Book of the Month: Under the Banyan Tree
Authors: Steven W Sinding
Journal: Journal of the Royal Society of Medicine (2003)

The modern ‘population movement’ began, if one wishes to assign an arbitrary date, in 1952, the year in which India announced the world's first population policy and both the International Planned Parenthood Federation and the Population Council were formed. It was inspired by the recognition among demographers of a demographic explosion in the developing world. In New York in particular, a small group of internationally minded citizens and foundations decided to organize efforts to address global rapid population growth. Foremost among these were John D Rockefeller III and the Ford and Rockefeller Foundations. In the years that followed, these early efforts led to a massive international movement, largely funded by the governments of industrialized countries.

The career of Dr Sheldon Segal has largely paralleled the history of the population movement. He began work at the Population Council in the late 1950s when the total fertility rate in the developing world was around 6.5 children per woman and contraceptive use was negligible. He was involved at the very outset of efforts by the Population Council to develop new methods of contraception that would be suited for women in the developing world. Now, half a century later, fertility in the developing world has declined to slightly under 3 children per woman and contraceptive use approaches 65% of women of reproductive age. The factors that both produced this notable accomplishment and coincided with it are the subjects of Segal's Under the Banyan Tree: A Population Scientist's Odyssey.1

Segal devoted his first 20 years to the search for improved methods of contraception as head of the biomedical research programme at the Population Council. He was at the Council when the two most significant advances in modern contraception occurred—the nearly simultaneous invention of ‘the pill’ and the intrauterine device (IUD). Though the Council did not participate in the discovery of either method it played an important part in the global dissemination of both. Under Segal's guidance, the Council initiated investigations that yielded better versions of the pill and IUD and led to the development of new contraceptive methods, most notably the subdermal implant known as Norplant.

Leaving the Population Council, Segal took over as the first Director of the Population Sciences Programme at the Rockefeller Foundation, from which vantage point his perspective widened. Now responsible for an extensive programme of training and demographic research, he was in a position to broaden his own understanding of the interacting social, programmatic, and technological changes that were contributing to rapid fertility declines in the 1980s and into the last decade. He maintained his strong interest in biomedical research and discovery but also used the Rockefeller Foundation resources to help scholars and policy-makers shape policies and programmes that would hasten the demographic transition and improve the lives of women and men in the developing world. Leaving the Rockefeller he returned to the Population Council, where for more than a decade now he has been pursuing his manifold interests in science and public affairs related to the population movement. Very few people are better placed to explain how and why the population movement was successful.

Under the Banyan Tree is not a history and not really a memoir either. Rather, it is a collection of short essays on various aspects of the field as Shelly Segal has experienced and understood them. The book deals with such diverse issues as the functioning of the male and female reproductive systems, the conflict between demographers and feminists at the time of the Population Conference in Cairo in 1994, and the organization of contraceptive research networks. Segal also comments broadly on global environmental and agricultural prospects, and throughout the book we are treated to intriguing vignettes concerning giants in this field encountered by Segal as he worked at or near the apex of influence. In places the book offers detailed explanations of such matters as how modern contraception actually works, what is known about it and what is not known, and the story of how some of the most important contemporary methods were discovered. Segal is a masterful interpreter of high science and the non-specialist reader will nowhere find a better description or explanation of how the human reproduction system functions and how modern science has helped individuals to regulate and control it.

But the book still came as something of a disappointment to me, having known the man and worked in the same area. First, when Segal speculates on matters further afield, such as the impact of population growth on food production and availability or its effects on the environment, he adds little to what others have written on these themes; one wonders why, in so personal an odyssey, Segal takes them on. More important, by adopting an idiosyncratic approach reflecting his passions and special interests, he leaves some issues unaddressed. Why, for example, has 40 years of public investment in contraceptive research yielded so little progress since the advent of the pill and the IUD? Convinced that industry would not invest in the development of technologies for couples in the third world, Segal was at the heart of a public-sector effort (government and private foundations) to develop contraceptive methods for those people; yet he offers no assessment of those 40 years of investment. Similarly, while Segal has glowing words for the efforts of the International Committee on Contraceptive Research and the subsequent South to South Contraceptive Research Network that he organized and later supported, Under the Banyan Tree leaves us wondering exactly what these institutions achieved and why he takes such pride in them.

Perhaps it is unfair of me to comment on the book I wish Segal had written, rather than the highly entertaining one he did write, but I longed for insights into the strengths and weaknesses, the comparative contributions, the successes and failures of the great institutions of the population movement—the Population Council, the large foundations, the UN Population Fund, the US Government's population programme, and the International Planned Parenthood Federation. Segal, despite having worked closely with all or most of these, has little to say on how, collectively and individually, they influenced and shaped human reproductive behaviour. One comes away from Under the Banyan Tree hungry for what he could still tell us about the story of the population movement and its achievements. The record of success is indeed amazing. Only the Green Revolution in agriculture matches it as an example of international development cooperation. Over the past 50 years fertility in the developing world has declined by half, and desired family size now approaches the replacement level of around 2 children per couple—a veritable reproductive revolution. Virtually every government in the world has adopted a policy that addresses population growth or the reproductive rights of individuals, and most provide assistance to their citizens that enables them to have children by choice. What were the keys to this success? I would mention the following as the most important: the invention around 1960 of the pill and the IUD; the US foundations' support of research and the training of the first generation of the movement's leaders in the developing countries; the massive support provided by governments, particularly the US Government, beginning in the late 1960s; and the creation of such international institutions as the International Planned Parenthood Federation and later the UN Population Fund to disseminate technical and financial assistance, as well as technology, to permit the establishment of family planning and other reproductive health services in developing countries.

The reproductive revolution is not over and it still faces large obstacles. Fertility remains high in Africa and parts of South Asia. The HIV/AIDS pandemic represents an enormous challenge to efforts to improve reproductive health. Infant and maternal mortality are stubbornly high in many places, and conservative social and religious forces continue to oppose efforts to make contraception and abortion available, particularly to young people. The largest ever generation of young people—more than one billion—are now coming of reproductive age. Somehow this ‘youth bulge’ must be accommodated by the service providers, if we are not to lose ground from the tremendous accomplishments of the past half-century.