end of the last century, the political focus had turned away from the topic.
Different misconceptions about population growth and how to stop it have since taken hold and
prevented further action, (Bongaarts et al, 1997).

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 One of these misunderstandings is that since fertility rates in some countries, and the global
growth rate, have decreased, (Our World In Data, 2022), many seem to have come to the
conclusion that the population will simply stabilize itself, and no further actions or policies are
required, (Bongaarts et al, 1997). The demographic transition theory suggests that rapid
population growth only is temporary as death rates fall first and fertility rates lag behind, (Kirk,
1996). The theory proposes that a population will inevitably have lower birth rates as death rates
diminish. It also mentions cultural shift away from high fertility norms, which is often forgotten
when the theory is mentioned, (O’Sullivan, 2013).

Figure 1: Shows the five stages of demographic transition. Source: (Our World In Data, 2022)

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Another misconception is that any measures taken to reduce population levels would have to be
forceful and infringe on human rights. This misconception started after countries like China and
India which, albeit taking the population issue seriously, used coercive strategies to reach their
goal, (Adlakha&Banister, 1995) This played a large part in future politicians shying away from
the topic, (Bongaarts et al, 1997). In addition, a common argument against the need for
population stabilization and reduction is that not the number of people, but rather their
consumption and the distribution of resources, is the problem. O’Sullivan (2013) argues that even
though we could house more people on this planet with the help of more food and further
technological advancements, such resources would be better used to accommodate fewer people
with a higher living standard instead.

What influences population growth?

The global population growth rate reached a peak in the 1960s with 2,2% and has since then
gradually declined. As of 2020 it was at 1,05% (Worldometer, 2022). This is however only the
mean growth rate across the world. Individual countries differ considerably. In some parts, like
Western Europe, growth rates are weakly negative with more deaths each year than births and the
population is declining. In places like Sub-Saharan Africa however growth rates can reach well
over 3%, making them even higher than the global peak in the 1960s, (Our World In Data, 2022).
During the past 100 years, the different parts of the world have gone in different directions. What
influences population numbers is a complex subject, one where the scientific communities are in
disagreement.

The Total Fertility Rate

The most important factor to consider regarding population growth is the Total Fertility Rate,
(TFR) and how it relates to different variables. In demography and biology, fertility refers to the
actualised amount of offspring rather than the potential to have offspring in the future. Therefore
fertility can be quantified, (United Nations, 2019). A woman with two children would have the
fertility of two, while a woman without any children would have the fertility zero. The Total
Fertility Rate measures the average number of children born per woman in a certain population
during her lifetime, given that she would both live until menopause and go through the exact age-
specific fertility rates within her region. For example, in 2019 Portugal had a TFR of 1,24
children per woman while Niger was the global frontrunner with a TFR of over 7, (Our World In
Data, 2022). Such data can be used to measure and compare fertility rates across different
populations, nations and over time. Developing countries have on average much higher fertility
rates than industrialised ones, with Africa at the very lead and the Middle east and certain parts of

9
Asia following closely behind, (Our World In Data, 2022). Since TFR is one of the most
important components of population growth, (Götmark&Andersson, 2020), it is essential to
understand its underlying factors.

Figure 2: TFR in different world regions from 1950-2050. Source: Our World In Data, 2022

Education
With good reason, more education is considered among the top measures in decreasing fertility
rates. In almost all parts of the world, women with higher levels of education have lower fertility,
(KC& Lutz, 2014). The only region to stand out from this is western Europe where TFR and
education were positively correlated, (Götmark&Andersson, 2020). This anomaly could possibly
be explained with increasing immigration to western Europe from areas which themselves have
very high TFR, such as the middle east and Sub-Saharan Africa. That would mean that the trend
with higher educated people having less children would still hold up but be masked by high birth
rates by newcomers with a lower education.
The difference that education makes in the number of children could potentially be significant.
One comparison can be made with women from Ethiopia where those with no official education
had on average six children while those with high school-level education had two, (The DHS
program, 2011; KC& Lutz, 2014). Education has a range of benefits which might influence TFR
in different ways. The knowledge obtained may in itself make persons better able to make
positive choices and give better understanding about how to decide exactly when and how many

