POPULATION DYNAMICS OF SUB-SAHARAN AFRICA

DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA

DEMOGRAPHIC EFFECTS OF ECONOMIC REVERSALS IN SUB-SAHARAN AFRICA

EFFECTS OF HEALTH PROGRAMS ON CHILD MORTALITY IN SUB-SAHARAN AFRICA

FACTORS AFFECTING CONTRACEPTIVE USE IN SUB-SAHARAN AFRICA

POPULATION DYNAMICS OF KENYA

POPULATION DYNAMICS OF SENEGAL

SOCIAL DYNAMICS OF ADOLESCENT FERTILITY IN SUB-SAHARAN AFRICA



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Demographic Change in Sub-Saharan Africa POPULATION DYNAMICS OF SUB-SAHARAN AFRICA DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA DEMOGRAPHIC EFFECTS OF ECONOMIC REVERSALS IN SUB-SAHARAN AFRICA EFFECTS OF HEALTH PROGRAMS ON CHILD MORTALITY IN SUB-SAHARAN AFRICA FACTORS AFFECTING CONTRACEPTIVE USE IN SUB-SAHARAN AFRICA POPULATION DYNAMICS OF KENYA POPULATION DYNAMICS OF SENEGAL SOCIAL DYNAMICS OF ADOLESCENT FERTILITY IN SUB-SAHARAN AFRICA

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Demographic Change in Sub-Saharan Africa     NOTE: This map, which has been prepared solely for the convenience of readers, does not purport to express political boundaries or relationships. The scale is a composite of several forms of projection.

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Demographic Change in Sub-Saharan Africa POPULATION DYNAMICS OF SUB-SAHARAN AFRICA DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA • • • • • • • • • • • • • • • Karen A.Foote, Kenneth H.Hill, and Linda G.Martin, Editors Panel on the Population Dynamics of Sub-Saharan Africa Committee on Population Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1993

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Demographic Change in Sub-Saharan Africa NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M.White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Robert M.White are chairman and vice chairman, respectively, of the National Research Council. Library of Congress Catalog Card No. 93–85568 International Standard Book Number 0-309-04942-3 Additional copies of this report are available from: National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20418. Call 800–624–6242 or 202–334–3313 (in the Washington Metropolitan Area). B166 Copyright 1993 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Demographic Change in Sub-Saharan Africa PANEL ON THE POPULATION DYNAMICS OF SUB-SAHARAN AFRICA KENNETH H.HILL (Chair), Department of Population Dynamics, Johns Hopkins University ADERANTI ADEPOJU, Institut de Développement Economique et de la Planification (IDEP), Dakar, Senegal JANE T.BERTRAND, School of Public Health and Tropical Medicine, Tulane University CAROLINE H.BLEDSOE, Department of Anthropology, Northwestern University WILLIAM BRASS, Centre for Population Studies, London School of Hygiene and Tropical Medicine, England DOUGLAS C.EWBANK, Population Studies Center, University of Pennsylvania PHILIPPE FARGUES, Centre d’Etudes et de Documentation Economique, Sociale et Juridique (CEDEJ), Cairo, Egypt RON J.LESTHAEGHE, Faculteit van de Economische, Sociale en Politieke Wetenschappen, Vrije Universiteit Brussel, Belgium PATRICK O.OHADIKE, Regional Institute for Population Studies (RIPS), Accra, Ghana ANNE R.PEBLEY, The RAND Corporation, Santa Monica, California DANIEL M.SALA-DIAKANDA, Institut de Formation et de Recherche Démographiques (IFORD), Yaoundé, Cameroon

