kritik response thd fp program

39Volume 35,Number 1,March 2009

C O M M E N T

Sharply rising energy and food prices have once againraised the specter of the human population outstrippingthe planets natural resources. Ever since Malthus, pes-simists have believed thatmankind is doomed due to over-population and overconsumption, while optimists have ar-gued that technological innovationwill improve standardsof living and that population growth is at most a minorissue.1,2 While this renewed debate at the global level re-ceives widespreadmedia attention, another less visible butequally important discussion of the impact of demo-graphic trends and policy options is under way among theleaders of the least- developed countries. A large majorityof these leaders agree that population growth andbirthrates are too high.3 Potential adverse effects includepoor health among women and children, slow economicgrowth and poverty, overcrowded schools and clinics andan overburdened infrastructure, as well as the depletion ofenvironmental resources.4 In addition, high unemploy-ment and inequality among rapidly growing young popu-lations may contribute to the spread of political violenceand civil strife.57

Inmany developing countries, these concerns have ledto action. Since the 1960s, alongside efforts to increase ed-ucational opportunity and improve health conditions, themain policy response to concern about rapid populationgrowth has been the implementation of voluntary familyplanning programs* that provide information about, andaccess to, contraceptives. This policy has permittedwomen and men to control their reproductive lives andavoid unwanted childbearing. Only in rare cases, most no-tably in China and briefly in India, has coercion been used.The choice of voluntary family planning programs as

the principal policy instrument to reduce fertility has beenbased largely on the documentation of a substantial levelof unwanted childbearing and an unsatisfied demand forcontraception.8,9 Family planning programs provide awin-win solution: The welfare of individual women and chil-dren is improved, and the national economy and environ-ment benefit. The international consensus on this issue isreflected in the Millennium Development Goals, specifi-cally in Target 5.b.to provide universal access to repro-ductive health by 2015 and to reduce the unmet need forfamily planning.10

Despite this long-standing and widely accepted ratio-nale for voluntary family planning programs, funding forthese programs has declined by 30% since the mid-1990s.11 A number of reasons can be cited, including the(in our view, mistaken) claim that the need for such pro-grams has declined, given the significant progressmade inreducing fertility, especially in Asia and Latin America;donor fatigue; persistent opposition fhrom conservativegovernments and institutions (in particular the Bush ad-ministration and the Vatican); and the need for resourcesto address other pressing problems, such as the AIDS epi-demic. Unfortunately, this neglect is encouraged by a smallgroup of influential and determined critics of family plan-ning, whose superficially plausible arguments encouragepolicymakers and donors to reduce investments in con-traceptive services and supplies.The literature is thin on rebuttals to these critics, al-

though it containsmany statements on the benefits of fam-ily planning programs.9,12,13 Our objective is to set therecord straight on several central issues in this debate, toshow why the most frequently cited critiques of familyplanning programs are misleading or wrong, and toreestablish a higher priority for family planning on the in-ternational agenda.

Critique: Family planning programs have little or no effect onfertility.14,15

Response: This argument is based on the view of a numberof economists that couples have the number of childrenthey want and can afford.14,16,17 It assumes that parents se-lect their family size in more or less the same way theychoose consumer durables. High fertility in poor countriesis considered to be the result of couples wanting manychildren to help with household chores and agriculturalwork and to provide for them in old age. Family planningcosts are often treated as aminor issue in parents decisionmaking.The real world is less simple. In the developing world,

137 million women who dont want to get pregnant arenot practicing contraception.13 The key cause of thisunmet need for contraception is that contraception isoften quite costly to individuals in terms of commodities(pills, condoms, IUDs, etc.), transportation, and providerfees for contraceptives and health care services, evenwhensubsidies are provided by the government. In addition,there are significant noneconomic costs, such as healthconcerns, social disapproval and spousal resistance, aswell as unnecessarymedical barriers (e.g., requiring a doc-

AResponse toCritics of FamilyPlanningPrograms

By John Bongaartsand Steven W.Sinding

John Bongaarts is vicepresident and distin-guished scholar of thePopulation Council.Steven W. Sinding is asenior fellow of theGuttmacher Institute.He is the retireddirector general of theInternational PlannedParenthoodFederation.

