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U.S. National Report on POPULATION
A report submitted by the U.S. Department of State in
preparation for the 1994 International Conference on
Population and Development
Table of Contents
Introduction                                   1
The Demographic Context                        2
U.S. Population Growth                         3
Components of Growth                           5
Racial/Ethnic Diversity of the U.S. Population10
Household and Family Trends                   13
Aging of the U.S. Population                  17
Work Force Trends                             20
Implications                                  23
The Population Policy and Program Framework   24
National Perceptions of Population Issues     24
Current Status of Population-Related Policies 25
Maternal and Child Health/Family Planning
    Service Delivery and Related Programs     37
Other Population-Related Activities           41
Experiences and Lessons                       46
Role and Relevance of the World Population
    Plan of Action                            47
Population and Consumption                    50
International Cooperation in Population       54
Population-Assistance Policies and Priorities 54
The Nature and Character of U.S. Population
    Assistance                                55
Trends in International Population
     Assistance                               57
Experiences in International Cooperation      58
Unresolved Issues and Future Priorities in
    International Cooperation                 59
Future Policies and Priorities for
    International Population Assistance       60
Conclusion                                    62
Footnotes                                     64
Basic References                              68
Table and Figure Sources                      69
In 1994, the United Nations will host what has become a
decennial international conference on population and
development. In preparation for these conferences, the
United Nations customarily asks each member nation to submit
a national report on population, so that it may analyze and
synthesize their experiences in addressing population issues
for the conference to take into account in its
This report describes the current population dynamics,
policies, and programs of the United States. Following an
outline prepared by the United Nations for developed
countries, it recounts current U.S. social and demographic
trends, it reports Americans' perceptions of population
issues, it summarizes U.S. policies and activities related
to population, and it chronicles U.S. cooperation in
international population assistance.
The U.S. population differs from most industrialized
countries by virtue of faster growth, greater racial and
ethnic heterogeneity, and uneven settlement patterns.
Consequently, the effect of changing demographic trends sets
a somewhat different social and political agenda for this
country. In particular,
   --  the issue of population aging is complicated by the
particularly large baby boom experienced after World War II
by the United States relative to other industrialized
countries, as well as by the difference in the age structure
of racial and ethnic groups;
   --  the issue of fertility is complicated by different
rates of fertility among different racial, ethnic, and
socioeconomic groups, changing patterns of marriage, and
differential access to contraceptives and abortion services;
   --  the issue of immigration is complicated by the uneven
distribution of large numbers of immigrants across the
country, and the uneven impact on the labor force of
fundamental changes in the U.S. economy.
In addition, multiple perspectives exist within the United
States on population-related issues and policies, as the
report attempts to make clear. The United States does not
have an official population policy, in part because there is
little public concern about U.S. population size or growth,
but also because there is little public consensus about the
nature and purpose of such policies. Nevertheless, many
policies and programs in such areas as health care,
immigration, urban planning, natural resources conservation,
and income security both affect, and are determined by, the
size and characteristics of the U.S. population.
Finally, the United States continues to be a leader in
providing population assistance to developing countries.
U.S. activities in this regard have undergone considerable
change over the past two decades, and are currently being
redirected to support a more comprehensive approach to
helping nations that wish to do so curb growth. However, the
goals of U.S. international population policy continue to
focus on improving the quality of life for all the world's
I. The Demographic Context
With a July 1, 1993 population of 257,927,000,/1 the United
States is the third-largest country in the world. It is the
largest among the more-developed countries, but a rather
distant third to the two largest countries, China (1.2
billion) and India (897.4 million)./2  In 1991, when the
U.S. population was 254 million, the more-developed
countries closest in population size were Russia (149.0
million), Japan (124.8 million), and Germany (81.1
million)./3  Compared with most other developed countries,
the United States:
   --  is growing faster, due to higher fertility and higher
   --  has greater racial and ethnic diversity; and
   --  has a pronounced bulge in the population of middle-
age-a result of the 1946-1964 baby boom.
On the brink of the 21st century, the U.S. population is,
therefore, both growing in size and changing in composition.
Its racial and ethnic diversity will increase and, if
current trends continue, the proportion of the population
that is foreign-born will increase. These elements of
diversity will not be spread evenly across the country, but
will cluster in certain regions, states, and cities.
Additional elements of diversity will include differences in
age structure for different regions and states, as the
elderly continue to migrate to selected retirement areas or
to age in areas younger people have left, and as working
families continue to migrate toward employment
A. U.S. Population Growth
The United States is adding nearly 2 million people a year
to its population through the excess of births over deaths.
Even before accounting for immigration,  this 0.7 percent
rate of natural population increase is one of the highest
among industrialized countries (see Figure 1)./4
According to the latest projections from the U.S. Census
Bureau, which attempt to account for immigration, the U.S.
population will continue to increase in size at least
through 2050 (see Figure 2)./5
The middle series of the current projections show the U.S.
with a population of roughly 276 million by the year 2000,
326 million by 2020, and 392 million-and still growing at a
rate of more than 0.5 percent a year-by 2050 (see Table 1).
Under these projections, the United States will add 76
million people in the three decades between 1990 and 2020.
This is an increase of more than one-quarter (30 percent),
or the equivalent of adding four more states the size of New
York-currently the second-largest state. If current
fertility and mortality trends continue, natural increase
(i.e., not counting immigration) will still be adding a
million people per year to the population in 2050. These
projections carry forward 1993 levels of childbearing and
immigration, assuming improvements in life expectancy
equivalent to those experienced in the 1980s.
Table 1. U.S. Population, 1970 to 2050
     Low-growth     Middle     High-growth
     1970     N/A     203,810     N/A
     1990     N/A     249,391     N/A
     2000     270,259     276,241     281,957
     2020     289,553     325,942     363,213
     2050     285,502     392,031     522,098
N/A-Not applicable
Note: Resident population. Numbers in thousands, as of July
1. Consistent with the 1990 census, as enumerated.
Source: U.S. Bureau of the Census.
A high-growth alternative scenario projects a population of
almost 282 million by 2000 and 363 million by 2020. This
scenario assumes a 20 percent increase in fertility for
whites (non-Hispanic), a 10 percent increase for all other
population groups, higher rates of net immigration, and
continued improvements in life expectancy.
The less likely slowest-growth scenario would have the
United States increasing in size to 270 million by 2000 and
almost 290 million by 2020. This scenario postulates a 10
percent decline in fertility rates for whites (non-Hispanic)
and a 20 percent decline for minorities; little change in
life expectancy; and a decline in net immigration, based on
a return to mid-1980s levels of legal and refugee
immigration, a decline of undocumented immigration, and an
accompanying increase in emigration.
Regional growth and distribution. The regions of the United
States are growing at quite different rates, which both
reflects and contributes to the increasing diversity of the
country. Between 1980 and 1990, the West grew by more than
one-fifth (22.3 percent), the South by 13.4 percent, the
Northeast by 3.4 percent, and the Midwest at an almost
static 1.4 percent./6  U.S. growth during the 1980s was
remarkably uneven. Just three Southern and Western states
accounted for more than half of the population growth of the
country: California (6.1 million), Florida (3.2 million),
and Texas (2.8 million).
Population deconcentration, or "exurbanization," is a trend
that has affected the distribution of the population in
every U.S. region./7  Residences and workplaces are
spreading outward from the historic central cities and more
recent suburbs of metropolitan areas. According to one
analysis, "exurban" counties have been the fastest-growing
component of the American landscape, accounting for 30
percent of the population growth between 1960 and 1985.
Exurban areas accounted for 20 percent of all new jobs and
61 percent of new manufacturing jobs created between 1965
and 1985./8
This pattern of population dispersal has helped shape
patterns of racial/ethnic concentration, energy use, land
use, wilderness encroachment and conservation, and many
other aspects of American life. For the elderly, for
example, "exurban" and suburban growth-coupled with people's
expressed desires to remain in their own homes-will
necessitate a shift from the planning and provision of
services on a concentrated basis to the geographic dispersal
of services with an emphasis on transportation needs.
B. Components of Growth
What is driving U.S. population growth? The major engine is
fertility, that is, how many children are being born.
Immigration is a significant secondary factor.
Fertility. The total fertility rate (TFR, or average births
per woman, given current age-specific childbearing patterns)
rose from 2.05 children per woman in 1992 to 2.07 children
per woman in 1993. In contrast, the average TFR among
European countries is 1.6, for Australia, 1.8, and for
Canada, 1.8./9  These seemingly small differences in TFR
make a big difference in population growth. For example, if
women in the United States gave birth at the average TFR for
European countries, there would have been about 3,200,000
births in the United States in 1991 instead of the 4,110,907
that actually were born.
The baby boom that took place between 1946 and 1964 produced
record numbers of births (see Figure 3)-more than 4 million
children were born in 11 of these years. The number of
births dropped substantially in subsequent years, as women's
participation in the labor force and their access to birth
control increased. Births only reached baby boom levels
again in the latter part of the 1980s, as baby boom women
had children of their own. This "echo" baby boom reached its
peak in 1990, at 4.2 million in 1990, declining to just
under 4.1 million in 1992, as the crest of the childbearing
wave of the baby boom generation passed. In 1994, the
youngest of the baby boom generation will turn 30, leaving
the prime age for childbearing. Nonetheless, in terms of
numbers of births and therefore numbers of children to be
served by school systems over the next two decades, current
U.S. birth cohorts are almost as large as the largest
cohorts of the baby boom.
The recent increase in births in the United States has been
shaped by two factors: large numbers of women in the
childbearing ages, and a shift to later childbearing by many
women. Starting in the 1970s, both the number of women over
age 30 and the fertility rates for women this age increased.
By 1990, the number of babies born to women aged 30 to 34
(886,063) was the highest ever recorded for that group, and
accounted for over 20 percent of all births./10  In 1975,
just after the trend to delayed childbearing began, this
group accounted for 12 percent of all births. Rates of
childbearing for women in their late 30s and 40s increased
as well. This trend seems to have reached its peak, since
the birth rate for women aged 30 to 34 declined in 1991 and
only increased slightly for those aged 35 to 39.
In contrast, childbearing rates for teenagers have continued
to rise. The birth rate for women aged 18 and 19 was higher
in 1991 than in any year since 1972, rising by 7 percent
from 1990 to 1991 alone. Teenage birth rates, previously on
the decline, have risen sharply since 1986 from 50.6 to 62
per 1,000 teenage women. One quarter of these teen mothers
are giving birth for a second, third, or more time. This
rise in teenage pregnancy is in part due to an increasing
proportion of teenagers who are sexually active. It may also
result from reduced access to contraceptives and abortion in
the 1980s.
Births to unmarried women have been increasing steadily,
reaching a record high of 1.2 million in 1991. In 1991,
unmarried women accounted for 30 percent of all births.
Births to minorities account for a growing proportion of
U.S. births. This is due both to higher fertility rates
among minorities, and to the increasing proportion of our
minority population that is made up of recent immigrants.
Moreover, the interaction of these two factors produces a
younger age structure for most minority groups, thus
yielding proportionally more women in or approaching their
reproductive years./11
Immigration. Immigration, currently at relatively high
levels, is also adding to population growth, both directly
and indirectly, through the higher fertility of some
immigrating groups (although immigrant fertility usually
falls to the national norm within one or two generations).
U.S. immigration has been rising for five decades. Legal
immigration, which stood at 373,000 in 1970, rose to 811,000
in 1992./12  Over 3 million persons received immigrant
status between 1989 and 1991, but many were previously
illegal immigrants granted legal status under the
Immigration Reform and Control Act (IRCA) of 1986.
The Census Bureau now projects 880,000 net immigrants a
year./13  Still, natural increase (the surplus of births
over deaths) outweighs immigration by more than two to one
as a component of U.S. population growth, and will continue
to contribute more than immigration-although by a
continually dwindling proportion-through 2050.
Immigration is an important factor in the changing racial
and ethnic composition of the United States, since a
majority of immigrants are either Asian or Hispanic. In
1992, 43 percent of legal immigrants came from countries in
Asia or in the Pacific, and 28 percent came from Hispanic
countries (see Table 2)./14  As a result, more Asians are
expected to be added to the population through immigration
than through births for the next three decades./15
Table 2. U.S. Immigrants by World Region, 1992
Region          Number             Percent
Total           810,633            100.0
Africa           24,826              3.1
Asia            348,553             43.0
Europe          143,729             17.7
North America   238,552             29.4
South America    50,488              6.2
Oceania           4,485              0.6
Hispanic countries  230,001         28.4
Source: Immigration and Naturalization Service.
Immigrants have been entering and taking up residence
primarily in a handful of states: California, New York,
Texas, Florida, New Jersey, Illinois, and Massachusetts. The
rest of the country, in contrast, is relatively untouched by
current immigration trends. This trend is enhancing
distinctly different patterns of racial and ethnic
composition that previously existed from state to state.
Mortality. In 1991, life expectancy at birth in the United
States reached an all-time high of 75.5 years./16  Life
expectancy in the United States is about the same as the
average for European countries, although several developed
countries-including Japan, France, Canada, and Australia-
exceed it by two or more years./17
Between 1970 and 1991, U.S. life expectancy increased 4.7
years. It increased especially for people of older ages, as
death rates came down substantially for two of the most
common causes of death: diseases of the heart and
cerebrovascular diseases. Death rates for cancer, the
second-leading cause of death, rose slightly, and current
trends suggest that cancer may soon overtake diseases of the
heart as the leading cause of death in the United States.
Unintentional injuries became the third-leading cause of
death in the early 1980s, as deaths from cerebrovascular
diseases declined to the fourth-leading cause.
U.S. women are currently expected to outlive U.S. men by an
average of 6.9 years, primarily because men have higher
rates of circulatory diseases and malignancies such as lung
cancer./18  Life expectancy has been rising fairly steadily
for white men and women, and for African American women for
the past two decades. It increased most for African American
women, by 5.3 years, although the gap between African
American and white women widened during the 1980s. Life
expectancy for African American men declined slightly in the
late 1980s, largely due to an increased incidence of
homicide. Death rates of African Americans are almost seven
times as high as those of whites for homicide and about
three times as high for HIV/AIDS, nephritis, and septicemia.
