Manes Feston, flanked by her children, holds her four-month-old son Fedson. He was one of triplets but his siblings died because of a lack of welfare support. High fertility rates can be seen in much of Africa with four or more births per woman. Generally, these countries are poorer with limited access to quality healthcare and contraception. Credit: Travis Lupick/IPS

By Tharanga Yakupitiyage
UNITED NATIONS, Oct 21 2018 (IPS)

Reproductive choice can transform the world and our goals towards a sustainable society, a new report says.

Every year, the United Nations Population Fund (UNFPA) examines the state of the world population. In this year’s report, the agency focuses on the power of reproductive choice and the role it can play to promote social and economic development.

“Choice can change the world,” UNFPA’s executive director Natalia Kanem said in the report’s foreword.

“It can rapidly improve the well-being of women and girls, transform families, and accelerate global development,” she added.

While progress has been achieved, the international community still has a ways to go, UNFPA’s Washington D.C. director Sarah Craven told IPS.

“There is no country in the world where reproductive rights and choices are enjoyed by all people at all times,” she said.

The State of the World Population 2018 report examines global fertility trends and how they are influenced by choice or the lack thereof.

High fertility rates can be seen in much of Africa with four or more births per woman.

Generally, these countries are poorer with limited access to quality healthcare and contraception.

UNFPA found that over 20 percent of women in the region want to avoid a pregnancy but have an unmet need for family planning.

At the same time, almost 20 million—or 38 percent—of the region’s pregnancies each year are unintended.

Practices such as early marriage, which is associated to an early start to child bearing, is also common.

In sub-Saharan Africa, approximately 38 percent of women are married by the age of 18. In Niger, 76 percent of girls marry by the age of 18.

Child marriage, which is accompanied with the end of education and the lack of opportunities for employment and thus reduced earnings in adulthood, denies girls’ decision-making power and their right to choose.

It also hinders progress on the Sustainable Development Goals (SDGs) such as the elimination of poverty, achievement of good health and well-being, and access to decent work.

Countries with high fertility have faster population growth, which poses challenges for governments already struggling to make progress on the SDGs and to provide education, healthcare, and employment opportunities.

On the other hand, while there are trends towards lower birth rates as a result of greater access to services, some women are having fewer children due to constraints rather than choice.

“The gap between desired and actual family size suggests that women and men are not fully able to realise their reproductive rights,” the report states.

For instance, the culture of overwork in East Asia has made it difficult for many to have both a career and a family.

In South Korea, almost 20 percent of employed women worked more than 54 hours a week in 2014.

The East Asian nation has a fertility rate of 1.17 births per woman, below the recommended replacement level of 2.1 and the level needed to sustain the current size of the population.

In Japan, which also has concerning fertility levels, the demanding work environment has even led to “karoshi,” or death by overwork.

In 2013, journalist Miwa Sado died of a heart failure and investigators found that she had logged 159 hours of overtime work one month before she died.

In 2015, 24-year-old Matsuri Takahashi committed suicide. It emerged that she worked for over 100 hours of overtime at her advertising job and had barely slept in the period leading up to her death.

In an effort to address this problem, both countries have started to put policies in place to restrict work hours.

However, women with children also often face discrimination in the labour market, which can be seen in countries such as South Korea and Japan where mothers predominately hold low-salary positions and have limited career options, resulting in vast gender wage gaps.

With fewer children and young adults, the labour force has been shrinking contributing to weaker economies.

At the same time, as older people account for larger shares of the population, governments face challenges to cover health-care costs and social security systems, further weakening economies.

Among the recommendations in the report is to provide universal access to quality reproductive healthcare, including access to modern contraceptives, make available sexuality education, and achieve gender equality.

“Choice can be a reality everywhere. This is something that governments should prioritise,” Craven told IPS.

In high fertility countries, there is a need for education on reproductive rights and employment opportunities for rural women while low fertility countries should implement family-friendly policies such as child care services and parental leave.

Questions and challenges remain as to how governments should achieve such policies as the debate over reproductive choice in many countries is often grounded in religious beliefs.