10
children would be optimal, e.g. with contraception. School attendance helps prevent teenage
pregnancies and enables women to have their first child later in life, which often means a lower
TFR, (Bongaarts et al, 1997). Indirectly, a higher education also correlates with an improved
personal economy which may also lower TFR, (Götmark& Andersson, 2020). These are the
personal benefits of education, not mentioning how increasing education of a population as a
whole positively affects health, food production, resilience against natural disasters and even in
evolving countries into modern democracies. The difference in population by 2050 may be as
much as 1 billion people depending on the levels of female education. In conclusion, educated
women have less children almost universally and this is one powerful tool in mitigating further
population growth. Studies clearly show that TFR is negatively correlated with education, both
male and female, (KC&Lutz, 2014). However, more research is needed in evaluating the
importance of content and quality of education, not just the length of school years themselves. It
is also worth mentioning that in many patriarchal communities, contraception is the choice of the
man, women may not be allowed to use it even if they wanted to. Therefore, male education,
especially about health and sexuality, remains an important issue, (Turner, 2021).

GDP per capita

A common notion is that fertility decline will happen automatically as countries develop.
People often conflate development with economic growth, perhaps because of a
misunderstanding of the demographic transition theory. When comparing developed to
developing countries, the first thing to stand out is indeed wealth as it can be measured as GNI,
GDP etc. According to Foreman, (2014), the theory in this simplified form gained wide support
and may be the reason why the issue of solving population growth lost public and political
support.
However, the notion that an increase in national wealth will result in lower TFR has been
disproven in several studies, (O’Sullivan, 2013; Bongaarts& Hardee, 2020). It has been
demonstrated that often it is fertility decline that boosts GDP per capita, not the other way
around, (Bongaarts& Hardee, 2020). Countries that implemented family planning programs and
lowered their birth rates experienced a faster increase in wealth compared to countries who did
not. Notably, the financial growth came after fertility decrease and often coincided with a TFR of
two or three children. This might be explained by a larger part of citizens in the workforce, as
opposed to those occupied by child rearing or dependent on government funds, to which children
count, (Götmark& Andersson, 2022). On the other end, studies show instead that population
growth impedes economic growth in both developed and developing countries. As additional

11
people are added to a country, it must dedicate additional funds to keep up the same living
standards for all its citizens, which takes away from resources which could have been spent on
improvements. A type of running to stand still. Lowering population growth is therefore a way to
boost economic growth and development and much more cost effective than investments in
education etc, according to some researchers, (O´Sullivan, 2013).

Contraceptives
Contraceptive use is assumed to be correlated with lower TFR. Lowering fertility rates across the
developing world can be related to contraceptive prevalence rate. (Götmark& Andersson, 2020).
The use of modern contraceptives however does not follow the same trends as GDP across
different nations. In fact, in some countries, GDP and contraceptive use develop in opposing
directions. This shows that the availability of modern contraceptives can give control to
individual women, rather than relying on increased economic growth, (Götmark& Andersson,
2022). Availability to safe birth control and reproductive health care are essential in controlling
birth rates but not enough on their own. Norms and knowledge are required to raise acceptance
and use of contraception as well. Even where contraceptives are widely available and people are
aware of their existence, there is no guarantee of effective use. Turner (2021) lists several factors
which negatively influence the use of contraception. These include religiosity, misconceptions,
low social status, polygamy, fear of sexual dissatisfaction, high child mortality and early
marriage, to name a few. Factors which had a positive effect on the other hand included removal
of economic constraints, female empowerment, better life quality and family planning programs,
(Turner, 2021).

