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The world is in the middle of a major demographic
transition. Its population continues to grow every year, but the pace of growth
has slowed as fertility rates decline. As population growth slows, the age
structure of the population is changing, with the share of the young declining
and that of the elderly growing. This changing age structure has important
implications for economic and social policies and hence for sustainable
development.
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But different
countries and regions are at varying stages of this transition, depending on
their fertility, mortality, and migration trends, creating a “demographic
divide” between countries (Kent and Haub 2005). In much of the industrial world
increasing life expectancy and aging populations have coincided with income
growth, healthier lifestyles, and fertility rates that are below population
replacement levels. For these countries there will be little change in future
population size in the absence of inmigration. In fact, large increases in
inmigration or in the retirement age would be needed to stabilize the labor
force and maintain current labor force to population ratios. In developing
countries fertility rates have also declined but remain much higher than in
industrial countries, and fertility rates vary considerably across regions:
high in Sub-Saharan Africa and the Middle East, but low in East Asia. Except in
the transition economies of Eastern Europe, where fertility rates are near or
below replacement levels, the population in developing countries will continue
to grow well into the twenty-first century, and outmigration will only modestly
reduce the population growth rate.
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Technology, consumption patterns, unequal distribution
of wealth, and the choices people and governments make all affect demographic
trends. These, in turn, affect social and economic outcomes, and, consequently,
what place these countries will take on the world stage in the future.
Sub-Saharan African countries are trailing most others in their progress
through the demographic transition. And if economic growth continues to lag
behind population growth, as was the case in the early 1990s, it will
exacerbate poverty in the region.
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The
challenges facing Sub-Saharan Africa as
it strives to meet its development
objectives are more daunting than those
facing other regions. Its efforts to
alleviate poverty, empower women, reduce
child mortality, and improve maternal
health have been undercut by the AIDS
epidemic, by conflict, and by human
displacement in the wake of natural
disasters. In the past three decades its
population has grown faster than that of
any other region, doubling between 1975
and 2000 and now growing at 2.5 percent
a year. Roughly 47 percent of the
Sub-Saharan population is between the
ages of 5 and 24, indicating that the
population will continue to increase
well into the twenty-first century. This
large cohort will require substantial
increases in future spending on health,
education, and care for dependents.
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Too little is being said about the
challenge of continuing rapid population
growth to African development. One
possible reason for this may be that the
success of fertility reductions in other
regions and in some African countries
has left the impression that the
population problem has been solved
(Cleland and Sinding 2005). Fertility
rates have declined dramatically in the
past 25 years where governments have
increased investments in education and
in women’s reproductive health (table
2a). Globally, contraceptive prevalence
increased from 54 percent in 1990 to 59
percent in 1995 and to more than 60
percent in 2003 (box 2b). |
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East Asia & Pacific |
5.4 |
3.0 |
2.1 |
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Europe & Central Asia |
2.5 |
2.2 |
1.6 |
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Latin America & Caribbean |
5.3 |
4.2 |
2.4 |
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Middle East & North Africa |
6.7 |
6.2 |
3.1 |
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South Asia |
6.0 |
5.2 |
3.1 |
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Sub-Saharan Africa |
6.8 |
6.7 |
5.4 |
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High-income |
2.5 |
1.9 |
1.7 |
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World |
4.8 |
3.7 |
2.6 |
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Source:World Bank
database. |
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The use of family planning among married women worldwide rose from
10 percent in 1960 to more than 60 percent in 2003. Due in part to modern
contraception, the decline in fertility and the shift to smaller families
occurred faster in developing countries—in only a few decades—than
had occurred in industrial countries, where the transition to low fertility
began in the 1830s. Crude birth rates were about 37 per 1,000 people in
pre-Revolutionary France and 42–43 in the 1850s in the United States,
before gradually commencing a decline to their current levels of 8 per
1,000 people. |
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What contributed to smaller families? Organized family planning
programs bringing contraceptive supplies and services to the people,
along with information campaigns promoting smaller, healthier families.
