THE STATE OF THE DEMOGRAPHIC TRANSITION IN AFRICA

ECA/FSSD

TABLE OF CONTENT

EXECUTIVE SUMMARY

A. Background
B. Theory of the demographic transition
C. Population dynamics in Africa
D. Best practices from African countries
E. Constraints in countries undergoing delayed demographic transition
F. Lessons from Asia
G. Lessons Learned on the demographic transition in Africa
H. The way forward

I. INTRODUCTION

A. Population and Development Situation
B. Challenges
C. Historical perspectives on population by African governments
D. Overview of the Demographic Transition Patterns
E. Scope and Objectives of the Study

II . OVERVIEW OF POPULATION DYNAMICS AND SELECTED SOCIO-ECONOMIC FACTORS

A. Population dynamics

1. Population and growth rates
2. Fertility Levels and Trends
3. Mortality Levels and Trends
4. Migratory Movements

B. Selected Socio-economic Factors

1. Status of women and the elderly
2. Illiteracy
3. Economic Situation
4. Nutrition and food availability
5. Urbanization
6. Health

C. Selected Demographic and Socio-economic indicators in eight countries selected for the study

1 Demographic and Socio-economic Indicators
2 Socio-economic Indicators

III. THE STATE OF THE DEMOGRAPHIC TRANSITION IN SELECTED DEVELOPING COUNTRIES IN AFRICA

A. Examples of countries experiencing sustained demographic transition

1 Mauritius
2 Botswana
3 Tunisia

B. Examples of countries undergoing delayed demographic transition in Africa 31

1. Cameroon
2. Egypt
3. Madagascar
4. Mail
5. Nigeria

IV. LESSONS ON THE STATE OF THE DEMOGRAPHIC TRANSITION FROM ASIA

A. General
B. Sri Lanka
C. Indian Village of Kerala
D. General Overview

V. BEST PRACTICES, CONSTRAINTS, LESSONS LEARNED AND THE WAY FORWARD FOR AFRICA

A. Best practices from African countries
B. Constraints in countries undergoing delayed demographic transition
C Lessons Learned on the demographic transition in Africa
D Lessons from South Asia
E The way forward

VI. REFERENCES

VII. FIGURES

VIII. ANNEX TABLES

EXECUTIVE SUMMARY

A. Background

Africa is a region with the highest population growth rates in the world. The growth rates in the region range from 2.2 per cent to 2.8 per cent, compared to 1.4 per cent and 1.7 per cent for the world as a whole. But Africa is also the poorest region of the world. The Human Development Report of 2001 indicates that out of 36 nations in the world with low human development, 29 are in Africa and the rest are in Asia. Therefore, Africa, which has the most serious socio-economic problems in the world, is also the continent with the most challenging population problems. This study is consequently focussed on the challenge of dealing with the pace of population growth in the region by examining the state of the demographic transition in continent.

B. Theory of the demographic transition

According to the theory of the demographic transition, the shift towards low mortality and fertility rates occurs when there is a process of overall modernization resulting from industrialization, urbanization, education, empowerment of women, and substantial overall socio-economic development. Such a shift, would lead initially to a drop in mortality through progress in hygiene and medicine and, subsequently, to a decline in fertility occasioned by economic growth. Giving mortality decline as a pre-condition for fertility decline forms the cornerstone of the theory. In this regard, the classical wisdom often describes infant mortality as a decisive factor influencing parents to reduce their fertility. The relationship of socio-economic development and fertility decline has also been the focus of many discussions. Although the theory has experienced a great deal of critical analysis, it has remained a useful framework for discussing the dynamics of fertility and mortality change in the world.

The theory is silent on the role of migration even though the experience of Europe has demonstrated that external migration may have provided a relief for internal population pressure. Europe, which experienced remarkable population growth in the nineteenth century, had the historic possibility of spilling over its surplus population through migration and transfer to the colonies. Currently, however, with so many restrictions on international migration, the opportunity of spilling over its surplus population to other regions through migration is not available to Africa.

C. Population dynamics in Africa

Available literature shows that the relatively high levels of fertility still observed in Africa, especially Sub-Saharan Africa, have more to do with a combination of cultural and socio-economic factors which determine the attitudes and behavior of people towards procreation. The high incidence of fertility at least reflects that reproduction starts at young ages, age at first marriage is early, and contraceptives are not being used in a widespread and effective manner.

Africa has certainly experienced an initial phase of mortality decline which happens to have been sustained for more than-half a century. The mortality decline caused by economic and social progress was also related to advances in medical science, the improvement of hygiene and the reduction of infant mortality. The conclusions, however, are less consistent with regard to fertility trends where fertility has not decreased significantly in most African countries.

The high rate of population growth observed in Africa over more than half a century is, therefore, the result of a continuing decline in mortality and relatively high fertility. In the absence of a significant decline of fertility, Africa is the last region of the world to have embarked on the demographic transition. Given, however, the fact that the continent is experiencing declining mortality (the likely reversals due to HIV/AIDS and the resurgence of malaria and tuberculosis notwithstanding), the question that arises is how can the transition be facilitated in Africa by accelerated fertility decline.

