III. Thematic Overview: Population
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This theme has been at the forefront of the international agenda for many years, as manifested by the series of World Conferences on Population held in the last three decades of the 20th century—starting with Bucharest in 1974 and ending with the landmark International Conference on Population for Development (ICPD), held in Cairo, Egypt, in 1994.
At the ICPD, 179 countries signed up to a far-reaching Program of Action, to be implemented over a 20-year period (1994–2014). ICPD was significant because it moved the debate away from its previous focus on numbers, toward an emphasis on population in the broader context of reproductive rights—a shift that did much to advance the notion of gender as an overarching development challenge, and set the stage for the Fourth World Conference on Women held in Beijing in 1995.
In December 2000, 189 countries signed on to the Millennium Development Goals, 8 targets that today represent a global consensus on what needs to be done to reduce poverty in the world’s poorest countries. The Millennium Declaration itself is widely viewed as the pinnacle of the final decade of international conferences. Put together, the ICPD Program of Action, the Millennium Declaration, and the MDGs have informed Africa’s agenda in the population field.
Demographic concerns and HIV/AIDS
Despite the acknowledgement of the Millennium Declaration, the African Common Position on the Progress of Implementation of the MDGs concedes that the majority of African countries are unlikely to meet most of the targets by 2015, because so many African countries are among the world’s poorest. The latest available statistics suggest that if current birth rates remain unchecked, Africa’s population, which has grown from 215 million to roughly 924 million since 1950, could rise to 2 billion by 2050, overtaking a projected 1.63 billion for India and 1.44 billion for China.
A number of demographic characteristics make Africa’s situation particularly inimical to development. One is the fact that 42 percent of Africans are under 15, and 3 percent over 65, meaning Africa has a high dependency rate. With young women and girls making up 52 percent, the so-called youth bulge will mean that even if fertility declines, population will still continue to rise. HIV/AIDS is currently Africa’s greatest challenge to sustainable development, with UNICEF and UNAIDS reporting that in 2004, sub-Saharan Africa accounted for 63 percent of infections among youth aged 15–24. HIV/AIDS and lower birth rates in Southern Africa mean its projected population growth rate is among the slowest regions, second only to North Africa. By 2050, West and East Africa will register the highest population growth, followed by Central Africa.
Despite being unable to deliver on the Cairo Consensus due to a lack of capacity to implement most of the Program of Action, and according to the Africa progress report prepared for ICPD+10 in 2004, population issues are being addressed to a better extent within the context of poverty, environment, and decentralized planning; actions are being taken on specific issues of population, including reproductive health; while specific population policies have been adopted in some 69 percent of the countries.
Taking ownership
While Africa’s population strategies are aligned to global norms and standards, the AU has sought to take ownership of the population problem. In 1996, its predecessor, the OAU, set up the African Population Commission (APC) as the main continental body dealing with population and development and reproductive health issues. In 2005 the APC was rationalized and mainstreamed into the AU Commission, which now serves as its secretariat. The AU recently published the State of the African Population Report 2006, the second in a series of biennial reports charting progress and recommending policy actions.
The 2006 Report served as the main background document for the 6th Ordinary Session of the APC, which took place in South Africa from 16–17 July 2007. The meeting expressed concern that halfway through the target period Africa was not on track to meet the MDGs. In particular, the target of reducing maternal and infant mortality was unlikely to be met due to the devastating impact of HIV/AIDS. Another concern was that the population and development debate was restricted to issues of population size and growth rate, at the expense of aspects of the age structure and the implications of population dynamics for poverty reduction and development.
Among other things, the Gauteng Declaration issued at the end of the meeting called for: increased investment and repositioning of family planning; increased investment in health programs directed at women, children, and youth; free primary education and increased investment in technical education; speeded-up responses to HIV/AIDS, malaria, and tuberculosis; and strengthened institutional capacity for coordination, implementation, and monitoring and evaluation of national population policies.
The Declaration also called for the active involvement of civil society in advocacy and service delivery around population issues. Currently, CSOs do not assume a prominent role in advocating for population issues in Africa to be addressed. The majority of CSOs view population within the broader context of reproductive rights, along the lines of the Cairo Consensus. While HIV/AIDS attracts significant CSO engagement, the broader debates on the relationship between population growth and economic development in Africa have largely been passed over.
