Towards a contextual analysis of
sub-Saharan African fertility
transition
Seamus Grimes
National University of Ireland, Ga...
Outline
O Population policy and ideology
O Placing the population variable in context
O Misconceived policies based on err...
Limitations of population ‘science’
O Relationship between population change
and economic development poorly
understood
O ...
The impact of demographic change is
secondary
O The error of isolating the demographic
variable
O to assume that many soci...
A wide range of factors, including
governance, capital, lower levels of technology
O high level of insecurity regarding pr...
Policies based on misconceptions and poor
quality analysis
O The neomalthusian ideological
preoccupation with controlling ...
The ideology of demographic security
O The Church does not deny a world demographic
problem which is most grave
O Fallacio...
Intervention of the state in matters of personal
conscience
O Prioritising family planning (contraceptive
prevalence) in b...
The paternalistic use and abuse of indicators such as ‘unmet need’
(for contraception) as overly simplistic representation...
African perspectives: the need for a deeper
anthropological understanding
O Some unique aspects of Africa that have
remain...
Understanding the context: being interested in
where people are coming from
O obliviousness of policymakers to cultural no...
The need for a paradigm shift in our thinking
(Makinwa-Adebusoye, 2001)
O Little awareness of the marked decline in
fertil...
Sub-Saharan Africa
Some empirical data
Country Maternal Mortality Rate 2010 Infant Mortality Rate 2012 Life expectancy at birth
2012
Total Fertility Rate 2012
Se...
A health warning about
statistics for SSA
O The need for a pinch of salt!
O See WHO, UNICEF, UNFPA and The World
Bank esti...
Changing maternal mortality
in sub-Saharan regions (AIDS impact)
(bearing in mind the range for uncertainty)
Europe and No...
Maternal mortality 2010
per 100,000 live births
0 100 200 300 400 500 600 700 800 900
Namibia
Madagascar
Uganda
Rwanda
Gha...
Maternal mortality rates per 100,000 live
births
O 1980 to 2008 for 181 countries: substantial
decline
O would have been m...
Maternal mortality
O good reason for optimism that substantial
decreases are possible over a short period
O the lack of th...
Kenya: MMR per 100,000 live births
up to 80% could be averted particularly with skilled assistance during
childbirth
0
100...
Infant mortality rate 2012
average: 67.1 (per 1000 live births)
0 20 40 60 80 100 120
Zimbabwe
Namibia
Ghana
Madagascar
Ke...
Infant mortality
O infant mortality: Average of 67.16 deaths per
1000 live births, from low 28.2 in Zimbabwe
to almost fou...
huge drop in child mortality (< 5 years) in Africa - a major step
forward in the development process
O since 2005: Senegal...
Gains in infant (< 1 year) mortality in 17
African countries – various factors..
more democratic and accountable
governmen...
half the most recent drop in Kenya’s infant mortality rate (per 1000 live births)
is the increased use of treated bednets ...
Under-fives
O very significant and relatively rapid decline in
under-five deaths
O most significant causes of death to sub...
0
50
100
150
200
250
1960 1970 1980 1990 2000 2010
Kenya: Under 5 years mortality per 1000 live births
HIV/AIDS
O HIV prevalence rates for pregnant women in
sub-Saharan Africa are 10-15% compared
with 0.15% in the US
O Rates ...
Urgent and effective response needed
Dr Margaret Ogola
O two million Kenyans have died, leaving behind
1.2 million orphans...
Recovery in Uganda, Zambia and Kenya (from HIV/AIDS) and
Rwanda (from genocide) in 1990s disrupting childhood mortality
de...
Life expectancy at birth (average: 55.8 years) and
% of 15-49 years with AIDS
0 10 20 30 40 50 60 70
Zimbabwe
Lesotho
Moza...
0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1985 1990 1995 2000 2005 2010 2015
Kenya: Adults (15+) with ...
Life expectancy
O a low of 51.8 for both Lesotho and
Zimbabwe (with HIV prevalence of 24.03
and 18.36) to the slightly hig...
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
Kenya Life Expectancy
Total Fertility Rate 2012
average: 4.9
0 2 4 6 8
Namibia
Lesotho
Ghana
Zimbabwe
Kenya
Tanzania
Senegal
Rwanda
Madagascar
L...
Total Fertility Rate (TFR)
O 2.41 for Namibia, a country with very low
maternal mortality, and Lesotho with
2.89, which ha...
