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OCR for page 52
The Socioeconomic Context
Contraceptive use is the expression of individual desires to space or to
limit births. Individual demands for birth spacing and limitation are them-
selves shaped by the surrounding social, economic, and policy environment.
If our aim is to understand contraceptive use in sub-Saharan Africa, we
must look first to the determinants of the demand for children. This chapter
opens the investigation with a consideration of the linkages between eco-
nomic development and fertility. Our discussion will emphasize levels of
income per capita, child mortality, educational attainment among adults,
and the costs and benefits of child schooling.
The overriding issue here and in Chapter 4 is whether, and under what
conditions, sub-Saharan Africa is likely to join in the process of fertility
decline in progress elsewhere. Recent demographic literature on Africa
presents no consensus about the prospects for change; indeed, the two views
that dominate the literature are strikingly opposed. In one, fertility decline
is seen as the natural concomitant of economic development; the demo-
graphic-economic linkages are thought to apply in sub-Saharan Africa much
as they do elsewhere. Continued high fertility is therefore explained in
terms of the factors that continue to inhibit economic development more
generally. In the other perspective, however, sub-Saharan Africa is re-
garded as being uniquely resistant to fertility decline. This resistance is
said to be rooted in fundamental and very nearly immutable features of
social organization, not easily swept away in the course of development.
The two competing perspectives on change are perhaps best exemplified in
52
OCR for page 53
THE SOCIOECONOMIC CONTEXT
53
two publications-a report by the World Bank (1986) and an article by
Caldwell and Caldwell (1987~.
The World Bank report locates the reasons for high fertility in Africa in
a set of conventional indices of economic development: low incomes per
capita, high infant and child mortality rates; low levels of adult literacy;
high proportions of the work force in agriculture; low percentages of the
population living in urban areas; and continuing difficulties across the con-
tinent in access to education, health, and family planning services. In none
of these dimensions has much of Africa advanced to a threshold sufficient
to induce fertility decline, according to the report. Thus, there should be
nothing very surprising about high African fertility and low contraceptive
use at present, but one should not expect these conditions to persist as the
development indicators begin to improve.
The alternative view, exemplified by the article by Caldwell and Caldwell,
draws attention to the unique features of African fertility decision making.
African societies are viewed as being wholly distinctive in respect to social
organization. They are said to differ from the remainder of the developing
world not merely in terms of the conventional categories of development,
but more fundamentally in the nature of spouse relationships, household
structure, kinship, culture, and religion. These elements have combined to
provide a powerful and coherent rationale for high fertility, one that is
without real counterpart elsewhere. Moreover, according to a later article
by Caldwell and Caldwell (1988), the high-fertility rationale remains intact
even in modern nation-states. The modern African state exerts only a su-
perficial influence on social organization, due to difficulties in formulating
population policies at the national level and to continuing deficiencies in
local service delivery. The state commands very few of the tools needed to
dismantle the high-fertility rationale.
These two lines of argument, seemingly so divergent, in fact have a
common point of origin in the historical record. The economic develop-
ment of sub-Saharan Africa has been profoundly affected by its distinctive
material conditions: principally, the relative abundance of land in compari-
son to labor; soil that in much of the region yields meager dividends to
intensified cultivation; and the very considerable uncertainties surrounding
the standard of living and life itself, owing to vagaries of climate and the
prevalence of disease (Locoh, 1991~. These material conditions are ex-
pressed in economic relations and kinship structure, and have shaped as-
pects of both culture and religion. They explain much of the high value
placed on labor and fertility, as well as the importance accorded to net-
works of mutual support, whether established through children, kin, or so-
cial relations. They may also help to explain the comparative recency in
Africa of territorially based bureaucratic structures, which provide the foun-
dation for nation-states. Thus, in reconciling the views of the World Bank
OCR for page 54
54
FA CTORS AFFECTING CONTRA CEPTI VE USE
(1986) and Caldwell and Caldwell (1987), what is at issue is not so much
the historical legacy, which has affected both the level of economic devel-
opment and social structure, as its relevance to African economies entering
the decade of the 1990s.
This chapter explores the view that high fertility in Africa can be ex-
pla~ned principally by levels of development. (Chapter 4 will focus on the
other view.) In an effort to weigh the evidence, we shall first review the
major theoretical linkages between socioeconomic variables and fertility.
These linkages are illustrated with cross-national data from developing countries
including some in sub-Saharan Africa. We also summarize a body of evi-
dence from household-level research on the socioeconomic determinants of
fertility, with the aim of assessing whether fertility levels are indeed less
sensitive to economic differentials in Africa than elsewhere. We then con-
sider in more detail the evidence on the relation between fertility and child
mortality and the prospects for increased survival, and the evidence on the
role of schooling costs and benefits in the demand for children. Finally, we
speculate as to the longer-run demographic consequences implicit in the
current era of economic stagnation and structural adjustment.
SOCIOECONOMIC DIFFERENTIALS OF FERTILITY
National-Level Relationships
In this section we briefly review the theoretical arguments linking fer-
tility levels to a set of socioeconomic determinants: income per capita,
child mortality, educational attainment among adults, and the costs and
benefits of child schooling. Where appropriate, we illustrate the theoretical
arguments with data drawn from recent cross-national samples of develop-
ing countries. In so doing, we take per capita income as a convenient
index of the level of economic development.
