Compiled by the Child, Youth and Family Development Research Programme, Human Sciences Research Council Published by HSRC Publishers Private Bag X9182, Cape Town 8000, South Africa www.hsrcpublishers.ac.za © 2003 Human Sciences Research Council and Department of Social Development First published 2003 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the HSRC and the Department of Social Development. ISBN 0-7969-2035-4 Cover by Jenny Young Beaded dolls crafted by township women from the Monkeybiz bead project, Te l: (021) 426-0145, email monkeybiz@iafrica.com, www.monkeybiz.co.za Production by comPress Design and typesetting by Christabel Hardacre Printed by Creda Press Distributed in Africa by Blue Weaver Marketing and Distribution, PO Box 30370, Tokai, Cape Town 7966, South Africa. Te l: +27 +21-701-4477 Fax: +27 +21-701-7302 email: booksales@hsrc.ac.za Distributed worldwide, except Africa, by Independent Publishers Group, 814 North Franklin Street, Chicago, IL 60610, USA. www.ipgbook.com To order, call toll-free: 1-800-888-4741 All other inquiries, Tel: +312-337-0747 Fax: +312-337-5985 email: Frontdesk@ipgbook.com Free download from www.hsrc p ress.ac.za Contents Foreword: Dr ZST Skweyiya, MP, ix Preface: Dr Mark Orkin xiii Overview: Department of Social Development xv Acknowledgements xvii Acronyms xviii Introduction: Christine Varga 1 Paper 1 Fertility transition in South Africa and its impact on the four major racial groups 7 Leon Swartz Paper 2 Fertility, poverty and gender 27 Barbara A Anderson Response to Paper 2 57 Monde B Makiwane Paper 3 Youth and fertility 59 Kim Eva Dickson Response to Paper 3 72 Eric O Udjo Paper 4 HIV/AIDS and fertility 77 Gretchen du Plessis Paper 5 Fertility issues in Southern Africa 117 John C Caldwell and Pat Caldwell Free download from www.hsrc p ress.ac.za List of figures Figure 1.1: Comparative levels of fertility in Southern and East Africa 8 Figure 1.2: Poverty rates among population groups, South Africa, 1998 9 Figure 1.3: Poverty gap by population group, South Africa, 1998 9 Figure 1.4: Differentials in total fertility rate by race, 1960–1998 10 Figure 1.5: Contraceptive use in sexually active women, South Africa, 1999 13 Figure 1.6: Comparison of contraceptive use by racial group, 1990–1998 18 Figure 2.1: Total fertility rate – lifetime births to a woman under current fertility rates, 1950–2000 28 Figure 2.2: Total fertility rate in South Africa in comparison with other African countries, 1950–2000 29 Figure 2.3: Total fertility rate by population group, South Africa, 1960–1998 30 Figure 2.4: Infant mortality rate – number of deaths by age one year per 1 000 births, 1950–2000 34 Figure 2.5: Infant mortality rate in South Africa in comparison with other African countries, 1950–2000 35 Figure 2.6: Percentage of population living in urban areas, South Africa, 1994–1999 38 Figure 2.7: Percentage of population with clean water, South Africa, 1994–1999 39 Figure 2.8: Percentage of population with flush or chemical toilet, South Africa, 1994–1999 40 Figure 2.9: Estimated and modelled percentage of children aged 0–14 years whose mother is dead 43 Figure 2.10: Percentage of African children with a living mother and who reside in a different household than the mother, Africans, 1995–1998 45 Figure 2.11: Relation of illness of mother to whether child is fostered, Africans, 1995 45 Figure 2.12: Relation of illness of mother to whether child is fostered, Africans, 1998 46 Figure R3.1: Reported and adjusted age-specific fertility rates, Limpopo province, 1998 75 Figure R3.2: Reported and adjusted age-specific fertility rates, North West province, 1998 75 vi Free download from www.hsrc p ress.ac.za List of tables Table 1.1: 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 15 Table 1.2: Contraceptive use by residence, 1998 18 Table 1.3: Contraceptive use by level of education, 1998 18 Table 2.1: Actual and ideal fertility of women aged 15–49, 1998 32 Table 2.2: Relation of various characteristics to the infant mortality rate, ten-year period before 1998 37 Table 2.3: Alcohol and tobacco use among women aged 15 years or older, 1998 42 Table 3.1: Adolescent pregnancy and motherhood, South Africa, 1998 62 Table R3.1 Total fertility rate in South Africa from various sources 74 Table 4.1: Global HIV/AIDS estimates 80 Table 4.2: HIV prevalence by province, 1998 81 Table 4.3: Estimates of total and age-specific fertility rates, South Africa, 1996 81 Table 4.4: Unmet need for family planning services, South Africa, 1998 87 Table 4.5: Planning status of births in the five years preceding the survey, according to birth order and mother’s age at birth, South Africa, 1998 88 Table 4.6: Comparative figures for total wanted fertility rates and total fertility rates, South Africa and selected sub-Saharan countries 89 Table 4.7: Percentage ever use of condoms (various DHS-rounds) 99 Table 4.8: Estimated risk and timing of MTCT of HIV 102 vii Free download from www.hsrc p ress.ac.za FERTILITY: THE CURRENT SOUTH AFRICAN ISSUES viii Free download from www.hsrc p ress.ac.za Foreword Although fertility has declined in South Africa in overall terms, high levels of childbearing still appear to be a demographic reality in certain segments of the population. In this respect the South African population policy addresses the issue of fertility by expressing concern about ‘the reduction of human