by Paul Morland
Pakistan, from which Bangladesh broke away, has been less successful and slower in reducing fertility, but nevertheless the rate has come down very substantially from six and two-thirds to three and two-thirds since the mid 1970s. This is a significant fall, although high by the standards of the developing world outside Africa. A large part of the explanation probably lies in the resistance of many Pakistani religious leaders to the use of birth control, a phenomenon which is not typical of the Muslim world as a whole.
Afghanistan had the highest fertility rate in the region in the post-war period and maintained it to the turn of the century, through the Soviet invasion and withdrawal and the arrival of the mujahideen and Taleban. Only since the start of the present century, possibly related to the NATO occupation and social programmes launched since then, has it started to fall; and although this has been very rapid, it has so far taken place only over a short period. Afghanistan still has (excepting tiny Timor Leste) the highest fertility rate outside Africa at over five children per woman, almost a child more than Yemen, the country in the Middle East with the highest fertility rate. Such anyway is the latest available UN data; more recently available information suggests that Afghanistan’s fertility rate is now falling so fast that it may have come down below five. As we have already seen, Islam as such is not necessarily a pro-natalist religion, but traditional Islamic societies seem to be exceptionally late in experiencing falling fertility–although, like everyone else, they get there eventually.
The fertility rate in India has notable regional variations. It is highest in the poorer states of the northern Hindi belt, lowest in the states of the south such as Kerala, where female education has been stressed. In Kerala and Tamil Nadu it is already below replacement level. There are also religious differences. Just as Pakistan and Afghanistan have a higher fertility rate than India, so Muslims in India have more children than the Hindu majority. The data for 1999 suggested that Muslim fertility in India was more than two and a half children higher than that of Hindus, although this seems improbable.18 The gap now appears to be much smaller, but still material. Although Muslim population growth in India is slowing, it is still half as high again as in the population as a whole, and so the Muslim share of the population continues to rise, from 13.4% to 14.2% of the total between 2001 and 2011.19 At independence and following the huge, chaotic and violent population exchange between India and Pakistan, it was less than 10%. Higher Muslim fertility and growing Muslim population share are controversial subjects in India and have at times been used to fuel intercommunal tension. In 2015, prime minister Modi’s government released a religious census, controversially, into the public domain, showing that the Muslim population had grown faster than that of the country as a whole since 2001. Modi’s enemies have accused him of stirring up demographic worries on the part of the Hindu majority in order to strengthen his political position.
While the general fall in fertility in India can be attributed to the normal causes–economic development, rising female literacy and urbanisation–government (both the Indian government and that of the US), has played a notable role in encouraging a hard line on population control.20 India was one of the first countries to make family planning an integral part of public policy. Policies have included raising the legal age of marriage and fixing constituency representation regardless of population rises to prevent local politicians encouraging the boosting of numbers to strengthen their clout at national level.21 In the 1970s, under prime minister Indira Gandhi and her son Sanjay, a campaign to encourage voluntary sterilisation got out of hand and became one of the most notorious excesses of the Emergency. More than 6 million men were sterilised in a single year and 2,000 died from botched operations.22 A total of 11 million men and women were sterilised from mid 1975 to mid 1977: in some areas water was withheld from farmers who refused, in another teachers’ salaries were withheld if they did not submit. One reporter recounts what happened in a village in Haryana in northern India:
The villagers of Uttawar were shaken from their sleep by loudspeakers ordering the menfolk–all above 15–to assemble at the bus-stop on the main Nuh-Hodol road. When they emerged, they found the whole village surrounded by the police. With the menfolk on the road, the police went into the village to see if anyone was hiding… as the villagers tell it, the men on the road were sorted into eligible cases… and they were taken from there to clinics to be sterilized.23
The discrediting of the campaign was a major setback to family planning policies.
These excesses were widespread but not long-lasting. In 1977 the Emergency was lifted and Indira Gandhi’s Congress Party was swept out of power in part thanks to the forced sterilisation scandal. Yet India’s fertility rate kept on falling steadily before, during and after the excesses, just as China’s had before and during the One Child Policy (as suggested in Chapter 8 above, it may not reverse itself). From China to India and Bangladesh, the lesson is everywhere the same: even without the desirable fruits of female education and economic development, people will generally choose to have fewer children when given the opportunity to choose for themselves. Coercion is not only cruel and even deadly; it is not necessary.
Life expectancy in south Asia has also followed a familiar pattern. Since independence, Indians have gone from expecting to live to their mid thirties to expecting to live into their late sixties. Indian life expectancy, although still lower than the global average, has taken dramatic strides, reflecting improved if still rudimentary public and personal health care and improving diets. Pakistani life expectancy, a little ahead of India’s at independence, is now a little behind, but still huge material progress has been made. Even Afghans, who in the early 1950s could not expect to live to thirty, can now expect to live to over sixty. It is once again a testimony to the power of the human tide that moderate improvements in material conditions, even when accompanied by all the violence and bloodshed in a country like Afghanistan over the past four decades, can still deliver transformative improvements in life expectancy.
