Вы находитесь на странице: 1из 148

POPULATION DYNAMICS,

ENVIRONMENT AND POVERTY

by

John Thinguri Mukui

Prepared for UNFPA Kenya Country Office,


National Coordinating Agency for Population and
Development, and the Kenya National Bureau of
Statistics
December 2008

TABLE OF CONTENTS
ABBREVIATIONS AND ACRONYMS .................................................................................... iii
ACKNOWLEDGEMENTS ........................................................................................................ iv
FOREWORD ............................................................................................................................... v
EXECUTIVE SUMMARY ......................................................................................................... vi
INTRODUCTION ....................................................................................................................... 1
1.1
1.2
1.3
1.4
1.5

Background ...............................................................................................................................1
The Role of Demography .........................................................................................................2
Population Dynamics, Environment and Poverty ..................................................................4
Methodology .............................................................................................................................5
Organization of the Report.......................................................................................................6

KENYA: POPULATION DYNAMICS ....................................................................................... 7


2.1
2.2
2.3
2.4

Overview ...................................................................................................................................7
Age Structure ............................................................................................................................7
Components of Population Change .........................................................................................8
The Stall in Fertility Decline ..................................................................................................11

ECONOMICS OF THE FAMILY ............................................................................................. 12


3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12

Introduction ............................................................................................................................12
Altruism ...................................................................................................................................12
Unitary versus Collective Models of the Household.............................................................13
Sibling Competition for Resources.........................................................................................14
The Demand for Children ......................................................................................................18
The Impact of Family Structure on Child Quality ................................................................18
Out-of-Wedlock Children and Teen Childbearing...............................................................20
Optimal Age at Marriage ........................................................................................................22
Intergenerational Transfers ....................................................................................................23
Children and Parents Labor Supply ......................................................................................25
Externalities of Childbearing .................................................................................................26
Feminization of Poverty .........................................................................................................27

POPULATION AND DEVELOPMENT .................................................................................. 29


4.1
4.2
4.3
4.4
4.5
4.6

Introduction ............................................................................................................................29
Malthusian Ideas .....................................................................................................................29
The Coale-Hoover Ideas .........................................................................................................30
Ester Boserup on Agrarian Change ........................................................................................31
Reconciling the Pessimists and the Optimists .......................................................................33
Evolutionary and Ecological Analysis of Human Fertility ...................................................33

DEMOGRAPHIC TRANSITION AND THE DEMOGRAPHIC DIVIDEND ....................... 38


5.1
5.2
5.3
5.4
5.5

The Nature of Demographic Transition ................................................................................38


Population Change and Economic Growth ...........................................................................40
Structural Factors that Influence Fertility .............................................................................42
The Role of Religion ...............................................................................................................45
Diffusion Theories and the Impact of Social Networks ........................................................47

POVERTY AND REPRODUCTIVE HEALTH ....................................................................... 49


6.1
6.2
6.3

The Elements of Reproductive Health...................................................................................49


Poverty in the Context of Reproductive Health ...................................................................49
Males and Reproductive Health .............................................................................................56

6.4

Integrating Family Planning and Maternal and Child Healthcare ......................................58

HIV-AIDS AND RURAL POVERTY....................................................................................... 60


7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9

Introduction ............................................................................................................................60
Links between HIV-AIDS and Poverty in Rural Households ..............................................60
The Effects of Prime-Age Mortality ......................................................................................63
A New Type of Famine ...........................................................................................................65
Links between HIV/AIDS and Water Supply .......................................................................67
HIV/AIDS and Education .......................................................................................................69
HIV/AIDS and Fertility ..........................................................................................................69
Impact of HIV/AIDS on Poverty and Inequality ..................................................................70
Impact of HIV/AIDS Deaths on Living Arrangements of Orphans .....................................71

POVERTY AND THE ENVIRONMENT ................................................................................ 72


8.1
8.2
8.3
8.4
8.5
8.6
8.7

Introduction ............................................................................................................................72
The Environment and MDGs .................................................................................................73
The Precarious State of Kenyas Environment ......................................................................74
Poverty, Environment and Natural Resources ......................................................................76
Population Dynamics and the Environment .........................................................................80
Environment and HIV/AIDS..................................................................................................82
Environment and Child Survival ...........................................................................................83

POVERTY AND DEMOGRAPHIC CHARACTERISTICS IN KENYA ................................. 84


9.1
9.2
9.3
9.4
9.5

Background .............................................................................................................................84
Population Structure ...............................................................................................................84
Dependency Ratios .................................................................................................................90
Mortality..................................................................................................................................93
Fertility ....................................................................................................................................96

SUMMARY OF MAIN FINDINGS AND EMERGING ISSUES ........................................... 101


10.1
10.2
10.3
10.4

Background ...........................................................................................................................101
Summary of Main Findings ..................................................................................................101
Areas for Priority Action ......................................................................................................102
The Cost of Inaction .............................................................................................................102

BIBLIOGRAPHY .................................................................................................................... 104

ii

ABBREVIATIONS AND ACRONYMS


AIDS
ASFR
AST
CBN
CDR
CPR
DHS
EKC
FGC/FGM
FP
FY
GDP
GFR
GNI
Ha
HIV
ICPD
IMR
IUD
KDHS
KFS
KIHBS
KNBS
LPG
MCH
MDGs
MMM
NASCOP
NCAPD
NEMA
NGO
NVF
OF
PA
PCEA
PMTCT
RCH
RH
RTI
STD
STI/STD
TB
TBA
TFR
UNDP
UNEP
UNFPA
UNICEF
VCT
WTP

Acquired Immuno-Deficiency Syndrome


Age-Specific Fertility Rate
Age-Structural Transitions
Cost of Basic Needs
Crude Death Rate
Common Property Resources
Demographic and Health Survey
Environmental Kuznets Curve
Female Genital Cutting/Mutilation
Family Planning
Financial Year
Gross Domestic Product
General Fertility Rate
Gross National Income
Hectare
Human Immuno-Deficiency Virus
International Conference on Population and Development, 1994
Infant Mortality Rate
Intra-Uterine Device
Kenya Demographic and Health Survey
Kenya Fertility Survey 1977/78
Kenya Integrated Household Budget Survey, 2005/06
Kenya National Bureau of Statistics
Liquefied Petroleum Gas
Maternal Child Health
Millennium Development Goals
Maternal Morbidity and Mortality
National AIDS and STI Control Programme
National Coordinating Agency for Population and Development
National Environmental Management Authority
Nongovernmental Organization
New Variant Famine
Obstetric Fistula
Prime-Age
Presbyterian Church of East Africa
Prevention of Mother-To-Child Transmission
Resource Curse Hypothesis
Reproductive Health
Reproductive Tract Infection
Sexually Transmitted Disease
Sexually Transmitted Infection/Disease
Tuberculosis
Traditional Birth Attendant
Total Fertility Rate
United Nations Development Programme
United Nations Environment Programme
United Nations Population Fund
United Nations Childrens Fund
Voluntary Counselling and Testing
Willingness to Pay

iii

ACKNOWLEDGEMENTS
This report was prepared for the United Nations Population Fund (UNFPA) Kenya Country Office,
the National Coordinating Agency for Population and Development (NCAPD) and the Kenya
National Bureau of Statistics (KNBS). The overall oversight role was vested on Fabian Byomuhangi
(UNFPA Deputy Representative) and Anthony K.M. Kilele (Director-General, KNBS). The day-today coordination was the responsibility of Zipporah W. Gathiti (Programme Officer, Monitoring
and Evaluation, UNFPA), Karugu Ngatia (Senior Assistant Director, NCAPD) and Godfrey K.
Ndenge (head of Poverty Analysis and Research Unit, KNBS).
The analysis of the Kenya Integrated Household Budget Survey (KIHBS) 2005/06 database was
undertaken by Samuel Kipruto (Senior Economist/Statistician, KNBS), Godfrey K. Ndenge (head of
Poverty Analysis and Research Unit, KNBS), P.W. Nyongesa (Principal Economist/Statistician,
KNBS) and Paul K. Samoei (Senior Economist/Statistician, KNBS).
Special thanks go to Alfred Agwanda (Population Studies and Research Institute, University of
Nairobi) for technical assistance in literature review and in preparation of the analysis plan for the
outputs based on the Kenya Integrated Household Budget Survey 2005/06.
The assistance of the abovementioned is gratefully acknowledged.
I am also grateful for comments on an earlier draft from participants in the Government of
Kenya/UNFPA Seventh Country Programme Design Workshop held during October 2-3, 2007.

iv

FOREWORD
This study was commissioned by UNFPA and conducted with the support of the National Coordinating
Agency for Population and Development (NCAPD) and the Kenya National Bureau of Statistics (KNBS). Its
main aim was to review the literature on the linkages between poverty, population growth and the
environment, as a basis for more focused theoretical and empirical research based on specific country
contexts. Such studies would then form the basis for policy design that integrates population and
environment issues in a countrys national development plans, supports the creation and growth of
institutions to foster policies and actions to reap the benefits of these linkages, and to disseminate positive
messages that stress these links as population issues are normally resolved at the individual and household
levels.
In the past few years, UNFPA has held various roundtable meetings on population and poverty linkages, with
special focus on the broader concept of human development as articulated in the Millennium Development
Goals and the ICPD Program of Action. The studies show explicit links between population change and
poverty reduction e.g. reductions in mortality that come from improved health services, reductions in
fertility that come from reproductive health, and the role of favorable demographics (reductions in mortality
and fertility) to increased economic growth. Much of the evidence has shown that slower population growth
improves investment and savings and has a positive effect on the quality of life. The areas of intervention to
address the issues of poverty and population include improving access to reproductive health services through
tackling income poverty; influencing inhibiting factors such as culture, religion, stigma, gender
discrimination and geography; and changing power relations of women, adolescents and the poor.
The chapter on the linkages between poverty and the environment mainly focuses on whether we must first
eradicate poverty before we can worry about the environment, or whether environmental degradation is the
major cause of poverty in the first place. This is based on the premise that the poor depend on ecosystem
services for achieving some of the very basic constituents of wellbeing, and there are barriers and drivers that
prevent the poor from using these ecosystem services to improve their wellbeing. It concludes that the
environment is crucial for the sustenance of livelihoods, as it actually means soil to grow food; water to drink,
wash and irrigate crops; air to breathe; and a host of natural food and medicinal products.
Related studies in population, health, and environment have encountered a number of barriers, most notably
a limited theoretical framework and incompatible methodologies. There are problems of working outside
ones academic discipline to deal with the complexities of multidisciplinary topics. This report draws
evidence from anthropology (ecological analysis of human fertility and the effect of the size of the service
sector on fertility), demography (age-structural transitions and the demographic dividend) and economics
(human capital theory) to inform national debates concerning the implementation of programs aimed at
achieving the reproductive health priorities set forth in the ICPD Programme of Action. Traditional
reproductive health policy matters are often stifled by policymakers fears of attracting criticism over such
sensitive issues as abortion, the human rights of women, and sexual politics. However, the economic rationale
and supporting evidence provided by a human capital approach to the promotion of reproductive health may
help strengthen the case for adopting policies and financing programs that will make the right to
reproductive health services and information a reality.
It is hoped that this report will foster a clearer understanding of the key issues at the interface between
poverty, population growth and environmental degradation. It is hoped that this insight will aid in the
formulation of effective strategies for the long term, sustainable eradication of poverty.
Mr. Kemal Mustafa PhD, UNFPA Representative, Kenya Country Office

EXECUTIVE SUMMARY
1.