*Since the landmark International Conference on Population and Devel-opment (ICPD) in Cairo in 1994, family planning has been included in thebroader concept of reproductive health.Moreover, in the years since theICPD, that concept has been broadened even further to incorporate sex-ual health and sexual and reproductive rights.

Note: This article contains corrected data and supersedes the version originally publishedin International Perspectives on Sexual and Reproductive Health in Volume 35, No. 1.

40 International Perspectives on Sexual and Reproductive Health

tor instead of a nurse or other trained health care workerto provide certain contraceptives.8 This unmet need is inturn responsible for most of the 76 million unplannedpregnancies that occur each year.13 About half of thesepregnancies end in abortion and the other half end inbirths; both contribute unnecessarily to health risks formothers and children, to the cost of raising families and tothe adverse impact of population growth.The existence of a high level of unmet need for contra-

ception convinced many policymakers that family plan-ning programs would be acceptable and effective. Thisconclusion is supported by results of such experiments asthe one conducted in the Matlab district of ruralBangladesh.18 When this experiment began in the 1970s,Bangladesh was one of the worlds poorest and least de-veloped countries, and there was considerable skepticismthat couples would be motivated to have smaller families.Comprehensive family planning and reproductive

health services were provided in the treatment area of theexperiment. A wide choice of methods was offered, high-quality referral and follow-up were provided and a newcadre of well-trained women (called Family Welfare Visi-tors) replaced traditional birth attendants as serviceproviders. Contraceptive use rose sharply as these im-provements were implemented. No such change was ob-served in the comparison area. The differences betweenthe two areas in contraceptive use and fertility were main-tained over time, thus convincing the Bangladesh govern-ment to adopt theMatlabmodel as its national family plan-ning strategy.The result was a 20-year fall in the fertility of

Bangladesh, from more than six children per woman tonearly three, as contraceptive use in the same period rosefrom fewer than 10% of married women to more than50%. Parts of Bangladesh now have fertility significantlybelow three births per woman.19 The success of theMatlabexperiment, and the subsequent success of Bangladeshsnational family planning program, demonstrated that ap-propriately designed services can reduce unmet need forcontraception and fertility, even in traditional settings.Another convincing illustration of the impact of volun-

tary family planning is the program introduced in Iran in1989. Free contraceptive services were provided through-out the country by an extensive network of village healthworkers.20 The response was immediate and large: Fertilitydeclined frommore than five births per woman in the late1980s to just two in 2000. No other country experienced adecline of thatmagnitude during the 1990s.While it is like-ly that some fertility change would have occurred withoutthese new services, the unprecedented pace of the fertilitydecline argues for a substantial impact of the program.Many other countries have introduced family planning

programs since the 1960s. The resources devoted tothemand hence their fertility impacthave varied wide-ly. The aggregate effect of all these efforts has been sub-stantial: Fertility declined in the developing world frommore than six to fewer than four births per woman be-

tween 19601965 and 19851990, and almost half of thatdecline43%is attributable to family planning pro-grams.21 Voluntary family planning programs are intend-ed to reduce the number of unplanned pregnancies, butthey also legitimize and diffuse the idea of smaller families,thus accelerating the transition to lower fertility. This is im-portant in countries where women still want large families.In such populations, there will have to be declines in thenumber of children desired before sustained fertility de-cline can occur. Desired family size is highly responsive toimprovements in human development, in particular in fe-male education and child survival.2224 This conclusion isstrongly supported by the fact that low fertility has beenachieved in some very poor societies, such as Cuba, SriLanka and the state of Kerala in India. Although poor,these populations have had high levels of literacy and fe-male empowerment and low infant and child mortality,along with access to family planning. The most effectivepublic policies to reduce high fertility, therefore, have pur-sued two strategies: encouraging human development andstrengthening the family planning program. In each casecited above, the government invested heavily in primaryhealth care and free public education for girls and boysthrough secondary school, thus addressing two of themost powerful determinants of fertilitythe reduction ofinfant mortality and the empowerment of women.