development potential influenced by the high incidence of unplanned and unwanted pregnancies and teenage pregnancies’. Whereas a woman has the right to as many or few children as she wishes, it is essential that specific services should be offered and information should be made available to protect women and especially mothers from abuse and sex- ual exploitation. South Africa can indeed pride itself on the reduction in fertility levels among all the population groups that has taken place in recent decades. In 1980 the total fertility rate for all South African women stood at 4.9 children per woman. By 1990 it had declined to 4.0. In 1998 the South African Demo- graphic and Health Survey (SADHS) established the total fertility rate as only 2.9. Looking at the 1996 census results, it is clear that there are statistical dif- ferences between the races. On average: •Whites had 1.9 children per women of childbearing age; •Indians had 2.7 children; •Coloureds had 2.9 children; and •Africans had 3.7 children. The 1998 SADHS found that the total fertility rate for Africans had declined even further, to 3.1, while there were no significant changes amongst the other groups. Te enage childbearing is an issue of great concern in South Africa. The high rate of teenage pregnancies has far-reaching consequences. The majority of teenage pregnancies are neither planned nor wanted. The father of the child seldom acknowledges or takes responsibility for the financial, emotional and ix Free download from www.hsrc p ress.ac.za practical support of the child. The mother often leaves school, thus ending her opportunities for personal development. She thus exposes herself to a future of poverty, exploitative and violent sexual relationships, and diminished career opportunities. Indeed, the 1998 DHS found that teenage pregnancy was the most frequent reason for leaving school amongst African and coloured women between the ages of 15 and 24 years. In spite of the dramatic decline in fertility amongst Africans, a high incidence of poverty persists. Women remain the primary caregivers to children and are also frequently burdened with the responsibility of earning the means to do so. This is simply because male partners are often absent, thereby making the woman the sole breadwinner. The result is an increase in female-headed fam- ilies with the associated social problems of vulnerability and a lack of positive adult male role models. HIV/AIDS and fertility is another issue that needs to be explored. Some demographers and policy-makers argue that the HIV/AIDS situation in South Africa will fast-track the downward trend in fertility rates. The impact of HIV/AIDS on fertility is expected to be threefold: •As more women die young before the completion of their reproductive years, total fertility will decline; •AIDS will reduce the 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 will further reduce fertility. The rate of change in people’s reproductive behaviour, and the accompanying fertility decline, is one of the most significant in the sub-Saharan African region and indeed the whole of Africa. In the Southern African Development Community (SADC) region, only South Africa and Zimbabwe have total fer- tility rates of less than five children per woman in the childbearing age group. Several social and economic factors have influenced the decline in fertility. We have a dynamic regional economy that offers more women the opportunity to work.Levels of literacy are high in comparison with other sub-Saharan African countries. The overall standard of living is improving for many South Africans as access to social services, clean drinking water, electricity, health and education increases. FERTILITY: THE CURRENT SOUTH AFRICAN ISSUES x Free download from www.hsrc p ress.ac.za Let us however not be under any illusions. There are still huge challenges to overcome: •Infant mortality is still high; •High levels of teenage pregnancy still persist; •Levels of abuse of women are still high; •The sexual integrity of women continues to be abused by men; •Poverty and inequitable access to basic services are widespread, especially in the Eastern Cape, Limpopo, KwaZulu-Natal and Free State; and •The continuing high incidence of HIV infections is wreaking havoc with the stability of our demographic structure. Government needs to continue to address these challenges. Existing and future policies, programmes and projects should prioritise interventions that will overcome these challenges. Specific focus needs to be placed on empow- erment programmes for teenagers and for vulnerable women in rural areas that will assist them to take control of their reproductive choices. I trust that this publication will make a useful contribution to addressing fertility issues in South Africa by suggesting and developing innovative and sustainable methodologies to overcome the challenges. Dr ZST Skweyiya, MP Minister of Social Development FOREWORD xi Free download from www.hsrc p ress.ac.za FERTILITY: THE CURRENT SOUTH AFRICAN ISSUES xii Free download from www.hsrc p ress.ac.za Preface The mission of the Human Sciences Research Council (HSRC) is to do research that makes a difference.This means working with partners and user- groups, clients and funders, from the inception of research to its implementa- tion, on social problems of national significance. The Department