Barbados,
a
Caribbean
island,
has
one
of
the
highest
population
densities
in
the
world.
A
family
planning
service
was
begun
in
1955
and
later
expanded.
This
study
reports
on
the
acceptance
of
the
programs
and
endeavors
to
evaluate
its
effectiveness
for
population
control.
POPULATION
CONTROL
IN
BARBADOS
G.
T.
M.
Cummins,
M.B.,
Ch.B.;
H.
G.
Lovell,
F.S.S.;
and
K.
L.
Standard,
M.D.,
M.P.I.,
F.A.P.H.A.
BARBADOS
iS
a
West
Indian
island
in
the
Eastern
Caribbean.
At
the
time
of
the
1960
census,3
the
island
had
a
population
of
232,327
contained
in
an
area
of
only
166
square
miles.
This
gives
it
one
of
the
highest
population
densities
in
the
world.
Population
density
is
usually
meas-
ured
as
the
number
of
persons
per
square
mile
and
is
1,400
in
Barbados.
A
more
meaningful
figure
for
the
islands
of
the
West
Indies
is
the
number
of
persons
per
acre
of
cultivable
land,
as
used
by
O'Loughlin.6
Barbados
has
six
times
as
many
people
per
acre
of
cul-
tivable
land
as
Dominica;
three
times
as
many
as
Jamaica;
and
twice
the
number
of
Trinidad
(see
Table
1)
.
In
1959,
the
latest
year
for
which
rates
were
available
for
all
the
islands
being
considered,
six
of
the
ten
islands
of
the
West
Indies
had
crude
birth
rates
greater
than
40
per
1,000
popula-
tion.
The
other
four
charted
(Figure
1)
had
birth
rates
between
30
and
40.
The
crude
death
rates
varied
between
just
under
10
and
15
per
1,000
popula-
tion.
Despite
the
fact
that,
excluding
Montserrat
which
has
a
small
popula-
tion
(12,000),
Barbados
has
the
lowest
natural
increase
in
the
area,
its
extreme
density
is
an
acute
problem.
Roberts,
testifying
on
the
demographic
position
of
the
Caribbean
before
a
House
of
Representatives
Committee
in
1963,
said
in
reference
to
Barbados:
"If
we
assume
that
the
growth
continues
at
the
rate
of
1.3
per
cent
per
annum,
this
island
of
166
square
miles
will
within
a
span
of
190
years-that
is,
within
somewhat
less
than
six
genera-
tions-attain
a
level
of
standing
room
only.
I
defined
the
term
'standing
room'
to
mean
literally
three
square
yards
per
person."8
In
any
developing
country
an
increas-
ing
population
can
delay
the
progress
in
social
and
economic
development
and
can
aggravate
many
community
prob-
lems.
In
an
already
densely
populated
area
health
can
be
affected,
particularly
among
members
of
large
family
groups.
Too
frequent
pregnancies
undermine
the
physical
health
of
the
mothers,
and
it
is
obvious
that
children
in
large
families
with
limited
resources
are
worse
off
than
those
in
small
families
with
the
same
resources;
this
is
sometimes
re-
flected
in
the
nutritional
status
of
the
children.
Mental
health
suffers,
too,
be-
cause
many
resign
themselves
to
a
life
of
despair
in
circumstances
where
food
and
shelter
are
at
a
premium;
many
parents
are
so
fully
occupied
in
an
ef-
fort
to
provide
basic
necessities
that
they
are
unable
to
give
their
children
VOL.
55,
NO.
10.
A.J.P.H.
1600
POPULATION
CONTROL
Table
1-Population
per
Acre
Cultivable
Land
Dominica
0.56
Jamaica
1.07
Montserrat
1.49
Grenada
1.68
Trinidad
1.78
St.
Kitts-Nevis-Anguilla
1.89
Antigua
2.20
St.
Vincent
2.45
St.
Lucia
2.69
Barbados
3.74
proper
supervision.
All
of
these
combine
to
produce
many
problems,
including
juvenile
delinquency,
which
may
have
far-reaching
effects
oIn
the
future
of
a
country.
