FACTS and PROSPECTS Sexual and Reproductive Health and Rights 2019 © UNFPA

FACTS AND PROSPECTS Sexual and Reproductive Health and Rights 2019 © UNFPA

DISCUSSION PAPER: A comparative analysis of selected International Conference on Population and Development indicators among Southern African and other upper middle- and high-income countries

BACKGROUND

The world’s middle-income countries (MICs) are a diverse As such, UMICs must remain proactive to steer their group by size, population, and income levels. Lower middle- sustainable development through inclusive policies and income economies (LMICs) with gross national income (GNI) strategies related to health, including sexual and reproductive per capita ranging from $1,026 to $3,995 and upper middle- health and rights (SRHR), economy, education, environment, income economies (UMICs) with a GNI per capita of $3,996 and gender equality, among others. The African continent has up to $12,375 at 2019 levels, often demonstrate the complexity eight UMICs and one high-income country (HIC), Seychelles. of coexisting wealth, economic prospects and development Half of the UMICs in the continent are in Southern Africa inequalities. The transition of MICs through resource- while two each are in West Africa and North Africa. This brief constrained contexts, emerging economy, and current MIC presents a comparative analysis1 of selected indicators related status present opportunities for economic acceleration, as well to the International Conference on Population and Development as risks of economic downturn and failed prospects. Programme of Action (ICPD) between Southern African UMICs and selected UMICs and HICs from other parts of the world, with a view to identifying opportunities for improvement2.

1 The analysis is based on global comparative data for countries and regions. Key sources are the 2019 State of the World Population Report (SWOP, UNFPA), Human Development Report 2018 (HDR, UNDP), Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division (Maternal Mortality Report [MMR], 2019), 2019 World Economic Outlook (International Monetary Fund) and World Bank Poverty and Equity Data Portal. Recommended citation for this document: United Nations Population Fund (UNFPA), Discussion Paper: A comparative analysis of selected International Conference on Population and Development indicators among Southern African and other upper middle- and high-income countries, 2019. 2 The countries included in the analysis are: Southern Africa (South Africa, Namibia, Botswana, Mauritius, Seychelles** and Eswatini), West Africa (Gabon and Equatorial Guinea), Middle East and North Africa (Algeria, Libya, Jordan and Israel**), East Asia and Pacific (China, Malaysia, Thailand and Singapore**), Latin America and Caribbean (Brazil, Mexico, Peru and Uruguay**). Throughout the presentations, HICs are denoted by ** while the selected Southern African countries are denoted by *.

01 POPULATION DYNAMICS

Total population: Population size varies widely among the Population age structure: The age structure of a population selected UMICs and HICs. As shown in Figure 1, South Africa is an important demographic feature that can provide tops the pack of the Southern African UMICs with a population an economic boost to countries. As fertility declines, the of nearly 60 million people. All the HICs have population of less population age structure changes towards a higher working- than 10 million, suggesting that a country’s wealth status is not age population (aged 15–64 years) relative to the dependent a function of its population size alone. population under 15 years of age. The surge in the working-age population and the decline in the dependent population present Population change is influenced by level of births (fertility), countries with a unique demographic dividend that can be deaths and migration. Changes in total fertility rate (TFR) channeled to socioeconomic development when supported by have a bearing on the population stock. Of the Southern African appropriate policies and strategies related to health, education UMICs, Mauritius has the lowest total fertility rate (1.4), and employment. Of the Southern African UMICs, Mauritius placing it among seven of the selected HICs and other UMICs has the highest proportion of the working-age population (71%) with below replacement level fertility (that is TFR below 2). as well as a growing older population, similar to Singapore, China and Thailand (Figure 3). Eswatini recorded the highest (42%) reduction in TFR among the selected Southern African countries during the last 25 Despite their level of wealth, all the Southern Africa MICs fall years, second to only Libya among the rest of the selected below the median life expectancy at birth (76 years) of the countries (Figure 2). Even though still characterized by a selected countries. Mauritius has the highest life expectancy at below replacement level fertility, the Russian Federation birth of 75 years while South Africa’s life expectancy at birth of saw a 29 per cent increase in its TFR during the last 25 64 years is the lowest among the Southern African UMICs, just years. Southern African UMICs may benefit from lessons on five years above Eswatini’s, a LMIC (Figure 4). effective population and development policies, strategies and programmes from the other countries that have experienced replacement (or below replacement) level fertility through South-to-South and triangular collaboration.