Critique: Fertility declines are underway everywhere, so thepopulation problemhas largely been solved and family plan-ning programs are no longer needed.15,25,26

Response: A revolution in reproductive behavior has sweptthe globe since the 1960s. In the developing world, con-traceptive use, once rare, is now widespread, and the av-erage number of births per woman has fallen by half. Inmost of the industrialized world, already-low fertility hasnow dropped below the replacement level of two chil-dren per woman.3 These developments have led to claimsthat the world population explosion is over.25,26

Instead of being near the end of the unprecedentedpopulation expansion of the past 50 years, human num-bers continue to increase by more than 75 million a year,just as has been the case in every year since 1970. TheUnited Nations expects the population of the world tocontinue to grow until at least 2050, adding 2.7 billion tothe 2005 population of 6.5 billion.3 Nearly all of this fu-ture growthwill occur in the developingworld, where pop-ulation size is projected to increase from 5.3 to 7.9 billionbetween 2005 and 2050. (In contrast, in the developedworld, population size is forecast to remain virtually stableuntil 2050.)Despite declining fertility rates, large increases in pop-

ulation are expected in Africa (by 1.1 billion), Asia (by 1.3billion) and Latin America (by 0.2 billion).3 There are threereasons for this.First, the average decline from six to three births per

woman still leaves fertility substantially above the two-child level needed to bring about population stabilization.

A Response to Critics of Family Planning Programs


jections for all developing regions, including Africa, pre-dict further large population increases. This is because theannual number of AIDS deaths (twomillion) is equivalentto just 10 days growth in the population of the develop-ing world. The population of Sub-Saharan Africa is ex-pected to grow by one billion between 2005 and 2050(from 0.77 to 1.76 billion). In fact, high AIDS mortality isnot expected to cause a decline in the population of anyAfrican country between 2005 and 2050. Even with thesteady future declines in fertility assumed by theUN,mostpopulations in Sub-Saharan Africa are projected to morethan double, several to triple and one (Niger) to quadru-ple by 2050.3

Critique: Family planning programs are not cost-effective.14

Response:Governments compare costs and benefits whendetermining whether investing in a family planning pro-gram is worthwhile. Costs include contraceptive com-modities, personnel and the management of a service de-livery system. Benefits include improvements in personalwell-being (giving a woman control of her body), in health(protection of women and infants frommedical risks dur-ing pregnancy, delivery and the postpartumperiod, as wellas a reduction in mother-to-child transmission of HIV), insocioeconomic development (more rapid economicgrowth and lower demands on public budgets), and in re-duced pressure on environmental resources (water, arableland, forests).The data to accurately estimate all these factors are lack-

ing, but the cost-effectiveness of family planning as ahealth investment is well established. The potential healthimpact is evident: The 76million unintended pregnanciesin the developing world in 2003 resulted in 184,000 preg-nancy-related deaths and 1.8million infant deaths.31 Rais-ing contraceptive use to reduce unintended pregnancieswill avert a part of these deaths. TheWorld Banks DiseaseControl Priorities Project estimates the cost of family plan-ning at $100 per life-year saved.32 This is of the same orderof magnitude as other health interventions, such as basicsanitation for diarrheal disease, a short course of chemo-therapy for TB and condom distribution for HIV preven-tion. It is worth noting that all these interventions areabout 10 times as cost-effective as antiretroviral treatmentof AIDS, which currently receives a large proportion ofhealth-related development aid.32

Investments in family planning are often also justifiedon economic and environmental grounds. Rapid popula-tion growth and high fertility typically lead to slower eco-nomic growth and higher levels of poverty thanwould oth-erwise be the case.4 Conversely, rapid fertility declinecreates a so-called demographic dividend, which boostseconomic growth for a few decades by increasing the sizeof the labor force relative to both young and old depen-dents and by stimulating savings.Governments of poor, largely agricultural countries also

realize that rising food demand caused by populationgrowth (compounded by rising incomes, as, for example,

Withmore than two surviving children per woman, everygeneration is larger than the preceding one; as long as thatis the case, population expansion continues.Second, declines in mortalityhistorically the main

cause of population growthwill almost certainly contin-ue. Higher standards of living, better nutrition, expandedhealth services and greater investments in public healthmeasures have increased life expectancy by 50% since1950, and further improvements are likely.The final factor is population momentum, which is

the tendency for a population to keep growing even if fer-tility could immediately be brought to the replacementlevel of 2.1 births per woman. The reason for this growthis a young population age structure. For example, in Sub-Saharan Africa, 43% of the total female population wasyounger than 15 in 2005.3 This large new generation ofgirls is now entering the childbearing years. Even if eachof these women has only two children, they will producemore than enough births to drive population growth fordecades to come.Further large increases in the population of the already-

crowded developing world are therefore virtually certain.In fact, it is possible that current projections underestimatefuture growth because they assume steady declines in fer-tility. This assumption has been proven wrong in a num-ber of countries, particularly in Africa (e.g., Kenya andGhana), where fertility declines that started in the 1970s,1980s or 1990s have now stalled.27 Even a modest slow-down in the pace of projected fertility decline will producesubstantial additional population growth.