With regard to international migration, the paucity of statistics on the subject in Africa (mostly from censuses) and the irregularity of most of these movements do not allow us to make an accurate assessment of international migration. It is probably more substantial than the net negative migration rate of 0.1 per thousand estimated for the whole continent. But while all the estimates made to date on migration in Africa have invariably shown a net negative migration, the numbers of immigrants have been too few to have any impact whatsoever on the dynamics of domestic natural population change. Migration does not, therefore, have a noticeable impact on demographic change in Africa.

Africa's sub-regional diversity and disparities within nations make it hazardous to venture any general proposals and strategies for reducing fertility on the continent. But more recent experience of the demographic transition in Africa provides a good opportunity to understand the facilitating and constraining factors for the transition in the region. A review of the experiences of selected countries that are experiencing sustained mortality and fertility declines and those that are experiencing delayed demographic transition facilitates the identification of best practices and lessons learned. Identified best practices and lessons learned will be useful for advocacy and dissemination in member States. Their adaptation to specific country situations may accelerate the demographic transition and the achievement of lower population growth rates in the continent.

The data and resources available compelled us to make a selection of various African experiences in demographic transition. Accordingly, among the eight countries selected for the study, three of them (Botswana, Mauritius and Tunisia) are considered to have made a successful demographic transition by having reached the stage of sustainable fertility decline. This does not apply to the five other countries (Cameroon, Egypt, Madagascar, Mali and Nigeria) which are in the early stages of the transition.

D. Best practices from African countries

The decline in fertility in Mauritius is assumed to be the most rapid fertility decline in the world, at least at the national level. It is due to a number of factors including (1) the rapid transition in marriage patterns (marriage postponement); (2) the provision of basic education especially for women; (3) the peaceful co-existence between the religions and religious leaders and their flexibility on family planning issues; and (4) the strong family planning efforts based on a broad consensus and actively supported by government.

In the case of Botswana, fertility decline was largely rooted in the many pragmatic and positive policies pursued during the 1980s and 1990s. These polices include (1) the extension of social benefits in health and education to a wide spectrum of population; (2) investing in the key physical and institutional infrastructures to facilitate the delivery of services; (4) provision of universal and free primary education; (5) efforts to close the gender gap in accessing education and employment particularly for women; (6) promotion of a systematic and integrated health care system that incorporates preventive care, primary health care and family planning services including mother and child health; (7) integration of population factors into development planning at all levels including mechanisms to promote the coordination of the various intervention efforts undertaken by all institutions and the private sector; and (8) maintenance of relative peace, stability and democracy.

In Tunisia, the major factors leading to fertility decline are (1) the general improvement of the living standard; (2) the implementation of a clear, well-designed and well planned family planning and health programme; (3) support given to the population policy by relevant legislation (such as abolishing of polygamy and legalizing divorce and abortion); (4) the political will given to the population policy at the highest level; and (5) the joint actions to raise the age at first marriage and the use of contraception.

E. Constraints in countries undergoing delayed demographic transition

In Cameroon, Mali and Nigeria the fertility rate is still higher than 5 children per woman, and somewhat lower in Egypt. The factors which explain the high fertility rates are (1) early marriages; (2) limited use of contraception; (3) high demand for children due to tradition, religion and high infant mortality; (4) the formulation and implementation of a multitude of programmes as well as involvement of a large number of institutions in population activities without effective co-ordination; (5) the persistence of customs and ancestral beliefs favouring large families, early marriages, and polygamy; (6) the need for more children to assist in food and livestock production; (7) the low level of education and limited access to health facilities due to inadequate infrastructure; and (8) lack of integration of population factors in development planning.

F. Lessons from Asia

Lessons from Sri Lanka and the Indian village of Kerala suggest that the demographic transition that occurred in parts of South Asia was generally a consequence of two major factors: an increase in age at marriage and control of marital fertility. The delayed age at marriage was a result of socioeconomic changes which were mainly a consequence of a better educational and health care system, while the control of marital fertility was a result of a well planned and carefully executed family planning programme. However, these factors were accompanied by other societal changes that reinforced their impact. Among these was the increasing centrality of the family, the increasing cost of living and the decreasing opportunities in agriculture.

G. Lessons Learned on the demographic transition in Africa

In the field of population, there are generally two major challenges for Africa. For countries such as Botswana, Mauritius and Tunisia, the challenge is to sustain the transition while avoiding lowering fertility below replacement levels. For countries which are in early stages of the transition, the challenge is for them to adapt and practice the lessons provided by Botswana, Mauritius and Tunisia. Lessons learned from South Asia reinforce some of the experiences that are taking place in Africa.

H. The way forward

The way forward should be focussed on the integration of population variables in national development plans, supporting late age at first marriage and the implementation of family planning programmes. Many family planning programmes have not achieved the desired results because of several reasons. These include:

i) Limited choice and lack of female empowerment to make conscious decisions (mainly as a result of a psychological and cultural transition that is seemingly and intimately tied to education, especially female education);

ii) The need to provide an environment in which reducing fertility must be advantageous (such as, for instance, reducing the high cost of education and increasing the desirability for education as a prerequisite for employment and careers); and

iii) Inadequate provision of effective contraceptive techniques.

