**Family Planning and Fertility Decline in Africa: From 1950 to 2010 1950 to 2010**

**Family Planning and Fertility Decline in Africa: From** 

DOI: 10.5772/intechopen.71029

#### Michel Garenne Michel Garenne Additional information is available at the end of the chapter

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Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.71029

#### **Abstract**

The study analyzes the links between family planning programs, contraceptive prevalence and fertility trends in sub-Saharan Africa. It is based on case studies of countries with demographic surveys. The study reveals a variety of situations. Some countries have completed their fertility transition, while others have reduced their fertility level rapidly in urban areas, but less so in rural areas. In some countries, fertility remained very high, or declined very little, in rural areas, when population policies and family planning programs remained insufficient or almost non-existent. The role of family planning programs in fertility decline is highlighted by contrasting countries with similar characteristics, one of which experiencing a sharp drop in fertility, while the other one is showing a small decline or no decline at all. In each case, the political, economic, and social context is presented in order to explain the differences between family planning programs and their outcomes. These case studies make it possible to draw conclusions about the conditions of fertility control in African countries.

**Keywords:** population policy, family planning, contraception, fertility trends, demographic transition, political environment, economic conditions, social situations, demographic and health surveys (DHS), sub-Saharan Africa

#### **1. Introduction**

The demographic transition is a universal phenomenon induced by new behaviors associated with economic development, technical progress, social change and population pressure. The decline in mortality creates an imbalance, unsustainable in the long run, which requires a decline in fertility in order to restore the demographic balance. In Europe and in countries of European settlement in North America and the Pacific, the fertility transition has been the result of individual initiatives, without state intervention, that is changing behavior of

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couples. To give a classic example, that of Sweden, the level of fertility has not exceeded 4.7 children per woman since the 18th century, began to decline rapidly around 1870, reaching 2 children per woman around 1930, a date that can be taken as that of the end of fertility transition. After this date, fertility followed several cycles, up and down, around this average level. The fertility transition itself lasted about 60 years or two generations. The number of births balanced approximately the number of deaths by 1800 and this balance was practically restored around 1980, about 50 years after the end of the fertility transition. This model is fairly general for European countries, with the notable exception of France, where fertility decline occurred much earlier, beginning in the 18th century, and was very slow, since it lasted nearly two centuries. Historical demographic studies in Europe showed that the fertility transition was virtually unrelated to short-term socio-economic indicators and that it affected different countries at different levels of development, as measured by income per capita, level of education level or level of urbanization [1, 2].

**2. Brief history of population policies and family planning programs**

**2.1. Awareness and organization**

birth control in New York City (1916) and in London (1921).

injectables (source: Demographic and Health Surveys, or DHS).

ception and limit population growth were made.

An abundant literature covers the history of population policies and family planning programs in the world since 1950. A synthesis book edited by the World Bank summarizes the major stages of these programs, focusing mainly on Asia and America Latin [9]. A review published by the Rand Corporation provides a detailed analysis of family planning programs and their problems [10]. A recent article presents the challenges for the 21st century [11]. This section presents the main stages of this construction, important for understanding the African context.

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121

The first voluntarist movements of birth planning, initially private initiatives, appeared in the United States and in England at the beginning of the 20th century, with activist women, most notably Margaret and Ethel Sanger and Marie Stopes, who installed the first clinics promoting

Awareness of the world population problem dates back to the years following the end of the Second World War, especially in the United States and in some European countries (England, Sweden), and it was from 1950 on that concerted efforts to develop and disseminate contra-

Initially, extensive research was funded to develop modern contraceptives with maximum efficacy and minimal side effects, and best suited to the needs of couples. This research produced a long series of important technological innovations: contraceptive pills (1960), Intra-Uterine Devices or IUDs (1958, 1962, 1968), spermicides (numerous products), injectable hormonal contraceptives (1969), implants (1983), abortion pills (1988), morning-after-pills (1999), non-surgical sterilization (2002), etc. These innovations enabled the development of family planning programs and the spread of modern contraception worldwide. These new methods complemented previously known methods (abstinence, interrupted coitus or withdrawal, condom, diaphragm, sterilization, induced abortion, etc.) and facilitated the adoption of new behaviors. It should be noted here that these new contraceptive methods are the most widely used methods in Africa: five modern methods (injectable, pill, implant, IUD, condom) account for 90% of contraceptive methods used, among which almost half (42% of total) are

It was also during this period that were founded the leading organizations responsible for disseminating modern contraception and monitoring its effects, such as the Population Council (1952), the International Planned Parenthood Federation (IPPF, 1952), the PathFinder Fund (1957), as well as the specialized programs of large American foundations (Ford, Rockefeller, Hewlett-Packard, etc.) and of the American government (USAID). At the level of international organizations, the United Nations created in 1967 an agency specialized in population issues: the United Nations Fund for Population Activities (UNFPA). Other UN agencies will also participate in this movement in various ways: World Health Organization (WHO), UNICEF, World Bank, etc.

With the development of major family planning programs worldwide, many consulting firms and consulting groups, mostly American and financed by USAID, were created since the 1970s,

Russia presents a different case because the state has begun to play an active role in the decline in fertility in this country. Available evidence suggests a small decline in fertility at the end of the 19th century, probably restricted to large cities. Then, after the troubled period of the Bolshevik revolution, fertility reached a peak in 1924. After this date, fertility started a steady decline, reaching a level of 2 children per woman in 1970, some 45 years after the beginning of the transition, after which it fluctuated upwards and downwards. What is important in the case of Russia is the voluntarist policy of the Soviet state, which authorized medical abortion as early as 1921, induced abortion being the main form of birth control in the USSR until 1990. This policy was above all a social and feminist policy aimed at ensuring greater freedom for women and encouraging them to work in industrial and agricultural production, and not a policy of population control in the Western sense. It was however interrupted at the time of the Second World War, in this case for demographic purposes [3–5].

In the Third World, fertility decline began most often after 1960, and is mainly the result of public policies, that is family planning programs. According to United Nations estimates, fertility in Asia fell from 5.67 to 2.24 children per woman between 1960 and 2010 and in Latin America from 5.95 to 2.20 children per woman during the same period, thus realizing the essential part of the transition of fertility in half a century. In sub-Saharan Africa as a whole, fertility declined only slightly during the same period of time, from 6.62 to 5.26 children per woman between 1960 and 2010 [6]. Africa is the last continent where the transition was delayed and remained largely unfinished by 2010. The consequences of this persistent high fertility are incalculable and will lead some countries to situations very difficult to manage, especially countries located in the Sahel and in Central Africa [7, 8].

The purpose of this study is to trace the history of family planning policies and programs and their impact on fertility and contraception in Africa, to highlight what worked and what did not work, and to document the reasons of successes and failures. The emphasis here is on rural areas, because demographic dynamics are different in urban areas which are much more advanced in the fertility transition. This study is intended for social scientists and policy makers, and therefore provides only few details on the demographic and statistical techniques that underlie the tables and graphs. These technical details are amply covered in other publications cited in text.