Family Planning Programs

Family planning and contraceptives are tightly linked. Without the aid of family planning
programs, the prevalence of contraceptive use remains low, despite an increase in female
education. In contrast, voluntary family planning programs increase contraceptive use
substantially even without higher education of women. These programs are the answer for
women in developing countries who do not want another child but whose needs for
contraceptives are unmet. The lack of contraceptive use results in over 70 million unplanned
pregnancies a year in the developing world alone, of which almost half end in induced abortions,
(Bongaarts& Hardee, 2020). Contraceptive use and availability is essential in reducing unwanted
pregnancies and giving women control over their own reproduction and bodies. Even though
some declare education and socioeconomic development to be the greatest drivers of TFR

12
reduction, it seems that family planning programs are at the root of the solution. They play a large
part in changing attitudes and norms regarding the desire for large families, (Bongaarts& Hardee,
2020; Robinson& Ross, 2007).
The specific design of these programs may vary between countries. They usually contain an
increased supply of contraceptives, often subsidized, reproductive health services and media-
campaigns that are aimed at creating a desire for smaller families, (de Silva& Tenreyo, 2017).
Several developing countries, such as The Philippines and Malaysia, have invested in
education for girls and achieved a high participation rate. Yet they barely lowered their TFR.
Other countries, such as Thailand, Indonesia and Morocco reduced their TFR considerably
despite having low levels of female education. The difference between them is the
implementation of politically supported family planning programs. The same pattern shows up in
much of Sub-Saharan Africa. Average school years for girls increase substantially in many
countries with little to no fertility decline while others decrease their birth rates despite very low
education levels. This indicates that increased education, specifically female education, may not
be enough on its own to reduce nations birth rates. It requires the support of family planning
programs to have the desired effect. They are tightly linked to both education, female rights and
the availability of contraceptives, (O’Sullivan, 2013).
Studies show that countries that committed to voluntary family planning programs achieved a
noticeable and faster fertility decline compared to similar countries that did not have such a focus.
This not only shows that family programs are working but also that it is in the hands of national
governments to lower TFR. Developing countries who chose to start strong family planning
programs succeeded in lowering their TFR with two to three children per decade. Compare this to
similar countries who, without such programs, experienced only a slow and almost halting
decline. This does not mean that efforts aimed at improving poverty and lack of education are
wasted. On the contrary, they are important in improving the overall life quality of hundreds of
millions of people and help in lowering birth rates. But they are not a replacement for family
planning programs. Global policy makers cannot rely on socioeconomic development alone to
lower birth rates, but rather must make conscious efforts, (O´Sullivan, 2013).
In conclusion, there is a clear correlation between the average school years of women, their
use of modern contraceptives and how strong the family planning programs in their countries are,
(Bongaarts& Hardee, 2020).

Female empowerment
The rights of women are tightly linked to all other factors. By improving the lives of young girls

13
and women there would also come improvements in other fields such as education, contraceptive
use and even economic growth, according to Kc& Lutz (2014). A large number of pregnancies
and births each year are unwanted. Many of these occur because of a lack of contraceptive use.
Even where contraceptives are available, many women are prevented from taking them for
different reasons, ranging from cultural norms to misinformation. Beliefs that contraception
might cause disease, infertility and lower sexual experience, often prevent people from taking
them. In several African countries, surveys showed than men considered child rearing as well as
contraceptives to be the woman’s responsibility. On the other hand, since men were the primary
decision makers in the household, without their help and support many women found it difficult
to obtain them on their own. Many cultures dictate large family sizes and pressure women into
having more children. Women who use contraceptives are looked down upon in many regions
and are thought to bring shame to their husbands. Some health care providers even refuse to
provide for women who are unmarried or have less than three children. In Sub-Saharan Africa it
is common for men to have much larger desired family sizes than women. This is especially
common among followers of an Indigenous religious church as well as Muslims. Therefore,
women’s control over their own fertility essentially lies in the hands of their husbands, (Turner,
2021).
Polygyny is common in some regions, especially in West Africa where TFR is high, driven by
men’s desire for large families. This leads wives to bear more children than they would have
wanted, to be able to compete with their co-wives. More children equal more attention and
resources from their husband, (Turner, 2021). For this reason, studies should always measure
males and females desired family sizes separately. Family planning programs help as they can
influence cultural norms and thereby reduce desired family sizes, (O’Sullivan, 2013).
By giving specifically girls access to more school years and education about sexuality, teen
pregnancies can be avoided and the onset age of pregnancy can be delayed. This would help
many developing nations and enable women to gain more knowledge, experience and
independence before their first child, (Bongaarts et al, 1997). Since women, especially in
traditional families, often have a deciding role in matters regarding their households, a higher
education likely has a positive effect on lowering child mortality and improving the health of the
household overall, (KC& Lutz, 2014). Family planning programs could be the tool to empower
women in developing countries to postpone pregnancy and choose for themselves when and how
many children they wish to have. This would give them more time to invest in higher education
and jobs, creating a positive feedback loop in which better prepared mothers create better lives
for their children, which then could do the same, (de Silva& Tenreyo, 2017).