It is evident that the countries that have been successful in reducing their fertility and mortality rates met these preconditions. Together with these preconditions, the way forward is to formulate and implement population and development policies and strategies with the following components:

i) Ensure that population measures or factors that are integrated into national development plans are empirically derived from proper population/development interrelationships;

ii) Prepare realistic strategies that incorporate long-term national objectives derived from the global and regional frameworks such as the DND, ICPD-PA, Agenda 21, Habitat II, and World Food Summit Plan of Action;

iii) Promote introduction of social and economic policies that provide sustainable livelihoods, reduce poverty, and provide alternatives to the demand for many children;

iv) Define more accurate family planning programme objectives by carrying out a realistic assessment of the requirements and demands for the target population;

v) Provide consistent support to the family planning programmes at the highest political level and financial support to the programmes;

vi) Ensure legislation that plays a catalytical role and gives the programme a crucial legal framework;

vii) Develop a meaningful information, education and communication (IEC) programme for the target populations including different social and professional categories and specific risk groups (such as adolescents, youths, and school girls);

viii) Reduce the number of sectors involved in the implementation of these policies and strategies; and

ix) Institutionalize a mechanism for effective monitoring, evaluation and co-ordination.

I. INTRODUCTION

A. Population and Development Situation

Since 1950, Africa has been the region with the highest population growth rates in the world with rates ranging from 2.2per cent to 2.8 per cent compared to 1.4 per cent and 1.7per cent for the world as a whole (United Nations, 2001). The population of Africa will nearly quadruple over the period 1995 to 2150 (increasing from 0.7 billion persons in 1995 to 2.8 billion in 2150). Within the same period, Europe's population will decline from 728 million in 1995 to 595 million in 2150, while the pace of change for the other regions will fall somewhere between these two extremes. Yet, in 1950, the population of Europe was more than twice that of Africa.

Africa is also the poorest region of the world. The Human Development Report of 2001 indicates that out of 36 nations in the world with low human development, 29 are in Africa and the rest in Asia (UNDP, 2001). The Human Development Index (HDI) ranges from 0.234 to 0.400 compared to the highest index of 0.856 in the world found in Norway. According to the Population Reference Bureau (2001), the per capita Gross National Income in purchasing power parity (GNI PPP) was US$ 6650 in the World, US$ 1799 in Africa, US$ 31260 in North America, US$ 6460 in Latin America and the Caribbean, US$ 17880 in Oceania, US$ 3930 in Asia, and US$ 14970 in Europe. This again confirms that the region is the poorest in the world.

Thus, Africa, which has the most serious socio-economic problems in the world, is also the continent with the most challenging population problems. As UNFPA (1999) puts it, population is growing fastest in the poorest countries, those least able to provide for basic needs and create opportunities. In addition, Africa also faces rising mortality rates in countries affected by HIV/AIDS, internal instability, natural disasters and social disruption. Many of the countries worst affected by HIV/AIDS are among the poorest in the world, most affected by other diseases such as malaria and tuberculosis, least provided with basic health services, and most heavily dependant on outside help to combat diseases. The same countries are affected by political instability and refugee movements that cause grave social and economic disruptions. In many of these countries, internal migration has increased. This migration responds and further contributes to stress on the environment and on service delivery systems.

B. Challenges

Under all likely scenarios, Africa's population will continue to increase rapidly at least during the first few decades of the 21^st Century. This is because of the in-built momentum of growth associated with the very young age structure of most African countries. This growth will be fuelled by high fertility levels. Yet, population growth can be substantially lowered by investments in family planning and other reproductive health programmes, by investments in education particularly for women, and by greater economic opportunities for the youth and women.

The major challenge for African Governments, therefore, is what they can presently do to promote sustainable development in the region. How can they promote balanced development of the quality of life of an individual member of the population in an environment of sustainable use of natural resources? More specifically, what can they do in the area of population to deal with the challenges of:

• Reducing the pace of growth;
• Reducing maternal morbidity and mortality;
• Reducing infant and child mortality;
• Ensuring food security and good nutrition;
• Reducing illiteracy rates and increasing the provision of equitable basic education and building of skills;
• Dealing with the HIV/AIDS epidemic, other diseases such as malaria and tuberculosis as well as their health and socio-economic consequences;
• Dealing with the special needs of adolescents and youth;
• Empowering women and improving their status;
• Managing international migration;
• Providing old age security and alternative living arrangements for the elderly;
• Promoting good governance and reducing wars and civil conflicts which lead to large refugee movements and groups of internally displaced persons; and
• Promoting support mechanisms of family systems to cope with socio-economic changes and rapid urbanization.

In this study, the focus will be put on the challenge of dealing with the pace of growth by examining the state of the demographic transition in Africa.

C. Historical perspectives on population by African governments

In the early years of independence the main concern of African countries was to give priority to nation building. Many of these countries underestimated the human resources dimension of development and had no political will to pursue population policies integrated into development planning. This is the most likely explanation for why a good number of objectives set in international strategies and development plans in past decades have not been achieved. These objectives include universal free education, health for all, improvement of the status of women, improvement of living standards, and checking the growth of unemployment (UNECA, 1996a)

Fortunately, the African position since then has gradually evolved towards better awareness of the problems created by rapid population growth. At the world population conference held in Bucharest in 1974, African Governments regarded population as an unimportant factor in development. But at Arusha, when they adopted the Kilimanjaro Plan of Action (KPA) for Africa on population in 1984, they unanimously recognized it as an important factor in development (UNECA, 1984). The pressures and constraints that rapid population growth imposes on development efforts and scarce available resources were clearly articulated in the Plan. Eight years later, the recommendations of the KPA were revisited and developed further in the 1992 Dakar/Ngor Declaration (DND) whereby African governments, for the first time, collectively committed themselves to quantified objectives for slowing down population growth in the continent and resolved to bring down the natural growth rate to 2.5 per cent by the year 2000 and 2.1 per cent by the year 2010 (UNECA, 1992; UNECA, 96b).