Kenya’s TFR: oscillated from 6 to 6.8 from 1948 to the early
1960s, before increasing to 7.8 in the late 1960s and to the ...
Fertility transition
O South Africa - fertility transition began about
1965, followed by Kenya from the 1980s not
recogniz...
TFR and MMR – no clear
relationship
TFR
2012
MMR
2010
Namibia 2.41 200
Lesotho 2.89 620
Ghana 3.39 350
Zimbabwe 3.61 570
K...
No single cause for fertility
decline
O An eclectic mix of circumstances specific to
each country
O Only a weak correlatio...
Hans Rosling’s evaluation of African progress
based on 25 years of epidemiological monitoring
in Africa: Not bad!
O Worldv...
The future
Who knows?
Demographic dividend?
O political and economic adjustments
necessary to accommodate significant
global shift in the demogr...
Potential, but challenges
O potential for 54 - 72 m more stable wage-
paying jobs in Africa by 2020
(McKinsey, 2012)
O Afr...
Eberstadt (2011)
Securing a better ‘economic climate’ throughout
much of sub-Saharan Africa – where economic
performance h...
Conclusion
O Demography not an exact science
O Erroneous projections, questionable data,
ideological influences (policy)
O...
SubSaharan African Context
O issues such as insecurity, property rights,
political corruption
O Why do African families va...
Ideological fears of the rich world of a migratory
surge from the South
O A preoccupation with planning the families
of th...
huge diversity between and
within countries in Africa
O demographic transition from high mortality
and fertility levels to...
A long, hard, incremental slog ahead
O Bearing in mind the hugely negative impact
of HIV/AIDS in eastern and southern Afri...
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
Contextualising demographic transition in subSaharan Africa
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Contextualising demographic transition in subSaharan Africa

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It explores different perspectives on demographic change in the context of sub-Saharan Africa, paying particular attention to the case of Kenya. It will seek to understand the relatively high levels of fertility, mortality and population growth in sub-Saharan Africa, despite the many decades of population programmes focusing on raising levels of contraceptive prevalence. Having explored the different philosophical perspectives, attention will be focused on empirical trends in relation to the dynamics of population change in the region.

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  • http://www.economist.com/node/21533364
  • http://www.economist.com/node/21533364
  • Contextualising demographic transition in subSaharan Africa

    1. 1. Towards a contextual analysis of sub-Saharan African fertility transition Seamus Grimes National University of Ireland, Galway
    2. 2. Outline O Population policy and ideology O Placing the population variable in context O Misconceived policies based on erroneous analysis O Sensitivity to the political and cultural context of Africa O Sub-Saharan Africa: empirical trends with particular reference to Kenya O Conclusions
    3. 3. Limitations of population ‘science’ O Relationship between population change and economic development poorly understood O Significant debate about the processes, determinants and consequences of population change O Little or no theory of fertility change – a frustrating search for social and economic determinants O A wide range of factors involved
    4. 4. The impact of demographic change is secondary O The error of isolating the demographic variable O to assume that many social and economic problems are driven by population growth O not the dominant factor in explaining economic stagnation in many African countries O It is vital to consider the total context
    5. 5. A wide range of factors, including governance, capital, lower levels of technology O high level of insecurity regarding property rights, inequality of opportunity, and institutional structures protected by the state which deprives large sections of the population from participating in a process of sustained economic development O in high-risk or chaotic societies particularly in Africa, the security problem has been solved mainly on the social side by large families
