The demographic transition in sub-Saharan Africa & sub-regional differences

Sub-Saharan Africa is composed by four main sub-regions according to the United Nations geoscheme: East , West , Middle and Southern Africa , and they together ^{26 27 28 29} host about one-seventh of the World population (i.e., 1’022 million inhabitants in 2017, mid-year). It is also the fastest population growing region in the world, with a projected average annual increase rate of 2.6% (2015-2020) ; and its total fertility rate amounts to ³⁰ 5.1 (2010-2015 projections), the highest such figure worldwide (UNDESA 2017b). ³¹ During the 1970s, demographers described sub-Saharan Africa as a relatively homogeneous region, with high fertility, high mortality, and both early and universal marriage. Today, however, countries within the region have transitioned at different paces, and researchers have moved from referring to a (single) sub-Saharan Africa’s demography to rather (plural) sub-Saharan African demographies (Tabutin &

Schoumaker 2004). Today, East, West, Middle and Southern Africa respectively represent 41.3, 36.4, 16 and 6.4% of the region’s population (UNDESA 2017b).

Southern Africa’s demography however sets itself apart from the rest of the region: it is

Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique,

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Rwanda,

Seychelles, Somalia, South Sudan, Uganda, United Republic of Tanzania, Zambia, Zimbabwe and the two French Overseas Departments of Mayotte and Réunion.

Benin, Burkina Faso, Cabo Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali,

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Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo and the British Overseas Territory of Saint Helena.

Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo,

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Equatorial Guinea, Gabon, and São Tomé and Principe.

Botswana, Lesotho, Namibia, South Africa and Swaziland.

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Way beyond the growth rate of other developing regions such as Asia (0.9%), Latin America and the

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Caribbean (1%), and the neighboring Northern Africa (1.8%).

In the other developing regions, total fertility rate estimations (2015-2020) are: 2.1% in Asia, 2.0% in

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Latin America and the Caribbean, and 3.1% in Northern Africa.

smaller, and its total fertility rate of 2.6 is approaching replacement fertility: its TFR is also closer to those of Asia and Latin America than to those of rest of the region, and its population growth is much slower than in the other subregions (1.3%) (2015-2010 projections) (UNDESA 2017b). The Republic of South Africa, which composes the overwhelming majority of the subregion, already witnessed an early fertility decline from the mid-1960s (Timæus & Moultrie 2003; Tabutin & Schoumaker 2004).

Botswana also followed similar fertility decline trends as its neighbor, with a confirmed decline since the 1970s (Rutenberg & Diamond 1993; Tabutin & Schoumaker 2004).

Swaziland and Lesotho followed later in the 1980s (Anderson 2003).

The other pioneer countries of the sub-Saharan Africa fertility transition belong to the East. Eastern Africa’s total fertility rate was however above the other regions in the eve of first regional declines, in the mid 1960s (Cohen 1993; United Nations World Population Prospect: The 2017 Revision). In this period, East Africa’s TFR reached the figure of 7.1, higher than in Western Africa (6.6), Middle Africa (6.3) and especially Southern Africa (5.9). This difference was due to a number of reasons. Southern Africa could have started its decline before, possibly due to its economy and to the fact that early efforts were made to provide contraceptives to the population (Caldwell &

Caldwell 1993). Western Africa, however, had lower fertility rates due to considerably longer period of postpartum abstinence, which allowed extended spacing. While in Middle Africa, the fertility was also lower due to the postpartum abstinence practice, but also because of serious pathologies provoking sub-fecundity, particularly in tropical areas (Retel-Laurentin 1980; Kirk & Pillet 1988; National Research Council 1993a;

Lesthaeghe 2014).

Nonetheless, in East Africa, South African’s neighbors, Zimbabwe and Kenya, started to exhibit declines since around the 1980s, but the two countries followed very different trends. Whereas Zimbabwe experienced a constant decline at national level, Kenya’s fertility trends witnessed great stalls. Today, while most countries in Eastern Africa can be qualified as mid-transitional (TFR 3-4.9), other countries, such as Zambia, Tanzania, Mozambique, Uganda Rwanda and Ethiopia are in an early transition stages (TFR 5-6.9), but both Rwanda and Ethiopia experienced rapid fertility declines in recent decades. Finally, countries such as Burundi and Somalia with fertility levels of ³² respectively 6 and 6.6 are not very far apart from pre-transitional fertility (TFR 2015-2020) (Tabutin & Schoumaker 2004; Ezeh et al. 2009; Teller & Hailemariam 2011; UNDESA 2017b). In sum, Eastern Africa is far from being a homogeneous region; and in spite of still having many countries in their early transition stages, its regional TFR of 4.9 (2015-2020) is still lower than the ones of West and Middle Africa’s.

Rwanda witnessed very rapid declines from the 1990s, and Ethiopia from the years 2000 (World Bank

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2017).

West Africa started to show transition signs by the 1980s with Cape Verde, followed by coastal nations in the 1990s such as Ghana, Gambia, Senegal, and Togo exhibiting the first signs of reproductive change. However, insular Cape Verde still remains an exception in the region, now showing fertility levels close to Southern Africa’s (TFR 2.5, 2015-2020). Today, some of the countries that initiated the transition (Ghana and Togo) along with coastal Liberia, Sierra Leone, Guinea-Bissau and Sahelian Mauritania find themselves at mid-transition levels (TFR 3.0-4.9). The remaining countries are still at early transition stages, despite Gambia and Senegal’s earlier signs of decline. Finally, Niger, the most striking case in sub-Saharan Africa, is stagnating at pre-transitional levels, with a TFR of 7.4 (2015-2020) (See chapter 5 for more details on Niger’s current situation) (Cohen 1998; Kirk & Pillet 1998; Tabutin & Schoumaker 2004; Teller &