Many have feared that longer life expectancies would
translate into a sharp increase in years during which people
tend to suffer from ill health, and have difficulty
functioning. However, new research indicates that not only
are Americans living longer, they are also doing it in
better health. The first documented increase in active life
expectancy in the United States occurred during the 1980s,
as measured by the reduced prevalence of chronic disability
and institutionalization among people aged 65 and older./19
During this decade, both the population and the medical
community became sensitive to the health problems of very
old people, and found that many problems were remedial.
Also, today's older population has  higher levels of
education and economic status than previous generations, and
the recent improvement in  active life expectancy was
greater among people with more education.
The U.S. infant mortality rate has been generally dropping
since the 1950s.  It was more than halved over the past two
decades, falling from 20.0 to 9.2 infant deaths per 1,000
live births between 1970 and 1990. Infant mortality remains,
however, about twice as high for African Americans, at 17.0
infant deaths per 1,000 live births./20
C. Racial/Ethnic Diversity of the U.S. Population
Already a multicultural society, the American population is
becoming steadily more diverse racially and ethnically.
Because of their lower fertility and lower immigration
rates, whites (non-Hispanic) are expected to contribute only
36 percent of the total population growth between 1990 and
2000./21  (According to U.S. statistical practices,
Hispanics are not considered a racial but an ethnic group,
and as such are not always shown separately in statistical
tabulations. An estimated 90 percent of U.S. Hispanics
report themselves as belonging to the white race, so in this
report the term "white," when not qualified as "non-
Hispanic," includes Hispanics.)
Between 1980 and 1993, the number of Asian Americans more
than doubled, increasing from 3.6 million to 8.3 million, a
jump of 134 percent (see Table 3)./22  The number of African
Americans increased from 26.1 million to 30.8 million, up by
18 percent. The white (non-Hispanic) population grew at a
much slower rate of 6 percent, increasing from 180.6 million
to 191.9 million. Native Americans increased by 31 percent
(primarily due to increased self-identification), but
remained relatively small in numbers, accounting for fewer
than 2 million people by 1992.
Table 3. Growth of U.S. Population by Race and Ethnicity,
1980 and 1993
             Population                 Change
         1980           1993          1980-1993
  Number  Percent  Number  Percent  Number  Percent
Total, U.S.
    226,546  100.0  257,927  100.0  31,381  13.9
Non-Hispanic white
    180,603   79.7  191,899   74.4  11,296   6.3
All minorities
     45,943   20.3   66,028   25.6  20,085  43.7
  African American
     26,092   11.5   30,768   11.9   4,676  17.9
     14,604   6.4    25,085    9.7  10,481  71.8
  Asian American
      3,551   1.6     8,298    3.2   4,747 133.7
  Native American
      1,433   0.6     1,876    0.7     443  30.9
1. Numbers in thousands. 1980 numbers as of April 1; 1993
numbers as of July 1.
2. Totals for African Americans, Asian Americans, and Native
Americans are for those who are not of Hispanic origin.
3. Total for Asian Americans includes both Asians and
Pacific Islanders.
4. 1980 total includes 264,000 people whose race was not
Source: U.S. Bureau of the Census.
The white (non-Hispanic) share of the population is
projected to fall from three-fourths of the whole in 1990 to
slightly more than two-thirds by 2010.  During the same
period, the Hispanic share of the population is projected to
increase from about 9 to about 13 percent, and the Asian
share from less than 3 percent to more than 5 percent. The
African-American share of the population will grow more
slowly, rising from 12 to 13 percent.
The racial and ethnic composition of the U.S. population is
therefore undergoing a rapid transition. The predominantly
white non-Hispanic population is changing to a society
composed of diverse racial and ethnic minorities. By mid-
century, if current trends continue, barely half of all
Americans will fall into the category of white (non-
For most of this century, most U.S. minorities were African
American. Although the minority population grew in numbers,
it continued to represent under one-seventh of the total
population. However, under the impetus of immigration from a
large number of countries and racial groups, the minority
population more than tripled since 1960. It now accounts for
about one-fourth of the total, and is far more diverse./23
Minority populations are younger than the majority, due to
their generally higher fertility rates as well as the
predominantly youthful character of immigration. As a
result, another compelling indicator of change is the rather
dramatic difference between the racial and ethnic
composition of children, working-age people, and older
people. Currently, minorities make up 33 percent of children
under age 18, 25 percent of working-age people, and 14
percent of people age 65 and older. In contrast, whites
(non-Hispanic) make up only 68 percent of children but a
much larger 86 percent of the elderly.
Minorities: How are they faring? As noted earlier, U.S.
minorities are far from a monolithic group. Different
minorities fare quite differently on such socioeconomic
indicators as educational attainment, employment, income,
and incidence of poverty (see Table 4). Moreover, there is
also a growing socioeconomic differentiation within, as well
as among, U.S. minority groups.
Table 4. U.S. Racial/Ethnic Groups-How They Fare on Various
  % of persons age    % of persons
    25-44 who are     age 16+ in    Median     % of
High school  College  the labor     household  persons
graduates   graduates force         income     in poverty
(1992)      (1992)    (1992)        (1989)     (1991)
Non-Hispanic whites
   91         28        66          $31,400       9
African Americans
   81         14        62          $19,800      33
   60         10        66          $24,200      29
Asian Americans
   92         47        64          $36,800      14
Native Americans
   78         11        60          $20,000      32
1. Totals for African Americans, Asian Americans, and Native
Americans are for those who are not of Hispanic origin.
2. Total for Asian Americans includes both Asians and
Pacific Islanders.
Source: Population Reference Bureau, Population Bulletin 47,
no. 4.
Across-minority Comparisons.  The educational attainment of
Hispanics, Native Americans, and African Americans is
strikingly lower than that of other groups.  Among people
aged 25 to 44 in 1992, only 10 percent of Hispanics, 11
percent of Native Americans, and 14 percent of African
Americans were college graduates, compared to 28 percent of
whites (non-Hispanic)./24  Almost half of Asian Americans in
this age group, 47 percent, had a college degree. Many of
today's Asian adults came to the United States specifically
to attend college; others arrived holding degrees.
These differences in education translate into different
opportunities in the work world. Younger, less-educated
minorities-particularly men-have higher unemployment rates,
and earn less when they are employed. In 1992, for example,
the unemployment rate for African-American men aged 20 to 24
was 24.5 percent, compared to 10.4 for white men the same
age./25  Additionally, studies indicate that African-
American men earn less than similarly educated white men.
Most minorities average a lower household income than do
whites (non-Hispanic). In 1989, the median household income
of whites (non-Hispanic) was $31,400. For African Americans,
it was only about two-thirds that figure ($19,800). Hispanic
households averaged $24,200, Native Americans, $20,000, and
Asian Americans, $36,800. Net worth figures, which take into
account such assets as home ownership, show even more
dramatic differences. As a result, members of each minority
group-even Asian Americans-are more likely to live in
poverty than whites (non-Hispanic). The percentage of
African Americans, Hispanics, and Native Americans in
poverty is about three times that of whites (non-Hispanic).
Growing differentiation. While income rose moderately for
most minority groups during the 1980s, a growing segment
within each group entered upper middle-class, even affluent,
income levels. The number of minority households with
inflation-adjusted incomes of $50,000 or more grew from 1.7
million in 1979 to 3.1 million in 1989. About 13 percent of
African-American households were in the $50,000-plus
category in 1989./26 This represents a major gain over the
decade, and is due as much to an increase in the number of
two-earner African-American households as the entry of
African Americans into high-income positions. In 1989, 16
percent of Hispanics were in the upper-income category. In
contrast, 26 percent of white households and 30 percent of
Asian households were at that income level.
D. Household and Family Trends
The household and family structure of the American
population has become significantly more diverse. This
change is exemplified by a historic shift that took place in
the early 1980s: married couples without their own children
living in the home surpassed married couples with children
as the most common household type. Between 1980 and 1992,
households composed of a married couple with children fell
from 31 to 26 percent (see Figure 4) of all U.S.
households./27  During the same period, the proportion of
married couples without children dipped less than 1 percent
to 29 percent. Some of these households are composed of
young couples who have not yet had children, but most are
older people whose children have grown and left home.
Between 1980 and 1992, other household types became more
common as well. The proportion of non-married-couple
families with children (overwhelmingly single women with
children) rose to about 8 percent of all households. Non-
married-couple families without children rose to about 7
percent. The number of nonfamily households, mostly people
living alone but also including unrelated adults living
together, grew rapidly and now accounts for 30 percent of
all households.
Households comprised of people living alone now make up one-
fourth of all U.S. households (women living alone make up 15
percent and men living alone make up 10 percent). Many are
older people, beyond working age, and many are young adults,
not yet married. But an increasing number are middle-aged,
as the large baby boom generation swells this age group.
Given current divorce and remarriage trends in this
generation, the number of single-person households will
probably push the married-couple-with-children household
into third place during the 1990s.
Changes in family formation. These household changes reflect
even more dramatic changes occurring in the structure of the
American family. Several trends are combining to create
these changes:
   --  Young people are marrying at older ages and more are
foregoing marriage. The median age at first marriage rose to
an all-time high in 1992: 24.4 years for women, 26.5 years
for men, compared with 22.0 years for women in 1980 and 24.7
years for men./28 The proportion of women who had not
married by their late 20s and early 30s also increased. By
1992, 33.2 percent of women in their late 20s and 18.8
percent of women in their early 30s had never married,
compared to 20.9 percent and 9.5 percent, respectively, in
1980. These trends, combined with  increases in the numbers
of widowed and divorced people, increased the proportion of
U.S. adults aged 18 and older who are not currently married
from 34.5 percent in 1980 to 38.8 percent by 1992.
   --  Marriage is less permanent; people are more likely to
divorce but also to remarry. Divorce rates soared in the
early 1970s, rising from 2.6 to 5.0 per 1,000 population
between 1966 and 1976./29  Divorce rates then plateaued,
falling slightly during the 1980s./30  At these high rates,
over half-perhaps as many as 60 percent-of recent first
marriages are likely to end in separation or divorce./31
The number of remarriages has risen steadily, from 754,000
per year in the late 1970s to 837,000 in the late 1980s.
However, a recurring survey of American women found that the
rate of remarriage has fallen: from 134 to 109 per 1,000
widowed and divorced women. Numbers and rates went in
opposite directions because the numbers of divorced women
rose even faster than the number of remarriages./32
Currently, in more than four out of ten marriages taking
place in the United States, at least one of the partners has
been married previously./33 The Census Bureau recently
estimated that the likelihood of remarriage in the near term
after divorce may be closer to "two-thirds than the three-
fourths usually cited in marriage analyses."/34
   --  More births are occurring outside of marriage. Of the
never-married women in the United States, more than 20
percent have had children./35  This proportion rose from
15.1 percent to 23.7 percent between 1982 and 1992.
Moreover, the numbers of unmarried women of childbearing age
also increased between the late 1970s and the late 1980s, as
the proportion of women aged 15 to 34 who had never married
rose-from 15.1 to 21.6 percent for white women and from 62.5
percent to 70.3 percent for African-American women./36
Births to unmarried women (both never-married and not
currently married) reached a record high of more than 1.2
million in 1991, up 4 percent from 1990 and 82 percent from
1980./37 The number of children born per 1,000 unmarried
women went from 270 to 443, an increase of 64 percent during
the decade. The most dramatic increase in nonmarital
childbearing occurred among relatively older women. One-
third of unmarried mothers in 1988 were aged 25 and older,
compared with about one-fourth in 1980. Unmarried teenagers
also account for one-third of unmarried births./38
Implications for children. As a result of these trends, more
U.S. children are being raised in single-parent homes. In
1992, about one in four families with children was headed by
a single parent, usually a mother./39  Demographers estimate
that about half of today's young children will spend some
time in a single-parent family./40
Unofficial projections suggest that these changes in family
composition and living arrangements of children will
continue, but in slower fashion at least through the rest of
the decade. That is, married-couple families with children
will account for proportionately fewer U.S. families while
other family types increase proportionately./41
The proportion of U.S. children living with both biological
parents is smaller than the household figures suggest. Of
children living with two parents in 1990, one in six lived
with a stepparent, mostly stepfathers./42  One estimate
suggests that one out of every three Americans is now either
a stepparent, a stepchild, a stepbrother or stepsister, or
some other member of a stepfamily. If current trends
continue, this share will rise to nearly half by the year
These trends have profound implications for the welfare of
children. The prevalence of divorce, remarriage, and
nonmarital births has eroded, to some extent, the cultural
norm that fathers live with and financially support their
biological children. Several recent studies show contact
with fathers  tending to diminish after a marriage
dissolves, especially after the first year or two./44  Child
support by absent fathers is often not paid. Even if
received, it is often not enough to keep children out of
poverty./45  In addition, poverty-related factors often lead
to developmental delay, which can have long-term effects on
These trends have been even more pronounced for African
Americans./46  Between 1980 and 1992, the proportion of
never-married African-American adults rose from 48.6 to 57.0
percent./47  One-third of African-American families were
female-headed families with children in 1990, while 29
percent were married couples with children./48  Fully 55
percent of African-American children live in single-parent
households, most of them with their mothers.
E. Aging of the U.S. Population
In the United States, as in other developed countries, the
population is aging. In general, two factors cause
population aging: falling fertility rates and improving
mortality rates. As discussed earlier, the United States has
been experiencing both of these trends.
Traditionally, a country's population has been distributed
by age in the form of a pyramid-with a relatively small
group of older people at the top, more middle-aged people in
the middle, and many young adults, teenagers, and children
at the base. As recently as 1970, this was an accurate
representation of the U.S. population, but several trends
are transforming this historic pattern (see Figure 5).
   --  Fewer, later births. Between 1946 and 1964, birth
rates rose markedly. Starting in 1965, the birth rate
dropped dramatically, and women began to postpone having
children until later ages. As a result, middle-aged people
now account for a larger share of the U.S. population.
   --  Moderate "echo baby boom." Now the baby boom is
completing its childbearing, but because many women have
delayed having children, demographers estimate that this
large generation will only replace itself, rather than
creating a larger generation.