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Demographic Change in Sub-Saharan Africa COMMITTEE ON POPULATION SAMUEL H.PRESTON (Chair), Population Studies Center, University of Pennsylvania JOSE-LUIS BOBADILLA, World Bank, Washington, D.C. JOHN B.CASTERLINE, Department of Sociology, Brown University KENNETH H.HILL, Department of Population Dynamics, Johns Hopkins University DEAN T.JAMISON, School of Public Health, University of California, Los Angeles ANNE R.PEBLEY, The RAND Corporation, Santa Monica, California RONALD R.RINDFUSS, Department of Sociology, University of North Carolina, Chapel Hill T.PAUL SCHULTZ, Department of Economics, Yale University SUSAN C.M.SCRIMSHAW, School of Public Health, University of California, Los Angeles BETH J.SOLDO, Department of Demography, Georgetown University MARTA TIENDA, Population Research Center, University of Chicago BARBARA BOYLE TORREY, Population Reference Bureau, Washington, D.C. JAMES TRUSSELL, Office of Population Research, Princeton University AMY O.TSUI, Carolina Population Center, University of North Carolina, Chapel Hill LINDA G.MARTIN, Director BARNEY COHEN, Research Associate SUSAN M.COKE, Senior Project Assistant KAREN A.FOOTE, Research Associate DIANE L.GOLDMAN, Administrative Assistant* JAMES N.GRIBBLE, Program Officer JOAN MONTGOMERY HALFORD, Senior Project Assistant** CAROLE L.JOLLY, Program Officer DOMINIQUE MEEKERS, Research Associate* PAULA J.MELVILLE, Senior Project Assistant * through December 1991 ** through July 1992

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Demographic Change in Sub-Saharan Africa Preface This report is one in a series of studies that have been carried out under the auspices of the Panel on the Population Dynamics of Sub-Saharan Africa of the National Research Council (NRC) Committee on Population. The Research Council has a long history of examining population issues in developing countries. In 1971 it issued the report Rapid Population Growth: Consequences and Policy Implications. In 1977, the predecessor Committee on Population and Demography began a major study of levels and trends of fertility and mortality in the developing world that resulted in 13 country reports and 6 reports on demographic methods. Then, in the early 1980s, it undertook a study of the determinants of fertility in the developing world, which resulted in 10 reports. In the mid- and late-1980s, the Committee on Population assessed the economic consequences of population growth and the health consequences of contraceptive use and controlled fertility, among many other activities. No publication on the demography of sub-Saharan Africa emerged from the early work of the committee, largely because of the paucity of data and the poor quality of what was available. However, censuses, ethnographic studies, and surveys of recent years, such as those under the auspices of the World Fertility Survey and the Demographic and Health Survey programs, have made available data on the demography of sub-Saharan Africa. The data collection has no doubt been stimulated by the increasing interest of both scholars and policymakers in the demographic development of Africa

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Demographic Change in Sub-Saharan Africa and the relations between demographic change and socioeconomic developments. In response to this interest, the Committee on Population held a meeting in 1989 to ascertain the feasibility and desirability of a major study of the demography of Africa, and decided to set up a Panel on the Population Dynamics of Sub-Saharan Africa. The panel, which is chaired by Kenneth Hill and includes members from Africa, Europe, and the United States, met for the first time in February 1990 in Washington, D.C. At that meeting the panel decided to set up six working groups, composed of its own members and other experts on the demography of Africa, to carry out specific studies. Four working groups focused on cross-national studies of substantive issues: the social dynamics of adolescent fertility, factors affecting contraceptive use, the effects on mortality of child survival and general health programs, and the demographic effects of economic reversals. The two other working groups were charged with in-depth studies of Kenya and Senegal, with the objective of studying linkages between demographic variables and between those variables and socioeconomic changes. The panel also decided to publish a volume of papers reviewing levels and trends of fertility, the proximate determinants of fertility, nuptiality, child mortality, adult mortality, internal migration, and international migration, as well as the demographic consequences of the AIDS epidemic. This volume comprises those eight papers. As is the case for all of the panel’s work, this report would not have been possible without the cooperation and assistance of the Demographic and Health Survey (DHS) program of the Institute for Resource Development/Macro Systems. We are grateful to the DHS staff for responding to our inquiries and facilitating our early access to the survey data. We are also grateful to the organizations that provided financial support for the work of the panel: the Office of Population and the Africa Bureau of the Agency for International Development, the Andrew W.Mellon Foundation, the William and Flora Hewlett Foundation, and the Rockefeller Foundation. Besides providing funding, the representatives of these organizations were a source of information and advice in the development of the panel’s overall work plan. The editors would also like to express their gratitude to all of the authors. In addition to writing the papers, the authors were exceedingly gracious in responding to the many questions that were asked of them throughout the preparation of this volume. They would also like to recognize the efforts of Dominique Meekers in coordinating the early work on this volume and of Janet Ewing for providing bibliographic assistance. Finally,