Hailemariam 2011; Guengant 2017; UNDESA 2017a). Today, West Africa’s TFR stands at 5.53, not too far from Middle Africa’s (TFR of 5.94) (UNDESA 2017a). However, as noted earlier, Middle Africa’s fertility used to be amongst the lowest in the region back in the 1960s. In this sense, countries like Cameroon and particularly Gabon which witnessed relatively fast fertility declines started out their transition with already relatively low levels of fertility due to pathological infertility (Guengant 2002). Today, about half of the countries in Middle Africa find themselves at mid-transition levels (TFR 3.0-4.9), and the remaining ones (i.e., Central African Republic, Angola and particularly Chad and Democratic Republic of Congo) were slower in their fertility decline, and they are still in the early transitional stage (TFR 5-6.9) (Tabutin &

Schoumaker 2004; Teller & Hailemariam 2011; UNDESA 2017a).

Some important disparities between the different regions could perhaps contribute to explain the differences in terms of TFRs. The nuptial regime in Western and Middle African countries tends to be overall different from the rest of the region. There, women tend to marry at earlier ages, with larger age differences between spouses and more widespread polygyny. In East and (more particularly) in Southern Africa, marriage typically occurs at later ages and polygyny is less prevalent. West and Middle Africa have maintained systems of societal organization more directed towards the kin and extended families networks, with high plasticity of family forms (i.e., such as through the widespread practice of child fostering), large families do constitute a crucial economic unit as well as a safety net. On the other hand, in East and Southern Africa, monogamy is more common, so in this more inwards looking family system, the costs of children tend to be felt more strongly and this could be a reason pushing families to be more willing to engage in fertility control. These differences are likely reflected in Southern and Eastern Africa’s total demand for family planning , which is much higher ³³ than in the rest of the region . Moreover, the fact that these regions have stronger ³⁴ traditions of publicly provided health services could have considerably facilitate the implementation of family planning programs (Caldwell 1994, Garenne 2004).

Total demand for family planning is the contraceptive prevalence plus unmet need for family planning.

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Southern Africa has a total demand for family planning of 77.4%, Eastern Africa of 65.9%, while Western

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and Middle Africa of only respectively 44.5% and 49.3% (UNDESA 2017a).

It is interesting to note that the exceptionality of the sub-Saharan Africa transition was still questioned in its early stages (Cohen 1993; Kirk & Pillet 1998), while today, researchers can state with certainty that "when it comes to fertility decline Africa is different" (Casterline 2017, p. 4). According to Bongaarts, the transition in sub-Saharan Africa can be elegantly summarized in these terms: "later, earlier, slower, and higher than the previous transitions in other regions of the developing world" (Bongaarts 2017a). First, as already mentioned, fertility started to decline in sub-Saharan Africa at the end of the 1980s, and on average in the mid-1990s: about two decades later than the other developing regions. With lower average socio-economic development levels compared to other developing areas, this state of affairs is coherent with the classic demographic transition theory since the onset of the African demographic transition came after Asia’s and Latin America’s (Notestein 1953; Bongaarts 2017a; Casterline 2017). Conversely, even though sub-Saharan Africa’s fertility decline came later from a time-frame perspective, it happened earlier from a relative point of view. Indeed, the average values of the socioeconomic indicators in sub-Saharan Africa were lower at the onset of the transition than in the other developing regions. According to the diffusion theory, new ideas about the family size, fertility regulation, etc., can spread throughout the population despite socioeconomic differences, thus propagating at faster rate within contexts that share similar culture and languages (Knodel & van de Walle 1979; Cleland

& Wilson 1987; Bongaarts 2017a). Moreover, the sub-Saharan African fertility transition was also slower in regard to the pace of decline, also in consistency with the classic demographic transition theory. Bongaarts noticed that overall development indicators such as education, life expectancy, urbanization and GDP per capita improved at a slower rate during the African transition than for the other developing regions.

Finally, sub-Saharan Africa is characterized by higher pre-transitional levels of fertility, and higher desired fertility preferences, stemming from a globally pro-natalistic traditional regime. The colonial rule likely exacerbated this condition, by maintaining high mortality levels in parallel to a very large demand for labor (Lesthaeghe 1989;

Caldwell et al. 1992; Pritchett 1994; Oppenheim-Mason 1997; Bongaarts 2017a;

Casterline 2017; Mbacké 2017).

Some authors further insist on the role of governance and of weak service structures in sub-Saharan Africa’s slow decline (Casterline 2017). Fragile governance typically translates into high levels of uncertainty. Large families and reliance on kinship, extended families, social ties and other networks consist one of the key strategies to cope with this vulnerability (Isiugo-Abanihe 1985; Lesthaeghe 1989; Ainsworth 1996;

Akresh 2009; Casterline 2017; Cissé 2018). In this sense, better governance, and reliance on stable institutions can have an impact on the desire for small families.

Casterline (2017) provided an example: "It is probably no accident that the most sizable and rapid recent fertility decline in sub-Saharan Africa has occurred in Rwanda, where the government’s management of the economy and provision of social and health services, including family planning, are exceptional by regional standards". Stronger institutions also help in promoting better contraceptive services. Bongaarts (2017) also sustains that in African countries where family planning programs were recently

established as a national priority, such as Ethiopia or Malawi, contraceptive uptake has rapidly risen, playing a key role in fertility declines. Altogether, as stated by Casterline and Agyei-Mensah, investing in effective contraception services may be critical to address to growing demand for fertility control, by acting upon the synergy operating between the desire to regulate childbearing and the effective implementation of those desires (Casterline & Agyei-Mensah 2017).