Althougli
high
population
density
rather
than
a
high
birth
rate
is
the
major
prol)lem
in
Barbados.
in
the
face
of
contracting
migration
outlets
the
birth
rate
must
be
attacked
if
the
increase
in
density
is
to
be
halted.5
Reducing
the
level
of
fertility,
and
consequently
the
birtlh
rate,
is
possible.
In
19-17
Japan
had
a
birth
rate
of
34.3
per
thousand
population,
comparable
with
the
present
rate
in
Barbados.
By
1961
the
rate
vas
downii
to
16.8
per
thousand.
The
Jap-
anese
rate
compares
with
those
of
Swve-
den
1
1.1
Denmark
16.3,
and
Britaiin
16.5
per
thousand
population.
By
con-
trast
the
United
States
rate
for
1961
wvas
estimated
at
23
per
thousand.
Yoshio
Koya,
reporting
on
a
family
planning
program
in
Japan,4
observed
that
there
was
a
sustained
birth
rate
from
year
to
year
in
the
houiseholds
of
nonusers
of
contraception
and
a
de-
cline
in
births
in
the
households
adopt-
ing
this
method.
There
was
also
an
ap-
preciable
decline
in
induced
abortions
(PAHO/WHO
-
1962)
10
(
20
30
40
50
l1
Death
rate
]
BEirth
rate
0
10
20
30
40
50
Figure
1-Birtli
Rates
and
Death
Rates
per
Thousand
of
Population-
1959
OCTOBER,
1965
ST
VINCENT
ST.
LUCIA
DOMINICA
GRENADA
ST.
KITTS
JAMAICA
TRINIDAD
ANT
KUA
MONTSERRAT[
BARBADOS
I
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I
1601
from
10.6
per
cent
in
the
first
year
of
the
program
to
4.1
per
cent
in
the
third
year
of
the
nonuser
couples.
This
is
probably
an
indication
of
movement
of
couples
in
the
nonuser
group
who
wished
to
avoid
births
into
the
contra-
ceptor
group.
The
data
further
suggest
that,
after
three
years
of
operation
of
the
program,
very
few
undesired
con-
ceptions
occurred.4
In
1951
the
Barbadian
legislature
set
up
a
committee
to
examine
the
problem
of
overpopulation
and
to
make
recom-
mendations
for
dealing
with
it.
The
com-
mittee
recommended
a
program
of
planned
parenthood.
In
May,
1954
a
voluntary
Family
Planning
Association
was
formed.2
The
first
local
clinic
was
opened
in
May,
1955,
with
the
assistance
of
a
field
consultant
from
the
Planned
Parenthood
Federation
of
America.
In
July
it
received
a
government
subsidy
of
$5,000
(BWI)
which
was
increased
to
$12,000
for
each
of
the
two
follow-
ing
years,
and
subsequently
to
$20,000
annually
($1
BWI=$7/12
US).
The
purpose
of
the
present
publication
is
twofold:
1.
To
document
the
acceptance
of
the
pro-
gram
by
the
Barbados
population;
2.
To
attempt
to
assess
the
effect
of
the
pro-
gram
on
population
trends
in
Barbados.
Staff,
Clinics,
Methods,
and
Technics
In
19571
the
staff
consisted
of
three
nurses,
two
field
workers,
and
a
full-
time
secretary.
Eight
clinics
were
held
weekly
at
the
three
Government
Health
Centers,
at
the
Maternity
Hospital,
and
at
the
St.
Michael's
Vestry
Clinic.
In
the
same
year
a
field
supervisor
and
group
worker
of
the
Jamaica
Family
Life
Project
arrived
in
Barbados
to
train
the
field
workers.
She
remained
for
six
months.
At
that
time
the
diaphragm
and
jelly
was
the
only
method
of
con-
traception
distributed,
but
other
forms
were
later
made
available.
In
1958
the
clinics
already
mentioned
were
continued,
and
a
new
one
was
opened
in
a
rural
district.
The
Family
Planning
Association
also
started
an
in-
tensive
educational
campaign
in
which
there
were
not
only
group
meetings,
film
shows,
and
the
distribution
of
pamphlets,
but
also
home
visiting
by
trained
case
workers.
In
the
following
year
there
was
a
change
in
the
opera-
tion
of
the
association's
clinics.
