Berlin Institute for Population and Development

Africa’s Demographic Trailblazers How falling fertility rates are accelerating development

+++ broad spectrum of demographic development +++ health workers improve child health in Ethiopia +++ rapid population growth in sub-Saharan Africa +++ regional trailblazers deploy effective measures +++ Tunisia remains a model for women’s rights +++ demographic bonus still a distant prospect for many African states +++ urbanisation accelerates falling fertility rates +++ more engagement necessary in demographic policy +++ growing educational opportunities for girls +++ no dividend without jobs +++ condom ads successful in Botswana +++ shift in the age structure generates economic upswing +++ About the Berlin Institute

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Africa’s Demographic Trailblazers

How falling fertility rates are accelerating development Imprint

June 2019

© Berlin Institute for Population and Development This work is protected by copyright. All rights reserved.

Published by the Berlin Institute for Population and Development Schillerstrasse 59 10627 Berlin Phone: (030) 22 32 48 45 Fax: (030) 22 32 48 46 E-Mail: [email protected] www.berlin-institut.org

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Translation: Tradukas GbR Design and Layout: Jörg Scholz (www.traktorimnetz.de) Printing: Laserline Berlin

Some thematic maps have been created with the programme EasyMap supplied by Lutum+Tappert DV-Beratung GmbH, Bonn.

ISBN: 978-3-946332-49-7

The authors:

Alisa Kaps, 1991, Master of Science in Economic and Social Geography at the University of Salzburg. Head of Department International ­Demography at the Berlin Institute for Population and Development.

Ann-Kathrin Schewe, 1992, Master in International Development from Sciences Po Paris, Master of Science in Business and Management from Stockholm School of Economics. Researcher at the Berlin ­Institute for Population and Development.

Dr. Reiner Klingholz, 1953, Doctorate from the Department of ­Chemistry at the University of Hamburg. Director of the Berlin ­ Institute for Population and Development.

The Berlin Institute would like to thank the Federal Foreign Office for funding the project. The Berlin Institute is solely responsible for the content of the study. CONTENTS

FOREWORD...... 4

THE KEY POINTS...... 5

1. WHY AFRICA’S POPULATION IS GROWING SO FAST AND WHAT THE INFLUENCING ­FACTORS ARE...... 6

2. AFRICA’S TRAILBLAZERS IN DEMOGRAPHIC CHANGE...... 16 2.1 ETHIOPIA...... 17 2.2 KENYA...... 20 2.3 BOTSWANA...... 22 2.4 GHANA...... 25 2.5 SENEGAL...... 27 2.6 MOROCCO...... 30 2.7 TUNISIA...... 32

3. LEARNING FROM EXPERIENCE AND USING NEW OPPORTUNITIES...... 35 3.1 HEALTHCARE...... 36 3.2 EDUCATION ...... 41 3.3 INCOME AND JOBS...... 44 3.4 THE WILL TO TRANSFORM...... 45

SOURCES...... 47 WHEN LESS MEANS MORE

The question of how many children people While the highly developed states of the Many countries in Asia that once had little have, how large their families are and how northern hemisphere have some catching up hope of experiencing positive development quickly an entire population multiplies, to do in changing their production and were able to benefit from the demographic touches on sensitive issues. No country or consumption patterns, the African states are dividend and rise to become threshold and individual appreciates external interference increasingly concerned with the question of industrialised countries. Some African in such issues or in the decisions they make their own population growth. For a long countries have now started embarking on about them. The right to reproductive self- time, the region was regarded as sparsely this path, too. It is worth examining the determination is one of the universal basic populated and a larger population was political, social and economic framework rights identified by the United Nations and a thought to be an advantage, because more conditions for this development more closely, goal of human rights-based policy. people means more productive forces, more for much can be learned from the countries consumers and therefore economic growth. that serve as examples here. In addition, they Nevertheless, the question of whether and In the meantime, however, it has become can provide models for other countries on the how strongly a population grows is not only clear that for many countries the increasing continent. a private matter but also a social concern. A number of inhabitants is hampering high fertility rate and strong population development to an ever greater degree. This study describes how some of the growth become a national issue when the Wherever the provision of essentials governments of Africa are tackling the issue, number of people increases much more becomes difficult to guarantee, the danger which instruments they are using to influence rapidly than the number of jobs and exceeds of social conflict grows. population growth directly or indirectly and the capacity of the country to provide how successful they have been. Others necessary infrastructure such as health should be encouraged to follow their services, schools and housing. Sustained Falling fertility rates are the example. population growth does not work in any prerequisite for and a consequence of case on a planet with limited space and development resources any more than a way of life that Berlin, June 2019 threatens the foundations of human The experiences of other countries that have existence does. It is precisely for these managed to escape poverty, such as in Asia Reiner Klingholz reasons that the declaration of the UN or Latin America, show that falling fertility Director Conference on Environment and rates offer the chance to boost development, Berlin Institute for Population and Development in Rio de Janeiro in 1992 opening up new prospects for the many Development stated the following in Principle 8: “States young people and setting a dynamic in should reduce and eliminate unsustainable motion that eventually helps broad swathes patterns of production and consumption of the population to achieve a higher and promote appropriate demographic standard of living. Countries that succeed in policies.” doing this go on to reap a “demographic dividend”, but only if falling fertility rates have first slowed down population growth.

4 Africa’s Demographic Trailblazers THE KEY POINTS

Nowhere else in the world is the population Learn from regional trailblazers The country chapters show that Africa growing as fast as it is in Africa. By mid- already offers some positive examples of a century, 2.5 billion people could be living on Owing to the continent’s huge diversity, it is successful demographic policy in states with the African continent – almost twice as many difficult to speak about “Africa’s demographic very different historical and cultural as today. This rapid increase in the number of development”. The range of fertility rates is a backgrounds. Those countries that are less inhabitants poses enormous challenges for broad one and the various countries are at advanced in their demographic development the African states, because it means that in very different stages of the demographic have a decisive advantage: they can draw on the future not only will even more people transition. This raises the question of why the knowledge now available about the key need to be provided with food, health these differences exist and which local factors factors influencing a decline in fertility rates services and education but they will also are responsible. and draw up population policy measures need the opportunity to find jobs that enable based on them. A collection of practical them to make a decent living. These are tasks The present study takes a closer look at seven examples provides an overview of where this that many states in Africa are unable to cope regional trailblazers – countries that either has already been successful and which with even today. already have a comparatively low fertility rate measures were used. or are moving in that direction. In East Africa The reason for this high population growth is this applies to Kenya and Ethiopia, in above all the continuing high fertility rates, Southern Africa to Botswana, in West Africa which, moreover, are preventing a change in to Ghana and Senegal and in North Africa to the age structure of the population that could Tunisia and Morocco. The countries were bring about a development boost of the kind selected according to important socio- that Asian states, for instance, have already economic parameters that have proved to experienced. The age structure of the “demo­ contribute to falling fertility rates either graphic bonus” is still a distant prospect for directly or indirectly. They include child most countries in Africa. To achieve the mortality, the level of education, especially progress required for the bonus to be among women, and income relative to the converted into a “demographic dividend”, the poverty threshold. We also used indicators of decline in fertility rates1 in Africa urgently gender equality and urbanisation and took needs to accelerate. into account social norms and the political commitment of governments to family planning.

Berlin Institute 5 WHY AFRICA’S POPULATION 1 IS GROWING SO FAST AND WHAT THE INFLUENCING ­FACTORS ARE

Since 1950, Africa’s population has more What is more, strong population growth is not A deficit of education and a lack of income than quintupled. Unlike in the rest of the a problem per se. As long as the increasing opportunities are inhibiting economic world, there is no sign of an end to such number of people can be provided with the development and thus making it difficult for growth. By mid-century, the number of services they need and, above all, with jobs, a people to escape the poverty trap. Since what Africans is likely to have almost doubled, large population can contribute to economic economic growth there is has to be shared from the present level of 1.3 billion to 2.5 growth and wealth creation. And, in such a among ever more people, the prosperity billion people. This means that Africa will case, more people mean more producers, gains are either modest or entirely absent. As account for half of global population growth more consumers and more innovators. a result, 40 percent of people in sub-Saharan in the next 30 years. While just under a fifth Africa have to live on less than the equivalent of the world’s population lives on the African of two US dollars a day and hence below the continent today, this share is likely to be more More people, finite resources poverty threshold as defined by the World than a quarter by 2050.1 Bank.8 All over the developing world, poor In Africa, however, this effect cannot be prospects also mean a high fertility rate and For a long time, Africa’s population growth observed. On the contrary, high population therefore continuing population growth. A was not considered particularly significant, growth has exacerbated many of the problems spiralling vicious circle, in other words. since the region was regarded as sparsely that Africans are already facing. Even today, populated. In 1950, with a total of 230 the majority of states – especially those south Since essential resources, such as water or million people, the continent’s average of the Sahara – are scarcely able to provide arable land, do not increase with the growth population density was just eight people per their populations with the health and in population, tensions and distribution square kilometre.2 As the colonial era drew to education infrastructure they need, let alone conflicts are becoming more frequent. a close, few foreign investors saw Africa as a sufficient jobs to give them a decent standard Climate change is likely to exacerbate this worthwhile location, since both the amount of living. This is unlikely to change in the situation still further in the future and force of cheap labour and the size of local markets foreseeable future: 37 million children of ever more people to leave their homeland. At were limited. Asia, which by 1970 was primary-school age in Africa are still unable the same time, a lack of prospects is already home to 2.1 billion people and hence to go to school and every year, the group of increasingly likely to motivate Africa’s youth well over half of the world’s population, children that should start school grows to look for better opportunities elsewhere – offered more lucrative opportunities and was roughly by an additional 5 million.4, 5 Even if in the overflowing mega-cities, in other of far greater interest.3 they are able to enjoy their right to education African countries and, to a lesser extent, in and complete school successfully, the next Europe. critical situation awaits them: currently, the group of young workers between the ages of 15 and 35 is growing by ten to twelve million people annually. Yet on the entire continent only about three million jobs are being created annually in the formal employment sector.6, 7

6 Africa’s Demographic Trailblazers If fewer children die, fewer From high to low mortality and fertility rates will be born Wherever children have better chances of survival, it is the case that one or two generations later parents decide to have fewer children. This link between falling child mortality and a decline in the fertility rate can be Whether the living conditions of people in observed in every country in the world as it undergoes its demographic transformation. Africa will improve in the future is closely linked with how quickly Africa’s states Deaths per 1,000 Children undergo the demographic transition. This live births per woman model reflects the only economic theory 350 7 capable of charting the path of development of all nations from a pre-industrial way of life 300 6 to a modern society. The transition begins in a phase when people have a large number of 250 5 children, but because of poor living 200 4 conditions many people from all age groups die. As long as the birth and death rates are 150 3 roughly balanced, the population will grow slightly or not at all. Only when the food 100 2 supply improves and the first hygiene and medical advances improve living conditions 50 1 does mortality – especially infant and South Korea Brazil Bangladesh 0 0 maternal mortality – fall and average life expectancy rise (phase 2). But because the fertility rate initially remains at its former 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 high level or declines only slightly, the 1950– 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 2010– 1950– 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 2010– 1950– 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 2010– population continues to grow strongly under these conditions. Development of child mortality (deaths of under-fives per 1,000 live births) and fertility rates (average number of children per woman), 1950 to 2015 After mortality rates have fallen, fertility (Data source: UN DESA10) rates follow suit in phase 3, so the theory goes, albeit somewhat later – and always in this order. Or at least that is what has As mortality falls, the socio-economic A slow decline in fertility happened in every country that is ahead of development that has led to longer life Africa in its demographic development. A expectancy continues to forge ahead: With the exception of the comparatively decline in child mortality is, after all, a healthcare improves further, schools and advanced states in North and Southern prerequisite (albeit an insufficient one) for universities offer new educational Africa, most countries on the African people to decide to have fewer children. opportunities, jobs are created in formal continent are still in Phase 2 or at the Because it takes them a while to realise that employment and women gain more rights. beginning of Phase 3 of the demographic more children are surviving than they These processes open up new prospects for transition process. Food imports, emergency expected, people do not start planning the people and allow more individual life aid and better healthcare have significantly size of their families and limiting them using planning. Wherever this has happened, reduced child mortality – even in under­ suitable means and methods until one or two fertility rates have declined. Accordingly, in developed countries like Chad, the Central generations later.9 10 this third phase of the demographic African Republic and Sierra Leone.11 But the transition, population growth slows down. socio-economic progress that needs to follow In Phase 4, when the fertility rate has fallen is scarcely gaining ground in Africa. In many to the level of the mortality rate, it tails off. places, people still have no prospect of That, in any case, is the theory and also the leading a self-determined life. For this reason, experience of the more developed states.

Berlin Institute 7 African states are entering and moving Still large numbers of children through the third phase of the demographic transition at a very sluggish pace, as a result Nowhere else in the world do average fertility rates exceed those in Africa. In more than 25 percent of of which fertility stubbornly remains at a African states, women have more than five children correspondingly high level. Although in on average. In Niger, the figure is even higher than Africa, too, fertility rates have fallen in the seven children per woman. The large numbers of past two decades, African women still have children being born are causing rapid population an average of 4.4 children – almost twice as growth on the continent. By 2050, Nigeria, Ethiopia and the Democratic Republic of Congo will probably 12 many as women in other parts of the world. have joined the top ten most populous countries in the world.17 All in all, fertility rates in Africa have so far declined much more slowly than they did previously in other regions of the world.13 Whereas in Asia the number of children per Large regional differences woman fell from 5.7 to 3.5 between 1965 and 1985 – a decline of 40 percent – the fall in This overview of the average values for Average number of the fertility rate in Africa not only came 20 or Africa conceals, however, the very broad children per woman, 2018 30 years later but also amounted to just 17 spectrum of demographic development on < 1.5 percent.14 Even the United Nations has been the continent. At one end of the spectrum 1.5 to < 2 repeatedly surprised by this slow develop­ are the highly developed island states of 2 to < 3 ment and accordingly has had to adjust its Mauritius and the Seychelles, together with 3 to < 4 population growth prognoses for Africa the more developed countries in the north 4 to < 5 upwards several times recently.15 16 17 and south of the continent, such as South 5 to < 6 Africa and Tunisia. Here the fertility rates 6 and more have already fallen below three children per women – and to just 1.4 children in (Data source: PRB16)

The path through the demographic USA transition Population China In the course of their socio-economic development, Tunisia Germany all countries throughout the world have undergone a demographic transition – albeit with a time lag and at Ghana different speeds. Through the improvement in living standards, the mortality rate falls initially and then, Ethiopia with a time lag, the fertility rate. In the meantime, Senegal the population continues to grow strongly. In Phase 4, fertility and mortality rates finally tail off at a lower level and population growth stops. Apart from a few states in North and Southern Africa, most Niger countries on the African continent are still at the beginning of this development: child mortality has Mortality rate already fallen considerably, but fertility rates remain persistently high. Africa is hence continuing to experience rapid population growth. Fertility rate Phase 1 Phase 2 Phase 3 Phase 4 Phase 5

Schematic diagram of the development of fertility and mortality rates as well as of the total population in the absence of migration (own diagram)

8 Africa’s Demographic Trailblazers Mauritius; according to UN prognoses, they are likely to fall further by 2020.18 In other words, these states are relatively advanced in their demographic development and, accordingly, their populations are now growing very modestly.