14
Child mortality
Child mortality typically refers to the death of children under five years old. It used to be
common all over the world, but has declined steadily since at least 1800. Most child deaths are
preventable since they come from unsanitary conditions, infectious diseases, poor healthcare and
malnourishment and declined as global living standards increased. In most of the western world,
Japan and South Korea, child mortality is well below 1%. That means less than 1 child per 100
dies before they reach five years old. In Sub-Saharan Africa however, many countries still have a
mortality rate of between 5 to 11,7%. Coincidentally, these countries also have the highest
fertility rates, (Our World In Data, 2022)
High fertility in the past and today has been partially attributed to parents having many births
due to the expectation that several will not result in surviving children, (Shapiro& Tenikue,
2017). In an environment with high mortality, many children become an insurance that at least
some will make it to adulthood and contribute to the family. This lowers the motivation to engage
in contraceptive use. If however almost every birth results in a healthy, grown-up child, there
would be an incentive for family planning, because the future becomes much more predictable.
Declining child mortality has been linked directly to lower fertility rates, both in the past and
present, all over the world, and is part of the theory of demographic transition, (Shapiro&
Tenikue, 2017)

Religion
TFR is higher in countries and regions with high religiosity, (Our World In Data, 2022).
Traditional religious leaders often support large families and oppose measures like contraceptives
and family planning as well as progressivism in general. People in these areas are more likely to
follow the direction of their religious leaders rather than external influences. When looking at
African countries, those who follow Islam or an Indigenous Religion have a significantly higher
TFR than Christians in the same area. Muslims also often had higher child mortality. Among
Muslims, contraception was used more commonly by Shia rather than Sunni. Sunni however
constitute the majority of Muslims with around 85-90%. Muslims are also the religious group
with the highest desired family size of all religions in Sub-Saharan Africa. Average number of
desired children among Muslims in Chad was 9,7 followed by Nigeria with 8,1, with slightly
lower numbers for Christians. The difference between religious groups was greatest in Kenya
where Christians generally only wanted 0-3 children whereas Muslims desired as many as six

15
children.
When just comparing Christians then followers of the Apostolic church had the highest
fertility of all denominations, (Turner, 2021). A country where this specific church is particularly
strong is Nigeria, which has a TFR of well over 5 children per woman, (Our World In Data,
2022). In other parts, and most of the world, Catholics generally have a higher fertility than e.g.
protestants. This can be attributed to the Catholic churches long history of opposing
contraceptives and other types of family planning.
Across all of Sub-Saharan Africa, there is a negative correlation between religiosity and
contraceptive use, resulting in high fertility, (Turner, 2021). High religiosity also has a negative
effect on factors like female education, gender equality as well as economic growth, (Götmark&
Andersson, 2020)
Changes in culture norms and attitudes are evidently required to lower fertility rates, although
more work is needed to evaluate individual factors. Family planning programs worked best in
regions where they had strong support from politicians, governments and local leaders as well as
increased funding, (Bongaarts& Hardee, 2020). Religious leaders should be an integral part of the
strategy in spreading knowledge and acceptance of contraceptives and lower birth rates, (Turner,
2021).

Method

The question
The opinion among Swedish citizens was quantified via an online web survey. The company
hired to conduct the survey was Novus, who has a representative web panel of roughly 50.000
participants, (Novus, 2022). Through this method it was guaranteed to reach people within all
ages, education levels and regions in the country. All who agreed to participate in the survey had
to read a small introduction and answer only one question. The entire survey was in Swedish, as
were all answers by the participants. The translation is as follows:

The population of the world is increasing and will continue to increase, according to the UN, for
the next 75 years. Birth rates and family sizes in developing countries have decreased on average
since the late 50s. But in many countries, e.g. large parts of Afrika, birth rates are still high and
are only falling slowly.