A
daily
morning
clinic
was
instituted
at
Enmore,
the
Government
Health
Center
in
the
city,
and
two
additional
clinics
were
held
in
the
rural
area
at
the
same
place
and
time
as
the
Government
Children's
Clinics
(Child
Health
Conferences).
This
arrangement
had
many
advantages
as
mothers
were
able
to
get
two
services
for
one
visit,
and
the
family
planning
program
was
linked
with
the
child
health
program.
In
1961
the
Western
Hemisphere
Conference
of
the
International
Planned
Parenthood
Federation
was
held
in
Bar-
bados,
under
the
auspices
of
the
local
Family
Planning
Association.
This
con-
ference
greatly
contributed
to
strength-
ening
the
association
which
also
de-
cided
to
undertake
a
program
for
the
mass
distribution
of
a
foam
contracep-
tive*
made
available
through
the
gen-
erosity
of
the
Sunnen
Foundation
of
USA.
Experimental
programs
were
car-
ried
out
in
two
areas.
In
one
area
vol-
untary
workers
attempted
a
house-to-
house
distribution,
while
in
the
other
area
an
attempt
was
made
to
distribute
the
product
through
shopkeepers.
The
latter
proved
ineffective
as
a
method
of
distribution.
The
voluntary
workers,
though
useful,
could
not
really
replace
the
regular
trained
field
workers.
The
distribution
was
continued,
using
the
services
of
the
regular
trained
field
workers,
and
from
August,
1961,
up
to
March
31,
1962,
6,288
bottles
were
distributed.
Clinics
were
still
operated
in
which
*
EMKO
Vaginal
Foam.
VOL.
55.
NO.
10,
A.J.P.H.
1602
POPULATION
CONTROL
the
previously
used
methods
were
still
available.
These
methods
include
vaginal
jelly
or
tablets,
cervical
cap,
the
dia-
phragm
and
the
condom
for
the
men
who
visited
occasionally.
Along
with
the
nurses
and
field
workers,
a
part-
time
doctor
attached
to
the
association
attended
some
clinics
in
the
city
area.
Attendances
at
the
Family
Planning
Clinics
In
the
early
months
of
the
clinics
those
attending
were
mainly
older
women
who
already
had
many
children,
but
on
the
advice
of
Dr.
Christopher
Tietze,
a
United
Nations
technical
as-
sistance
officer,
the
service
was
later
extended
to
include
younger
women
with
smaller
families.
Field
workers
of
the
Family
Planning
Association
at-
tended
Government
Health
Centers
and
Health
Clinics,
where
every
facility
was
afforded
them.
It
is
clear
that
attendances
at
these
clinics
have
risen
progressively
during
the
period
under
consideration
(Table
2).
This
is
as
true
of
the
new
attend-
ances
as
it
is
of
total
attendances.
During
the
years
1956
to
1958
rec-
ords
were
kept
on
the
basis
of
calendar
years.
From
1958
onward,
government
accounting
procedures
were
adopted
and
the
association
year
made
to
coincide
with
that
of
the
government-April
1
to
March
31.
Both
sets
of
figures
are
given
for
1958
(Table
2).
In
the
year
1961-1962,
there
was
a
considerable
increase
in
new
registra-
tions
occasioned
by
the
free
distribu-
tion
of
EMKO.
Total
attendances
rose
less
than
new
registrations
in
this
pe-
riod
partly
due
to
the
fact
that
fewer
visits
to
the
clinics
were
required
when
the
foam
contraceptive
was
used.
Recent
Trends
in
Population
Growth
In
1946
the
birth
rate
in
Barbados
was
31.4
per
1,000
population,
the
death
rate
was
16.7,
and
thus
the
nat-
ural
increase
was
14.7
per
1,000
popu-
lation.
Between
1946
and
1955
the
birth
rate
ranged
from
30.2
to
33.4,
the
death
rate
fell
from
16.7
to
12.7,
and
the
natural
increase
rose
from
14.7
to
20.7
per
1,000
population.
Family
Planning
Clinics
were
started
in
May,
1955.
The
total
number
of
births
in
1955,
as
in
1954,
was
approxi-
mately
7,600.