With regard to mortality rates, the DND objectives for the year 2000 and for Africa as a whole were to reduce infant mortality rates to less than 50 per thousand, child mortality rates to at least 70 per thousand, halve the 1990 maternal mortality rate and achieve a life expectancy at birth of at least 55 years (UNECA,1996b). The required reduction in fertility was expected to result from achieving the objective of doubling utilization rates of contraceptives within the region from approximately 10 per cent to 20 per cent by the year 2000, and 40 per cent by the year 2010.

The underlying assumption in setting these regional objectives was the need for the African people to commit themselves to an evolutionary process characterized by a significant reduction of mortality and fertility. Such demographic change (which first took place in Europe and the New World before spreading recently to the developing countries) was named the demographic transition. Nineteenth century Europe served as the laboratory for the design and development of the theory. It provides a general framework for describing and explaining the passing of a given population from approximately stationary growth with high birth and death rates to a state of balance with low fertility and mortality rates and near-zero growth. In the intermediate phase, the population undergoes strong natural growth which slows down gradually until the final stage. According to the theory of the demographic transition, the shift towards low mortality and fertility rates occurs when there is a process of overall modernization resulting from industrialization, urbanization, education, empowerment of women, and substantial overall socio-economic development. Such a shift, would lead initially to a drop in mortality through progress in hygiene and medicine and, subsequently, to a decline in fertility occasioned by economic growth .

The theory is silent on migration even though the experience of Europe has demonstrated that external migration may have a regulating influence on population change. Indeed, Europe which experienced remarkable population growth in the nineteenth century, had the historic possibility of spilling over its surplus population through migration and transfer to the colonies. Currently, however, with so many restrictions on international migration, the opportunity of spilling over its surplus population to other regions through migration is not available to Africa.

D. Overview of the Demographic Transition Patterns

The demographic transition classifies populations by various combinations of fertility and mortality. One of the initial formulations of the demographic transition theory is credited to Blacker (1947) who defined five phases of population growth as follows:

i) A stage of high fertility and high mortality characterized by a low population growth rate;

ii) A stage of high fertility and high mortality with mortality beginning to decline and thereby generating increasing population growth rates;

iii) A stage of declining fertility but sustained reduction in mortality with the latter declining at a faster rate than that of fertility and causing rapid population growth;

(iv) A stage of demographic balance between low mortality and low fertility and, with it, a low rate of population growth; and

(v) A stage of low fertility and low mortality with the latter becoming higher than the fertility rate and thereby leading to negative natural growth.

These five phases were subsequently reduced by Thompson (1948) to the following three phases:

(i) A stage of balance between high and uncontrolled mortality and fertility rates characterized by a low rate of population growth;

(ii) A stage of low fertility and a sharper decline in the mortality rate leading to rapid population growth; and

(iii) A stage of balance between mortality and fertility rates maintained at low levels with almost zero population growth.

The theory was later considerably enriched by the demographic transition experiences of developing countries and some European countries during the 1980s. The subsequent stages revisited by Zarnoun and Tabutin (1994) seemed to best summarize and capture the model pattern of demographic transition as follows:

(i) Pre-transition stage with birth and death rates fluctuating slightly at levels as high as 30-40 per thousand and slight population growth;

(ii) Beginning of the steady decline of mortality while birth rates remain high resulting in high natural population growth;

(iii) Beginning of a more or less rapid reduction in the birth rate lagging behind the decline of mortality at a time when the population growth rate is beginning to slow down; and

(iv) Post-transitional stage where death and birth rates stabilize at levels as low as 10 per thousand with the latter remaining slightly higher than the former and leading to slow population growth.

All demographic transition models obviously emphasized the synchronization of respective mortality and fertility patterns. Placing mortality decline as a pre-condition for fertility decline formed the cornerstone of the theory

Many writers have criticized the theory of demographic transition, particularly those aspects which explain the decline of fertility. Coale and Hoover (1958), for instance, question certain elements of the theory by indicating that in developing countries reductions in the birth rate are not always predicated upon the reduction of death rates, and that urbanization is not a sufficient condition for the decline of birth rates. The example of some African countries also shows that fertility can decline independently of the degree of socio-economic development (Kirk, 1996). In addition, in some cases, mortality decline was followed by a temporary increase in fertility (Latin America, Africa and a major part of Asia) (Dyson and Murphy 1985).

E. Scope and Objectives of the Study

Since a variety of economic, social, demographic, cultural and biological factors have helped to significantly reduce mortality and fertility in the world, the study seeks to identify the most important factors in order to propose to decision-makers and development planners the strategies and programmes that must be pursued with a view to facilitating the process of the demographic transition in Africa. More specifically, an attempt will be made to: (i) analyze the main socio-economic and demographic characteristics and the associated trends in some countries, describe the situation of these countries relative to various stages of the demographic transition and identify best practices; (ii) draw relevant lessons from demographic transition experiences while taking into account the need to guide and facilitate the process in Africa; and (iii) suggest the way forward for member States.

