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Expert Group Meeting on Completing The Fertility Transition

2. South Africa's fertility trends
 
South Africa's experience in the fertility transition is among the most advanced in sub-Saharan Africa. South Africa displays demographic regimes that are typical of both developed and developing worlds. These tend to be linked to socio-economic divisions along racial and urban-rural lines. Living standards are closely correlated with race in South Africa. While poverty is not confined to any one racial group in South Africa, it is concentrated among Africans in particularly. Many of the apartheid measures, including the extensive welfare system available to White people, the higher quality of education available to White students, and the formal and informal job reservations for White workers, was specifically designed in preventing poverty among the White population. As shown in Figure II, poverty among Whites is close to zero. On the contrary, poverty among 'Africans', the most disadvantaged group stands at 60,7% compared to 38,2%, and 5,4% for Coloureds and Asians. It is interesting to note, however, that the very few poor Asians and Whites also seem to be at a considerable distance below the poverty line.

Figure II: Poverty Rates among population groups

Source: Poverty and Inequality in South Africa (PISA). Fishwicks, Durban. 1998.

With Africans making up 77% of the population, their high incidence and severity of poverty amongst them ensures that they account for 95% of the poverty gap, with the remaining 3% largely accounted for the poverty among Coloureds with the 1% each shared by the Asians and Whites, respectively as shown in Figure III.

Figure III: Poverty Gap

Source: Poverty and Inequality in South Africa (PISA). Fishwicks, Durban. 1998.

The differences in poverty by race also contribute to the distribution of poverty by location since the racial groups were unevenly distributed in the country. At the same time, among Africans, the group comprising nearly all the country's poor, the pattern of much higher poverty in rural areas and the concentration of poverty in the former homelands and some of the provinces still holds. The fertility trends among population groups in South Africa shows the same patterns as that of poverty. The African component which is the poorest with regard to per capita income has the highest fertility rate, while the White population which has the highest per capita income has the lowest fertility rate as explained below.

Thus, among all the four major racial groups in South Africa a decline of fertility has been observed from as early as the 1960s. Figure IV shows that the swiftest decline occurred among the coloureds, followed by Africans.

Figure IV: Differentials in total fertility rate by race, South Africa 1960-1998

Source: Report of the Science Committee of the President's Council on demographic trends in South Africa (Pretoria, Government Printers, 1983)., SADHS Project Team, " South Africa in transition: selected findings from the South African Demographic and Health Survey" (Pretoria, Government Printers, 1998) and Population Reference Bureau, World Population Data Sheet, 1998 (Washington: PRB, 1998).

For South Africa as a whole, fertility was high and stable between 1950 and 1970, estimated at an average of 6 to 7 children per woman. It dropped to an average of 4 to 5 children per woman in the period 1980 to 1995 (United Nations, 95). The current total fertility rate of South Africa stands at 2,9(SADHS, 1999).

Whites experienced a long and sustained fertility decline from the end of the 19th century until attaining below-replacement fertility by 1989, with a TFR of 1,9 (Chimere-Dan, O, 1993). Asian fertility also declined steadily, from a TFR of about 6 in the 1950s to 2,7 in the late 1980s. Coloured fertility declined remarkably rapidly from 6,5 in the late 1960s to about 3 by the late 1980s. African fertility is estimated to have decreased from a high of 6,8 to a low of about 3,9 between the mid-1950s and the early 1990s. Although it continues declining, African fertility is still substantially higher than that of the other racial groups.

2.1. Reasons for fertility decline?

However despite this dramatic decline in fertility the majority of African population, especially women still lives in poverty. The question that we, however, need to ask is, "How did this fertility transition came about"?

  1. South African past Population policies


  2. This question will be answered by investigating the government's past population policies. The government began to provide strong support for family planning in the 1960s. This support was driven by the fear that rapid population growth would undermine South African prosperity and economic development, but also by concern among white political leaders and administrators that the fast growing African population would overwhelm the much smaller number of whites. As early as 1963, the apartheid government provided substantial funding for private and public family planning services and furnished free contraceptives. In 1974, the South African government launched the well-funded National Family Planning Programme.

    The results were impressive and unprecedented in sub-Saharan Africa. By 1983, over half the eligible women in the country were practicing contraception. Despite the aim to lower the African population the government at the same time was encouraging an increase in the white population through immigration. The programme consequently came under much pressure, both for its ideological focus and the inadequacy of its services. By mid-1980s the programme's management had distanced itself from the demographic intent of the Population Development Programme (PDP). Instead, it promoted the programme's health benefits and started to integrate family planning into other primary health care services.

