Population and Reproductive Health in Sub-Saharan Africa
Goliber, Thomas J., Population Bulletin
Dr. Goliber would like to thank his colleagues at the iI.S. Agency for International Development, The Futures Group International, Research Triangle Institute, and The Centre for Population and Development Activities for their assistance in preparing this Population Bulletin. He also thanks Barbara Crane, Kenneth Hill, John May, Dominique Meekers, and Karen Stanecki for constructive review comments, and Population Reference Bureau staff for valuable help. Most of all, he is grateful to his African colleagues who have devoted their professional lives to the development of the continent and the health of its peoples.
The race between population growth and economic development in sub-Saharan Africa is one of the great dramas of the modern world. High rates of population increase and slow-growing or stagnating economies throughout much of the region have thwarted modernization and development efforts. Against this backdrop, the drama remains as engaging and intense as ever.
The pace of population growth is expected to slow in sub-Saharan Africa, either through lower birth rates or-tragically-through higher death rates. Fertility has declined already in a handful of African countries, but an increasing number of countries face an HIV/AIDS epidemic that is reversing hard-won gains in life expectancy.
Even so, sub-Saharan Africa, which includes many of the poorest countries in the world, is likely to more than double in population size by 2050. The nations are struggling to provide education, housing,jobs, and health care for their burgeoning populations, while trying to compete in the world economy, cope with internal and international political conflicts, and contain epidemics.
Most countries in sub-Saharan Africa have adopted policies that acknowledge the important role that demographic trends play in their quest to modernize, but these policies are carried out differently among the region's diverse cultures. Following the International Conference on Population and Development, held in Cairo in 1994, many countries are now trying to shape their population policies from the broader perspective of reproductive health (see Box 1, page 4).
This Population Bulletin will survey the demographic situation in the 42 countries of the sub-Saharan African mainland and on the island of Madagascar. It will focus on two factors critical to the future size and structure of the region's population: the transition to lower fertility and the HIV/AIDS epidemic.
Africa south of the Sahara Desert is usually treated as a region separate from the six countries at the northern edge of Africa-Algeria, Egypt, Libya, Morocco, Tunisia, and Western Sahara. Historically, the Sahara Desert has divided the continent as completely as would an ocean. The people of the sub-Saharan region have followed different cultural paths than those to the north.
Sub-Saharan Africa is geographically vast and culturally and economically diverse. The region includes 42 countries on the mainland, plus the island of Madagascar, 100 miles off the East African coastline (see Figure 1). Six other islands or island groups (Cape Verde, Comoros, Mauritius, Reunion, Seychelles, and Sao Tome and Principe), which have a combined population of less than 2 million, are also classified as part of sub-Saharan Africa, but they are not included in this Population Bulletin. Thus, as defined here, sub-Saharan Africa had a population of about 614 million people in mid-1997, or about 10 percent of the world total.'
The region's population was growing by about 2.7 percent per year in the mid-1990s. At this rate, the population would double in just 25 years. The sub-Saharan population is growing faster than that of any other major world region because of the vast gap between birth rates and death rates. Death rates in sub-Saharan Africa fell significantly in past decades, although they are still high by world standards. …