Are African women having too many babies?

Twenty-five of the 28 high-fertility (more than 5 children per woman) countries are in Africa. This and related facts have revived the concern that Africa will miss out on the “demographic dividend” –the rapid economic growth rates associated with declining fertility, as experienced by many countries in Asia. But Africa is also the continent with the slowest economic growth in the past. And, as The Economist (and others) pointed out, economic growth is probably the best contraceptive. 

The problem may be that African economies are not growing fast enough; if and when they do grow, fertility rates will come down. To be sure, the relationship between declining fertility and economic growth goes both ways, so we can’t be complacent and let economic growth do all the work. Furthermore, we may not get that rapid economic growth.

If something needs to be done in these high-fertility countries (or perhaps in rapidly-growing countries where fertility is not falling fast enough), what should be done? The answer is not straightforward because the decision of how many children to have is a private decision of the household. Public intervention in that decision can only be justified if there is a “market failure”—an externality or public good associated with fewer children. One of the main market failures is in information about contraceptives and family planning. The intervention then should be providing information. Linking the intervention to the market failure is important because some governments have used the market-failure justification to introduce draconian measures to control population growth.

If the intervention should be providing information, what kind of information is most useful? My colleague Ed Bos tells me that African women know about the availability and use of contraceptives—but they are unsure about side effects, and that is one reason for the low contraceptive prevalence in Africa.

There may be another, indirect reason for intervening: Africa also has the highest maternal mortality ratio in the world—824 per 100,000 births. One reason could be that they are not spacing the children enough. But maternal mortality has many other causes, including the poor state of service delivery. We need to tackle these problems too, if we want to improve the health and survival of African mothers.