Introduction

The UN Millennium Summit held in 2000 and the International Conference on Population and
Development (ICPD) of 1994 agreed on a series of goals intended to improve reproductive health
outcomes and halve the number of people living in poverty by 2015. The ICPD Programme of
Action emphasized that population policies should focus on the wellbeing and quality of life of
individuals and on the right of women to make decisions on matters affecting their reproductive
health.
There is concern, however, that there is a dearth of scientific evidence to support rights-based
arguments in the promotion of reproductive health and household welfare. Research has shown
that the first seven (of the eight) Millennium Development Goals (MDGs) cannot be delivered
without the provision of good reproductive health services.
Based on its mandate, the United Nations Population Fund (UNFPA) is expected to play a key role
in ensuring that countries attain the MDGs. The UNFPA therefore supports efforts to determine
evidence-based linkages between population, development and poverty. It is against this
background that the assessment of population and poverty linkages was undertaken in Kenya.
The study methodology comprised of two sequential stages: literature review, covered in chapters 2
to 8 of the report, and analysis of data from the Kenya Integrated Household Budget Survey
(KIHBS) 2005/06, whose findings are reported in chapter 9. The final part of the report is a
synthesis of information contained in chapters 2-9 so as to generate specific recommendations that
can be implemented to advance the population agenda in Kenya in line with the countrys
development priorities as expressed in Vision 2030.
2.

Population Dynamics

Kenya was one of the first countries in sub-Saharan Africa to experience a demographic transition in
the early 1980s. However, the current situation indicates a stall in fertility decline and an upsurge in
mortality particularly at infancy. On the basis of the KIHBS 2005/06, Kenyas population in 2006
was projected at 35.51 million. In 2006, 79.9% of the population lived in rural areas compared with
20.1% in urban areas, which sharply contrasts with an urbanization rate of 18% in 1989, 15% in
1979 and 8% in 1969.
The KIHBS dataset shows that the Kenyan population exhibits a youthful age structure with 54% of
the population being under 19 years, compared with 58% in 1999; and only about 3.7% of the
population is aged 65 years and over. The total dependency ratio based on KIHBS data is about 81,
implying that 81 people in the age range 0-14 and 65 plus years depend on 100 people in the age
range 15 to 64 years. The rural population has a higher proportion of young people compared to the
urban population. The mean age of the population is 22.5 years, while the median age is 18 years.
At the regional level, the mean age varies widely from a low of 13 years in North Eastern province
to a high of 23 years in Nairobi. The average household size for urban residents was about 4.1

vi

persons, while rural household size averaged 5.6. Regionally, mean household size varies from a
low of 3.8 in Nairobi to a high of 6.2 in North Eastern province.
The main sources of population dynamics are fertility, mortality and migration. The KDHS shows
that Kenyas fertility rate was 4.9 in 2003, which is about twice the global average (2.53), although
it is slightly lower than for sub-Saharan Africa combined (5.19). Regional differentials in fertility
are closely associated with regional disparities in knowledge and use of family planning methods.
Womens schooling is strongly associated with lower fertility.
The infant mortality rate (IMR) declined from 119 deaths per 1000 live births in 1969 to 66 in 1989,
but increased to 78 in 2003. The life expectancy at birth declined from 58 years to 54 years for
males and 61 years to 57 years for females during the period 1989-1999. The upsurge in childhood
mortality has been attributed to the HIV/AIDS pandemic, poverty and low levels of child
immunization.
A stall in fertility decline occurred in Kenya between 1998 and 2003. The flattening in fertility
decline is seen throughout the country but is particularly evident among the least educated women
while those with secondary or higher education still show a modest decline in fertility. The stall in
contraceptive prevalence is seen mainly among younger women and among those with less
education.
3.

Economics of the Family

Although altruism towards blood relatives is a universal human trait (Smith, 1759; Becker, 1976;
Becker, 1981; Becker, 1991), all members of the family are not treated the same in that unit. There
is discrimination in household allocation of duties and rewards, based on gender and birth order. In
particular, girls tend to work more than their brothers, and appear to underwrite high fertility
through support to their parents in childrearing.
Strong associations exist between family structure during childhood and childrens outcomes later
in life. In particular, some family structures may be negatively correlated with health and schooling
of children.
The potential channels through which early pregnancy and childbearing are associated with
poverty include poor health outcomes for the young mother and her child, low educational
attainment for both the mother and her child, and low labor force participation by the young
mother.
The age at which women become mothers has increased to an all time high in most countries,
accompanied by a rising number of women in education and professional careers. Virtually all of
the effects of education on fertility are due to postponement of marriage and a delay from marriage
to reproduction. This delay, coupled with age effects on fecundity (the physiological capacity of a
woman to produce a child) results in low completed fertility.
The human lifecycle has two stages of dependency - childhood and old age - separated by a long
stage of surplus production. The shortfalls in old age are normally met through intergenerational
transfers from their children, but this traditional support system is under threat in low income
countries, partly due to poverty among the would-be-givers and erosion of traditions of family and
community-based transfers. The reasons for intergenerational transfers include old age support in

vii

the case of upward transfers by children, education of children in the case of downward transfers
by parents, and money to help with family sustenance.
Children are costly to their parents as are aged parents to children. However, on balance, wealth in
Kenya transfers downward from parents to children, especially in urban areas. The observed
negative association between fertility and womens labor force activity reflects the incompatibility
between caring for children and participating in economically productive work that typifies
industrialized societies. Women may also self-select themselves into sectors that are familyfriendly, which explains the tendency for women to look for employment in particular sectors.
There are costs and benefits for an additional child that are not borne directly by the parents, but
are passed on to other families and society as a whole. The sources of these externalities could be
public sector inter-age transfers (e.g. education for the young and healthcare and pensions for the
elderly), common resources or collective wealth (e.g. environmental goods), provision of public
goods or social infrastructure, and depressed wages due to excess labor. These externalities may lead
to collective failures of household decisions. Consequently, fertility outcomes at the household
level can affect macroeconomic and social systems. To deal with these externalities, institutions can
complement critical services that children provide to parents e.g. mandatory wage-based social
security systems and credit markets so that parents can save for old age.
4.

Population and Development

Scholarship on agricultural change and economic development has been greatly influenced by the
works of Malthus (1798) and Boserup (1965).
Malthus argued that rapid population increase endangers food security, while Boserup saw
opportunities for developing technologies for increasing crop yields in the face of population
pressures. Many authors agree with Boserup that increasing farm productivity to meet the needs of
a growing population is generally a precondition for improving food security and incomes in rural
areas. However, some of the negative effects of productivity-enhancing technologies include the
promotion of monocultures and the loss of genetic diversity, and increased dependence on factors
that may be ecologically harmful and unaffordable for poor farmers (e.g. fertilizers). In addition,
the cultivation of fragile, often steeply sloped terrain and slash-and-burn farming techniques result
in serious and rapid soil exhaustion, erosion and sedimentation.
Malthus and Boserup share various assumptions about the relationships among population,
technology, and resource use. The two differ primarily in their views about the origins of
technological change. Boserups view is that population growth spurs technological change, while
Malthus holds the opposite view. However, Boserup advances that slower population growth is
beneficial to economic development in most developing countries, a view in line with Malthusian
ideas.
Coale and Hoovers (1958) report on Population Growth and Economic Development in Low
Income Countries, which had a profound impact on US foreign policy, gave support to the
Malthusian doctrine.

viii

5.

Demographic Transition and the Demographic Dividend

The classical demographic transition is normally characterized by declining mortality and fertility.
Early in the demographic transition, there is a baby boom followed by a bulge of the working age
population, and finally a large cohort of elderly people, who become dependent again. When the
baby boom generation reaches working age, the dependency ratio falls, and if it is productively
employed, economic growth occurs, creating what is now referred to as a demographic dividend.
There are two demographic dividends. The first demographic dividend is associated with the
increase in the working age population, while the second dividend is associated with an increase in
savings and investment due to a desire to provide for old-age support.
Fertility normally begins to decline after mortality has dropped. The mortality decline is gradually
succeeded by reductions in fertility, because fertility decisions respond to changes in child
mortality as parents realize that they can rear fewer children and still attain their reproduction
goals such as the desired number of offspring for old-age support. This desire to control fertility is
reflected in trends in the use of contraceptives. Several authors argue that sub-Saharan countries
may find it difficult to catch up with lower levels of fertility experienced in the rest of the world.
Generally, the empirical testing of demographic transition theory focuses on discovering the
conditions which lead to the onset of the transition, but gives much less importance to its
progression and, in particular, to its end state. In addition, the demographic dividends associated
with demographic transition are earned through the right policy environment e.g. through
increased job opportunities, and social security schemes to provide for rising numbers of old people.
There is need for investment in public health and access to care; family planning and related
reproductive health policies to help families achieve their desired size; education policies to
increase access to schooling; and economic policies that promote labor market flexibility and
provide incentives for investment and savings. If appropriate policies are not formulated, the
demographic dividend might in fact be a penalty on the economy, leading instead to
unemployment and an unbearable strain on education, health, and old age security.
In recent years, the debate on whether population growth restricts, promotes, or is independent of
economic growth has emphasized the age structure of the population, since peoples economic
behavior varies by age. A high proportion of children are likely to divert resources to their care,
which tends to depress the pace of economic growth. Similarly, if a large proportion of a nations
population consists of the elderly, its effects can be similar to those of a very young population.
Rapid population growth can impede economic growth, worsen income inequality and exacerbate
poverty.
6.

Determinants of Fertility

6.1
Womens Labor Force Behavior
Womens labor force behavior lies at the heart of most explanations of fertility change, and many
nations have formulated policies based on the inverse association between these two central aspects
of womens lives. Social programmes that increase womens labor force participation have a
tendency to reduce fertility because they raise womens cost of rearing children.
6.2
Investment in Human Capital
Investment in human capital, particularly secondary and tertiary education of women, reduces total
fertility. Government policies that increase school enrolment (e.g. compulsory schooling laws) can

ix

account for variations in fertility decline. Such laws can also affect the evolution of income per
capita, average education, and the income distribution of a country over time.
6.3
Gender Relations
Unequal gender relations tend to adversely affect fertility decisions of all women as these social
norms are imposed on individuals by society. Where husband-dominated decision-making is
common, contraceptive use by women is limited.
6.4
Income Inequality
In developing countries, economic inequalities contribute to high poverty rates. Among the poor,
parents peg their hopes for the future on one of their children prospering enough to take care of
them in future. As household income improves, parents rely more on their own accumulation of
assets for old age security. A high level of income inequality is associated with high aggregate levels
of fertility.
6.5
Modes of Production and Livelihood
Stocks of physical capital, land, and other natural resources affect fertility differently from wage
income. Where income is derived from land, it is likely that fertility will remain high, because
parents might view land and labor of children as complementary factors of production.
6.6
Religion
The role of religion in fertility decisions is important in virtually all societies. Through their
influence on individuals, cultures, and policies, religions play a critical role in shaping attitudes
toward reproduction and sexuality. Religion also affects availability and use of family planning.
7.