   --  Longer life expectancy. More people are reaching old
age, and this yields a larger share of older people in the
As these trends work to reshape the population over the next
few decades, the American age structure will come to
resemble not a pyramid, but a pillar, with greater shares of
middle-aged and older people relative to young people. The
proportion of the population over age 65 will rise
dramatically beginning in 2011, when people born in 1946 and
later begin to reach age 65. This trend has implications for
both public and private care-although with Americans living
longer, healthier lives, they are also able to be productive
Demographers conclude that the population will continue to
age because, even if fertility were to rise above the
current, replacement-level rate-say to a rate of 2.2-women
will still have fewer children in the future than women have
borne, on average, in the past./49  Even with high
immigration, higher life expectancy will offset the influx
of younger people into the population. Therefore, the
replacement of the traditional pyramid by the pillar is a
reasonable long-term image for the age structure of the U.S.
Elderly and children. These changes will transform the
composition of the dependency ratio: the proportion of
people who are younger or older than working age. In 1970,
34 percent of the population was under age 18, while barely
10 percent of Americans were aged 65 or older./50  By 1990,
a smaller share of the population was younger-26 percent,
and a larger share was  older-13 percent. By 2020, less than
one-quarter (24 percent) of the  population will be under
age 18 and over one-sixth (17 percent) will be aged 65 or
These trends are taking place unevenly from state to state
within the United States. Between 1980 and 1990, the number
of Americans aged 65 and older went up 22 percent
nationwide, and increased in every state./52  However, it
nearly doubled in Nevada and Alaska, and increased by half
or more in Arizona and Hawaii. In contrast, it increased by
less than one-tenth in Iowa, Nebraska, New York, and the
District of Columbia.
The elderly population in the United States is becoming
concentrated in certain states through two mechanisms.
Certain states have become "elderly magnets" for retirees,
while in others, the elderly stay behind as working-age
people migrate to new employment opportunities, generally in
the South and West. Florida, which has the highest
concentration of elderly people (18.3 percent of Floridians
were aged 65 and older in 1990), is an example of a
retirement magnet; Pennsylvania, with the next highest
concentration of elderly (15.4 percent), is an example of
"aging in place."
Even though the number of children under age 18 remained
roughly the same nationwide in 1980 and 1990, the child
population declined in 33 states. The 1990 child population
ranged from 36.4 percent of the total population in Utah to
22.1 percent in Florida.
F. Work Force Trends
The U.S. labor force stood at 123 million people in 1990,
and is growing at a rate of 1.3 percent each year./53  Of
this growth rate, 1.0 percent is due to population increase
and 0.3 percent is due to an increase in labor force
participation. Between 1990 and 2005, the labor force is
projected to increase to 151 million, an increase of 26
million, or 21 percent. This is slower than growth over the
previous 15-year period, 1975 to 1990, when the labor force
grew by 31 million.
Three demographic trends are reshaping the U.S. workforce:
aging within the working-age population, a greater female
presence in the workforce, and increasing racial/ethnic
diversity. In addition, the increasingly diversified
household structure of workers is changing the needs of the
labor force.
   --  The workforce is aging. Because the large baby boom
generation is entering middle age, the U.S. labor force is
aging./54  In 2001, the oldest baby boomers will reach 55;
in 2011, they will reach age 65. Assuming that most wait
until age 65 to retire, the size of the working-age
population relative to the population as a whole will peak
The aging of the workforce, however, is not just an artifact
of the U.S. baby boom. Accompanying this cycle is the long-
term structural change in the age distribution of the
population described earlier. As a result, middle-aged and
older workers are making up a greater share of the labor
force, in a pattern characteristic of mature industrial
economies. The challenge will be to match these workers with
productive opportunities.
   --  Women are making up a larger share of the work force.
The number of women in the labor force increased by half (51
percent) between 1975 and 1990, bringing women's share of
the work force to 45 percent./55  In contrast, the number of
men in the labor force increased by a much smaller one-
fifth, and the labor force grew about one-third overall. The
number of women is still growing, but more slowly: it is
projected to increase only half as much between 1990 and
2005 as in the previous 15-year period.
The 1990s will probably be the last decade in which the
share of women in the labor force continues to increase.
This will be due largely to the aging out of the working
ages of the last generation of women for whom homemaking was
the dominant career choice./56  The women starting to move
into the older working ages are, by and large, women for
whom paid work has been the primary adult activity.  In
1990, 37 percent of women in the prime working ages were
aged 45 and older; this share will increase to 44 percent by
the end of the decade.
   --  The racial and ethnic composition of the work force
is becoming more diverse. Hispanics and Asians are the
fastest-growing segments of the working-age population.
Between 1990 and 2005, both these population groups will
increase their numbers in the working-age population by
about three-fourths, raising the Hispanic share to 11
percent, and the share of Asian Americans and other races to
4 percent. The numbers of African Americans will increase by
almost one-third, and amount to 12 percent of the labor
The 1990-2005 period will thus see three crucial turning
points in the composition of people entering the workforce:
1) white (non-Hispanic) women will edge out white men as the
largest component of entrants; 2) Hispanic entrants will
begin to outnumber African-American entrants; and 3)
minority entrants (Hispanic, African-American, and
Asian/other combined) will surpass the one-third mark,
bringing minorities to 27 percent of the work force as a
whole. Since entrants are mostly young people, the youth
labor force will take on a new character in the early years
of the 21st century.
A key factor in the proportional increase in minorities and
women in the labor force as a whole is the homogeneity of
the older labor force.  Older workers who are at or
approaching retirement are predominantly white (non-
Hispanic) men, so this group will account for a
disproportionate number of upcoming retirees.
Work/family trends. A diminishing share of the work force is
composed of married men supporting wives and children-
circumstances which were once considered typical of most
workers (see Figure 6). An increasing number of people in
the workforce are not married-either young people who have
not yet formed families, or older people who have foregone
marriage, or are divorced or widowed. Many workers are
people without children, including those whose children have
grown. In addition, an increasing proportion (about two-
fifths) of those who are married have a spouse who is also
These changes also mean that more children lack a nonworking
parent. In 1990, two out of three children aged 6 to 17
shared their parents with work-either both parents in a two-
parent family, or the sole parent in a one-parent family.
Among children under age 6, 57 percent lived with parents
who also had work responsibilities-42 percent with two
working parents, and 15 percent with a single parent who was
in the work force. Only 31 percent of the nation's preschool
children lived in the traditional two-parent, one-worker
In 1990, 38 percent of the women in the labor force had
children under age 18, up about one-quarter (26 percent)
since 1980./59  Of the 31.7 million U.S. women who had
children under age 18, mothers in the labor force
outnumbered mothers who were not in the labor force by a
factor of almost two to one.
As might be expected, women with school-age children were
more likely to be in the work force than were women with
younger children. Three-fourths of mothers with children
aged 6 to 17 and over half (58 percent) of mothers of
preschoolers were in the labor force in 1990. In 1980, there
were fewer mothers with children under age six in the labor
force than not in it.
G. Implications
The demographic dynamics at work within the United States
suggest that the country will remain distinct from most
other developed countries. A relatively high birth rate
among the white (non-Hispanic) majority and relatively high
rates of immigration suggest that-even as it experiences
considerable societal aging-the U.S. population will remain
somewhat younger than those of most other developed
countries. Moreover, the growing minority composition of the
population will create more racial and ethnic heterogeneity
than in most developed countries.
Changing demographics will set much of the domestic agenda
for the United States as it approaches the 21st century. Key
trends include population aging, growing racial/ethnic
diversity, and broadening population differences from place
to place.
The aging of the baby boom generation will give a sharper
focus to debates over financing income security and health
care programs for the elderly. The character of age
dependency will shift rapidly over the next few decades: in
1990, there were roughly five people of working age for
every person age 65 or older. By 2030, the ratio will be
only three to one. This change in the ratio of working-age
to older persons will call for the development of creative
solutions in both the work world and the social insurance
arena. For the next 20 years, the baby-boom generation will
be laying the foundation not only for its own retirement and
older years, but also for the nation's future as it sees its
children grow and its parents age.
Growing geographic disparities in population composition-
between the percentage of children, elderly people, foreign-
born people, and minority groups-will add new complexity to
the process of making decisions about the structure of
programs benefiting different groups. This complexity will
be exacerbated by the growing concentration of the poor,
especially the minority poor, in cities, as the more
affluent choose exurban residences.
The United States has at different times in the past
provided a haven for immigrants and refugees and at other
times created strict barriers to entry. After three decades
of relatively liberal immigration policy, the national
debate on immigration is sharpening, as the impact of
immigrant workers on native-born workers has become
controversial. In addition, the impact of immigrants,
particularly illegal immigrants, on social spending at the
community level is being scrutinized relative to their
contribution to local economies.
In another development, the middle-aging of the baby boom
seems to have brought a slowing in the rate of change in
family patterns. Nevertheless, rates of extramarital
childbearing, divorce, and remarriage remain relatively
high. The rates currently in place are making the family
structures in which people will spend their childhoods and
their adult lives increasingly subject to diversity and
change over the life course. Policymakers are only beginning
to perceive this shift, and to lay the groundwork for
understanding its dimensions.
A growing population suggests that the U.S. infrastructure
will not only need repair and maintenance, but also
additional building. A growing population also raises issues
of energy use, waste disposal capacity, air and water
pollution, traffic congestion, and encroachment of protected
conservation spaces. The trend toward urban population
deconcentration gives a special character to these
challenges. According to some experts, "Exurban development
will demand that resources be plowed into public services,
facilities, and transportation systems that are very costly
to provide over large areas at low densities... Ultimately,
there is the concern that exurban development weakens
efficiencies associated with urban agglomeration."/60
This demographic analysis points up many key questions for
the United States in the 21st century, several of which the
country is already beginning to face. The answers may be, as
yet, far from apparent. However, the most important social
issues for the 21st century are already crowding the agenda.
II. The Population Policy and Program Framework
In many countries, population policy is driven by concern
over absolute size or rate of growth. Population density is
low in the United States compared to most countries, and
even though many urban areas have experienced rapid growth,
large regions of the country are sparsely populated. Another
reason for the lack of an official population policy is that
there is little public consensus about either the need for
population-based policies, or their nature.
In 1972, with the release of the report of the Commission on
Population Growth and the American Future, the United States
came close to adopting a national population policy. The
Commission concluded that no additional economic or
environmental benefits could be realized from a growing
population, and they recommended "that the nation welcome
and plan for a stabilized population." The recommendations
of the Commission were not adopted. At present, the United
States does not have an official population policy; however,
it does have many policies that, taken together, address
many aspects of population concerns.
A. National Perceptions of Population Issues.
Large nationally representative surveys have repeatedly
found that Americans are concerned about international
population growth, but this concern is intermittent. In
seven surveys conducted between 1974 and 1991, The Roper
Organization, a private polling firm, asked Americans to
rank items on a list of "problems people might or might not
be facing 25 to 50 years from now." Along with
"overpopulation," the list included nuclear warfare,
illiteracy, lack of privacy, and such environmental issues
as air and water pollution.  In 1974, 60 percent of
Americans said overpopulation would be "a serious problem .
25 to 50 years from now." (The survey was conducted a few
months after the International Conference on Population and
Development held in Bucharest that year, which was
extensively reported in the media.)
The proportion mentioning "overpopulation" fell to 44
percent in 1978, and did not regain its 1974 level until
1989. In 1991, a record 65 percent of Americans said they
expected overpopulation to become a problem, ranking it
behind seven other issues: severe air pollution, shortage of
landfill space for garbage and trash, severe water
pollution, congestion of cities and highways, AIDS, shortage
of water supplies, and divisions between rich and poor in
the United States. In contrast, 49 percent were concerned
about nuclear warfare, an issue which had concerned 71
percent of Americans as recently as 1982.
As these findings indicate, surveys have consistently found
that environmental issues are the prism through which most
Americans perceive population size and growth. In recent
years, the public has also become concerned with the
demographic, social, and economic effects of immigration,
primarily illegal immigration, but legal as well. The 1991
Roper survey found that 57 percent of Americans thought that
illegal immigration was a serious problem for the future,
and a 1993 Roper poll found that 69 percent of Americans
favored a reduction in legal immigration as well.
B. Current Status of Population-Related Policies
Major policy initiatives affecting the health status of the
population. The health of the nation's population is a major
policy issue. Two overarching initiatives describe how the
United States is working toward improving the health status
of its population.
First, President Clinton's proposed Health Security Act of
1993 would extend health insurance coverage with a
comprehensive benefits package to all Americans. The
President's plan emphasizes accountability, prevention, and
a close working relationship between the personal care and
public health systems.
Second, in the national strategy for improving the health of
Americans, Healthy People 2000, the United States recognizes
the interrelatedness of good public health and a safe and
clean environment, the importance of health promotion and
disease prevention in improving public health status, and
the special needs of vulnerable groups. The U.S. Department
of Health and Human Services developed this national plan,
drawing from the input of state and local governments, other
federal agencies, interested individuals, and
nongovernmental organizations. The 523 objectives are linked
through three goals:
   --  Increase the span of healthy life for Americans
Average life expectancy has increased dramatically for
Americans, largely due to the advances of science and public
health in conquering life-threatening diseases. Now chronic
diseases and injuries are the leading causes of death and
disability, and the nation's goals include not only research
into their causes and cures but also the adoption of healthy
behavior by more Americans.
   --  Reduce health disparities among Americans
Members of certain racial and ethnic groups, people with low
income, and people with disabilities are historically
disadvantaged economically, educationally, and politically,
and this disadvantage is reflected in poorer health,
especially for poor people. The nation's goals include
reducing and finally eliminating such disparities among
population groups.
   --  Achieve access to preventive services for all
Preventive services are the core of many of the more than
500 national goals for health. For instance, specific goals
for maternal, adolescent, and infant health include:
- Reduce the pregnancy rate for adolescents aged 15 to 17 to
no more than 50 births per 1,000.
- Reduce unintended births to no more than 30 percent.
