Intended for healthcare professionals

Education And Debate

Paths to lower fertility

BMJ 1999; 319 doi: (Published 09 October 1999) Cite this as: BMJ 1999;319:985
  1. John Caldwell, professor (
  1. National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT 2601, Australia

    A sustained fall in fertility is a relatively recent phenomenon. Before the late 18th century, two large agrarian civilisations constrained population growth by mechanisms additional to natural mortality. In western Europe delayed marriage of women, and, even more effective, forgone marriage, kept down the birth rate, as individuals strove to ensure that families would not begin their existence doomed to poverty.13 In China, Japan, and some North Indian castes the family was protected from starvation and penury by infanticide, predominantly of girls, which was greatest during subsistence crises (Zhao Z. Australian Population Association conference, Adelaide, 1996).

    From the late 18th century a sustained fall in fertility began in France, and fertility declines became general in western and central Europe, as well as in English speaking settlement countries, in the last quarter of the 19th century.4 The reasons were complex. The fall in mortality—itself the product of social and behavioural change as well as scientific and technological advance—made a fall in fertility possible and ultimately inevitable. In France, with the revolution forcing the church into retreat and leading to a rethinking of social values and personal relationships, the fall started a century before that in richer Britain. In Britain there was a sustained and effective battle, led by the medical profession, to preserve the Victorian spousal relationship from the morally corruptive impact of the discussion and practice of contraception.5

    The introduction of child labour laws and then compulsory schooling, devised with other aims, hastened the control of family size by increasing spending on children and reducing their earning potential. Control of fertility was aided in Britain and other English speaking countries by the debate over the 1877 trial of Bradlaugh and Besant for their republication of a family planning manual. The trial was reported in the …

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