Fertility rates have dramatically decreased all around the world since the 1960s. The most rapid decrease was seen in developed countries, with developing ones following suit, albeit at a slower pace. Of these developing countries, the African Region has displayed a dramatic decline in its fertility rate. In keep with the UN Sustainable Development Goals, this decrease can be attributed to better access to healthcare and reproductive options in Africa across the board, the major pillars of SDG 3: Ensure healthy lives and promote well-being at all ages.
Comparing the two snapshots depicting fertility rates across the world between 1960 and 2020 indicates that globally, the number of births per woman has significantly gone down (noticeable by the change in color from dark blue in 1960 to lighter shades in 2020). Africa is obviously the darkest region compared to the rest of the world in both images, however, fertility rates in African countries have nearly halved between 1960 and 2020, with some countries, such as South Africa, achieving rates as low as those of developed countries.
Potential Reasons for this Decline:
Better healthcare:
In line with SDG3.c, health expenditure per capita (current $US) has steadily increased across Africa between 2000 and 2020.
The number of births attended by skilled professionals has been on the rise, reaching nearly 70% in Eastern and Southern Africa
Average infant mortality rate has more than halved across the African continent
The number of children under 5 taken to a health provider has increased, albeit modestly
Informed decisions regarding reproductive health:
The percentage of women making informed decisions regarding sexual relations, contraceptive use, and reproductive healthcare has increased, going as high as 73% in countries like Madagascar
The percentage of women using contraceptives has more than doubled across the different African regions, with nearly 40% of women practicing safe sex in Eastern and Southern Africa in 2019, up from 16.5% in 1990.
Recommendations:
Better access to healthcare enables a safer birthing process and post-natal care. Hence, governments should continue to spend on healthcare to further decrease infant mortality rates, improve maternal care, and increase access to reproductive health options. Increased spending on women’s education should also be promoted, as this will improve their knowledge around their health and bodies, as well as that of their children, and provide them with skills to improve their livelihoods and future.
At the dawn of the 1990s, the People’s Republic of China was a typical developing nation. The majority of its population lived in poverty mainly in rural areas. The country’s GDP per capita was $318 which was almost equal to that of the African nation of Mali ($317) and much less than the GDP per capita of the South American nation of Guyana ($533.5). However, the most challenging problem that the Asian dragon faced was the high infant mortality rate of 42.7 deaths per 1000 births which was considered high according to UN standards (12 deaths/1000 births). Since then, the government implemented ambitious and bold economic reforms and opened gradually its economy to the rest of the world. The country witnessed an influx of foreign investment that resulted in the increase of the nation’s GDP per capita from $318 in 1990 to $10,144 in 2019! Beijing took advantage of its miraculous economic growth by incrementing investment in its health system. It focused on health financing, human resource development and health information systems and promoted the equalization of health services including maternal and child health services. As a result, the infant mortality rate in China decreased from 42.7 deaths/1000 births in 1990 to 5.9 deaths/1000 births in 2019. In other words, China triumphed in decreasing its infant mortality rate by 86% in almost 20 years, an achievement that even the most developed nations of the world did not accomplish. China is the example of a nation that has benefited from its economic development to decrease infant mortality rate. In this way, it achieved target 3.2 of the Sustainable Development Goals set by the United Nations for countries to reach by 2030 -the ending of preventable deaths of newborns to less than 12; and most importantly achieved the health and welfare of its population.
References:
Guo Y, Yin H. Reducing child mortality in China: successes and challenges. Lancet. 2016;387(10015):205-207. doi:10.1016/S0140-6736(15)00555-3
Department of Economics and Social Affairs, United Nations: Sustainable Development Goals, Goal 3: https://sdgs.un.org/goals/goal3
Childbirth is considered to be a landmark and joyous moment in any woman’s life. And although health experts say that no two childbirth experiences are the same, it is quite astounding that this can, in many cases, reach the extreme of death. According to statistics released by UNICEF, the World Health Organization (WHO), the United Nations Population Division, United Nations Population Fund (UNFPA) and the World Bank Group, around 2.8 million pregnant women and newborns die every year of preventable causes [1]. This turns childbirth into an event to be feared as it poses a significant threat to the lives of many women across the globe. According to the United Nations’ Department of Economic and Social Affairs, quality education is defined as one the of the seventeen sustainable development goals (SDGs), so how can education help mitigate childbirth mortality?
“Pregnancy is not a disease. It should not lead to deaths. Every maternal death should be regarded as an abnormality.” – Vivianne Ihekweazu, Director of the Nigerian Health Watch [2]
How are Childbirth Deaths Related to Education?
The World Development Indicators data from the World Bank [3] allows us to look into the impact of education on childbirth by exploring the percentage of births that are handle by skilled health staff. In the figure below, we plot the average life expectancy at birth in years with respect to the average percentage of births attended by skilled staff for each country. There is a clear positive correlation between the two variables. We therefore conclude that children who are delivered by skilled health workers during labor are more likely to have a higher life expectancy.
However, the impact of having educated people overseeing child delivery does not stop here. Unfortunately, carrying out child delivery without proper understanding of the necessary health procedures has more alarming implications. In the dashboard below, we notice a sharp decrease in both maternal mortality (women dying during labor) and neonatal mortality (newborns dying at birth) in countries where more childbirths are handled by skilled health workers. This implies that many of the childbirth related deaths can be attributed to the lack of necessary health skills.
Where are these Childbirth Deaths Mostly Occurring?
Below we find the places that suffer the most from this by selecting the countries that have a below average percentage of births attended by skilled staff.
By looking at the geographical distribution of these countries we unsurprisingly find that the majority is located in Africa. Furthermore, we notice that the educational attainment in these countries is significantly lower than countries that have more professionally handled childbirths. This is an expected causality since to have more skilled people perform childbirth procedures we need more educated people.
So the Solution Is, Educate More People!
“The benefits of education permeate all walks of life right from the moment of birth.” – Irina Bokova, Director-General of UNESCO [4]
In light of the above, we clearly need to have more educated people that are able to professionally handle childbirth procedures. This is especially needed in developing countries where childbirth mortality is more pronounced. A key approach strategy here is to educate the local birth attendants and community midwives that are already active in these communities. These local and community health workers are already more connected to the women and families in their towns making their newly found skills more accessible and allowing them to spread health awareness to pregnant women in their communities [5]. Finally some communities in rural Africa are located in remote locations faraway from any medical supply and service centers. Therefore, setting up portable medical outposts near these towns would greatly enhance the quality of services provided by birth attendants.