Some countries – especially in East Africa – are currently experiencing a rapid decline in their fertility rates. In Rwanda, for example, the number of children per woman has fallen since 1990 from 6.5 to around 4. In Ethiopia the fertility rate has fallen from more than seven children per woman to a similar level over the same period. By contrast, in most West and Central African states there has been negligible or even zero progress and average fertility rates are still at 5.2 and 5.5 children per woman, respectively.19 In some countries – including Angola, Mali and Chad – the changes in the fertility rate have so far been so slight that experts doubt whether socio-economic and demographic change has, in fact, begun there at all.20 21

Late and slow Children per woman 7 The decline in the fertility rate in Africa is clearly lagging behind that in other regions of the world. Latin America and the Caribbean Africa 6 Whereas Latin America and Asia experienced a rapid decline in the fertility rate between 1960 and 1980, Asia this trend did not begin in Africa until 20 or 30 years 5 later and then at a much slower pace. Currently at Oceania four children per woman, the average fertility rate in 4 Africa is today at the same level as that in Asia and Latin America in the 1970s. 3 North America Europe 2

1

0 1950 – 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 2010– 2015– 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020

Average number of children per woman in various regions of the world, 1950 to 2015 (Data source: UN DESA21)

Berlin Institute 9 No demographic bonus in sight distant prospect. According to the United such as Mali, Chad and Angola cannot hope Nations, the demographic bonus does not to attain a demographic bonus before The slow decline in fertility rates means not emerge until the share of young people under 2060.27 just a continuing high rate of population the age of 15 who need to be provided for has growth but also a worsening of the supply fallen below 30 percent of the total Even this dangerously slow-sounding shift in situation. At the same time, the high fertility population while the share of over-64-year- the age structure will happen only if the rates are preventing a shift in the age olds has not yet reached 15 percent.25 Or to fertility rates fall as rapidly in these countries structure that could usher in an economic put it another way: only when for every as they have done in other regions of the boom, such as the one in the Asian tiger dependent person there are at least 1.7 world. But given the rather slow fall in states like South Korea, Thailand and employable people aged between 15 and 64 fertility rates to date, even this development Singapore. After all, as the number of will states reach that favourable situation in is questionable. Whether and how quickly children being born continues to fall, sub­ which an economic upswing is facilitated.26 Africa will be able to make up its develop­ sequent cohorts become smaller and the According to UN estimates, this is unlikely to mental lag and offer its people better population bulge shifts to young people of happen in most sub-Saharan countries and in prospects thus depends largely on how rapid working age. This means there are a dis­ most countries north of Namibia, South the demographic transition is. A decline in proportionately large number of people able Africa and Botswana until 2035 at the the number of children born per woman is to work and be productive. By the same earliest. Central and West African countries essential for this to happen.28 token, the number of children and teenagers who need to be provided with food, schooling and healthcare by the working population declines. Bonus sooner – or later

This favourable age structure is known as the A demographic bonus emerges when there are more people of working age than there are young and old people to be provided for. Thanks to a rapid decline in fertility in the 1960s and 1970s, Mauritius was already able to demographic bonus, which, given favourable benefit from an economically favourable age structure in the 1980s. Whereas the island state has already been political and economic conditions, can be able to convert this into a dividend – a demographically determined boost to development – the demographic transformed into an economic upturn, the bonus is still a long way off for other African countries. Niger, for example – the country with the world’s so-called demographic dividend. For this to highest population growth at present – can hope for a bonus around 2080 at the earliest. happen, the young generation must be well qualified and must find jobs to match their 2.5

qualifications. Economists agree that the demographic Mauritius economic rise of the Asian tiger states was bonus 2.0 attributable mainly to those countries Morocco making use of the demographic bonus.22

1.5 Together with some of the African island Ethiopia states, the more developed countries in Senegal Nigeria North and Southern Africa have already 1.0 reached this favourable age structure. They Niger have a large number of young, increasingly well-qualified people of working age. What 0.5 has so far been missing are the correspond­ ing jobs.23, 24 For the majority of African states, however, an age structure that offers 0 an opportunity for a demographically

determined boost to development is still a 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065 2070 2075 2080 2085 2090 2095 2100 Ratio of the working age population aged between 15 and 64 to dependents (people aged 0 to 14 and over 64), 1950 to 2100 (Data source: UN DESA28)

10 Africa’s Demographic Trailblazers What causes fertility to fall Where children die early

But how can this process be accelerated A child’s chances of reaching his or her fifth birthday vary depending on where on the African continent he or she is born. New-borns have the best prospects in the highly developed island states of Seychelles and without compulsory measures of the kind Mauritius, followed by the North African countries. The picture is rather less rosy in Chad and the Central that have been seen in China, for instance? African Republic, where one child in eight dies before reaching the age of five.32 Which factors lead to falling fertility rates has been well documented by scientists. There are also a number of interventions that are known to accelerate socio- Tunisia economic progress and that lead – directly Morocco or indirectly – to a decline in the number of Algeria children born. The following socio-economic Libya Egypt parameters are central: West Sahara

Cape Verde Mauritania Mali Niger Senegal Eritrea Chad Sudan Djibouti Health Gambia Burkina Faso Guinea Benin As long as parents do not know how many Ghana Nigeria Central Ethiopia Guinea- Togo African South Sudan of their children will survive into adulthood, Republic Bissau Cameroon they tend to have a large number of Sierra Leone Equatorial Somalia Ivory Guinea children. In traditional societies, children Liberia Coast Uganda Kenya São Tomé Congo mean extra workers and the prospect for Gabon Democratic Rwanda and Príncipe Republic of parents of having someone to take care of Congo Burundi them in their old age. If fertility rates are to Child mortality (deaths per Tanzania Seychelles fall, children’s chances of survival must 1,000 live births), 2015–2020 improve. The infant and child mortality risk < 30 in Africa is still the highest in the world, 30 to < 50 Angola Malawi Zambia despite major progress. On average, one 50 to < 70 child in 14 dies before reaching its fifth 70 to < 90 Mozambique 29 These deaths are usually caused 90 to < 110 Zimbabwe birthday. Namibia Madagascar by respiratory diseases, diarrhoea or 110 and more Botswana Mauritius malaria, in others words, diseases that are No data Eswatini easily preventable. (Data source: UN DESA31)

Maternal health is important, too. Medical South Africa Lesotho supervision during pregnancy and after birth can by no means be taken for granted throughout Africa. In some African countries only half of all births are medically supervised, in Chad and Burkina Faso only one in four.30 If the health of children and mothers is to improve further, it is essential to expand the health infrastructure and ensure that medical personnel are well trained.31 32

Berlin Institute 11 Education Population (aged 20 to 64) with secondary education or higher, in percent, 2015

Many experts believe that education is the < 15 best method of birth control since it has an 15 to < 20 impact on people’s living situation via 20 to < 30 various channels and hence on the number of 30 to < 40 children born. People with more education 40 to < 50 tend to lead healthier lives and find it easier 50 and more to earn a decent living. They are thus less No data dependent on their children to provide for (Data source: Wittgenstein Centre39) them in their old age.33 Parents who have been to school themselves attach more value Where secondary education remains a privilege to their children having good education too. And because this entails higher costs, In many African countries a good school education cannot be parents tend to decide to have fewer taken for granted. Although today around 80 percent of children.34 children start school, many fail to finish primary school and only a few attend secondary school. In 26 of the 54 states, less than a quarter of the population has a secondary education. But Women’s education has an especially it is precisely this that has been proved to have a major important role to play in falling fertility rates influence on the decline in fertility rates. – for several reasons. First, the likelihood of small children surviving increases with the mother’s level of education, since educated mothers are better informed about hygiene, healthy food and vaccinations.35 Second, the Income opportunities and If more people are able to earn a secure longer they have attended school, the later growing prosperity income and to work productively, this will not women marry and have children. Third, only lead to improved living standards of the education means more individual life The number of children born always falls in individual but will also give the state more prospects for them that go beyond their role places where people’s living conditions latitude. A growing economy will bring as mothers.36 All this contributes to the fact improve. Alongside better healthcare and a money into the state coffers, which can be that women with secondary education in higher level of education, income invested in expanding the health and Africa on average wish to have around two opportunities are paramount. Only when education infrastructure and developing a children fewer than women with no people no longer have to live from hand to pension system. Social security systems can education and are better able to realise this mouth and are able to escape the sub­ then assume the role previously played by wish.37 The fertility rate therefore tends to fall sistence trap can they begin to plan their children in taking care of people in their old as the level of women’s education rises. This own lives and to think differently about the age. Economists have investigated the effect is greatest if women have attended size of their families.40 In order to achieve a influence of state social security systems secondary school after completing primary reduction in fertility rates in Africa, it is such as pensions on fertility rates in Europe school. Women with a secondary education essential to create formal and productive and the United States: a rise in state social in Kenya and Ethiopia, for instance, have less jobs in industry and services. Currently, benefits amounting to 10 percent of GDP was than half the number of children than those around half – in the less developed accompanied there by a reduction in fertility who have never been to school.38 39 countries even around 70 percent – of the rates of between 0.7 and 1.6 children per African population works in an agricultural woman.42 43 sector characterised by small-holdings, which is generally not very productive and does not offer attractive future prospects for the younger generation.41

12 Africa’s Demographic Trailblazers Share of the population living below the Social norms and traditions poverty threshold (1.90 US dollars/day) in percent, 2007 to 2017, in each Most African societies are very traditional, case the last year for which figures are available especially in the countryside, where on average more than half of the African < 10 population lives.48 Here the (extended) family 10 to < 25 and the village community have an important 25 to < 40 role to play as a social security net – not least 40 to < 55 because state social security programmes are 55 to < 70 lacking. Marrying young and having children 70 and more at as early an age as possible is often a No data necessary form of social security, particularly (Data source: World Bank43) for girls from poor families. Their social role is then reduced to motherhood and producing a 49 Where people are poorest male heir.

In many African states a large share of the population has to What is more, for all their diversity African make do with less than two US dollars a day. In the Democratic societies are almost uniformly very religious, Republic of Congo and Madagascar this applies to eight out of and an An abundance of children is often ten people. Wherever poverty inhibits development opportunities and there is no state social security system, regarded as worth striving for. Even the parents tend to have a large number of children in the hope this younger generation are still keen to have a will give them security in their old age. relatively large number of children. On average African women wish to have two been shown empirically.46 Thus, the status of children more than women in other developing Gender equality women in society, namely whether they have countries; among African men, the desire is equal access to education and to the labour for three children more than men elsewhere. Almost everywhere in Africa women want market and thereby serve as role models for Even women with secondary education on fewer children than men do. The difference is the next generation of young girls, has an average wish to have one child more than greatest in the countries of the Sahel region. impact on how quickly fertility rates fall.47 women elsewhere.50 51 Here woman want one or two children fewer than men do; in Chad the difference is as great as three.44 The fertility rates in these countries are so high because, apart from the low level of education, women have little say Where women are at a disadvantage in family affairs.45 Almost everywhere in Africa women want fewer children than their partners do, but often the Where woman are lacking in equality, they decision about the number of children they have is tend to have more children. If, on the other taken by men. With respect to gender equality there hand, they are able to assert themselves are major differences on the continent, as the UN’s Gender Inequality against their husbands and the family – for Gender Inequality Index shows. This evaluates the Index, 2017 instance, because they are better educated discrimination of women in the areas of health, < 0.4 education, participation in the labour market and 0.40 to < 0.50 and can contribute to the family income – the political co-determination. Here “0” represents 0.50 to < 0.55 number of children born decreases, as has absolute gender equality and “1” the highest level of gender inequality. 0.55 to < 0.60 0.60 to < 0.65 0.65 and more No data

(Data source: UNDP47)

Berlin Institute 13 Where people want many children All of this helps to explain the fact that both Family planning women and men in cities want far fewer In many places in Africa an abundance of children is children. The higher cost of living in cities, The factors described above influence how regarded not as a burden and a cost factor but rather as a blessing. African men, in particular, are keen to however, often make this wish a necessity. In many children women and men want to have have a large number of children, on average almost cities, where living space and food are more and thus indirectly the fertility rates. Whether twice as many as men in other developing countries. expensive, each additional child means people are in practice able to limit the size of higher costs, whereas in the countryside their families should they wish to do so children represent economic value added as ultimately depends on their knowledge about workers. Fertility rates are therefore much and access to contraceptives. Only if people lower in cities than in rural regions. In are informed about the purpose of Ethiopia, Angola and Zambia, women living in contraceptives and how to use them and only cities have almost three children fewer than if they have free access to them can they those living in the countryside.54 55 decide how many children they would like and at what intervals they would like to have them. Average number of children desired by Where people live in cities However, many African countries are lagging men, 2000 to 2017, behind when it comes to informing people in each case the last Everywhere in Africa fertility rates are lower in the about and providing contraceptives: in Chad, year for which cities than in the countryside, since in the city it is the Central African Republic and Mauritania figures are available much easier to gain access to health services, roughly one woman in three does not know of < 3.5 education, jobs and, not least, contraceptives. a single modern method of contraception.56 3.5 to < 4.5 However, in more than 30 African states more than half of the population lives in the countryside. To Concerns about possible side-effects remain 4.5 to < 5.5 achieve a rapid decline in fertility, it is necessary, widespread, even among young people.57 The 5.5 to < 6.5 above all, to improve basic provision. rate of use of modern contraceptives is hence 6.5 to < 7.5 low compared with other regions of the 7.5 and more world: on average, only one woman in five No data between the ages of 15 and 49 in Southern (Data source: DHS51) and East Africa uses a modern method of contraception and only one in ten in West and Central Africa.58 One reason for this is the Urbanisation lack of access to contraceptives: according to a study by the US Guttmacher Institute, African cities are growing by around 3.5 around half of women in Africa who would 52 percent a year on average. This presents a like to avoid pregnancy have no access to challenge for urban planners, but at the same Share of the urban modern methods of contraception.59 60 61 time it may provide an opportunity for population as a per­ demographic change. In cities people have centage of the total easier access to health services, education, population, 2018 jobs and, not least, contraceptives. Since < 25 women living in cities go out to work more 25 to < 35 often and new role and family models 35 to < 45 become more quickly established as the 45 to < 60 norm, there tends to be more gender equality 60 to < 70 here than in rural regions.53 70 and more No data

(Data source: UN DESA55)

14 Africa’s Demographic Trailblazers Where the size of families can be planned Formally at least, more than 80 percent of Where governments promote African states have a population policy that family planning By no means every woman who would like to have aims to reduce the number of children per fewer children is able to realise this wish in practice, How much governments are doing to promote family since in many places access to contraceptives is woman and to put a brake on population 62 planning and thus decrease fertility cannot be difficult. Whereas in Kenya, Morocco and some other growth. But in many places these policies determined from a single figure. The Family Planning countries more than half of women use modern are not being properly implemented. Program Effort Index thus evaluates the efficacy of contraceptives, in countries like South Sudan or Population growth and family planning national programmes using 30 different indicators, Eritrea the figure is not even one in ten – mostly programmes have to date rarely been the including: What is the political framework of the because they are simply unavailable.61 main focus of political thinking in Africa – programme and how is it being implemented? Will the access to and the usage rate of contraceptives be other issues have usually been given priority. improved and how are they to be made available? At the international level, too, diplomacy has How the African countries score in the Index varies tended for decades to handle the subject with widely: whereas Rwanda, Tunisia and Morocco are on kid gloves. Reservations about interfering in a par with Asian states, which have already made sensitive issues like sexuality and repro­ major progress in this field, other African countries are lagging far behind. duction are simply too strong. In addition, the views of African politicians are often marked by cultural norms according to which a large Married women family is a goal worth striving for. Many of between the ages those in power see a large and growing of 15 and 49 who population as an economic and geopolitical use modern family advantage, an attitude that used to be planning methods, widespread almost everywhere in the world.63 in percent, 2018 < 15 These kinds of attitude mean that those in 15 to < 20 positions of responsibility often misinterpret Family Planning 20 to < 25 the theory of the demographic dividend, Program Effort 25 to < 35 which Africa needs so urgently and whose Index, 2014 35 to < 55 great benefits the World Bank portrayed in a < 40 55 and more 2015 study.64 In many places the idea prevails 40 to < 45 No data that a large, young population is in itself a 45 to < 50 60 (Data source: PRB ) guarantee of economic progress.65 The fact 50 to < 55 that a decline both in fertility rates and in the 55 to < 60 size of future cohorts is a fundamental 60 and more The political will for change prerequisite for a demographically No data determined economic upswing is often (Data source: Avenir Health66) When and how quickly the number of ignored. children born in a given country decreases also depends on what governments do to In order to change such views of population achieve such a decline. This includes dynamics, a sober analysis and the indirect measures, such as efforts to expand recognition of scientifically proven linkages the health and education systems and to are required. In addition, African politicians create jobs. But projects that have a direct and those engaged in international effect, such as family planning information cooperation with these countries need to campaigns and national programmes rethink their strategy.66 designed to increase the population’s awareness and understanding of the advantages of smaller families, play a central role too.