Reproductive Health

7.1
Reproductive Health Services and Outcomes
The relationship between investment in reproductive health and economic growth can hardly be
appreciated without looking at the linkages between poverty, growth and reproductive health.
The factors influencing maternal health provision and access include household and community
characteristics, demographic and biological factors, malnutrition and infections, and health systems.
The household and community-level factors range from financial situation of the households, and
intra-household power relations.
Maternal morbidity and mortality are associated with poverty, e.g. through limited access to
antenatal and peri-natal care, malnutrition, lack of access to family planning, and incidence of
diseases that are aggravated by pregnancy and high fertility. In most countries, young women from
poor households are more likely to marry early; and are less likely to practice contraception, use
maternal health services, and prevent transmission of HIV. Moreover, they are less likely to be selfsupporting, to be enrolled in school, or exposed to regular mass media.
There are several ways through which reproductive health can be improved. For example, access to
reproductive health services can lead to changes in childbearing. The availability of modern
contraception can result in delayed first birth, longer birth intervals, or lower number of births
during a womans reproductive years. Other effects of access to reproductive health services can be
seen in womens educational attainment, schooling of children, nutrition status, migration
opportunities of household members, and household structure.

7.2
Malnutrition and Infection
A key factor affecting reproductive health is malnutrition and infections, especially protein-energy
malnutrition and micronutrient deficiencies, anemia, malaria and HIV/AIDS. Malaria is a major
source of complications during pregnancy, and is associated with spontaneous abortion and
stillbirth. Women who develop severe anemia from malaria are at increased risk of maternal death.
Iron-deficiency anemia is associated with poor pregnancy outcomes, lower resistance to infection,
decreased work capacity, and poor cognitive development.
7.3
Gender Roles
In many societies, women lack the power to negotiate sexual relationships, a situation that places
them at risk of HIV/AIDS. This is reflected in the high HIV prevalence among women compared to
men. Adolescent and youth sexual and reproductive health are shaped by socio-cultural and gender
norms, which send mixed messages about sexuality and standards of behavior for boys and girls.
7.4
Unsafe Abortion
Unsafe abortion and poverty are closely connected. Most deaths due to unsafe abortion are in poor
countries of sub-Saharan Africa and South Central Asia. Of all age groups, adolescents are
particularly vulnerable to this cause of death since they have a relatively high risk of unwanted
pregnancies and are least likely to obtain a safe, legal abortion. The Kenya Penal Code classifies
offences against morality to include abortion and assisting one to secure an abortion.
7.5
Obstetric Fistula
Direct causes of fistula include childbearing at a very early age, malnutrition, and limited access to
emergency obstetric care. Although studies suggest that obstetric fistula is prevalent in some poor
regions, its extent is not known. It remains invisible to policy makers due to the stigma attached to
it. In some communities in Kenya, obstetric fistula is closely associated with harmful cultural
practices (e.g. infibulations, early marriage and early sexual debut). An important cause of this
problem is low awareness about it among health workers and community members.
7.6
Female Genital Cutting
Female genital cutting is still rampant in many regions in Kenya. There is a trend towards its
medicalization, which has been condemned by traditionalists. They see it as a violation of the
cultural value and meaning associated with the rite; while some people see medicalization as an
impediment to its abandonment.
7.7
Adolescent and Youth Sexual and Reproductive Health
Maternal related adolescent deaths comprise almost one quarter of maternal fatalities, most of
which are due to complications as a result of unsafe abortion. Early marriage is associated with
early childbearing, which increases the potential to have many children and hence a longer
exposure to maternal death risks. Teenage pregnancy poses a threat to the health of both mother
and child, and often forces girls to drop out of school, and thus narrows their career opportunities.
7.8
Contraceptive Delivery Systems
Studies conducted in Indonesia and Zimbabwe show the importance of supply-side factors in
satisfying the unmet need for contraceptives (for fertility control or for birth spacing). The
Indonesian results showed that 75% of the fertility decline from 1982 to 1987 resulted from
increased contraceptive use. The dramatic impact of demand-side factors (education and economic
autonomy of women) on contraceptive use was possible only because there already existed a highly

xi

responsive contraceptive supply delivery systems. Zimbabwe is one of sub-Saharan Africas success
cases in family planning, where the program is largely dependent on community-based distributors
of contraceptives in rural areas and on accessible health facilities in urban areas. Research in this
area has underscored the need for outreach program in rural areas and the need to integrate
HIV/AIDS services with family planning programs.
7.9
Role of Males
Males can contribute to reproductive health of women if they take reproduction to be a dual
responsibility of both sexes, as male dominance in reproductive health and sexual decisions affects
prevention of STIs and unwanted pregnancy. A number of recent studies have documented medical
benefits of male circumcision in reducing the odds of HIV infections, but an official policy is likely
to be contested in a country where it would affect only a few communities. Moreover, male
circumcision can be harmful to health if it is performed under unsanitary conditions.
8.

HIV-AIDS and Poverty

In general, HIV/AIDS significantly undermines a households ability to provide for basic needs,
food included. HIV/AIDS deprives individuals, households, networks and communities of physical,
human and natural assets or undermines sustainability of these assets. Loss of prime-age labor, for
example, may reduce the ability of communities and user groups to collectively manage common
property resources such as rangelands. Less labor-intensive and less nutritious crops may be farmed,
or land may remain fallow for a prolonged period thereby threatening tenure rights.
HIV/AIDS has long-term consequences on fertility, education and child labor. In particular, primeage adult mortality destroys existing human capital, or weakens future generations, as children are
left orphaned, with little or no schooling, and the surviving adults are burdened by new
responsibilities.
The relationship between HIV/AIDS and fertility may be driven by the parents desire to increase
the number of children in the face of high HIV/AIDS deaths, and by their desire to reduce the
number to avoid the risk of contracting or transmitting the virus. There may be reduced
childbearing in the presence of high death rates from HIV/AIDS. There may also be precautionary
demand for children in the face of uncertainty about child survival. Parents who are faced with a
high mortality environment for young adults due to HIV/AIDS may choose to have more children
and provide each of them with less education, a situation that would lead to a reversal in
demographic transition. When households lose adult members, they also lose knowledge about
local farming systems and natural resources, and transfer of knowledge from parents to children
breaks down.
Studies of prime age mortality conducted in Kenya, Mozambique and Rwanda identify many
negative impacts of HIV/AIDS such as loss of labor, shifts in cropping patterns, and asset stripping.
The gender of the deceased adult affects the nature of crop loss. For example, grain crops are
adversely affected by adult female mortality while cash crops such as coffee, tea, and sugarcane are
adversely affected by death of an adult male. In periods of HIV/AIDS crisis, households often cope
through sale of assets such as goats and sheep. Orphanhood is a major risk factor for poverty in
adulthood, mainly through shortfalls in human capital investments during childhood.

xii

In many farming communities, women are not entitled to land in the same way as men, and the
living conditions of surviving widows and their children are drastically impaired. Even in cases
where the household is not deprived of its land, it can sell the land, or parts of it.
Data from several sub-Saharan African countries shows that poverty incidence is associated with
HIV prevalence. The burden of providing support to households affected by HIV/AIDS can drag
households providing such support into poverty.
9.

Poverty and the Environment

Kenyas economy is largely natural resource-dependent, based on agriculture, forestry, wildlife


tourism and basic manufacturing. The high population growth has had adverse effects on the
environment. In particular, it has led to encroachment of marginal lands, overconsumption of wood
fuel resources, as well as poor disposal of waste products. Rapid population growth and
urbanization have resulted in a shortage of appropriate housing, inadequate water and sanitation
services, deteriorating road and transport system, and shortage of energy supplies. The impacts have
led to falling living standards, polluted air and water, unsanitary living conditions, increasing
informal settlements and slums, wood fuel depletion, increased soil erosion, and land degradation.
Kenyas gazetted forests cover only about 1.7% of total land area, compared with the
internationally recommended minimum of 10%. It is estimated that Kenya has 650 m3 of renewable
surface water per capita, against a global recommendation of 1,000 m3 per capita, and this puts the
country in the category of chronically water scarce countries. The impact of pollution on water
resources is manifested by water of poor quality, which gives rise to water toxicity to mammals and
aquatic life, and high cost of water supply as polluted water is expensive to treat.
There are several links between environment and poverty. Locations inhabited by the poor are
often environmentally vulnerable or degraded, e.g. erosion-prone hillsides in rural areas or urban
neighborhoods with inadequate water and sanitation facilities. Moreover, pollution damages health
through water pollution, and indoor air pollution from use of biomass as household energy.
Environmental degradation depresses the ability of the poor to generate income by diverting their
labor to survival strategies such as fuel wood collection and natural resource depletion.
The most serious consequence of environmental degradation in the developing world takes the
form of damage to human health. The literature on determinants of mortality finds a strong
positive correlation between child survival and access to safe water and improved sanitation.
Degradation of rangelands and drinking water resources can increase the time cost of fuel wood,
water gathering and livestock pasturing. Since these activities are undertaken by children, and for
which they may be valued, it could provide incentives for high fertility.
10.

