This document discusses trends in population and development in sub-Saharan Africa. It provides data on maternal mortality rates, infant mortality rates, life expectancy, total fertility rates, and HIV prevalence across various African countries. Some key points made are that maternal mortality in SSA has declined significantly from 1980 to 2008, though rates still vary widely by country; infant and child mortality have also declined rapidly in some countries like Kenya, Rwanda, and Senegal in recent years; and total fertility rates have fallen in many countries but still remain high in others like Niger and Uganda. The document argues for considering the complex contextual factors that influence demographic trends in Africa.

1. Towards a contextual analysis of
sub-Saharan African fertility
transition
Seamus Grimes
National University of Ireland, Galway

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

19. Sub-Saharan Africa
Some empirical data

20. 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

21. 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!

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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)

33. 0
50
100
150
200
250
1960 1970 1980 1990 2000 2010
Kenya: Under 5 years mortality per 1000 live births

34. 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%.

35. 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

36. 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

37. 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

38. 0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1985 1990 1995 2000 2005 2010 2015
Kenya: Adults (15+) with HIV

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. The future
Who knows?

49. 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

50. 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

51. 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.

53. 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

54. 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

55. 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

56. 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

57. 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