Berlin Institute 15 AFRICA’S TRAILBLAZERS IN 2 DEMOGRAPHIC CHANGE

In terms of geography, culture and language we have taken into account indicators of Altogether we have chosen seven countries the African continent is enormously gender equality and urbanisation as well as that either on the continent as a whole or at diverse. Occupying a fifth of the earth’s social norms and the political commitment of least within their respective region can be total land mass, it comprises 54 states, governments to promoting family planning. considered trailblazers in demographic whose inhabitants cultivate widely varying development. In East Africa this applies to traditions and religions and speak a total of Kenya and Ethiopia, in Southern Africa to 2,000 different languages. In Europe, by Morocco Botswana, in West Africa to Ghana und Senegal 1 2 3 contrast, there are only 300 languages. 2019 37mn 2015–2020 and in North Africa to Tunisia and Morocco. This degree of diversity alone makes it 2050 46mn 2,4 difficult to talk about Africa’s demographic development. After all, the countries that Tunisia make up the African continent are at very 2019 12mn 2015–2020 different stages of the demographic North Africa: 3.1 2050 14mn 2,2 transition. Senegal The countries in North and Southern Africa, 2019 17mn 2015–2020 Ethiopia in particular, are much more advanced in 2050 34mn 4,7 2019 110mn 2015–2020 this respect than those in the other regions 2050 191mn 4,0 of the continent, although in the meantime certain countries, especially in East Africa, have started to experience a rapid decline in their fertility rate. This raises the Ghana question of why these differences in 2019 30mn 2015–2020 2050 51mn 3,9 demographic development exist and what West Africa: 5.2 the influencing factors are. East Africa: 4.5

This chapter takes a closer look at some of Central Africa: 5.5 the regional trailblazers – in other words, Kenya countries that either already have a 2019 52mn 2015–2020 comparatively low fertility rate or are Botswana 2050 95mn 3,8 moving in that direction. The countries 2019 2mn 2015–2020 were selected on the basis of how the 2050 3mn 2,7 important socio-economic parameters outlined in Chapter 1 have changed – in Population in millions, other words, child mortality, level of 2019 and 2050 education and poverty rates. In addition, average number of children per woman, 2015–2020 (Data source: UN DESA3) Southern Africa: 2.5

16 Africa’s Demographic Trailblazers A broad spectrum

Africa’s diversity is also evident in the number of children women have. Whereas women in Mauritius now have only 1.4 children on average, women in Niger still have more than seven children and those in Somalia more than six. Fertility is declining at different rates, too: in Ethiopia and Rwanda the figure has fallen significantly since the mid-1990s, but there has been much less progress in West and Central Africa.

Children per woman 9 1990–1995 8 2015–2020 7 6 5 4 3 2 1 0 Mali Togo Chad Libya Niger Egypt Benin Kenya Sudan Congo Ghana Gabon Eritrea Angola Liberia Guinea Tunisia Algeria Malawi Nigeria Zambia Gambia Uganda Lesotho Burundi Senegal Rwanda Somalia Djibouti Ethiopia Namibia Morocco Eswatini Comoros Tanzania Mauritius Botswana Cameroon Zimbabwe Seychelles Cape Verde Cape Ivory Coast Mauretania Madagascar South AfricaSouth Sierra Leone Sierra South Sudan South Mozambique Burkina Faso Guinea-Bissau Equatorial Guinea Dem. Rep. of Congo Central African Rep. Central São and Tomé Príncipe Average number of children per woman, 1990–1995 and 2015–2020 (Data source: UN DESA2)

2.1 Ethiopia From a demographic point of view, too, agree that the government‘s comprehensive Ethiopia’s recent development can be development strategy, which it began Over the past year, Ethiopia has been a described as a success, although this process implementing in 1995, has contributed to greater focus of international attention than actually began back in the mid-1990s, long this success. Alongside the promotion of has almost any other African country. First before the current prime minister came to agriculture, investment in the development of came the conflict-free transfer of political office. Since then, the average number of the health and education systems has been power, then the conclusion of peace with children per woman has fallen from around paramount.7 In both areas, the strategy was neighbouring Eritrea and finally the seven to roughly four, a rate of decline that is to expand provision in such a way that it appointment of a woman as head of state – a without parallel in Africa.4 While the fertility would reach the population in rural and first in the country’s history. Ever since forty- rate remains high, the trend towards fewer remote regions. After all, in the mid-1990s, two-year-old Abiy Ahmed became prime children seems to be continuing. If Ethiopia more than 85 percent of Ethiopians lived in minister in April 2018, Africa’s second-most manages to reduce its fertility rate further, the countryside – and even today around 80 populous country has been spurred on by the then it could reach a favourable age structure percent still do.8 rapid pace of reform. Although it is still one of from 2035 onwards, which, under the right the continent’s poorest states, its image has conditions, could then be translated into a been transformed from that of a country of demographic dividend – i.e. into an Helpers for better health eternal hunger to that of a new beacon of accelerating economic upswing.5 6 hope. With respect to healthcare the Ethiopians had But why is it that Ethiopia – which for such a to start from scratch. After years of war and long time was synonymous with hunger, tyranny under the communist regime, many conflict and underdevelopment – has hospitals were left destroyed or plundered managed to make such progress? Experts

Berlin Institute 17 Rapid decline in fertility Why children in Ethiopia die

All over the world, better access to health services and a rising level of education have meant a decline in Thanks to the development of the health system, fertility rates. This link has already been shown clearly in Asian countries like Vietnam and Bangladesh, which child mortality in Ethiopia has fallen sharply. used to be poor. Now it is becoming visible in Ethiopia as well: in no other sub-Saharan country did the fertility Nevertheless, about one child in fifteen still dies rate fall more sharply between 1995 and 2015. before reaching the age of five. In most cases, the cause of death is diarrhoea, pneumonia or malaria – Children per woman diseases that can be prevented through hygiene and 8 Development of fertility, other prophylactic measures or that can be cured 1980 to 2020 with antibiotics. Further improvements in child 7 Niger (Data source: UN DESA6) health will require more medical personnel, since, despite efforts to date, there are still only seven 6 Sub-Saharan Africa medical professionals for every 10,000 inhabitants.15 5

4 Ethiopia Bangladesh 3 World 19 23 2 Vietnam 1 2 0 1980– 1985– 1990– 1995– 2000– 2005– 2010– 2015– 3 1985 1990 1995 2000 2005 2010 2015 2020 3

and medical personnel were scarce. In the vaccinations. At the same time, they teach 7 15 framework of the so-called Health Extension local families about basic health so that they (HEP), launched by the Ministry of are able to prevent avoidable diseases – from Program 9 Health in 2003, 16,500 health centres were diarrhoea to malaria and HIV/Aids.11 11 established with the help of international 9 partners – one in every community. In order Even then, the health extension workers are to overcome the shortage of personnel, the by no means able to reach all of the more government trained more than 40,000 than 100 million Ethiopians. On average, Distribution of the causes of death in children community women as so-called health each of them has 2,500 people to take care under the age of five in Ethiopia, in percent, 2014 extension workers within a year.9 The idea of.12 In order to extend the reach of health Diarrhoea was, on the one hand, to give women with services and health education, the Ethiopian Pneumonia secondary education an opportunity to earn government launched a second programme Lack of oxygen at birth an income and, on the other, to boost local in 2011: the so-called Health Development Premature birth acceptance of the new health services within Army. Under this programme employees of Neonatal sepsis the communities.10 the health centres train voluntary female Malaria helpers from the communities, who then give Injuries Right from the start, the health extension advice and information on health issues in HIV/AIDS workers concentrated, in particular, on their neighbourhoods. Each of the volunteers Birth defects improving the health of children and mothers. takes care of five households and receives Other illnesses Their work includes looking after women support from a team leader, who is in (Data source: African Health Observatory14) during pregnancy and after birth and constant contact with the health extension ensuring that small children receive the workers. This creates a network structure necessary aftercare check-ups and designed to ensure an exchange on health issues within the communities and to get people to take better care of their own health.13 14 15

18 Africa’s Demographic Trailblazers 100 From falling child mortality to fewer No contraceptive Hormonal contraceptives on the rise children Other The increase in the prevalence rate of modern The pill contraceptives is attributable, above all, to hormone 90 The positive effects of the HEP and the Health Hormone implants injections and hormone implants having become Army are already clearly evident: since the Hormone injections more widely available. These are easy to use and do turn of the millennium female mortality Traditional methods not require women to visit a health centre, which associated with pregnancy has halved, and // particularly in rural areas of Ethiopia is often far the same applies to infant mortality. Today, away, more than once every few months or even years. The distance to a health centre is one of the children in Ethiopia have much better reasons why seven out of ten Ethiopian women have chances of surviving beyond their fifth 30 not used contraceptives to date: often they simply do birthday than they did in 2000. Avoiding not have access to them. drinking contaminated water – the most frequent cause of diarrhoea – combatting 20 hunger and vaccinating children against access to contraceptives. In 2007, it waived childhood diseases such as polio or measles the import tax on contraceptives and allowed to offer hormone have helped child mortality to fall between 10 health extension workers 2000 and 2016 from 166 per 1,000 live injections. Two years later the government births to 67.16 Share of methods of began to train them to insert hormone contraception used by implants.21 0 women in Ethiopia, The fact that children now have a better in percent 19 chance of surviving has changed attitudes in 2000 2005 2011 2016 (Data source: DHS ) Ethiopia towards family size. Since the turn of Women have more say the millennium, the number of children that Ethiopian women wish to have has fallen 1993, not a single service centre existed at All this has contributed to a quintupling of the from 5.3 to 4.5; among men the decline is any public health facility in the country where prevalence rate of contraceptives in Ethiopia even larger, from 6.1 to 4.6. The changes are women and men could inform themselves since the turn of the millennium. Today, one especially apparent in rural areas, where the about contraceptives and obtain them at the Ethiopian woman of reproductive age in four number of children born is much higher than same time, the only exception being a clinic uses a modern method of contraception. in the city: in the countryside, women on in the capital, Addis Ababa. Today, these Among the 44 African states for which data average still wish to have 4.6 children; services are offered at every health centre in on prevalence rates are available, Ethiopia nonetheless that is one child fewer than in the country. What is more, the number of comes 19th.22 Nevertheless, the Ethiopian 2000.17 national and international NGOs tackling this government failed to meet its own target of issue has increased significantly.18 19 increasing the rate to 44 percent by 2015, A decline in the desired number of children and unmet demand remains high: in 2016, does not in itself, however, bring about the Through the educational efforts of the health one woman in five on average who wanted to rate of fertility decline that Ethiopia is extension workers, the network of volunteers use contraceptives did not have the currently experiencing. After all, women and and the NGOs, information about modern opportunity to do so.23 But the progress made men need to be able to put their wish to limit methods of contraception has now reached to date is certainly in the right direction. It the size of their families into practice – using almost all regions of the country. The demand has already improved the living conditions of suitable family planning methods. Here, too, for modern contraceptives has accordingly millions of women in rural areas, who are quite a lot has been accomplished in the past risen, particularly in rural areas. Whereas in now freer to decide how many children they two decades. When Ethiopia adopted a 2000, 30 percent of women in the want and at which intervals they want to national strategy for population policy in countryside were eager to use contraceptives have them.24 to prevent pregnancy, 16 years later the figure had risen to 42 percent.20 To meet the rising demand, the Ethiopian government implemented further measures to facilitate

Berlin Institute 19 Health care and access to contraceptives are 2.2 Kenya Political pressure for family planning not the only reasons why the lives of Ethiopian women are changing. The Ethiopian “Panga uzazi”, Daniel arap Moi proclaimed It was only from the 1980s onwards, under government recognised at an early stage that soon after he had been appointed Kenyan President Moi, that the state family planning women are key to positive demographic and president in 1978: “Plan your family!”29 At the policy picked up momentum. The government socio-economic development and took time, Kenya’s fertility rate was 7.6 children expanded the initiative with financial support account of this in its development strategies. per woman, one of the highest in the from the World Bank and created a new The National Population Policy Strategy, for world.30,31 Driven by neo-Malthusian coordinating organ for population policy, the instance, had already set a target as long ago arguments, according to which overly strong National Council for Population and as 1993 for improving education for girls and population growth drives a country into Development.37 As a result, the number of female access to the labour market.25 Here, misery, and by pressure from international centres distributing contraceptives and the too, Ethiopia, can boast some successes: donors, the new Kenyan president decided to number of health workers trained in family since 1995, the number of girls starting take family planning in hand.32, 33 planning rose significantly.38 To publicise school has almost quintupled and they are these services better, the government now at much less of a disadvantage vis-à-vis In fact, as early as 1967 Kenya had become launched a media advertising campaign that boys – at least at primary school level.26 In one of the first countries in sub-Saharan via newspapers, radio and television sought addition, women in Ethiopia are more often Africa to formulate a national population to promote smaller families and modern engaged in paid work, for example, in cut policy.34 Moi’s predecessor, Kenya‘s first methods of contraception.39 NGOs and flower plantations, in grain mills, as teachers president, Jomo Kenyatta, had never been private initiatives likewise intensified their and health extension workers, in the civil very resolute in implementing family efforts, inspired by the government’s new service and as self-employed owners of small planning policy, however.35 Strong opposition motivation. The Family Planning Association businesses.27 from religious and pro-natalist camps, to of Kenya, for example, started a project to which important decision-makers belonged, distribute contraceptives at the community At the political level, too, a clear signal was rejected family planning of any sort. For this level. In addition, a privately financed given in the direction of more gender equality reason, in the 1960s and 1970s, attempts to organisation providing voluntary sterilisation in autumn 2018. Half of the members of the put the population policy into practice was established.40 new cabinet are women, and the diplomat remained weak and ineffective.36 Sahle-Work Zewde has been elected the new head of state. This should not, however, Modern contraceptives quickly in vogue disguise the fact that in many areas of daily life women are still at a disadvantage – The Kenyan government’s major commitment to family planning in the 1980s and 1990s meant that Kenya whether it is secondary school attendance, reached a high prevalence rate of modern contraceptives earlier than its East African neighbours. The population’s high level of education and the generally stable economic situation were other factors formal employment or decision-making contributing to more people wanting to plan the size of their families with the help of modern methods. within the family.28 To ensure that fertility rates continue to fall in the future, the country In percent will need to realise further measures under its Malawi 60 new government to bring about more gender Kenya equality, to improve healthcare and education Rwanda 50 and to create more jobs in the formal labour Uganda market. It will also need to defuse the ethnic Tanzania 40 tensions that have driven thousands of people Burundi from their homes and made it impossible to 30 conduct a new census. Only if Ethiopia can consolidate its progress to date will it have 20 the chance to transform its favourable age Rate of use of modern structure into a demographic dividend. 10 contraceptives by married women, in percent, various years 0 (Data source: DHS45) 1985 1990 1995 2000 2005 2010 2015

20 Africa’s Demographic Trailblazers These new efforts were reflected in the High expenditure on education results for Kenya in the Family Planning Effort Index. The indicator measuring the Kenya had begun investing more in education than other African countries at an early stage. Despite cuts in expenditure on education from 2005 onwards, spending was still among the 20 highest of all African countries, commitment of the government to family namely, at around 5.2 percent of GDP.56 planning doubled between 1982 and 1989.41 The prevalence rate of contraceptives rose In percent steeply, too: whereas in 1984, only 17 Kenya 8 percent of married Kenyan women said they Malawi 7 used contraceptives, the figure had risen to Rwanda 27 percent five years later, an increase Uganda 6 attributable almost entirely to the use of modern contraceptives.42, 43 Currently, it is 5 still mainly state centres that distribute 4 contraceptives. In 1989, more than 70 percent of users obtained them via a state 3 clinic or hospital pharmacy. In 2014, the 2 share was still 60 percent.44 45 State expenditure on education as a share of 1 GDP, in percent, various years 0 Marrying later through education (Data source: UIS55) 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

One success of the government programme In order to make schooling available to larger attendance among girls.53 This meant, in turn, was that by 1990, Kenyan women were on numbers of children and young people, the that between 1989 and 2014, the average age average having 1.5 children fewer than ten government gradually reduced the cost of at which women married for the first time rose years earlier. Today, Kenya’s fertility rate is education, abolishing school fees for the first by another two years, as did their average age around 3.8 children per woman, one of the four years of primary school entirely in 1974 when the first child was born.54 55 56 lowest in East Africa.46 There was, however, and introducing compulsory primary another factor that contributed significantly education in 1978. Because girls then went to this development: the population’s to school for longer and achieved a higher HIV crisis causes setback comparatively high level of education. In level of education, on average they married 1990, more than a third of Kenyans of and became mothers later.49 When an With respect to both education and family working age between 20 and 64 had educational reform extended primary school planning Kenya got off to a good start earlier attended secondary school for at least some by one year in 1985, the likelihood that girls than did other African countries. Nevertheless, years. By 2015, this figure was 61 percent would already be married at the age of 18 fell the decline in fertility slowed down shortly – an outstanding result by African standards: by more than 6 percent. At the same time, the before the turn of the millennium and was only in South Africa, Zimbabwe, Algeria, number of children that young women under even briefly reversed according to data from Seychelles, Egypt and Botswana are the the age of 25 had decreased by 0.3.50 the Demographic Health Survey: between values higher.47 The high level of education of 1998 and 2003 the number of children per Kenyan women influences not only the Over the past fifteen years, Kenya has made woman rose again by 0.2 children.57 Which number of children they want to have more progress in the area of education. In factors led to this deceleration remains (women who have completed secondary 2004, school fees for the entire eight years of unclear.58 Experts assume, however, that a school want to have four children fewer than primary school were abolished and in 2008, decline in investment in the national family women who have never been to school) but the government waived fees for secondary planning programme may have had something also the type of family planning they use. school.51,52 A constitutional reform in 2010 to do with it: at that time, the government Four times as many women with secondary defined an eight-year primary education as a reduced its commitment to family planning in education use modern methods of basic right of all Kenyans. Parents who fail to order to concentrate on the catastrophic contraception as those who have not send their children to school now incur a effects of the HIV epidemic.59 Kenya was badly completed any kind of school.48 penalty. All in all, these measures have hit by this outbreak from the 1990s onwards. resulted in an improvement in school