In the United States, a new set of proposed rules will expand religious exemptions, allowing employers to deny health care access such as reproductive health coverage and access to contraception.

In Saudi Arabia, child marriage is still widespread and often justified by clerics.

Craven expressed concern over any policy that restricts individuals to access information and services, and highlighted the importance of reproductive choice.

“You will not achieve the SDGs if you don’t also achieve reproductive rights of your citizens,” she said.

Kanem echoed similar sentiments in the foreword of the report, stating: “The way forward is the full realisation of reproductive rights, for every individual and couple, no matter where or how they live, or how much they earn…the real measure of progress is people themselves: especially the well-being of women and girls, their enjoyment of their rights and full equality, and the life choices that they are free to make.”

By Joseph Chamie and Barry Mirkin
NEW YORK, Nov 17 2015 (IPS)

Concerned with the consequences of demographic decline and population ageing, especially with respect to economic growth, national defence and pensions and health care for the elderly, a growing number of governments are seeking to raise birth rates. Whereas nearly 40 years ago 13 countries had policies to raise fertility, today the number has increased four-fold to 56, representing more than one-third of the world’s population.

The most recent and largest addition to this pronatalist group of countries, which includes Australia, France, Germany, Iran, Israel, Italy, Japan, Russia, South Korea, Spain and Turkey, is China. The Chinese government announced that it will change its controversial one-child policy to a two-child policy per couple in order to balance population development and address the challenge of an ageing population.

Assuming a slight increase in its current fertility level, China’s population of 1.38 billion is projected – according to the UN medium variant – to peak by 2030 at 1.42 billion and then decline to 1 billion by the end of the century (Figure 1). However, if fertility were to remain constant at its current level, China’s population would soon begin declining, reaching around 0.8 billion by the year 2100. If fertility were to instantly reach the replacement level, an unlikely event, China’s population would grow to 1.51 billion by midcentury.

Source: United Nations Population Division.

China’s population age structure is also becoming older than any time in the past. Whereas in 1950 less than five per cent of the Chinese were aged 65 years or older, today the proportion has doubled to 10 per cent. By 2035 China’s proportion elderly is expected to double again and reach one-third by around midcentury.

Similar to China, 82 other countries – accounting for almost half of the world’s population – are experiencing fertility rates below the replacement level of about two births per woman. As a result, the populations of 48 of those countries, including Germany, Japan, Russia and South Korea, are projected to be smaller and older by midcentury, even assuming modest gains in birth rates. If fertility rates were to remain constant at their current levels, the declines and ageing would be even more pronounced than currently expected (Figure 2).

Source: United Nations Population Division.

In an attempt to counter those two major demographic trends, many governments have adopted a variety of policies to raise birth rates. At one extreme are draconian measures such as prohibiting contraception, sterilization, abortion and the education and employment of women. As those measures violate basic human rights, few governments are prepared to take such drastic steps to raise fertility. Moreover, such measures have undesirable demographic consequences, including higher levels of unintended pregnancy, illegal abortion and maternal mortality.

Some governments are promoting marriage, childbearing and parenting through public relations campaigns, incentives and preferences. Such programs highlight the vital role of motherhood and its valuable contribution to the welfare and growth of the country. Australia and South Korea, for example, are among those making appeals to women to have one more child. Also, Iran is considering legislation that would encourage businesses to prioritize the hiring of men with children.

Perhaps the most common pronatalist policies aim to reduce parent’s considerable financial costs for childbearing and child rearing. Those policies include cash bonuses at the time of a child’s birth and/or recurrent cash supplements for dependent children

In Turkey, for example, parents are entitled to 300 Turkish lira (108 dollars) for the birth of their first child, 400 Turkish lira (144 dollars) for the second and 600 Turkish lira (215 dollars) for the fourth and subsequent child. One consequence of this legislation, however, has been the need for the provision of government financial assistance to needy families with large families.

Additional policies, especially popular among many Western countries, focus on making employment and family responsibilities “compatible” for working couples, especially mothers. In addition to extended maternity leave as well as paternity leave, other measures include part-time work, flexible working hours, working at home and family-friendly workplaces, including nurseries, as well as pre-school and after-school care facilities.

