The Pill is Mightier Than the Sword

Abstract

One determinant of peace is the role of women in society. Some studies suggest that a young age structure, also known as a "youth bulge" can facilitate conflict. Population growth and age structure are factors amenable to change in a human rights context. We propose that policies which favor voluntary family planning and the education of women can ameliorate the global burden of disease associated with conflict and terrorism.

Full text

The Pill is Mightier Than the Sword
Malcolm Potts, Aafreen Mahmood, Alisha A. Graves
*
Abstract
One determinant of peace is the role of women in society. Some studies suggest that a young age structure,
also known as a “youth bulge” can facilitate conflict. Population growth and age structure are factors amenable
to change in a human rights context. We propose that policies which favor voluntary family planning and
the education of women can ameliorate the global burden of disease associated with conflict and terrorism.
Keywords: Population, Security, Conflict, Women, Family Planning, Iran
Copyright: © 2015 by Kerman University of Medical Sciences
Citation: Potts M, Mahmood A, Graves AA. The pill is mightier than the sword. Int J Health Policy Manag.
2015;4(8):507–510. doi:10.15171/ijhpm.2015.109
*Correspondence to:
Alisha A. Graves
Email: agraves.oasis@gmail.com
Article History:
Received: 19 March 2015
Accepted: 31 May 2015
ePublished: 9 June 2015
Perspective
The OASIS Initiative, University of California, Berkeley, CA, USA
hp://ijhpm.com
Int J Health Policy Manag 2015, 4(8), 507–510
doi
10.15171/ijhpm.2015.109
I
SIS in Syria and Iraq, the Taliban in Afghanistan, and Boko
Haram in Nigeria all kill and injure people. Refugees from
conflict and climate change are exposed to exploitation
and death. Fighting causes additional mortality and morbidity
by destroying the health care systems. Today’s battles differ
from those in the past. At the battle of Gettysburg in 1863,
40 000 men were killed or wounded but only one woman died
from a stray bullet. Today, it is often women and children
who suffer most from conflict. Poignantly, it is also women
who hold a key to peace. The question is not, why does war
break out? But, why does peace break out? We suggest that one
factor in ameliorating the global burden of disease associated
with conflict and terrorism is the increased role of women
in society, enabled by policies related to family planning and
women’s education.
Rapid population growth resulting in a distorted age
structure is one of many factors associated with civil unrest
and violence. Others include persistent poverty, repressive
governance, food shortages, global economy, resource
consumption, and extreme interpretations of religion. We
argue that the biological, economic, and sociopolitical
ramifications of the “youth bulge” resulting from rapid
population growth are primary contributors to political
conflict and terrorism – especially in environments with
inadequate job opportunities. These ramifications warrant
research attention and programmatic investment because they
are most amenable to change from a human rights perspective
through voluntary family planning and girls education.
The Biology of Violence
The overwhelming majority of soldiers, terrorists, criminals,
European football hooligans, political radicals, rock stars,
outstanding mathematicians, highest automobile insurance
premium payers are men in the 15 to 29 years old age
group. Men in their twenties also possess the highest
testosterone levels,
1
which are associated with dominance
2
and competition. Relative to married men at the same age,
unmarried men have higher testosterone levels and are three
times as likely to murder someone.
3
Testosterone levels rise
during competitive sports for both male players and fans –
even among old men playing dominoes.
4
High testosterone
levels are also correlated with hedge fund managers’ risk
taking on Wall Street.
5
The Demography of Violence
Populations with a low median age are often more conflict-
driven than those with a higher median age. Of the 800 000
people murdered in 100 days in 1994 Rwanda, half of all adult
men were in the 15 to 29 age cohort. In war torn Liberia the
mean age of the population is 17, as opposed to 35 in the
United States. In Pakistan and Afghanistan, 44% to 47% of all
adults belong to this volatile age group. The 9/11 Commission
Report points out how:
“‘High birth rates…throughout the Moslem world’ have
produced ‘a large, steadily increasing population of young
men without any reasonable expectation of suitable
or steady employment - a sure prescription for social
turbulence.’’’
6
Mesquite and Weiner found the ratio of younger to older
men accounted for about one-third of the variance in war and
terrorism occurrences.
7,8
While this may indicate a compelling
relationship in social science terms, the impact of this ‘youth
bulge’ is context-specific. In a socially homogenous society,
such as South Korea or Taiwan, a youth bulge can help drive
economic growth.
9,10
However, a youth bulge can facilitate
conflict in societies with ethnic and/or religious divisions,
lack of education, employment opportunities, and healthcare.
In Sri Lanka, Sinhalese political radicalism began in the 1950s
and 60s as the ratio of men ages 15 to 29 exceeded 20% of the
total Sinhalese population. The minority Tamil population’s
violent response in the 1980s occurred precisely when the
ratio of younger men to the total population of Tamils also