-Which factor do you think is most important for falling birth rates in developing countries?

16
State your own opinion. If you are unsure, answer as well as you can. Name only one factor, the
one you think is most important. Ignore forced population measures, which a few countries have
used, (mostly China). Reply only to the question above. Please read it several times. Do not seek
aid in answering.

The answers were in free text form to let each person think and express themselves freely. The
aim was to measure the real levels of knowledge and thought among the population. They were
encouraged to guess, even if they were unsure, to catch thoughts they might have picked up
unconsciously via media, school, books etc. Pre-made categories would likely guide a person to
the answer they thought sounded most correct, even if they had never guessed it otherwise. It
would therefore not be a real representation of peoples thoughts on the subject.
The survey was sent out on the 13th of April, 2022, to 1741 persons in the web panel and the
response rate was 58%. In total, 1010 answers came back. For each participant there was
information about gender, age, education level as well as their general location.
The age groups were sorted into Young Adults 18-38, Adults 39-59 and Seniors 60-80. Each
age group thus comprised a 20 year interval. Even though it is a matter of opinion where the age
limit for young adults should be, it was necessary to keep the borders at the current levels. If
Young Adults had been reduced, there were too few participants in certain categories for testing
and they would have been excluded entirely instead. Also, young adulthood is climbing upwards
in age. It is common in Sweden today not to have children or a house before 30, (SCB, 2022).
Originally there were three education levels. These were elementary school or corresponding,
upper secondary school and university or corresponding. There were however to few participants
in the lowest education level, therefore elementary and upper secondary participants were
grouped together into Upper secondary school or lower.

The response categories

All answers were read individually, interpreted and sorted into categories. The interpretation and
categories were also discussed with a person having knowledge of the subject. To preserve the
nuance of each answer, smaller sub-categories were constructed in the sorting and classification
process. These however contained too small samples for meaningful testing, and so were in turn
grouped together in larger categories for Chi-Square testing. The final categories produced were
as follows;
Increased education- contained the subcategories Education in general and Education for
women.
Reduced child mortality- no subcategory

17
Increased living standard- contained Better economy and Better socioeconomic factors.
These were separated due to many respondents answering specifically that increase in countries’
BNP or personal wealth was the reason for the reduced fertility rates. The broader socioeconomic
factors also include healthcare, safety, class, employment and social security.
Family planning- meaning family planning programs and similar initiatives
Progressivism- with the subcategories Female rights, Individualism, Secularisation, Democracy
and Cultural Shifts. Individualism refers to the notion of people focusing more on themselves
rather than the community, and the choice to delay or forego children in favour of personal
fulfilment through work, traveling and freedom. Cultural shifts refers to societies’ move away
from traditional norms that favour many children and the expectation on women to bear them.
Contraceptives- meaning the access to them as well as use and the knowledge of how to use
them. No subcategories.
Sterilisation- either voluntary or forced. Sometimes referring to past measures from certain
countries.
Reduced sexual activity- contains people who either thought that wars kept men from home,
thereby not being able to conceive children, or those who thought that people simply had less sex
than before.
High mortality- contains the notion that many people in developing countries die for various
reasons so that fertility rates go down. Contains the subcategories War, Starvation and Disease.
Uncertain future prospects- the thought that future uncertainty caused by things e.g. climate
change, political unrest, war or personal problems makes people choose not to have children.
Bad living standards- contains the subcategories Corruption/Oppression and Bad socioeconomic
factors.
Don’t know- people who choose not to answer because they judged themselves to be uninformed.

Misunderstood the question- people who clearly did not understand the question and gave
unrelated answers.
Many categories had to be added after reading the entries, simply because the number of people
answering them. When there were multiple, mutually exclusive answers, only the first answer
was used in the analysis. If the answer however described a theme, an interpretation was made to
place it in a corresponding category. There was no discrimination between quality of answer
since the point was to compile all suggestions of the respondents, regardless of how plausible
they appeared to be.