- Increase contraceptive use by sexually active adolescents
aged 15 to 19 to 90 percent at first intercourse and 90
percent at most recent intercourse.
- Reduce infant mortality to no more than 7 deaths per 1,000
- Reduce low birth weight to no more than 5 percent of live
- Increase first trimester prenatal care to at least 90
percent of live births.
Other maternal and infant health objectives target reducing
rates of fetal death, maternal mortality, and fetal alcohol
syndrome; increasing abstinence from tobacco, alcohol,
cocaine, and marijuana during pregnancy; increasing the
proportion of mothers who gain enough weight during their
pregnancies, as well as increasing the number who breast-
feed their babies; reducing severe complications of
pregnancy and cesarean delivery rates; increasing the
availability of preconception care and counseling, as well
as of genetic services and counseling; improving the
management of high risk cases; and increasing the proportion
of babies who receive recommended primary care services.
Improving access to preventive services involves more than
just making such services available. By and large, Americans
receive their health care through private health insurance,
supplemented by public insurance for the poor and the
elderly. Nearly 80 percent of Americans aged 64 and younger
have private insurance coverage; another 6 percent are
covered by public health insurance, leaving 15 percent with
no insurance. Consequently, a fundamental national goal is
increasing the number of Americans who have adequate
insurance coverage.
National expenditures for health care grew from $250 billion
in 1980 to $675 billion in 1990, reaching an estimated $900
billion in 1993. On a per capita basis, this amounts to
$3,500 per person per year. The government share of this
spending was almost 44 percent of the total in 1991, and is
projected to exceed 50 percent by the end of the decade.
Thus, meeting the goal of increasing the number of Americans
who have adequate insurance coverage is conditioned on
reaching an overall objective of containing health care
The legislative agenda for health care thus focuses on
reducing health disparities and improving the health of all
Americans. For a broad national goal like reducing smoking
the U.S. has adopted a combination of measures, including
regulating smoking in public places and increasing taxes on
tobacco. However, legislative and regulatory measures
regarding most health-promoting behaviors are limited to a
few specific areas. Occupational health is one of them, and
a broad array of regulations are directed toward maintaining
safety and health in the work place. Insuring that food is
safe and wholesome and that drugs, biological, and medical
devices are safe and effective is another.
HIV infection and AIDS is a national priority for disease
prevention, as diseases related to personal behaviors have
become critical components of health and mortality
indicators. The National Commission on AIDS was established
by public law "for the purpose of promoting the development
of a national consensus on policy concerning AIDS and of
studying and making recommendations for a consistent
national policy." The Commission's final report, "AIDS: An
Expanding Tragedy," was released in June 1993. It calls for
a strong emphasis on prevention as well as the development
of a clear, well-articulated national strategic plan that
addresses the issues of prevention, care, and research.
President Clinton has named a national AIDS Policy
Coordinator to facilitate implementation of federal AIDS
control programs.
The federal government is devoting more resources and more
attention to the AIDS epidemic than to any other infectious
disease ever. By the end of 1993, it will have spent nearly
$17 billion on the fight against HIV infection, with much
spent on research which will be applicable to preventing or
treating the disease in peoples around the world. Currently
about one million Americans are estimated to be infected
with HIV.
HIV infection occurs unevenly throughout the population.
Young adults are the primary victims: AIDS is the second-
leading killer of men and the fifth-leading killer of women
aged 25 to 44, and it affects minority populations
disproportionately. Furthermore, victims are concentrated
geographically. In 1990, HIV infection was the leading cause
of death among men in this age group in 5 states and in 64
cities; it was the leading cause of death among women in
this age group in 9 cities./61
Nearly half of all AIDS cases in the U.S. have occurred
among African Americans and Hispanics, although these two
groups represent only 21 percent of the population. Of the
12 percent of women who have been diagnosed with AIDS,
almost three-fourths are minorities. In addition, the HIV
infection is spreading rapidly among teenagers. Between 1991
and 1992, the number of AIDS cases among adolescents aged 13
to 19 increased by 65 percent. The U.S. currently excludes
immigrants who are HIV positive.
The United States also has a national surveillance system
for syphilis, gonorrhea, and other sexually transmitted
diseases in addition to AIDS. These systems are based on
mandated reporting for these diseases within each state,
although the system for chlamydia is not yet fully
functional. This system allows for special screening of
populations shown to be at high risk, and special outreach
to educate them.
Migration policy. The United States began as a nation of
immigrants, largely from a few Northern European nations,
joining a small population of Native Americans. Immigration
has continued throughout American history, at varying
levels, from countries throughout the world. In total, the
United States has received far more immigrants than any
industrialized nation.
This rich immigration history has been characterized by an
equally rich legislative history, as circumstances changed
in sending countries as well as in the United States. In
earlier decades, immigration policy was guided by the United
States' development needs and its preferences about the
national origin of immigrants; in recent decades it has been
guided by the principles of reunifying immigrant families,
whatever their national origin, and adding needed skills to
the work force. A strong policy guide throughout has been
maintaining the nation's humanitarian tradition of providing
a refuge for the oppressed of other lands.
In the past two decades, economic disparities have also
increased the flow of illegal or undocumented aliens,
particularly from other countries in the Western Hemisphere.
In response to all these changes, two major laws have
transformed the Immigration and Nationality Act of 1952,
which remains the basic law: the Immigration Reform and
Control Act of 1986, and the Immigration Act of 1990.
The Immigration Reform and Control Act of 1986 addressed the
growing problem of undocumented immigration. Since the
economic magnet of higher wages is agreed to be the
principal factor behind this increase, the legislation
targeted the employment process. It established penalties
for employers who knowingly hire aliens unauthorized to work
in the United States. These employer sanctions were
accompanied by antidiscrimination measures to protect
foreign-appearing U.S. workers.
The Act created two legalization programs-a general program
for aliens residing illegally in the U.S. since before 1982
and a special program for seasonal agricultural workers. The
legalization programs had no immediate effect on the number
of people living in the United States because the legalized
aliens were already in this country. Nearly  3 million
aliens received lawful permanent resident status. The
general program was an attempt to deal humanely with people
who had put down roots in the United States before the
change in policy represented by the new Act. The
agricultural worker program was designed to assure an
adequate supply of authorized farmworkers in the United
States, given that employer sanctions were going into
effect. Also, a four-year replenishment agricultural worker
program was included, although never utilized, to address
any subsequent shortages in agricultural workers. Finally,
the Act called for increased enforcement along U.S. borders.
The Immigration Act of 1990 focused on legal immigration,
including the numerical limits on permanent immigration.
This legislation responded to several concerns resulting
from changing patterns of immigration since 1965, when the
previous legislation had been enacted. First, the tightening
labor market produced by the changing age structure
described earlier led to a reconsideration of the relatively
small numbers of immigrants admitted as needed workers.
Although U.S. immigration policy continues to be based
primarily on the humanitarian principles of family
reunification and refugee resettlement, employment-based
immigration took on a larger role as a result of the
increased numbers allocated for needed workers, particularly
highly skilled workers. Second, diversity programs were
included in the legislation to give aliens of under-
represented countries the opportunity to immigrate to the
United States. Since the vast majority of immigrant
admissions are based upon  reuniting families, aliens coming
from countries with recent immigration flows were dominating
immigration to this country. The diversity programs are an
attempt to broaden immigration flows by encouraging "new
seed" immigration.
The new Act increased the total number of immigrants under
an overall flexible cap, increased annual employment-based
immigration from 54,000 to 140,000, and provided for
"diversity" immigration from under-represented countries. It
set a permanent annual level of at least 675,000 immigrants
beginning in fiscal year 1995, preceded by an annual level
of approximately 700,000 during fiscal years 1992 through
1994. Refugees were the only major group of aliens not
addressed by this legislation.
The Act established a three-track preference system for
family-sponsored, employment-based, and diversity
immigrants. Additionally, the Act significantly amended the
work-related non-immigrant categories for temporary
The Act addressed a series of other immigration-related
concerns. For instance, it authorized the Attorney General
to grant temporary protected status to nationals of
designated countries subject to armed conflict or natural
disasters. In response to criticism of employer sanctions,
it expanded the antidiscrimination provisions of the
Immigration Reform and Control Act and increased the
penalties for unlawful discrimination. Also, as part of a
revision of all the grounds for exclusion and deportation,
it significantly rewrote the political and ideological
grounds which had been controversial since their enactment
in 1952.
Current legislative attention to immigration occurs in the
context of an uneven distribution of immigrants among the
states. As noted earlier, the bulk of new immigrants have
settled in just seven states. The perceived impact of
immigration on the resident population has led to
legislative initiatives in three areas: language, social
welfare benefits, and reducing immigration.
The language initiatives center on the use of languages
other than English in public settings. Some initiatives
support the use of other languages, for instance in such
public documents as census questionnaires, election ballots,
and licensing procedures. Proponents of these initiatives
are concerned that many recent immigrants do not speak
English, and that the demand for publicly supported English-
language training far outstrips current programs. Others
attempt to prohibit public use of languages other than
English, fearing that such practices discourage new
immigrants from learning English and thus slow their
integration into society and the economy.
The benefits initiatives rest on an assertion by state and
local governments that immigration, a federally controlled
activity, has increased the costs of benefits that federal
legislation requires states and localities to provide. These
states and cities want the federal government to pay these
increased costs, or to restrict the flow of immigration.
There is no public consensus on this issue either. The
immigration reduction initiatives center on proposals to
identify false claims for political asylum, to provide
additional support for the border patrol to reduce illegal
immigration, and there is public debate on the issue of
reducing  legal immigration to the United States.
On the international side, the United States also recognizes
the need to give greater attention to worldwide migration
trends and issues. Current policies focus on active
participation in multilateral fora concerned with migration
and refugees, strong support for humanitarian assistance
programs through the U.N. High Commissioner for Refugees
(UNHCR) and other organizations, increased attention to the
root causes of uncontrolled migration flows, and a new focus
on the linkages between migration and development.
Legislation on contraception and abortion. The current U.S.
legislative climate on contraception and abortion dates from
the 1960s. This was a period in which technological advances
resulted in convenient and effective contraceptives, notably
the oral contraceptive, which was approved for general sale
in 1960. It was also a period in which sexual attitudes and
behaviors changed, and these changes brought about legal
changes, as the Supreme Court struck down a series of laws
in which various states restricted contraception.
   --  In 1965, states were prohibited from restricting the
use of contraceptives by married people.
   --  In 1972, states were prohibited from restricting the
sale of contraceptives to unmarried people.
   --  In 1976, states were prohibited from requiring
parental consent before minors could use the services of
federally funded programs.
   --  In 1977, states were prohibited from restricting the
sale of contraceptives to minors, as well as restricting
their advertising and display.
   --  In 1983, states were prohibited from restricting the
advertising and distribution of contraceptives through the
Enacted in 1970, Title X of the Public Health Services Act-
although neither the only nor the largest source of support
for family planning-is the only federal grant program
focused solely on family planning. The legislation, intended
to ensure that family planning and reproductive health
services were available to low-income persons, reflects
trends in making these services available to all regardless
of marital status or age.
In 1978, the statute was amended to expressly state that
services to adolescents were mandated in the program. (The
program had always served adolescents, and program
regulations had always interpreted the original mandate,
"that services be made readily available to all persons in
the U.S.," to include adolescents.) Although an unsuccessful
regulatory attempt was made in the early 1980s to require
parent notification when a minor received services,
confidential family planning services for all persons
continue to be available through the Title X program.
This legislative history responds to several demographic
   --  Young people are marrying later than they used to,
which places more of them at risk of a premarital pregnancy
or birth: the median age at first marriage for women is now
24, up from 21 in 1970, and the proportion of women aged 20
to 24 who have not yet married is now 63 percent, up from 36
percent in 1970./62
   --  More and younger unmarried adolescents have become
sexually active: the proportion of females aged 15 to 19 who
have had premarital intercourse was 52 percent in 1988, up
from 29 percent in 1970, according to the National Survey of
Family Growth./63  In 1988, 88 percent of all unmarried 19-
year-old boys had had sex, as had 81 percent of unmarried
   --  More older, usually married women-an important target
population for family planning programs-have chosen
sterilization to avoid having more children, once they reach
their desired family size. In 1965, only 9 percent of
married couples relied on sterilization of the husband or
the wife as a method of birth control, but by 1975, 31
percent did./64  Among women who intended no more births,
the proportion of married couples relying on sterilization
as a form of contraception rose from 14 percent in 1965 to
43 percent in 1975.
Although there are no rules or restrictions for
sterilizations that are paid for with private funds, certain
restrictions apply for those performed with federal funds.
By court order and because of previous instances of abuse,
sterilization subsidized by federal funds is limited to men
and women aged 21 or older, there is a 30-day waiting period
from the time informed consent is given and the
sterilization is performed, a sterilization procedure cannot
be performed in conjunction with a delivery or other
surgical procedure, and sterilization may not be performed
on institutionalized persons or others unable to provide
informed consent.
In recognition of current trends, the Department of Health
and Human Services (HHS) has set a goal for the year 2000 to
"increase to at least 90 percent of the proportion of
sexually active, unmarried people aged 19 and younger who
use contraception." In other words, policy has shifted from
discouraging contraception on the basis of age and marital
status to promoting it to all who do not have access to
Many factors make implementing this goal a major challenge.
First, in the absence of comprehensive national health-care
coverage, and with funding cutbacks to Title X and other
programs, low-income women who rely solely on subsidized
family planning services have a harder time obtaining a full
range of contraceptive services. Additionally, the efforts
of state and local governments to ensure that all
adolescents receive comprehensive information regarding
sexual behavior and the use of contraceptives through the
school system or otherwise is often impaired by the politics
of social, religious, and cultural resistance to these
An important legal change took place in 1973, when, in the
Roe v. Wade decision, the Supreme Court confirmed that
abortion is a Constitutionally protected right.  Under Roe,
states may not restrict abortion during the first trimester
of pregnancy, but they may impose some restrictions during
the second and third trimesters. In the second trimester,
they may require that abortions be performed in a hospital;
during the third trimester, that abortion be provided only
if there is grave risk to the physical or mental health of
the mother.
