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Sub-Saharan Africa: The Challenge of High Fertility. John F. May Lead Population Specialist Africa Region, World Bank Washington, DC, July 16, 2008. Key demographic features. SSA annual rate of growth: 2.5% (it could even accelerate if mortality declines faster)

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Sub saharan africa the challenge of high fertility

Sub-Saharan Africa:The Challenge of High Fertility

John F. MayLead Population Specialist

Africa Region, World Bank

Washington, DC, July 16, 2008


Key demographic features

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

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

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

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

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


Rationale for intervention

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

  • Reduce population pressure on land tenure and ecosystems

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




  • Modifying the age structure (3)

  • Three key messages:

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

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

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


Changing attitudes in SSA

  • Women do want services (large unmet needs)

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

    However

  • Need for more proactive policies

  • Scarcity of real champions

  • Weakness of M&E framework


What can be done?

A few key interventions vs. scattered programs:

  • Stronger and more persistent advocacy

  • More consistent provision of family planning and reproductive health services

  • Breastfeeding programs

  • Contraceptive security plans

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

  • More involvement of men


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