Studies in the 1990s showed that these programs were responsible
for about half the fertility decline of developing countries since the
1960s. Even couples in remote rural communities in Bangladesh and
Vietnam gained access to modern contraceptives through nationwide
family planning programs. |
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Contraceptive prevalence is a key determinant of declining fertility.
Based on the current use of family planning services, contraceptive rates
are not expected to increase rapidly because of Africa’s widespread
poverty, high rates of illiteracy, largely rural populations, and strong
traditional preferences for large families. However, there is an emerging
preference for spacing and limiting births among married women
of reproductive age in African countries, ranging from 10 percent to
35 percent. The increased availability of contraception has reduced
the gap between the number of women who want to limit births and
those who can in most countries. But in some countries unmet need
remains high. |
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The slowdown in population growth
(table 2c) can be traced to these
fertility declines. In Europe and
Central Asia women now have on average
only 1.6 births—too few to replace
today’s population. At the other
extreme is Sub-Saharan Africa, with
average fertility remaining very high. |
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East Asia & Pacific |
2.0 |
1.6 |
1.2 |
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Europe & Central Asia |
1.3 |
0.9 |
0.1 |
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Latin America & Caribbean |
2.6 |
2.0 |
1.6 |
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Middle East & North Africa |
2.6 |
3.0 |
2.1 |
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South Asia |
2.2 |
2.2 |
1.8 |
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Sub-Saharan Africa |
2.6 |
2.9 |
2.5 |
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High-income |
1.1 |
0.7 |
0.8 |
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World |
1.9 |
1.7 |
1.4 |
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Source:World Bank
database. |
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Even in Sub-Saharan Africa regional
figures mask huge differences across
countries (table 2d). In South Africa,
Botswana, Zimbabwe, and Lesotho
fertility continues to decline as a
result of successful family planning
programs. Of women ages 15–49, 54
percent were using contraception in
Zimbabwe and 48 percent in Botswana,
compared with 14 percent in Niger and
8 percent in Chad in the past decade.
Even in countries with high fertility,
the rates vary by socioeconomic
status. In Benin the fertility rate
was 7.3 births for women in the lowest
asset quintile and 3.8 for women in
the richest quintile. |
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Niger |
7.7 |
Lesotho |
3.5 |
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Uganda |
7.1 |
Zimbabwe |
3.4 |
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Guinea-Bissau |
7.1 |
Botswana |
3.1 |
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Mali |
6.9 |
South Africa |
2.7 |
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Burundi |
6.8 |
Mauritius |
2.0 |
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Source: World Bank
database. |
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Sub-Saharan Africa is becoming
fragmented in its fertility declines.
There are several reasons for this.
The logistical and cultural challenge
of delivering family planning
programs, the often poor quality of
health services, ignorance about
reproductive health issues,
differences in economic status, and
continuing gender inequality all
contribute to high fertility rates.