For women of all ages, the rate of pregnancies that ended in
abortion rose from 16.3 per 1,000 in 1973 to a high of 29.3
in 1980 and 1981. It has come down slightly since then, to
27.3 in 1988, the latest year for which data are available.
The use of abortion is especially striking among teenagers.
The abortion rate for women ages 15 to 19 went from 19.1 in
1972 (when abortion was still illegal in most states) to
42.4 per 1,000 in 1979, and has fluctuated around 43 per
1,000 since then./65
Due in large part to national legalization of abortion in
the United States, abortion-related deaths are now very
rare. The American Medical Association has attributed this
decline to a reduction in self-induced or non-medically
supervised abortion procedures, increased contraceptive use,
and greater access to earlier abortion services, as well as
to factors such as increased access to antibiotics and
improved physician training.
Abortion has been, and continues to be, the focus of
legislative attention because the issue is a politically
polarizing one. Following the Roe decision, a majority of
states enacted legislation imposing restrictions on
abortion, most of which-with the exception of certain
restrictions on young women and on subsidies for the medical
expenses of low-income women-were struck down by the court
as infringing on individuals' right to privacy. However, in
1989 the Court's Webster v. Reproductive Health Services
decision indicated a new willingness to uphold a wide range
of such restrictions. In response, more than 600 bills
restricting abortion and birth control have been introduced
in state legislatures and Congress.
Early in 1993, the new Clinton Administration removed
several regulatory provisions created by previous
administrations: the federal ban on using fetal tissue for
research; withholding funding from international family
planning organizations that provide advice, counseling, or
information regarding abortion; and prohibiting privately
funded abortions at U.S. military hospitals.
A regulation prohibiting counseling or referral for abortion
in Title X clinics was proposed in 1988. A series of legal
challenges repeatedly prevented implementation and, in
January 1993, President Clinton suspended the regulation and
ordered the promulgation of new regulations requiring that
non-directive counseling on pregnancy options (including
abortion) be provided in federally funded family planning
C. Maternal and Child Health/Family Planning Service
Delivery and Related Programs
Serving the health care needs of women and children in the
United States, including those with special health care
needs, is a mammoth undertaking.
If enacted, the Health Security Act introduced by President
Clinton will significantly reshape and improve the current
complex patchwork of programs serving women and children.
For the first time, women and children will have universal
financial coverage of a comprehensive set of benefits that
places an appropriate emphasis on those services most needed
by women and children, namely prevention and primary care
services. Reproductive health care is part of the proposed
benefit package.
Existing government programs serving women and children will
be integrated into this overall system through reimbursement
mechanisms, expansion of certain programs, and the
establishment of new programs to assure universal access to
health care. As personal health care services become more
available in the private sector to low income women and
children, certain public programs will see their emphasis
shift to supportive or enabling services as well as to
promoting overall community health through core public
health functions.
Currently, maternal and child health/family planning
(MCH/FP) services are provided through a complex system that
includes three sectors:
1) private, for-profit;
2) public (including different levels of government, such as
federal, state, or local government); and
3) private, nonprofit.
Funding comes primarily from patient-paid fees and health
insurance, either public, proprietary, or nonprofit.
Funding streams may flow from one sector to another. For
example, a private, nonprofit family planning clinic may
operate with a mix of funding including:
   --  public funds from a federal program matched with
state and local funds (in varying proportions in different
   --  fees for service (perhaps determined by a sliding
scale, depending on the income of the client), and
   --  charitable donations of money and volunteer time.
A further layer of complexity is added by the multitude of
third-party payers. In 1991, 83 percent of nonelderly
Americans were covered by either public or private health
insurance./66  Almost two-thirds (64 percent) were covered
by employment-related health insurance. Employment, however,
does not guarantee health insurance: more than half of
uninsured children (57 percent in 1991) live in homes where
the head of the family works full-time.
About one in ten of the non-elderly were covered by
Medicaid, a federal insurance program. About 9.5 million
children (15 percent) and 17 percent of all non-elderly
people were without any health insurance. About 60 percent
of pregnant women were covered under employer plans, as
employees or dependent spouses, and about 6 percent had non-
group coverage./67
In 1987, about $50 billion was spent in the United States on
health care for children./68  This averages an estimated
$893 for each child that actually incurred such spending. In
addition, an estimated $15.2 billion was spent on
obstetrical care in 1987, or $3,983 per live birth,/69
almost 99 percent of which occurred in hospitals. Of the
children's health expenditures, nearly one-fourth came from
government (12 percent from Medicaid, the federal insurance
program for poor people, plus another 12 percent from other
public sources). About 43 percent came from private
insurance, and 27 percent from out-of-pocket payments
(including insurance copayments and deductibles). The
remaining 6 percent came from other private sources,
including free from the provider.
Government programs. The major federal programs serving
children and pregnant women are Medicaid, the Maternal and
Child Health Block Grant Program, the Special Supplemental
Food Program for Women, Infants, and Children (WIC), and the
Community and Migrant Health Center Program. Funding from
several public programs support family planning services. In
addition, many other smaller programs impact maternal and
child health.
   --  Medicaid. The Medicaid program-jointly funded and
administered by the federal and state governments-has been
the primary public program serving low-income Americans
since its inception in 1965. Primarily a reimbursement-for-
services or public insurance program, Congress mandated
broader eligibility for pregnant women and children in the
mid-1980s. Prior to that time, Medicaid coverage was tied to
receipt of Aid to Families with Dependent Children (AFDC).
By 1989, states were required to cover women and their
children in households with income amounting to 133 percent
of the federally defined poverty level. On average states
went from covering women and children with income at 56
percent of the poverty level in 1987 to 161 percent in
1993./70  Although Medicaid covers prenatal and obstetrical
care, the federal program has banned the use of funds for
abortions since 1977. A few states have continued to provide
such services through their own funds.
   --  The Maternal and Child Health Block Grant Program.
The MCH programs typically support the direct delivery of
services in public health care settings. States contribute
roughly $3 in matching funds for every $4 in federal funds
they receive. Eligibility limits are set at 185 percent of
the federal poverty level.
   --  WIC. The two-decade-old nutrition education and
supplement program for women, infants, and children (WIC)
was serving 6.4 million as of May 1993, estimated to be less
than half of those eligible./71  About one-fourth (23
percent) were women who were either pregnant, post partum,
or nursing; the remainder were infants and children aged 5
and younger. WIC was funded at almost $2.9 billion in 1993.
   --  Community and Migrant Health Center Program (C/MCH).
The C/MCH centers, established in 1965 to deliver
comprehensive primary care services in medically underserved
areas, receive direct federal grants. In 1989, these centers
served about 1.3 million women of childbearing age and 2.1
million children under age 15./72  The 1991 appropriation
for this program was $530 million.
   --  Family planning. Major federal funding for U.S.
family planning began with Title X of the Public Health
Services Act in 1970. This program spurred the development
and expansion of the extensive outpatient women's health
service delivery network throughout the country today./73
Initiated to assure low-income women access to affordable
family planning and reproductive health services, the
network now provides a standardized core set of services at
each clinic. Family planning clinics form an outpatient
health services network for low-income women, offering a
gateway for referrals to other medical services if needed.
Beginning in the late 1960s, the Office of Economic
Opportunity supported provision of family planning services
through a federal program. The 1970s were a period of
development and growth for family planning in several
programs, including Title X of the Public Health Services
Act and Titles V (Maternal and Child Health), XIX (Medicaid)
and XX (Social Services) of the Social Security Act.
However, support for these programs waned during the 1980s.
During the 1980s, federal funding for the Title X program
was cut and the Title V and Title XX programs were folded
into block grants-Maternal and Child Health Services Block
Grant and Social Services Block Grant, respectively. Family
planning expenditures through Medicaid continued to
increase, largely because of the overall changes in this
In 1990, the federal and state governments spent an
estimated $504 million on contraceptive services and
supplies./74  Services were delivered through a network of
agencies including over 4,000 clinics serving more than 4
million women in every state and territory. Public and
nonprofit clinics are operated under different auspices:
city and county health departments (40 percent of clients),
local hospital outpatient clinics (11 percent), Planned
Parenthood affiliates (28 percent), and other community
agencies such as community health centers (21 percent)./75
In 1990, the federal government provided almost three-
fourths (72 percent) of the revenues, with funding from
Medicaid, Title X of the Public Health Service Act, and the
Social Services and MCH block grants. States also provided
resources for contraceptive services.
Federal and state spending on sterilization services in 1990
were $95 million. In addition, $65 million in public funds
were spent on abortion (99 percent from state funding),
because the Hyde Amendment--a legal restriction on the use
of federal funds for abortions--has been in effect since
Much of the need for family planning, in the United States
and elsewhere, can be met with current contraceptive
methods. However, the development of new methods will expand
individuals' choices and improve options for families.
Furthermore, research continues to be necessary to monitor
and improve individuals' reproductive health. In fiscal year
1993, the United States spent approximately $25 million on
the development of new contraceptive methods. A total of
$144 million was spent on all aspects of population
research. While this is more than any other nation spent,
considering the vast implications of improved contraceptives
for the health and well-being of families, it is a small
D. Other Population-Related Activities
Women's Health. The Department of Health and Human Services
has developed a comprehensive agenda for women's health to
promote health and well-being across the life span and to
empower women to make informed choices about their health.
While meaningful progress has been made in many areas, such
as mortality declines for certain chronic health conditions,
women remain at risk for many other problems, including
violence, mental health disorders, substance abuse, HIV/AIDS
and other sexually transmitted diseases, maternal mortality
and morbidity, as well as a number of chronic and disabling
The focus on women's health reflects the important
biological, behavioral, socioeconomic, and cultural
influences on women's health issues and the need for
effective and integrated strategies as evidenced by the
following goals: to support comprehensive, community-based
health promotion/disease prevention programs for women; to
promote access to a full range of health care services for
women of all ages, all racial and ethnic backgrounds, and
all socioeconomic levels; to strengthen and sustain research
on methods to improve access to and quality and
effectiveness of health services for women; to educate and
inform women about relevant health issues, policies, and
programs; to support professional training in the
recognition and management of women's health conditions; and
to promote the appointment of women to national and
international leadership positions which impact women's
health and quality of life.
The elderly. Concern about the aging of the population has
led to a series of government-funded studies of its likely
impact on society and the economy, as well as on individuals
and families. In response, the government has developed
policies to maintain strong programs of health and income
support for the elderly. In 1959, 35 percent of the elderly
lived in households with income below the federally
determined poverty level, compared to 22 percent of the
population as a whole. By 1982, the proportion of the
elderly living in poverty fell below the national proportion
of 15 percent. In 1989, just 11 percent of the elderly were
poor, compared to 13 percent of the population as a whole.
Government-supported research has also indicated a
noticeable improvement in the health of the elderly, as
described earlier. Researchers who have traced the effects
of this change attribute it to more preventive behavior on
the part of an elderly population that is better educated
about its health, as well as to better knowledge of the
elderly on the part of health practitioners.
Currently the federal government is reviewing the impact on
income and health security programs for the elderly of the
projected increase in this population early in the 21st
century. By that time, the changes in the age structure of
the population will have produced significantly large
numbers of elderly in proportion to the population of
working age, as described earlier. Already the government
has planned a phased transition to a later age for
retirement. Beginning in 2000, the age for receiving full
benefits will rise from 65 years by two months a year to age
66 in 2005. Beginning in 2017, it will rise by two months a
year to reach age 67 in 2022.
Immigrants and racial and ethnic minorities. The principal
activity conducted around the nation's large immigration
flows is an attempt to control the inflow of illegal aliens,
as described earlier. With the exception of special
assistance programs for refugees, the United States has
virtually no programs specifically designed for the
integration of immigrants. Since the vast majority of them
are admitted on the basis of their family ties or need for
their skills, they are expected to make their own way in the
United States.
The fact that the United States has no programs specifically
designed for immigrants does not mean that immigrants are
denied access to education, social insurance, employment and
training programs, and so forth. However, it is not their
immigration status that qualifies them. Rather, eligibility
for these programs is usually based on permanent residence
in the United States, low income levels, or minority groups
The United States does have specific programs for refugees
which are designed to make them economically self-sufficient
as soon as possible. Also, various organizations offer
training in civics designed to assist all immigrants who
want to become U.S. citizens. Most immigrants are eligible
for citizenship after five years in permanent resident alien
status, although some are eligible after shorter time
The federal government spends about $300 million each year
through a variety of financing mechanisms on English
language education. The majority of such programs are funded
and managed through state and local governments. By and
large, the demand for such lessons largely exceeds their
availability, and in states and localities with large
concentrations of new immigrants, publicly funded programs
have long waiting lists.
The arrival of large numbers of immigrants has contributed
to the changes in the racial and ethnic composition of the
population described earlier. These changes have focused
public attention on issues of equity for racial and ethnic
minorities. The government has longstanding policies to
assure equality of opportunity in education, in employment,
and in access to credit, housing, and health and other
services. In addition, the government has developed programs
to assist those populations in gaining access to
opportunities or services. U.S. Public Health Service
programs like the Community Health and Migrant Health
Centers are designed with underserved populations in mind,
and the National Institutes of Health has developed an
initiative to research the special health needs of minority
populations, as well as of women.
Families. The changing nature of families described earlier
has led to a number of initiatives and activities. In
response to the increasing numbers of working women, who
have traditionally taken care of both children and elderly
family members, the Family and Medical Leave Act was enacted
and went into effect in August 1993. Under the provisions of
this act, firms with 50 or more employees must provide them
with up to 12 weeks of unpaid leave, if necessary, to attend
to family and medical emergencies.
The Family Support Act of 1988, another federal initiative
responding to the increasing numbers of women who are
raising children without a spouse, states that:
   --  children have a right to support from their parents,
   --  both parents have a responsibility to support their
children to the best of their ability, and
   --  should parents abdicate these responsibilities,
government must enforce the continued, appropriate payment
of child support obligations.
Under the provisions of this act, the Administration for
Children and Families of the Department of Health and Human
Services establishes paternity, establishes child support
orders, and collects child support from absent parents via
wage withholding, if necessary. In 1990, this program
collected a record $6 billion in child support.