Poverty and Demographics

The main demographic characteristics captured by the Kenya Integrated Household Budget Survey
2005/06 include age, gender, marital status, children ever born, and children dead.

xiii

10.1
Population Structure
The Kenyan population exhibits a youthful age structure with 54% of the population under 19
years and only about 3.7% aged 65 years and over. The rural population has a higher proportion of
the young compared to the urban population.
The dependency ratios are highest in areas that have largest household sizes and the highest
proportions of households below the poverty line. The rural poor have a high dependency ratio of
98 compared to rural non-poor at about 80. Similarly, the urban poor have a total dependency ratio
of 73 compared with 52 among the urban non-poor.
The mean age of the population was 22.5 years, while the median was 18 years. In both rural and
urban areas, the mean and median ages for the non-poor were higher than for the poor. The rural
poor have a lower median age (16 years) compared to their urban counterparts (18 years). The poor
have lower median ages across all provinces compared to the non-poor.
There is a higher proportion of women with no education (45.4%) compared with 35.1% for men.
The proportions with primary education decrease with age, but the decrease is slightly steeper
among women, which is a sign of relative improvement in female education over time.
10.2
Infant and Under-five Mortality
The mortality rates are highest among male children, where 74 per 1000 die before their first
birthday and 114 per 1000 die before their fifth birthday. For the female children, 65 out of 1000
die before the first birthday and 104 die before the fifth birthday. There has been a decline in both
infant and under-five mortality rates. The 1999 census and the 2003 Demographic and Health
Survey showed a stagnation of infant mortality rate at 77, while the KIHBS 2005/06 shows a much
lower level at 70. Similarly, the under-five mortality has recorded a decline from 116 per 1000 in
the 1999 census to 109 in 2005/06. The mortality rates are higher in rural than in urban areas, but
this rural-urban mortality gap seems to be narrowing.
Both infant and under-five mortality rates decline as mothers education improves. In 2005/06, the
infant mortality rate among uneducated mothers was 75 per 1000 compared with 57 for mothers
with secondary education. Similarly, the under-five mortality among mothers with no education
was estimated at 118 per 1000 compared with 87 among mothers with secondary education.
10.3
Fertility
The estimates of fertility are normally based on the fertility reports of women aged 15-49 years.
The KIHBS 2005/06 collected information on the number of children ever born, children surviving
(both at home and away from home), and the date of birth and survival status of the last child.
The total fertility rate was about 5.0 children, with rural women recording a higher rate of 5.5
compared with 3.2 in urban areas. Fertility is higher among poor women in rural and urban areas
and is negatively associated with womens education. Between 1969-79 and 2005/06, the decline in
fertility was highest for mothers with primary or secondary education, and lowest among those
with no education.

xiv

CHAPTER ONE

INTRODUCTION

1.1

Background

The UN Millennium Summit held in 2000 and the International Conference on Population and
Development (ICPD) of 1994 agreed on a series of goals intended to improve reproductive health
outcomes and halve the number of people living in poverty by 2015. The millennium development
goals recognized that poverty is multidimensional, and hence placed time-bound targets on
education, health (including reproductive health), nutrition, water and sanitation, employment,
and social and political participation. It was appreciated that income or consumption poverty is
only one aspect of the deprivation of the right to human development. The paradigm shift brought
about by ICPD and MDGs moved towards broader human development goals, encompassing social
equity and gender equality, and altered the way development programming is done at national and
local levels.
The ICPD changed the focus of population policies, which until then had been directed at
demographic goals and regulating womens fertility. The ICPD Programme of Action emphasized
that population policies should focus on the wellbeing and quality of life of individuals and on the
right of women to make decisions about their bodies and on matters affecting their reproductive
health. Further, it advocated the need for health and population programs to have an integrated
focus centered on sustainable development and the eradication of poverty, and based on human
rights norms and standards. The empowerment of women their autonomy and self-determination
in all spheres of life, particularly with regard to sexuality and reproduction was seen as the
cornerstone of all health and population programs.
The ICPD did not adopt or recommend demographic targets, such as specific reductions in birth
rates or family size, since experience in some countries had shown that such targets could lead to
human rights abuses by overzealous administrators. Instead, the emphasis was on personal choice
and on the quality of reproductive health/family planning services. Underlying the ICPD approach
is the assumption that creating suitable conditions will lead women and their menfolk to make
the right choices in terms of birth spacing and family size.
There is concern that it will be difficult to persuade governments of the societal benefits of
investment in reproductive health without compelling scientific analysis to complement rightsbased arguments for a government role in the promotion of reproductive health and welfare.
However, research shows that investment in human capital and reproductive health will increase
the productive potential of individuals and their families.
One of the key factors hindering implementation of the ICPD Programme of Action is a
generalized lack of capacity to identify effective means of integrating a gender and rights
perspective into planning and priority-setting activities. As a result, policies and program changes
since the ICPD have tended to focus on how to bring together what are often seen as the three
legs of reproductive health: maternal health, family planning, and prevention and treatment of
sexually transmitted infections (STIs). However, reproductive health agenda involves much more

than adding a few components to existing maternal and child health and family planning programs.
It calls for concrete approaches to integrating human rights concerns, and for addressing gender
inequalities within an overall framework of equity and social justice.
The other main obstacle to better reproductive health is the international taboo that accompanies
discussion of the population factor. Although people are comfortable discussing scarcity of water,
land, food, medicines, education, the disappearance of forests, the depletion in fish stocks, trade and
sustainable development, they do not talk about population growth in the same way (Loefler,
2003).
Research has also shown that the first seven (of the eight) Millennium Development Goals cannot
be delivered without the provision of good reproductive health services. There are numerous
instances where high population growth can produce negative economic, social and environmental
impacts, and compromise key development objectives of poverty alleviation, and investment in
healthcare and education. In addition, there is a strong correlation between large family size and
instances of poverty.
High fertility rates go hand in hand with lower rates of economic growth in poor countries,
diverting resources into current consumption and away from investment in productivity. When
poor families have many children, the parents cannot invest adequately in the health, education
and nutrition of all of them. Secondly, rapid population growth puts direct stress on limited
environmental resources. Thirdly, a rapidly growing population is probably an important factor in
civil conflict, as countries where young adults (aged 15 to 29 years) represent more than 40% of the
adult population are more likely to experience an outbreak of civil conflict (Cincotta, Engelman
and Anastasion, 2003).
There are several implications of the implementation of the ICPD Programme of Action on the
MDGs. First, population and reproductive health programs and policies that reduce the unmet need
for family planning are needed so as to promote the goals of reducing poverty by half in developing
countries. Secondly, the main effects will be felt only after desired fertility falls. Thirdly, the
benefit from the potential effects in terms of poverty and fertility reductions should be
accompanied by appropriate policies that promote employment and savings and that channel
savings into productive investment. The ICPD Programme of Actions goal of eliminating the
unmet need for family planning and ensuring that reproductive health programs are universally
available are not reflected in the MDGs, although they are fundamental to the achievement of the
MDGs. The potential benefits or challenges from population change need to form a key part of the
evidence-based policy dialogue on poverty reduction, placed firmly in the context of reproductive
rights.

1.2

The Role of Demography

There is a long tradition of research on population and economics, with the most celebrated classic
being that of Thomas Malthus. Rapid population growth during the second half of the 20th century
led to renewed interest in the developmental effects of population growth. There has been a surge
of research among economists on the consequences of population aging and interest in
demographic behavior e.g. marriage, divorce, childbearing, sexual behavior, and other social
activities, mainly influenced by the work of Gary Becker (1960; 1974; 1991). The same principles
that govern traditionally modeled forms of exchange apply to demographic behavior, e.g. marriage

can be modeled as an agreement between two individuals to exchange time, material resources, and
love (Mason, 2005).
In the last fifty years, economists have also developed the overlapping generations models that
address important issues that arise with intergenerational transfers (Samuelson, 1958; Diamond,
1965), which has also brought demography and economics closer. In addition, the increased
availability of surveys and micro-level studies has greatly improved our ability to measure familial
transfers and to discover why they occur. The transfers are thought to occur from working-age
adults to dependent children and the elderly. The literature on intergenerational transfers within
families emphasizes two motives: to satisfy distributional objectives on the assumption that
individuals care about others within the family (Becker, 1974; 1976; 1981) or as implicit contracts,
e.g. grandparents watch over their grandchildren in return for support or parents expecting their
children to support them at old age. A government may also intervene to ensure a more equitable
distribution of resources e.g. by imposing mandatory minimum levels of education.
Intergenerational transfers are also in the realm of public policy, e.g. through taxation and social
security reform.
However, there is widespread concern by experts in reproductive health that the economists who
prepare plans and strategies for development in a typical developing country underplay the role of
population dynamics and reproductive health in poverty reduction. A partial explanation of this
lies in the way economists are trained, and the subject matter emphasized in most universities
curricula.
A typical graduate program in economics includes courses like resource economics, environmental
economics and economic demography, but in most cases these are electives rather than compulsory
courses. This review of how economists look at population, reproductive health and natural
resources was motivated by Dasputa (2000) on the diversity of opinion on the causal links between
poverty, population growth and natural resource base. He argues that the controversy is, in part,
brought about by the way modern theories of economic growth view fertility and natural
resources; the way population growth and economic stress in poor countries are studied by
environmental and resource economists; and the way development economists accommodate
environmental stress in the analysis of contemporary poverty.
In addition, as Dasgupta and Mler (1991; 2004) observe, there has been a puzzling cultural
phenomenon where natural scientists see in humanitys current use of Natures services symptoms
of a deep malaise, even while another group, usually economists, document the fact that people
today are on average better off in many ways than they had ever been. This debate would be
blunted if (a) use was made of a comprehensive measure of wealth to judge the performance of
economies, and (b) possible irreversibilities in ecological damages were acknowledged.
Behrman and Knowles (1998) provide a standard economic framework to evaluate population and
reproductive health policies, in an attempt to facilitate cross-disciplinary exchanges between
economists and others working in the population and reproductive health fields.
One area of study that economists, demographers and anthropologists seem to have common
concern is in the theory of demographic transition and the so-called demographic dividend.
According to Kohler et al (2002), the majority of the worlds population is living in countries with
near-replacement or below-replacement fertility. For example, at the end of the 1990s, 14 countries
in Southern, Central, and Eastern Europe with a total population exceeding 370 million had total

fertility rates (TFR) below 1.3. The emergence of lowest-low fertility in Europe has emerged
mainly from the postponement of fertility. In contrast, TFR level in the United States is close to 2.1,
and is characterized by rarity of high-order births (4 births plus), a substantial proportion of
childless women, delayed childbearing, and a substantial proportion of births to unmarried women
(Morgan, 1996).
The demographic transition is normally characterized by declining mortality and fertility. Initially,
improvements in medicine and public health, nutrition, and the wider practice of healthier
behaviors gradually lead to higher life expectancies and lower infant mortality rates. The mortality
decline is gradually succeeded by equally dramatic reductions in fertility, since fertility decisions
seem to respond strongly to changes in child mortality as parents realize that if fewer children are
likely to die in childhood, they can give birth to fewer children to attain their desired number of
offspring. This desire to control fertility is reflected in trends in the use of contraceptives. If
children have a higher chance of survival and a long life expectancy, it is wise to invest intensively
in them, and the major form of investment is education, which inevitably leads to more educated
women and thus reinforces the likelihood that families will become smaller as womens time
becomes more valuable.
In the theory of the demographic dividend, the demographic transition is accompanied by an
extended period during which the labor force grows more rapidly than the population. But as the
demographic transition proceeds, the population growth rate declines more rapidly than the labor
force growth rate. The labor force grows more rapidly than the population because of favorable
changes in age structure (higher proportion of the working-age population) and in increased female
labor force participation. Human capital (e.g. secondary school enrolment) has been seen as an
important determinant of economic growth, while the number of children and investment in their
human capital are jointly determined by changes in real income and prices. Human capital
investment in women has increased their ability to regulate fertility.
The transmission mechanism between inequality and growth is thought to take place through
differential fertility and the accumulation of human capital. Families with less human capital
decide to have more children and invest less in their education. When income inequality is high,
large fertility differentials lower the growth rate of average human capital, since poor families who
invest little in education make up a large fraction of the population in the next generation, thus
affecting the overall growth. In this framework, it is not overall population growth, but the
distribution of fertility within the population which is important. In this regard, policies aimed at
equalizing access to education would be more effective compared to traditional income
redistribution policies.