Berlin Institute 21 At the peak of the epidemic in 2003, A new commitment to achieving the 2.3 Botswana around 0.4 percent of the population died demographic bonus as a result of a weak immune system within With around 600,000 square kilometres, a year.60 Life expectancy at birth fell by In the years that followed, however, the Botswana is roughly the same size as France. seven years between 1985 and 2000.61 In government took steps to counter the But this land-locked country in Southern order to check the spread of the virus, the downward trend in the use of modern Africa has only 2.3 million inhabitants, government began investing in HIV methods of contraception. From 2006, it whereas France has more than 65 million.72 information, prevention and treatment approved additional funding to avoid supply By African standards, people in Botswana are campaigns, taking some of the resources it bottlenecks in the distribution of doing relatively well: According to the Human required for this purpose from the family contraceptives. With comprehensive Development Index, it is one of the few states planning programmes. Moreover, important programmes like APHIA (Aids, Population on the continent with a high level of human international donors had cut off funding to and Health Integrated Assistance) and development.73 Today, only 16 percent of the the programme in the belief that this would APHIAplus, international donors such as population has to live on less than 1.90 US not endanger the progress already made.62 USAID supported Kenya in better linking dollars a day and the average per capita The result was different to what had been HIV prevention and treatment to family income is among the highest in Africa.74 Much expected, however: the supply of modern planning services and in strengthening of Botswana‘s prosperity is due to mining: contraceptives to the population and their healthcare structures at community level. huge reserves of natural resources, especially rates of use fell between 1998 and 2003 This involved not only improving health diamonds, which are exploited in the world’s for the first time after years of growth.63 services but also, in some cases, providing largest mine in Orapa, brought about education and employment opportunities enormous economic growth between 1970 It might have been possible to make use of for under-served sectors of the and 1990.75 The remarkable thing about this the synergies generated by the family population.66, 67 wealth is that the government of Botswana, planning programme and the campaign to which is the oldest multi-party democracy in combat HIV, for example, by increasing the As a result, the rate of use of modern Africa, understood how to use the income use of condoms, which can be used to contraceptives rose considerably again. In generated from mining for the good of the prevent both pregnancy and infection with 2014, it reached 53 percent among married population. HIV. But because the focus was on curbing women – one of the 10 highest rates in the epidemic, the national family planning Africa.68 The decline in fertility accelerated programme suffered a setback, although in once again from the mid-2000s onwards. Exemplary governance 2001 there was a separate campaign Since then, it has fallen from around 5 to encouraging people to use condoms. These approximately 3.8 children per woman.69 Unlike many other countries with natural campaigns had little effect on the This means that Kenya is likely to reach the resources, Botswana did not succumb to the behaviour of couples, however. Condoms age structure of the demographic bonus by so-called resource curse, whereby rising remained unpopular and in 2003, only 1.2 2035 – assuming fertility continues to fall state revenues from oil or valuable minerals percent of married Kenyan women said steadily.70 But much will still have to happen tend to favour corruption and state they and their partner used them regularly. if such a structure with a disproportionately mismanagement instead of poverty Instead, hormone injections, the pill and large working population is to result in reduction. The government of Botswana hormone implants remained the most strong economic growth. Above all, jobs invested its high revenues in the population popular methods of contraception; but need to be generated for the large number and hence in the long-term future of the because of the reduced budget, they of young people. Today, just under a fifth of country.76 This policy of investing for the became less and less available at public 15 to 24 year olds are formally common good focused on expenditure on distribution centres.64 This reveals a unemployed.71 education, social security and health as well weakness of Kenyan population policy: as as on economic diversification aimed at in many African states, the success of state reducing the country’s dependence on raw family planning programmes fluctuates in materials.77 accordance with the flow of funds from international donors.65

22 Africa’s Demographic Trailblazers The government puts budget surpluses in the uses it for.78 Not least for this reason, Early progress in the health system “Pula Fund” – a play on the name of the Botswana is one of Africa’s examples of good currency, Pula, and the word for rain in the governance. In the Democracy Index of the At an early stage Botswana invested part of national language, Setswana – in order to be Economist Intelligence Unit, Botswana is its revenues from exploiting raw materials in able to balance the state budget when ranked in the second best category and has a comprehensive health system. By the end revenues from natural resources fluctuate the third-best rating in Africa after the island of the 1970s, the country was already trying and to save part of the money for future states of Mauritius and the Seychelles.79 A to reduce child mortality and had introduced generations. A key to the success of the fund number of factors account for Botswana’s a vaccination programme for small children is the strict regulation of what the parliament positive development. First of all, its very to this end.84 Nevertheless, it remains a homogenous society has given less ground challenge to reach people in remote regions for internal conflicts over resource of this large and sparsely populated country. A democratic model distribution.80 Botswana’s colonial history The Ministry of Health has therefore set up Botswana has for a long time been regarded as a was much less repressive than that of other more than 800 mobile health teams model African country – especially when it comes to parts of Africa, which led to stable alongside health centres and hospitals. These political leadership. From the seat of government in institutions following independence.81 In teams consist of a nurse and a “family health the capital, Gaborone, Africa’s oldest multi-party addition, ownership rights and a transparent trainer” chosen by the community itself. In democracy has ruled the country since 1966. From the year when the index was first compiled, in 2006, administration were values already anchored this way, even people who live beyond a this state with 2.4 million inhabitants has always in the Botswanian tribal tradition and were radius of eight kilometres from the nearest scored top marks in the categories “civil liberties” preserved after independence.82 83 health facility receive medical care.85, 86 and “electoral process and pluralism”. This improved access to health services has Tunisia Morocco proved to be effective: the vaccination rate of the children’s immunisation programme Algeria Libya Egypt recommended by the WHO had risen to 90 West Sahara percent by 2007.87 Not least for this reason the number of children dying before their Mauritania fifth birthday has fallen by two thirds since Mali Niger Eritrea the late 1970s. With 34 deaths per 1,000 live Senegal Chad Sudan Djibouti births, Botswana currently has one of the Gambia Burkina Cape Verde Faso lowest child mortality rates in Africa and life Guinea Benin expectancy, at 68, is six years above the Ghana Nigeria Ethiopia Togo Central South Sudan African average.88 Guinea- Liberia African Republic Bissau Cameroon Sierra Leone Equatorial Guinea Somalia Uganda The relatively high level of government Ivory Coast São Tomé Congo Kenya and Príncipe Gabon Democratic Rwanda expenditure on health is partly responsible Republic of Democracy Index 2018 Congo Burundi for this success. Between 1995 and 2012, an average of 5 percent of GDP flowed into the unter 2 Tanzania Authoritarian health sector, one of the highest rates in 2 to < 3 regime sub-Saharan Africa.89 Botswana is also one of 3 to < 4 Angola Malawi the few countries in the region that is able to Zambia 4 to < 5 finance its healthcare almost entirely itself. Hybrid regime 5 to < 6 Mozambique Funding from donors is used only for Zimbabwe 6 to < 7 Flawed Namibia Madagascar combatting HIV/Aids – which continues to be Botswana 7 to < 8 democracy the biggest challenge for the Botswanian health system.90 8 to < 9 Full Eswatini 9 to < 10 democracy South Africa Mauritius No Data Lesotho (Data source: Economist Intelligence Unit83)

Berlin Institute 23 Successful advertising for condoms A joint programme of the US development Poverty reduction via lower fertility organisation USAID and the Botswanian The HIV/Aids epidemic, which raged in the government targeted men and young people, Despite the setbacks caused by the HIV/ 1990s, has had a lasting impact on because these groups came into too little Aids epidemic, Botswana is on a positive Botswanian society and eliminated health contact with the existing services offered by development path – including in demo­ successes that had been achieved previously: health facilities. The programme sought to graphic terms. Since its independence from by 2000, average life expectancy had sunk promote condoms as contraceptives and as the United Kingdom in the mid-1960s, the again to the pre-1955 level of only 49 years.91 protection against HIV. One NGO, for fertility rate has fallen from around 7 to 2.6 The government responded with HIV example, distributed condoms free of charge children per woman. This places Botswana prevention and treatment measures. As part or at low prices in bars and hotels as well as in the ranks of the ten African states with of the state education and therapy at petrol stations and markets. A television the lowest fertility rates.97 As a result, the programme Masa, thousands of people and radio campaign drew additional age structure of the Botswanian population continue to receive antiretroviral drugs free attention to the issue and thereby increased is changing. Whereas in the mid-1970s of charge.92 demand. Councillors trained by the Ministry every person of working age had on average of Health visited companies in order to one child or young person to provide for, Unlike, say, in Kenya, the Botswanian educate men about family planning and HIV today the figure is 1.8 people of the working government succeeded right from the start in at the workplace and to distribute condoms age. It is predicted that the country will be linking its HIV prevention and treatment there.94 As a result the rate of infection able to benefit from its favourable age programme with family planning. Midwives declined, and in 2011 condoms were the structure by 2055, assuming that it and nurses were trained in both areas.93 most popular method of contraception in manages to diversify the economy and to Botswana.95 Nevertheless, the prevalence of create sufficient jobs for the large share of HIV is still the second-highest in the world.96 young people of working age.98, 99 100 101

Changing age structure age 1980 2020 Thanks to the rapid decline in fertility, 80 and older Men Women Men Women the growing working-age population of 75–79 Botswana is required to provide for ever 70–74 fewer children and young people. The 65–69 population structure is changing from a 60–64 typical pyramid to a drop shape. 55–59 According to a study by the World Bank, 50–54 Botswana is already benefiting from this 45–49 change in its age structure: according to 40–44 this, around 20 percent of the poverty 35–39 reduction that took place between 2002 30–34 and 2009 was attributable to the fall in 25–29 the dependency ratio. The only factor 20–24 that had a greater impact over this 15–19 period was the programme of subsidies 10–14 for smallholders designed to raise 5 –9 101 productivity in agriculture. 0–4

Composition of the population according in thousands 90 60 30 0 30 60 90 150 120 90 60 30 0 30 60 90 120 150 to age group in Botswana, 1980 and 2020 (Data source: UN DESA100)

24 Africa’s Demographic Trailblazers 2.4 Ghana At the same time, the yields of staples like Fewer children born in the cities maize and manioc have doubled through the In certain respects Ghana is an exception use of fertiliser and better-quality seeds.105 Today, 56 percent of Ghana’s population lives in cities, compared with an African average of 42 among West African countries. With almost This has transformed the living conditions of percent.113 The comparatively high rate of 30 million inhabitants it has been a stable Ghanaian smallholders. Better harvests urbanisation has had an impact on the overall fertility democracy for more than two decades and brought higher incomes and enabled many rate, since in the cities new role and family models can boast some economic successes. In families to escape poverty. Measured in tend to become the norm more quickly and women demographic terms, too, Ghana is a national standards, the poverty rate of the have far fewer children than in the more traditional rural societies. trailblazer in the region. In no other country rural population fell from 64 to 39 percent in West Africa – the exception being the between 1991 and 2005.106 Meanwhile, food Children per woman island nation of Cap Verde – do women have security rose, one factor contributing to an 5 so few children on average as in Ghana. At improvement in the health indicators of the 4.7 3.9 children per woman the fertility rate is Ghanaians – especially those for small 102 way below the regional average of 5.2. children. Since the 1990s the share of 4 3.9 Ghana is therefore further advanced in the underweight children has more than demographic transition than its West African halved.107 These successes have led to a 3.3 neighbours and will be the first to achieve a considerable reduction in child mortality. 3 favourable age structure. From 2035, there Whereas in 1980 around 160 children per will be 1.7 people of working age to every 1,000 live births died before reaching their dependent under the age of 15, which has the fifth birthday, today the figure is 60.108 2 potential to generate an economic upswing. Children’s better chances of survival were a key prerequisite for the decline in fertility. 1 Agriculture as a starting point Urbanisation as a motor of social One reason why Ghana has the edge over change 0 neighbouring countries is its positive Total Urban Rural economic development. Between 1990 and The productivity gains in agriculture also Average number of children per woman in the 2015, annual GDP growth averaged 5.5 meant that fewer hands were needed to cities and the countryside in Ghana, 2017 percent, one of the highest growth rates on produce sufficient food. A growing number of (Data source: DHS112) the continent. Ghana’s economy depends not people therefore migrated to the cities, only on natural resources like gold and crude especially to the capital, Accra. There they oil, its most important exports, but also on increasingly began working in sectors that Urbanisation makes its own contribution to agriculture. The agricultural reforms of the were more productive in terms of gross value falling fertility rates. Studies have shown that 1980s focused mainly on cocoa production. added than smallholder agriculture – not only migrants from the countryside in Ghana The government created incentives for cocoa in (informal) retail and catering, for example, quickly adapt to the urban environment and farmers to improve productivity – they but also in public service, communications adopt the prevailing norms regarding family subsidised fertilisers, supplied pesticides and finance.109 This structural change fuelled size. On average they have fewer children free of charge and introduced varieties with the growth of the Ghanaian economy, than women of the same age in rural higher yields.103 The measures proved reducing poverty still further.110 Rising regions.114 Apart from different attitudes to effective. Since the early 1980s, the volume incomes and more consumption also family size, costs play a role. Whereas in the per hectare of cocoa farmers’ production has generated more tax revenue for the countryside more children mean additional more than doubled.104 government, which it used to invest in health and education.111 112 113

Berlin Institute 25 labourers and thus represent an economic Free education than 63 percent of the 9,400 female benefit, in the cities, where food is more respondents between the ages of 15 and 49 expensive, they tend to be a burden on the Education is an important factor influencing said they had completed at least secondary family purse. Thus the change of the place of Ghana‘s positive demographic development. education. Among all the African countries residence is usually accompanied by the wish In terms of educational indicators, too, for which current data are available, Ghana to have a smaller family. This wish is easier to Ghana stands out among the countries of occupies seventh place with respect to the realise in the city, since information about West Africa: in 2015, on average half of all level of education among women.119 family planning and contraceptives is more Ghanaians between the ages of 20 and 64 readily available.115 Access to education is had received a secondary school education. The fact that, at least formally, the Ghanaians easier, too, in urban centres. Children in the In neighbouring countries like Togo and Ivory now have a high level of education is linked cities generally receive more education and Coast this is the case for only about a fifth of to the large volume of investment in thus have fewer children than their parents the adult population.118 Women, in particular, education. Since the mid-2000s, the did.116 117 have a significantly higher level of education Ghanaian government has spent between 20 than those in many other West African states. and 38 percent of the national budget on In household surveys conducted by the education. The only other country in West Demographic Health Survey in 2014, more Africa to spend a similarly high amount on education during this period was Senegal.120 Regional differences The Ministry of Education used part of these resources to finally abolish school fees. Upper East 42.6 How much education young women in Upper West Although access to basic education was Ghana receive varies considerably from supposed to have been free nationwide since one region to another. Whereas in the capital, Accra, eight out of ten women can 1992, many schools continued to charge fees 121 read and write, the figure in the rural 41.2 in order to cover their expenses. Since this regions in the north of the country is only prevented many families – especially poorer around three to four women. This is also ones – from sending their children to school, reflected in fertility rates: in the capital, from 2005 onwards the government began Accra, where the level of education is the Northern highest in the country, women have an paying a flat rate per pupil to all public average of 2.8 children, whereas those in 30.7 education institutions, which they could use the Northern Region have more than twice to cover the costs of school materials, repairs as many. to the school building or sports and cultural events. Since then, education from Children per woman kindergarten to lower secondary school has 122 ≤ 4 Volta been free for all children in Ghana. Starting Brong Ahafo > 4 to 5 in the 2017–18 school year, the Ghanaian government abolished fees for higher > 5 60.4 48.2 secondary school and for vocational schools Literacy rate 59.8 as well. This was designed to do away with the still unequal access to education.123 64.2 Ashanti 55,2 Ghana