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International Journal of Health Policy and Management, 2015, 4(8), 507–510508
exceeded 20%.
11
Other factors skewing the population structure can also
correlate with violence. In 19th century China, widespread
female infanticide skewed the sex ratio as high as 129 males
to 100 females. Unmarried men often formed bands of
vagabonds.
12
By contrast, in mid-nineteenth century England
and Wales, many men had emigrated to the colonies and
for the first time in history, 500 000 women did not marry
and were not swept into a life of continuous child-rearing.
Worsnop argues that these unmarried women were a driving
force in establishing the professions such as nursing, making
higher education accessible to women, and ultimately sparked
calls for female equality.
13
The Case of Syria
The United Nations (UN) has declared Syria’s ongoing civil
war as the “worst humanitarian crisis” with estimates of over
200 000 dead, millions displaced in refugee camps, sectarian
violence, and a broken healthcare system.
14
The Assad
regime’s failure to respond to extreme drought conditions
and exploitative irrigation policies for government cronies
left over 800 000 young, poor farmers unemployed.
15
As
unemployed farmers migrated with their families to Syrian
cities, resources, education, and employment opportunities
for the large incoming youth population were further
strained. The Assad regime’s silencing of dissent, coupled
with sectarian conflict, diminishing resources, ammunition
from surrounding countries, and a fast-growing population
eventually culminated in the Syrian revolution.
15
Five years
of Syria’s civil war have pulled thousands of young men
into violence as a means of achieving economic security
and political inclusion. Syrian women fleeing this violence
suffer disproportionately in refugee camps, where they lack
access to basic contraception.
14
As a result, refugee camps are
experiencing a rising incidence of unintended pregnancies
and pregnancy complications.
14
Connecting the Dots
During the Eisenhower administration, General William
H. Draper Jr. emphasized the strategic significance of rapid
population growth. Draper Jr. crafted many aspects of
United States and international family planning assistance.
In
1974, Henry Kissinger’s National Security Memo 200
suggested expanding US aid assistance to international family
planning. Vatican pressure has been credited with blocking
the implementation of key recommendations.
16
Forty years
and 3.3 billion additional people later, the British Ministry
of Defense argues that its military should understand
demography and the importance of investing in women.
17
The Foreign Affairs Committee of the UK Parliament, chaired
by Sir Richard Ottaway, concluded:
“There is clear evidence that in many cases, high population
growth in the developing world tends to correlate to political
instability and to the spread of radical or extremist views….”
17
Women’s Empowerment
Women’s empowerment – or women’s freedom to make
choices about their bodies and their lives – is fundamental
for peace. Though African women are doing the majority of
agricultural work, they are only given control over a small
minority of capital resources. Each year, over 14 million
girls under age 18 are married, many against their will.
18
In
Afghanistan, the Taliban even deny women access to a male
doctor when complications arise in pregnancy. In 2012,
Hudson et al, in a careful quantitative study confirmed that
measures of the “the physical security of women [in a society]
is strongly associated with the peacefulness of the state.”
19
Investing in girls’ education may be the most leveraged
and cost effective investment a region in turmoil can make.
Among other benefits, educated girls tend to marry later and
have fewer children. Education, for good reason, is considered
the primary driver of social and economic development.
Nonetheless, Pakistan spends only 2.2% of its gross domestic
product (GDP) on education for its exploding population,
leaving it with only approximately 30 000 madrassas, or
religious schools, as sources for knowledge. Educating its 30
million illiterate women would cost the Pakistani government
approximately two billion dollars. By comparison, the new
Joint Strike Fighter program costs about $200 billion – only to
be used a few times in a shooting war, as opposed to education
which lasts a lifetime.
Access to Family Planning
Access to family planning has a powerful impact on birth
rates.
20-25
Family size falls when women have the knowledge
and means to separate sexual intercourse from childbearing.
It is a common sense assertion, but often overlooked by
influential economists and development strategists. Without
use of contraception, the default position in any heterosexual
partnership is a large family. Deciding on the size of one’s
family depends on a conscious, persistent and often difficult
effort to turn off fertility.
Children in small families are more likely to enter school and
stay in school than children in large families.
26
In countries
where the birth rate has fallen, children graduating from school
are more likely to be employed as adults. In Egypt, 800 000
young people enter the job market annually; however, the
unemployed young men are called hayateen – “men who lean
against walls.” They are tinder for extreme political teachings
and fundamentalist religious sects. Falling family size pays an
economic “demographic dividend,”
9,10
at the national level, as
savings rates increase when family size decreases. The “Asian
tigers,” such as Korea, Taiwan, and Singapore, have small
families because in the 1960s their governments instituted
organized family planning programs as a strategy to escape
from poverty.
In countries where the couples’ desire to control their family
size has been met with access to family planning, the birth
rate has almost always fallen.
23
Thailand and the Philippines
have had the same population size since 1950. Thailand made
contraception and safe abortion widely available, thereby
decreasing the average number of children in a family from
6 to 1.8. In the Philippines, religious barriers often prevent
women from accessing contraception. Today, the average
family has 3 children and the population is 96 million. Over
time, a seemingly small difference in family size makes a