of Social Development is a key government user and ally in a great deal of the work that the HSRC does, and especially in the work of the research programme Child, Youth and Family Development (CYFD). Joint projects include research to support family policy, social security for vulnera- ble children and the development of a disability assessment tool. To gether the Department of Social Development and CYFD have planned a series of meetings to reconsider fertility in the light of changing social circumstances. Some of these changing conditions include the impact of HIV/AIDS, the empowerment of women, the importance of youth develop- ment and the role of men in programmes to support sexual and reproductive health. Fertility rates are dropping faster than expected, with far-reaching impli- cations and this is an issue of obvious importance for future projections around the provision of services such as schooling and social security grants for children. For this reason it is important that the relevant communities of practitioners and researchers scrutinise and debate emerging trends in fertility. The HSRC is proud to be able to assist the Department of Social Development in its work. We appreciate the financial assistance of the Department, and look forward to future joint meetings and publications on fertility as well as on a number of other issues of mutual interest. Dr Mark Orkin Chief Executive Officer, HSRC xiii Free download from www.hsrc p ress.ac.za [...]... intermediate fertility country,3 many questions remain with regard to fertility dynamics in the country What factors have led South Africa to such low fertility rates? How have the critical and sweeping socio-political changes over the last decade influenced fertility in this country? What does the future hold for South African fertility profiles? Another distinctive characteristic of South Africa’s fertility. .. total fertility rate of South Africa stands at 2.9 (SADHS Project Team, 1999) Whites experienced a long and sustained fertility decline from the end of the nineteenth century until attaining below-replacement fertility by 1989, with a total fertility rate (TFR) of 1.9 (Chimere-Dan, 1993) Asian fertility also declined steadily, from a TFR of about 6.0 in the 1950s to 2.7 in the late 1980s Coloured fertility. .. in South Africa Overall, non-marital fertility has been declining more than marital fertility 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 nonmarital total fertility is more likely to be driven... HIV/AIDS will affect fertility rates, demographic growth, and ultimately population well-being in South Africa? The papers in this collection provide insight on all these issues and lay the groundwork for further debate and exploration of fertility- related topics in South Africa Swartz provides a thorough rendering of South Africa’s fertility trends and explores the influence of potential mediating... the fertility agenda, that of theory and method Her paper brings to the fore the limits of a ‘proximate determinants’ framework in understanding fertility dynamics and suggests ways forward to gain a deeper and more meaningful undertanding of fertility dynamics Further, the paper argues for greater attention to qualitative research as well as more triangulated data-collection approaches to both fertility. .. where poverty usually goes hand in hand with high fertility This paper investigates issues around lower fertility, factors contributing to it, its impact on the different population groups, as well as policies to address its impact South Africa’s fertility compared to that of sub-Saharan Africa Figure 1.1 clearly illustrates that the South African fertility rate is significantly lower than that of... explained below in more detail Total fertility rate (women aged 15–49) Free download from www.hsrcpress.ac.za Figure 1.1 Comparative levels of fertility in southern and East Africa 8 6 6.1 5.9 5.6 5.6 5.1 4 4 2.9 2 0 Malawi Namibia Zimbabwe Uganda Zambia Tanzania South Africa Country Source: PRB, 2000 South Africa’s fertility trends South Africa’s experience in the fertility transition is among the most... provinces still holds The fertility trends among population groups in South Africa show the same patterns as those for 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, a decline of fertility has been observed... agespecific fertility rates Most sub-Saharan African countries have observed striking regularity in age-specific fertility declines – that is, fertility has 2 Free download from www.hsrcpress.ac.za INTRODUCTION declined across all age groups, and in particular among adolescents and young adult women (Caldwell, Orubuloye & Caldwell, 1992; Kirk & Pillet, 1998) In this country, adolescent fertility rates... late 1960s to about 3.0 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 to decline, African fertility is still substantially higher than that of the other racial groups Reasons for fertility decline Despite this dramatic decline in fertility, the majority of the African population, . age- specific fertility rates. Most sub-Saharan African countries have observed striking regularity in age-specific fertility declines – that is, fertility has FERTILITY: . 1990–1998 18 Figure 2.1: Total fertility rate – lifetime births to a woman under current fertility rates, 1950–2000 28 Figure 2.2: Total fertility rate in South