18
The analyses
To determine possible statistically significant difference within each of the three expectations set
up, a Chi-Square test was used. It was carried out on SPSS which gave the χ2-value, p-value as
well as Phi and Cramer’s V effect sizes. It was necessary to remove two response categories from
the tests due to small sample sizes. These were “reduced sexual activity” and “sterilisation”. Each
category had one woman and one man so in total 4 respondents were removed. That left 1006
people with which all tests were conducted.

Results

Overall
I found clear statistical significance for all three expectations, according to the Chi-Square test.
Of the original 1010 responders, 1006 were included in the tests. Of those remaining, 530 were
men and 476 were women. The null hypothesis could be rejected in case of gender, education
levels and age (P<0,001, see below). The most frequent answer was better living standard
followed by increased education and progressivism. Low child mortality and family planning
were last by far, with 20 and 19 answers respectively.

Gender
The Chi-Square test showed that there was a significant difference between male and female
responders, ( χ2= 99.2, p<.001). Cramer’s V and Phi showed a medium effect size of 0.3. Thus,
the null hypothesis is rejected.
When looking at the distribution of answers, it is clear where the differences are most
prominent. (see Figure 3a). Almost four times as many women compared to men, (>16% vs. 4%),

19
had “Contraception” as their main answer. A separate two-way Chi-Square test for this specific
category confirms the results to be significant and not due to chance, (χ2= 38,65, p<.001). On the
other hand, almost a third of men favoured “Increased living standard”, especially in regards to
economy and BNP, whereas only a sixth of women did. When it came to education however, they
were almost equal, with women mentioning it slightly more often. But women emphasized
female education to a relatively greater extent than men. Of all the people who choose ”Increased
Education”, a fourth of women picked ”Education for women” specifically, in contrast to only a
fifth of men. Women also answered family planning thrice as much as men, which said it less
than 1%. These roles were reversed when it came to misunderstanding the question. For sub-
categories, differences between men and women were also marked, (Figure 4).

Figure 3a: Bar chart showing the distribution of answers between males and females in percent.

20
Figure 4: Bar chart showing the distribution of answer between gender regarding various subcategories in percent.

Education level
There was a significant difference between those who had a higher education compared to those
who had completed upper secondary school or lower, (χ2 =56,9, p<.001).
The effect was on the smaller side with 0,2 for both Cramer’s V and Phi.
The strongest difference was found in the category “Increased living standards”, where those
with a higher education were 12 per cent units more likely to have answered this. People with an
university-level education also showed a higher preference for the answer “Increased education”
as well as “progressivism”. Those with an upper secondary level education or less where more
than twice as likely to answer that they do not know but they also misunderstood the question less
often. They also had a preference for “uncertain future prospects” and “high mortality”. In the
remaining categories, both education groups were close in frequency of their answers.

21
Figure 3b: Bar chart showing the distribution of answers between people with upper secondary level education or
less and people with university-level education. Displayed in percent.

Age
Of all three expectations tested, age showed the weakest differences, (χ2=46.2, p<0.001). The
effect size for Cramer’s V was low with 0,15 but slightly better with a Phi-value of 0,2.
Over 30% of Young Adults answered “Increased living standards”, compared to 22,3% and
23,2% for Adults and Seniors respectively. The most preferred answer for people aged 39-59 was
“Increased education”. Both young adults and especially Adults showed a larger preference for
more education and progressivism, which included things like female rights and individualism.
Seniors, people between 60-80, answered family planning most often of all three age groups.
Seniors also stood out in answering ”Uncertain future prospects” and ”High mortality” on
average almost 4 per cent units more often than the closest following group. They also
misunderstood the question most, with middle aged people close behind.

22
Figure 3c: Bar chart showing the distribution of answers between the three age groups 18-38, 39-59 and 60-80.
Displayed in percent.

