Fertility Decline Key to Capturing the Demographic Dividend in Africa

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Edited by: Nawsheen Elaheebocus

High-profile speakers like Dr. Babatunde Osotimehim, Executive Director for UNFPA and Hans Rosling, Chairman of Gapminder Foundation spoke at length about the importance of family planning in Africa during the high level dialogue between Ministers of Finance and Health on “Value for Money, Sustainability and Accountability” which was held in Tunis, Tunisia on July 4-5, 2012. The conference was organized by the African Development Bank and other Harmonization for Health in Africa (HHA) partners. It gathered Ministers of Finance and Health and/or their representatives from 54 African countries, African parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. His Excellency Hamadi Jebali, Prime Minister of Tunisia, Dr. Donald Kaberuka, President of the African Development Bank, and Dr. Margaret Chan, Executive Director of the World Health Organisation delivered the opening remarks.

Sub-Saharan Africa has one billion people today and the rapid population growth will result in 2.3 billion by 2050. Whether the region will benefit from the doubling of population size, will depend on how it reaps the demographic dividend. The demographic dividend occurs when the largest proportion of the population is in the working age group and the proportion of those in the dependant age groups (children and elderly) is smaller. The productivity of those in the working age groups contributes to economic growth. There are many factors that can contribute to the demographic dividend in Africa but the key is fertility decline. Only when average fertility decreases, will the number of dependants relative to the working age population reduce, leading to a decline in the dependency ratio.

Although Sub-Saharan Africa has the highest total fertility rate (5.1) in the world, some countries in the region are undergoing dynamic and unprecedented fertility transitions. In recent years, contraceptive prevalence rates, especially for modern contraceptive methods, have increased several-fold in Malawi, Namibia, Rwanda, Tanzania, Zambia, and Zimbabwe. The region is also witnessing changes in the proximate determinants of fertility, including increases in the age of marriage. Ongoing transformations in contraceptive use and fertility behavior signal the onset of fertility declines in more countries in the years to come. However, much more needs to be done to increase family planning use to accelerate fertility decline in the region.

Many countries that were successful in reducing fertility adopted population policies and instituted family planning programs relatively early. High-level policy commitment and political ownership of the population program was a key ingredient for success. Lessons drawn from countries that have made progress attest to the importance of political commitment, institutional arrangements, and service delivery strategies in increasing the use of family planning methods and lowering fertility.

The existence of strong family planning programs is a prerequisite to reducing fertility. Family planning programs that are generally effective are those that provide a range of contraceptive methods, ensure easy availability of contraceptives, provide counseling, follow up care, are non-coercive and seek greater involvement of men in family planning decision making and adoption. Several countries have tried community-based approaches to increase access to family planning methods. Outreach programs, community health workers and mobile family planning clinics have had a powerful impact on family planning adoption.

There still remains a large unmet need for family planning in Africa. Unmet need measures the gap between demand for family planning and use of contraception. Expressed as the percentage of sexually active women who do not want additional children but are not using any family planning method, this measure is often considered a precursor of fertility decline, as it indicates that demand for family planning services exists but that is not being met.

In the years to come, a greater emphasis is needed for improving the scope and quality of family planning programs to cater to the reproductive health needs of the young population. Undoubtedly, this will accelerate the onset of the demographic dividend leading to improved human development and faster economic growth in the region.

This conference emphasized the urgent need for greater domestic accountability, reduced dependence on foreign aid and value for money in the delivery of health services in Africa. It gathered the expertise from all over Africa as well as globally featuring speakers from India, China, Brazil, Vietnam and Kyrgyzstan. This high level dialogue culminated in a Tunis Declaration endorsing, among other things, taking advantage of Africa’s demographic transition to invest in human capital and provide equitable access to skilled health workers and the introduce measures such as results based financing to enhance transparency, performance and reduce wastage in order to deliver better health services in Africa.