However, the costs of family friendly policies are not insignificant. For example, with fertility at two children per woman, France’s extensive scheme of family benefits is estimated to cost four per cent of gross domestic product, one of the highest percentages in the European Union.

Some governments are also looking to selective immigration to maintain the size of their workforce and slow down the pace of population ageing. However, a recent United Nations study concluded that international migration at current levels would be unable to compensate fully for the expected population decline. Between 2015 and 2050, the excess of deaths over births in Europe is projected to be 63 million, whereas the net number of international migrants to Europe is projected at 31 million, implying an overall shrinking of Europe’s population by about 32 million.

In addition, the financial costs, social integration and cultural impact of immigration have come to the political forefront in recent months. A growing tide of refugees and economic migrants – mainly from Syria, Afghanistan, Eritrea, Iraq, Nigeria and Pakistan, estimated at over 800,000 – have arrived on the shores of the European Union since the beginning of 2015 to escape war, repression, discrimination and unemployment.

As part of its response, the EU is considering a plan to offer aid money and visas to African countries that agree to take back thousands of their citizens who are unlawfully residing within its borders. Also aiming to stem the record inflows of refugees, various EU members have put up fences, imposed border controls and tightened asylum rules.

Other countries that are averse to encouraging immigration, such as Japan and South Korea, have instead opted to boost labour productivity as a means of compensating for a shrinking labour force. Those governments are also reviewing legislation to encourage more women to join and remain in the labour force by offering them family friendly work environments, improved career mobility and promotions to management and senior positions.

While family-oriented measures may encourage some women to have children, those policies are costly and their overall effect on fertility is weak or unclear. The many forces pushing fertility to low levels are simply too powerful for governments to overcome with dictates, financial incentives and public relations campaigns.

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By Joseph Chamie
NEW YORK, Oct 29 2015 (IPS)

Women are having fewer than two children on average in 83 countries, representing nearly half of the world’s population. And in some countries, such as Germany, Italy, Japan, Poland, Singapore, South Korea and Spain, average fertility levels are now closer to one child per woman than the replacement level of about two children (Figure 1).


Largely as a result of women’s reproductive decisions, the populations of 48 countries are projected to be smaller and have older age structures by mid-century. Looking further ahead, the prospects for those countries are compounded over time resulting in even smaller and older populations by the close of the century.

For example, if Japan’s fertility rate of 1.4 births per woman were to remain unchanged, its current population of 127 million would be 64 million by 2100 with more than 40 percent of the Japanese aged 65 years and older. Similar demographic outcomes occur in many other countries when low fertility levels remain unchanged, such as Germany, Italy, Russia and South Korea (Figure 2).

Based on the demographic trends observed over the last five decades, once birth rates fall below the replacement level, especially when less than 1.6 births per woman, they tend to stay there. And even if birth rates were to increase somewhat, the pool of women of childbearing age in many of the low fertility countries is shrinking, resulting in fewer babies being born.

Although relatively little supporting empirical research exists, countries tend to view demographic decline and population ageing as critical concerns. They believe those demographic trends will have serious repercussions on national interests affecting economic growth, military defence, cultural integrity, pensions and health care, especially for the elderly.

Some governments, including Germany, Italy, Japan, Russia, Singapore and South Korea, have concluded that intervention efforts are needed to raise their country’s birth rates in order to stem the projected decreases and rapid aging of their populations. Most recently, those twin demographic concerns have led China to announce that it is abolishing its one-child policy in favour of a two-child policy per couple.

However, despite government policies, considerable financial expenditures and various pronatalist initiatives, including national conception day, family night, “love cruises,” match-making, economic incentives, promotion of motherhood and appeals to patriotism and civic duty, efforts to raise fertility back near the replacement level have generally failed to convince women to have more children. In many low fertility countries birthrates have remained well below replacement for decades.

There are many factors or reasons why fertility levels have fallen below replacement and continue to persist at low levels. Marriage as a valued social institution has declined with divorce and separation becoming more common and acceptable. Also, marriage is no longer being viewed as just for reproductive purposes.