Discussion

Survey and gender

Men and women had the largest differences in answers. Several interesting numbers stand out.
Almost a third of men thought that increased living standards was the leading cause for falling
fertility rates in developing countries. This only came on fourth place for women. When looking
at the subcategories, nearly 11% of men specifically singled out better economy and increased
GDP. This might show how men think in wider perspectives and that they personally hold
economic wealth to be important. In turn, this may be related to how men traditionally have had a
providing role within families. Even in Sweden, which is one of the most equal countries in the
world, men still only took out 30% of the paid parental leave in 2020, (Försäkringskassan, 2022).
Women on the other hand seem to be more concerned with the individual and thinking of what
would influence their own choices. They responded “Increased education” as the most important
factor. More than a fifth of women answered education, compared to 17% of men. Furthermore,
more than a fourth of all the women who chose education specifically said female education,
which shows they understand the importance in educating women and girls. Studies have shown
that fertility rates all over the world are negatively correlated with female education, (KC& Lutz,
2014), and that this is one of the factors which influences fertility rates.
The second most frequent answer among women fall within the umbrella term progressivism.
There, individualism and female rights were the most common answers. Women in Sweden seem

23
to recognise the importance of the individual women making their own choices and how this in
turn lowers fertility rates, since women in developing countries often desire less children than
they end up having, (Turner, 2021). Only 2,6% of men answered female rights and they answered
“Progressivism” less overall, which indicates that their focus partly lies elsewhere.
In the category contraceptives, the differences became most obvious. Contraception was on the
third place for women but only on seventh place for men. Women are clearly aware that without
modern birth control, reduction of birth rates is more difficult. Men’s lack of attention to the
importance of contraception indicates how it is still more of women’s responsibility, even in a
“modern” country like Sweden. If men were they main users of birth control, presumably the
roles would be reversed. This would be an interesting basis for repeating the study if and when
male birth control pills come out to the public, or in areas where the use of condoms is frequent.
The use of different modern contraceptives varies markedly among countries.
Women’s concern for the individual can also be seen among those answering “Uncertain
future prospects”. Women seem to value predictability and safety above child bearing. In times of
unrest, given the choice, women would want fewer children. The differences between men and
women here were not large, but still visible. However, it is unclear whether an uncertain future
has been a reason for falling birth rates in developing countries, although it was a factor in
Eastern Europe as the Soviet Union fell apart, (Tichá, 2019).
Lastly, it is interesting that women admitted to not knowing the answer more frequently than
men. Men however misunderstood the question more often. Perhaps this is an indication of
accurate self-judgement on the women’s part. The women’s answers were generally much easier
to understand, interpret and divide into categories with less uncertainty. These results indicate
that women place greater importance in factors like birth control and women’s issues overall and
this translates into general knowledge about fertility as well. Overall, the results suggest that
women have more knowledge about factors that influence birth rates in developing countries,
compared to men. Both sexes however have much to learn as, as is clear from the scientific
literate reviewed above.

Survey and education

Originally there were three different education levels. Since those who had completed elementary
school or less were so few, they had to be combined with the upper secondary group as not to be
excluded entirely. So the two groups for testing were Upper secondary or lower and University
graduates, with 465 and 541 respondents respectively.
The answers from those with upper secondary education or less were spread more evenly

24
across different response categories, while those with a university degree concentrated mainly on
three big groups. These were “Increased living standard”, “Increased education”, and
“Progressivism”, in that order. The three largest categories however were the same for both
groups. The biggest difference was that university graduates wrote ”Increased living standard”
more, (30,3% vs 18,7%). Maybe this was a reflection of themselves since people with a higher
education tend to have access to better jobs and housing as well as fewer children later in life,
(KC& Lutz, 2014). This is also consistent with their second most preferred category of
”Increased education” which they choose over 6 per cent units more than the other group. Clearly
education is important to this group, which is reflected in their own life choices. The third largest
category was progressivism in which there was only a small difference between those with
university level education and those without. Interestingly, the less educated group scored higher
on contraceptives and reduced child mortality, and nearly the same on family planning, three
important factors according to scientific literature. The less educated also misunderstood the
question slightly less often and were more likely to answer “I don’t know”. This might also be an
indication of better self judgement on their part, and perhaps those with a high education rather
guessed than admitting to not knowing the answer. These results might be interpreted as that a
university education not necessarily translates into better knowledge about population and
fertility issues and that specific information about these topics is needed if people are to be
informed, both in and outside of schools.