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International Journal of Health Policy and Management, 2015, 4(8), 507–510
509
significant overall difference in population size. In 2050,
Thailand is expected to have 61 million people and become
a prosperous, democratic country. Without a major shift in
population growth regulation policies and related services, the
Philippines will have about 157 million people. This growth
will outstrip the country’s ability to provide basic services
and jobs, which we predict will ultimately lead to poverty and
political instability.
Unfortunately, in countries covering more than half of the
world’s population, the range of family planning methods
offered remains limited. Low-income women in developing
countries face a great many unjustified barriers that often
stand between them and accessing the fertility regulation
technologies they need.
27
For example, medical traditions
commonly require women to attend a family planning clinic
on the day she is menstruating in order to demonstrate that
she is not pregnant. Barriers to family planning are a tangle of
such details and often result in women having larger families
than they desire.
The Experience of Iran
The Islamic Republic of Iran has seen the most rapid decline
in birth rates than any country on the planet. In the late 1980s,
informed decision-makers understood that rapid population
growth was outpacing growth in the GDP – a recipe for
increased poverty. The religious leadership endorsed family
planning on health grounds, Iran manufactured its own oral
contraceptives and condoms, and offered vasectomies and
female sterilization. Before young couples could marry, they
were required to receive family planning instruction. In the
decade 1986 to 1995, family size in Iran fell from 5.6 to 3.3
children, and today it stands at 1.8. There are now more women
than men in Iranian universities. However, a draconian new
Comprehensive Population and Exaltation Family Bill aims to
lower the age of marriage and outlaw voluntary sterilization.
In 2013, over 270 000 girls aged 10 to 19 were married and
several births to girls aged 10 were registered.
28
Conclusions
Family planning is about responding to what women want,
and not telling them what to do. Just as forced or coercive
contraception is cruel and unacceptable, so is forced
pregnancy and childbearing due to lack of family planning.
Family planning is natural and essential for modern living, as
it allows societies to reach economic prosperity, security, and
achieve sustainable population growth. Effective use of family
planning can prevent skewed age structures that result in the
“youth bulge,” which – among various external factors – is a
precursor for violence. We invite others to examine further
empirical evidence for this view and recommend that security
experts consider girls education, family planning, and youth
employment among their strategies. Through ensuring
women the freedom and resources to make informed
decisions about their body and family size, we expect to find
that the pill is mightier than the sword.
Ethical issues
Not applicable.
Competing interests
Malcolm Potts, physician and biologist, is Professor of Maternal and Child
Health in the School of Public Health, University of California (UC), Berkeley,
CA, USA. He is author of “Sex and War: How Biology Explains Warfare and
Terrorism”. Alisha Ann Graves, is Vice-President, Population Programs at
Venture Strategies for Health and Development. Together, they started and lead
the Organizing to Advance Solutions in the Sahel (OASIS) Initiative, a project of
UC Berkeley. Aafreen Mahmood is a rising senior at UC Berkeley, majoring in
Public Health and minoring in Global Poverty and Practice.
Authors’ contributions
MP wrote the majority of the paper. AM wrote the section “the Case of Syria.”
AAG wrote the sections “Women’s Empowerment” and “Access to Family
Planning” and did the majority of revisions.
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