Figure 1: Total poulation (millions), selected countries, 2019 Figure 2: Total fertility rate and percentage change, selected countries, 1969 - 2030 Brazil Russian Federation Mexico Turkey Thailand 5 40% South Africa* Algeria 30% Peru Malaysia 4 20% Sri Lanka Jordan 10% Israel** 3 Libya 0% Singapore** Uruguay** -10% Armenia 2 Namibia* -20% Botswana* Gabon 1 -30% Eswatini* Equatorial Guinea -40% Mauritius* Sychelles* 0 -50% 0 50 100 150 200 250 Peru Libya Brazil China Gabon Jordan Turkey Algeria Mexico Israel** Armenia Thailand Malaysia Sri Lanka Eswatini* Russian... Namibia* Sychelles* Uruguay** Mauritius* Botswana* Equatorial... Singapore** South Africa*

TFR 2019 TFR percentage change, 1994 - 2019

Figure 3: Population age composition, selected countries, 2019 Figure 4: Life expectancy at birth (years), selected countries, 2019 Thailand Singapore** Mauritius* Singapore** China Israel** Brazil Uruguay** Malaysia Mexico Sychelles* Turkey Libya China Armenia Algeria Turkey Thailand Russian Federation Sri Lanka Mexico Peru Sri Lanka Malaysia South Africa* Brazil Jordan Peru Mauritius* Botswana* Armenia Uruguay** Sychelles* Jordan Libya Namibia* Russian Federation Israel** Botswana* Gabon Gabon Eswatini* Namibia* Equatorial Guinea South Africa* Eswatini* 0% 20% 40% 60% 80% 100% Equatorial Guinea 0 10 20 30 40 50 60 70 80 90 0 - 14 years 15 - 64 years 65+ years

02 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS

Maternal mortality rate: Maternal deaths per 100,000 With the exception of Uruguay with a teenage pregnancy live births (MMR) is an important marker of health system rate of 51, the other HICs, Israel and Singapore, have teenage performance. Of the Southern African UMICs, Namibia has the pregnancy rates below the median of 39. Indeed, Singapore highest MMR (195), following Eswatini, a LMIC (437) (Figure shows that it is possible to eliminate teenage pregnancy given 5). Despite falling below Namibia, South Africa is the only of its low rate of 3 births per 1,000 girls aged 15–19 years. the Southern African UMICs to have recorded an increase (72%) in its MMR during the last 25 years. Other countries Contraceptive use: Modern contraceptive prevalence rate with an increase in MMR include Libya (167%) and Jordan (CPR) is mixed among the selected UMICs (Figure 7). Eswatini (48%). Southern African UMICs can still improve on their has the highest modern contraceptive prevalence rate (65%) of MMR to attain the Sustainable Development Goals (SDG) the selected Southern African countries, followed by Namibia target of less than 70 maternal deaths per 100,000 live births. (59%). CPR rates above 76 per cent in Thailand, Uruguay, Brazil and China suggest that Southern African countries can Teenage pregnancy: In addition to being an indicator of girls’ still improve on their CPR and reduce the unmet need for family empowerment, teenage pregnancy is a contributing factor planning (FP) (Figure 8). to maternal mortality. Figure 6 shows that Namibia has the highest teenage pregnancy rate among the Southern African UMICs with 82 births per 1,000 girls aged 15–49 years, Eswatini’s is 87.

Figure 5: Maternal mortality ratio (2017) and percentage change Figure 6: Adolscent birth rate per 1,000 girls aged 15-19, (1994 - 2017), selected countries selected countries, 2006 - 2017

500 200% Singapore** China Israel** 400 150% Libya Malaysia 72% 48% 100% Algeria 300 Sri Lanka Russian Federation 50% Mauritius* 200 Armenia 0% Jordan Turkey 100 -50% Botswana* Thailand Uruguay** 0 -100% Brazil Mexico Peru

Peru Sychelles* Libya Israel Brazil China Gabon Jordan Turkey

Algeria South Africa* Mexico Eswatini Namibia Uruguay Armenia Thailand Malaysia Sri Lanka Russian... Mauritius Botswana Namibia* Singapore

Equatorial... Eswatini* South Africa Gabon Equatorial Guinea MMR 2017 MMR percentage change, 1994 - 2017 0 50 100 150 200

Figure 7: Modern contraceptive prevalence, 1994 - 2019 Figure 8: Unmet need for family planning (women 15-49), selected countries, 2019 90%

80% Gabon Libya 70% Malaysia Namibia* 60% South Africa* 50% Botswana* Eswatini* 40% Armenia Jordan 30% Singapore** Mexico 20% Algeria Mauritius* 10% Russian Federation Israel** 0% Sri Lanka Uruguay** Peru Peru Libya Brazil China Brazil Gabon Jordan Turkey Algeria Mexico Israel** Armenia Thailand Malaysia