    6. 6. Policies based on misconceptions and poor quality analysis O The neomalthusian ideological preoccupation with controlling fertility of the other O The hypocrisy of double values as European nations (with an average TFR of 1.59) offer incentives to increase fertility O greater humility on the part of those pushing for fertility reduction in seeking to explain the current trend towards widespread below replacement fertility
    7. 7. The ideology of demographic security O The Church does not deny a world demographic problem which is most grave O Fallacious ideological argument that underdevelopment is caused by population growth O The more fundamental problem of the universal destination of the goods of the earth O The rich world cannot be the world’s police to contain the migratory surge of Africa’s growing population (Schooyans, 1997)
    8. 8. Intervention of the state in matters of personal conscience O Prioritising family planning (contraceptive prevalence) in budgeting for aid O Unscientific faith in effectiveness of family planning programmes O Policy should focus on reducing mortality (maternal, infant, etc)
    9. 9. The paternalistic use and abuse of indicators such as ‘unmet need’ (for contraception) as overly simplistic representation of complex issues O ‘that this measure reflects not just women who want contraception but also ‘those women who require motivation to want what they are presumed to need’ (Pritchett, 1994) O Demographic Health Surveys (DHS): women struggling to explain circumstances not envisaged by survey designers O inconsistency of answers with many respondents stating they did not want their last child but that they did want more children
    10. 10. African perspectives: the need for a deeper anthropological understanding O Some unique aspects of Africa that have remained unchanged for generations: primarily rural with high fertility supported by pronatalist institutions such as patrilineal descent, patrilocal residence, inheritance and succession practices and hierarchical relations O predominantly Muslim rural Gambia in 1993: small percentage of Gambian women who used Western contraception at that time was to achieve a two-year-minimum birth interval in order to ensure the survival of many children
    11. 11. Understanding the context: being interested in where people are coming from O obliviousness of policymakers to cultural norms relating to child bearing, and the lack of recognition of significant differences within the population are identified as reasons for the failure of Nigeria’s population policy O the recent stalling of Kenya’s fertility decline and low contraceptive prevalence may be a rational response to pervasive poverty and insecurity, particularly about the survival of children
    12. 12. The need for a paradigm shift in our thinking (Makinwa-Adebusoye, 2001) O Little awareness of the marked decline in fertility in the past three decades O continued preoccupation with high rates of population growth in the poorest regions of the world is somewhat ironic in a world which is increasingly characterised by rapidly diffusing below replacement fertility
    13. 13. Sub-Saharan Africa Some empirical data
    14. 14. Country Maternal Mortality Rate 2010 Infant Mortality Rate 2012 Life expectancy at birth 2012 Total Fertility Rate 2012 Senegal 370 56.4 60.1 4.69 Rwanda 340 64.0 58.4 4.81 Kenya 360 52.3 63.0 3.98 Uganda 310 62.4 53.4 6.65 Ghana 350 47.2 61.4 3.39 Zambia 440 66.6 52.5 5.90 Mozambique 490 78.9 52.0 5.40 Ethiopia 350 77.1 56.5 5.97 Tanzania 460 66.9 53.1 4.02 Madagascar 240 51.4 64.0 4.96 Nigeria 630 91.5 52.0 5.38 Benin 350 61.5 60.2 5.22 Niger 590 112.2 53.8 7.52 Mali 540 111.3 53.0 6.35 Malawi 460 81.0 52.3 5.35 Guinea 790 61.0 58.6 5.04 Zimbabwe 570 28.2 51.8 3.61 Lesotho 620 55.0 51.8 2.89 Namibia 200 45.6 52.1 2.41 Liberia 770 72.7 57.4 5.02 Average 461.5 67.16 55.8 4.92 Table 1 Demographic indicators in selected African countries Source: CIA Factbook 2012
    15. 15. A health warning about statistics for SSA O The need for a pinch of salt! O See WHO, UNICEF, UNFPA and The World Bank estimates: Trends in maternal Mortality 1990 to 2010 O 19: MMR for SSA 2010: 500 (400-750) the range/uncertainty O Beware of demographers compromised by the system!