The relationship between income and fertility has been the subject of
much study. Evidence from many regions of the world that have experi-
enced fertility declines shows that income growth is associated with lower
fertility in the long run (World Bank, 1984~. However, economic theory
suggests that fertility may rise with increases in income, because additional
resources allow the family to afford more children. In the short term, this
iThe data are taken from the sample of countries covered in the 1991 World Development
Indicators (World Bank, 1991) and limited to countries with an income level per capita of
$3,000 or less in 1989. The income cutoff is used because no sub-Saharan country exceeded
this level in 1989. Gabon's per capita income in that year was estimated as $2,960; South
Africa's was $2,470; and the next highest level of income per capita, $1,600, was in Botswana
(estimates in 1989 U.S. dollars.)
OCR for page 55
THE SOCIOECONOMIC CONTEXT
o Sub-Saharan Africa ~ Other LOCs
an
90
ao
70
Q) 60
JJ
~50
a
L)
~40
~_
a, 30~
20
10
O -
+
Zimbabwe ~
+ a+ ~
+ /
~ +
+
ˇ it+
~ Kenya +
/
~ Botswana
4.
55
0 500 1000 1500 2000 2500 3000
GNP per Capita: 1939 $
FIGURE 3-1 Contraceptive prevalence versus per capita GNP. SOURCE: World
Bank (1991 ) and Demographic and Health Survey data tapes for sub-Saharan Africa.
positive relationship has been observed many times. The income-fertility
relationship is complicated, mainly because changes in income are related
to other aspects of economic development, such as educational opportuni-
ties, the participation of women in the work force, accessibility of consumer
goods, and the value of time. Thus, the effects of income on fertility are
both direct and indirect, and income may exhibit both negative and positive
associations with fertility (Mueller and Short, 1983~. However, it is gener-
ally agreed that in the long term, income is negatively associated with
fertility, because of the relationship of changes in income with changes in
other factors that reduce the demand for children (World Bank, 19841. (See
the section in this chapter on economic stagnation and adjustment for fur-
ther discussion.)
To set the stage for the theoretical discussion, Figure 3-1 shows the
positive relationship of contraceptive prevalence (all methods) to gross na-
tional product (GNP) per capita for more than 35 developing countries. The
data include a small number of sub-Saharan African (SSA) countries with
information on contraceptive prevalence as of 1990. In ascending order of
incomes, the sub-Saharan group includes Burundi (9 percent prevalence),
OCR for page 56
56
FACTORS AFFECTING CONTRACEPTIVE USE
Uganda (5), Mali (5), Kenya (27), Ghana (13), Togo (12), Senegal (12),
Zimbabwe (43), and Botswana (33).2 Sub-Saharan countries taken as a
whole clearly display lower levels of contraceptive prevalence than would
be expected given their levels of development.3 The African countries
compose the majority of countries in the sample with low incomes and
prevalence rates. Kenya, Zimbabwe, and Botswana are outliers by compari-
son with their sub-Saharan counterparts. Kenya and Zimbabwe have the
prevalence rates expected given their levels of income, and Botswana, with
the highest level of income of the sub-Saharan countries shown here, has a
lower than expected prevalence rate (although still higher than all other
sub-Saharan countnes, except Zimbabwe).
Estimates of total fertility rates4 are available for a much larger sample
of sub-Saharan countries. In what follows, we generally rely on fertility
data to provide an indication of the level of demand for births or for surviv-
ing children in the populations in question.5 Figure 3-2 depicts the relation-
ship between total fertility rates (TFRs) and income per capita in 1989. As
the figure shows, in comparison to developing countries outside the region,
those in sub-Saharan Africa display higher TFRs than their income levels
alone would suggest.
2Income-level data are not available for Liberia.
3In Figure 3-1 and several figures that follow, a regression line is used to help guide the eye
through the data. In each case the regression was calculated by taking the variable displayed
on the vertical axis as the dependent variable and that on the horizontal as the independent
variable. Regressions were estimated by using the full sample comprised of all developing
countries with per capita incomes of less than $3,000. Linear (y = a + bX) and log-linear (y =
a + blnX) specifications were examined in each case; the better-fitting line is shown in the
a.
figures.
4The total fertility rate (TFR) is a measure of the average number of children that would be
born to a woman who survives through her reproductive years. It is usually calculated on a
period-specific or calendar-year basis by using the age-specific fertility rates in effect in the
period in question.
SFertility may vary for reasons having little to do with the demand for births or for surviving
children. In parts of Central Africa, for example, primary and secondary sterility places
important constraints on fertility, and in this case, levels of fertility are not easily interpreted
in terms of the underlying demands. In other parts of Africa, observed fertility may be higher
than desired because there is not perfect control over actual fertility (due to lack of access to
efficient contraception, among other reasons). Despite these difficulties in interpretation, we
think that fertility rates provide the best approximation of the demand for births.
It is not obvious that the important postpartum proximate determinants, breastfeeding and
postpartum abstinence, necessarily cause any difficulties in the interpretation placed on fertili-
ty levels. To the degree that these behaviors reflect a demand for surviving children that is,
to the degree that birth spacing is understood to be related to child survival in the populations
in question the level of fertility is a good indicator of the underlying demand. If for some
reason the connection between spacing and survival is not recognized, however, the interpreta-
tion of fertility levels in terms of demand is more problematic.
OCR for page 57
THE SOCIOECONOMIC CONTEXT
o Sub-Saharan Africa + Other LCDs
91
B
cr 6 ~
L
a'
LL
57
a
oo
°`S,
onto Q'O CX: of
Oo :+ 0
4.