Eastern

Average number of children per woman 69.2 Western 49.3 (2017) and literacy rate of women in percent (2016), by region in Ghana Central Greater (Data source: DHS117) 51.9 Accra

26 Africa’s Demographic Trailblazers How important education is, particularly rate among highly educated women fell from 2.5 Senegal secondary education, is evident from a 35 percent in 2003 to around 27 percent in glance at fertility rates in Ghana according to 2014. In the same period the total share of In Francophone West Africa the average level of education. Women who have never women who say in surveys that they do not fertility rate is the highest in the world. It is been to school have six children on average. wish to use contraceptives in the future rose therefore hardly surprising that women in If, on the other hand, they have completed from 42 to 58 percent. Often the reason given Senegal have an average of 4.6 children – secondary school, the average number of is fear of side-effects.129 more than in all the other countries under children is 3.6, while women who have scrutiny here. Nevertheless, this state with completed university have only 2.5 Where this rejection of modern 17 million inhabitants has recently become a children.124 One reason for this is that contraceptives comes from is unclear. It regional model with respect to population educated women are better informed about would therefore be important to counter the policy. The Senegalese government has family planning methods and use them. Like scepticism of these educational groups by taken measures above all in two areas that everywhere else in Africa, women in Ghana offering more non-hormonal methods of could contribute to a fall in the fertility rate who have been to school generally use contraceptives such as IUDs and condoms, in the future. It has improved access to contraceptives more than those who have which are associated with fewer health risks education for the growing population and never been to school.125 In addition, these or none at all. At the same time, the made it easier for people to obtain women have the opportunity to pursue a government needs to step up its efforts to contraceptives. career and to earn an income independently improve access to contraceptives for those of a male breadwinner. who wish to use them, since currently around Senegal stands out in Africa with respect to 30 percent of women who want to avoid investment in education: in the last ten pregnancy are not able to use family planning years the government has consistently spent More efforts needed in family planning methods.130 between 20 and 25 percent of the state budget on the education sector. In 2017, Despite all this, in 2014 only around one The latest efforts of the Ministry of Health expenditure on education was – at 22 married Ghanaian woman in five used suggest that this situation will change. In the percent – the highest among all African modern methods of contraception. Although future, all family planning-related services states for which figures are available.132 With this is twice as high as the 1993 figure and are to be covered by the state health 74 percent of children attending primary the second-highest level in West Africa, the insurance and contraceptives made available school and 37 percent secondary school, prevalence rate is, in fact, much lower than free of charge in all health facilities.131 If it Senegal still lags behind the African average the comparatively high level of education of succeeds in reducing the unmet demand for with respect to access to schooling, while Ghanaian women would lead one to expect. contraceptives and consolidating the the quality of education also leaves In Kenya, where women’s level of education progress already made in education and the something to be desired.133, 134 But progress is somewhat lower but which, like Ghana, economy, Ghana will have a chance of has been made, especially with respect to adopted its first population strategy in the converting its favourable age structure into a education for girls. 1960s, the prevalence rate among married demographic dividend in the foreseeable women is – at 53 percent – more than twice future. as high.126, 127 Positive impact of girls’ education

It is striking that women who have completed Even as recently as 2000, there were still secondary or even tertiary education have only 88 girls starting school for every 100 fewer children but use modern boys. By 2017, this ratio had been reversed: contraceptives less than those with only today, for every 100 boys attending primary primary education.128 Indeed, the prevalence school, there are 112 girls.135 Thus educational opportunities for girls in Senegal are now better than they have ever

Berlin Institute 27 been – including at the secondary level. More education – fewer children Children per woman Whereas almost everywhere in Africa more 8 No education Everywhere in less developed countries educated boys attend secondary school than girls, in Primary education Senegal the opposite is the case. The woman have fewer children than uneducated women do. This effect is greatest if they go to secondary Secondary education targeted promotion of girls’ education began school after attending primary school. Senegalese 7 Tertiary education with the Scofi Programme, which the women with secondary education have on average Senegalese government launched together two children fewer than those who have never been with the World Bank in 1995. Both this to school. One of the reasons for this is that because 6 programme and its successors included they spend longer at school they marry and have children later. information campaigns in communities emphasising the importance of education for 5 girls. School materials were distributed and schools equipped with separate buildings become pregnant again, they can breastfeed 4 housing toilets for girls. At the same time, the the first-born child for longer and recover government awarded state grants and from the first pregnancy.140 141 promoted a nationwide sponsorship 3 system.136 Innovations for more family planning The obstacles that girls encounter in the 2 Senegalese school system have yet to be For women to be able to decide when they completely removed, and the traditional role want to have children and at what intervals, models that regard women primarily as they need access to contraceptives and 1 mothers and housewives persist. In 2015, knowledge of how to use them. The there were still more illiterate women than Senegalese government has therefore been men, including among 15 to 24-year-olds.137 promoting family planning more rigorously 0 2012 2017 2016 However, the fact that girls and young women for some years now with the declared aim of Niger Senegal Ethiopia are now attending school for longer has further improving child and maternal health already has a direct effect on the age at and putting a brake on population growth. Average number of children per woman which they marry: whereas in 1992, young The means it is using to achieve this goal according to level of education Senegalese women married on average at the include a broad-ranging media campaign and (Data source: DHS141) age of 16, today they do not tend to marry more money for the family planning until they are 20. This means they become programme.142 Together with eight other mothers later. Over the same period the Francophone countries in West Africa Encouraged by the Ouagadougou Partnership average age at which young women become Senegal in 2011 initiated the Ouagadougou and agreements with the international pregnant for the first time has risen from 19 Partnership, a coalition of government initiative Family Planning 2020 Senegal has to around 22.138 At the same time, the interval representatives, donor institutions, religious set itself an ambitious goal: by 2020, it aims between births has grown. At 34.6 months in leaders and actors from civil society. to have increased the rate of use of modern 2017, women on average had their next child Together they plan to work towards contraceptives among married women to 45 2.2 months later than they did in 1992.139 All improving the population strategies of the percent.144 Taking 2016 as a base, this would of this has a positive effect on both maternal respective countries and increasing funding mean a doubling of use in just four years.145 health and children’s chances of survival – for family planning campaigns as well as An important step in achieving this ambitious and hence indirectly on the fertility rate. If reporting back to the others about their goal was to improve the supply of contra­ women are over 20 when they bear their first experiences. Their goal is to have an ceptives. At state health facilities, where 85 child, the risk of premature birth is lower, as additional 2.2 million women using family percent of Senegalese woman make use of is that of underweight new-borns and other planning methods in the region by 2020. The family planning services, condoms, the pill complications. If mothers wait at least two states will receive support for this and other types of contraceptives were years after the birth of a child before they programme from internal donors and partner generally in short supply.146 In order to solve organisations.143 this problem, the Senegalese government

28 Africa’s Demographic Trailblazers together with the Senegal Urban Repro­ The Senegalese government and its partners’ more than 20 percent of married women who ductive Health Initiative in Dakar launched a commitment to family planning is working. would like to avoid pregnancy have to date pilot project in 2012 called the “Informed Whereas in 2011 only about 9 percent of had no access to contraceptives.152 But recent Push Model”. The novel aspect of this Senegalese women were using a modern progress and the Senegalese government’s programme was that whereas previously method of contraception, by 2017 this figure engagement with respect to family planning, medical personnel in health facilities had to had increased to 19 percent. Over the same maternal and child health and education for order and collect the required contraceptives, period, the prevalence rate among married girls are all reasons to hope that things will now private logistics companies keep track of women even rose from 12 to 26 percent, the continue to improve. If it succeeds in demand and deliver the required products highest level in West Africa.151 Senegal is still consolidating these achievements and at the directly to the health centres. Within just a lagging behind other African countries with same creating jobs for the growing number of year, the shortages at the 140 test facilities respect to family planning, and the unmet young people, Senegal will have a chance of a had been almost completely overcome.147 demand for contraceptives remains high: demographically determined development boost around 2060.153

With religious support Three-fold division

Following these first successes the “Informed Senegal has made major progress when it comes to using contraceptives: since 2011, the share of married Push Model” will now be gradually extended women who use modern contraceptives has more than doubled – to a total of 26 percent. Nevertheless, there to the whole country. But improving the are still big regional differences. At 37 percent, the prevalence rate among married women living in cities is on average almost double that of married women living in rural areas. The biggest difference is between the supply of contraceptives is not in itself capital, Dakar (42 percent), and Matam (10 percent), one of the poorest and most remote regions of the sufficient to persuade more people to use country.150 them. This applies particularly to the rural regions of Senegal, where the level of Prevalence rate education is lower and traditional norms play Saint-Louis 30 and more a bigger role than they do in the city. There 15 to < 30 women and men need to be informed about < 15 the benefits of family planning methods and encouraged to use them. In Senegal, where Louga the majority of the population is Muslim, many people are afraid to use contraceptives Matam for fear that it contravenes the Koran. In Thiès Diourbel addition to television and radio information campaigns, the Senegalese Ministry of Health Dakar and its partner organisations are therefore Fatick Karine working together with imams who advocate Kaolack Tambacounda family planning. Together they want to put paid to the myth that the Koran forbids family planning per se. Instead, they emphasise the passages in the Koran that speak in favour of Kolda planning one’s family – for instance, the Ziguinchor Sédhiou Kédougou positive effects on both child and maternal health of longer intervals between births and of breastfeeding for longer.148 149 150

Prevalence rate of modern contraceptives among married women aged 15 to 49 in Senegal, in percent, 2017 (Data source: DHS149)

Berlin Institute 29 2.6 Morocco Early decline in fertility Interview Morocco was one of the few countries in the With 2.4 children per woman Morocco has Mena region to emerge from the Arab Spring one of the lowest fertility rates in the whole Mr Courbage, why did the number of without a change of leadership. King of Africa, and its population is therefore likely births begin to decline in Morocco Mohammed VI introduced constitutional to grow much more slowly than in other precisely in a period of economic reforms shortly after the wave of protests countries on the continent. While the difficulty? began and called new parliamentary population is predicted to increase by about elections. While this put an end to the ten million people by 2050, this is still only During the 1970s, the prosperity of the protests, the distribution of power in the an annual growth rate of 1.26 percent, half Moroccan population fell steadily. monarchy barely changed. The king the African average.159 The reason for such Families suddenly had to find ways of continues to determine the political sluggish growth is the sharp decline in the earning extra income. That shook up agenda.154 fertility rate – from an average of seven traditional family structures. Whereas children per woman in the early 1960s to 2.4 before the crisis the man had been the Similarly, there has been little change in the children today.160 By comparison, the figure sole breadwinner, this was no longer conditions that caused the uprisings in the for Africa as a whole is currently 4.4 children viable for many families in the 1970s. whole Arab region. As before, young, per woman.161 Moroccan women began to look for increasingly well-educated people of working work and found it above all in the age have few prospects or opportunities to The decline in fertility began much earlier in textiles industry, which at that time was earn their living.155 In Morocco, unemploy­ Morocco than in most African states and flourishing owing to high demand from ment has been high for many years. This during a period of economic difficulties to Europe. For the development of fertility applies particularly to the younger gene­ boot. After gaining independence from in the country, this had clear ration. In 2010, the year before the France in 1956, the Moroccan economy grew consequences: the opportunity costs for “Arabellion” began, unemployment was at fast, mainly as a result of phosphate mining. an additional child rose considerably 17.8 percent among 15 to 24- year-olds; since When the world market price for phosphates once women started going out to work. then it has, in fact risen, to 21.9 percent.156 collapsed in the mid-1970s amid global At a time when concepts such as overproduction, Morocco slid into recession, maternity and parental leave were not So far Morocco has been unable to make use and many jobs in this sector were eliminated. known, absence from work as a result of of its favourable age structure – namely, a To balance the state budget the government pregnancy and birth often led to women large group of young people of working age abolished state social payments and raised losing their jobs. To ensure their and a smaller share of children and older taxes. Many families suffered financial financial security, many families were people. The window of opportunity in which hardship.162,163 forced to limit the number of children the country could reap its demographic they had and to use contraceptives. dividend opened up around 2005 and, Why was it precisely this situation that according to UN prognoses, is likely to close induced a decline in fertility in Morocco and What role did the state play in this again between 2040 and 2050, when a what other factors had a role to play is development? smaller number of people of working age will explained by Youssef Courbage from the have to provide for a growing group of older French National Institute for Demography The Moroccan government’s positive people.157 The government is trying to drive (Ined) in an interview with the Berlin attitude to family planning was forward industrialisation in the country,158 Institute. He has been studying the important right from the start: the but it remains questionable whether this will demographic development of the Mena monarch at the time, King Hassan II, yield sufficient jobs for Morocco to be able to region for decades. In the interview he also had already declared in official utilise its favourable age structure. appraises Morocco’s chances of reaping a speeches in 1966 that the country’s demographic dividend. socio-economic development depended on a decline in population growth. The

30 Africa’s Demographic Trailblazers government therefore began to distribute ideas soon spread to the Moroccan Can other African countries nevertheless contraceptives free of charge supported by hinterland. Through field studies we were learn something from Morocco? USAID and by international organisations able to establish that rural regions with high like the UN Population Fund. rates of emigration experienced high rates The demographic transition in Morocco was of schooling and more educational equality not always perfect, but it can still serve as a Since King Mohammed VI came to the between boys and girls sooner than did positive example – say, for the Sahel throne in 1999, the government has made areas with less emigration. Moroccans who countries. Morocco has a similar culture and significant progress in promoting education returned home from abroad encouraged the same religion as, for example, Mali, for women. The share of children starting their relatives and friends to send girls to Niger, Chad and Burkina Faso, which have primary school was 97 percent according to school and to use contraceptives to plan the extremely high fertility rates. For many the last census in 2014 and there was size of their families. Some migrants even African countries Morocco sets an example scarcely any difference between girls and brought back contraceptives from Europe that would be much more convincing and boys. However, the state promotion of and distributed them in their homeland. much easier to understand than examples of education for girls began at a much later lower fertility in Europe. Morocco could say stage. With 2.4 children per woman Morocco is to those countries: “Look at us, in the 1970s comparatively far advanced with respect to we had similarly high fertility rates to yours I believe, nonetheless, that education demographic change. What are Morocco’s today, but nowadays Moroccan families are originally played only a negligible role in the chances of reaping a demographic dividend? deciding to have far fewer children. And we decline in fertility – the level of education are nonetheless Muslims just like you!” That was very low at the time. Instead there was Morocco’s age structure is favourable today, would show that it is not about religion or another factor that, in my opinion, had a key but that alone is not sufficient to promote belief. influence on developments: migration to economic progress. The country is suffering Europe. Historically, Morocco had always from high unemployment, especially among All in all, I think it’s very difficult to convince been more engaged in exchange with young people, as well as a very low a country that low fertility is necessary. The Europe and this was enhanced by migration. employment rate for women. The trend of government representatives in those In this respect the country is different from the 1970s, when Moroccan women flooded countries, who themselves are often poly­ those in other Arab regions like the Middle the labour market, has unfortunately been gamous and have many children, do perhaps East. reversed and today almost 75 percent of not always set a good example. But I do women of working age are without paid believe very much in the power of contagion: How did this exchange affect the decline in employment. There are many reasons for what emigration to Europe did for the fertility? this, one cannot attribute it solely to the development of Morocco could be accom­ conservative culture. Morocco is in a plished for countries with a high fertility rate Moroccan migration to Europe began in the difficult economic situation: for the through more exchange between North and late 1950s. The migrants initially went to economy to gather momentum, jobs need to sub-Saharan Africa. I think this is the only France and Belgium and somewhat later to be created, for which massive investment way to bring about such change. At the same other European states. A growing number of would be required. As long as the time, we need to go on patiently investing in migrants thereby came into contact with population of working age cannot find education. The basics of demography need European values and ways of life. Having in employment, the demographically to be taught at school: young people must some cases left their homeland without an favourable age structure will remain unused. understand what fertility and mortality are education and even as illiterate, they and why lower fertility rates are better both discovered in Europe that both girls and for maternal health and for the economic boys went to school and that the average development of a country. When young European family had far fewer children than people start to think differently about family families in Morocco. On account of the planning, their parents’ generation will be geographical proximity to Europe and influenced, too, in the long term. Education regular visits home by the migrants, these stands at the beginning of such a development.