1.3

Population Dynamics, Environment and Poverty

The United Nations Population Fund is mandated, in line with the ICPD Programme of Action, to
support countries in using population data for policies and programs to reduce poverty and to
ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS,
and every girl and woman is treated with dignity and respect. Based on its mandate, UNFPA is
expected to take a key role in ensuring that countries attain the MDGs as a measure to improve the
quality of life. The UNFPA supports efforts to determine evidence-based linkages between
population, development and poverty. It is against this background that the assessment of
population and poverty linkages was carried out. The findings of the assessment provide valuable

information for strengthening capacities of UNFPA, the Government and development partners to
dialogue on issues of population dynamics, MDGs and sustainable use of the environment.
The report documents the linkages between population dynamics, poverty and environmental
changes. It provides evidence on how poverty status determines differences in population and
health outcomes.
The report provides insights into processes of human capital formation in a context of a
predominantly young population. The trends of the transition of young age groups to productive
age structures are analyzed.
Evidence is also provided on how reductions in mortality come from utilization of improved health
services and reductions in fertility, and the critical part played by economic growth and equitable
policies in improving health.
The report shows how decline in the relative size of the working age population inhibits economic
growth, a situation that is currently facing many countries in sub-Saharan Africa due to effects of
HIV/AIDS pandemic.
The report argues that the environment is a major area of concern in the achievement of MDGs
given its links to poverty and health outcomes, and because reproductive health and environment
both appear as orphans in the international development agenda despite their centrality in the
achievement of MDGs. Population and poverty are inextricably linked to the environment, as
environmental degradation leads to poverty. At the same time, extreme poverty levels affect the
environment. Indeed, the idea of sustainable development entails improvement of the wellbeing of
the current population without destroying or degrading natural resources.

1.4

Methodology

Although Kenya has a rich database on population and poverty compared to other sub-Saharan
African countries, a number of challenges still exist. For example, some sources of data cannot
provide reliable measures of poverty (DHS, Census) particularly measures related to income, while
household budget surveys are rich in poverty-related data but may be insufficient to generate
measures related to population dynamics and its determinants. The available nationally
representative data has also not been analyzed in detail to provide reliable indicators of the nexus
between poverty and population dynamics and its correlates.
Additional evidence to support the arguments of the report was obtained from an extensive review
of the literature. Although there are several existing datasets in Kenya that can provide information
on population dynamics, the environment and poverty linkages, most of the analysis so far
conducted was not specifically designed to provide answers on these linkages. The data from the
Kenya Integrated Household Budget Survey 2005/06 and the national welfare monitoring surveys
conducted in the 1990s provided valuable evidence on poverty rates and trends in Kenya.

1.5

Organization of the Report

Chapter two presents a brief overview of Kenyas population dynamics, in an attempt to show
whether Kenya has a population problem. Chapter three presents the economics of the family, as
the family is the social environment where gender and reproductive issues and problems are
usually resolved. Chapter four presents contrasting paradigms on agricultural change, anchored on
two small books with enormous impacts, namely the works of Thomas Malthus (1798) and Ester
Boserup (1965). Chapter five briefly touches on the demographic transition, and investigates several
links between population change and economic growth, namely, public education, womens
education and empowerment, contraceptive use, optimal age at marriage, religion, and how main
source of income (or inheritable capital) relates to fertility.
Chapter six starts by defining the elements of reproductive health and reproductive rights as agreed
at the ICPD in 1994, and investigate the relationships between investments in reproductive health
and economic growth and poverty reduction, with particular reference to teenage childbearing,
contraception, use of maternal health services, abortion, obstetric fistula, unequal gender roles, and
potential male contribution to reproductive health. Chapter seven presents findings on HIV/AIDS
and poverty, while Chapter eight focuses on the relationship between environment and poverty.
Chapter 9 reports on the findings on poverty and demographic characteristics based on the KIHBS
2005/06. Chapter ten summarizes the findings of Chapters 2 to 9.

CHAPTER TWO

KENYA: POPULATION DYNAMICS

2.1

Overview

Kenyas population was 28.7 million in 1999 but is currently projected at 38 million. The Kenyan
population growth rate rose steadily from about 2.5% per annum in 1948 to around 3.8% per
annum in the 1980s. In the mid-1980s the growth rate declined to the current level of 2.9% per
annum. The initial rise in population growth rate was attributed to high and rising fertility with
rapidly declining mortality rates. The change in population growth rate in the 1980s was attributed
to declining fertility and almost constant mortality. The growth rate of the population at the
current level (2.9% p.a.) is still considered high, with an approximate doubling time of 15 years.
This implies that by the year 2030 the population will be about 65 million. The changing size and
age structure has implications for resources needed to reduce poverty as well as provide safeguards
against shocks to families.
Kenya was one of the first countries in sub-Saharan Africa to have begun a rapid demographic
transition in the early 1980s. Table 2.1 shows the trends in demographic indicators for the last 50
years. The crude death rate (CDR) decreased from 17 to 14 per 1000 from 1969 to 1979 but stood at
11.7 in 1999. The current situation indicates a stall in fertility decline but an upsurge in mortality,
particularly at infancy.
Table 2.1: Kenyas Demographic Indicators
Period
1948
1962
1969
1979
1989
1999
Population (millions)
5.4
8.6
10.9
15.3
21.4
28.7
Total fertility rate
6.0
6.8
7.6
7.9
6.6
5.0
Crude birth rate (per 1000)
50.0
50.0
50.0
52.0
48.0
41.3
Crude death rate (per 1000)
25.0
20.0
17.0
14.0
11.0
11.7
Infant mortality rate (per 1000)
184.0
Na
118.0
104.0
66.0
77.3
Annual growth rate (percent per annum)
2.5
3.0
3.3
3.8
3.3
2.9
Life expectancy at birth (years)
35.0
44.0
49.0
54.0
60.0
57.0
Source: Compiled from the 1948, 1962, 1969, 1979, 1989 and 1999 Kenya Population Census
Reports

2.2

Age Structure

As a result of high growth rates in the 1970s and early part of 1980s, the population below the age
of 24 years in 1999 was about 18.8 million, representing 66% of the total population. Children
below 18 years made up 53% of the population, while those between 10 and 24 years comprised
36% of the total population. The population of the age group 10-24 years stood at about 12 million
(34%). Available projections indicate that the proportion will remain constant by 2020 but the
absolute size will be approximately 14 million. Although old age dependency is low, the child

dependency will continue to be high arising from the high fertility rates. Currently, the number of
working adults per dependant child is about 1.3 and is expected to reach 1.8 by 2030 (PRB, 2007).
There are several health and economic challenges facing young people, including HIV/AIDS, early
childbearing and unemployment.
The population of the elderly (55 years and above) stood at about 2.2 million in 1999, about 6.3% of
the total population, majority of whom were women (57%). Social and economic support systems
are needed to avoid poverty among the elderly.

2.3

Components of Population Change

2.3.1 Fertility
Population growth rate in Kenya is driven by high fertility. Regional differentials in fertility
indicate that most of the provinces except Central and Coast experienced an increase in fertility,
with Nyanza recording the highest increase (CBS, 2004). Thus apart from the stall in fertility
decline, the increase in fertility especially in areas affected by HIV/AIDS is a matter of concern.
In 1999, the total fertility rate among the poor was more than twice the rate among the non-poor
(7.6 versus 3.1). The mean age at first birth stood at 18.6 years in 1999 but was 3 years lower than
among women in the wealthiest group. The median age at first marriage was four years lower than
the median age for the wealthiest group. Despite early entry into motherhood, the contraceptive
prevalence rate among the poor was 12% compared with 45% among the wealthiest group. The
continued high fertility among the poor has diverse consequences. Children from poor families are
1.6 times more likely not to reach their fifth birthday. Poor women are also less likely to utilize
reproductive health services.
Most women in Kenya want fewer children compared to the past, and contraceptive prevalence
rates for modern methods have stalled at around 32%, but with varying regional and social strata
differences. The proportion of births that are mistimed (wanted later) has stagnated at 25% with
higher proportions among the poor and uneducated, while unplanned fertility (unwanted and
mistimed) has remained at about 44%.
Table 2.2 shows that Kenyas fertility rate is about twice the global average (2.53), although it is
slightly lower than for sub-Saharan Africa combined (5.19). The data also shows that low income
countries have a higher total fertility rate than middle income countries, which in turn have a
higher rate than high income countries.
Table 2.2 also includes South Africa and Zimbabwe as examples of countries in east and southern
Africa where fertility is lower and contraceptive prevalence higher than in Kenya. Zimbabwe is
one of sub-Saharan Africas success cases in family planning, where the program is largely
dependent on community-based distributors of contraceptives in rural areas and the utilization of
stationary facilities in urban areas. The Zimbabwean study by Muhwava (2003) underscores the
need for outreach programs in rural areas so that a large proportion of women can access
contraceptives.

Table 2.2: A Global Comparison of Fertility and Per Capita Income, 2006
Region

East Asia &


Pacific
Europe &
Central Asia
Latin America
& Caribbean
Middle East &
North Africa
South Asia
Sub-Saharan
Africa
Low income
countries
Middle
income
countries
High income
countries
World
Kenya
Tanzania
Uganda
Zimbabwe
South Africa

Fertility rate,
total (births per
woman)
1.96

GNI per capita,


Atlas method
(current US$)
2,180

Adolescent fertility rate


(births per 1000 women
ages 15-19 years)
16

Contraceptive prevalence
rate (% of women ages
15-49 years)
78

1.62

6,051

29

63

2.39

5,540

77

67

2.88

2,794

31

60

2.79
5.19

880
952

68
121

53
22

4.29

578

97

33

2.21

2,872

42

69

1.72

37,566

22

64

2.53
4.97
5.26
6.70
3.80
2.73

7,958
680
400
340
340
5,760

53
104
123
156
62
63

60
39
25
24
60
56

Note: Gross national income (GNI) is the sum of the value added by all resident producers plus any product
taxes (less subsidies) not included in the valuation of output plus net receipts of primary income
(compensation of employees and property income) from abroad. The Atlas method refers to the system used
to convert GNI in local currency to US dollars.

Source: World Bank, World Development Indicators 2008


2.3.2 Childhood Mortality
The infant mortality rate (IMR) declined from 119 deaths per 1000 live births in 1969 to 88 and 66
in 1979 and 1989, respectively, but increased to 78 in 2003. The life expectancy at birth declined
from 58 to 53 years for males and 66 to 60 years for females between the intercensal periods 197989 and 1989-99.
The most striking change in childhood mortality is the continued upsurge and the wide regional
and social class differences in the risk of child deaths. The upsurge in child mortality has been
attributed to the HIV/AIDS pandemic, poverty, and the level of child immunization. Children aged
12-23 months receiving full vaccination against vaccine-preventable diseases fell from 65% in 1998
to 60% in 2003. The continued upsurge in childhood mortality is not likely to trigger further
fertility declines because of the close linkages between fertility and mortality in the demographic
transition.

