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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Population Dynamics of Kenya 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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Population Dynamics of Kenya NOTE: This map, which has been prepared solely for the convenience of readers, does not purort to express political boundaries or relationships. The scale is a composite of several forms of projection.

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Population Dynamics of Kenya Population Dynamics of Kenya William Brass and Carole L. Jolly, Editors Working Group on Kenya 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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Population Dynamics of Kenya NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 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. 93-84968 International Standard Book Number 0-309-04943-1 Additional copies of this report are available from: National Academy Press, 2101 Constitution Ave., N.W., Box 285, Washington, D.C. 20055. Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). B167 Copyright 1993 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Population Dynamics of Kenya WORKING GROUP ON KENYA WILLIAM BRASS (Chair), Centre for Population Studies, London School of Hygiene and Tropical Medicine, England LINDA H. (WERNER) ARCHER, Independent Consultant, Nairobi, Kenya JOHN KEKOVOLE, Population Studies and Research Institute, University of Nairobi, Kenya SIMON W. NDIRANGU, Ministry of Culture and Social Services, Nairobi, Kenya AINEAH O. OYOO, Nairobi City Commission, Kenya WARREN ROBINSON, Economic Research Associates, Washington, D.C. CAROLE L. JOLLY, Staff Officer SUSAN M. COKE, Senior Project Assistant JOAN MONTGOMERY HALFORD, Senior Project Assistant* *   through July 1992

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Population Dynamics of Kenya 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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Population Dynamics of Kenya 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 Demograpby, 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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Population Dynamics of Kenya 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's 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 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.

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Population Dynamics of Kenya 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, nuptiality, the proximate determinants of fertility, child mortality, adult mortality, internal migration, and international migration, as well as the demographic consequences of the AIDS epidemic. This report, one of the two in-depth country studies, analyzes the population dynamics of Kenya, with particular emphasis on recent fertility change. Kenya was chosen because of interest in recent survey results indicating substantial demographic change in a country that once had the highest population growth rate in the world. The report examines trends in fertility and mortality and their relationship to socioeconomic changes. As part of this examination, the proximate determinants of fertility are analyzed, and multivariate analysis is used to assess the factors associated with contraceptive use. The report does not examine, in any detail, recent migration patterns because of very limited access to data from the 1989 census. 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, particularly Steven W. Sinding of the Rockefeller Foundation, were a source of information and advice in developing the working group's overall work plan. This report results from the joint efforts of the working group members and staff and represents a consensus of the members' views on the issues addressed. The Committee on Population and the Panel on the Population Dynamics of Sub-Saharan Africa appreciate the time and energy that all the

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Population Dynamics of Kenya working group members devoted to the study. The following people deserve recognition for their special contributions: Warren Robinson synthesized a diverse literature on socioeconomic and program factors related to demographic change and drafted Chapters 2 and 6. He also drafted the introduction to the report and was instrumental in guiding the research of the members living in Kenya during the initial stages of the project. Linda H. Archer (formerly Werner) and John Kekovole collected much of the socioeconomic data used to explain recent demographic change and wrote a background paper for the report on socioeconomic changes during the last 20 years. Archer also played a key role in organizing the efforts of the working group members living in Kenya during the later stages of the project. Simon W. Ndirangu and Aineah Oyoo participated in all the working group meetings, and their intimate understanding of the Kenyan experience was useful in drafting the report. William Brass served admirably as the working group's chair and directed the research of the group. He had primary responsibility for analyzing changes in fertility and mortality and their relationship to socioeconomic change. The results of his efforts are presented in Chapters 3, 4, and 7, which he drafted. Carole Jolly analyzed the proximate determinants of fertility, drafted Chapter 5, and performed the multivariate analysis of the factors associated with contraceptive use, which is presented in Chapter 7. Brass and Jolly served as the principal editors and coordinators of the report. Linda Martin provided substantive comments on numerous drafts of the report and participated in all the group's meetings. Jay Gribble took care of unnumerable details in the final drafting stages. As noted above, however, this report reflects the views of the working group as a whole, and considerable effort by all the members and staff went into its production. The working group was assisted in its efforts by several other people. Simon Murote Kangethe collected socioeconomic data from numerous Kenyan government agencies. Anne Scott performed data analysis of fertility and mortality trends. Jordan Shapiro authored a paper on migration in Kenya. John Blacker provided extensive analyses of Kenya fertility and mortality, much of which is unpublished. Special thanks are also due Susan Coke and Joan Montgomery Halford for providing superb administrative and logistical support to the working group, to Florence Poillon for her skillful editing of the report, and to Elaine McGarraugh for meticulous production assistance. Eugenia Grohman was instrumental in guiding the report through the report review process and production. SAMUEL H. PRESTON, Chair Commottee on Population

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Population Dynamics of Kenya Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   5 2   DEMOGRAPHIC AND SOCIOECONOMIC BACKGROUND   8     Socioeconomic Development   11     Demographic Change   14     Summary   23 3   MORTALITY TRENDS   25     Child Mortality   25     Adult Mortality   44     Summary   46     Appendix   47 4   FERTILITY TRENDS   51     Evidence of Declines in Fertility from Recent Surveys   58     Differentials in the Declines in Fertility   68     Patterns of Fertility Decline   72     Comparison of the Pattern of Fertility Decline, in Kenya with Other Populations   75     Differentials in the Patterns of Fertility Decline   78     Fertility Declines by District   81     Summary   86     Appendix   87

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Population Dynamics of Kenya 5   PROXIMATE DETERMINANTS OF FERTILITY   92     Framework   92     Results   104     Relation Between Changes in Proximate Determinants and Fertility   114     Comparisons of the Proximate Determinants of Kenya with Other Sub-Saharan Populations   118     Summary   120     Appendix   121 6   SOCIOECONOMIC AND PROGRAM FACTORS RELATED TO FERTILITY CHANGE   123     Analytical Framework   123     Changes in Reproductive Preferences   124     Growth of Government Programs   126     Effects of Government Initiatives on Fertility   134     Summary   137 7   LINKAGES BETWEEN SOCIOECONOMIC FACTORS AND DEMOGRAPHIC CHANGE   139     Child Mortality and Socioeconomic Factors   139     Fertility and Socioeconomic Factors   149     Child Mortality Linkages with Fertility Declines   153     Multivariate Analysis of Contraceptive Use   156     Summary   162     Appendix   163 8   CONCLUSIONS   168     Mortality   169     Fertility   171     The Future   174     Relationship to Demographic Change in Other Countries   175     References   176