Berlin Institute 31 2.7 Tunisia A pioneer of women’s rights and polygamy and raised the minimum age at education which girls could marry, initially to 15 and Addressing the assembly of the UN Council subsequently to 17.169 for Human Rights in Geneva in February Strengthening the role of women in society is 2018, Tunisia’s head of state, Béji Caid a strong tradition in Tunisia. Right after the As well as improving the legal status of girls Essebsi, advocated one thing in particular: country gained independence from France in and young women, Tunisia’s first president more equality between men and women.164 1956, Tunisia’s first president, Habib took measures to improve their access to At 92, he was probably the oldest person Bourguiba, advocated more gender equality. education. After he had introduced free and attending the assembly, so it might seem His reforms changed social structures and obligatory primary school education, the surprising that he of all people should call for improved the social status of women, who government was forced to establish the more rights for women. But his homeland, from then on were allowed to vote and no necessary educational infrastructure. Tunisia, the country where the Arab Spring longer had to wear the veil.168 Another Through major investment in education of up began nearly a decade ago and the only state important step in female emancipation was to 34.5 percent of the national budget it was in the region that managed the transition to a the Code du statut personnel, a series of able to accomplish this in 1971 even in liberal democracy, is a pioneer of women’s progressive laws that came into force in 1957. remote regions, whereupon the rates of rights in both Africa and the Arab world. The The legislation stipulated that both partners school entry rose steeply. Despite initial new constitution, adopted in 2014, put men should consent to a marriage, banned reservations on the part of both parents and and women on an equal legal footing in teachers, the number of girls attending nearly all spheres in this state with almost 12 school increased too.170 171 172 million inhabitants.165 Gender equality lowers the fertility rate Although gender equality has yet to make its mark on the everyday lives of many members How gender equality influences fertility in Africa is abundantly clear: the more opportunities women have to participate in the labour market and in politics, the more their reproduction rights are guaranteed and the of the population – especially in the remote better educated they are, the fewer children they will have on average during the course of their lives. Tunisia regions of the country far away from the has the second-lowest level of gender inequality on the African continent – and one of the lowest fertility rates. capital, Tunis – under the sprightly president Children per woman the Tunisian government is pushing through ever more changes in the law in order to 8 further strengthen women’s rights: for Niger example, a provision has been abolished that 7 prohibited Tunisian women from marrying Chad non-Muslim men, and new guidelines have 6 been adopted to curb violence against women and to increase their participation in 5 166 political decision-making processes. On Rwanda National Women‘s Day in August 2017, 4 President Essebsi announced the reform of a discriminatory law of inheritance. If the 3 Tunisia parliament approves the draft law giving Morocco 2 women the same rights to inherit as men, this would be a novelty in North Africa and the Mauritius 1 entire Arab world.167

0 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 Gender Inequality Index Average number of children per woman (2018) according to gender inequality, according to the Gender Inequality Index (2017), whereby “0” represents absolute gender equality and “1” the highest level of gender inequality (Data source: PRB171 and UNDP172)

32 Africa’s Demographic Trailblazers This contributed to a rapid improvement in planning teams visited smaller hospitals and The success of the family planning pro­ the level of education: whereas in the 1970s schools according to a weekly rota to inform gramme, the rising standard of education and only about 15 percent of adult Tunisian people about family planning methods and the emancipation of women, who women could read and write, the share of provided contraceptives free of charge. In increasingly have paid jobs, has brought literate women was more than twice as high addition, the government launched Tunisia rapid socio-economic change. Child by the mid-1980s.173, 174 Today, 72 percent of information campaigns on the radio and in mortality fell from roughly 260 deaths per women over the age of 15 are literate, and newspapers and tried to win the support of 1,000 live births in 1965 to around 60 in among 15 to 24-year-olds, the figure is 96 religious leaders.180, 181 Since President 1990 and by 2015, the figure had fallen percent. In higher education young Tunisian Bourguiba had officially proclaimed his further to 20.187 Over the same period life women are, in fact, doing better than men: in support for family planning and the issue was expectancy rose from 44 to 76 today – the 2017 almost seven out of ten university discussed relatively frequently in Tunisian third-highest figure on the continent.188 graduates were women.175 society, the prevalence rates of modern These development successes also led to a contraceptives rose rapidly: from a baseline of rapid fall in fertility rates. Whereas in the 25 percent in 1978, 40 percent of women 1960s women still had around seven Political commitment to family aged 15–49 were using modern contra­ children, by the turn of the millennium the planning ceptives ten years later and 50 percent by fertility rate had fallen below the repro­ 2012.182 183 184 duction level of 2.1 children per woman, at The Tunisian government recognised at an which a population stops growing in the early stage that giving women equal social The commitment of the president – who has medium term without migration.189 190 status and a good education were among other things awarded an annual prize prerequisites for putting the brake on high to organisations and individuals who have population growth and at the same time campaigned for family planning – was an No dividend without jobs ensuring the country’s economic success. In important component of the success of the order to lower the fertility rate, which in the programme.185 How strong the political will Tunisia is thus the first country on the African 1960s was still almost seven children per has been with respect to this issue in mainland to achieve the economically woman, the Tunisian government looked to comparison with other African countries is favourable age structure of the demographic another area: a comprehensive family shown by the Family Planning Effort Index. bonus: while in 2000, there were 1.8 people planning programme.176, 177 First it had to Since the 1970s, Tunisia, together with of working age to provide for each dependent repeal the law passed by the former colonial Mauritius and Botswana, has always ranked – i.e., children and old people – in 2015, the power, France, which had made distributing near the top among African countries. In figure was already 2.2.191 Since the turn of the and advertising contraceptives punishable 2014, Tunisia even scored the second-highest millennium Tunisia has had a dispropor­ offences.178 Subsequently, government number of points after Rwanda among the 90 tionately large number of workers at its representatives turned to Asian countries, countries evaluated worldwide.186 disposal, which could bring about a among others, for inspiration, since these had demographically determined economic already put successful family planning programmes in place. In 1964, a first pilot project was launched in Tunisia and, after two Early start 1957 1959 years of tests, extended to the entire country.179 With the Code du statut personnel Tunisia has the Tunisia‘s government The first woman is most modern personal statute law in Africa and at the strengthens women’s elected to the rights by, among Tunisian parliament. With support from the US Ford Foundation same time probably the most successful family planning programme in the region – and has had for other things, raising In neighbouring and the Population Council, the Ministry of more than fifty years. The many different reforms and the minimum age of Morocco this does Health trained doctors and midwives. programmes under President Bourguiba were marriage and not happen until Municipal clinics included family planning pioneering in their time, especially for a Muslim prohibiting poly­ 1993. services in their catalogue of healthcare. In country. gamy. In addition, it reforms divorce laws the countryside mainly mobile family and legalises abortion for women (own diagram after Brown who already have and Baliamoune-Lutz 183,184) five children.

Berlin Institute 33 upswing based on the model of the Asian Temporary deviation from the trend tiger states. But currently the country is far from being able to harness this potential; Thanks to its early socio-economic transformation, Tunisia experienced a decline in fertility rates long before the sub-Saharan countries and a more rapid decline than its North African neighbours. By the turn of the like almost everywhere in Africa, there are millennium the fertility rate had fallen below 2.1 children per woman. Amid the upheavals following the Arab insufficient jobs for the large number of Spring, the number of children born has risen slightly again, albeit far less than for example in Egypt. people of working age.192 Children per woman The Arab Spring in Tunisia showed what 8 explosive power is harboured in a young and formally relatively well-educated population 7 of working age that is lacking in prospects 6 and income opportunities. Protests like Sub-Saharan Africa those in January 2018 – triggered by a new finance law – have flared up time and again, 5 showing that discontent has not dwindled even eight years later. At 15 percent, 4 unemployment is still at a high level; among Egypt the 15 to 24 year olds it was estimated to be 3 more than twice as high, at 35 percent, in Morocco 2 2018. Women, in particular, are affected, Tunisia Development since unemployment among them is almost of fertility rates, 1 1960 to 2050 ten percentage points higher than among (Data source: 190 men. Despite all the gender equality laws 0 UN DESA ) they are much less likely to have a job than 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 2010– 2015– are men. In 2015, 70 percent of men were 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 employed, but only 26 percent of women.193

The difficult economic situation in Tunisia as however, suggest that this deviation from the reach, economic reforms need to ensure that well as the low rate of employment or high downward fertility trend is only temporary. jobs are created – and soon. From around rate of unemployment among women may Similarly, the government’s current efforts 2040, the window in which Tunisia’s be one explanation why the country recently are likely to further strengthen women’s favourable age structure can be converted recorded an increase in the number of position in society. In order for fertility to into a dividend will already start to close births. Past experience and UN forecasts, continue to fall and for the chance of a again.194 demographic dividend to remain within

1962 1963/64 1966 1967 1968 1973

The national Government The national family The pill becomes The Tunisian The National Bureau economic and social representatives planning programme generally available. Association for for Family Planning development plan evaluate successful is launched. Sexual and and Development names a reduction in family planning Reproductive Health opens. The population growth programmes in Asia is established with government further as one of the most and the United government support. liberalises the important goals in States. Sub­ President Bourguiba abortion law. order to achieve sequently, the test strongly advocates economic and social phase of the Tunisian family planning. progress. programme begins.

34 Africa’s Demographic Trailblazers LEARNING FROM 3 EXPERIENCE AND USING NEW OPPORTUNITIES

The demographic transition has always been after World War II, as knowledge increased proximity to Europe, which brought the – and will continue to be – a result of about the factors influencing demographic modern family profile to Morocco, or a development. If people’s living conditions development – especially fertility.2 In the detailed development strategy such as that in improve, if they receive more education and if meantime, the factors that contribute to Ethiopia, where concrete improvements in they achieve greater prosperity and have new declining fertility rates have been well healthcare, education and the labour market opportunities to shape their own lives, then researched. And for this reason, we know rapidly changed people’s living conditions. their views will change about repro­duction today which adjustments have this or that Each of these countries had to find its own and family size. In Europe and North America effect on the desire of women/families to way to trigger a decrease in the fertility rate the demographic transition began during the opt for fewer children. and then consolidate that trend. This does Industrial Revolution. In Asia and Latin not always happen in a straight line and America it got under way after World War II, without setbacks, as evidenced by the whereby it was, above all, the rapid spread of Harnessing the available knowledge fertility rate having meanwhile halted its medical knowledge that led to a sharp decline decline in Kenya and started to climb again in in mortality rates.1 As a result, more children African states in which the demographic Tunisia. But once a significant downward survived beyond their first years of life and transition remains stuck in the early stages trend in the fertility rate has been one to two generations later the fertility rates have a decisive advantage over those established, it has so far proved irreversible eventually sank, too – almost as a side effect countries that are ahead of them: unlike the in every region of the world.3 of general development. European countries two hundred years ago, they are able to tap the available knowledge Besides those countries already considered, Many of the breakthroughs that accompanied about the major factors influencing declining there are other states on the African this process were neither foreseeable nor fertility rates and decide which demographic continent whose measures and programmes planned – at least in the “pioneer countries” policy measures to take. Here the biggest contribute to declining fertility rates or at of the demographic transition in Europe and lesson to be learned to date is that fertility least are likely to do so in the future. This North America. After all, no one could have rates decrease significantly only if all the chapter highlights the main spheres of action known that through inventions such as the important influencing factors work together in healthcare (including family planning), steam engine, mineral fertiliser, vaccinations – in other words, if people’s living conditions education (including more gender equality) and antibiotics, fertility rates could be improve, if access to healthcare services and and employment as well as the role of the expected eventually to decrease and that this educational institutions is made easier and engagement of politicians and religious would have an enormous influence on if employment opportunities emerge. Access leaders. At the same time, practical examples demographic development. Such a realisation to family planning methods and greater provide an overview of the measures taken was possible only with hindsight through the gender equality are part of this overall by various actors in African countries that are scientific evaluation of the developmental package, too. having a direct or indirect influence on process. fertility rates or are likely to do so in the The country examples included in this study future. We also showcase approaches that State interventions in the areas of healthcare show where there has already been positive and family planning designed to influence the change along these lines on the African mortality and fertility rates did not begin until continent and which influencing factors have thereby played a role. This could be

Berlin Institute 35 staff.9 Together with an environment in which Good practice: Mauritius – an African “tiger state” pathogens spread quickly – from a “malaria- friendly” climate to the lacking basic Today, the small island state of Mauritius is one of Africa’s richest countries. In the sanitation and contaminated drinking water Human Development Index, only the neighbouring island state of the Seychelles ranks – and an often precarious food situation, this higher among all the countries on the continent.4 This is no coincidence because in results in overall poor health indicators. The contrast with its neighbours on the mainland, Mauritius has almost concluded its mortality risk for infants, small children and demographic transition and used the accompanying change in the age structure of its mothers in Africa remains the highest in the population to its advantage. To put it succinctly: the microstate in the Indian Ocean has world.10 succeeded in reaping a demographic dividend. The starting point for this achievement was an early and rapid decline in the fertility rate. If the number of children per woman Providing good nutrition and clean water was more than 6 in 1960, this figure had fallen to around 3.5 within 10 years. Today the One of the main reasons for the persistently fertility rate in Mauritius is just 1.4 children per woman and thus already lower than that high mortality rates is the insufficient in Germany.5 provision of clean water in many places. On average, only a quarter of the population of The rapid decline in the fertility rate was urgently needed on the island, which is even the sub-Saharan countries has access to smaller in size than the Saarland and in the 1960s was still desperately poor. The drinking water sources that do not pose any government therefore began to invest in education and family planning – despite the health risk.11 In those places where this is no initial opposition of Catholic Church leaders as well as Muslim ethnic groups. Thanks to clean water or sanitation facilities, pathogens rapid progress in education, family planning methods were soon accepted among the and parasites can quickly spread and cause population. By the early 1980s, 40 percent of woman of corresponding age were life-threatening diseases such as diarrhoea attending secondary school.6 – one of the most common causes of death among small children. According to various As the level of education increased and the fertility rate declined, the island’s economy studies, the child mortality rate could be began to gain momentum: between 1985 and 1995, Mauritius recorded consistently reduced by 25 deaths per 1,000 live births if high economic growth with an average annual growth rate of around 6 percent and governments would invest more in the thereby numbered among the five fastest-growing countries on the continent. Per capita provision of drinking water and sanitation gross domestic product grew during this period by more than 150 percent. Since then, it facilities.12 has more than doubled again. In 2017, adjusting GDP for purchasing power parity, the Mauritians had the third-highest per capita income – on average some 20,000 US Some countries have already made dollars – on the continent, and they achieved that even without exporting valuable raw considerable progress in this area: in materials.7 In fact, the economic rise of the island state began, as is often the case, with Senegal and Rwanda, investments in water the textiles industry. Today, Mauritius is not only a holiday paradise but also one of the infrastructure and the training of specialists most important IT and financial centres in Africa.8 have enabled the goal of the Millennium Development Agenda – halving the share of the population without access to clean drinking water – to be achieved. Above all, use new technologies to solve old problems 3.1 Healthcare the greater involvement of the population has and can be relatively easily applied across contributed to this success.13 In Botswana, the board. All these measures can be an Throughout the world, the demographic too, the government has expanded the water inspiration to those states that, together with transition began with an improvement in supply network and thereby significantly international donors, non-governmental health indicators and a decline in child improved access to clean water. By 2006, organisations and other partners, want to mortality rates. But for poor African states it two-thirds of the population were able to expedite the decline in the fertility rate is already a huge challenge even to maintain receive their drinking water via the water within their borders.4 5 6 7 8 the existing healthcare services for the mains.14 growing number of people. Especially in rural areas there is a lack of hospitals and appropriate equipment, as well as of medications and, above all, well-trained