    16. 16. Changing maternal mortality in sub-Saharan regions (AIDS impact) (bearing in mind the range for uncertainty) Europe and North America 2008: 7.0 SSA 1980 2000 2008 Central 711 770 586 East 707 776 508 Southern 242 373 381 West 683 742 629
    17. 17. Maternal mortality 2010 per 100,000 live births 0 100 200 300 400 500 600 700 800 900 Namibia Madagascar Uganda Rwanda Ghana Ethiopia Benin Kenya Senegal Zambia Tanzania Malawi Average Mozambique Mali Zimbabwe Niger Lesotho Nigeria Liberia Guinea
    18. 18. Maternal mortality rates per 100,000 live births O 1980 to 2008 for 181 countries: substantial decline O would have been much greater but for the effect of the HIV epidemic in eastern and southern Africa O A counterforce to efforts to reduce MMR in SSA O ranges from the relatively low 200 for Namibia to 770 for Liberia and 790 for Guinea
    19. 19. Maternal mortality O good reason for optimism that substantial decreases are possible over a short period O the lack of the most basic postpartum care, childbirth and labour complications can have fatal consequences for both mother and baby O the provision of neonatal units that are easily accessible for poor communities is urgent
    20. 20. Kenya: MMR per 100,000 live births up to 80% could be averted particularly with skilled assistance during childbirth 0 100 200 300 400 500 600 700 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
    21. 21. Infant mortality rate 2012 average: 67.1 (per 1000 live births) 0 20 40 60 80 100 120 Zimbabwe Namibia Ghana Madagascar Kenya Lesotho Senegal Guinea Benin Uganda Rwanda Zambia Tanzania Liberia Ethiopia Mozambique Malawi Nigeria Mali Niger
    22. 22. Infant mortality O infant mortality: Average of 67.16 deaths per 1000 live births, from low 28.2 in Zimbabwe to almost four times that in Niger and Mali O most diseases including malaria in Africa affect people living in the poorest areas with little access to healthcare
    23. 23. huge drop in child mortality (< 5 years) in Africa - a major step forward in the development process O since 2005: Senegal, Rwanda and Kenya had falls of more than 8% a year O What took 25 years to bring about in India has taken place in Rwanda and Senegal within a five-year period, providing some hope that infant mortality could be significantly reduced throughout Africa within a relatively short period
    24. 24. Gains in infant (< 1 year) mortality in 17 African countries – various factors.. more democratic and accountable government, the end of the debt crisis, new technologies creating opportunities for business and political accountability and a new generation of policymakers, activists and business leaders
    25. 25. half the most recent drop in Kenya’s infant mortality rate (per 1000 live births) is the increased use of treated bednets in the malaria zone where 40% of the population lives, from 8% of households in 2003 to 60% in 2008 0 20 40 60 80 100 120 140 1960 1970 1980 1990 2000 2010
    26. 26. Under-fives O very significant and relatively rapid decline in under-five deaths O most significant causes of death to sub-Saharan African children is not from AIDS but rather include malaria, diarrhea, pneumonia, other infectious diseases and preterm birth complications O stunting, severe wasting and vitamin deficiencies are related to infectious diseases and are a significant risk factor of under-five mortality (33% affected)
    27. 27. 0 50 100 150 200 250 1960 1970 1980 1990 2000 2010 Kenya: Under 5 years mortality per 1000 live births
    28. 28. HIV/AIDS O HIV prevalence rates for pregnant women in sub-Saharan Africa are 10-15% compared with 0.15% in the US O Rates in Africa vary from under 1.0% in Madagascar, Senegal and The Gambia to above 20% in Botswana, Zimbabwe, South Africa, Swaziland and Lesotho O revisions downwards in a number of countries, particularly Kenya from the previous UNAIDS figure of 15% to 6.7%.
    29. 29. Urgent and effective response needed Dr Margaret Ogola O two million Kenyans have died, leaving behind 1.2 million orphans, with about 20% of children not getting any form of support O Only about 40,000 of the 200,000 needing medication to prolong life have the necessary access O In those African countries reporting a reduction, there has also been a reduction in the number of men and women reporting more than one sex partner over the course of a year
    30. 30. Recovery in Uganda, Zambia and Kenya (from HIV/AIDS) and Rwanda (from genocide) in 1990s disrupting childhood mortality declines O A long slog of broad incremental improvements in public health, education, income and urbanisation that promoted declines in US and UK and elsewhere O Influence of mother-to-child transmission of HIV
    31. 31. Life expectancy at birth (average: 55.8 years) and % of 15-49 years with AIDS 0 10 20 30 40 50 60 70 Zimbabwe Lesotho Mozambique Nigeria Namibia Malawi Zambia Mali Tanzania Uganda Niger Ethiopia Liberia Rwanda Guinea Senegal Benin Ghana Kenya Madagascar
    32. 32. 0 200000 400000 600000 800000 1000000 1200000 1400000 1600000 1985 1990 1995 2000 2005 2010 2015 Kenya: Adults (15+) with HIV