-5_ _~,
4- + +'
+ ~
'__
3
2 ~
1 -
O ~
-
o
14.
o
4-
I I I I I T
0 500 1000 1500 2000 2500 3000
GNP per Capita: 1989 $
FIGURE 3-2 Total fertility rates by per capita GNP. SOURCE: World Bank
(1991~.
Figure 3-3 presents fertility rates and income among only the sub-Sa-
haran countries with per capita incomes of less than $1,700 (excluding
Gabon and South Africa). Within this group, we should distinguish two
sets of countries: the five most populous countries of the region excluding
South Africa, that is, Nigeria, Ethiopia, Zaire, Sudan, and Tanzania; and the
three countnes, Kenya, Zimbabwe, and Botswana, thought to be the fore-
runners of an African fertility transition.6 The set of largest countries ac-
counts for some 51 percent of the total sub-Saharan population (as of 1989~;
Nigeria alone accounts for 23 percent. Simply by virtue of their size, these
6South Afnca's 1989 population, some 35 million, would place it third in terms of size, on a
par with Zaire. We have excluded South Africa for consideration here because (1) its per
capita income ($2,470 in 1989) is much higher than the norm for the region; and (2) the
considerable demographic and economic heterogeneity of its population leads to difficulties of
interpretation .
Sudan does not appear in some of our figures because the World Bank data sets that we used
did not supply an estimate of its income per capita in 1989. The total fertility rate for Sudan
was estimated to be 6.4 as of 1988, and an income estimate per capita for that year was $480
(World Bank, l990b).
OCR for page 58
58
. .
a)
9 _
Q _
CJ
a,
CD 7 ~
o,
6 ~
5 ~
.,.
._
.,,
4
a)
3 ~
0 2 ~
4 ~
O ~
FACTORS AFFECTING CONTRACEPTIVE USE
o
Ethiopia
o
o° Kenya
0 0 o.
°lanz. /. ~
/ Zaire ° 0
Nigeria
o
o
~ Zimbabwe
o
.
Botswana
1 1 1 '
0 250 500 750
GNP per Capita: 1989 $
1000 1250 1500
FIGURE 3-3 Total fertility rates in sub-Saharan Africa (countries with GNP per
capita less than $1,7001. SOURCE: World Bank (1991~.
countries must dominate the demographic future of the region. Kenya's
population is very nearly the size of Tanzania's. By contrast, Zimbabwe
and Botswana collectively comprise only 7 percent of the region's popula-
tion. Thus, the importance of the higher use countries rests not so much on
their contribution to regional totals, as on the lessons they may embody
regarding the determinants of change.
Of the countries with higher prevalence, Figure 3-3 shows that both
Botswana and Zimbabwe belong in the upper strata of sub-Saharan coun-
tries in respect to income per capita. Kenya, by contrast, lies in the middle
rank in terms of income and has a TFR comparable to that of Nigeria or
Tanzania. Evidently, then, the interest that surrounds the case of Kenya has
less to do with the present level of fertility than with its current contracep-
tive prevalence and the fact of a recent downward change in fertility (Locoh,
19911.
Mortality
The linkages between fertility and mortality consist partly of what has
been termed a "physiological effect," whereby a child's death truncates
OCR for page 59
THE SOCIOECONOMIC CONTEXT
59
breastfeeding, leaving the woman reexposed to the risk of conception. We
expect this physiological effect to be more powerful in societies with longer
periods of full breastfeeding, where the contraceptive effect of breastfeeding
is itself stronger, and also where postpartum abstinence is linked to breastfeeding.
Lloyd and Ivanov (1988), in reviewing Preston's (1975, 1978) work, sug-
gest that in a population with long durations of breastfeeding and postpar-
tum abstinence, a reduction of one infant death would be associated with
some 0.25 to 0.30 fewer births over a typical reproductive lifetime. Thus,
declines in mortality could be expected to produce declines in fertility, if on
something less than a one-to-one basis.7
The behavioral linkages between mortality and fertility consist of what
are termed insurance and replacement effects, the former having to do with
the influence of perceived or anticipated mortality risks on decisions re-
garding fertility; the latter, with the household's response to an actual child
death. The insurance effect is thought to be evident in coefficients that
relate community- or area-level indicators of mortality to individual-level
information on fertility or contraceptive use.
Very little is known about the relationship between the risks of mortal-
ity facing adults and the decisions that adults make regarding fertility. We
raise the point here because it will likely become an issue in the regions of
Africa suffering from a high prevalence of acquired immune deficiency
syndrome (AIDS; see the research agenda laid out in Grabble, 19921. A
pronatalist reaction to the threat of AIDS is certainly plausible, especially
as infant and child mortality due to mother-child transmission of human
immunodeficiency virus (HIV) will increase in these regions. However, the
social upheavals associated with an epidemic of the scale anticipated for
Central and parts of southern Africa may call into question many previously
established behavioral relationships. We see little basis for the extrapola-
tion of existing demographic theory on mortality-fertility linkages to such
unprecedented circumstances.
Figure 3-4 shows the relationship between total fertility rates and child
mortality rates, with the sub-Saharan countries highlighted. It can be seen
that African countries conform to the statistical norm wherein high levels of
7If the decline in fertility is less than one to one, we expect the net reproduction rate (the
average number of daughters born per woman in a cohort given certain mortality rates) to
. . ~ . . .
increase as lntant survivors. alp improves.