Between
1956
and
1959
total
births
per
annum
fell
to
approxi-
mately
7,100
(Table
3).
The
cor-
responding
birth
rates
are
shown
in
the
figures-33.4
in
1955
and
30.7
in
1959.
These
rates
are
based
on
population
fig-
ures
corrected
so
as
to
agree
with
those
of
the
1960
census.
The
apparent
increase
in
the
birth
rate
in
1960,
which
contrasts
with
the
downward
trend
of
previous
years,
has
yet
to
be
investigated
fully.
In
1962
the
birth
rate
was
29.6
and
the
death
rate
was
9.1.
These
figures,
like
those
illustrated
in
the
diagram,
are
corrected
to
coincide
with
the
1960
census,
and
therefore
disagree
with
those
in
the
Registrar
General's
Reports.7
Crude
birth
rates
for
1959,
1960,
and
1961
were
30.7,
33.7,
and
29.0
respectively.
The
possible
effect
of
migration
has
been
considered.
Table
3
shows
births
and
net
emigration
for
the
appropriate
years.
Table
2-New
Registrations
and
Total
Attendances
at
the
Barbados
Family
Planning
Association
Clinics,
1956-1961
New
Total
Year
Registrations
Attendances
1956
662
1,656
1957
727
2,939
1958*
910
3,724
1958-59*
860
3,734
1959-60
1,081
4,334
1960-61
1,222
5,132
1961-62
2,055t
5,574
*
From
1958,
the
year
Is
from
April
1
to
March
31.
t
Dbtribution
of
EMKO
was
started
In
August,
1961.
OCTOBER.
1965
1
603
BIRTH
RATE
NATURAL
INCREASE
DEATH
RATE
46
i48
'50
I52
'54
YEAR
56I
'56
.58
'60
'6
2
Figure
2-Population
Growth-Barbados
1946-1961
There
is
no
correlation
between
the
extent
of
(net)
migration
and
number
of
births
in
the
same
or
following
year.
It
is
unlikely
that
the
pattern
of
births
can
be
explained
by
migration
alone,
since
this
would
require
that
the
age
distribution
of
migrants
violently
fluc-
tuated
from
year
to
year.
Nevertheless,
a
more
detailed
analysis
of
migrants
by
age,
sex,
and
familial
relationships
might
throw
some
light
on
other
factors
influencing
population
control
in
Barbados.
In
an
attempt
to
eliminate
any
pos-
sible
influence
of the
age
distribution
of
migrants,
numbers
of
births
are
re-
lated
to
numbers
of
Barbadian
women
at
risk
of
pregnancy
in
Table
4.
This
table
shows
that
the
population
of
women
in
the
child-bearing
age
range
has
been
fairly
stable
during
these
years;
the
range
of
variation
being
less
than
2
per
cent.
There
has
been
a
general
decrease
in
the
live-
birth
rate
per
1,000
women
aged
15-44,
despite
the
increase
in
1960,
which
has
already
been
noted.
This
decrease
has
been
accompanied
by
a
decline
in
the
proportion
of
childless
women
which
was
41
per
cent
in
1946
and
35
per
cent
in
1960.8
Thus
there
must
also
have
been
some
limitation
in
family
size.
Roberts
Table
3
Year
Births
Net
Emigration
1955
7,593
3,143
1956
7,082
4,186
1957
7,314
2,197
1958
7,115
232
1959
7,110
1,039
1960
7,833
4,231
1961
6,754
4,963
1962
6,881
*
*
Figure
not
available.
VOL.
55.
NO.
10.
A.J.P.H.
"*1*
36-
321
281
24-
20-
16'
12'
8'
4.
1
604
POPULATION
CONTROL
Table
4-Birth
Rates
per
1,000
Women,
Ages
15-44
Years
Live
Women*
Birth
Rate
Age
15-44
Live
per
1,000
Year
Years
Births
Women
1955
51,800
7,528
145
1956
51,710
7,007
136
1957
51,200
7,261
142
1958
51,500
7,068
137
1959
51,700
7,045
136
1960
51,500
7,756
151
1961
52,180
6,578
126
*
Population
of
women
adjusted
to
conform
with
the
1960
census
data.2
concludes
that
the
success
of
bados.