36 Africa’s Demographic Trailblazers In remote regions, access to drinking water Bringing healthcare services to the people Aids, the healthcare system has also trained is particularly difficult. There people have to In developed states, it is usual for small HIV-positive women as mentors who support draw their drinking water mainly from wells children to be vaccinated, pregnant women to and advise pregnant women and mothers or waterholes and transport it in canisters go regularly for ultrasound scans and other who have contracted the same illness.20, 21 over long distances. Germs and pathogens routine examinations and children to be born have an easy time in such places. In Kenya, in hospitals under medical supervision. In Since 2011, Zambia has followed suit in Malawi and Uganda, development most African states, the infrastructure and training female healthcare workers who are organisations and foundations have recently the personnel are simply lacking for such intended to form a bridge between the found a simple way of improving the quality services – with the corresponding con­ available hospitals and people living in of water: within the framework of the sequences: in the sub-Saharan countries the remote regions. In order to make the work Dispensers for Safe Water Programme, risk of women dying during pregnancy or more attractive, the Ministry of Health almost 25,000 chlorine dispensers have while giving birth is still around 70 times guarantees not just a wage but other been installed next to wells, waterholes and higher on average than in the EU.18 Above all benefits, like those granted to civil servants, other sources of water in the three countries, in rural regions, a day’s journey is often and provides the healthcare workers with allowing more than four million people to required to reach the nearest hospital. bicycles, mobile phones and uniforms.22 gain access to germ-free drinking water. A Ensuring the provision of basic healthcare teaspoon of the disinfectant per water services for people living in remote areas is Developing the provision of medical services canister suffices to kill off the harmful therefore a central factor in achieving better with the help of voluntary or employed bacteria.15, 16 health indicators and, indirectly, declining healthcare workers is by no means a new fertility rates. approach. Many African countries have Just as important as access to water is the launched similar programmes in order to battle against famine. It is above all children As the chapter on individual countries shows, improve healthcare infrastructure and to who are prone to infectious diseases if they Ethiopia has achieved this within the integrate the state system into the are under- or malnourished. Famine can be framework of its Health Extension Program communities through already existing sustainably fought only if the productivity of with a relatively small amount of funding. initiatives. However, the programmes have Africa’s farmers significantly increases. Even While the network of health centres is by no not been successful everywhere. Important ancillary measures are having an impact means sufficiently dense to provide adequate prerequisites for success include strong here: for example, in 2015, the government care to the more than 100 million people political engagement, well trained and highly of Ethiopia launched, together with living in the country, female health workers motivated medical workers and the international donors, the Productive Safety spread knowledge about fundamental health acceptance and trust of the population.23 Net Programme, which provides people issues. And the successes to date in reducing affected by food shortages with support for child and maternal mortality show that up to six months of the year – either through Ethiopia is on the right track. The concept Telemedicine offers new opportunities the provision of food free of charge of was successful in particular because women through the so-called Cash-for-Work from communities were trained as healthcare In those countries where attempts to provide Programme. Since the introduction of the workers. This not only promoted acceptance sufficient health workers in all communities back-up programme – the largest on the among the local population but also created and villages have failed, other approaches African continent – the share of those a source of income for women.19 have proved helpful – for example, mobile affected by undernourishment has fallen clinics such as those in Botswana and from 40 to 29 percent.17 Malawi, too, has a network of healthcare Tunisia. Health advice via mobile phone also workers, which essentially has existed since offers completely new potential. Omomi, the the 1950s, and the scope of its tasks has healthcare app developed by Carles been constantly expanded. The medical Akhimien, a Nigerian physician, provides personnel distribute modern contraceptives, pregnant women and mothers with treat children suffering from typical information about children’s health, among childhood illnesses such as pneumonia, other things. Within a few minutes, medical malaria and diarrhoea and provide information about HIV/Aids. To prevent mothers infecting their children with HIV/

Berlin Institute 37 personnel answer questions on how common More mobile phones, new opportunities childhood illnesses can be avoided and treated. In addition, an online forum allows Mobile phones are spreading rapidly throughout Africa: today more than 440 million people use such devices in the sub-Saharan countries alone; by 2025, this figure is expected to reach 634 million. Smart phones are women to exchange information and give one being used more frequently, too. While in 2017 a third of all mobile phone users owned a smart phone, it is another health tips. Some 32,000 women in likely that around twice as many will do so by 2025.30 That will lead to new opportunities in many areas – for Nigeria, Kenya, Ghana and Tanzania are example, in access to health information, training programmes and knowledge about agriculture. already using the service. The plan is to expand it to the entire continent in the future.24, 25, 26

In South Africa another app enables female healthcare workers to contact specialists from hospitals via video link and decide jointly how a patient should be treated. Moreover, healthcare workers in rural areas can use the app to undergo further training.27,28 Because the use of mobile and smart phones has since become increasingly widespread, similar projects could be introduced in other countries.29 30 31 32 Share of mobile phone users in the population, in percent, 2016–17

< 30 30 to < 40 40 to < 50 50 to < 60 60 to < 70 70 and more No data

(Data source: GSMA29)

New approaches: Drones as whether they reach a hospital in time or country with donor blood and medication; healthcare helpers whether donor blood arrives at the local the plan is to increase that number in the clinic in time. future. Now Ghana is following in In many countries on the African continent, Rwanda’s footsteps. Since April 2019, 30 health centres in rural areas have a major New technologies can lead to improve­ Zipline drones have been supplying problem: owing to the lack of roads, they ments in this area, too. In Rwanda they are vaccinations, medication and donor blood are often hard to reach and are frequently already doing so: in 2016, the 12 million to a total of 2,000 healthcare centres located a long way from the nearest state in East Africa became the first throughout the country from four logistics hospital in which people who are seriously country worldwide to develop – together centres. In the future, 12 million people ill or injured can be treated. If, for example, with the US company Zipline – a supply – almost half the Ghanaian population – women lose a lot of blood while giving network involving drones.31 To date, the are to receive supplies through some 600 birth, it is a question of life or death aircraft supply 21 healthcare centres in the flights a day.32

38 Africa’s Demographic Trailblazers 3.1.1 Family planning Like in Ethiopia, the family planning Bringing the private sector on board programme in Rwanda relies on female If children’s chances of surviving increase healthcare workers in the communities Making contraceptives available to as large a thanks to an improvement in healthcare making modern contraceptives widely part of the population as possible is no easy provision, women/couples tend to think available. In 2015, around 80 percent of task. And in rural areas the provision of differently over time about the size of their women using modern contraceptives contraceptives is twice as difficult. On the family. But the desire to have a smaller family received them via a local health centre or one hand, family planning and contraception can be better realised if modern family from community workers. The usage rate of are often taboo subjects, which means planning methods are accessible. Therefore, contraceptives among married women in women are reluctant to ask about them in it is imperative that improved access to Rwanda has risen sharply: while it stood at healthcare centres or clinics.35 Moreover, family planning services always be taken into just 10 percent in 2005, it had increased to contraceptives are frequently difficult to account in developing healthcare infra­ 48 percent 10 years later.33 One of the factors obtain at state healthcare institutions structure. Most of the countries examined in contributing to this development was a because of unwieldy procedures for ordering Chapter 2 have been successful by African broad-based information campaign that them or because new supplies fail to reach standards in stemming population growth, included monthly discussions with remote regions. above all because they have family planning administrative personnel, action days programmes that are relatively well funded providing information about maternal and Senegal’s successful Informed Push Model and implemented – or, at least, had such child mortality, and radio advertising.34 shows that the private sector can help solve programmes at some point. Moreover, as a these problems. In this sector it is not rule their governments have developed healthcare personnel but private logistics services in hospitals or rural healthcare companies that ensure that healthcare centres offering information about and the centres have regular supplies of family means of family planning. In some cases, mobile clinics have become a way here, too, of reaching remote or undersupplied areas. Radio spots about family planning

Until now radio has been the most common means of disseminating information about family planning and contraception. However, there are large differences in this regard between the African countries: in Kenya and Creating and meeting demand Liberia, around three-quarters of men and women aged 15–49 said in surveys that they had received information in this way. In Chad, the corresponding figure is just some 10 percent of women and 20 percent of Regardless of where and how contraceptives men. Television and newspapers reach even fewer people. are distributed, it is important to have a broad range of means to hand in order to In percent meet the various needs. The rapid rise in the Kenya 2014 80 Women Men use of modern contraceptives in Ethiopia, for Liberia 2013 example, would hardly have been possible if Malawi 2015–16 70 the government had not approved the use of Niger 2012 60 hormone injections and implants. Such Chad 2014–15 means are effective over a relatively long 50 period and save women having to pay regular visits to a clinic, which particularly in rural 40 areas could mean travelling a long distance. Share of men and women aged 15–49 who 30 have received information about family 20 planning from radio, television or 10 newspapers, in percent (Data source: DHS38) 0 Radio Television Newspapers Radio Television Newspapers

Berlin Institute 39 Good practice: Longer lives and more As healthcare infrastructure is developed, The government stepped up its activities in family planning in Malawi people in Malawi are using modern this area through a comprehensive radio contraceptives much more frequently: the campaign, which, alongside other health Malawi is one of the poorest countries in usage rate doubled from 26 percent of topics, offered extensive information about the world: 70 percent of the population married women in 2000 to almost 60 family planning, sexuality and contra­ lives below the poverty threshold of 1.90 percent in 2016.48 Thus, the use of contra­ ceptives. The broadcasts were developed in US dollars a day, adjusted for purchasing ceptives is now more prevalent in Malawi cooperation with local communities and power parity.44 But the landlocked country than in almost any other country on the dealt mainly with the problems that are in the southeast of the African continent continent – despite the government having caused by too large families, such as the has made astonishing progress in the area begun to invest in family planning at a later shortage of land.50 In 2000, 69 percent of of healthcare over the past two decades: stage than other African states. Indeed, women and 82 percent of men taking part life expectancy, a good across-the-board during the thirty years of the autocratic in household surveys said that they had indicator of the well-being of the regime of President Hastings Kamuzu heard about modern contraceptives from population, rose by 17 years during the Banda (1966–94), family planning was the radio.51 Since 2011, there has also been period 2000–16 from 47 years previously even officially prohibited. It was not until a nationwide health hotline that provides to 64 years.45 This means that in recent the introduction of a multiparty democratic free information on all subjects related to years the Malawians have on average system in 1994 that the country developed health. gained more than 12 months of additional a demographic strategy and subsequently lifespan annually. This rise is to be launched a family planning programme. Just The initial impact on the fertility rate is attributed, above all, to the huge decline in a few years later, contra­ceptives were already evident. Between 2000 and 2017, child mortality, which fell by half over the available free of charge at most healthcare the average number of children per woman same period.46 The reason for this success facilities. A particularly important role here decreased from 6.3 to 4.2.52 Nonetheless, is the robust development of the network of was the work of the rural health workers, much remains to be done: compared with rural healthcare centres and the training of who were involved in distributing and the sharp increase in the prevalence of community health workers, which the providing information about contraceptives modern contraceptives, the decline in the Malawian government has promoted right from the start. A 2002 evaluation of fertility rate has been slow. A possible together with international partners. In this the programme showed that users valued explanation for this, according to a recent way, the basic provision of healthcare was especially this low-threshold access to study, is the irregular use of hormonal extended to remote regions – a key factor in information about contraception.49 contraceptives, mainly owing to insufficient a country in which 83 percent of the supplies in rural areas. For example, in population live in the countryside. In 2011, 2012 only half of the women using there were already more than 10,000 hormonal injections – the most widespread health workers throughout the country, method of contraception – in the remote whose main tasks include providing northern part of the country received their preventive services such as vaccinations first follow-up injection on time.53 and malaria prophylaxis. According to one evaluation, more than 6,000 deaths among small children were prevented in 2013 alone.47

40 Africa’s Demographic Trailblazers planning means.36 They include the start-up the German development bank KfW is 3.2 Education Kasha from Rwanda, whose goal is to supported by traditional dignitaries, improve access to contraceptives as well as nationally famous female singers and Today, the decisive role that education plays other healthcare and sanitary products. Via wrestlers. Subjects such as education for in achieving socio-economic progress and app or text message, women can place their girls and child brides are addressed in the thus in reducing the fertility rate is known orders, which are then delivered by moped. radio spots, too.40 The fact that prominent well beyond expert circles. Equally clear is In rural areas a total of 75 local female figures such as wrestlers, who are celebrated that the poor level of education is one of the workers ensure that the goods reach the as national heroes in Niger, campaign for the main causes – if not the main cause – of customers and that information about the use of condoms has been a major contributor Africa lagging behind in its development and service and products provided by Kasha is to the campaign’s success. They demonstrate, fertility rates remaining persistently high. made broadly available. To date, some above all to men, that talking about and using Indeed, it is no coincidence that fertility rates 20,000 people have used the delivery contraceptives in no way reflects badly on are highest precisely in those countries in service, which recently expanded to Kenya.37 them.41 which the level of education is lowest. In 38 Niger, where women have the most offspring Mobile phones are also playing an in the world – on average 7.2 children – less Information a prerequisite increasingly important role in this effort to than one third of adults can read and write.54 inform the public.42 For example, the If there is to be any demand at all for family initiative m4RH – Mobile for Reproductive Facilitating access to education, improving planning methods, the dissemination of Health uses them to spread information the quality of teaching and promoting information about contraceptives is of central about contraceptives. Via text message, vocational education and training are key to importance. Often couples – and women in users receive information about the various driving forward Africa’s development. This is particular – are reluctant to use contra­ means of protection and find out at which because, as explained in Chapter 1, education ceptives because of concerns about side healthcare institution in their neighbourhood has a positive impact via many different effects or out of fear of being stigmatised by they can be obtained. In Kenya, Tanzania channels on people’s prospects and thus, relatives and members of the community. and Rwanda this project has been indirectly, on how many children they want to Alongside sex education in schools and youth implemented by the US non-governmental have. The examples of Kenya, Ghana and clubs, information campaigns on the radio organisation FHI 360 together with the local Senegal cited in the previous chapter and television have proved useful means of health ministries. In Tanzania m4RH is confirm the positive effects of education on breaking the taboos surrounding the subjects already being used in 98 percent of declining fertility rates and show what can be of sexuality and contraception. Almost every districts.43 44 45 46 47 48 49 50 51 52 53 achieved in this area with high levels of African country has conducted such media investment. Like in the healthcare sector, campaigns, but the results have been both proven methods and new technologies varied.39 can help make education available to everyone. Whether such a campaign is successful depends – alongside funding and reach – on whether it enjoys the support of prominent Providing incentives to attend school individuals. In Niger, the country with the highest fertility rate in the world and one of In order to increase the overall level of the lowest usage rates of modern education in Africa, the existing obstacles to contraceptives, such important advocates obtaining an education must be removed have been found. Here a radio information – from persistent poverty, which makes it campaign about contraceptives co-funded by impossible for parents to pay for school materials for their children, to inadequate infrastructure and too few teachers, who can hardly keep up with the demand from the constantly growing younger cohorts. What means can be used to overcome this deficit is

Berlin Institute 41 now sufficiently well known. For example, on the learning outcomes and participation in the so-called cash transfer programmes have classes, they nonetheless ensure that girls New approaches: Mobile proved they are able to help, in particular, who do not finish their schooling are less vocational training children from poor families gain access to likely to marry or become pregnant at an education. Under these programmes, parents early age. Overall, the likelihood of pregnancy Africa needs to create new jobs and receive cash payments if they send their among those girls who left school early train qualified specialists in order to children to school, which at the same time decreased by 27 percent owing to the improve its economic performance and reduces poverty and famine.55, 56 programme, while the risk of an early thereby promote its economic and marriage fell by as much as 44 percent.59 demographic development. An Since the 1990s, many African countries important step in this direction is to have run cash transfer programmes. However, Often children have to break off their strengthen vocational training, which the results have been varied according to the schooling because the parents need them as until now has remained in its infancy in funds available and local framework agricultural labour in order to produce almost every state on the continent and conditions. In 1998, South Africa became sufficient food for their families. In many has a mostly poor image. In rural areas one of the first African countries to introduce developing countries, the provision of lunch as well as in the poor municipal a grant programme – the South Africa Child free of charge to schoolchildren has helped districts and slums, there is usually no Support Grant. Under this programme, solve this problem. Botswana has been opportunity whatsoever to undergo currently some 10 million children and young providing a warm lunch at all primary and vocational training.66 people under the age of 18 and from low- secondary schools since the 1960s and has income families receive regular grants. An funded this programme without the support In Zimbabwe, mobile classrooms for evaluation of this programme carried out by of international donors since 1998. Children vocational students are intended to UNICEF and the South African Ministry for who come from remote, mostly poor regions facilitate access to training. The Young Social Develop­ment shows that on average, and board at school also receive an evening Africa organisation has launched a children participating in the programme meal as well as food rations on days when programme in which trainers equipped remain at school longer, are absent less there is no school.60 In Mali, Nigeria and with the necessary technology and frequently and achieve better results in Ivory Coast such programmes have helped teaching materials offer twelve-week reading, writing and arithmetic.57 improve both attendance at school and the vocational training courses at different learning achievements of the children.61 places in the countryside – including In Ghana, Kenya, Zambia and several other According to the World Food Programme of instruction in entrepreneurial skills. African countries, similar social transfer the United Nations, they can also contribute Young Africa is working together with programmes have contributed to the to reducing the share of children and young local authorities, and pupils receive a improvement of enrolment and attendance people who do not finish school by 40 certificate once they have completed rates at primary and secondary schools – percent.62 the course. In addition, the organisation even without obligatory attendance being a is striving to help those who complete condition for receiving financial support.58 their training to take out microloans Evaluations of the Zomba Cash Transfer Using new technologies with which to establish their own small Programme in Malawi show the positive companies. The aim is to improve the effects that such programmes can have on Alongside tried and tested means, modern prospects of young people in rural the educational opportunities and future technologies can help to improve access to areas.67 prospects of girls: above all, conditional education and, moreover, the quality of grants have a positive impact on their teaching. In Sudan, for example, 600 achievements at school. While unconditional children have been able to gain access to transfer payments have a less marked effect education through an e-learning programme. A computer game that runs on tablets allows them to learn arithmetic via a game.63 In the pilot project BridgeIT, launched in Tanzania, teachers can download via their mobile phones support materials in the form of