Opportunities for education, employment, mobility and financial independence, together with effective contraception, permit women to delay or forgo motherhood altogether. In many developed countries, especially in Europe, 10 per cent of women in their forties are childless and even in some, such as Germany, Italy and the Netherlands, the number is close to 20 per cent.

Also instead of marriage many women and men are choosing to cohabitate, thereby avoiding legal issues, social responsibilities and long-term commitments. Even if they subsequently decide to marry, many are content to continue with their partner just as a couple.

Growing numbers of young women as well as men are choosing personal self-fulfillment and career development rather than centring their lives on family and children. After years of being without children, many have become accustomed to an urban life style, higher social and economic status and unrestricted freedoms.

Women also report that they have no children because they are not able to find a suitable partner who would be willing to share equally in parenting and household chores. For example, when asked if she wanted to have a child, one young Japanese woman replied, “No, because in order to have a baby I’d have to marry a baby.”

Also, many young couples find that they cannot live on one person’s income alone and therefore both are obliged to work. The additional costs of children plus the need to save for longer years of old age place increased financial demands on household income as well as exerting powerful brakes on childbearing.

Another compelling factor accounting for low fertility in many countries is the lack of sufficient support and social services for those with children, especially single-parent families. That issue has become particularly salient given the fact that the majority of women are no longer simply mothers but are working mothers.

The demands of employment, career development and parenting combined with the costs of childrearing have also created “the hurdle of the second child.” Given those pressing circumstances, especially as childcare still falls largely on women, many mothers are reluctant to have a second child. Even if some women decide to cross the second-child hurdle, comparatively few are willing to consider having three or more children.

Some women as well as men have limited their fertility due to concerns about global overpopulation and its damaging consequences on the natural environment. They are convinced that the world would be a better and more sustainable place to live with low birthrates, which would in turn lead to a smaller future global population.

Government policies and schemes to encourage women to have more births in order to stem population decline and ageing have also encountered resistance and objections about unwarranted government interference and meddling in women’s lives. In Germany, for example, the recent introduction of a childcare allowance for stay-at-home mothers was harshly criticized for discouraging women to pursue careers as is widely promoted and expected of men and fathers.

Will governments be successful in persuading women to call off their reproductive strike and have significantly more children, thereby perhaps raising fertility rates to near the replacement level? It seems highly doubtful.

Based on their current behaviour and what they’re reporting, women in low fertility countries are not likely to increase their reproduction for the sake of the nation, limited financial incentives or other governmental pronatalist schemes. Most young women have decided not to return to the traditional, restrictive reproductive roles that their mothers and grandmothers followed. Consequently, for the foreseeable future, birthrates in low fertility countries are likely to remain below the replacement level.

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Karam and Adam, twin Palestinian babies born after their mother underwent IFV treatment using sperm smuggled out of the Israeli prison where their father has been held for the last 11 years. Credit: Silvia Boarini/IPS

By Silvia Boarini
GAZA CITY, Jul 31 2015 (IPS)

Thirteen-year-old Hula Khadoura sits on a large sofa in her grandfather’s home in the neighbourhood of Tuffah, Gaza City, her one-year-old twin brothers Karam and Adam on her lap. “I am so happy they arrived,” she beams, holding the babies’ feeding bottles in her hands.

There is an aura of mystery and something of the miraculous around the  twins’ births – their father, Saleh Khadoura, has spent the past 11 years in an Israeli prison and has had no physical contact with Hula’s mother, Bushra, since then.

Hula hears people refer to her brothers as ‘special babies’ but does not fully grasp what the fuss is about. She is completely unaware of the unusual obstacles her father’s sperm had to overcome to reach her mother’s eggs.“After the suffering I am put through with each visit [to her husband in an Israeli prison], with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken” – Bushra Abu Saafi

Freedom ambassadors

Bushra Abu Saafi, is one of around 30 Palestinian women who have conceived babies since 2013 with sperm smuggled out of the Israeli prisons in which their husbands are being held. She was only the second woman in Gaza to do this. Before her, two had tried but only one succeeded.

According to the Palestinian Prisoners’ NGO Addameer, there are currently some 5,750 Palestinian political prisoners being held in Israel. Of these, roughly 5,550 are adult males.