Trends
in
Birth
of
Mother
this
is
an
indication
of
fertility
control
in
Bar-
Rates
According
to
Age
We
shall
next
consider
how
birth
rates
have
changed
for
women
of
dif-
ferent
ages.
Table
5
compares
birth
rates
for
5-year-age
groups
in
the
years
1954
through
1961.
There
has
been
a
significant
de-
crease
in
the
rate
for
women
aged
15-19
years
and
for
those
aged
20-24
years
(p<0.001)
.
The
birth
rates
for
women
aged
25-29
and
30-34
have
increased
significantly.
That
for
women
aged
35-39
has
decreased
a
little
(p<O.Ol),
and
there
has
been
no
change
for
those
over
40
(Table
5).
When
births
are
analyzed
according
to
birth
rank,
it
is
found
that
there
has
been
a
fall
in
the
relative
numbers
of
first,
second,
and
third
pregnancies
(Table
6).
The
effectiveness
of
the
Family
Plan-
ning
Program,
as
measured
by
a
reduc-
tion
in
the
pregnancy
rate
per
100
women-years
of
exposure,
has
been
re-
ported
by
Tietze
and
Alleyne.1
Union
Status
and
Fertility
In
Barbados,
as
in
other
parts
of
the
West
Indies,
formal
marriages
account
for
only
a
relatively
small
proportion
of
family
unions.
Shifts
from
one
type
of
union
to
another
are
easily
made
and
of
frequent
occurrence.
A
woman
may
begin
with
a
series
of
visiting
relation-
ships,
move
to
the
common-law
category,
and
then
become
married
near
the
end
of
her
child-bearing
days.
The
main
types
of
union
recognized
in
the
1960
census
(see
Table
7)
were
marriage,
which
is
the
only
type
of
un-
ion
having
legal
sanction;
common-law,
indicating
that
the
woman
shares
a
common
household
with
a
man
to
whom
she
is
not
married;
visiting,
which
de-
scribes
a
woman
who
is
neither
married
nor
in
a
common-law
union,
but
had
had
a
child
in
the
12
months
preceding
the
Table
5-Age-Specific
Birth
Rates
per
1,000
Barbadian
Women,
1954-1961
Age
of
Mother
in
Years
1954
1955
1956
1957
1958
1959
1960
1961
15-19
132
141
127
136
124
119
133
110
20-24
232
235
232
231
226
222
243
200
25-29
185
199
197
200
204
202
235
185
30-34
144
145
143
156
151
158
184
151
35-39
100
99
86
97
96
91
100
89
40-44
34
32
31
38
34
36
40
33
OCTOBER.
1965
1
605
Oo
o
o%
0
eo
Lf
oo
(=
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c
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o
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Co
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00
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00
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cli
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i-
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O=
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o
or
oo
or
oR
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er
C4
00
census;
and
single,
which
applies
to
women
who,
although
previously
mar-
ried
or
in
common-law
unions,
were
at
the
time
of
the
census
no
longer
in
such
unions.
The
term
none
is
used
for
women
who
had
never
been
married
or
in
common-law
unions,
irrespective
of
whether
or
not
children
had
been born
to
them
in
the
past.
Because
of
their
more
constant
"ex-
posure
to
risk,"
we
should
expect
the
fertility
rates
for
married
women
and
those
in
common-law
unions
to
be
greater
than
for
the
other
groups.
Rob-
erts
and
Braithwaite9
found
this
to
be
so
in
another
West
Indian
population.
Of
47,550
women
recorded
in
the
1960
census
of
Barbados
aged
15-44
years,
12,851
(27
per
cent)
were
mar-
ried
and
out
of
a
total
of
7,833
live
births
in
the
same
year
2,849
(36.4
per
cent)
were
legitimate.
Data
are
not
available
to
allow
a
detailed
analysis
of
the
contribution
of
each
type
of
union
to
the
births,
but
a
crude
estimate
is
given
in
Table
8.
Since
"visiting"
refers
to
women
who
were
neither
married
nor
in
common-law
union
but
had
given
birth
to
a
child
within
the
previous
twelve
months,
the
number
of
births
to
such
women
must
be
approximately
equal
to
the
number
of
women
of
that
type.