Table 2.3: Trends in Infant and Under-five Mortality by Sex, 1989-2003


1989
1993
1998
Infant Under-five Infant Under-five Infant Under-five

2003
Infant Under-five

Males
63
96
67
97
75
108
Females
54
86
59
89
67
103
Total
60
89
62
96
74
112
Source: Kenya Demographic and Health Survey, 1989, 1993, 1998, 2003

84
67
77

122
103
115

Table 2.4: Trends in Childhood Mortality by Region and Education of the Mother
Socioeconomic
characteristic

1993
Infant
Under-five
mortality
Mortality

1998
Infant
Under-five
mortality
Mortality

2003
Infant
Under-five
mortality
Mortality

Residence
Urban

46

75

55

88

61

93

Rural

65

96

74

109

79

117

Nairobi

44

82

41

66

67

95

Central

31

41

27

34

44

54

Coast

68

109

70

96

78

116

Eastern

47

66

53

78

56

84

Nyanza

128

187

135

199

133

206

Rift valley

45

61

50

68

61

77

Western

64

110

64

123

80

144

No education

66

100

82

123

80

127

Primary
Incomplete

80

121

91

138

97

145

Primary complete

57

79

61

87

69

98

Secondary

34

54

40

60

44

63

Kenya

63

93

71

105

77

115

Province

Education

Note: The rates are per 1000 live births


Source: Kenya Demographic and Health Survey, 1993, 1998, 2003
2.3.3 Internal Migration and Urbanization
The urban setting today is a complex and dynamic environment dominated by three interrelated
characteristics: rapid rate of urban growth, upsurge in urban poverty, and the proliferation of
slums. The continued high rate of urbanization has led to urban poverty, poor provision of urban
services, considerable strain on the existing urban infrastructure, an increase in the number of
street children, urban unemployment, urban transportation problems, displacement of persons,
urban crime, proliferation of slums, and urban environmental degradation. Other issues include the
relationships between migration and diseases, HIV/AIDS pandemic, and breakdown of families.

10

2.4

The Stall in Fertility Decline

A stall occurred in the decline of fertility between 1998 and 2003 (Westoff and Cross, 2006). Before
then the fertility rate had been declining and contraceptive prevalence had been increasing for a
quarter of a century. The stall or reversal of the fertility decline is seen throughout the country but
is particularly evident among the least educated women while women with a secondary or higher
education still show a modest decline in childbearing (Westoff and Cross, 2006). The slowdown in
contraceptive prevalence is seen mainly among younger women and those with less education. The
use of oral contraceptives, intra-uterine devices (IUD), and sterilization declined over the preceding
decade while the use of injectables increased. There was a decline in the proportion of women who
had sex in the four weeks preceding the survey, which may be related to the high prevalence of
HIV/AIDS. Another factor underlying the stall in contraceptive prevalence and decrease in fertility
is the observed decline in the proportion of women who want no more children, a marked
departure from the steady increase in this variable since 1977. HIV/AIDS may have a role in the
reversal of reproductive preferences because it has contributed to the increase in child mortality.
Several authors concur that total fertility in Kenya is unlikely to level out at less than 3 births per
woman in the near future (Blacker, 2002).
According to the Kenya Demographic and Health Survey 2003, TFR was 4.9 children per woman
for the three-year period preceding the survey, with 5.4 in rural areas and 3.3 in urban areas.
Fertility was lowest in Nairobi (2.7) and highest in North Eastern province (7.0). Fertility in Central
province is relatively low (3.4) compared with Nyanza (5.6), Rift Valley (5.8) and Western (5.8).
Regional differentials in fertility are closely associated with regional disparities in knowledge and
use of family planning methods. Womens education is strongly associated with lower fertility,
with TFR of 6.7 for women with no education and 3.2 for women with some secondary education.

11

CHAPTER THREE

ECONOMICS OF THE FAMILY

3.1

Introduction

Bianchi and Casper (2000) analyzes the American family in the latter half of the 20th century to
better understand what changes in the family portends for the first half of the 21st century. The
study covers changing economy and society (changing family norms, an aging society), family
structure and living arrangements, parenting (single mothers, fathering, father-only families,
grand-parenting, wellbeing of single-parent families), income and poverty (poverty, childrens
material hardship, increase in family income inequality, economics and change in family life), and
blending of work and family (housework, child care, attitudes about womens work and family).
The concerns mentioned in Bianchi and Casper (2000) have been studied by economists in the last
twenty years, and broadly correspond with the themes covered in this chapter.
This chapter presents the economics of the family, as the family is the social environment where
gender and reproductive issues and problems are usually resolved (Yotopoulos, 1980). Economic
models of consumer demand and labor supply begin with an individual economic agent choosing
actions that maximize his or her utility function subject to a budget constraint. The multiplicity in
decision making in the family is dealt with through either the common preference approach
(treating the family as though it were a single decision-making agent) or by modeling family
demands as a solution to a bargaining game (Manser and Brown, 1980; Lundberg and Pollak, 1996).
One cannot satisfactorily examine human resource investments without analyzing how resources
are distributed within the family.
The chapter covers the issue of altruism towards blood relatives, unitary versus collective models of
household resource allocation, violation of unitary model of the household through gender and
birth order discrimination in allocation of household resources, and intergenerational transfers. The
chapter also examines out-of-wedlock children and teen childbearing.

3.2

Altruism

Adam Smith (1759) observed that every man feels his own pleasures and pains more than those of
others (see also Bergstrom, 1996; and Rothschild, 2001). After the self come the members of his
family, those who usually live in the same household, his parents, his brothers and his sisters. The
sympathies are directed more strongly toward his children than toward his parents.
Economic theory assumes that self-interest dominates all other motives. According to
sociobiologists and economists, altruism toward siblings, children, grandchildren, or anyone with
common genes is one of the enduring traits of human behavior (Becker, 1976; Becker, 1981).
Rationality related to genetic selection has been added to individual rationality familiar to
economists.
For example, Bergstrom (1996) starts by saying that the sympathies and affections of most people
are entangled in a web of family relations. He outlines a genetically-based theory of evolution of

12

interpersonal sympathy among family members, and reviews the literature on the relationship
between demographic transition and intergenerational flows of wealth, and on conjugal structures
(mainly monogamy and non-monogamy). Despite the fact that altruism towards blood relatives is a
universal feature in all societies, there are competing interests and discrimination in the way
resources are distributed within the family.

3.3

Unitary versus Collective Models of the Household

Common preference models assume that family members behave as if they are maximizing a single
utility function, so that demand behavior depends on total family income and not the incomes of
individual members. However, a number of studies also focus on intra-household allocation of
resources (Lundberg and Pollak, 1996). A good summary of the policy implications of unitary
versus collective models of the household is provided in Alderman et al (1995), where the unitary
model assumes that what matters is the income the household receives and not the identity of the
individual recipient, while the collective model is based on bargaining between household
members and therefore the individuality of the household member is important. At the extreme,
domestic violence can even be viewed as a dictatorial version of the unitary household model.
For example, market-based development efforts frequently create opportunities to generate income
from goods previously produced and consumed within the household. A study in a nomadic
pastoral setting in Kenya (McPeak and Doss, 2006) shows that household decisions are contested
rather than cooperative, with husbands resisting the ability of their wives to move milk from
current cultural institutions into the market domain, possibly because they do not share the
benefits.
Edmonds (2006) considers the relationship between sibling composition and child labor (childminding, cooking, and cleaning) in Nepal. The study found that girls, especially older girls, tend to
work more than their brothers. As household sizes increase, the extra work associated with being
an older girl increases significantly. The extra work performed by girls is such that at the modal
birth spacing, the younger girl actually spends significantly more time working than her older
brother. In particular, the type and amount of work performed by older siblings is correlated with
the gender of younger siblings, with adding a younger boy to a household leading to more time
spent in market work such as agriculture or wage employment compared with adding a younger
girl.
Studies have also been conducted on whether there are differences in the allocation of household
resources depending on the gender of the child and if these differences vary with the gender of the
parent. The main reasons why allocation of resources by gender matters is because nutrition and
socialization in childhood largely determine ones health and station later in life, other factors
being equal. This is best illustrated by a quote from William Wordsworth (in his poem My Heart
Leaps Up When I Behold, 1802) that the child is the father of the man, as man is the outcome of
the child (Mackenzie, 1906; Harris, 2001) see also Morton (2004) ingenious application of the
concept to maternal anthropometry. The society takes over from parents to discriminate against
those of low stature, regardless of whether the stature is due to genes or poor feeding in childhood.
For example, based on US and British data, Case and Paxson (2008) show height to be highly
correlated with labor market success (see also Steckel, 1995; and Strauss and Thomas, 1998). On
average, American men in white collar occupations are an inch taller than men in blue collar

13

occupations. Among 30-year-old men in the UK, those working in professional and managerial
occupations are significantly taller than those in skilled non-manual jobs, who in turn are taller
than those in manual occupations. Results for women are quite similar. Taller people also have
higher average incomes and earnings. The study confirmed earlier studies of the U.S. labor market,
which showed that this also affects the status of people in the same profession e.g. that bishops are
taller on average than preachers and sales managers are taller than salesmen, with similar results for
lawyers, teachers and railroad employees (Gowin, 1915, chapter 3).
A study of malnutrition and gender relations in Western Kenya (Whyte and Kariuki, 1991) shows
perceived nutrition problems as embedded in gender and family relations. In the context of marital
and familial conflict, a woman may leave home for a period of time and leave the children under
the care of someone else; husbands may devote all their attention and resources to another wife (or
woman); men who are away working may neglect their wives and children; husbands who are at
home may not always be supportive; and adopted children may be neglected.
3.4

Sibling Competition for Resources

As observed by Schultz (1997), parents can prefer boys over girls for at least three reasons. First, net
economic productivity of boys may exceed that of girls, given their respective childrearing and
human capital investment costs, e.g. returns to boys education could exceed that of girls in the
labor market and at home. Secondly, the remittances rate to parents may differ such that old age
insurance value of boys exceeds that of girls. Thirdly, the non-economic value of boys may exceed
that of girls; for example, perhaps boys can perform certain customary rituals at the death of
parents or maintain the family line.
Biology also creates birth order effects, e.g. maternal depletion (which puts children of high birth
order at a disadvantage) and parental inexperience in childcare (which puts children of low birth
order at a disadvantage). For example, Ejrns and Portner (2004) develop a model of intrahousehold allocation with endogenous fertility, which captures the relationship between birth
order and investment in childrens schooling. It shows that a birth order effect in intra-household
allocation can arise even without assumptions about parental preferences for specific birth order
children or genetic endowments varying by birth order. The implications of the model are that
children with higher birth order (i.e. are born later) have an advantage over siblings with lower
birth order, who are born earlier. The paper thus attempts to integrate models of fertility with
models of intra-household allocation, since birth order is the realization of the parents fertility
decisions. The number of children is endogenously determined by parents, who take into account
their budgetary constraints, the genetic endowments of existing children, and their expectations
about the genetic endowments of possible future children.
3.4.1 Gender and Birth Order
Duncan Thomas (1994) used household survey data from the United States, Brazil and Ghana to
examine the relationship between parental education and child height, an indicator of health and
nutritional status. In all three countries, the education of the mother has a bigger effect on her
daughters height; paternal education, in contrast, has a bigger impact on his sons height. In Ghana,
relative to other women, the education of a woman who is better educated than her husband has a
bigger impact on the height of her daughter than her son. In Brazil, womens non-labor income has
a positive impact on the health of her daughter but not on her sons health. If relative education of
parents and non-labor income are indicators of power in household allocation decisions, then these
results suggest that gender differences in resource allocation reflect both technological differences

