›October 17, 2013 // By ECSP Staff
Today approximately 44 percent of the world’s 7.2 billion people are under 24 years old – and 26 percent are under 14. Of those 7.2 billion people, a staggering 82 percent live in less developed regions of the world – primarily sub-Saharan Africa and Asia. Currently, the global median age is 29.2 years old, a sharp contrast to Europe, for example, where the median age is 41.
›August 7, 2013 // By Elizabeth Leahy Madsen
In a recent post on the new United Nations population projections, I discussed the risk in assuming that countries in sub-Saharan Africa will progress through the demographic transition at a pace similar to other regions. Making this assumption is questionable because fertility decline in Africa has generally proceeded more slowly than in other parts of the world, with several cases of “stalls” and even small fertility increases over time.
›June 26, 2013 // By Elizabeth Leahy Madsen
October 31, 2011, was notable not only for the annual ritual of candy and costumes, but also for its designation by the United Nations as the date when global population reached seven billion. Although just an estimate – demographers are not able to count individuals in real time on such a large scale – the event was an important opportunity to present population trends to the media and public dialogue. Several babies born that day were named the “seven billionth;” in Russia, where various incentives have been implemented to try to boost an ultra-low fertility rate, Vladimir Putin visited a maternity ward to greet one of them.
Sub-Saharan Africa is perhaps the riskiest place for a woman to give birth. According to the United Nations Population Fund (UNFPA), African women comprise approximately 56 percent of the maternal deaths and 91 percent of HIV-related maternal deaths worldwide every year. In order to bring life into this world, women in Africa literally must put their own lives on the line.
›May 8, 2012 // By Elizabeth Leahy Madsen
A Trio of Emerging Success Stories
For many countries in sub-Saharan Africa, rapidly growing populations concentrated among youthful ages are outpacing improvements in quality of life and testing governments’ capacities to provide basic health services, education, and jobs. For the region as a whole, the contraceptive prevalence rate (CPR) for modern methods increased by just 0.3 percentage points per year between 2000 and 2009, following similarly sluggish annual increases in the previous two decades.
At this growth rate, more than a century would pass before sub-Saharan Africa, which had an average CPR of less than 16 percent in 2009, achieves the same levels of contraceptive use seen today in North Africa.
Given this regional context, the release of three successive surveys showing rapid jumps in CPR was noteworthy. In Ethiopia, the percentage of married women using a modern contraceptive method jumped from just 6 percent in 2000 to 27 percent in 2011. Malawi, starting from a higher baseline, experienced an increase from 26 percent in 2000 to 42 percent in 2010. Both countries’ CPR rose at a pace of more than two percentage points per year, about seven times faster than the regional average. However, the changes reported in Rwanda were undoubtedly the most dramatic. Contraceptive use more than tripled in just five years, growing by seven percentage points annually. In turn, fertility fell by 25 percent, from 6.1 to 4.6 children per woman in just five years.
Fertility Rises Elsewhere
In March, demographic surveys carried out by MEASURE DHS and funded by USAID were published for Mozambique, Uganda and Zimbabwe (the available reports for Mozambique and Uganda are based on preliminary findings). While one of these countries had an increase in contraceptive use, the other two recorded showed no progress.
Uganda, which has one of the highest fertility rates and youngest populations in the world, experienced an uptick in contraceptive use, from a rate of 18 percent for modern methods in 2006 to 26 percent in 2011. Although not at the pace seen in Ethiopia, Malawi, or Rwanda, the average growth of 1.6 percentage points annually was above the regional average. Its fertility rate declined from 6.7 to 6.2 children per woman.
More disheartening is the very unusual finding that fertility rates are increasing and contraceptive use is stagnant in both Mozambique and Zimbabwe. Over the past 15 years, CPR has increased slightly and since plateaued in Mozambique, while fertility has continued to rise. Between 1997 and 2003, contraceptive use jumped from 5 to 12 percent, where it remained in 2011. Meanwhile, fertility has risen from 5.5 to 5.9 children per woman since 2003.
Zimbabwe is one of the few countries in sub-Saharan Africa where more than half of married women use a modern contraceptive method, but the rate has dipped slightly, from 58 to 57 percent over five years. More surprising is the increase in the fertility rate, from 3.8 to 4.1 children per woman. Fertility among the youngest mothers, ages 15 to 19, is higher today than in the late 1980s and early 1990s.
The central characteristic of population trends today at the global level is their diversity. Some countries in East Asia and Europe are reaching unprecedented low fertility rates, near one child per woman, and many developing countries are nearing the later stages of the demographic transition, with family sizes around two or three children per woman. Yet most countries in sub-Saharan Africa have not followed the pattern of steady fertility decline. Do the mixed results from these recent surveys indicate that demographic diversity is becoming the norm within Africa too?
Although there is tremendous variance at the country level, on average, fertility declines by one child per woman for every 15 percentage point increase in contraceptive use. However, fertility changes have multiple determinants and the effect of changing contraceptive use is not immediate. In Malawi especially, the fertility rate remains relatively high given that contraceptive use has surpassed 40 percent, a puzzle that will be explored at a national family planning conference hosted by the government and several international partners this month.
Although it is unlikely that current trends will hold exactly, the figure below shows results if the most recent changes in fertility are projected forward at a steady rate. Most countries’ fertility rates would change by less than one child per woman over the next decade and all but Rwanda would remain at or above four children per woman.
The recent changes in contraceptive use therefore suggest that progress through the demographic transition will remain fairly slow in these countries. Populations will continue to grow rapidly and remain very youthful, and continued investments in family planning are necessary in order to promote the potential social and economic benefits of a more balanced age structure.
Lessons From Neighbors
The factors promoting success in the three countries where the pace of family planning use is ramping up have been carefully analyzed.
In Ethiopia, Mengistu Asnake of Pathfinder International attributes success to the government’s commitment to improve access to services in rural areas by constructing 15,000 health posts and training community members as health extension workers. The World Health Organization has identified the policy empowering local health workers to distribute injectable contraceptives, a popular method, as key to Malawi’s success. And Rwanda’s rapid growth in contraceptive use has been linked to tangible support from policymakers at the highest levels and the introduction of community-based insurance networks, as well as plentiful funding.
The divergent trends found in these six surveys are an important reminder that demographic trends do not operate in a vacuum. Countries do not progress through the demographic transition or achieve the demographic dividend at a predetermined pace. The policy environment, culture, and socioeconomic factors have tremendous influence on health outcomes and the behavioral determinants of fertility change.
If leaders in Mozambique, Uganda, Zimbabwe, or other countries wish to alter their current trajectories, the emerging successes of family planning programs in Ethiopia, Malawi, and Rwanda prove the tremendous impact of political support and intensive expansion of services to underserved areas and people.
Note: The figures reported for contraceptive use in Mozambique vary between StatCompiler and the DHS reports, and have been updated based on clarifying information received by the author. StatCompiler was used for all other fertility and contraceptive prevalence rates, except those not yet included in StatCompiler, in which case data was drawn from the relevant final DHS report (preliminary reports for Mozambique and Uganda).
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Sources: Asnake (2011), Bongaarts (2008), Leahy Madsen (2011), Mack (2012), MEASURE DHS, Solo (2008), Tsui (2011 and 2001), United Nations Population Division, USAID, WHO.
Image Credit: “Psychosocial support group in Zimbabwe,” courtesy of U.K. Department for International Development. Chart Credit: Elizabeth Leahy Madsen.
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