Critique: The death toll of the AIDS epidemicmakes familyplanning undesirable and unnecessary.28

Response: By the end of 2006, a cumulative total of about25million individuals had died of AIDS. The death toll willreach much higher levels in the future because 33 millionindividuals are currently infected and many new HIV in-fections are occurring each year.29 By far the largest epi-demics are found in southern Africa, where about one infive adults are infected. In contrast, other continents expe-rience infection levels of only a fraction of 1%. The causesof the concentration of the epidemic in one region of Africainclude a relatively high frequency ofmultiple and concur-rent sexual partners, low levels ofmale circumcision, a highprevalence of other STIs and low use of condoms.30

A massive global effort has been mounted to reduce in-fections through prevention programs (which encourageabstinence, reduction in number of partners and increasedcondomuse, as well as VCT and use of family planning byinfected women) and to extend the lives of infected indi-viduals with antiretroviral therapy. These prevention ef-forts are partly responsible for amajor recent turning pointin the epidemic.30 After a period of rapid spread, the epi-demic appears to have stabilized inmost countries and theproportion of adults infected with HIV is no longer risingand may even be declining.29,30

Despite the substantial mortality from AIDS, UN pro-


is now occurring in India and China) will be difficult tomeet as environmental constraints on production growover time. Nearly everywhere, themost productive land isalready used for agriculture or covered byman-made struc-tures, the best river sites have been dammed and watershortages are often acute. The newest threat to food pro-duction comes from steeply rising energy prices. Energy isan integral part of every step in the food production sys-temcultivation, harvesting, transportation, refrigeration,packaging and distributionand prices of hydrocarbon-based fertilizer and pesticides have skyrocketed. In suchcircumstances, raising agricultural production and stan-dards of living while the populationmore than doubles ishighly problematic.Improved national security is yet another potential ben-

efit from lower fertility. High fertility in many countries ofAfrica and the Middle East has resulted in very young agestructures, with up to half the population younger than 15.The inability of many of these countries to provide ade-quate educational and employment opportunities is a so-cially and politically volatile mix, often producing frus-trated youthwho are potentially susceptible to the appealsof radical political ideologies.6,7

Critique: Family planning programs at best havemadewomenthe instruments of population control policies and,atworst,have been coercive.15,33

Response: In the 1960s and 1970s, evidence that familyplanning programs could help meet an existing demandfor contraception and reduce fertility was still limited. Pilotprojects in places like Taiwan and Korea were successful,and surveys in a number of countries documented a de-mand for contraception.34 This evidence persuaded pro-ponents of voluntary family planning programs that scal-ing upwould be effective. Twomajor international donors,USAID andUNFPA, also advocated this approach. Howev-er, skeptics claimed that couples were insufficiently moti-vated to adopt contraception and pointed to a lack of fer-tility change inmany developing countries, including Indiaand Pakistan, where very early and poorly designed familyplanning programs had produced disappointing results.35

Especially in Asia, where concern about rapid popula-tion growthwasmost acute, several national governmentsemployedmeasures that were designed to address directlythe perceived weakness of demand for smaller families.These measures ranged from fieldworker targets and quo-tas for enlistment of new acceptors of contraception (astrategy employed by many Asian countries) to incentivepayments to adopt family planning (Bangladesh, India), toso-called disincentives regarding large families (Singapore),to community pressures to use contraceptives (Indonesia),to outright coercion (China, India in 19761977).Human rights andwomens health advocates, as well as

many of those promoting voluntary family planning, wereappalled by such policies and attacked themwith increas-ing passion through the 1970s and 1980s and into the1990s. Such policies, they argued, reduced poor people,

women in particular, to the role of passive victims of pop-ulation control policies sponsored by the elite. They ar-gued that rather than working to improve the underlyingconditions of the lives of the poor, whichwould invariablyresult in a reduced demand for children, policymakerswere employing the shortcut of population control poli-cies, violating human rights, and in many cases, actuallyworsening poor peoples living conditions and opportu-nities to escape from poverty.In addition, by the 1980s, overwhelming evidence indi-