8Although we emphasize only the associations through which mortality affects fertility, it is
important to recognize that causation can run in the other direction as well. Higher fertility
may imply shorter intervals between births and greater proportions of births occurring in the
portions of the maternal age span (under age 20 or over age 35) when children face higher
mortality risks (Working Group on the Health Consequences of Contraceptive Use and Con-
trolled Fertility, 1989).
OCR for page 60
60
a,
CD
.,
FACTORS AFFECTING CONTRACEPTIVE USE
0 Sub-Saharan Africa
9 _
B
7 -
6- ~
5 - +. j
.,'
4- +
c' 3_ >/-
2 - ~ ~
o
O -
~ Other LCDs
o
O O
0 0
o o
°° ° loo ° _&~°
~o
to ~ O+
0
+
+
~ +
o
o
1 1 1
O 50 100 150 200 250
Child Mortality Rate: 1989
FIGURE 3-4 Total fertility rates versus child mortality rates. SOURCE: World
Bank (l991~.
fertility are associated with high levels of mortality. Similar correlations
are evident across regions within individual African countries. For ex-
ample, Montgomery and Kouame (1992) find a significant influence of area-
level child survival rates on cumulative fertility in Cote d'Ivoire. Kelley
and Nobbe (1990) report a high negative correlation between infant mortal-
ity and contraceptive use in a set of Kenyan provinces.
Educational Attainment of Adults
Few relationships have been so exhaustively studied as that between a
woman's educational attainment and her fertility. Yet the basis of the
relationship remains far from understood (Cochrane, 1979, 1983), particu-
larly in settings such as those characteristic of Africa.
Economists have drawn attention to the link between education and
labor market earnings. The higher a woman's educational attainment is, the
greater is her potential wage. If time spent in work and time in child care
are mutually exclusive, then wage measures one of the principal opportu-
nity costs of childrearing. It follows that the higher is the price of time, the
lower should be fertility.
OCR for page 61
THE SOCIOECONOMIC CONTEXT
100
90
~P
Be
70
60
50
40 -
30
20
10
O -
61
o
Zimbabwe
0 ~
o
Zaire O O
Nigeria
0 0
o
0 0
0 0
- o
.
0 0
Kenya
Botswana
.
o
o
o
o
1 1 1 1 1 1 1
. 0 250 500 750 1000 1250 1500
GNP per Capita: l98g $
FIGURE 3-5 Female literacy rates in sub-Saharan Africa (countries with GNP per
capita less than $1,700~. SOURCE: World Bank (1991~.
Figure 3-5 shows that higher levels of female literacy are associated
with lower total fertility rates in sub-Saharan Africa, as elsewhere. How-
ever, it is not at all clear that the chain of reasoning spelled out above can
be applied to African economies. For most African women, work need not
conflict directly with child care. Where a conflict exists, it may be resolved
through the employment of low-cost substitutes for the mother's time in
child care, such as care provided by relatives. The link to the opportunity
cost argument is therefore likely to be weak.
In an influential paper, Caldwell (1982) envisions a larger role for edu-
cation than that considered in the simple economic model. In his view,
education serves as a vehicle for the adoption of Western ideas regarding
the family. It may encourage a more child-centered view of one's parental
responsibilities. Education may alter the definition of what constitutes ac-
ceptable child care, giving greater weight to the time spent by the mother
with her child, compared to time given by mother substitutes. Education
may also affect the distribution of authority within the household, so that
educated women gain a measure of autonomy vis-a-vis their husbands, and
couples vis-a-vis their elders. Little is known in any quantitative sense
about these issues (see Chapter 4 on the subject of emotional nucleation),
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62
FACTORS AFFECTING CONTRACEPTIVE USE
but we suspect that adult educational attainment, and particularly schooling
for women, may be a precondition for a decline in the demand for children.
Schooling of Children: The Quantity-Quality Trade-Off
In any number of societies that have gone on to experience fertility
decline (for Thailand, see Knodel et al., 1987, 1990), changes in the per-
ceived benefits and costs of child schooling have played a key role in the
transition. The impetus for fertility change originates in the economic re-
turns associated with schooling. In the course of modernization, an economy
begins to display significant differentials in earnings by schooling level.
Parents then come to regard schooling as an avenue to a better life for their
children and as a human capital investment that may, over the long term,
pay dividends to the parents themselves. Yet education is costly in terms of
both direct costs and opportunity costs of forgone child labor; it generally
remains too costly for parents to give each child the desired schooling and
continue to bear the customary number of children. Some element of household
expenditures must give way, and typically fertility falls as household in-
vestments in education per child increase. The increase in child schooling,
coupled with the decline in fertility, has been termed a quantity-quality
demographic transition (Becker and Lewis, 1973; Willis, 1973; Caldwell,
1982~.
Figure 3-6 gives an indication of the quantity-quality transition in de-
veloping countries. Total fertility rates for 1989 are arrayed on the vertical
axis the quantity dimension. The horizontal axis shows the quality dimen-
sion, as expressed in 1988 primary school enrollment ratios. Viewed differ-
ently, the vertical axis represents the principal determinant of the future rate
of labor force growth, that is, fertility. The horizontal axis indicates the
levels of human capital with which future labor market entrants will be
equipped (albeit with a shorter time lag). A quantity-quality demographic
transition is therefore fundamental to economic development, in that it im-
plies a reduction in future labor force growth and an increase in human
capital per worker.