42 Africa’s Demographic Trailblazers teaching videos that correspond to the Gender-sensitive teaching timetables and 3.2.1 More rights for women national curriculum and thereby improve the materials can also help to improve the quality of their teaching.64 In West Africa, too, educational opportunities for girls and young If the goal is to promote demographic apps and e-learning platforms are revolution­ women.70 In Zambia, together with the transformation and stem population growth, ising the world of education. In Togo, for Belgian non-governmental organisation then it is essential to encourage girls to example, the app OkpaBac helps pupils in the VVOB and the Forum for African Women realise their potential and strengthen the last years at secondary school to prepare for Educationalists, the government is investing position of women in society overall – not the school-leaving examination. The app in further training for teachers and school just in the area of education. The reasons for includes sample questions from the previous directors in the area of early, gender-sensitive this are given in Chapter 1. The positive year’s examination and quiz questions with education.71 With the help of special teaching impact that more gender equality can have is which pupils can test their own knowledge.65 materials developed with teachers of either to be seen in Tunisia. Here the government 66 67 sex in Zambia, Rwanda and South Africa, recognised at an early stage that the equality gender stereotypes are to be dismantled and of women in society and a good education teachers given support to encourage children system are prerequisites for a demographic Targeted promotion of girls to develop their own potential and talents transformation. Accordingly, as early as 1956 regardless of their gender.72 73 74 Tunisia’s first president, Habib Bourguiba, The impact of education on demographic was the driving force behind a series of development is especially large if girls have legislative amendments that granted women the same opportunities to attend school as more rights – for example, the right to vote, a boys do (see the explanations in Chapter 1). Opportunities for girls In percent legal minimum age for marriage and the This impact is particularly evident in trail- prohibition of polygamy.75 blazing states such as Senegal and Ethiopia, In some African countries, the 100 where the education of girls plays a central opportunities for girls to receive an education have already improved. 90 role. Other states, too, have been actively In Botswana, Ghana and Senegal, promoting girls and young women in the area the enrolment rate at the primary 80 of education: in Kenya, for example, the and secondary school level for girls is now even higher than for boys. In prospect of receiving a scholarship to attend 70 secondary school has improved the Ethiopia, the opportunities for boys to attend school are increasingly performance of girls towards the end of their improving. But the girls have 60 primary education and at the same time caught up significantly: while there helped increase the secondary-school were only 65 girls to 100 boys 50 enrolment rate.68 enrolled at schools in the 1990s, 74 that figure today is 93. 40 More female teachers could serve as a role model for girls and improve their attendance 30 at school. To allow the teaching corps to become more female has an additional Girls at primary school 20 effect: correspondingly qualified women are Boys at primary school 10 thereby given the opportunity to earn an Girls at lower secondary school income and gain respect within society. Boys at lower secondary school 0 Girls at upper secondary school Together with UNESCO, the educational arm Botswana Ghana Senegal Ethiopia of the United Nations, the government of Boys at upper secondary school 2013–14 2018 2017 2015–2017 Mali is working on the targeted promotion of women in teacher training and on finding Net enrolment rates at primary and secondary school jobs for them at schools. To encourage more according to gender, in percent women to choose this career path in the (Data source: UIS73) future, the project includes courses to prepare for the entrance examinations at teacher training colleges.69

Berlin Institute 43 Other countries on the continent have laws At the same time, more gender equality produce surpluses and earn more money. In providing for more equality enshrined in their means giving women the possibility to earn the course of this development, food security constitutions. In Malawi the 1964 an adequate income. Until now, women in improved while poverty and child mortality constitution prohibits discrimination of any Africa – especially in the sub-Saharan rates fell. Through the productivity gains, kind, sexual harassment and violence against countries – have worked mainly in agriculture labour was freed up and mostly migrated to women. In 2004, Botswana made gender- and mostly only for their own needs. The the towns, where jobs were available in the based discrimination a punishable offence.76 work is hard and time-intensive and the factories being established there. Former The constitution of Zimbabwe, approved in majority of women earn almost nothing.80 agricultural countries transformed 2013, stipulates that marriage requires the But being able to contribute to the household themselves in this way into ever more consent of both partners and that men and income or having money at their own prosperous industrial and eventually service women who are married have the same disposal is an important step towards more economies. rights and obligations. Moreover, women are autonomy for women. Widespread measures legally entitled to earn the same as men.77 aimed at improving the opportunities for In Africa this transformation has barely Such laws are important for paving the way women to earn a living include microcredit started. The agricultural sector – which for more gender equality, even if their and state employment programmes. In South consists mainly of small-scale subsistence implementation in daily life is frequently still Africa and Madagascar, such programmes farming – remains the continent’s main problematic. have contributed to women not only pursuing employer. However, productivity in this paid work more frequently but also working sector remains so low that Africa cannot feed Some states are striving to ensure that there as entrepreneurs and holding leadership its own populations and is dependent on are more women in leadership positions and positions.81 food imports.82 But the example of Ghana political office. This is important for the shows that it does not need to be this way: needs of the female members of the agricultural reforms and subsidy programmes population to be taken into account by 3.3 Income and jobs for fertilisers and pesticides as well as better- policymakers. For example, Rwanda, quality seeds have led to soaring yields not Burundi and Eswatini have written into their One of the most urgent challenges for the only of staple foods like manioc and maize constitutions a fixed quota of women in African countries is creating jobs. There are but also of cocoa – the country’s most political posts. Burundi’s constitution two reasons for this. First, an adequate important export. In this way, farmers’ stipulates that 30 percent of ministerial posts income is important for families to be able to incomes have improved, as has food security are to go to women.78 In Ethiopia, there are escape poverty and no longer be dependent and children’s chances of survival – two no legal stipulations about the share of on their children as a labour force. Second, important conditions for the fertility rate to women in politics. Nonetheless, Abiy Ahmed, this is the only way to ensure economic decline.83 who has been prime minister since 2018, has growth that allows the state to invest more in filled half of his cabinet with women; and healthcare and educational infrastructure even the post of president of the country was and in the development of a pension system recently held by a woman. In this way, the and thereby improve people’s living standing of women in society as well as the conditions. opportunities for them to take part in every area of daily life are likely to improve in the This can be seen from past experience: every future.79 country that is economically successful today has, during its demographic development, experienced a structural transformation that has created a large number of new jobs with higher value added. The starting point for this transformation was always productivity gains in agriculture, which enabled farmers to

44 Africa’s Demographic Trailblazers In Ethiopia, too, state programmes have helped farmers to use modern techniques to Good practice: Morocco’s path from To attract foreign investment, the increase their yields. To this end they receive an agricultural to industrial state government is banking not just on low assistance from agricultural advisers. As a wage costs but also on the establishment result, the grain yields have more than Morocco has long been represented on of special economic zones, in which doubled while coffee production has almost world markets only by agricultural goods, companies benefit from tax and customs trebled. The goal is to further increase raw materials like phosphate and simple incentives. The aim is for companies from agricultural output in the future and to products such as textiles. But in the future one sector, such as the automobile process the products in so-called agro- the country would like to become an industry, to open subsidiaries in the same industrial parks. This will not only allow more important industrial centre on the location to take advantage of the cluster money to be earned but will also create new continent. Initial progress has already effect.94 Such a special economic zone has jobs along the downstream value chain.84 been made: today Morocco’s car industry already been established in the port city of produces the largest share of the country’s Tangier, from where the transport route to This kind of industrialisation for the export goods – 24 percent – and thus Europe is short. The French car company processing of agricultural products is so far more than agriculture.90 The cutting of red Renault, which built its first factory in the exception in Africa. In the sub-Saharan tape, as for example in expedited court Casablanca back in 1959, opened a second countries, the share of processed goods in proceedings in trade disputes, and one in that city in 2012 with an investment total agricultural production is just 20 targeted incentives for high-profile foreign of 1.5 billion US dollars. Further invest­ percent. Only in South Africa and Mauritius companies to open subsidiaries in the ments by Peugeot, Nissan and Tata have can other exceptions be found: in these country have made Morocco an attractive made Morocco the second-largest African countries agricultural products such as fruit, location. In 2015, the North African state car manufacturer after South Africa.95, 96 vegetables, sugarcane and fish are mostly received the largest amount of investment processed and marketed to create value in the manufacturing industry Africa-wide The government wants to push ahead added.85 and the fourth-largest amount of foreign further with industrialisation in the future. investment overall, while in 2006 it was Since 2017, it has been building, together The potential to create jobs exists in other still ranked 14th. All in all, the with the Chinese government, a one billion industrial sectors, too, not least because manufacturing industry accounts for some US dollar new industrial park in Tangier, owing to wage growth in China, some 100 16 percent of gross domestic product and which is intended to attract, above all, million jobs in the processing industry are to 10 percent of formal employment in the Chinese manufacturers and create another be relocated outside that country.86 Many country.91, 92, 93 100,000 jobs.97 These are urgently needed African states in which the transformation to if Morocco is to transform its currently an industrial economy has already begun favourable age structure into a have been promoting the development of a demographic dividend (see Chapter 2.6). manufacturing industry through the establishment of special economic zones, which attempt to attract foreign companies with good infrastructure as well as tax and 3.4 The will to transform – Moreover, politicians and other people in customs incentives. Often access to these leadership positions have an influence on zones is, as in the case of Nigeria, linked to a among politicians and cultural norms and traditions. Developments minimum investment. Alternatively, in some traditional leaders in Tunisia and Kenya at the end of the countries, like Zambia, companies have to 1970s have shown what impact can be prove that their activities will contribute Whether the demographic transformation made if presidents speak out publicly in sustainably to economic diversification.87 88 89 can be expedited in the African states favour of women’s rights or family planning. 90 91 92 93 94 95 96 97 depends to a large extent on how much Similarly, Rwanda has been able to make political engagement exists on the ground. such enormous progress in spreading the After all, this is where the decisions will be use of contraceptives not least because the made about how the healthcare and political leadership – including President education systems can be improved or how Paul Kagame – has advocated family easy it is to create jobs.

Berlin Institute 45 Industry a future job generator? In percent 100 Until now, agriculture has been the main employer in Africa, especially in the less 90 developed states. An industrialisation process 80 like the one in other parts of the world, which Services in the past created huge numbers of jobs for 70 the growing population, has barely started to 60 date. Today, two-thirds of the value creation in the manufacturing industry on the continent 50 comes from just four countries: Nigeria, South 89 40 Africa, Egypt and Morocco. Good framework Agriculture conditions for investors could create more 30 formal jobs in the manufacturing sector in Industry other countries in the future. 20 10 0 Estimated share of employment by economic sector, in percent, 2019 Mali Togo Chad Libya Niger Egypt Benin Kenya Congo

88 Ghana Gabon Eritrea Angola Liberia Guinea Tunisia Algeria Malawi Nigeria (Data source: ILO ) Zambia Gambia Uganda Lesotho Burundi Senegal Djibouti Ethiopia Morocco Eswatini Tanzania Mauritius Botswana Zimbabwe Mauritania Cape Verde Cape Ivory Coast Madagascar South AfricaSouth Sierra Leone Sierra Burkina Faso Guinea-Bissau Central African Republic Central Democratic Rep. of Congo

planning and stressed the importance of its However, this requires not only the engage­ children and smaller families. They began role in the country’s development progress.98 ment of the political leadership but also that thereupon to speak on the radio and in their For example, at the international family of influential people in the communities and communities about the advantages of family planning conference in the Rwandan capital, villages. Above all, new role and family planning and thereby broke the taboo that Kigali, in 2018, Prime Minister Éduard models must first gain a foothold in the until then had prevented many people from Ngirente stated that family planning was not mainly tradition-based societies of rural considering using contraception.102 simply a women’s issue but rather one that areas so that people will begin to plan the affects the development of entire nations.99 size of their families voluntarily. Village These practical examples from different elders or priests and imams can have a African countries show that there is much Another leader who has publicly campaigned significant influence on the prevailing norms happening on the continent that is having a for demographic development is the president and traditions. The advantages of having positive influence on declining fertility rates of Malawi, Peter Mutharika. In 2015 he was local advocates of family planning can be and thereby on the demographic trans­ named Champion for Youth and Demographic seen in Senegal. In other countries, too, formation in the region. This process should Dividend by the United Nations and in this religious leaders are promoting issues such be expedited – and as quickly as possible. capacity is striving to persuade other African as education for girls, family planning and The leaders of the African states have the heads of state to invest more in their young reproductive health. In Zambia, for example, responsibility to make the necessary people.100 If there were more such voices members of the Churches Health Association, adjustments highlighted in this study. among African leaders, especially in those the largest non-state provider of healthcare countries that have already made consider­ services in the country, are lobbying for able progress, this could have a further improved access to family planning positive influence on the debate about methods.101 In northwest Nigeria, the subjects like family planning, women’s rights prevalence rate of modern contraceptives has and demographic policy. doubled since a USAID campaign succeeded in convincing religious leaders of the advantages of bigger intervals between

46 Africa’s Demographic Trailblazers SOURCES

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Education Entwicklung im Nahen Osten und Economics and Social Affairs – Vorbild für den afrikanischen 29 Chesoli, K. (03.09.). Burgeoning and Fertility: Evidence from a Policy Nordafrika beeinflussen und was das ­Population Division (2018). World ­Aufschwung? Berlin. population calls for return to family Change in Kenya (Discussion Paper für Europa bedeutet. Berlin. Urbanization Prospects 2018. New www.berlin-institut.org (04.01.19). planning path. Daily Nation Kenya. 6778) www.berlin-institut.org. York. bit.ly/2zBCOkF (14.12.18). 6 See endnote 2. bit.ly/2EqHzzN (04.03.19). 51 See endnote 49.

Berlin Institute 47 52 See endnote 40. 81 Acemoglu, D., et al. (2001). An 109 World Bank (2015). Poverty (21.01.19). leading another revolution -- on 53 Kibui, A. W. & Mwaniki, B. (2014). African Success Story: Botswana. MIT Reduction in Ghana. Progress and 144 See endnote 142. women’s rights, The Washington Department of Economics Working Challenges. Washington D.C. Post. Washington D.C. wapo. Gender Equity in Education 145 See endnote 16. ­Development in Kenya and the new Paper No. 01-37S. 110 See endnote 109. st/2JqdAvW (26.02.19). 146 Hasselback, L., et al. (2017). constitution for vision 2030. 82 See endnote 80. 111 Overseas Development Institute 168 Brown, G. F. (2007). Tunisia. ­International Journal of Scientific Understanding and addressing The Debut of Family Planning. In W. C. 83 See endnote 79. (2015). Ghana -The Rising Star. contraceptive stockouts to increase Research and Innovative Technology, Progress in political voice, health and Robinson & J. A. 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Berlin Institute 49 Berlin Institute for Population and Development Schillerstrasse 59 10627 Berlin

www.berlin-institut.org

ISBN: 978-3-946332-49-7

+++ broad spectrum of demographic development +++ health workers improve child health in Ethiopia +++ rapid population growth in sub-Saharan Africa +++ regional trailblazers deploy effective measures +++ Tunisia remains a model for women’s rights +++ demographic bonus still a distant prospect for many African states +++ urbanisation accelerates falling fertility rates +++ more engagement necessary in demographic policy +++ growing educational opportunities for girls +++ no dividend without jobs +++ condom ads successful in Botswana +++ shift in the age structure generates economic upswing +++