Desired family size, though decreasing
slowly over past decades, remains
high—as high as eight children in some
African countries (table 2e). By
contrast, the desired family size in
South Asia is typically fewer than
three children. |
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Cameroon (2004) |
5.7 |
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Bangladesh (1999/2000) |
2.5 |
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Chad (1996/97) |
8.3 |
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India (1998/99) |
2.6 |
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Eritrea (2002) |
5.8 |
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Nepal (2001) |
2.6 |
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Niger (1998) |
8.2 |
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Source: Demographic and
Health Surveys. |
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High desired family sizes are
associated with high infant mortality
rates. But when birth rates began to
drop in Bangladesh and Nepal in the
1980s their infant mortality rates
were higher than those in many western
and central African countries (Cleland
and Sinding 2005). |
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Another reason for high fertility
rates is that contraceptive prevalence
rates remain low. For 9 of 20 African
countries that conducted Demographic
and Health Surveys between 1999 and
2005, contraceptive use, including
traditional methods, was less than 10
percent for women ages 15–49. Compare
that with other regions, where on
average 40 percent of women were using
a method of contraception. In addition
to contraceptive use, the method of
contraception is also important for
sustained fertility declines. In
countries with low contraceptive
prevalence, fewer women use modern
methods, further diluting the effect
of low contraceptive use on fertility
(table 2f). Of 17 African countries
that conducted Demographic and Health
Surveys between 2000 and 2004, in 8 of
them use of modern methods was
estimated at less than 10 percent. |
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Kenya |
39.3 |
31.5 |
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Madagascar |
27.1 |
18.3 |
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Benin |
18.6 |
7.2 |
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Burkina Faso |
13.8 |
8.8 |
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Nigeria |
12.6 |
8.2 |
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Bangladesh |
58.5 |
47.6 |
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Haiti |
28.1 |
22.8 |
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Cambodia |
23.8 |
18.8 |
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Source: Demographic and
Health Surveys. |
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Finally, HIV/AIDS has affected
fertility and mortality trends in
Sub-Saharan Africa. AIDS-related
deaths among working-age adults in the
seven worst AIDS-affected countries
will produce an age structure not seen
before, with large numbers of old and
very young and a relatively small
working-age population. But recent
data indicate that prevalence among
pregnant women attending antenatal
clinics in Zimbabwe is declining in
all age groups. In South Africa, with
the largest number of infected people,
rates of HIV infection among pregnant
women ages 15–24 have stabilized since
2000. HIV prevalence among pregnant
women has declined countrywide in
Kenya and Uganda (UNAIDS and WHO
2005). But in western and central
Africa there is no consistent evidence
of declining prevalence among pregnant
women in recent years. And overall in
Sub-Saharan Africa the prevalence of
HIV infections in people ages 15–49
has remained at about 7 percent since
2000. So while life expectancy has
fallen in some cases, fertility
remains stubbornly high for many
Sub-Saharan African countries, and
high fertility remains the dominant
influence on current and future
population growth and size. |
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In many West African countries, where
HIV prevalence has remained lower than
in other regions in Africa, more women
die from unsafe abortions than as a
result of AIDS (Population Action
International 2006). If African
nations can expand the capacity and
quality of family planning sevices,
that will bring about much needed
declines in fertility rates while
strengthening the status of women.
Until this happens, continuing high
fertility rates and rapid population
growth may prove a more serious
obstacle to poverty reduction than
will AIDS. |
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The population of Sub-Saharan Africa
has grown from 225 million in 1960 to
733 million in 2004. The World Bank
projects a doubling of the population
to 1.4 billion by 2050, increasing the
region’s share of the world population
from 13 percent today to 20 percent.
Fertility rates will remain over 3.5
births per woman until 2025, producing
a youthful age structure, with a large
proportion of children under 15 years
old. Comparisons with South Asia,
another region with high fertility,
show that the fertility transition in
Sub-Saharan Africa lags one generation
behind (figure 2g). |
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Source: World Bank staff
estimates. |
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Very rapid population growth is
expected to continue in several
African countries, with the population
likely to triple in Burkina Faso,
Burundi, Chad, Democratic Republic of
Congo, Republic of Congo,
Guinea-Bissau, Liberia, Mali, Niger,
and Uganda (United Nations 2005).
Among the nine countries expected by
the United Nations to account for half
the world’s projected population
increase between 2005 and 2050, four
are in Sub-Saharan Africa: Democratic
Republic of Congo, Ethiopia, Nigeria,
and Uganda. |
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Although fertility rates have started
to decline in many Sub-Saharan
countries, the rates of decline are
expected to be more modest and to be
achieved over a longer period of time.
And they will occur at different
paces. For several decades fertility
declines in western and central Africa
are expected to lag behind those that
have already taken place in southern
Africa (table 2h). |
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Western Africa |
5.4 |
4.8 |
4.4 |
3.9 |
3.5 |
3.2 |
3.0 |
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Central Africa |
6.1 |
5.8 |
5.4 |
5.0 |
4.5 |
4.1 |
3.6 |
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Southern Africa |
2.7 |
2.5 |
2.4 |
2.3 |
2.2 |
2.1 |
2.0 |
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Source: United Nations 2005. |
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As average population growth slowed
globally over the past half century,
the range of national and regional
demographic experiences widened.