cated that such fertility reductionmeasures were unneces-sary. The results of numerous community studies andlarge-scale survey research revealed a demand for familyplanning services sufficient to bring about substantial de-clines in fertility.8,13 There were also the early success sto-ries of high-quality, voluntary family planning programs incountries like Thailand, Korea, Tunisia, Morocco, Colom-bia,Mexico andCosta Rica, where rapid and large declinesin fertility occurred without use of coercive measures. Forexample, between 19601965 and 19801985, the totalfertility rate in Thailand declined from 6.4 to 3.0, and inKorea from 5.6 to 2.2.3 Parenthetically, in our view the ab-sence of access to contraception should also be considereda formof coercion, because it frequently condemnswomento bearing children they do not wish to have.As a result of both the outrage inspired by intrusive and

unethical policies and the existence of a large unmet needfor contraception, the International Conference on Popu-lation and Development at Cairo in 1994 explicitly con-demned such policies and reiterated the call of earlier pop-ulation conferences for reproductive health programs,including family planning, to be completely voluntary. Theconference went beyond earlier meetings in calling oncountries to drop demographic targets and family plan-ning acceptor quotas. Today, nearly all programs aroundthe world respect the right of couples to make informedreproductive choices, free from undue persuasion or co-ercion. A typical example is the decision by India, shortlyafter the Cairo conference, to adopt a target-free approachin its reproductive health program (even though methodchoice remains limited in many parts of the country). Animportant exception is China, where the one-child policycontinues to violate Cairos reproductive rights standards.Yet the perception lingers that family planning programsthroughout the developing world still place undue pres-sure on families, and particularly on women, to conformto reproductive norms imposed by governmentsa per-ception that is no longer supported by the evidence.

CONCLUSION

Since the time ofMalthus, population growth andwhat todo about it has been the subject of controversy. Perhapsbecause at its most fundamental level it deals with sex, ithas been a peculiarly incendiary subject of public policydebate. This is no less true today than it waswhenMalthuswrote more than 200 years ago. Yet much of todays dis-cussion about family planning programs, a principal in-



ducing fertility, thus benefiting society. Morally unaccept-able policies designed to pressure or compel people to limittheir fertility have been shown to be unnecessary and thushave been abandoned, except in China.Unfortunately, funding for family planning programs

has faltered for more than a decade. Between 1995 and2008, while funds committed by donors and developingcountries to HIV and AIDS programming increased bynearly 300%, funds devoted to family planning declinedby some 30%.27 As a result, many countries are less able toprovide family planning services today than they were adecade ago, and much of the earlier commitment haswaned. There are indications that fertility declines are lev-eling off or even being reversed in some countries.Why does this matter? Women and children continue

to suffer and die as a consequence of unwanted and unin-tended childbearing. Beyond that are renewed concernsabout a variety of environmental issues and about the se-curity of nations and the stability of governments, as wellas deepening worries about food security and pervasivepoverty. In the face of declining political and financial com-mitment to family planning programs, we must addresshead-on the faulty criticisms that have held back efforts tosatisfy the unmet demand for family planning services.High fertility and rapid population growth remain realproblems that merit our attention and action.

REFERENCES1. Ehrlich PR and Ehrlich AH,One with Nineveh: Politics, Consumption,and the Human Future,Washington, DC: Island Press, 2005.

2. Lomborg B, The Skeptical Environmentalist: Measuring the Real Stateof the World, Cambridge, UK: Cambridge University Press, 2001.

3. United Nations (UN), World Population Policies 2007, New York:United Nations, 2007.

4. Birdsall N, Allen K and Sinding S, eds., Population Matters:Demographic Change, Economic Growth, and Poverty in the DevelopingWorld,Oxford: Oxford University Press, 2001.

5. Cincotta R, Engelman R and Anastasion D, The SecurityDemographic: Population and Civil Conflict After the Cold War,Washington DC: Population Action International, 2003.

6. Cincotta R, How democracies grow up, Foreign Policy,March/April2008, pp. 8082.

7. National Commission on Terrorist Attacks, The 9/11 CommissionReport: Final Report of the National Commission on Terrorist Attacks uponthe United States,New York: W.W. Norton& Company, 2004.

