The soft underbelly of development: demographic transition in conditions of limited economic change
Caldwell, J.C.
Proceedings of the World Bank Annual Conference of Development Economics 1990: 207-253
1990
DOI: 10.1093/wber/4.suppl_1.207Document Number: 377292
Population policy is driven by two sets of theories, which are examined here. The first, demographic transition theory, proclaims the inevitability of a global transition from high to low birth and death rates as a world society and economy develop. Experience to date supports this generalization, but researchers have had little success in identifying threshold socioeconomic or demographic indexes that would predict the onset of fertility decline. The second, demographic-economic theory, predicts that slower population growth rates will lead to faster rises in per capita income. The historical evidence does not confirm these predictions, however. This paper examines the case of sub-Saharan Africa, where mortality has been falling consistently, although often driven more by educational and other social changes than by rising incomes or enhanced medical care and halted only by war and civil disorder. However, declining fertility in sub-Saharan Africa is not a certainty, despite population projections by international organizations that assume that widespread decline is imminent. Evidence indicates that African fertility is peculiarly sensitive to infant and child mortality levels, and therefore amenable to decline through service-intensive combined health and family planning programmes; but it is not clear that governments can implement such programmes on a national scale. On the demographic-economic nexus, some evidence suggests that in sub-Saharan Africa high levels of natural population increase do slow growth in per capita income. Family planning programmes might also catalyze changes in family social and economic structures that would contribute to faster economic growth. Finally, as the full scale of the African AIDS epidemic becomes clearer, it will come to dominate all other population-related concerns, creating a compelling case for huge expenditures on comprehensive health, family planning, and social services aimed at reducing mortality, curing sexually transmitted diseases, detecting HIV infection, and providing follow-up services.