Women whose husbands are serving decades-long sentences do not want to see their dream of starting a family, or increasing its size, taken away by the very same authorities that took away their husbands.

Until recently, the Israeli Prison Service (IPS) was highly sceptical that sperm smuggling could be happening at all. Spokesperson Sivan Weizman told the press that tight security made it very unlikely. Recently, though, they have acknowledged that it may be an issue.

The Palestinian National Authority and Hamas, on the other hand, have never shown any doubt and have financially supported women wishing to try this very unconventional method of conceiving.

In May in Gaza, the Palestinian Ministry of Prisoners even organised a collective birthday party for the little ‘ambassadors of freedom’, as babies born this way are often called.

Families apart

“It was my husband who suggested we try ‘in vitro fertilisation’ (IVF) treatment with his smuggled sperm,” Bushra Abu Saafi told IPS from her father’s apartment, where she lives with her five children.

The majority of Palestinian households have at least one relative in an Israeli prison. For a people under occupation, political prisoners become part of the collective identity, they are adopted by Palestinians as long lost brothers, sisters, mothers or fathers and are celebrated at Prisoners’ Day marches and recurring demonstrations.

In the private sphere, the prisoners continue to be individuals and occupy prominent places in the home. Their handicrafts are displayed with pride, their photos adorn each room and the vacuum they have left is still palpable.

A flowery picture frame with a photo of her smiling husband Saleh in his twenties sits on a side table in Bushra’s living room. He was arrested at the age of 23, accused of being part of the Islamic Jihad. They had been married for five years and only two of their children have had the privilege of spending some time with him as a family.

When Saleh was imprisoned, Bushra was pregnant with Ahmed. “It hasn’t been easy these past 11 years,” she told IPS.  “We miss him terribly, my son Ahmad especially. He doesn’t know the meaning of the word ‘father’. He tells me ‘when I grow up I want to be like grandad’.”

Smuggling new life out of jail

Entering a fourth pregnancy was something Bushra did not take lightly and her father worried about the extra pressure. “When Saleh proposed this to me from prison, I was sceptical,” she confessed. “My family and I worried about what people would say. Imagine, pregnant with a husband in jail!”

She need not have worried. The advice she was given, like other women undergoing IVF in this way, was to tell everyone in her family and village that her husband’s sperm had been brought out and would be used for insemination. Since then, local media stations have helped spread the story and both Palestinian society and local religious authorities have been highly supportive.

“In the end, my father saw that it was my desire to try for another baby and eventually supported my choice,” Bushra said. It took two months and many tests before she could be ready for the operation.

Although the women do not wish to discuss how the sperm is smuggled past Israeli security and out of prison, it is acknowledged that it may be slipped into the clothes of  unaware children.

While wives talk to imprisoned husbands through glass and over a phone, children are the only ones allowed physical contact at the end of a visit. The clinics performing the operation,  both in Gaza and in the West Bank, report that sperm has arrived in a variety of improvised containers, from sweet wrappers to eye drop bottles.

“The preparation, the waiting, it was all very tough,” said Bushra. “But when the news came that I was pregnant, the pressure was off and we finally celebrated.” The double surprise came later, when she was told that twins were expected.

She describes the steps leading to this pregnancy as being about resistance and overcoming challenges. “After the suffering I am put through with each visit, with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken.”

Fertility and non-violent resistance

According to Liv Hansson, a Danish public health specialist who has researched fertility in Palestine, the practice of sperm smuggling only makes associations between fertility and resistance easier to draw.

“In a context such as Palestine, where women are well educated and child mortality is low, a lower fertility rate would be expected according to classic demography,” Hansson told IPS. The fertility rate of 4.1 registered in Palestine between 2011 and 2013, then, must be seen in the light of Israel’s ongoing occupation.

Indeed, fertility has long been considered by Palestinians as part of resistance efforts against Israel’s military occupation. For its part, Israel views high fertility rates in the West Bank and Gaza, and in majority Palestinian areas inside Israel, as a very real threat. Talk of the ‘demographic time-bomb’ – the time when Palestinians will outnumber Jewish Israelis – is very common.