The data and resources available have compelled us to make a selection of various African experiences in demographic transition. Accordingly, among the eight countries selected for the study, three of them (Botswana, Mauritius and Tunisia) are considered to have made a successful demographic transition by having reached the stage of sustainable fertility decline. This does not apply to the five other countries (Cameroon, Egypt, Madagascar, Mali and Nigeria) which are in the early stages of the transition. The analysis of the various experiences will provide us with useful lessons on the factors facilitating or constraining the demographic transition.

The following sections will constitute the study. After this introductory section, Section II will provide a concise description of population dynamics and selected socio-economic growth factors. The selected experiences of the demographic transition will be summarized in two sections: Section III on selected experiences from Africa; and Section IV on some lessons from Asia. The last section, Section V, will dwell on best practices, constraints, lessons learned and the way forward.

II . OVERVIEW OF POPULATION DYNAMICS AND SELECTED SOCIO-ECONOMIC FACTORS

A. Population dynamics

1. Population and growth rates

The data presented in Annex Tables 1 and 2 provide a comparative analysis of world population and growth rates by major area and region from 1950 to 2050 using medium estimates and projections (United Nations 2001). World population was estimated at 6.1 billion in 2000. Out of this total 13.1 percent or 794 million lived in Africa. This percentage is slightly higher than that of the European population (12.0 per cent); Asia has slightly more than three fifths of the world population; Latin America and the Caribbean have 8.6 per cent; North America has 5.1 per cent; and Oceania has 0.5 per cent. Figures 1, 2a and 2b clearly depict world population by major regions.

FIGURE 1, 2a and 2b here

With regard to population growth, Africa, with an annual growth rate of about 2.4 per cent over the period 1995 to 2000, has the highest population growth rate in the world. The rates for other regions, within the same period, varied from less than zero percent for Europe to 1.6 per cent for Latin America and the Caribbean (see Figure 3). The relatively high population growth rate for Africa was essentially due to high fertility and gradually declining mortality levels.

FIGURE 3 here

2. Fertility Levels and Trends

The birth rate is certainly the main factor influencing the rapid population growth observed on the continent. The most recent United Nations estimates for the period 1995-2000 show a crude birth rate of 24 per thousand worldwide and of 39 per thousand in Africa (Annex Table 3). The table also shows crude birth rates in the range of 29-30 per thousand in North Africa and Southern Africa, and in the range of 43-44 per thousand in Eastern, West, and Central Africa. Figure 4 shows the crude birth and death rates for Africa (1950 to 2000).

FIGURE 4 here

Fertility levels measured in terms of the total fertility rates (TFRs) enable fertility rates to be more appropriately compared, since in contrast with the crude birth rates (CBRs), the TFRs do not depend on the age and sex structure of the population under study¹. Figure 5 and Annex Table 4 show that for the period 1995-2000, the TFR was 2.8 worldwide, 1.4 for Europe, 2.0 for North America, 2.4 for Oceania, 2.7 for Asia, and 2.7 for Latin America and the Caribbean, and 5.3 for Africa. The value estimated for Africa contrasts sharply with the values for the other continents and means that fertility levels in Africa far exceed the level of 2.2 children required to replace the population. The estimates for West, Eastern and Central Africa show that the fertility level is more than 5.5 children, which is a significantly higher level than the values of 3.6 and 3.3 indicated for North Africa and Southern Africa.

FIGURE 5 here

While fertility has been declining worldwide over the past 30 years, the tempo of the decline appears to have been slower in Africa. The most significant decline in developing countries within that period was observed in Asia. In Africa, the decline was moderate and affected all sub-regions but was felt more in North and Southern Africa where the TFR declined by at least 1.4 children.

Available literature shows that the relatively high levels of fertility still observed in Africa, especially Sub-Saharan Africa, have more to do with a combination of cultural and socio-economic factors which determine the attitudes and behavior of people towards procreation. The high incidence of fertility at least reflects that reproduction starts at young ages, age at first marriage is early, and contraceptives are not being used in a widespread and effective manner (Schoenmaeckers,1988).

Nevertheless, certain pockets of high incidence of sterility have been located in Africa. They stretch from Cameroon and Gabon, through the Congo, the Democratic Republic of Congo, the Sudan, the Central African Republic, and Uganda to Tanzania (UNECA, 1986). This belt of primary and secondary infertility has a major effect on fertility. Frank (1983) states that if the issue of female infertility is not addressed soon, the fertility decline runs the risk of being, delayed in Africa since it will make the domestic and external pressures being exerted on families to reduce the number of children counterproductive.

3. Mortality Levels and Trends

The crude death rate (CDR) currently estimated at 9 per thousand worldwide ranges from 7 per thousand in Latin and the Caribbean to 14 per thousand in Africa (Figure 4 and Annex Table 3). The relatively high CDR in Africa, compared to that for other regions, is due to high mortality resulting from infectious and communicable diseases as well as poor living conditions and food insecurity. Sub-regional variations of the CDR in Africa show that the highest levels of mortality are in Eastern, Central and West Africa where CDRs are far in excess of 10 per thousand. In contrast, North Africa and Southern Africa have relatively lower levels of mortality with CDRs of 8 and 12 per thousand respectively.