A growing number of African countries have integrated population issues into the formulation, implementation, and evaluation of various sustainable development policies and programs. However, concerns over migration, human resource capacity, fertility, life expectancy, and availability of reproductive health commodities could affect the modest progress achieved.
Migration
An estimated one-third of the world’s 150 million migrants are said to be Africans, including a growing number of female migrants. Within Africa, some 16 million people are reported to be living in a country other than their birth—forced by political instability, environmental degradation, and poverty. Among issues arising from this movement of people is the concern that Africa’s best brains are leaving the continent. The large number of professionals leaving Africa on a consistent basis could erode capacity at a time when Africa needs to enhance labor productivity to move up the value chain of technological innovation as a means of leapfrogging its constraints.
In light of its implications for Africa’s human resource capacity, the dearth of organizations of any type highlighting the migration issue constitutes a major cause for concern—particularly given policy interventions by the EU and other Western donors from a security perspective. Research has also shown that remittances are not always effective as a replacement for aid, since their primary purpose was to support the day-to-day subsistence and reproduction of family members.
There are few organizations in Africa prioritizing the migration issue, notwithstanding the role of international organizations such as International Organization on Migration (IOM).
Reproductive Health
Population can be a double-edged sword. On the one hand, adequate labor and consumer markets are good for economic growth. On the other, however, unchecked population growth in the absence of enough land and public services can wreak havoc. Africa’s birth rate of 38 per 1,000 remains the highest in the world, and is set to rise, even with the deaths caused by the HIV/AIDS pandemic and other infectious diseases. At the same time, HIV/AIDS is causing significant declines in life expectancy to as low as 34–40 years. Africa’s average of 52 years is itself is low when compared to 80 years for citizens of developed countries.
For a number of reasons, and outside Northern and Southern Africa, the uptake and use of contraceptives remains relatively low. At the same time, there are problems of availability of so-called reproductive health commodities, making family planning all the more difficult. The evidence shows that where information and contraceptives are made available, there is a moderate-to-rapid decline in the birth rate as well as economic improvement, better health for women and their families, and higher educational attainment and status. In countries where the birth rate has not fallen, there has been explosive growth in urban slums, failed education strategies, and in some cases continuing oppression of women.
A number of continental organizations work in population-related areas. On HIV/AIDS, key players include the Population Council, Partners in Population and Development (PPD), African Council of AIDS Service Organizations (AfriCASO), and the African Networks for Health Research & Development (AFRO-NET). Along with the Partner in Population Development and the Regional Center for Training in Family Planning and Reproductive Health (RCT), the Population Council also works on reproductive health issues. Organizations such as the African Medical Research Foundation (AMREF) and programs such as the Health Systems Research for Reproductive Health and Health Care Reforms in the Eastern and Southern African Region also focus on the wider challenge of strengthening Africa’s health systems.
Though there are many organizations conducting research related to reproductive health and HIV/AIDS, this tends not to include work on the challenges of HIV/AIDS in areas prone to conflict. This is an aspect of the research agenda that needs to be strengthened. Since the absolute numbers infected are much greater among the poor, and since reaching them with information and services is more difficult, resources should be deployed to ensure that the poor are provided with life-saving information, treatment of STDs, and access to condoms.
More emphasis needs to be placed on prioritizing prevention interventions due to scarcity of resources available in confronting the HIV pandemic in Africa. Since many organizations are involved in the awareness campaigns about the primary mode of transmission, there is need to focus on behavior change. Those involved in prevention should attempt to refocus their attention on youth, with the aim of making them advocates for and designers of intensified prevention efforts. Youth represent untapped terrain for support and investment, as those between the ages of 14 and 24, account for 20 percent of Africa’s population.
Population does not exist in a vacuum. As such, another challenge that must be addressed in the coming years is the parlous state of health systems of most African countries due to persistent poverty, population growth, and diverse endemic diseases such as HIV/AIDS and malaria. The recognition that well-organized and sustained health systems are necessary to achieve results on the ground needs to be matched by concrete action in a number of areas. These include putting together the right chain of processes (i.e., financing, regulatory framework for private sector-public collaboration, governance, insurance, logistics, provider payment and incentive mechanism, information, well-trained personnel, basic infrastructure, and supplies) to ensure equitable access to effective service delivery.