14

in childrearing and differences in the preferences of parents. It all goes to show that there is a
difference in allocation of household resources depending on whether the money comes from the
purse or the wallet.
Using survey data on family health and nutrition in Brazil, Thomas (1990) shows that unearned
income (e.g. from social security and pensions, returns on financial or physical assets) in the hands
of a mother has a bigger effect on her familys health than income under the control of the father;
for child survival probabilities the effect is almost twenty times bigger. There was also evidence for
gender preference: mothers prefer to devote resources to improving the nutritional status of their
daughters, fathers to sons. The maternal income effects for both sons and daughters are much
higher than the effect of paternal income.
Using household survey data from Chile, Rubalcava and Contreras (2000) present evidence of how
nutritional status of the child is determined by birth order in the family and whether being a son or
a daughter reflects how parents allocate the resources. The results showed that mothers give more
resources to their daughters and fathers to their sons. This gender polarity was more significant for
non-oldest daughters and non-oldest sons, reflecting perhaps infant-order experience in childcare
specialization.
The gender bias in resource allocation can also affect aggregate population sex ratios. Qian (2008)
uses plausibly exogenous increases in sex-specific agricultural income caused by post-Mao reforms
in China to estimate the effects of total income and sex-specific income on sex ratios of surviving
children. The results show that increasing income alone has no effect on sex ratios. In contrast,
increasing female income, holding male income constant, increases survival rates for girls;
increasing male income, holding female income constant, decreases survival rates for girls.
Moreover, increasing the mothers income increases educational attainment for all children, while
increasing the fathers income decreases educational attainment for girls and has no effect on boys
educational attainment.
Rosenzweig and Wolpin (2000) summarize the findings of Butcher and Case (1994) on child gender
as a schooling instrument and the quality-quantity tradeoff. Butcher and Case suggest that natural
variation in the sex of siblings, in particular whether a girl has any sisters, can be used to obtain an
estimate of the schooling return, and how exogenous gender differences in the return to human
capital can affect parental human capital investments in a given child. If boys receive a higher
return to each level of schooling, we should expect to see not only that boys receive more
education, but also that the presence of sons reduces the educational attainment of daughters. In
addition, the gender of ones siblings may affect a childs preferences for schooling investments,
with girls who have brothers perhaps adopting masculine traits and vice-versa. For this reason,
they found that girls who have sisters have lower school attainment than do girls with no sisters.
However, unlike Butcher and Case (1994), Angrist and Evans (1998) present evidence that parents
do prefer mixed-gender families, as parents of same-sex siblings are more likely to go on to have an
additional child.
In many economies, returns to investing in sons are higher than investing in daughters, often due
to cultural practices and labor market imperfections rather than inherent productivity differences.
As a result, children will fare better when a greater fraction of their siblings are female rather than
male. For example, data from a large household-level data set from Ghana yields predictions that
enrollments in secondary schooling improve by over 50% when children move to all-sister
households from all-brother households (Garg and Morduch, 1998). Similarly, measures of health

15

outcomes would increase by 30% to 40% under the same change. The results suggest that
improving market conditions can greatly increase human capital investments, even when a familys
lifetime resources remain unchanged. Accordingly, from the point of view of both female and male
children, it is better to have more sisters than brothers. Policies that reduce market imperfections
can thus be effective in improving child health and education.
Krdar et al (2007) investigate the effects of sibship size, birth order and sibling sex composition on
childrens school enrollment in urban Turkey. The results indicate that the negative correlation
observed between sibship size and school enrollment among urban Turkish households does not
have a causal interpretation. However, there is evidence for a parabolic impact of birth order where
middle-born children fare worse, except for the top 15% of the income distribution. A higher
fraction of older male siblings decreases the enrollment probability of female children in poorer
households, and has the opposite effect in the wealthiest families. The finding that birth order and
sibling sex composition matters more for poorer households suggests that scarce financial resources
are the underlying cause of the sibling composition effects.
Dahl and Moretti (2008) show how parental preferences for sons to daughters affect divorce, child
custody, marriage and shotgun marriage when the sex of the child is known before birth, and
fertility stopping rules. They found that parents with girls are significantly more likely to be
divorced, that divorced fathers are more likely to have custody of their sons, and that women with
only girls are substantially more likely to have never been married. Perhaps the most striking
finding is that, for those who have an ultrasound test during their pregnancy, mothers carrying a
boy are more likely to be married at delivery. In addition, for families with at least two children,
the probability of having another child is higher for all-girl families than all-boy families. They also
found that the gender bias is largely driven by men. The international evidence presents a similar
picture. The parental sex bias is largest for China and Vietnam, and smallest for the U.S., with
Mexico, Colombia and Kenya in between. They conclude that the bias for boys may lead to worse
outcomes for daughters, since existing evidence shows that children from divorced families are
more likely to grow up in poverty, drop out of high school, become parents while teenagers, or be
unemployed.
It has also been suggested that intra-household distribution of food discriminates against women
and young children, and that in most developing countries this discrimination increases at times of
shortage. However, a study in Bangladesh (Abdullah, 1989) did not find evidence that the pattern
of intra-household distribution of food is affected by seasonal fluctuations in the availability of food
insofar as adult men and women are concerned. Although young boys normally receive a larger
share of family food resources than young girls, young girls tend to receive a larger share of family
food at times of shortage, ostensibly in order to increase their attractiveness in the marriage market.
Booth and Kee (2009) used a recent British Household Panel Survey to explore the degree to which
family size and birth order affect a childs subsequent educational attainment. They found that
sibling shares decrease with birth order, and children from larger families have lower levels of
education. If on average children from smaller families achieve higher educational qualifications,
the increase in the proportion of small families will undoubtedly lead to an increase in the
countrys stock of human capital. And since higher levels of human capital translate into higher
growth rates, then lower fertility rates could well be associated with higher per capita GDP growth
rates through their impact on educational attainment.

16

3.4.2 The Twins Experiments and other Natural Experiments


According to Rosenzweig and Wolpin (2000), the costliness of, and limitations on, experiments
involving human subjects has been a major constraint on the progress of economic science, on
subjects such as the effects of schooling or work experience on earnings or of income on savings.
This is mainly attributed to the fact that the variation in many of the variables whose effects are of
interest may not be observable e.g. pre-existing or endowed skills and preferences. In recent years,
economists, in recognition that nature provides almost perfect randomness with respect to
important variables, have ingeniously exploited naturally random events as instrumental variables
e.g. twin births, human cloning (monozygotic twins), birth date, gender, and weather events. The
twins experiments have been used to test the effect of nurture on child outcomes, returns to
schooling (assuming equal genetic endowments among monozygotic twins), and on the parents
realized fertility. The identification of people who are actually identical but who, for whatever
reason, obtain different levels of human capital has been an exciting research industry in the socalled natural experiments.
For example, Sanders, Hotz and McElroy (2005) exploit a natural experiment associated with
human reproduction to identify the effect of teen childbearing on subsequent educational
attainment, family structure, labor market outcomes and financial self-sufficiency. The authors
exploit the fact that a substantial fraction of women who become pregnant experience a miscarriage
(spontaneous abortion) and thus do not have a birth. They used women who had a miscarriage in
their teens as a control group with which to contrast teenage mothers. They found adverse
consequences of teenage childbearing immediately following a teen mothers first birth, but these
negative consequences appeared short-lived. By the time a teen mother reaches her late twenties,
she appears to have only slightly more children, is only slightly more likely to be a single mother,
and has no lower levels of educational attainment than if she had delayed her childbearing to
adulthood.
Ashenfelter and Krueger (1994) conducted a survey to contrast wages of identical twins with
different school levels. The data indicated that an additional year of schooling increases wages by
12-16%.
Li et al (2008) tested the tradeoff between child quantity and quality within a family using data
from the Chinese Population Census. They found a negative correlation between family size and
child educational attainment (even after controlling for the birth order effect), and having a twin
birth leads to a higher parity, which ranges from 0.6 to 0.9.
Using the 1994 and 1997 Kenya Welfare Monitoring Surveys, Schultz (2005) found that having
twins appears to increase a womans number of children by 0.74 in 1994 and by 0.89 in 1997,
suggesting that the average Kenyan couple is able to offset, through birth control and other
compensating behavior, between 26% and 11% of the effect of the unanticipated birth of twins, as
it affects their cumulated fertility at the time of the survey.
The twins experiments are already producing results that challenge conventional wisdom. For
example, Behrman and Rosenzweig (2002) study using monozygotic (identical) female and male
twins did not find significant effect of maternal schooling after controlling for womens earnings
and schooling of their husbands.

17

3.5

The Demand for Children

The observed negative correlation between fertility and household income has been mainly
explained through (a) the quality-quantity tradeoff, which acknowledges that parents demand
children but also children with certain qualities, and (b) the importance of parental time, especially
that of mothers, in the rearing of children. The concept of child quality treats children as selfproduced consumer durables, and the quality is indexed by expenditure per child. A second major
reason for a negative relationship between income and fertility is the hypothesis that higher
income is associated with a higher cost of female time, either because of increased female wage
rates or because higher household income raises the value of female time in non-market activities.
In these models, an exogenous decrease in infant and child mortality (e.g. through improved health
systems) is interpreted as a shift in the supply of surviving children, and is hence positively
correlated with fertility.
This model of demand for children has been extended to allow for childrens contribution towards
their upkeep and the cost of fertility control. Farm families tend to be larger than urban families
since the net cost of children is reduced if they contribute to family income by performing
household chores, in family business, or working in the marketplace (Meeks and Lee, 1979).
The cost of fertility control include out-of-pocket costs, time costs in their execution (e.g. visit to
physician to obtain prescription) and psychic costs (e.g. if using a condom reduces the pleasure of
sexual intercourse). In addition, the choice of contraception method is based on a balance between
the costs of contraception and the benefit of preventing a birth temporarily or permanently.
Consequently, a couple who wants to terminate childbearing is more likely to incur the costs than a
couple that is just attempting to space births.