The
contribution
of
common-law
unions
is
therefore
approximately
2,164
(i.e.,
7,833-2,849-2,820).
Thus,
the
approximate
number
of
births
con-
tributed
by
married
and
common-law
unions
is
5,013
(i.e.,
64
per
cent
of
all
births)
.
Of
the
women
aged
15-44
years
in
1960,
40.5
per
cent
were
either
married
or
in
common-law
unions
(Table
7),
and
these
women
contributed
approxi-
mately
64
per
cent
of
the
births
in
that
year
(Table
8).
It
seems
that
a
fertility
control
program
operating
with
limited
resources
will
obtain
better
results
if
directed
specifically
toward
these
un-
ions
than
it
would
if
more
generally
oriented.
VOL.
55,
NO.
10.
A.J.P.H.
*
-0--4
-4
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Cd
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4-
$..
.
4
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pq
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-
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4)
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*F
I4
1606
POPULATION
CONTROL
Table
7-Women
in
Types
of
Union
Status:
Barbados
1946
and
1960
Age
15-44
Age
45-64
Type
1946
1960
1946
1960
of
Status
No.
%
No.
%
No.
%
No.
%
Married
15,399
31.9
12,851
27.0
7,217
40.4
10,365
46.2
Common-law
5,993
12.4
6,414
13.5
944
5.3
1,962
8.7
Single
3,895
8.2
]
3,671
16.4
Visiting
i
26,816
55.6
2,820
5.9
9,705
54.3
8
0.0
None
J
21,183
44.5
6,007
26.8
Not
stated
5
0.0
387
0.8
2
0.0
435
1.9
Total
48,213
47,550
17,868
22,448
Discussion
If
the
only
factor
influencing
birth-
rate
trends
was
the
introduction
of
fam-
ily
planning,
this
would
indicate
that
the
greatest
impact
was
on
younger
women.
The
higher
birth
rates
in
women
over
25
could
be
due
to
postponed
pregnan-
cies,
since,
in
the
seven-year
period
1954-1961,
a
woman
would
have
moved
from
one
age
group
into
the
next
or
the
one
above
that.
The
slight
reduc-
tion
in
birth
rate
for
women
aged
be-
tween
35
and
39
years
could
be
due
to
the
fact
that
instruction
and
help
in
family
limitation
were
first
made
avail-
able
to
married
women
who
would
tend
to
be
older.
However,
we
do
not
know
that
family
planning
is
the
only
factor,
since
we
do
not
know
what
the
pattern
of
births
would
have
been
without
it.
Further-
more,
the
introduction
of
family
plan-
ning
is
so
recent
that
it
is
unlikely
that
deviations
from
a
predicted
trend
would
be
large
enough
to
show
the
effect
of
family
planning,
even
if
a
considerable
real
difference
has
been
effected.
This
view
has
also
been
expressed
by
Rob-
erts
(1963).
Dr.
Tietze,
who
visited
Barbados
in
November,
1956,
suggested
that
if
the
program
continued
at
its
prevailing
trend,
a
reasonable
estimate
could
be
made
that
the
total
live
births
per
mother
would
decrease
by
7
per
cent
and
the
birth
rate
would
also
fall
by
1
per
cent-from
33.1
to
30.8-
Table
8-Estimated
Contributions
of
Types
of
Union
to
Barbadian
Births
in
1960
Birth
Union
No.
of
Women
No.
of
%
of
Rate
per
Status
Aged
15-44
Births
Births
1,000
Women
Married
12,851
2,849
36.4
222
Common-law
6,414
2,164
27.6
337
Visiting
2,820
2,820
36.0
*
*
An
unknown
number
of
women
In
the
"single"
and
"none"
categories
needs
to
be
added
to
the
denominatqr
to
give
a
meaningful
figure
here.
OCTOBER.
1965
1
607
over
more
than
20
years.
This
as-
sumed
that
one-third
of
those
attending
clinic
had
a
decrease
in
childbearing.10
The
fall
has
been
greater
than
pre-
dicted.
The
proportion
of
all
women
aged
15-44
who
are
childless
has
declined
from
41.4
per
cent
in
1946
to
35.8
per
cent
in
1960
(the
last
two
census
years).