Sri Lanka Turkey Eswatini* Russian... Namibia* Uruguay** Mauritius* Botswana*

Equatorial... Thailand Singapore**

South Africa* China 1994 2019 0% 5% 10% 15% 20% 25%

ECONOMIC PERFORMANCE AND EQUITY

Gross domestic product: The gross domestic product (GDP) Economic growth alone is an insufficient measure of prosperity. growth rate is mixed among the selected UMICs. April 2019 Attention must also be paid to the distribution of that wealth projections of the International Monetary Fund suggests that among the population. The Gini index, a measure of wealth South Africa and Namibia will have less than 2 per cent growth, or income distribution, is an important measure of equitable while Botswana, Mauritius and Seychelles will have more than growth. 3 per cent growth, all of which are below the rates above 4 per cent projected in 2019 for other UMICs such as China, Malaysia, Armenia and Libya. Eswatini, Turkey, and Equatorial Guinea are expected to record negative real GDP growth of between -0.4 to -4.0 per cent (Figure 9). 03 Figure 10 shows that South Africa has the highest level of Figure 10: Gini coefficient, selected countries, 2010 - 2017 income inequality, not only among the Southern African Algeria Armenia countries, but among all the selected countries. Indeed, all Jordan Mauritius* the Southern African UMICs (as well as Eswatini) have the Russian Federation Thailand highest levels of inequality compared to the rest of the selected Uruguay** Sri Lanka countries, with the exception of Mauritius. Israel** Turkey Gabon China The level of inequality in the selected countries is further Mexico Peru highlighted in Figure 11 on the distribution of income and Malaysia Sychelles* consumption. Here again, South Africa, Namibia and Botswana Brazil Eswatini* lead with the richest quintile accounting for between 59 and 68 Botswana* Namibia* per cent of their income and consumption distribution. South Africa* 0 10 20 30 40 50 60 70

Figure 9: Real GDP annual percent change, 2019 (projections) Figure 11: Distribution of income or consumption by quintile, selected countries China Malaysia Armenia Algeria (2011) Libya Armenia (2017) Mauritius* Jordan (2010) Peru Botswana* Mauritius* (2012) Thailand Thailand (2017) Sri Lanka Gabon (2017) Seychelles* Uruguay** (2017) Gabon Algeria Malaysia (2015) Jordan Sri Lanka (2016) Brazil Turkey (2016) Uruguay** Peru (2017) Russian Federation Mexico (2016) Mexico Namibia* Sychelles* (2013) South Africa* Eswatini* (2009) Eswatini* Brazil (2017) Turkey Botswana* (2015) Equatorial Guinea Namibia* (2015) -4% -2% 0% 2% 4% 6% 8% South Africa* (2014) 0% 20% 40% 60% 80% 100%

Poorest quintile Second quintile Third quintile GENDER EQUALITY Fourth quintile Richest quintile

Inequality in the MICs extends also to other social spheres, Figure 12: Gender inequality index, selected countries, 2017 such as gender. The gender inequality index (GII) provides Gabon Eswatini* a composite measure of gender inequality, using three Namibia* Jordan dimensions: reproductive health (MMR and adolescent birth Algeria Botswana* rate), empowerment (political positions held by women and Brazil Thailand secondary level education among women), and labour force South Africa* Mauritius* Peru participation. Countries with low GII value have low inequality Sri Lanka Mexico between women and men, and vice-versa. As Figure 12 shows, Turkey Malaysia Namibia and Eswatini have the highest levels of gender inequality Uruguay** Armenia not only among the Southern African MICs, but among all the Russian Federation Libya selected countries, second to only Gabon, a major oil producing China Israel** country that has been characterized by political instability in Singapore** recent years. Both Israel and Singapore with GII close to zero 0 0,2 0,4 0,6 0,8 1 confirm that achieving gender equality is an important element of development.

CONCLUSION

The UMICs in Southern Africa demonstrate diverse performance Ensuring rights and choices for all since 1969 in the selected ICPD-related indicators. As the countries continue to undergo demographic transition, deliberate efforts are required to promote learning as well as exchange on effective policies, United Nations Population Fund strategies and programmes among themselves and with other East and Southern Africa Regional Office countries from the rest of the world, through a South-to-South 9 Simba Road / PO Box 2980, Sunninghill, and triangular collaboration. South Africa, 2191 +27 11 6035300

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