    The introduction of the Population and Development Programme (PDP) in 1984 aimed explicitly at lowering the national population growth rate because the country's resources (especially water) would not sustain the prevailing high rate of population growth. Ironically, the African population was either being denied access to well water-resourced arable land, or being removed and relocated to poor water-resourced land. Thus the minority population owned, or was systematically taking ownership of most of the well water-resourced land in the country. The PDP included interventions in other areas that have an impact on fertility levels, namely education, primary health care, economic development, human resource development, and housing. However, it did nothing to uplift the African population economically nor did it address women empowerment among the African and females.

    It must also be said, while it fell short of its original objectives, the programme substantially expanded family planning services. By the end of the decade about 61.2 percent of women ages 15-49 (including about half African married women) were using some form of contraceptive (See Figure V).

    Figure V. Current contraceptive use in sexually active women

    Source: SADHS Project Team, " South Africa in transition: selected findings from the South African Demographic and Health Survey" (Pretoria, Government Printers, 1998).

    Thus ironically, while South Africa's family planning program was conceived and implemented by a minority white government intent on slowing the growth of the majority African population and the African communities resisted this approach. It must, however, made clear that many African women adopted family planning despite the political agenda of the programme.

    Most of these women were the only breadwinners and in this sense they were forced to adopt contraceptives. This can be seen in the context that African women assumed management of their fertility because they found themselves increasingly in precarious circumstances. Many factors - cultural, political and social - converged to deprive African women of financial and familial security. These circumstances compelled them to curtail childbearing and to practice family planning, with or without the consent of their husbands or partners. The high use of contraceptive injection indicates that many women are not free to discuss reproductive issues, including contraceptive use, with their husbands or partners. This suggests that the reproductive rights of majority of South African women are still under siege.

    Furthermore, many rural African women were without husbands for long periods, since the latter served as migrant labourers in cities. Their prolonged absence left the women to fend for themselves and their children. Many of these migrant husbands simply stopped sending money home or earned too little to be able to afford doing so. This, together with the landlessness and joblessness of the homeland system, forced many African women to make their own decisions about family maintenance and reproduction. The modern family planning programme introduced by the white apartheid regime in the early seventies, assured that their need for fertility control was met.

  3. Non-marital fertility in South Africa


  4. Marriage and contraceptive use are two of the most powerful determinants of fertility. In most populations, fertility is directly related to marriage; married women generally have more children than unmarried women of the same age. Traditionally, births to unmarried women were not accepted in most societies, thus women began bearing children after marriage and continued throughout her reproductive lifetime as long as they remained married. In Africa, marriage used to be almost universal and marital fertility was high while non-marital fertility was very low.

    In the South African context, marriage seems to have lost its value as determinant of fertility. This can be seen, firstly, from the small and insignificant difference between marital and non-marital fertility of African women in South Africa: in 1996, the average TFR for African women who were never married or who were cohabiting was 3,9, while that of those who were married was 4,3 (Chimere-Dan, 1999). Secondly, it can be seen from the high rate of teenage pregnancies, mainly to unmarried girls.

    Although there is a general decline in fertility, teenage pregnancies are still a major concern as illustrated by Table 1. The 1998 SADHS found that 35% of all teenagers had been pregnant or had a child by the age of 19 years. This represents a very high level of teenage fertility and is a serious source of concern to the government, communities and researchers. Teenage pregnancies are more prevalent among coloured and African girls particularly those with little or no education. The proportion of teenage girls who had experienced a pregnancy grew from 2,4% to 35,1% with each additional year of age, as shown in the third column of Table 1.

    Table 1. Teenage pregnancy and motherhood (Percentage of women aged 15 to 19 who are mothers or who have been pregnant by background characteristics, South Africa 1998)


    Background Characteristics Percentage who:
    Are Mothers Were pregnant
    Age    
    15 2,0 2,4
    16 5,2 7,9
    17 10,7 14,2
    18 19,8 24,6
    19 30,2 35,1
    Residence    
    Urban 10,5 12,5
    Rural 16,3 20,9
    Race    
    African 14,2 17,8
    African urban 11,6 13,7
    African: non- urban 16,4 21,1
    Coloured 15,7 19,3
    White 2,2 2,2
    Asian 2,9 4,3
    Total 13,2 16,4

    Source: SADHS Project Team, " South Africa in transition: selected findings from the South African Demographic and Health Survey" (Pretoria, Government Printers, 1998).


