**A. Annex**

World Bank, UNICEF, European Union, etc.), bilateral aid (United States, European countries, Japan, etc.), international federations, American foundations (Ford, Rockefeller, Gates, etc.), and many intermediary actors. This international aid has made it possible not only to provide free contraceptives, but also to finance a significant part of the operation of

**5.** *Population receptivity*: the fertility transition is essentially a paradigm shift for families, from a situation of "natural fertility" to a situation of control of offspring at a low level, the ultimate norm being two children per couple. This radical social change is gradual, on average over two generations, that is to say over periods of 60 years, sometimes faster (as in South Africa or Mauritius), sometimes slower. The receptivity of the population therefore evolves over time, starting from a negative attitude toward a positive attitude. This transformation can take place at different levels of development. It is moving faster in urban areas, where changes are faster due to economic development and social change (income levels, production and consumption structures, educational levels, information, mass media, family models, etc.). But it can also be realized in rural areas, even in societies that are still fairly traditional. The examples presented above illustrate this point for Africa, as has been amply demonstrated for Asia and Latin America a few decades ago. Ethnographic arguments often opposed to family planning and in favor of a maximum number of children (such as the place of the child in traditional societies, the contribution of children to family production, insurance for old age, etc.) do not resist a dynamic analysis of situations. As soon as couples understand their interest in having fewer children, they quickly adopt

**6.** *Socio-economic correlates*: contrary to what is often stressed in the press and in international circles, low levels of economic development, income, wealth and education are not definite obstacles to the adoption of birth control. Some programs work very well and have a significant impact even in poor countries, where women have low levels of education and little autonomy. This has been well documented in Asia, the Middle-East, North Africa and Latin America in the past, and appears to be the case in sub-Saharan Africa, as illustrated

by some of the countries presented in this study (Ethiopia, Madagascar, Rwanda).

This study gave little consideration to the different epidemiological situations. In particular, the HIV/AIDS epidemic has several possible interactions with contraception and fertility. On the one hand, the virus itself induces a decrease in fertility by a biological effect. On the other hand, the fight against AIDS has led to an increase in condom use in many countries. In the case studies presented above, it appears that these interactions had no impact on the fertility transition: in three cases (Rwanda/Burundi, Kenya/Uganda, Ghana/Nigeria) the epidemiological situation of HIV was comparable in the case and control countries. In the case of the comparison between Madagascar and Mozambique, the situation was rather the opposite of what one would have expected, because HIV was rare in Madagascar but frequent in Mozambique. Even in the Zimbabwe/Zambia comparison, there was slightly less condom use in Zimbabwe (3.2% women) than in Zambia (4.2% women), while the first country was slightly more affected by HIV than the second (prevalence of 15.2% and 13.3% respectively). The impact of epidemiological situations seems therefore negligible compared to the functioning of family planning programs.

the programs on the ground.

144 Family Planning

these new behaviors, even in traditional societies.


**Author details**

Michel Garenne1,2,3,4\*

South Africa

**References**

University Press; 1986. 484 p

Paris, PUF; 1986. 582 p

No 168. 2016

2015 Sales: ST/ESA/SER.A/377

\*Address all correspondence to: michel.garenne@pasteur.fr 1 FERDI, Université d'Auvergne, Clermont-Ferrand, France

2 Institut de Recherche pour le Développement (IRD), UMI Résiliences, Bondy, France

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

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

147

4 MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,

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[8] Garenne M. La pression de la population dans les pays sahéliens francophones: Analyse des estimations et projections de population 1950-2100. Ferdi Working Papers

[9] Robinson WC, Ross JA, editors. The Global Family Planning Revolution: Three Decades of Population Policies and Programs. Washington, DC: The World Bank; 2007

[10] Seltzer JR. The Origins and Evolution of Family Planning Programs in Developing

[7] Bongaarts J. Slow down population growth [comment]. Nature. 2016;**530**(7591)

[4] Blum A. Naître, vivre et mourir en URSS (1917-1991). Paris, France: Plon; 1994. 273 p

today's developing world. Population Bulletin. 1980;**34**(6):3-44

URSS jusqu'en 1991. Population. 1994;**49**(4-5):903-933

Countries. Santa-Monica, CA: Rand Corporation; 2002

3 Institut Pasteur, Unité d'Épidémiologie des Maladies Émergentes, Paris, France

**Table A1.** Percentage of achievement of the fertility transition in 2010, by country (source: Reconstruction from demographic surveys).