Growth rates remained high in many
African countries such as Burkina Faso
and Chad, while they plummeted in
countries in other regions, including
Italy, the Republic of Korea, and
Thailand. Other countries with
moderate growth rates—such as
Bangladesh, Brazil, India, and
Indonesia, which have had impressive
fertility declines—still have
considerable momentum for future
growth due to a young age structure. |
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Each demographic situation is
associated with its own social,
economic, environmental, and political
challenge (box 2i). What is of concern
about the demographic divide is not
the differences in population growth
rates, but the disparities in living
standards, personal well-being, and
future prospects associated with these
trends. |
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Future trends in population size, age structure, births, deaths, and other
demographic variables are of interest to policymakers, government planners,
and industry strategists. The reason: population forecasts can
imply a wide range of consequences for society and its environment.
Country projections became more accurate over the 1950s and 1960s,
as demographic data improved, but since then there have been few
significant improvements. |
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Fertility, mortality, and migration are the components of population
growth. While broad trends can be discerned and projected into the
future with reasonable confidence, substantial uncertainty is attached
to the specific trend for any country or region. Uncertainty arises in part
because the present demographic situation in any country is not known
perfectly. But the main cause of uncertainty is that future trends in fertility,
mortality, and migration are subject to unpredictable influences.
Future economic development; societal, cultural, epidemiological, and
environmental changes; or progress in science and technology cannot be
predicted. Uncertainty also arises from the fact that humans can influence
the future through deliberate policy intervention, such as investing
heavily in family planning and reproductive services. |
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Some demographers argue that population forecasts should not go
beyond a horizon of 30–35 years, due to the rapid increase in uncertainty
beyond this point. Others note, however, that if the forecast carries
an appropriate indication of the range of uncertainty, users can decide
when the informational content of the forecast ceases to be useful. |
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Source: NRC 2000. |
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People in Japan and Nigeria, with
populations of similar size in 2004
but at opposing ends of the divide,
have starkly different lives today—and
they face very different futures
(table 2j). In Japan the elderly
dependency ratio is expected to
increase dramatically, straining
government budgets because of higher
spending on pensions, health care, and
long-term residential care.
Econometric models suggest that the
projected decline in the working-age
population could result in lower
savings and investment rates and
slower GDP growth (IMF 2004). |
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Population (millions) |
137 |
205 |
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128 |
120 |
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Total fertility rate per woman |
5.6 |
3.3 |
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1.3 |
1.8 |
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Population ages 0–14 (percent) |
45.1 |
36.2 |
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14.8 |
12.5 |
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Population ages 65 and older (percent) |
2.7 |
3.4 |
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16.5 |
28.1 |
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Life expectancy at birth (years) |
45 |
52 |
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82 |
84 |
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Infant mortality rate (per 1,000 live births) |
98 |
72 |
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3 |
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Adults with HIV/AIDS (percent ages 15–49) |
5.4 |
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0.1 |
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Health expenditure per capita |
60 |
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2,476 |
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GNI per capita |
430 |
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37,060 |
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Source: World Bank database. |
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By contrast, in Nigeria, a microcosm
of Sub-Saharan Africa, per capita
growth could be boosted by the
increase in the working-
age population. With 36 percent of its
population under age 15 in 2025,
Nigeria has a considerable momentum
for future growth well into the
twenty-first century. This growth
depends, however, on the country
pursuing sound economic and social
policies to enable the large wave of
potential workers to acquire skills
and find productive employment. Its
inability to deal with a higher burden
of infectious diseases, lower
education levels, and limited
investment in health infrastructure
could result in very different
economic outcomes. Without investments
in physical stocks and human capital,
Nigeria’s population growth will exert
an unsustainable demand for public-
sector-provided health, education, and
other services.
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