The trade-off should be understood to represent a systematic associa-
tion between two variables, fertility and child schooling, both of which are
determined by the preferences, costs, and financial constraints of the house-
hold. Higher fertility does not in itself cause lower school enrollment, nor
does greater enrollment cause lower fertility. Rather, each of these vari-
ables taken individually reflects the full set of opportunities and constraints
facing households. Nothing requires that the relationship between fertility
and child schooling have a negative slope. Indeed, Figure 3-6 shows that
for sub-Saharan countries, the negative relationship between fertility and
primary schooling is far weaker, if it exists at all, than is the case among
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74
FACTORS AFFECTING CONTRACEPTIVE USE
Direct Costs
Although the experiences of the past decade are varied and difficult to
quantify with any precision, the trend in the direct private costs of school-
ing in the region appears to have been upward. The World Bank (1988)
estimates that as of 1975-1980, private expenditures accounted for some 14
percent of total national spending on education in the Sudan, 23 percent in
Tanzania, 31 percent in Zimbabwe, 48 percent in Sierra Leone, and 53
percent in Ghana. The private share of total spending has increased over
time as governments place greater emphasis on the collection of fees and
other charges for educational materials, and increasingly transfer responsi-
bility for capital expenditures to local communities, which in turn pass them
on to parents.
For Nigeria, Makinwa-Adebusoye (1991) draws a sharp contrast be-
tween present-day private costs of schooling and those of an earlier era
when education (and health) services were highly subsidized. She presents
examples drawn from focus group studies confirming that the perceived
costs of education are high in both Lagos and Calabar. Okojie's (1991)
results for Bendel and Kwara State also show that parents are conscious of a
dramatically changed situation with respect to educational costs.
For Kenya, Kelley and Nobbe (1990) and Robinson (1992) see increases
in the costs of schooling as being associated in part with the educational
reform of 1985 (which added an additional year to the primary curriculum)
and with the introduction of new financing mechanisms that required par-
ents to pay in direct proportion to the number of children enrolled. (Kenyan
parents do not pay tuition fees; rather, they are responsible for school sup-
plies, books, uniforms, and a share of capital costs.) Most of the capital
costs for primary schools have been transferred from the national to the
local level. Taken together, the private costs borne by Kenyan parents are
said to be high, perhaps amounting to as much as 10 to 15 percent of
household cash income per child.
In Zimbabwe, Lucas (1991; citing Davies and Sanders) notes that pri-
mary school fees were abolished in the early 1980s and then, in the face of
a very rapid rise in enrollments, were replaced by various levies and capital
charges (also see World Bank, 1988~. In Botswana, by contrast, public
sector primary school fees were reduced through the 1970s and finally eliminated
altogether in 1980. Secondary school fees (at state-supported schools, which
enroll roughly two of every three secondary students) were eliminated in
|8The World Bank (1988) does not provide a source for these figures, but they appear to
include outlays on private educational institutions as well as the fees and capital levies borne
by families with children in public sector institutions.
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THE SOCIOECONOMIC CONTEXT
75
1988. Evidently the elimination of fees in Botswana was not counterbal-
anced by increases in other charges.
In summary, the general trend is that of an increase in the direct costs
of schooling, although Botswana may provide an exception to the trend and
the net change in Zimbabwe is unclear. Very little information is available
regarding fees and other costs in the private educational sector, which is a
significant presence at the secondary school level in a number of African
countries (see World Bank, 1988~.
Perceived Benefits of Schooling
If the direct costs of schooling are indeed on the rise, will the perceived
benefits of schooling in Africa be substantial enough to sustain a quantity-
quality transition? The evidence on this critical issue is conflicting. By all
accounts, African parents express a continued commitment to schooling and
display a willingness to make sacrifices in other areas so that their children
can be educated (see, among others, World Bank, 1988; Adegbola et al.,
1991; Okojie, 1991; Makinwa-Adebusoye, 1991~. But there is great uncer-
tainty regarding the economic benefits of schooling in African economies
and therefore in the extent to which educational aspirations, however deeply
felt, will be reflected in educational investments.
The benefits are expressed principally in the gradient of earnings with
respect to education; earnings, in turn, depend on the relative supplies of
and demands for labor by educational level. The demand for educated labor
depends in part on the growth of modern sector employment, which contin-
ues to be slow in sub-Saharan Africa (Hansen, 1990; Vandemoortele, 1991~.
The public sector component of employment will continue to be affected by
cutbacks in government budgets. Vandemoortele (1991) finds a compres-
sion of wage scales in the public sector and general declines over the past
decade in the real earnings of civil servants. To the extent that educational
investments in children are made in the expectation that they will eventu-
ally secure employment in the public sector, these changes may reduce the
private returns of schooling. However, as Vandemoortele points out, coun-
tries in which public sector pay is deteriorating often show counterbalanc-
ing increases in private sector earnings. The net effect on the anticipated
payoff to schooling remains unclear.
There is clear evidence of an erosion in the quality of schooling in sub-
Saharan Africa, such that the economic gains gleaned from schooling by
older cohorts may no longer be available to younger cohorts. The evidence
regarding quality decline is drawn from a mix of statistical and impression-
istic accounts. In a careful study of the Ghanaian wage sector, Glewwe
(1991) finds that the returns to schooling evident in wage differentials have
declined for more recent cohorts; indeed, the cognitive achievements of
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76
FACTORS AFFECTING CONTRACEPTIVE USE
recent cohorts per year of schooling are lower than those achieved by older
cohorts.~9 Glewwe attributes this change to difficulties in sustaining school
quality over the postindependence period of rapid expansion in primary and
secondary enrollments (also see Schultz, 1987~.