These overwhelming numbers are driving world history and power just as surely as they were when Britain escaped the Malthusian trap. A country the size of India, like China, can only be of little international account when stricken with poverty and immobility. With the first stirrings of sustainable economic progress, India is fast on the road to becoming an economic superpower. A still poor but rapidly rising population is making the world increasingly reliant on India for its contribution to global economic growth. With the decline in its fertility rate, India is set to enjoy a demographic dividend as China’s fades. Both India and China undertook cruel and unnecessary coercive steps to curb population as well as sensible ones allowing women to make their own choices. In part because of its slower economic development, in part because of its culture, India has the prospect of a long demographic dividend to enjoy, while China faces imminent challenges of a declining workforce and an ageing population.
Sub-Saharan Africa: The Final Frontier
The human tide takes some surprising turns. Nevertheless, in some ways its course is fairly predictable. The great surprise, taking the historic long view, was breaking out of the Malthusian trap, something that now seems almost universal, and the rich world has taken on global responsibility for aiding even the poorest to achieve this. Once out of the trap–with fast-falling mortality rates and fast-growing population–there is then a fairly standard process through which eventually fertility rates fall towards replacement level. After that, the bets are off; it is far from clear, for example, that the second demographic transition of personal choice, individualism and sub-replacement fertility will become truly universal. Perhaps we are simply too close to events to be able to see the new emerging pattern, as was Malthus in the early nineteenth century or those in the UK before the First World War, who lamented the fall of the national birth rate without realising that it would become universal. One of the most important factors in history at any one time is where in this transition
different societies and cultures are.
To put it another way, demographic development is like a film playing at different times at different cinemas; although the screening has yet to finish at a number of venues, we know how it ends. That, at least, is the theory which, throughout most of the world, seems to hold. UK fertility fell between the 1870s and the period before the First World War from around six to around three children per woman. The same happened in India over a period of similar length, between the middle and the end of the twentieth century, slowly compared with many other countries undergoing a late-twentieth-century transition. In general, later falls in fertility have been faster but, as the case of India shows, not always. Rises in life expectancy, meanwhile, have occurred much faster as countries have rapidly and relatively cheaply been able to adopt the techniques, technologies and policies which reduce mortality.
Africa south of the Sahara is the final frontier of the demographic transition. This can be seen simply from the data produced by the UN in 2017. Of the forty-eight states and territories with fertility rates of four or above, all but seven are in sub-Saharan Africa. Nine out of the ten countries with the highest fertility rates are in Africa. Every one of the thirty countries with lowest life expectancy is in sub-Saharan Africa; so are all but two of the thirty with highest infant mortality rates and the lowest median age. The population of sub-Saharan Africa is growing more than twice as fast as the world as a whole.24 These are not random data but, as those who have followed the argument in this book so far will realise, part of a very clear pattern. Africa south of the Sahara as a whole is in the early stage of the demographic transition, with persistently high fertility, life expectancy still low but lengthening fast, meaning more births, fewer deaths and a ballooning population. And so it is here that the demographic whirlwind is now at its most intense.
We have been careful so far to speak of ‘sub-Saharan Africa’ because, as already seen, the picture on the Mediterranean littoral, the countries of North Africa, is very different. That said, the picture across sub-Saharan Africa itself is far from uniform. For a start, South Africa is in a category of its own. For all the problems it is encountering, it has a combination of physical infrastructure and political institutions which still make it the envy of the continent. Whether cause or effect, its demography is in line with its development status. Its fertility rate is around two and a half children per woman, half that of the continent as a whole; infant mortality, still high at just below forty per thousand, is notably better than the continental norm of closer to sixty per thousand; and median age is around twenty-six, more than five years older than the regional average. Other countries in southern Africa are not that far behind, with Botswana enjoying a fertility rate of below three and Lesotho and Swaziland not far above three. The South African government continues to prioritise birth control with a stress on free provision and choice. This is a model for the continent, and has meant that for all the other problems it faces, South Africa will not have to cope with an unmanageable surge of young people putting pressure on economic resources.