“Former Palestinian president Yasser Arafat famously stated that ‘the wombs of Palestinian women are the greatest weapon of Palestine’,” Hansson told IPS. “Fertility is seen as something of interest not only to the family but to the community, society at large and to politicians too.”

The wait

Bushra and her five children will have to wait three more years to be reunited as a family with Saleh. Since 2012, following the release of kidnapped Israeli soldier Shalit, Israel’s Prison Service has been slowly reinstating visiting rights for family and prisoners from Gaza.

Ahmed saw his father two years ago for the first time, Hula six months ago and for the twins, the only meeting so far has been through the photograph on the side table, portraying Saleh as a young man eager to live life.

Edited by Phil Harris    

By Julitta Onabanjo, Benoit Kalasa, and Mohamed Abdel-Ahad
JOHANNESBURG, Sep 21 2014 (IPS)

Different issues will be competing for the attention of different African leaders attending the 69th United Nations General Assembly Special Session on International Conference on Population and Development (ICPD) Beyond 2014 in New York on Sep 22.

But the central question for Africa’s development today is this: How do we harness the dividend from the continent’s current youthful population?

Solving this issue has never been more fundamental to Africa’s development than it is today.

For decades many, African countries have come up with a variety of ‘development’ plans. But often missing in these documents is how best to harness the potential of the youthful population for the transformation of the continent.

Therefore, strategic investment to harness the potential of the youth population can no longer wait.“African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights”

The groundswell for change

Africa is undergoing important demographic changes, which provide immense economic opportunities. Currently, there are 251 million adolescents aged 10-19 years in Africa compared with 1.2 billion worldwide, which means that around one in five adolescents in the world comes from Africa.

Africa’s working age population is growing and increasing the continent’s productive potential. If mortality continues to decline and fertility declines rapidly, the current high child dependency burden will reduce drastically. The result of such change is an opportunity for the active and employed youth to invest more.  With declining death rates, the working age population in Africa will increase from about 54 percent of the population in 2010 to a peak of about 64 percent in 2090.

This increase in the working age population will also create a window of opportunity  that, if properly harnessed, should translate into higher economic growth for Africa, yielding what is now termed a ‘demographic dividend’ – or accelerated economic growth spurred by a change in the age structure of the population.

Reaping the demographic dividend requires investments in job creation, health including sexual and reproductive health and family planning, education and skill and development, which would lead to increasing per capita income.

Due to low dependency ratio, individuals and families will be able to make savings, which translate into investment and boost economic growth. This is how East Asian countries (Asian Tigers) were able to capitalise on their demographic window during the period 1965 and 1990.

The impact of such a demographic transition on economic growth is no longer questionable – it is simply a fact.

But this transformation requires that appropriate policies, strategies, programs and projects are in place to ensure that a demographic dividend can be reaped from the youth bulge.

Seizing the moment

Without concerted action, many African countries could instead face a backlash from the growing numbers of disgruntled and unemployed youth that will emerge.

In the worst-case scenario, such a demographic transition could translate into an army of unemployed youth and significantly increase social risks and tensions.

To seize the opportunity, African states will need to focus their investments in a number of critical areas. A priority will be the education and training of their youth.

African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights.

If these efforts are to succeed, this will demand addressing gender disparities between today’s boys and girls especially, but more specifically, addressing the vulnerabilities of the adolescent girl.

Beyond rhetoric

As we move toward the post-2015 development agenda, unleashing the potential and power of Africa’s youth should be a critical component of the continent’s developmental strategies, as reflected in the Addis Ababa Declaration on Population and Development – the regional outcome of ICPD beyond 2014 – and the Common African Position on the post-2015 development agenda.

This can no longer be reduced to election or political polemics. It requires urgent action.

Young people are central to the realisation of the demographic dividend. It is therefore important to protect and fulfil the rights of adolescents and youth to accurate information, comprehensive sexuality education, and health services for sexual and reproductive well-being and lifelong health, to ensure a productive and competitive labour force.

Africa cannot afford to squander the potential gains of the 21st Century offered by such an important demographic asset:  its youthful population.

Edited by Ronald Joshua

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