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Global Health Policy Blog


This is a joint blog with Jean-Pierre Guengant, Researcher Emeritus, Research Institute for Development (IRD), Marseille.

Between 1970 and 2010, most emerging countries achieved impressive gains in contraceptive coverage.  As a result, their fertility has declined, their population growth rate has slowed down, and many of these countries have been able to capture the economic benefits of the demographic dividend, which occurs when the labor force becomes relatively larger in the total population thanks to lower fertility levels.  In addition, the fertility decline improves the dependency ratios and reduces the burden of youth on working adults.

By contrast, many sub-Saharan African (SSA) countries (which can be seen at bottom of the graph) have started their contraceptive revolution very late and progress to date has been minimal.  Today, SSA countries have among the lowest contraceptive prevalence rates in the world.  Even Kenya, which had once shown promising downward fertility trends, has been affected by the poor performance of its family planning program between 1995 and 2005. By and large, the lack of progress in contraceptive coverage has precluded significant decreases in fertility in the region.

The widespread belief in SSA that “development was the best contraceptive” has been the major reason why countries did not launch organized family planning programs.  More recently, the promise of rapid economic growth has enticed African leaders and donors to believe that fertility would eventually decline on its own.  With the benefit of hindsight, this appears to have been wishful thinking.  In any case, this view is not supported by data from emerging countries.

The sluggish decline in fertility in SSA has had far-reaching economic consequences, not to mention the plight on the health of women and their children.  Since the independences in the 1960s, economic growth in SSA has been counteracted by fast population growth.  The end result has been a paltry increase of the GDP per capita of about 50% on average.  In fact, several SSA countries have a GDP per capita that is lower today than what it was 50 years ago.  Whereas most SSA countries have seen their economies grow at 4 to 6% per year since 1995, their populations have increased at a rapid pace of around 3% per year.  At these rates, most SSA countries would need between 25 and 70 years just to double their (already low) current GDP per capita.  Because of the very slow decline of their fertility levels, many SSA countries might not be able to capture the demographic dividend either.

What happens (or doesn’t happen) today in many SSA countries will also impact the total population of the planet.  A delay of a rapid fertility decline in, say, Nigeria, will eventually increase global population figures.  At the end of this century, the population numbers might be vastly bigger from what they are anticipated today—an effect that should be attributed to slow fertility transitions in many SSA countries.

In fact, SSA countries and the African women need a true game changer, and this is rapid fertility decline.  For too long, one the main policy levers at hand to achieve this, namely the expansion of contraceptive coverage, was absent from the development debate.  In this respect, the London Summit on Family Planning was a clarion call.  What is most needed now is a swift implementation of the Summit’s resolutions to serve an additional 130 million women among the 222 million that still need family planning services.  For this to be achieved within eight years at a price tag or about 4 billion, governments and donors alike will need to maintain momentum around their recently renewed commitments.

The authors would like to thank Kate McQueston for her great contributions to this blog.


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.