During the period 1995-2000, life expectancy at birth ranged from 51 years (both sexes) in Africa to 77 years in North America (Table 1). The values shown by sex reflect that expectation of life at birth is always higher for females than for males. Further, the trends observed from 1950-55 to 1995-2000 reflect that the world has experienced an incipient decline in mortality over time. The decline has, however, been more substantial in some regions than in others. For example substantial gains were made in Asia (61 per cent for both sexes) compared to Africa (34 per cent) Latin America (35 per cent), Oceania (21 per cent), North America (12 per cent) and Europe (11 per cent).

With regard to infant mortality, Africa is the only region of the world where the infant mortality rates (IMRs) still remain much higher than the rate which Europe experienced in 1950-1955. In 1995-2000, Africa had an estimated IMR of 91 per 1000 compared to 10 per 1000 in Europe (Table 2). Other regions of the world fall somewhere between the two extremes. Overall, infectious and parasitic diseases, respiratory infections and malnutrition are noted to be the major causes of morbidity and mortality in Africa.

TABLE 1. EXPECTATION OF LIFE AT BIRTH (YEARS) BY MAJOR AREA, REGION AND SEX , 1950-1955, 1975-1980, 1995-2000

Source: United Nation, 2001. World Population Prospects, 2000, pp. 616-640

4. Migratory Movements

In Africa, internal migration is characterized by the movement of people from rural areas to urban areas (rural-urban drift) or between the rural areas themselves. In most cases, such migration leads to an uneven spatial distribution of the rural population and to an excessive concentration of the urban population in the cities. Compared to other continents, the main feature of Africa migration lies in the continents recent experience of urbanization characterized, on the one hand, by a low degree of urbanization and, on the other hand, by high growth rates of the urban population. Accordingly, from 1950 to 1970, the annual growth rate of Africa's urban population, which was estimated at 4.7 per cent, was only very slightly higher than the 4.3 per cent estimated for Latin America and Asia. Nevertheless, while the rate was diminishing in other developing regions, it continued to increase in Africa where it reached 5 per cent in 1970-1990 compared to 3.4 per cent in Latin America and 4 per cent in Asia. By the end of the century, the rate was estimated to be 4.8 per cent in Africa (leading to a doubling of the urban population in 15 years only).

TABLE 2. INFANT MORTALITY RATES PER 1000 BY MAJOR AREA AND REGION 1950-2000

Source: United Nation, 2001. World Population Prospects, 2000, pp. 644-650

The types and patterns of external migration are relatively well known in Africa (UNECA, 1983a). In West Africa for example, people move from such landlocked Sahelian countries as Burkina Faso and Mali to the more developed coastal farming or mining countries such as Cote d'lvoire and Ghana. In Southern Africa, the migratory flows towards the gold mines of South Africa from Botswana, Lesotho, Malawi, Mozambique, Swaziland and Zimbabwe have, for several years, been one distinctive aspect of migration in that sub-region. In North Africa, international migration is chiefly oriented towards the countries of Western Europe and, more recently, towards the oil producing countries of the Arabian Peninsular, the Persian Gulf and the Libyan Arab Jamahiriya.

While the overall trends are known, the paucity of statistics in Africa (mostly from censuses) and the irregularity of most of these movements do not allow for an accurate assessment of international migration. It is probably more substantial than the net negative migration rate of 0.1 per thousand estimated for the whole continent over the period 1990-1995. Therefore while all the estimates made to date on migration in Africa have invariably shown a net negative migration, the numbers of immigrants have been too few to have any impact whatsoever on the dynamics of domestic natural population change.

In the case of the massive movement of refugees, the problem began to arise in the 1960s when the total number was estimated in 1964 at 400,000. This figure rose to 500,000 in 1970, then to 3 million in 1979 before going on to a peak of 5.4 million in the 1990s, accounting for one third of the refugees in the world (ECA 1991). While countries of origin and destination of refugees have changed over the years, the major countries affected by refugee movements continue to be those in Central and Eastern Africa (particularly Burundi, Democratic Republic of the Congo, Ethiopia, Malawi, Rwanda, Somalia, Sudan and Tanzania) and, more recently, in West Africa ( Cote d'Ivoire, Guinea, Liberia and Sierra Leone).

Domestic and external migration in Africa, just like refugee movements, traditionally occurred as a reaction to adverse climatic, economic, socio-demographic and political conditions and to the series of international crises which affected most African countries. Chief among the reasons for such migration were the factors of rapid population growth, slowing or declining agricultural productivity, drought and desertification, natural disasters, conflicts, the debt overhang and balance of payments difficulties (Adepoju, 1988).

B. Selected Socio-economic Factors

1. Status of women and the elderly

The status of African women compared with that of men remains low in contrast to the developed regions of the world. Also very rapid and severe erosion of traditional family support systems due to, among other factors, rapid urbanization and industrialization and poor economic conditions may portend difficult years ahead for the African elderly as many countries lack old age security and alternative living arrangements for the elderly. The low status of women and insecurity in old age are some of the factors known to support the desire for many children.

