Download World Bank Policy Research Bulletin November-

World Bank Policy Research Bulletin
November--December
Volume 5, Number 5
1994
Population policies for Sub-Saharan Africa
The population of Sub-Saharan Africa is growing at 3 percent a year. It has already doubled
since the 1960s, and at its current rate of growth will double again in 22 years. By comparison,
the population of South Asia, the developing region with the next highest rate, is growing at 2.2
percent a year and global population is growing at 1.7 percent a year. At the same time,
economic growth in Sub-Saharan countries in recent years has been disappointing. Between
1965 and 1988 per capita gross national product (GNP) for Sub-Saharan Africa grew by only 0.2
percent a year. During the 1980s GNP per capita declined by 2.6 percent a year. Further, human
capital in the form of schooling and other training is low, and in many countries school
enrollment rates have fallen.
Today's high birthrate coupled with slow growth in incomes is producing a rapidly growing labor
force with low levels of human capital---not a good prospect for improved living conditions.
Further, by the end of the century the number of people in poverty in Sub-Saharan Africa will
have increased by 100 million since 1985.
Not all of Africa's development problems can be directly attributed to population growth, and
reducing the rate of population growth alone will not be sufficient to improve the quality of life,
absent other supportive policies. But there is widespread concern that rapid population growth is
constraining African development. At the same time, low quality of life, high child mortality,
and economic uncertainty predispose couples to want large families. This means that slowing
population growth must involve policies to reduce high fertility and child mortality while raising
population quality.
Recent demographic surveys show that both fertility and child mortality are high in Sub-Saharan
Africa. The average total fertility rate is between six and seven children per woman, the highest
of any developing region. Child mortality has declined steadily since World War II. As many as
30 to 40 percent of African children died before their fifth birthday in the 1950s, but by the mid1970s this figure had been reduced to about 20 percent. Nevertheless, infant and child mortality
remains relatively high. In 20 countries infant mortality rates are over 100 per thousand, and in
five countries the rate is greater than 140 per thousand.
There are pockets of women who want fewer children and who lack easy access to family
planning. But by and large, desired family size is still high---between six and nine children per
woman. So, lowering fertility and raising contraceptive use will rely on both improving
socioeconomic conditions associated with reduced demand for children and increasing the
effectiveness of family planning programs in attracting clients. Designing such policies will
require good estimates of the effect of different social policies on fertility and on contraceptive
use. This article summarizes the key findings of a World Bank research project on the economic
and policy determinants of fertility in Sub-Saharan Africa.
Women's schooling and fertility
Women's schooling can lower fertility by:
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Improving economic opportunities for women and thus raising the cost of their time,
which is a major input into child-rearing.
Raising the demand for child schooling, prompting parents to reconsider the number of
children they can afford.
Lowering child mortality and thus reducing the number of births necessary to ensure
survival of a desired number of children.
Improving the effectiveness of contraceptive use.
Improving the status, bargaining power, and independence of women.
At the same time, schooling may inadvertently raise fertility through improved maternal health
(lowering pathological sterility) or through reduced duration of breastfeeding and its
contraceptive benefits.
The research project examined the relation between women's schooling and fertility in 15
countries, using data from the Demographic and Health Surveys and the Living Standards
Measurement Surveys. The mean levels of completed schooling among women of reproductive
age in the samples were quite low---from less than two years in Burundi, Cote d'Ivoire, Mali,
Niger, and Senegal to six years in Zimbabwe. While the mean levels are low, there are very few
women in the data sets with exactly the mean level of schooling. The share of women of
reproductive age with no schooling ranges from more than 75 percent in the Sahelian countries
and in Burundi to 21 percent or less in Botswana, Zambia, and Zimbabwe.
The study found that, overall, increased schooling for women is associated with lower fertility.
In eight countries both primary and secondary schooling among women are associated with
lower fertility, and in seven women's schooling has no negative effect on fertility until the
secondary level (figure 2).
Husbands' schooling similarly is a proxy for the value of their time, but we don't expect it to
affect the costs of children, since men spend less time in child-rearing. But husbands' education
can also be used as a proxy for household wealth or income. To look at the effect of husbands'
schooling on wives' fertility, all never-married women were dropped from the sample,
eliminating as many as 45 percent of the women in some countries.
In four countries only women's schooling significantly lowers fertility and husbands' schooling
has no impact. In eight countries both women's and husbands' schooling lower fertility, but the
effect of women's schooling is greater. In Burundi neither women's nor husbands' schooling has
a negative effect, and in Niger only the husband's schooling matters in the restricted sample of
ever-married women.
Women's schooling and contraceptive use
Women's schooling is positively associated with use of modern contraceptive methods in all the
countries studied, and the relation steepens with higher levels of schooling.
The relationship between women's schooling and contraceptive use can be expected to change as
average levels of schooling, women's status, and availability of family planning services are
improved. In Botswana, Senegal, Zambia, and Zimbabwe women's schooling has a statistically
significant and positive relation with contraceptive use. But the slope of the predicted
relationship and the intercept for women with no schooling is quite different. This can be
explained by differences across countries in the levels of women's schooling (fewer than two
years in Senegal, five years or more in the others), the availability of family planning (best in
Botswana and Zimbabwe), job opportunities for women, and so on.