    The high rate of teenage pregnancies has far reaching consequences, especially for the Africans and coloureds that are the poorest and most disadvantaged groups in the country. The majority of these pregnancies are neither planned nor wanted. The father of the child seldom acknowledges or takes responsibility for the financial, emotional and practical support of the child. The mother often leaves school, thus ending her opportunities for personal development, making her vulnerable to poverty, exploitative sexual relationships and violence as well as low self-esteem.

    On the other hand, getting pregnant in African communities does not necessarily mean a loss of educational opportunities. When a school-going girl falls pregnant, she may be forced to leave school, but often only for the rest of the academic year. So high a value is placed on schooling and post-school training, that pregnancy is not allowed to jeopardize it. Teenage pregnancies among Africans and coloureds do not seem to be perceived in the same negative light as in the case of whites and Asians. In most cases the girl does not even marry the father of her first child. Both African women and men value fertility in the African community very highly. It is thus not surprising that, even for unmarried women and teenage girls, pregnancy has a positive value not generally experienced in white communities (Preston-White and others, 1990).

    Nevertheless, teenage pregnancies remain one of our major population concerns, which affect mostly communities in the Western Cape, Gauteng and Kwazulu-Natal. This is a challenge to be addressed in a constructive manner, especially in light of the HIV/AIDS pandemic as well as the fact that the human rights of many teenage girls are infringed through acts of sexual abuse and rape.

    It has been argued that a higher fertility rate among unmarried and single mothers is a rational response on the part of women, especially Africans and coloureds, to oppressive and disempowering patriarchal economic, social and cultural systems. Among Africans and to some extent coloureds, marriage is far from being an early and universal social institution. African women have consistently low marriage prevalence at all ages. High levels of male migration from rural to urban mining areas have affected lower marriage rates among Africans. Nevertheless, childbearing is almost universal amongst African women. As a result, female-headed households are a common feature in disadvantaged rural and urban fringe areas. Women's burden of carrying the sole responsibility for these children is awesome. The negative implications of this situation manifest themselves as unwanted pregnancies, abortions, abandoned and street children, child neglect and abuse.

    A dominant issue in especially the African fertility pattern in South Africa is that of male responsibility in reproductive decision making and health as well as in childbearing and rearing. Women have to take on the burden of caring for children and often also of earning the means to do so. This situation initially arose because of the migrant labour system in South Africa; it was entrenched by the creation of homelands without viable economic bases and influx control into cities and "white" areas. Men had to go away to work and earn money; women stayed home in rural areas where they had to care for children. Often, the absent fathers stopped sending money home and women had to take on the role of childrearing without the fathers' support. This situation eventually prevailed also in the African townships outside of the homelands, with women taking the main or even exclusive responsibility for children.

    Marriage appears to have lost its role as the exclusive domain for socially legitimate childbearing in South Africa. Overall non-marital fertility has been declining more than its marital counterpart in South Africa both on the national level and across the major population groups in the country (Mencarani, 1999). This intensive control of non-marital fertility appears to be the dominant force in the fertility transition in South Africa. The decline in non-marital total fertility is more likely to be driven by contraceptive use. In addition, as the HIV/AIDS situation in South Africa worsens, the downward trend of fertility can be expected to continue at a much faster pace. The impact of HIV/AIDS on fertility is expected to be threefold: as more women die young before completion of their reproductive years, total fertility will decline; AIDS reduces fecundity of women who would otherwise have borne more children, and increased condom use as a result of public education about the prevention of HIV infection may further boost contraceptive use.

  5. Contraceptive use


  6. Because of South Africa's past history of widely accessible family planning services and health services that are well established relative to the situation in the rest of sub-Saharan Africa, the low fertility rate can also be explained by the high use of contraception. The SADHS found almost universal knowledge of at least one contraceptive method. Three-quarters of all women interviewed indicated that they had used a contraceptive method at some stage during their lives, while 61% of sexually active women reported that they were currently using contraception - see Figure V. The national average level of current contraceptive use is higher in urban areas at 66% than in rural areas at 52,7%.

    Of the different methods used by sexually active women, 30% comprise injectable contraceptives, 13% the pill and 12% female sterilisation. Condom use is a low 2.3% (SADHS, 1999). The very low prevalence of traditional methods (0,7%) is highly significant, as modern methods of contraception are more effective in preventing pregnancy. At 98,8%of all current contraceptive usage, the use of modern methods is very high compared to that in other sub-Saharan countries. This high use of modern contraception indicates that South African women generally have good access to family planning services and that they generally trust modern contraceptive methods to achieve their goals of either spacing or limiting the number of children they intend to have.

