Sub-Saharan Africa:The Challenge of High Fertility

Sub-Saharan Africa:The Challenge of High Fertility

John F. MayLead Population Specialist

Africa Region, World Bank

Washington, DC, July 16, 2008

SSA annual rate of growth: 2.5% (it could even accelerate if mortality declines faster)

Total population could reach 1.8bn people by 2050 - from 800 million today - if fertility declines rapidly

TFR is above 5 today and needs to decrease to 2.5 in 2050 to match these projections

HIV/AIDS will not fundamentally change the demographic equation (except in Southern Africa)

2 out of 3 people are under 25 (youth bulge)

Key demographic features

Health rationale as highlighted in “Fertility Regulation Behaviors and Their Costs”

Reduce population pressure on land tenure and ecosystems

Human capital investments (e.g., education and health) and fiscal space

Rationale for intervention

Population Pyramid Mali, 2005

15 10 5 0 5 10 15

0-4

15-19

30-34

45-49

60-64

75-79

Ag

e

Male (%) FemaleSource: DNP/DNSI

Modifying the age structure (1)

Population Pyramid More Developed Regions, 2005

10 5 0 5 10

0-4

15-19

30-34

45-49

60-64

75-79

Ag

e Male (%) Female

Source: UN

Population Pyramid Mali, TFR = 2.1, 2035

10 5 0 5 10

0-4

15-19

30-34

45-49

60-64

75-79

Ag

e

Male (%) FemaleSource: World Bank calculations

Modifying the age structure (2)

Population Pyramid Mali, TFR = 3.0, 2035

10 5 0 5 10

0-4

15-19

30-34

45-49

60-64

75-79

Ag

e

Male (%) FemalesSource: World Bank calculations

Modifying the age structure (3)

Three key messages:

• The bottom of the population pyramid needs to take a rectangular shape to facilitate the formation of human capital

• Such a process will require the acceleration of the fertility transition

• Fertility will need to drop to low levels to change the shape of the population pyramid

Women do want services (large unmet needs)

Politicians, traditional & religious leaders, and civil society are more open to discuss Pop/RH issues

However

Need for more proactive policies

Scarcity of real champions

Weakness of M&E framework

Changing attitudes in SSA

A few key interventions vs. scattered programs:

Stronger and more persistent advocacy

More consistent provision of family planning and reproductive health services

Breastfeeding programs

Contraceptive security plans

Female education and legal reform (e.g., age at marriage)

More involvement of men

What can be done?