2. Illiteracy

Illiteracy rates (for adults 15 years and more) are highest in Africa reaching almost 85 per cent (80 per cent for males and 93 per cent for females) in countries like Niger compared to other regions of the world where the highest recorded rates are 54 per cent for males and 84 per cent for females in Afghanistan (Asia), 7 per cent for males and 13 per cent for females in Macedonia (Europe), 53 per cent for males and 59 per cent for females in Haiti (Latin America & the Caribbean), and none in North America and Oceania (UNDP 2001, UNFPA 1999). Except for a few countries like Botswana, Lesotho and Namibia, enrolment rates in primary and secondary schools for girls are always lower than those for boys.

3. Economic Situation

The Human Development Report of 2001 indicates that Africa is the poorest region of the world. Within the continent, Southern Africa and North Africa are relatively better off regions than the rest of the regions (Table 3). East Africa turns out to be strikingly the poorest region.

It is estimated that assuming an average population growth rate of 2.8 per cent for sub-Saharan Africa, a GDP growth rate of 8 per cent is required to achieve poverty reduction in the region (UNECA, 2001). Yet Africa's overall economy grew by an estimated rate of only 3.2 percent in 1999. This suggests that if the poverty reduction objectives are to be achieved, simultaneous efforts should be made to reduce the pace of population growth while increasing the rate of economic development.

Table 3 Per capita income (US$) by major regions in Africa, 1998 and 1999

Region	1998		1999
	Income level	Income growth	Income level	Income growth
North Africa	1264	1.92	1273	0.70
West Africa	409	1.01	411	0.42
Central Africa	937	3.75	953	1.22
East Africa	177	-1.11	179	1.18
Southern Africa	1388	1.79	1379	-0.64
Africa	688	0.72	690	0.35

Source: UNECA, 2001. Transforming Africa's Economies: Overview, pp.50-51

4. Nutrition and food availability

Available statistics reveals that the number of chronically undernourished people in the region increased from 89 million in 1969-71 to 126 million in 1979-81, to 164 million in 1990-92, and then to 180 million in 1995-97 (FAO, 1996). Food insecurity is expected to accelerate substantially in the future such that by the year 2010, every third person in Sub-Saharan African could be food insecure compared with every eighth person in South Asia and every twentieth person in East Asia.

5. Urbanization

During the last two to three decades, Sub-saharan Africa (SSA) experienced the highest growth rates in urbanization in the world except for East Asia and the Pacific which experienced a growth rate of 11.5 per cent between 1980 and 1991(UNECA, 1983b). The fastest growing urban areas in Africa were in Mozambique and Tanzania with average urban growth rates of over 10 per cent between 1970 and 1995. Other countries with average urban growth rates exceeding 6.5 per cent during the period include Burkina Faso, Burundi, Rwanda, Niger, Gabon, Kenya, Lesotho and Mauritania. The most highly urbanized countries in which over 50 per cent of the population lived in urban areas by 1995, however, are Algeria, Congo, Gabon, Mauritius, South Africa and Tunisia. Other countries in which urban populations constitute 45 per cent or more of the total population are Egypt, Morocco and Zambia.

6. Health

Available information indicates that almost the entire population of Egypt, Mauritius, and Tunisia had access to health care in 1980 and 1993 (World Bank, 1997). In Morocco and Nigeria, about two-thirds of the population had access to health care. Information on other important indicators of the health situation in African countries were also gathered by the UNCTAD (UNCTAD, 1997). Burkina Faso, Central African Republic (CAR), Chad, Ethiopia, Malawi, Niger, Tanzania and Rwanda had the largest population per physician. Between 1970 and 1990 the population per physician was reduced by almost 50 per cent in Burkina Faso, CAR, Chad, Mali and Niger.

Currently, the continent is gravely affected by HIV/AIDS, tuberculosis and malaria. In the case of HIV/AIDS, the following facts are noted as of 1998 (UNFPA, 98/99):

· Africa with about 13 percent of the world's population has 68 percent of global HIV/AIDS cases.

· 95 percent of Africans infected with HIV/AIDS live in abject poverty.

· About 90 percent of all HIV transmission in Africa occurs via heterosexual sex. This is 100 per cent preventable.

· About eight million children in Sub-Saharan Africa are orphaned by AIDS.

· Progress in raising child survival rates has been reversed in many parts of sub-Saharan Africa where nearly 94 percent of the world 3.2 million child AIDS deaths have occurred.

· AIDS has lowered average life expectancy levels by 10-20 years in some African countries. In hardest hit countries, such as Zimbabwe, AIDS has reduced life expectancy by more than 20 years. Life expectancy in Botswana is projected to fall to 41 years by the year 2005, 29 years less than expected in the absence of AIDS.

· AIDS has overtaken malaria and other diseases as the leading cause of death for adults between the ages of 15 and 49 in Botswana, Burundi, Malawi, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe and in capital cities such as Abidjan, Addis Ababa, Nairobi and Ouagadougou.

C. Selected Demographic and Socio-economic indicators in eight countries selected for the study

The countries selected for the study include Botswana, Cameroon, Egypt, Madagascar, Mali, Mauritius, Nigeria and Tunisia. Botswana, Mauritius and Tunisia are well known examples of countries experiencing sustained fertility and mortality decline. The rest of the countries are undergoing delayed demographic transition. Mortality and fertility levels and trends in these countries indicate that the rest of the selected countries are in stage II of the transition. In addition, care has been taken to ensure that at least one country has been selected to represent each of the sub-regions of Africa.