The federal government and the states also provide cash
welfare payments to children through the Aid to Families
with Dependent Children program. These payments are directed
to children who have been deprived of parental support or
care because their father or mother is absent from the home
continuously, incapacitated, deceased, or unemployed. Each
state defines "need," sets benefit levels, establishes
income and resource limits, and administers the program.
Federal funds pay from 50 to about 80 percent of the benefit
costs, and 50 percent of the administrative costs. The
federal government also makes funds available to states for
child welfare, foster care, and adoption activities.
Communities. The United States has no specific policies to
modify the spatial distribution of the population. As
described earlier, the American population has become
largely urban, and increasingly suburban and exurban. In
addition, large-scale migration during the 1970s and 1980s
shifted the regional distribution of the population from the
North and Midwest to the South and West. As a result, the
population of cities in the latter two regions has grown
rapidly, while cities in the former have remained stable or
even lost population. Also, cities across the country have
seen population grow in the suburbs and beyond, rather than
in city centers.
Growth management has thus become an important concern for
urban planners, particularly since fiscal resources have
become increasingly constrained. Local governments are being
more assertive in requiring developers of new housing or
business facilities to bear the costs of providing streets,
utilities, and other services. Local governments are also
developing or revising regulations that determine where new
buildings can be constructed, and how many people they may
shelter.  They are also monitoring the environmental impact
of new development, and requiring developers to file, and
gain approval of, statements specifying how each project
will affect the environment.
E. Experiences and Lessons
Individuals make demographic decisions-marriage, migration,
children, and so on-on the basis of their needs and
preferences as seen within the social and economic context
in which those decisions will bear fruit. Understanding this
interaction is a fundamental basis for assessing these
decisions, and making appropriate public policies.
For instance, migration flows within the United States have
put new pressures on state and local governments-those that
are losing migrants as well as those that are gaining them.
Experience has shown that other things equal, people will
move to the extent that they perceive superior economic
opportunities elsewhere. Migration flows stop and even
reverse when the perception changes.
During the 1980s, both California and New England were
employment magnets for people with the technological skills
then in demand in those areas. The inflow of economic
migrants was constrained by the high cost of housing; it
also contributed to the rise in the cost of housing, as both
regions had various growth management policies in place that
imposed costs on new housing. When employment conditions
reversed in high tech industries, the migration flows
halted, and reverse migration began.
The growth management policies in those localities were
developed on the basis of prior experience. Historically,
U.S. communities have welcomed population growth because
economic growth generally accompanied it. However,
increasing knowledge about the costs of such growth in terms
of harmful effects on the environment, as well as on the
functioning of the community, have led to a broader
assessment of the costs of growth, one which weighs both
positive and negative effects and makes policies
Recent experiences have also heightened the nation's
appreciation of the importance of an educated population.
For example, the aging of the population is creating a new
understanding of the role of education in maintaining
health. The advances against morbidity among the elderly
measured in the 1980s have been attributed by researchers
only partly to improved medical knowledge-they also reflect
better health maintenance behavior on the part of
individuals throughout their lifetime. As a result, the
concept of a healthy or active life expectancy has emerged,
and both researchers and individuals are exploring the
concept of the quality of years of life, not just the
quantity. In turn, society is being asked to broaden its
beliefs about roles and activities that are appropriate in
old age, and to reassess old assumptions about how much care
the elderly need and how much they can provide for
The importance of education as a factor in demographic
decisions and economic outcomes has also been receiving more
attention. The link between educational levels and decisions
about marriage and childbearing is distinct: Americans with
less education marry earlier and divorce more than average;
they also tend to have more children. The link between
educational levels and economic outcomes has tightened as
the economy undergoes a transition to a new structure, one
in which technology and information play a greater role. The
exact nature of that emerging structure is still unclear,
but it is clear that high-income workers are those with high
levels of education. It is also clear that they have greater
economic security because they have more employment options.
F. Role and Relevance of the World Population Plan of Action
Although the United States does not have a formal population
policy, the federal judiciary has made several rulings
affecting reproductive rights. An example is the
interpretation of the U.S. Constitution by the Supreme Court
as including a right to privacy protecting contraception and
abortion services from any significant interference by the
state or federal governments. Additionally, the United
States has enacted numerous subsidy programs designed to
subsidize family planning and reproductive health services.
These programs seek to meet some of the unmet needs of low-
income communities for the medical services necessary to the
exercise of these rights. The ban on subsidies for abortion
has constituted an exception to this policy.
Various other U.S. policies are recognized as having a
demographic impact, as described earlier.
   --  The executive and the legislative branches of the
U.S. government work together to formulate immigration
policies which consider immigration's economic and social
   --  Population growth is being assessed in increasing
numbers of communities for its impact on environmentally
sustainable development, and policies that maintain both the
environment and a strong jobs base are being sought in many
parts of the country.
   --  Other demographic trends, particularly population
aging, child poverty, and nonmarital pregnancy, are being
monitored by national and local policymakers for their
effect on the health and well-being of the nation's
Although the United States is a developed country, the
general principles and objectives of the World Population
Plan of Action are relevant to the U.S. In addition, many of
the specific recommendations embody goals and policies that
the United States has set for itself in Healthy People 2000,
the national strategy for improving the health and well-
being of the nation, as described in Part B of this section.
   --  The U.S. has set targets for improving overall life
expectancy and years of healthy life, particularly for
underserved populations. In particular, by the year 2000
African Americans should, at birth, expect 60 years of
healthy life, Hispanics 65 years, and all Americans aged 65
should expect 14 more years of healthy life.
   --  The U.S. has set targets for improving infant
mortality, particularly for underserved populations. In
particular, by 2000 the infant mortality rate for African
Americans should be no more than 11 (per 1,000 live births),
for Native Americans no more than 8.5, and for Puerto Ricans
no more than 8.
   --  The U.S. has set targets for combatting HIV and AIDS,
as well as other sexually transmitted diseases. In
particular, by the year 2000 no more than 800 per 100,000
people should have HIV infection, and there should be no
more than 225 cases per 100,000 people of gonorrhea, and no
more than 10 of primary and secondary syphilis.
The recommendations of the World Population Plan of Action
having to do with reproduction and the family also reflect
many U.S. concerns and activities. The U.S. has set these
targets to achieve by 2000:
   --  increasing the proportion of sexually active
unmarried adolescents who use contraception to at least 50
   --  reducing pregnancies among girls aged 17 and younger
to no more than 50 per 1,000 adolescents; and
   --  reducing the proportion of all pregnancies that are
unintended to no more than 30 percent.
The World Population Plan of Action also speaks to the U.S.
goal of achieving the full integration of women into society
on an equal basis with men. U.S. law prohibits any form of
discrimination based on gender, and has actively sought the
advancement of women by mandating their participation in
education and their inclusion in all parts of the labor
force. Women now represent the majority of enrollees in
higher education, women's earnings relative to men's
improved significantly in the 1980s, and women are now
employed in the highest positions in both the public and
private sectors-though they are still underrepresented
compared to men, and continue to experience many subtle
barriers to full participation, including pay disparities
and barriers to professional advancement.
The demographic changes in the U.S. population described
earlier make the recommendations in regard to aging, and to
shifts in family and household structures, particularly
relevant to the United States.
The World Population Plan of Action also has relevance in
regard to the treatment of:
   --  documented migrant workers and their families,
   --  undocumented migrants, and
   --  refugees.
Finally, the World Population Plan of Action is relevant to
U.S. efforts to collect and analyze population and related
statistics. The U.S. has a full range of data collection
efforts, including a decennial census and many ongoing
national surveys. The U.S. has been making a concerted
effort to make sure that such data adequately reflect the
multicultural nature of its population, and that data can be
disaggregated by racial and ethnic origin as well as by
Fiscal constraints are threatening the continuation of such
efforts, so the U.S. is actively engaged in finding more
cost-effective ways to perform them. In particular, it is
making increasingly intensive use of computers and other new
data collection and processing technology. It is exploring
statistical techniques that will enable it to make reliable
estimates for data that are now collected formally. And it
is investigating ways to use data from administrative
records to supplement or substitute for data collected by
G. Population and Consumption
Given its large economy and advanced state of economic
development, the United States is one of the world's leading
consumers of natural resources, on both an overall and a per
capita basis. The United States faces significant challenges
in redirecting its pattern of development toward long-term
sustainability, including high rates of natural resource use
and waste as well as a lack of integrated analysis and
planning mechanisms.
These challenges are made more difficult by the growth and
distribution of the U.S. population. Even small population
increases and distribution shifts can have significant
impacts on efforts to protect the environment and promote
broad-based sustainable development, given the extensive per
capita use of resources. For example, California is expected
to grow by 10 million people during the 1990s, and many of
these new residents will be moving to the San Joaquin
Valley, where aquifers are already being pumped at a rate
that exceeds recharge by more than five billion gallons a
Resource use statistics in several key areas reflect the
high rate of resource consumption in the United States. With
only 5 percent of the world's population, the United States
consumes 25 percent of the world's commercial energy. In
1992, it consumed 82 quads of energy, at a per capita rate
of more than 300 million BTUs-accounting for more than 20
percent of the carbon dioxide released worldwide. U.S.
citizens use an average of 1565 gallons of water per day,
and the U.S. produces and disposes of more than 150 million
tons of waste per year.
President Clinton and his administration have taken numerous
steps to help promote resource conservation and
environmental protection while furthering economic progress
and an enhanced quality of life. The United States is
implementing strategies to use energy more efficiently,
encourage recycling of resources, reduce pesticide use, and
better manage its natural resource base for economic and
conservation purposes. Some specific examples are:
The President's Council on Sustainable Development (PCSD).
The PCSD was established in 1993 as a follow-up to the U.N.
Conference on Environment and Development. It is a
partnership formed to explore and develop policies that
encourage economic development, job creation, and protection
of natural resources. Membership includes representatives
from industry, government, environmental, labor, and civil
rights organizations. Task forces are addressing issues of
population and consumption, sustainable communities,
national resource use, energy, sustainable agriculture, and
The United States Climate Change Action Plan. A plan
released in 1993 identifies 44 initiatives for U.S.
government agencies to implement. The plan was developed to
fulfill the President's commitment to return U.S. greenhouse
gas emissions to their 1990 level by the year 2000. One
initiative, the Green Lights Program, aims to convert U.S.
businesses to energy-efficient lighting systems. The
Climate-Wise initiative encourages private industry to set
energy-efficient targets and report progress to the
Department of Energy.
Demographic Change and the Environment. This project of the
Environmental Protection Agency aims to examine demographic
change in the United States and its implications for long-
term environmental quality and policies. The project is
designed to broaden the understanding of population-
environment linkages and facilitate the integration of
population issues into long-range environmental policy and
Recycling. The United States has implemented a wide range of
recycling strategies at all levels-federal, state, and
local. The portion of municipal solid waste handled through
recycling and composting grew to 19 percent in 1990.
Emergency Planning and Community Right to Know. Under a 1986
law, major industries must report on the hazardous and toxic
chemicals they store, release into the environment, or
transfer to disposal facilities. It also imposes an
affirmative duty on the Environmental Protection Agency to
disseminate the information to the public. This process is
now being expanded to include all federal agencies that
manufacture, process, or use toxic chemicals.
33/50 Project. The Environmental Protection Agency asked
6,000 major companies in 1993 to voluntarily reduce their
emissions of toxic chemicals by 33 percent by the end of
1992 and by 50 percent by 1995. This program is being
expanded through a requirement that all federal facilities
set a voluntary goal of 50 percent reduction by 1999 of
their toxic releases.
Minimize outputs of air pollutants. Through the Clean Air
Act (CAA) and other programs, the United States is working
to minimize the output of air pollutants from energy and
other industrial production processes. Through measures
already undertaken or ones that are expected to be
implemented in the future, U.S. emissions of sulfur dioxide,
carbon monoxide, and lead will continue to decline through
the end of the century.
Forests. The United States announced in June 1993 its
commitment to the goal of achieving sustainable management
of all U.S. forests, particularly those owned by the U.S.
government, by 2000.
Waste minimization. The national goal for solid waste
management continues to be the reduction of the amount and
toxicity of wastes through source reduction and recycling
programs. The Environmental Protection Agency is
implementing a national program for businesses that provides
extensive guidance on waste prevention and recycling;
improving and expanding markets for recycled products;
helping states and localities plan for safe and cost-
effective waste prevention, recycling, and disposal;
facilitating information exchange; providing technical
assistance; and setting minimum standards governing the safe
management of municipal waste.
The Intermodal Surface Transportation and Efficiency Act.
This act mandates transportation planning and seeks to
encourage alternatives to single-occupancy vehicles.
The United States is acutely aware of the links between
population patterns, such as demographic growth and
distribution, and resource consumption, resource waste,
environmental degradation, and overall quality of life, as
well as the need to improve linkage in program and policy
planning, implementation, and monitoring. At the same time,
the United States believes that achieving more sustainable
production and consumption patterns is compatible with and
integral to promoting sustained economic progress.
In many cases production processes which are more
environmentally sound are also more economically efficient.
Many U.S. companies have found that investing in pollution
prevention and energy efficiency has provided significant
cost savings in the long term. However, governments can do
much more to assist the private sector and the public in
making environmentally sound choices through information
dissemination, demonstration projects, increased funding for
research and development, and by providing an example of
sustainable development principles in action.
III.  International Cooperation in Population
A.  Population Assistance Policies and Priorities
The United States is committed to moving population issues
to the forefront of its international priorities.  Rapid
population growth, unintended pregnancy, and the spread of
AIDS and other sexually transmitted diseases are seen as
interrelated threats to development and health objectives in
much of the world.  The global population (currently 5.5
billion) will nearly double by the middle of the next
century, according to United Nations medium projections,
further burdening already stressed ecosystems.  Moreover,
unintended pregnancy associated with lack of access to means
of fertility regulation is a key impediment to achieving
equality for women, and perpetuates and reflects gender
inequities in the socioeconomic status of women.