Survey and age

The smallest differences were found between the three age groups. This might be due to the age
groups simply being too wide in span (20- year intervals). Smaller groups might give clearer
results but would also risk too small sample sizes in certain categories, making the test less
conclusive.
The youngest groups answered “increased living standards” most often. Possibly a reflection of
personal values since younger generations make higher demands on their personal life situation
before starting a family. Interestingly, they did not score highest on progressivism, as the middle
aged (Adults) did. Seniors answered family planning more often, which weakly supports the
hypothesis that they remember when family planning was a public issue. They also placed a
relatively large emphasis on uncertain future prospects. Having the benefit of hindsight, maybe,
since older people have been observing problems for longer, they have a different perspective.
They also answered “high mortality” equally often as “uncertain future prospects”, describing a

25
bleak outlook on the world. It is hard to make general conclusions but these interesting results
give cause for further studies.

Possible sources of bias

The categories created were essential for sorting the answers, but are not perfect. Since the
quantification of answers into categories contained partly subjective interpretations, another
person might get slightly different distributions. In my view, software quantification (machine
learning, etc) would be difficult in the present case, since the survey question was answered in so
many ways. Some answers fit several categories and some were nearly impossible to understand
the meaning of. We received answers we could not have anticipated if pre-made given
alternatives had been available to respondents. Without the free text option, we would have
missed the full scope of thoughts and misconceptions among the public. The relatively high
number of people who misunderstood the question indicates that the thought of birth numbers
falling is foreign to many, and they apparently read the question wrong, thinking of reasons for
“high population growth”. Several respondents thought that the only way for birth rates to be
falling in developing countries must be high death rates. A reason for this could be because we in
the west only hear about the negative news from developing countries, but not their progress.
Common ways people misinterpreted the questions were:
-Why are birth rates in Sweden falling?
-Why are birth rates in immigrant groups in Sweden higher than among native Swedes?
-Why are birth rates in Sweden lower than in developing countries?
-What are the consequences of falling birth rates?
-What are the consequences of too high birth rates?
-Why are birth rates in developing countries so high?
-What can/ should be done about the high birth rates in developing countries?
The results for gender were clear but education and age would benefit from further analyses.
With more participants, elementary school education and smaller age groups would be interesting
to explore in more detail.

Conclusions
Studies tell us that family planning is the single greatest factor which reduces fertility rates,
(Bongaarts& Hardee, 2020; O’Sullivan, 2013), and yet this was the smallest out of all the groups.
This is not surprising since even some distinguished researchers of overpopulation, like
Wolfgang Lutz, omit family planning from their papers. Only 19 of 1010 participants answered

26
it. Another important, but overlooked, factor is reduced child mortality, which only 20 people
answered. With the two possibly greatest factors being the two smallest response categories, it
seems that important information is not reaching the general public. Contraception and education
were common answers and are indeed very influential but not nearly as important as the size
contrast to the two smallest categories, according to the public, would suggest. The most popular
response of all however was increased living standard. This was the number one largest category,
by far, of all the groups and many researchers would consider this a misconception, or factor of
low importance. Studies show how lowered fertility rates are not correlated with an increase in
GDP, (O’Sullivan, 2013, Götmark& Andersson, 2022), and yet this seems to be the most
widespread belief. I personally believe the misunderstanding comes from when people compare
developed nations to developing. The first thing which stands out is wealth and people assume
this to be the reason for the low birth rates. But this is a simplification and overlooks all the other
important factors lowering fertility rates, discussed above. This is why it is important to spread
information about how lower fertility rates precede an increase in economic growth, (O’Sullivan,
2013; Bongaarts& Hardee, 2020; Götmark& Andersson, 2022).
Overpopulation is a pressing concern affecting every region of the planet. Policy makers need
to take the issue seriously and start working towards a common goal of a reduced human
population. The first step to solving this problem is to inform the public about what truly
influences fertility rates.

Acknowledgements
I would like to thank Frank Götmark, who provided inspiration and guidance throughout the
writing of this thesis. Thank you for all your help and support.

27
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