In this subsection, a brief examination of selected demographic and socio-economic indicators is given for the selected countries.

1. Demographic and Socio-economic Indicators

a) Growth rates

Between 1975-99 all the selected countries except Mauritius, experienced population growth rates of over 2 per cent (Table 4). In the period 1999-2015, however, Botswana, Mauritius and Tunisia are projected to experience growth rates of 1.2 per cent or less. The rates for the other countries are going to be much higher than these.

b) Population under 15 years

The proportions under age 15 will continue to constitute major components of the population of the countries under study due to the in-built momentum of growth (Table 4). But countries which have experienced a relatively longer period of sustained demographic transition such as Mauritius and Tunisia will have dramatically reduced proportions in the year 2015.

TABLE 4: DEMOGRAPHIC AND SOCIO-ECONOMIC TRENDS INDICATORS

Note: a) Because data are based on national definitions of what constitutes a city or metropolitan area, cross-country comparisons should be made with caution.

b) Data refer to medium variant projections

c) Data refer to estimates for the period specified.

Source: UNDP. 2001. Human Development Report , pp 154-157

c) Population aged 65 and over

The population over age 64 will increase over time as countries experience thedemographic transition. Among the selected countries, Mauritius and Tunisia provide good examples of the ageing process as the transition progresses (Table 4).

d) Fertility indicators

During the period 1970-75 all the selected countries, except Mauritius, had total fertility rates of over 5 children per woman (Table 4). In the period 1995-2000, however, Botswana, Egypt and Tunisia had joined Mauritius in having rates under 5 children per woman.

e) Mortality rates

Since the 1950's, mortality rates have experienced incipient decline in all the selected countries. For example, the decline in infant mortality was from 175 per thousand in 1975 to 35 per thousand in 1990 for Tunisia (Table 5). Overall, the mortality rates of children under age five reached levels of 21.2 per thousand in Tunisia and 81.2 per thousand in Botswana.

The values of life expectancy estimated for males and females separately reflect the expected biological advantage of females over males as well as the continued mortality decline in the eight countries, except Botswana, up to 1995. The dramatic drop from 1990 to 1995 in life expectancy in Botswana is a further reflection of the devastating effects of HIV/AIDS on the survival of the population.

TABLE 5. MORTALITY TRENDS INDICATORS

Source: United Nations, 2001.

2. Socio-economic Indicators

a) Urbanisation

The evolution of urbanisation among the eight countries reached at least 25 per cent in 1999 (Table 4). The most dramatic change took place in Botswana where the proportion urban changed from 12.0 per cent in 1975 to 49.7 per cent in 1999, and is expected to reach 58.4 per cent in 2015. The proportions will range from approximately 40 per cent for the least urbanised country to 73 per cent in Tunisia in the year 2015.

b) Human Development Index

The Human Development Index recorded in 1999 indicates that among the selected countries, Mauritius had the highest index 0f 0.765 and Nigeria had the lowest index of 0.455 (Table 6). The countries observed to be experiencing sustainable demographic transition had indices above 0.600 from 1985 to 1995. But in 1999, Botswana's index dropped to 0.577. This is most likely due to the dramatic drop in life expectancy resulting from the effects of HIV/AIDS.

TABLE 6. TRENDS IN HUMAN DEVELOPMENT INDEX ^a

Country	Index
	1975	1980	1985	1990	1995	1999
Botswana	0.495	0.558	0.615	0.654	0.621	0.577
Cameroon	0.407	0.453	0.502	0.511	0.497	0.506
Egypt	0.433	0.481	0.531	0.573	0.603	0.635
Madagascar	0.398	0.431	0.425	0.432	0.439	0.462
Mali	0.251	0.277	0.291	0.310	0.344	0.378
Mauritius	0.628	0.655	0.685	0.721	0.745	0.765
Nigeria	0.326	0.386	0.402	0.423	0.447	0.455
Tunisia	0.512	0.564	0.611	0.644	0.680	0.714

Note: a) The index is calculated by UNDP on the basis of date on life expectancy: adult literacy rates; combined primary, secondary and tertiary gross enrolment rations; GDP at market prices (constant 1995 US$); and population and GDP per capita (ppp US$).

Source: UNDP, 2001. Human Development Report pp. 145-148

c) Social Security Programmes

A survey of social security programmes indicates that all the selected countries have programmes related to old age, disability and death; sickness and maternity; work injury; and unemployment. But these programmes vary in their coverage of the population. The best organised programmes identified were those of Mauritius (whose programme covers all citizens for old age, disability and death; sickness and maternity; and unemployment); and Botswana, which covers all citizens for old age, disability and death (Table 7). The programmes in the rest of the countries largely cover employees in the formal sector (a very small proportion of the population).

Table 7. Social Security Programs in Selected African Countries

Source: US Social Security Administration; Office of Policy (1999).

d) Fertility by background characteristics

Available information indicates that fertility is generally lower in urban than rural areas, and for women with secondary or higher education than for those with lower education (Table 8).This is largely due to the fact that women with higher education delay their marriage and are more empowered to use contraceptives to plan their child bearing than women who are less educated. On the other hand, women in urban areas are more educated than women in rural areas.

TABLE 8: FERTILITY BY BACKGROUND CHARACTERISTICS