Among other factors influencing school quality, the World Bank (1988)
draws attention to the very low level of public spending per pupil in Africa
at the primary and secondary grades (if not at the tertiary). There is evi-
dence that spending per pupil may have even declined in the 1980s (see
below). In the important category of educational matenals, sub-Saharan
governments make very small contributions. Public expenditures for educa-
tional materials (World Bank, 1988) amount annually to less than 60 cents
per pupil. The share of the primary education budget going to instructional
materials is only 1.1 percent, compared to a 4.0 percent share among devel-
oped countnes. (Recall that the responsibility for these expenditures is
increasingly being shifted to parents.) All these factors are consistent with
the relatively poor performance of African students on standardized tests of
achievement in math, reading, and the sciences, even by comparison to their
counterparts in other low- or middle-income countries (World Bank, 1988~.
Moreover, the impression of decline in school quality in Africa is not con-
fined to statistical accounts. It is also a widely shared perception among
African parents and a common theme in conversation.
To sum up, we regard the prospects for a quantity-quality demographic
transition in the region as being decidedly mixed.20 Recent accounts taller
from focus group studies (e.g., Adegbola et al., 1991; Okojie, 1991) suggest
that changes in the costs of schooling are perceived to add significantly to
the financial burdens of large families. In time, these relative price effects
|9Recent studies show that with native ability held constant, cognitive achievement explains
a large part of educational differentials in earnings. That is, an extra year of schooling is
rewarded in the labor market primarily because it produces a change in the cognitive skills that
are valued in the market. Among wage earners in Nairobi and Dar es Salaam, Boissiere et al.
(1985) find strong evidence that cognitive achievement is a more powerful determinant of
earnings than years of schooling per se; achievement is itself affected by years of schooling as
well as by innate ability. Glewwe's (1991) findings for Ghana are similar. In summarizing the
results for Kenya and Tanzania, the World Bank (1988) suggests that an earnings differential
of 25 percent for secondary relative to primary schooling is attributable to the improvement in
cognitive skills produced by secondary school.
The above is not to deny the importance of credentialism and other factors in determining
the private returns to education in Africa. But tests for "diploma effects" (Boissiere et al.,
1985; Glewwe, 1991) show that the effects are weaker than the influence of cognitive achieve-
ment, save perhaps in the public sector. Credentialism may have its largest effect on earnings
at the outset of the work career.
20The picture is further muddied when child fostering and spouse decision making are con-
sidered in relation to the quantity-quality transition (see Chapter 4).
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THE SOCIOECONOMIC CONTEXT
77
may help to bring about a fertility transition. But we cannot assume that
African parents will continue to make sacrifices to invest in human capital
if the payoff to that investment is in doubt. Indeed, in some countries,
primary school enrollment rates fell in the 1980s, as discussed below. Policy-
driven changes in the direct costs of education can have little long-run
effect on fertility if the economic benefits of schooling cannot be sustained
and improved.
ECONOMIC STAGNATION AND ADJUSTMENT:
EFFECTS ON FERTILITY
The 1980s and early 1990s witnessed a contraction of incomes across
sub-Saharan Africa, such that many countries were left only slightly better-
off in terms of average incomes than they had been in the early 1960s
(Vandemoortele, 1991~. During the decade a number of countries responded
to economic stagnation and crisis with structural adjustment programs. These
programs sought to redirect government spending and to reduce the size of
the government sector; in addition, they were often designed explicitly to
influence the relative prices of food, education, and health care. Thus, the
past decade has been one of profound change not only in income levels, but
also in relative prices and policies determining access to social services. In
an influential paper, Lesthaeghe (1989a) speculated that the economic re-
versals and turmoil of the 1980s in sub-Saharan Africa might hold the seeds
of what he termed a "crisis-led" demographic transition.
In one sense, the idea of "crisis" breaks no new ground, in that it
simply revisits many of the socioeconomic factors that have already been
discussed above. The difference is that these factors are brought together in
a particular configuration, and in addition, the concept introduces a distinc-
tion between short-term demographic effects at work in the crisis period
itself and the potential longer-term consequences. Thus, comparatively temporary
income contractions may have effects on fertility decisions that depend on
expectations regarding longer-run income growth. Government retrench-
ments, intended to ameliorate short-term problems in the balance of pay-
ments, may have a long-run effect on access to education and health ser-
vices. And a temporary receptivity to family limitation on the part of
households under economic pressure may translate, over time, into a greater
acceptability of family planning in more normal circumstances.
There is little doubt about the depth of economic crisis in many African
countries, although experiences are perhaps more varied than might have
been thought. In some countries the term "stagnation" better describes the
situation during the past decade than does "crisis." Figure 3-8 depicts the
changes in income per capita between 1975 and 1987 in the five largest
countries of the sub-Saharan region. Population-weighted averages for sub
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78
1200
1000
800
600
400
Boo
FACTORS AFFECTING CONTRACEPTIVE USE
GNP per Capla, Dow
\
\
\
O
1975 1977 1979 1981
Year
~ Zaire
- End + Ted ~ So
~ Nag
1983 1985 1987
~ Sit AInca
FIGURE 3-8 Per capita GNP, 1975 to 1987 (1980 dollars). SOURCE: World Bank
199Oa).
Saharan Africa. A steady deterioration in income levels can be observed in
the region from the high point in 1981 Among the larger countries, the
collapse of incomes in Nigeria is particularly marked, but Zaire has also
experienced a long decline. By contrast, among the three countries with
higher prevalence, Botswana has exhibited a reasonably steady advance in
income over the decade, and Kenya and Zimbabwe have displayed fluctuat-
ing incomes with little apparent deterioration (see Figure 3-9~.