    33. 33. Life expectancy O a low of 51.8 for both Lesotho and Zimbabwe (with HIV prevalence of 24.03 and 18.36) to the slightly higher values of 60 years or more for Senegal, Kenya, Ghana, Madagascar and Benin O Average life expectancy in Kenya declined from 59 to 53 in 1980s because of AIDS
    34. 34. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Kenya Life Expectancy
    35. 35. Total Fertility Rate 2012 average: 4.9 0 2 4 6 8 Namibia Lesotho Ghana Zimbabwe Kenya Tanzania Senegal Rwanda Madagascar Liberia Guinea Benin Malawi Nigeria Mozambique Zambia Ethiopia Mali Uganda Niger
    36. 36. Total Fertility Rate (TFR) O 2.41 for Namibia, a country with very low maternal mortality, and Lesotho with 2.89, which has high maternal mortality, to Niger with 7.52, Uganda with 6.65 and Mali with 6.35 O TFRs in Kenya, Ghana and Zimbabwe: <4
    37. 37. Kenya’s TFR: oscillated from 6 to 6.8 from 1948 to the early 1960s, before increasing to 7.8 in the late 1960s and to the late 1970s and then reducing gradually to the current estimate of 3.98 children per woman 0 1 2 3 4 5 6 7 8 9 1948 1962 1969 1979 1989 1999 2008 2012
    38. 38. Fertility transition O South Africa - fertility transition began about 1965, followed by Kenya from the 1980s not recognized until the 1990s O fertility transition in Kenya triggered by improvements in childhood survival O rather than a family planning, policy should allocate resources to childhood and maternal health
    39. 39. TFR and MMR – no clear relationship TFR 2012 MMR 2010 Namibia 2.41 200 Lesotho 2.89 620 Ghana 3.39 350 Zimbabwe 3.61 570 Kenya 3.98 360 Mali 6.35 540 Uganda 6.65 310 Niger 7.52 590 O Not possible to explain why some have a steeper decline – different contexts (HIV, malaria) O Road kilometres per sq km of land O Access to skilled birth attendance O Improved sanitation
    40. 40. No single cause for fertility decline O An eclectic mix of circumstances specific to each country O Only a weak correlation with decrease in child mortality O Might expect low fertility countries to have moved further along the demographic transition – only partly true O The link between mortality and broader demographic change also seems weak
    41. 41. Hans Rosling’s evaluation of African progress based on 25 years of epidemiological monitoring in Africa: Not bad! O Worldview of many dates from 1950s O Unaware of extent of fertility change and huge diversity in Africa O In 50 years, Africa has progressed from the pre-medieval world to Europe of 100 years ago O The seemingly impossible is possible
    42. 42. The future Who knows?
    43. 43. Demographic dividend? O political and economic adjustments necessary to accommodate significant global shift in the demographic centre of gravity toward less developed regions O over a third of the growth in young manpower (15-29) of 70 million people will take place in sub-Saharan Africa
    44. 44. Potential, but challenges O potential for 54 - 72 m more stable wage- paying jobs in Africa by 2020 (McKinsey, 2012) O Africa could potentially benefit from a demographic dividend because of its young and rapidly growing workforce and declining dependency ratio, that is assuming that effective policies are implemented
    45. 45. Eberstadt (2011) Securing a better ‘economic climate’ throughout much of sub-Saharan Africa – where economic performance has generally been so abysmal over the past three or four decades, and where so much of the world’s manpower growth is to occur over the next 20 years – looks to be a much more daunting prospect today than inculcating institutional reforms in other parts of the low- income world, but it is hardly a less pressing concern for that reason.
    46. 46. Conclusion O Demography not an exact science O Erroneous projections, questionable data, ideological influences (policy) O demographic variable not to be isolated from the social, cultural, economic and political context O Examine demographic change within its deeper anthropological context
    47. 47. SubSaharan African Context O issues such as insecurity, property rights, political corruption O Why do African families value children more highly than in the west? O Rather than a paternalistic interpretation of the life of the other
    48. 48. Ideological fears of the rich world of a migratory surge from the South O A preoccupation with planning the families of the other O Ideology and hypocrisy leads to ineffective and harmful policy such as defining the ‘unmet need’ of the other O Responses like Matercare’s new clinic for maternal health in Merti, Kenya very impressive
    49. 49. huge diversity between and within countries in Africa O demographic transition from high mortality and fertility levels to low, but individual countries move along this transition in different ways according to the context O often are no clear correlations between fertility decline and other demographic variables O A general lack of awareness of the extent to which fertility has already declined
    50. 50. A long, hard, incremental slog ahead O Bearing in mind the hugely negative impact of HIV/AIDS in eastern and southern Africa in 1980s on progress previously made O A major issue is access (physical +) to skilled assistance at childbirth O Substantial and rapid declines in maternal, infant and child mortality in recent years O reasons for optimism

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