(PDF) Is urbanisation in South Africa on a sustainable trajectory?

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Sub-Saharan Africa has had the lowest life expectancy levels and the slowest rate

of improvement. Consequently, life expectancy, which was 51 years during the

period 1990-95, is still considerably below that of the other developing-country

regions (Bongaarts, 1995). Sub-Saharan Africa will continue to lag in life expectancy

partially because the continent is severely impacted by the AIDS epidemic. There are

various projections regarding the negative impact of the disease on life expectancy.

Although the AIDS epidemic can be said to have had a limited impact in the

1980s, its impact will most certainly grow with the size of the epidemic and, in the

21 st century, mortality measures will be substantially affected (Bongaarts, 1995).

Based on projections for 15 African countries, the average life expectancy during

2000-05, with and without AIDS, is reduced by more than 6 years (57.7 minus 51.2)

and the death rate is higher by 2.9 deaths per 1,000 people (13.7 minus 10.8). The

population growth rate would also be lowered but growth is expected to remain high

as the birth rate would be basically unaffected. Under this scenario, in sub-Saharan

Africa as whole, the population growth rate would be reduced by only 0.1 percent

in 2000-05 (Bongaarts, 1995).

Mortality is the result of the interaction of three sets of factors affecting an

individual’s physical well-being. These are (1) public health services, such as im-

munization, which affect mortality regardless of individual behaviour; (2) health and

environmental services (for example, clean water), which reduce the costs of health

to individuals but require some individual response; and (3) an array of individual

characteristics, including both income, which affects health through food consump-

tion and housing, and education, which affects the speed and efficiency, with which

individuals respond to health and environmental services (Birdsall, 1980). Of these

three sets of factors affecting mortality, the benefits of the first have been more or

less fully harvested. Further mortality declines depend therefore on changes in indi-

vidual behaviour that are facilitated by increasing income and education and better

access to health services.

Africa is the only region in the world that is yet to experience significant re-

productive change. The total fertility rate for sub-Saharan Africa as a whole has

remained virtually unchanged at about 6.3 to 6.6 for the past 25 years. This is sig-

nificantly higher than in other regions and countries with similar levels of income,

life expectancy, female education, and contraceptive prevalence. In a few countries

in sub-Saharan Africa fertility has, in fact, increased while it has been declining

in the rest of the developing world (Cleaver and Schreiber, 1994). Nonetheless,

there are a few countries where there are encouraging signs of fertility decline.

The currently available literature, though not necessarily agreeing on the reasons

for such a change, demonstrates fertility declines in Zimbabwe, Botswana, Kenya,

Nigeria, Cote d’lvoire, Ghana, Mozambique, and Sudan, for example (Adamchak

and Mbizvo, 1993; Thomas and Mercer, 1995; Thomas and Muvandi, 1994; Ruten-