In considering the longer-run prospects for demographic transition, it is
important to separate the effects of income on fertility from the effects of
changes in relative prices. As long as fertility remains a normal good (one
whose consumption increases with income) in the economic sense of the
term, one would expect income contraction to be accompanied by a fertility
decline, or at least by a pause in family building. One would equally well
expect a return to high fertility as income levels improve. Thus, if current
economic circumstances are to set off a demographic transition in sub-
Saharan Africa, the origins of the transition must lie in a transformation of
both incomes and relative prices, which is precisely the argument employed
above in reference to the quantity-quality transition.
The implications of relative price changes induced by structural adjust
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THE SOCIOECONOMIC CONTEXT
t800
1600
1400
1200
1000
8009
600
400
200
o
1975 1977 1979 1981
GNP per Capla, Dow
, , , . , . .
-
Year
- Kenya ~Botswana * ~rr~we
79
1983 1985 1~7
FIGURE 3-9 Per capita GNP in Botswana, Kenya, and Zimbabwe (1980 dollars).
SOURCE: World Bank (199Oa).
ment for fertility are less than clear-cut (World Bank, l990c). Food price
increases, which drive down the standard of living for urban consumers,
may well improve living standards among rural producers (indeed, this is
the prime motivation for adjustment policies that remove artificial food
price ceilings). If conditions in agriculture improve, might that not increase
the derived demand for child labor and exert a pronatalist influence on rural
fertility? Would improvements in agricultural earnings reduce the disper-
sion in earnings levels according to schooling, further dampening the pros-
pects for a quantity-quality transition? Do cutbacks in public sector salaries
and employment, however well justified with respect to longer-term eco-
nomic efficiency, further depress the private returns to schooling and thereby
delay the quantity-quality transition?
The task of documenting the distribution of benefits and costs associ-
ated with economic reversals and adjustment policies is just under way in
sub-Saharan Africa (World Bank, l990c; Working Group on the Demo-
graphic Effects of Economic and Social Reversals, 1993~. Nothing defini-
tive can be said about these complex matters, and given the many interlock-
ing markets that are involved, economic theory alone can provide no clear
guidance. However, the current economic situation, which combines in-
come contraction and various increases in childrearing costs, may well have
rendered acceptable, for the first time, the notion of family limitation. Such
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80
FA CTORS AFFECTING CONTRACEPTIVE USE
a development is certainly consistent with the views expressed in the results
of qualitative studies in Nigeria (Caldwell and Caldwell, 1987; Adegbola et
al., 1991; Makinwa-Adebusoye, 1991; Okojie, 1991), in which Nigerian
parents seem to comprehend rather fully the negative consequences of high
fertility in the new regime of income and prices. The negative aspect,
however, is that macroeconomic austerity may reduce the capacities of gov-
ernments to improve access to education, family planning, and health ser-
vices. It is therefore important to assess what has happened to public
investments and access to services over the past decade.
Access to Education and Health
How have the social sectors, including education and health, fared in an
era of general retrenchment in government spending? Hicks (1991; also see
Hicks and Kubisch, 1984) finds that in periods of overall reduction in gov-
ernment expenditures in developing countries, recurrent expenditures on the
combined social sectors (including all spending on health, education, hous-
ing, and other social services) tend to be well protected in comparison to
the productive, infrastructural, and general public sectors. That is, the
social sectors tend to experience less-than-proportionate cuts in budget as
total government budgets decline. Capital expenditures tend to be cut much
more severely than do recurrent expenditures, and these cuts tend to be in
roughly the same proportion across all sectors. Thus, perhaps contrary to
expectation, the policy response to economic crisis and adjustment has typi-
cally been to compromise in the dimension of physical capital investments.
However, even if the education and health sectors have been able to
protect their shares of government budgets, they have not been able to
escape cutbacks on a per capita basis.22 Figure 3-10 shows the trends in per
capita central government spending on education, both for the largest coun-
tries in the region and for sub-Saharan Africa as a whole (for the latter,
results are weighted by population). There is an unmistakable downward
2iThe sample used by Hicks (1991) includes, but is not limited to, countries from sub-
Saharan Africa. The productive sector includes expenditures for industrial and agricultural
development; infrastructure includes power, transportation, and communications; and general
public services encompass administration, police, and the judicial system.
22In their analysis of the 1979-1983 period in sub-Saharan Africa, Pinstrup-Andersen et al.
(1987) note a stagnation or decline in per capita expenditures on health and education, with the
decline being more apparent in respect to health expenditures. They note considerable diversi-
ty among countries in the extent to which the health and education sectors maintained their
budget shares. Like Hicks (1991) and Hicks and Kubisch (1984), they find that capital expen-
ditures tended to be cut more than recurrent expenses, particularly in the economic services
sector.
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THE SOCIOECONOMIC CONTEXT
25
20
15
103
Expenditure per Capita, Dollars
O i ~i
1 980
-
1 ~
1981 1982 1983 1984 1985 1 ~1~7
Year
- Niger a
° Tanzania ~Zaire
81
Ethiopia ~ Sudan
~ Sub Saharan Avenge
FIGURE 3-10 Central government educational expenditure per capita. SOURCE:
World Bank ( 1990a).
trend in per capita education spending for the region; among the large coun-
tries this trend is mirrored in the experiences of Zaire, Tanzania, and Nige-
ria. Figure 3-11 considers health expenditures per capita; here, there is less
evidence of a systematic downward trend. However, the very low levels of
per capita expenditure on health in sub-Saharan Africa certainly did not
improve.