8.Casterline J and Sinding SW,Unmet need for family planning in de-veloping countries and implications for population policy, Populationand Development Review, 2000, 26(4):691723.

9. Cleland J et al., Family planning: the unfinished agenda, Lancet,2006, 368(9549):18101827.

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11. Speidel J, Funds for family planning and reproductive health, paperpresented at the International Parliamentarians Conference on theImplementation of the ICPD Programme of Action, Bangkok, Nov.2122, 2006.

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strument through which population policies have beenimplemented over the past 50 years, is based on faulty per-ceptions and misinformation. Large-scale national familyplanning responses to unprecedented rates of populationgrowthwere an invention of themid-20th century, and forthe most part they have been remarkably successful.First, family planningprogramshave had amajor andun-

ambiguous impact on fertility rates in many countries. Insome countries, fertility fell from very high levels to re-placement level within one generation, a previously un-heard-of decline that could not have occurred so rapidly inthe absence of the modern technologies and delivery sys-tems offered by such programs.21 It is also likely that fertili-ty decline, in the absence of family planning policies andprograms, would have commenced somewhat later than itactually did in several countries. The secondhalf of the 20thcentury witnessed a veritable reproductive revolution, sup-ported by unprecedented cooperation between interna-tional agencies and governments in the developing world.Second, despite this success, there are still countries and

regions in which high fertility remains a challenge andwhere progress in raising incomes and improving liveli-hoods is imperiled by rapid population growth and popu-lation pressures on fragile ecosystems.36 Foremost amongthese ismuch of Sub-Saharan Africa, theworlds poorest re-gion, where average fertility remains above five children perwoman and declines are slow. Falling fertility elsewhereand low fertility in todays richest countries should notdeter us from helping these remaining high-fertility coun-tries to address their large unmet need for contraception.Third, although the AIDS epidemic has exacted a terri-

ble toll on the prospects of some countries and onmillionsof families and individuals, its impact on both global de-mographic rates and even those of the most seriously af-fected regions is considerably smaller than expected adecade ago. Furthermore, by providing voluntary coun-seling and testing, and by helping to prevent mother-to-child transmission, family planning programs representone of the most important avenues for preventing the fur-ther spread of the virus that causes AIDS, an avenue thatup to this point has been neglected.Fourth, family planning is highly cost-effective. The cost

of averting births is small in comparison with the savingsthose averted births represent to families and countries.Furthermore, few public health interventions aremore im-portant or less expensive than family planning in reduc-ing the morbidity and mortality of mothers, infants andyoung children. Family planning programs are a develop-ment bargain.Finally, the dilemma that governments faced in trying to

balance societal needs against individual reproductive free-domhas largely been resolved. Throughout the developingworld, and particularly in Africa, there is a large, empirical-ly verified demandmuch of which remains unmetforfamily planning services for both spacing and preventingfuture births. High-quality, voluntary family planning pro-grams benefit women and children and are effective in re-


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22. Sen A,Development as Freedom,New York:Alfred Knopf, 1999.

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25. Eberstadt N, Doom and demography, TheWilson Quarterly,Winter2006, pp. 2731.

26. Wattenberg BJ, The population explosion is over, New York TimesMagazine,Nov. 23, 1997, pp. 6063.

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28. Mosher S, AIDS and population control in Africa, PopulationResearch Institute Weekly Briefing, 2000, 2(16):13.

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30. Bongaarts J, Has the AIDS epidemic peaked? Population andDevelopment Review, 2008, 14(2):199224.

31. Vlassoff M et al., Assessing costs and benefits of sexual and repro-ductive health interventions, Occasional Report, New York: The AlanGuttmacher Institute, 2004, No. 11.

32. JamisonDT et al.,Disease Priorities in Developing Countries,Oxford,UK: Oxford University Press, 2006.

33. Mosher S, Population ControlReal Costs, Illusory Benefits, EdisonNJ, USA: Transaction Publishers, 2008.

34. Berelson B and Freedman R, The record of family planning pro-grams, Studies in Family Planning, 1976, 7(1):1-40.

35. Wyon JB and Gordon JE, The Khana Study: Population Problems inthe Rural Punjab, Cambridge, MA, USA: Harvard University Press,1971.

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Author contact: [email protected]


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