    The comparison of contraceptive use by racial group depicted in Figure V shows clearly that there was a definite increase in contraceptive prevalence amongst all groups except the white population, which, at about 80%, had in any case reached saturation level.

    Contraceptive preference has changed dramatically: some women are more likely to use contraceptives than others and the type of contraceptives used differ. Contraceptive usage is very high amongst urban women, including urban African women - see Table 2, and women with higher levels of education - see Table 3

    Table 2: Contraceptive use by residence, South Africa 1998


    Residence All modern methods (%)
    Urban 66,0
    Rural 52,7
    Total 61,2

    Source: SADHS Project Team, " South Africa in transition: selected findings from the South African Demographic and Health Survey" (Pretoria, Government Printers, 1998).


    Table 3: Contraceptive use by level of education, South Africa 1998


    Level of education All modern methods (%)
    No education 33,1
    Grades 1 to 5 43,7
    Grades 6 to 7 53,6
    Grades 8 to 11 64,6
    Grade 12 73,1
    Higher 78,1
    Total 61,2

    Source: SADHS Project Team, " South Africa in transition: selected findings from the South African Demographic and Health Survey" (Pretoria, Government Printers, 1998).


    Choice of contraceptive method in South Africa follows racial stratification. Whites, who make the least use of public family planning services, choose from a wider range of contraceptive methods. Africans and coloureds, which constitute the bulk of clients of organised public family planning services, tend to predominately use the contraceptive injection (35% and 27% respectively). This raises questions about information sharing and the widening of reproductive choices, as well as the issue of women's control over their own bodies and their sexuality.

    As illustrated in Figure IV, African fertility declined from 6,6 in 1960 to 3,1 in 1998. This is exceptionally low compared to other sub-Saharan African countries. This can be seen in the context that African women assumed management of their fertility because they found themselves increasingly in precarious circumstances. Many factors - cultural, political and social - converged to deprive African women of financial and familial security. These circumstances compelled them to curtail childbearing and to practice family planning, with or without the consent of their husbands or partners. The high use of contraceptive injection indicates that many women are not free to discuss reproductive issues, including contraceptive use, with their husbands or partners.

    However, fertility control is far from ideal in South Africa, as evidenced by the fact that about 50% of currently married women have an unmet need for family planning. Unmet need for family planning is inversely related to level of education: the percentage of women with no formal education who have an unmet need for family planning is six times higher than the percentage of women at the highest level of education who show such a need. (Du Plessis, 1999). This further emphasises the fact that the majority of South African women have not yet achieved satisfactory control over their reproduction. Addressing the unmet need for family planning entails not merely greater access to contraceptive services, but also the enhancement of the status of women through education and employment as well as changes in social structures that influence female autonomy.

  7. Birth spacing and abortion


  8. Younger South Africa women prefer spacing their children, as compared to older women, who prefer limiting the number of births (Du Plessis, 1996). The general trend by age reveals that younger African, coloured and white women tend to view all their pregnancies as too closely spaced, while older women feel that only some of their births are closely spaced. This indicates the extent to which unplanned and mistimed pregnancies occur among young women in South Africa. The gap between stated fertility preferences and observed fertility levels further illustrate the constraints on women's autonomy in decision-making regarding reproduction. In this regard, the SADHS revealed that in most cases the ideal number of children a woman wanted was lower than the living number of children she actually had. Again this suggests that there is a fair amount of unwanted childbearing amongst South African women.

    Abortion was legalised in South Africa on socio-economic grounds in 1996. Before the introduction of legal abortion, the termination of unwanted pregnancies often led to increased risk of death and complications arising from unsafe abortions. Although abortion is now legal, there are still moral and religious barriers in some sectors of our society that deter women from practicing this right. The greatest need for access to legal abortion services exists among disadvantaged women.

    With the increase in prevalence of HIV-infected women and the risks that the continuation of their pregnancies hold for themselves and their children, the number of women seeking abortion could increase considerably. At this stage it is unclear what effect legalised abortion will have on the total fertility rate, although literature in this regard suggests that, in countries where legal abortions are common, low fertility is generally associated with a high combined prevalence of abortion and contraceptive use. (Rossouw & Du Plessis, 1999).


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