The curves show the relationship for marginal (small) increases in women's schooling. Large
increases can affect the slope of the curve as well as shift the curve upward. So, raising women's
schooling from three years to six years in Senegal, for example, could be expected to have a
much larger effect on contraceptive use than is implied by the slope of the curve in figure 3; it
would shift the curve upward, in the direction of the curves for Botswana and Zimbabwe.
Family size and child schooling
Schooling policies can also lower fertility by encouraging parents to have fewer children in order
to increase schooling and other human capital investments for each child.
The project found evidence of such a tradeoff between number of children and child schooling in
urban Cote d'Ivoire and in both rural and urban areas of Ghana: higher incomes are associated
with higher child schooling and lower fertility. In rural areas of Ghana increased female
schooling has the same effect. In rural areas of Cote d'Ivoire, however, higher incomes are
associated with higher schooling and higher fertility.
Quality, price, and availability of family planning
The characteristics of health facilities and pharmacies offering family planning affect the cost of
averting births. Lower prices, better access, and higher-quality services should raise
contraceptive use and lower fertility.
The project studied the impact of the quality, price, and availability of family planning in Ghana,
Nigeria, Tanzania, and Zimbabwe, where in-depth surveys of service providers could be linked
to contraceptive use in household surveys. Reduced distance to or improved availability of
specific services is associated with higher current use of contraception in all countries except
Tanzania. The availability of specific methods is associated with higher use in Nigeria and
Tanzania (pill, injection) and in Ghana (spermicides). The results reveal the potentially important
role of pharmacies in expanding contraceptive use in Nigeria and Tanzania.
Additional methods do not have an impact in Zimbabwe, where the family planning program
relies heavily on the pill. But the limited variation in the methods offered in Zimbabwe could
account for the lack of results.
Child mortality
Infant mortality in the 15 countries ranged from 36 per thousand in Botswana to 161 per
thousand in Mali. In six of the countries rates exceed 100 per thousand.
High child mortality rates may encourage large families as parents have more children to replace
children who die. Couples also may raise their fertility in response to high child mortality in their
community. At the same time, high fertility may raise child mortality through the effects of
frequent, closely spaced pregnancies on the mother's capacity to bear healthy children and the
strain that large families can place on household resources.
In 14 Sub-Saharan countries an additional year of women's schooling is associated with a
reduction in the mortality rate of children under two of six to nine per thousand. In-depth studies
found that women's education has a smaller impact on reducing child mortality in C™te d'Ivoire,
where levels of schooling are very low, than in Ghana, where female schooling is more
widespread. Proximity to health care also is associated with lower child mortality in C™te
d'Ivoire, where the average distance to health care is 12 kilometers. But that is not the case in
Ghana, where facilities already are much closer to households (7 kilometers, on average). In both
countries, on average, women compensate for child mortality by having one more birth for every
five child deaths they experience.
Conclusions
This research points to a number of socioeconomic and policy determinants of fertility in SubSaharan Africa on which to base effective policies to slow population growth and improve
population quality. Foremost among these factors is women's schooling, which is by far the most
consistently significant determinant of fertility and contraceptive use. With only a few
exceptions, levels of female schooling are very low across the continent. In most cases men's
schooling also is relatively low. So, most governments face the task of raising levels of schooling
for both men and women, but particularly for women. Schooling policies also will affect the
number of children in the short run by prompting couples to improve child quality and have
fewer children. Curbing child mortality is another essential policy for lowering fertility.
The study also shows that easing constraints in the provision of family planning services would
result in higher contraceptive use. Physical access to services is limiting contraceptive use in
rural Ghana, Nigeria, and Zimbabwe. In Nigeria and Tanzania improved availability of methods
through pharmacies would increase use.
Given these results, it comes as no surprise that the three countries with declining fertility--Botswana, Kenya, and Zimbabwe---have the highest levels of female schooling, the lowest levels
of child mortality, and the widest availability of family planning services. Nor is it unexpected
that fertility remains very high in countries such as those in the Sahel---where child mortality is
the highest, female schooling is the lowest, and family planning services are in least supply.
More difficult to explain are the countries in between the extremes, such as Cameroon, Ghana,
Nigeria, Tanzania, and Zambia. For example, female schooling is relatively high in Ghana and
the family planning program is an old one, yet fertility remains high and female schooling has a
weak effect. Some explanation might be sought from information on labor markets in the
different countries: the rates of return to schooling in the Ghanaian labor market are low at the
primary level.
The project was not able to quantify the effect of a very important set of policies: those (other
than education) that affect the status of women. Specifically, these include laws governing
marriage and divorce, inheritance, ownership of property, employment opportunities, and access
to credit.
See Martha Ainsworth, ''Socioeconomic Determinants of Fertility in Sub-Saharan Africa,'' a
summary of the findings of a World Bank research project, Policy Research Department,
Washington, DC, 1994