Yet in one way, South Africa has been disappointed. Its life expectancy, at just short of sixty, is barely better than that of sub-Saharan Africa as a whole. Given its superior achievement in bringing down the infant mortality rate, this is surprising; the reason is Aids. Although much of Africa has been stricken, South Africa has been a particularly bad case. Life expectancy in South Africa was higher in the late 1980s than it is today (although it has been lower since and is now rebounding). One report has shown that in 2013 nearly 30% of South African schoolgirls were HIV positive. Drugs for treating HIV and preventing full-blown Aids are now much more affordable than in the past, but until recent times it was not only cost that was preventing their use. South Africa’s previous President, Thabo Mbeki, took an unorthodox approach to Aids, questioning its link to HIV. Following Mbeki’s departure, the use of anti-viral drugs for those infected by HIV has more than doubled, and the effects are now being seen in a slowly improving life expectancy rate.25 This was one of the happier legacies of Jacob Zuma, but while it has helped, there is still much to do; it is estimated that 7 million of South Africa’s 55 million population are HIV positive,26 and thousands are becoming infected every week.
The impact of Aids on neighbouring Botswana has been even more devastating relative to the size of the country; here, life expectancy fell from over sixty to under fifty between the late 1980s and the start of the new century, and today nearly one in four adults is infected. Supported financially by global aid, particularly from the United States under the administration of George W. Bush, the government aggressively and successfully tackled the problem. In one small village where there were funerals every week, one villager reported: ‘Most of the people who were very, very down, now they’re starting to pick up and being able to assist themselves. Some who couldn’t even walk, now they’re even walking around the village.’27 In the past, the human tide often persisted by its own momentum in the face of genocidal forces; today, it is helped along by the intervention of the international community.
The development in terms of fertility is not so encouraging elsewhere in Africa. Overall, contraceptive use, although much higher than forty years ago, is still the lowest in the world.28 Some countries are making great strides in bringing down their fertility rates, however. Women in Ethiopia are having nearly three children fewer than they were in the 1980s–but still well over four each. Kenya has halved its fertility rate since the late 1960s when it was, astonishingly, more than eight children per woman. Today, however, it is still just above four. As ever, urbanisation and a rise in personal aspirations are motivating the use of contraceptives where they are available. As one resident of a Kenyan suburb says:
I feel that the cost of living has gone up and the number of children that I have are the ones I am able to take care of. If I give birth to more children, I don’t have that kind of job which I can say will make me meet the needs of more children and that’s why I decided to use family planning, so that I can take care of my children.29
These are precisely the sentiments which drove down fertility rates in Britain a hundred years earlier and in Puerto Rico fifty years earlier.
Kenya is rapidly proving that African women are no more perennially fertile than any other group. Where the usual benefits of modernisation, even in moderation, are introduced and women are given access to birth control, patterns of family size change. UNICEF reports that over 80% of Kenyan women in the eighteen to twenty-four age bracket are literate. Literate women are not only likely not to want extremely large families but are also more able to prevent them.
By contrast, progress in reducing fertility rates has been slow in other parts of Africa. Nigeria matters because it has by far the largest population in the region. Its fertility rate, although falling slowly, is still not much below six children per woman. The same is true of Uganda. Meanwhile, the Democratic Republic of Congo–insofar as any data coming out of this vast and chaotic country can be trusted–still has a fertility rate of over six.30
The better news, and usually a precursor to further falls in fertility rates, is that infant mortality rates and life expectancy are improving almost everywhere. An infant mortality rate of around sixty per thousand sounds scandalous in the second decade of the twenty-first century but it is one-third of the level of 1950 and falling fast. It is worst in Sierra Leone and the Central African Republic, with ninety-four in a thousand children not reaching their first birthday. This is not a place to counsel complacency, and every effort should be made to save life, but it is worth noting that the infant mortality rate in even the worst performers is better than, say, in the Russia of 1950. Life expectancy, although still short of sixty, is again around where it was in Russia in the middle of the twentieth century and more than two decades longer than it was in sub-Saharan Africa at the time.31
Unsurprisingly, given high fertility rates and falling infant mortality, this is a young contine
nt. The median age in sub-Saharan Africa is around eighteen and it has barely changed for sixty years. That might come as a surprise, given the lengthening life expectancy, but recent population growth means that there are relatively few older people while there are more young people thanks to gains in child survival. The median African is less than half the age of the median European. This can be a blessing or a curse. A large number of young people in a population can make for political instability and violence, as in the Middle East, but it can also make for dynamism and economic growth, as in many countries from Britain and Germany through Russia to China. With its large number of countries and rich diversity of cultures, Africa will probably experience both effects, and others besides. Already the young populations of the continent are driving some of the most rapidly growing economies, from Rwanda to Côte d’Ivoire. At the same time, Africa is experiencing the most devastating (and under-reported) wars in the world. Numbers are uncertain, but it is likely that 5 or 6 million people died in the recent civil war in the Democratic Republic of Congo, and although the conflict appears to have died down, the situation is far from settled as this book goes to print.