Accordingly, the United States is committed to contributing
financial resources to meet unmet family planning and
reproductive health needs in a manner consistent with human
The main elements of the U.S. policy approach on population
and related issues are:
   --  ensuring that couples and individuals have the
ability to exercise their right to determine freely and
responsibly the size of their families;
   --  ensuring a compassionate, prompt, and preventive
response to the global tragedy of maternal morbidity and
mortality due to unsafe abortion;
   --  promoting access to the full range of quality
reproductive health care, including women-centered, women-
managed services;
   --  stressing the need for governments and public and
private organizations to commit themselves to quality of
care in family planning and reproductive health services;
   --  supporting the empowerment of women so that all
societies may move toward full gender equality in all
aspects of decision-making concerning economic and social
   --  ensuring access to primary health care, with an
emphasis on child survival;
   --  examining the link between population pressure and
uncontrolled migration;
   --  preserving the endangered natural environment of the
   --  ensuring that U.S. population policy supports the
world's priority for sustainable development; and
   --  highlighting the importance of further study on the
root causes of irregular migration flows.
B.  The Nature and Character of U.S. Population Assistance
U.S. population assistance has been provided through both
bilateral and multilateral channels under the Foreign
Assistance Act. This act is currently being redrafted, in
part to reflect the priorities listed above. The U.S. Agency
for International Development (USAID) is the principal
organization responsible for carrying out U.S. population
assistance programs.  Since its inception in 1965, the U.S.
population assistance program has had a clear strategic
focus on the provision of high-quality, voluntary family
planning services.  Studies have demonstrated a large unmet
need for family planning, and that when quality services are
available, they are used.
USAID's population program has focused primarily on service
delivery, with more than 75 percent of expenditures devoted
directly to assisting the provision of family planning
information and services, including contraceptives.  Along
with support for the infrastructure of public sector
programs, the United States has emphasized the involvement
of the private voluntary and commercial sectors.  Support is
provided for multiple service delivery approaches, including
clinic-based programs, door-to-door distribution, commercial
retail sales, employee-based programs, and programs with
health insurance companies.  Other forms of population
assistance have also been provided:
   --  Assistance in population policy development provides
up-to-date information on population and family planning to
high-level officials in developing countries, including
briefings, analytic studies, cost-benefit analyses,
conference support study tours, and training in policy
development to developing country institutions.
   --  The contraceptive research and development program
has supported the development of new methods, improvement of
existing technology, and the introduction and support of
these methods in existing service delivery programs.
   --  Management support and training programs have
supported the training of almost 200,000 health care
professionals from nearly 7,000 institutions in 122
countries, and of over 1,500 senior and mid-level program
administrators from more than 25 countries, as well as study
tours, fellowships, and other management training.
   --  The commodity support program buys contraceptives
through a consolidated procurement system.  The United
States provides 50 to 70 percent of all donor-provided
contraceptive assistance and nearly all logistics management
   --  Communications activities support publications and
other communications materials as well as innovative
programs to deliver family planning messages through mass
   --  Data collection assistance has funded censuses and
demographic surveys, provided technical assistance and
training for data collection efforts, and supported social
science research on population issues in the developing
world.  Over the last 20 years, the United States has
supported more than 160 surveys in almost 70 countries,
providing the basis for much of what is known about family
planning and reproductive health behavior.
U.S. population assistance has been provided through
multilateral as well as bilateral channels.  The United
States was the leading donor to the United Nations
Population Fund (UNFPA) from the time of its founding in
1969 through 1985.  U.S. contributions were terminated
between 1985 and 1992 due to the application of a
legislative restriction on U.S. funding to any organization
which "supports or participates in the management of a
program of coercive abortion or involuntary sterilization."
Contributions resumed in 1993, when it was determined by
USAID that this restriction did not apply to UNFPA's
assistance to China or any other country.  (U.S. funds are
nevertheless to be kept in a separate account and are not to
be used in China.)
Contributions also resumed in 1993 to the International
Planned Parenthood Federation (IPPF), which, like UNFPA, was
a major recipient of U.S. funding until 1984.  IPPF became
eligible for funding in 1993 after President Clinton
rescinded the so-called "Mexico City" policy, a previous
Executive Order that had prevented support for
nongovernmental organizations involved in abortion-related
activities with funds from any source.  The United States
also contributed in 1993 to the Human Reproductive Research
Program of the World Health Organization.  Finally, the
United States supports international cooperation in
population and related areas as a major donor to other
international organizations, including the World Bank and
other multilateral development banks.
The Foreign Assistance Act authorizes USAID to administer
grants to assist developing countries in creating and
improving their family planning programs. In 1973 the act
was amended to ban the use of funds "for the performance of
abortions as a method of family planning or to motivate or
coerce any person to practice abortion." The Clinton
Administration has proposed a revised foreign aid bill that
does not include this ban on abortion funding.
C.  Trends in International Population Assistance
The United States has unquestionably been a dominant
presence in the population and family planning field.  It
was one of the earliest supporters of international
cooperation, and U.S. financial support has historically
constituted roughly half of all international aid to
worldwide population efforts.  The United States remains the
largest single donor in population/family planning today,
contributing more than one-third of total assistance from
all sources-bilateral, multilateral, and private
philanthropic (see Table 5).
Table 5. Total Population Assistance: All Accounts, FY 1980-
1993 ($000)
                Economic   Development   Sahel
   Population   Support    Fund for   Development
Year   Account   Fund      Africa         Fund   Total
1980   184,920   10,000      -             -   194,920
1981   189,906   18,500      -             -   208,406
1982   211,050   26,700      -             -   237,750
1983   214,846   24,800      -         3,400   243,046
1984   242,364   20,300      -         1,572   264,236
1985   288,181   19,192      -        10,331   317,704
1986   237,539   42,709      -        15,300   295,548
1987   267,154   15,150      -         4,300   286,604
1988   198,549   17,500    32,017          -   248,066
1989   201,579   15,500    40,499          -   257,578
1990   225,648   21,650    39,830          -   287,128
1991   249,319   29,245    73,754       1,471  353,784
1992   249,507   10,624    65,512          -   325,643
1993   357,966   11,000    76,170          -   445,136
TOTAL  3,318,528  282,870  327,782   36,374  3,965,554
Source: U.S. Agency for International Development, Office of
In a number of countries, U.S. assistance in the early years
accounted for the bulk of national budget allocations for
population and family planning.  In most countries where
USAID has concentrated its assistance, the organization has
maintained continuity in support of population activities
over a period of a decade or longer.
D.  Experiences in International Cooperation
In the mid-1960s, 15 million people were using family
planning services in the developing countries (excluding
China).  Today, more than 200 million people are using these
services, and this number is expected to double within the
next 20 years.  During the last two decades, the overall
contraceptive prevalence rate for developing countries
(excluding China) has risen from 15 percent to about 40
A major factor accounting for the growing use of
contraception has been the contributions of the U.S. and
other donors to increasing the availability of family
planning services.  Dramatic improvements in the quality and
coverage of services, increases in contraceptive use, and
declining fertility in countries such as Thailand,
Indonesia, Colombia, and Morocco can be directly linked to
international cooperation and assistance.  In other
countries, such as Bangladesh, Zimbabwe, Kenya, and Egypt,
substantial progress has been made in recent years, as past
investments in program development are yielding increasing
In the area of family planning, experience suggests that
successful programs have the following characteristics:
   --  political support at all levels for family planning;
   --  policies that promote private sector involvement;
   --  multiple service delivery channels;
   --  availability of a variety of contraceptive methods;
   --  active participation of women at all stages of
policy-making and program implementation;
   --  an extensive cadre of trained service providers;
   --  a well-informed clientele; and
   --  a supportive socioeconomic environment
E.  Unresolved Issues and Future Priorities in International
The 1990s is a critical decade for addressing rapid
population growth.  Because of previous periods of high
fertility, record numbers of women are in their childbearing
years.  Although individual women are having fewer children,
on average, than their mothers, there are simply more women
having children, resulting in continuing increases in annual
additions to the world's population.  The pace of fertility
decline needs to be accelerated now in order to avoid
untenable growth in the next century.
In May 1993, U.S. State Department Counselor Timothy Wirth
summarized the U.S. position thus: "If we do nothing, the
world's current population of 5.5 billion will double in the
next 35 to 40 years and move on to 13 to 15 billion people
before leveling off. To imagine a world in which population
doubles in this fashion is unfathomable and clearly does not
allow us . to maintain the quality of life or respect for
individuals that are fundamental to what we believe in the
United States."
A new framework for action is needed -- one that proposes
more effective partnerships to implement a population policy
that incorporates the variety of factors that contribute to
fertility.  To accomplish our goals, this broad-based policy
should be simultaneously implemented by all governments.
The strategies are:
   --  Improve and expand family planning:  Focus on meeting
the growing unmet need for contraceptive and reproductive
health services; ensuring a wide availability of quality
services; promoting access to safe abortion; providing STD
screening, prevention, and treatment; expanding services for
adolescents; and promoting male responsibility. Voluntarism
and respect for individual rights are guiding principles for
U.S. assistance.
   --  Women's health and status:  Additional attention must
be given to decreasing pregnancy-related morbidity and
mortality, reducing unsafe abortion, and advancing women's
rights and empowerment.  Female literacy and education, and
access to economic opportunity must be improved, and legal
and social barriers to gender equality must be eliminated.
   --  Invest in children:  Intensify societal and parental
investment in children to improve child survival and
   --  Environmentally sustainable development:  A renewed
population policy must go beyond issues of family planning,
reproductive rights and health, and the empowerment of
women.  Efforts must be directed toward other societal
concerns with economic growth, environmental protection,
urbanization, internal and international migration, and
population aging.
Meeting the population and development challenges ahead
requires commitment, knowledge, and resources.  The U.S.
agrees with the attention focused on these issues in the
preparations for the International Conference on Population
and Development, and in the ICPD itself.  Clearly, these
ingredients cannot be supplied by the public sector alone.
Partnerships with the private sector and broad participation
from all of the affected constituencies will determine what
can be accomplished.
F.  Future Policies and Priorities for International
Population Assistance
The United States will continue providing strong global
leadership on behalf of international population programs.
It gives high priority to increasing its funding for
population activities as part of its overall development
assistance efforts and to mobilizing additional resources
from other donors, host governments, and private sources.
USAID has adopted a new strategy for "Stabilizing World
Population Growth and Protecting Human Health." The strategy
is founded on these principles and objectives:
   --  promoting the rights of couples and individuals to
determine freely and responsibly the number and spacing of
their children;
   --  improving individual health, with special attention
to the reproductive health needs of women and adolescents
and the general health needs of infants and children;
   --  reducing population growth rates to levels consistent
with sustainable development;
   --  making programs responsive and accountable to the
The strategy provides a framework for investing resources
where they can (1) have the most impact on global population
growth and health problems and (2) make the greatest
contribution to sustainable development at the country
level.  USAID will continue to channel assistance through
direct bilateral agreements with host countries and through
agreements with U.S. NGOs, PVOs, and U.S. government
agencies.  While the number of USAID missions will be
reduced, renewed assistance to UNFPA, IPPF, and WHO
effectively extends U.S. population support to over 100
The types of programs USAID will support will vary depending
on the particular needs of each country.  However, in
keeping with the challenges identified above, it is expected
that USAID's population program will focus on four areas:
   --  Support for family planning services.  Family
planning will continue to be the centerpiece of USAID's
population program, and the current level of support for
family planning in proportion to overall development
assistance will at a minimum be maintained.  USAID's
population program will continue important recent
initiatives in developing and providing appropriate new
contraceptive technology, improving quality of care,
reducing unnecessary medical restrictions, advancing gender
considerations, and engaging men as supporters and users of
family planning.
   --  Expanding other reproductive health care
interventions.  Priority interventions include prevention of
STDs (especially HIV/AIDS), safe motherhood, and activities
to reduce unsafe abortion and prevent abortion-related
morbidity and mortality.  Expanding family planning programs
to include key reproductive health interventions will be
done in a phased fashion.  Operations research will be
utilized to test the cost-effectiveness and program
viability of new, more integrated approaches and to ensure
that family planning activities are not compromised.
   --  Addressing adolescent needs.  New emphasis on
addressing the rising incidence of adolescent exposure to
pregnancy, abortion, and STD/HIV affords USAID the
opportunity to influence lifetime reproductive behaviors and
   --  Increasing linkages with related areas, particularly
other health programs, women's education and empowerment
initiatives, and the environment.  Improving infant and
child health will continue to be a priority for USAID's
health program.  Linkages to family planning programs will
be increased.  Over the next several years, USAID will seek
to increase the synergies between family planning programs
and other USAID-funded women's education and development
programs.  National population and environment efforts
should be clearly linked at the policy level; linkages at a
programmatic level are harder to define, yet need to be
IV. Conclusion
The demographic diversity of the U.S. population described
at the beginning of this report is matched by diversity in
its population-related policies and programs. The federal
structure of the United States and the separation of powers
among the executive, legislative, and judicial branches
shape the policymaking process. The result is considerable
decentralization of authority, especially on matters of
social policy, to states and localities.
As this report has described, population policies and
programs within the United States are characterized by
national goals, where national consensus exists, and by
specific targets, particularly for underserved or changing
demographic groups. In health care, the United States has
set national goals for the year 2000, with targets for such
groups as teenagers or racial and ethnic minorities. Meeting
these targets requires related action on the part of state
and local governments as well as private organizations, in
addition to programmatic activities by the federal
In immigration, national policymakers are weighing
conflicting requests from state and local officials, as well
as from different segments of the population. In family
planning, philosophical and political controversies continue
to complicate the task of national policymakers and program
planners, and to differentiate the delivery of services
across the nation. Other population-based policies and
programs have to respond to growing diversity within the
nation's families and among the nation's communities.
1 U.S. Bureau of the Census, Population Projections of
the United States, by Age, Sex, Race, and Hispanic
Origin: 1993 to 2050, P25-1104.
2 Population Reference Bureau, 1993 World Population
Data Sheet.
3 Council of Europe, Recent Demographic Developments
in Europe and North America, 1992.
4 Population Reference Bureau, 1993 World Population
Data Sheet.