Consequences for lIuman Capital Investment
With regard to primary enrollments, the 1980s appear to have marked
the end of an era of expansion in sub-Saharan Africa. Primary enrollment
ratios, which reached their high point of 74 percent in 1981 (population
weighted), gradually slipped back to less than 70 percent by the end of the
decade (United Nations Educational, Scientific and Cultural Organization,
19901. Among the largest countries, Nigeria, Zaire, and Tanzania experi-
enced sharp declines in enrollments from about 90 percent in the early
1980s to 65-75 percent in the latter part of the decade. These declines are
no doubt due in part to income effects and in part to policy-driven increases
in the private costs of schooling described above. Let us emphasize again
that the more responsive the demand is for education with respect to price,
the less likely are the prospects for a quantity-quality transition in fertility.
Moreover, the primary-age cohorts of the mid-1980s are now entering their
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82
7
64
4
3
2
1 ,
O L
1980 1981 1982 1983 1984 1985 1 ~1~7
FACTORS AFFECTING CONTRACEPTIVE USE
ExpendRum ~ C - = ~1~
Year
- Sudan
+ NbeNa
~ Rhbpla ~Tot
Are
Sub Seaman Avenge
FIGURE 3-11 Central government health expenditures per capita. SOURCE: World
Bank (199Oa).
childbearing years. They will be without the benefits of the schooling
levels that they might otherwise have enjoyed in the absence of an eco
. . .
nomlc crisis.
The situation with respect to secondary schooling is very different.
Enrollment ratios at this level continued to advance through the decade,
although Zaire again and Tanzania present an exception to the general trend,
with Zaire showing a dramatic decline and Tanzania showing little change.
The advance in secondary schooling by Nigeria, from less than 20 percent
in 1980 to about 24 percent in 1987, is especially noteworthy, given the
decline in its primary enrollments over the period (United Nations Educa-
tional, Scientific and Cultural Organization, 1990~.
Also of interest is the continuing increase in the enrollment ratios of
women relative to men. Although males continue to outnumber females at
both the primary and the secondary levels, the enrollment gap between them
is being reduced progressively (United Nations Educational, Scientific and
Cultural Organization, 1990~.
Summary
The diverse experiences among countries show that there is no neces-
sary connection between macroeconomic stagnation and crisis, and cutbacks
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THE SOCIOECONOMIC CONTEXT
83
in access to services (Pinstrup-Andersen et al., 1987~. In Kenya, for ex-
ample, the period from 1979 to 1982 saw an annual decline in per capita
gross domestic product on the order of 1 percent per year, yet government
expenditures on health and education continued to increase. Cornia and
Stewart (1987) cite the cases of Botswana and Zimbabwe, which met their
episodes of severe drought in the early 1980s with well-designed drought
relief programs that targeted health care and children's supplementary feed-
ing programs. Health expenditures increased, in general, even as economic
conditions deteriorated; primary school enrollments also continued to rise.
Moreover, the recent study by another working group of the Panel on the
Population Dynamics of Sub-Saharan Africa, the Working Group on Demo-
graphic Effects of Economic and Social Reversals (1993), indicates that the
effects of economic reversals have varied considerably from country to
country.
CONCLUSION
The socioeconomic record offers few general lessons regarding fertility
transition that can be applied across the whole of sub-Saharan Africa. Cer-
tainly the steady increase in female educational attainment, albeit from very
low levels in some regions, may remove one of the props supporting high
fertility. But in other respects the likelihood of fertility decline is very
much a country-specific matter. Although mortality has fallen substantially
in many sub-Saharan countries, the decline is not universal. Most of the
largest countries still exhibit relatively high levels of child mortality. In
Nigeria, the largest country, little progress, if any, has been made in the last
decade and a half. Changes in the costs of living, and specifically the costs
of education, may well hold the key to fertility trends in some countries, but
as we have argued, the responses to higher education costs depend on the
nature of the benefits to schooling. The economic crises of the 1980s may
have opened the door to the acceptability of family limitation, but if income
growth resumes without structural change, fertility decline need not follow.
The experiences of sub-Saharan countries have been so varied in re-
spect to socioeconomic development, and governments so heterogeneous in
their social sector policies, that no general forecast regarding fertility and
contraceptive use should be made. Enough has been said to indicate that
the three countries that may be the forerunners of fertility change, Kenya,
Botswana, and Zimbabwe, are distinctive with respect to policy and socio-
economic setting. Among the larger countries, Nigeria shows some indica-
tions of sensitivity to the costs of schooling, but its decline in primary
enrollments is worrisome. Ethiopia and Sudan remain in sociopolitical
turmoil, which will necessarily limit the reach of policy; Zaire gives evi-
dence of severe deterioration over the past decade with worsening condi
4
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84
FA CTORS AFFECTING CONTRACEPTIVE USE
lions since 1990. None of these large countries displays the steady ad-
vances against mortality characteristic of the higher use countries, and it is
doubtful that major fertility declines at a national level can be initiated
without such improvement.
Yet even in the larger countries, economic stagnation, and structural
adjustment may have brought into relief previously latent demands for fam-
ily limitation among important subgroups of the population. In an atmo-
sphere of austerity, policies addressed to these subgroups may find a newly
receptive audience.
Representative terms from entire chapter:
fertility rates
