Determinants and Consequences of Mortality and Fertility Trends

have usually been in approximate balance, at least until modern times.High death rates were approximately matched by high birth rates.With rising levels of living, first the death rates and then the birth rates declined.The decline in birth rates tended to restore approximate bal¬ ance between fertility and mortality.But now it is feared that extension of modern health services to less developed countries will have appalling consequences (1).It is feared that the extension of alien methods and mate¬ rials, with external technical and financial as¬ sistance, will disrupt the dynamic equilibrium of economic and demographic transition which was observed during the gradual industrializa- tion of Western Europe.The extreme experiences of Ceylon, Mauritius, and British Guiana are cited in support of claims that public health techniques at low cost per capita have resulted in precipitous reduc- tions in the death rates in the postwar era, quite independently of any improvements in the lev¬ els of living, which may decline or be difficult to attain as a result.Lacking substantial im¬ provements in the levels of living, there would be no reduction in fertility.