5 U.S. Bureau of the Census, Population Projections.
6 U.S. Bureau of the Census, "Population Trends and
Congressional Apportionment," 1990 Census Profile 1,
March 1991.
7 Arthur C. Nelson and Kenneth J. Dueker, "The
Exurbanization of America and Its Planning Policy
Implications," Journal of Planning Education and
Research 9, no. 2, 1990; William H. Frey, "The New
Urban Revival in the United States," Urban Studies 30,
no. 4/5, 1993.
8 Arthur C. Nelson, "Regional Patterns of Exurban
Industrialization: Results of a Preliminary
Investigation," Economic Development Quarterly 4, no.
4, November 1990.
9 Population Reference Bureau, 1993 World Population
Data Sheet.
10 National Center for Health Statistics, "Advance
Report of Final Natality Statistics, 1991," Monthly
Vital Statistics Report 42, no. 3 (Supplement),
September 9, 1993, table 1.
11 National Center for Health Statistics,
"Childbearing Patterns Among Selected Racial/Ethnic
Minority Groups-United States, 1990," Morbidity and
Mortality Weekly Report 42, no. 20, May 28, 1993.
12 Immigration and Naturalization Service, 1991
Statistical Yearbook of the Immigration and
Naturalization Service, and unpublished data.
13 U.S. Bureau of the Census, Population Projections.
14 Immigration and Naturalization Service, unpublished
15 U.S. Bureau of the Census, Population Projections.
16 National Center for Health Statistics, "Advance
Report of Final Mortality Statistics 1991," Monthly
Vital Statistics Report 42, no. 2, August 31, 1993.
17 Population Reference Bureau, 1993 World Population
Data Sheet.
18 National Center for Health Statistics, "Final
Mortality Statistics, 1991."
19  Kenneth G. Manton, Larry S. Corder, and Eric
Stallard, "Estimates of Change in Chronic Disability
and Institutional Incidence and Prevalence Rates in
the U.S. Elderly Population from the 1982, 1984, and
1989 National Long-Term Care Survey," Journal of
Gerontology (forthcoming).
20 Tabulated by race of mother, NCHS' current
practice, the infant mortality rate is 18.0. In 1989,
NCHS began tabulating birth and infant mortality data
by the race of mother rather than, as in the past, by
the race of the child. This change results in more
births classified as white and fewer as black, which
yields slightly lower infant mortality rates for white
infants and higher rates for black infants.
21 U.S. Bureau of the Census, Population Projections.
22 U.S. Bureau of the Census, Population Projections.
23 William P. O'Hare, "America's Minorities-The
Demographics of Diversity," Population Bulletin 47,
no. 4.
24 Ibid.
25 U.S. Bureau of Labor Statistics, Employment and
Earnings, January 1993.
26 O'Hare, "America's Minorities."
27 U.S. Bureau of the Census, Household and Family
Characteristics: March 1992, P20-467, and earlier
28 U.S. Bureau of the Census, Marital Status and
Living Arrangements: March 1992, P20, No. 468.
29 National Center for Health Statistics, "Advance
Report of Final Marriage Statistics, 1988," Monthly
Vital Statistics Report 40, no. 4 (Supplement), August
26, 1991.
30 U.S. Bureau of the Census, Marriage, Divorce, and
Remarriage in the 1990's, P23-180.
31 Larry Bumpass, "What's Happening to the Family?
Interactions between Demographic and Institutional
Change," Demography 27, no. 4.
32 U.S. Bureau of the Census, Marriage, Divorce, and
33 National Center for Health Statistics, "Final
Marriage Statistics, 1988."
34 U.S. Bureau of the Census, Marriage, Divorce, and
35 U.S. Bureau of the Census, unpublished data.
36 U.S. Bureau of the Census, Households, Families,
and Children: A 30-Year Perspective, P23-181.
37 National Center for Health Statistics, "Final
Natality Statistics, 1991."
38 National Center for Health Statistics, "Final
Marriage Statistics, 1988."
39 Ibid.
40 Bumpass, "What's Happening to the Family?"
41 Dennis A. Ahlberg and Carol J. De Vita, "New
Realities of the American Family," Population Bulletin
47, no. 2.
42 U.S. Bureau of the Census, Households, Families,
and Children.
43 See Jan Larson, "Understanding Stepfamilies,"
American Demographics, July 1992.
44 Frank F. Furstenberg, Jr., and Kathleen M. Harris,
The Disappearing American Father? Divorce and the
Waning Significance of Biological Parenthood. Paper
presented at Demographic Perspectives on the American
Family, Albany conference, April 6 and 7, 1990; Judith
A. Seltzer and Suzanne M. Bianchi, "Children's Contact
with Absent Parents," Journal of Marriage and the
Family 50; Frank L. Mott, "When Is Father Really Gone?
Parent-child Contact in Father-Absent Homes,"
Demography 27, no. 4.
45 Sara McLanahan and Karen Booth, "Mother-only
Families: Problems, Prospects, and Politics," Journal
of Marriage and the Family 51.
46 See Thomas J. Espenshade, "Marriage Trends in
America: Estimates, Implications and Underlying
Causes," Population and Development Review 11, no. 2.
47 U.S. Bureau of the Census, Marital Status and
Living Arrangements, 1992.
48 O'Hare, "America's Minorities."
49 Samuel H. Preston," Demographic Change in the
United States, 1970-2050," in Demography and
Retirement: The Twenty-first Century, Westport, CT:
Praeger, 1993.
50 U.S. Bureau of the Census, Census of Population,
1970, General Population Characteristics, PC-1-B1,
table 52.
51 U.S. Bureau of the Census, Population Projections.
52 Martha Farnsworth Riche and Kelvin M. Pollard, The
Challenge of Change: What the 1990 Census Tells Us
About Children, Washington, DC: Center for the Study
of Social Policy, September 1992.
53 Howard N Fullerton, Jr., "Labor Force Projections:
The Baby Boom Moves On," Monthly Labor Review,
November 1991.
54 Martha Farnsworth Riche, "Demographic Change and
the Destiny of the Working-Age Population," in As the
Workforce Ages: Costs, Benefits, and Policy
Challenges, Olivia S. Mitchell, ed., Ithaca, NY: ILR
Press, 1993.
55 Fullerton, "Labor Force Projections."
56 Martha Farnsworth Riche, Population Reference
Bureau, Presentation for the Staff of the House
Appropriations Committee, January 29, 1993.
57 Fullerton, "Labor Force Projections."
58 Riche and Pollard, The Challenge of Change.
59 Martha Farnsworth Riche and Kelvin M. Pollard, What
the 1990 Census Tells Us About Women: A Data Book,
Washington, D.C.: Population Reference Bureau
60 Nelson and Dueker, "The Exurbanization of America."
61 R. M. Selik, S. Y. Chu, and J. W. Buehler, "HIV
Infection as Leading Cause of Death Among Young Adults
in U.S. Cities and States," Journal of the American
Medical Association, June 16, 1993.
62 U.S. Bureau of the Census, Marital Status and
Living Arrangements, P-20, various years.
63 "Facts at a Glance," Washington, DC: Child Trends,
Inc., 1992.
64 Westoff and Jones, 1977, cited in Martha R. Burt,
"Recent Legislative and Policy History of Family
Planning in the United States, and Implications for
the 1990s," Washington, DC: The Urban Institute, 1992.
65 Martha R. Burt, "Recent Legislative and Policy
History of Family Planning in the United States, and
Implications for the 1990s," Washington, DC: The Urban
Institute, 1992.
66 Employee Benefits Research Institute, "Sources of
Health Insurance and Characteristics of the Uninsured:
Analysis of the March 1992 Current Population Survey,"
EBRI Issue Brief Number 133, January 1993.
67 John F. Sheils and Patrice R. Wolfe, "The Role of
Private Health Insurance in Children's Health Care,"
The Future of Children 2, no. 2 (Winter 1992).
68 Eugene M. Lewit and Alan C. Monheit, "Expenditures
on Health Care for Children and Pregnant Women," The
Future of Children 2, no. 2 (Winter 1992).
69 Ibid.
70 "State Coverage of Pregnant Women and Children,
January 1993." MCH UPDATE, National Governors
Association, May 1993.
71 Personal communication, Janice Steinschneider,
Center for Budget and Policy Priorities, September 7,
72 Ian T. Hill, "The Role of Medicaid and Other
Government Programs in Providing Medical Care for
Children and Pregnant Women," The Future of Children
2, no. 2 (Winter 1992).
73 Rachel Benson Gold and Daniel Daley, "Public
Funding of Contraceptive, Sterilization, and Abortion
Services, Fiscal Year 1990, Family Planning
Perspectives 23, no. 5, 1991.
74 Burt, "Recent Legislative and Policy History."
75 A. Torres and J.D. Jorrest, "Family Planning Clinic
Services in the United States, 1983," Family Planning
Perspectives 17, no. 1, 1985.
76 U.S. Bureau of the Census, Money Income and Poverty
Status of the Population, Current Population Reports,
Series P-60, various years.
Basic References
Population Reference Bureau, 1993 World Population
Data Sheet, Washington, DC: Population Reference
Bureau, 1993.
U.S. Bureau of the Census, Population Projections of
the United States, by Age, Sex, Race, and Hispanic
Origin: 1993 to 2050, Current Population Reports, P25-
1104, Washington, DC: U.S. Government Printing Office.
U.S. Bureau of the Census, Estimates of the Population
of the United States to June 1, 1993, Current
Population Reports, P25-1103, Washington, DC: U.S.
Government Printing Office, 1993.
National Center for Health Statistics, "Advance Report
of Final Natality Statistics, 1991," Monthly Vital
Statistics Report 42, no. 3 (Supplement), September 9,
National Center for Health Statistics, "Advance Report
of Final Mortality Statistics, 1991," Monthly Vital
Statistics Report 42, no. 2 (Supplement), August 31,
William P. O'Hare, "America's Minorities-The
Demographics of Diversity," Population Bulletin 47,
no. 4, December 1992.
William H. Frey, "The New Urban Revival in the United
States," Urban Studies 30, nos. 4/5, 1993, pp. 741-
U.S. Bureau of the Census, Household and Family
Characteristics: March 1992, Current Population
Reports, P20-467, Washington, D.C.: U.S. Government
Printing Office, 1993.
U.S. Bureau of the Census, Marital Status and Living
Arrangements: March 1992, Current Population Reports,
Series P20, no. 468, Washington, DC: U.S. Government
Printing Office, 1992.
National Center for Health Statistics, "Advance Report
of Final Marriage Statistics, 1988," Monthly Vital
Statistics Report 40, no. 4, August 26, 1991.
Martha R. Burt, "Recent Legislative and Policy History
of Family Planning in the United States, and
Implications for the 1990s," Washington, DC: The Urban
Institute, 1992.
Employee Benefits Research Institute, "Sources of
Health Insurance and Characteristics of the Uninsured:
Analysis of the March 1992 Current Population Survey,"
EBRI Issue Brief Number 133, January 1993.
U.S. Department of Health and Human Services, Healthy
People 2000, 91-50212, Washington, DC: U.S. Government
Printing Office, 1992.
Table and Figure Sources
Table 1.  U.S. Bureau of the Census, Population
Projections of the United States, by Age, Sex, Race,
and Hispanic Origin: 1993 to 2050, Current Population
Reports, P25-1104, table C.
Table 2.  Immigration and Naturalization Service,
"Immigrants Admitted by Class of Admission and Country
or Area of Birth," Detail Run 410, unpublished table.
Table 3.  1980 figures from U.S. Bureau of the Census,
1980 Census of Population, General Social and Economic
Characteristics, PC80-1-C1, table 75; 1993 figures
from U.S. Bureau of the Census, Population Projections
of the United States, by Age, Sex, Race, and Hispanic
Origin: 1993 to 2050, Current Population Reports, P25-
1104, table 2.
Table 4.  William P. O'Hare, "America's Minorities-The
Demographics of Diversity," Population Bulletin 47,
no. 4, Washington, D.C.: Population Reference Bureau,
Inc., December 1992, tables 7 and 11; figures 9 and
Table 5.  U.S. Agency for International Development,
Office of Population, unpublished table.
Figure 1.  Population Reference Bureau, 1993 World
Population Data Sheet, Washington, D.C.: Population
Reference Bureau, Inc., 1993.
Figure 2.  1950 to 1979 figures from U.S. Bureau of
the Census, United States Population Estimates, by
Age, Sex, Race, and Hispanic Origin: 1980 to 1988,
Current Population Reports, Series P-25, No. 1045,
table 6; 1980 to 1992 figures from U.S. Bureau of the
Census, Estimates of Population of the United States
to June 1, 1993, Current Population Reports, P25-1103;
1993 to 2050 figures from U.S. Bureau of the Census,
Population Projections of the United States, by Age,
Sex, Race, and Hispanic Origin: 1993 to 2050, Current
Population Reports, P25-1104, tables 1 and 4.
Figure 3.  1950 to 1959 figures from National Center
for Health Statistics, Vital Statistics of the United
States 1988 (Volume I-Natality), table 1-1; 1960 to
1991 figures from National Center for Health
Statistics, "Advance Report of Final Natality
Statistics, 1991," Monthly Vital Statistics Report 42,
no. 3 (Supplement), September 9, 1993, table 1; 1992
figures from National Center for Health Statistics,
"Births, Marriages, Divorces, and Deaths for 1992,"
Monthly Vital Statistics Report 41, no. 12, May 19,
1993, front page table.
Figure 4.  U.S. Bureau of the Census, Household and
Family Characteristics: March 1992, Current Population
Reports, P20-467, table A.
Figure 5.  1970 figures from U.S. Bureau of the
Census, Census of Population 1970, General Population
Characteristics, PC-1-B1, table 52; 2020 figures from
U.S. Bureau of the Census, Population Projections of
the United States, by Age, Sex, Race, and Hispanic
Origin: 1993 to 2050, Current Population Reports, P25-
1104, table 2.
Figure 6.  1940 to 1990 figures from Howard V. Hayghe,
"Family Members in the Work Force," Monthly Labor Review
113, no. 3, March 1990, pp. 14-19; 1991 figures from Bureau
of Labor Statistics, unpublished data.
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