No
breakdown
by
age
and
marital
con-
dition
is
as
yet
available
for
1960
to
enable
this
decline
to
be
examined
in
detail,
but
it
appears
to
indicate
that
there
has
been
some
limitation
in
fam-
ily
size
due
to
the
introduction
of
fer-
tility
control.
Summary
Barbados,
a
small
island
in
the
East-
ern
Caribbean,
has
one
of
the
highest
population
densities
in
the
world.
A
family
planning
service
was
started
in
May,
1955,
expanded
in
1958,
and
ex-
tended
further
in
1961.
An
attempt
is
made
to
demonstrate
the
acceptance
of
the
program,
and
to
evaluate
its
effec-
tiveness
on
population
control.
New
registrations
rose
from
662
in
1956
to
2,055
in
1961-1962,
while
total
attend-
ances
also
increased
from
1,656
to
5,574
for
the
same
years.
Recent
trends
in
the
population
growth
show
that
there
has
been
a
decline
in
the
birth
rate
from
33.4
in
1955
to
29.6
in
1962.
It
seems
that
a
fertility
control
program
operating
with
limited
resources
will
be
most
effective
if
specifically
directed
toward
married
and
common-law
unions.
ACKNOWLEDGMENTs-We
wish
to
thank
the
officers
of
the
Barbados
Family
Planning
Asso-
ciation
for
permission
to
consult
their
records,
and
Mrs.
Gilkes,
the
secretary
of
the
associa-
tion,
for
her
cooperation.
We
also
thank
Mr.
George
Roberts
and
Mr.
Lloyd
Braithwaite
of
the
Department
of
Sociology,
University
of
the
West
Indies;
Dr.
W.
E.
Miall
and
Mr.
H.
McKenzie
of
the
M.R.C.
Epidemiological
Re-
search
Unit,
U.W.I.,
for
helpful
discussions,
and
Mrs.
W.
E.
Miall
for
drawing
the
charts.
REFERENCES
1.
Abstract
of
Statistics
No.
2.
Barbados,
1957.
2.
Annual
Reports
of
Barbados
Family
Planning
Asso-
ciation.
3.
Barbados
Population
Census
1960,
Vol.
II.
4.
Koya,
Yoshio.
Milbank
Mem.
Fund
Quart.,
Vol.
XL.
No.
3
(July),
1962.
5.
Lowenthal,
D.
Social
and
Economic
Studies.
Vol.
6,
No.
4,
1957.
6.
O'Loughlin,
C.
In
"Economy
of
the
West
Indies."
Edited
by
G.
E.
Cumper.
University
of
the
West
Indies,
1960.
7.
Registrar's
Report
on
Vital
Statistics
and
Registra-
tions.
Barbados,
W.
I.:
Goy.
Ptg.
Office,
1956-1961.
8.
Roberts,
G.
W.
Committee
on
the
Judiciary
Sub-
committee
No.
1
House
of
Representatives,
USA
Special
Series
No.
6.
Washington,
D.
C.:
Gov.
Ptg.
Office,
1963.
9.
Roberta,
G.
W.,
and
Braithwaite,
L.
Ann.
New
York
Acad
Sc.
Vol.
84,
Art.
17,
1960.
10.
Tietze,
Christopher.
Report
to
Government
of
Bar-
bados
on
Research
Related
to
Family
Planning
Service
(mimeo.),
1957.
11.
Tietze,
Christopher,
and
Alleyne,
Charles.
Fertility
and
Sterility
Vol.
10,
No.
3
(May-June),
1959.
Dr.
Cummins
is
a
lecturer
on
obstetrics
and
gynecology;
Dr.
Lovell
is
a
statistician;
and
Dr.
Standard
is
a
lecturer
on
social
and
preventive
medicine
and
medical
officer,
Medical
Research
Council,
Epidemiological
Research
Unit,
University
College
of
the
West
Indies,
Mona,
Jamaica.
This
paper,
originally
submitted
for
publication
in
December,
1963,
was
revised
and
resubmitted
in
April,
1964.
VOL.
55.
NO.
10,
A.J.P.H.
1608