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Demographic Change in Sub-Saharan Africa special thanks are also due Paula Melville for superb administrative support, Florence Poillon for skillful copyediting of the volume, Elaine McGarraugh for meticulous production assistance, and Eugenia Grohman for ably coordinating the review and editing process. SAMUEL H.PRESTON, Chair Committee on Population

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Demographic Change in Sub-Saharan Africa Contents 1   INTRODUCTION Linda G.Martin, Kenneth H.Hill, and Karen A.Foote   1 2   FERTILITY LEVELS, DIFFERENTIALS, AND TRENDS Barney Cohen   8     Introduction,   8     Sources and Quality of Demographic Data in Africa,   10     Methods for Estimating Total Fertility Rates,   12     Characteristics of African Fertility,   14     Recent Evidence of a Fertility Decline in Countries Participating in the DHS,   38     Comparison of Recent Fertility Trends in Africa and Other Developing Regions,   52     Conclusions,   57     References,   59 3   THE PROXIMATE DETERMINANTS OF FERTILITY Carole L.Jolly and James N.Gribble   68     Introduction,   68     Data,   69     Framework,   69     Empirical Results,   77     Conclusion,   101     Technical Notes,   102     Appendix,   107     References,   114

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Demographic Change in Sub-Saharan Africa 4   RECENT TRENDS IN MARRIAGE AGES Etienne van de Walle   117     Introduction,   117     Conceptual and Measurement Issues,   120     Ascertaining Time Trends in Age at Marriage,   132     Age at Marriage and Fertility,   137     Conclusion,   144     Appendix: Median and Mean Age at First Marriage,   146     References,   149 5   TRENDS IN CHILDHOOD MORTALITY Althea Hill   153     Introduction,   153     Data Development Since 1987,   155     New Country Data and Results,   159     Overview of Trends in Countries With New Data,   180     Conclusions on Childhood Mortality Trends,   180     Appendix A: Summarization Process for Table 5–2: Country Notes,   184     Appendix B,   191     References,   213 6   ADULT MORTALITY Ian M.Timœus   218     Introduction,   218     Sources of Data,   219     Methods of Analysis,   220     Adult Mortality Levels,   225     Causes of Death,   238     Conclusions,   243     Appendix,   245     References,   252 7   INTERNAL MIGRATION, URBANIZATION, AND POPULATION DISTRIBUTION John O.Oucho and William T.S.Gould   256     Introduction,   256     Internal Migration,   258     Urbanization,   275     Population Distribution and Density,   281     Conclusion,   288     References,   289

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Demographic Change in Sub-Saharan Africa 8   INTERNATIONAL MIGRATION Sharon Stanton Russell   297     Introduction,   297     Data Sources,   298     Regional Patterns,   299     Migration of the Highly Skilled and Emigration from the Continent,   308     Effects of International Migration on Age and Sex Distributions,   310     Conclusion,   314     References,   347 9   MODELS OF THE DEMOGRAPHIC EFFECT OF AIDS Michael A.Stoto   350     Introduction,   350     Epidemiology of AIDS in Sub-Saharan Africa,   352     Purposes and Types of HIV/AIDS Models: General Considerations,   353     Existing HIV/AIDS Models,   355     Summary and Conclusions,   375     References,   377