3.6

The Impact of Family Structure on Child Quality

Many studies have reported significant empirical associations between family structure during
childhood and childrens outcomes later in life. It may be that living in a non-intact family has
adverse consequences for children. On the other hand, it may be that some unobserved processes
jointly determine family structure and childrens outcomes.
3.6.1 Infant Health Outcomes
Heiland and Liu (2006) examine the role of the relationship between the biological parents in
determining child wellbeing, focusing mainly on infant health and behavioral developments. The
main findings are that children born to cohabiting biological parents realize better outcomes, on
average, than those born to mothers who are less involved with the childs biological father.
Furthermore, children born to cohabiting or visiting biological parents who end their relationship
within the first year of the childs life are up to 9% more likely to have asthma by age one
compared to children whose biological parents remain (romantically) involved. Stressful life events,
such as parental relationship conflicts, have been found to be associated with asthma onset among
infants, mainly through parents coping abilities that translate into inadequate parenting.
3.6.2 Schooling
Manski et al (1992) studied empirical associations between family structure during childhood and
childrens outcomes later in life (measured by high school graduation). The empirical analysis

18

strengthens the evidence that living in an intact family increases the probability that a child will
graduate from high school; and that the probability of high school graduation increases markedly
with both parents education, regardless of family structure.
Joshi (2004) estimated the impact of female-headship on childrens schooling in Matlab,
Bangladesh. Female household-heads fall into two broad groups: widows and married women. The
results indicate that children residing in households headed by married women have stronger
schooling attainments than children in other households, while children of widows are more likely
to work outside the home.
Using US data, Bethke and Sandefur (1998) examine the effects of family structure and school
changing on attendance during high school and educational continuation through college entry.
The results indicate that adolescents who live with one parent, one parent and another adult, or
neither parent are more likely to miss school, be late for school, and cut classes than those who live
with both of their parents. In addition, students from stepparent families and students who do not
live with either of their parents are less likely to make the transition to postsecondary education.
When they do make the transition, they are more likely to enroll in a 2-year than a 4-year
program.
Ginther et al (2004) show that educational outcomes for both types of children in blended families
(stepchildren and their half-siblings who are the joint biological children of both parents) are
similar to each other, but substantially worse than for children reared in traditional nuclear
families. They conclude that the crucial distinction is between children reared in traditional
nuclear families (i.e. families in which all children are the joint biological children of both parents)
and children reared in other family structures (e.g. single-parent families or blended families). They
add that family structure may well be a proxy for other variables that affect outcomes for children
e.g. family resources and mothers education. An additional explanation is stress in handling and
disciplining a stepchild. The stress factor might explain why children in blended families have
worse educational outcomes than children in other two-parent families.
Case, Lin and McLanahan (2000) compared the educational attainment of birth and non-birth
children of women, and found that children raised by step, adoptive or foster mothers (the socalled blended families) obtain significantly less education on average than do the birth children of
the same women (see also Wilson and Daly, 2004). In particular, the non-birth children of a
woman receive on average one year less schooling than do her birth children, with the educational
break occurring at the time children finish high school and begin college.
3.6.3 Behavior of Children
Antecol et al (2007) add to the growing body of literature that demonstrates that children raised by
single parents are more likely to become sexually active, commit illegal acts, and use illegal drugs at
young ages. In particular, youth who spend part of their childhood/youth living in a household that
does not include their biological father are more likely to smoke regularly, become sexually active,
and be convicted of crime.
Comanor and Phillips (2002) studied the impact of parents on the behavior of their children. Using
data from a national longitudinal survey of youth, they conclude that the single most important
factor affecting measures of delinquency (measured by youths contact with the criminal justice
system) is the presence of his father at home.

19

3.6.4 Reproductive Health Outcomes


Ngom, Magadi and Owuor (2003) study among the Nairobi urban poor compared reproductive
health outcomes of never-married adolescent girls aged 12-19 years who live with neither parent,
father only, mother only, and both parents. The results showed that when the father is present in
the household (i.e. father only or both parents present), adolescent girls are 42% less likely to have
ever had sex, 45% less likely to have been sexually active in the most recent four-week period, and
59% less likely to have ever experienced an unwanted pregnancy than when neither parent, or
only the mother, is present in the household. The study concluded that in the slums of Nairobi,
fathers presence is associated with stronger resilience among adolescents.

3.7

Out-of-Wedlock Children and Teen Childbearing

Over the past twenty years, a growing proportion of children are born outside of marriage. As nontraditional family settings are becoming more common, understanding the ramifications of growing
up in non-marital family arrangements between the biological parents (such as cohabiting, visiting
and other non-marital relationship arrangements) for childrens wellbeing becomes increasingly
important.
Teenage pregnancy limits a young womans access to education and training and, in turn, improved
economic opportunities. Teen pregnancy threatens the mothers health and leads to infant health
problems that translate into disadvantages, which often start before birth but can last a lifetime.
Teenage childbearing has been implicated in intergenerational transfer of poverty, and social and
public health problems e.g. dropping out of high school, low birth weight, and high infant
mortality (Geronimus and Korenman, 1992).
The young brides status in the family is frequently dependent on her demonstrating her fertility at
a time when she is not yet physiologically and emotionally prepared. Additionally, girls are made to
be responsible for the care and welfare of future generations while still children themselves. The
young girls are normally married to older spouses, and this age gap creates unequal power relations
that result in husbands having total control over sexual relations and decision-making, and are thus
often unable to use contraception or to plan their families. Therefore, early marriage directly
compounds the feminization of poverty and intergenerational transfer of poverty (Otoo-Oyortey
and Pobi, 2003).
3.7.1 Teen Childbearing
Nour (2006) says that child marriage in Africa has had far-reaching health, social, economic and
political implications for the girl and her community. It truncates a girls childhood, creates grave
physical and psychological health risks, and robs her of internationally recognized human rights.
Increasing mean age for marriage often results in part from overall advancement of an economy
(decreasing poverty) and enables countries to improve education, increase employment, and
provide better healthcare. Keeping girls in school or vocational training also helps protect them
from HIV infection, pregnancy, illness and death, and enhances their earning potential and
socioeconomic status.
The study by Kaufman et al (2001) on adolescent childbearing in South Africa explores teenage
childbearing as it relates to key transitions into adulthood e.g. the advent of a pregnancy and the
decision to terminate or carry the pregnancy to term; the impact of early childbearing on school,
work, and marriage; and consequences of premarital childbearing on future relationships, including

20

subsequent fertility. The study found that teenage mothers may return to school once they have
given birth and that this opportunity is strongly related to a long delay before the birth of a second
child. Babies born to teenage parents are extremely vulnerable (as the support and maintenance of
the child are subject to paternal recognition and commitment) and the presence of a baby also
generally means less bride wealth for a future marriage.
Waszak et al (2003) study in Nepal suggests that the causal relationships between lack of education,
early marriage, low social status and poverty may be circular rather than linear. The family
economic situation determines which families send children to school; gender norms then may
determine which, if any, children in the family go to school. Even when schooling is available for
girls, parents fear that more education will reduce their daughters chances of finding suitable
husbands. And for many, the wellbeing of the family is dependent on the marriage of their
daughters according to local norms. However, a longer period of being single may create risks of
premarital pregnancy and STIs, especially in an environment in which information and services are
not available to unmarried girls and boys, and in which there are severe social sanctions for girls
who experience premarital pregnancy. They conclude that greater access to education for girls is a
logical step towards delaying childbearing and creating better lives for girls (see also Choe, Thapa
and Mishra, 2005).
The debate on adolescent childbearing in the United States has received much attention since
Campbell made the fatalistic statement in 1968 (cited in Greene and Merrick, 2005): The girl who
has an illegitimate child at the age of 16 suddenly has 90 percent of her lifes script written for her.
Her life choices are few, and most of them are bad. Had she been able to delay the first child, her
prospects might have been quite different (see also Luker, 1991; and Luker, 1996). Lloyd (2005)
summarizes the potential channels through which early pregnancy and childbearing relate with
poverty to include:
Poor health outcomes for the young mother and her child: higher risk of obstetric complications,
leading to higher maternal mortality and morbidities if she survives, increased risk of abortion
and abortion complications if the abortion is unsafe, low birth weight and other problems for the
newborn;
Poor educational outcomes for both the mother and her child, including dropping out of school
and less schooling for the child;
Lower and/or altered consumption patterns of the mothers immediate and extended family for
rearing the child;
Possibly lower labor force participation by the young mother, with less opportunity to contribute
to household income; and
Reduced acquisition of social capital through reduced community participation and greater
chances of divorce or single parenthood.
3.7.2 Out-of-Wedlock Children
Willis (1999) presented a model that shows that out-of-wedlock childbearing can be explained as
an equilibrium outcome of marriage market behavior caused by the possibility that men may free
ride on the willingness and ability of women to rear their children at low or zero economic cost to
themselves. The theory suggests that out-of-wedlock childbearing will be most prevalent when
females are in excess supply, when they have sufficient income to support a family on their own,
and when the gains to marriage are small because male incomes are low. The theory also implies
that non-marital childbearing will be most frequent among persons in the lower portions of the
income distribution.

21

The results by Willis (1999) are consistent with the black-white differentials in rates of out-ofwedlock childbearing. This is because male-female ratio has been lower for blacks than for whites,
and the supply of marriageable black men is further reduced by high rates of incarceration and
unemployment. Cross-sectional variations in sex ratios have a significant impact on the prevalence
of female-headed households, especially among blacks. In addition, female-male wage ratios are
higher among blacks than among whites.
Willis (1999) also presents a summary on who benefits and who is harmed by out-of-wedlock
childbearing by low income women. First, out-of-wedlock equilibrium tends to benefit adults at
the expense of children (as a child born out of wedlock will tend to have fewer resources devoted to
him/her), and may benefit men at the expense of women who would otherwise marry and receive
greater benefits from their husbands (i.e. if it reduces her future marriage prospects). Where there
is residential sibship (composed of half-siblings with different fathers), it may be difficult for
fathers to control the distribution of resources they provide to ex-partners so that they are
preferentially directed toward their genetic offspring, and such men may have less incentive to
invest in them, placing further pressure on women to garner resources from other sources (Kaplan
and Lancaster, 2003). In addition, men who father children outside of marriage may be less certain
of their paternity and, as a consequence, may be less willing to pay support for children to whom
they may not be genetically related (Shackelford and Weekes-Shackelford, 2004).
3.7.3 Shotgun Marriage
A shotgun marriage is defined as one occurring within seven months prior to the birth of the baby.
Akerlof, Yullen and Katz (1996) relate the erosion of the custom of shotgun marriage to the
legalization of abortion and the increased availability of contraception to unmarried women in the
United States. The decline in shotgun marriage accounts for a significant fraction of the increase in
out-of-wedlock first births. The authors state that the advent of female contraception and legal
abortion, by making the birth of the child the physical choice of the mother, makes marriage and
child support the social choice of the father. The authors also provide an analogy between women
who do not adopt either birth control or abortion and the hand-loom weavers, both victims of
changing technology, and say that this technology-shock hypothesis is an alternative to welfare and
job-shortage theories of the feminization of poverty (see also Stevenson and Wolfers, 2007).

3.8

Optimal Age at Marriage

Gustafsson (2001) observes that the age at which women become mothers has increased to an all
time high in most European countries in the last decennia. The increase of the age at first birth is
the main explanatory variable for the rapid decrease in fertility in European countries, which is in
turn explained by consumption smoothing and career planning of the women. The mans income
profile matters, and its effect is to delay births until a moment when costs of the child can be offset
by his higher earnings.
Goldin and Katz (2002) observe that the fraction of U.S. college graduate women entering
professional programs increased substantially just after 1970, and the age at first marriage among all
U.S. college graduate women began to soar around the same year. The direct effect of the pill
decreased the cost to women of remaining unmarried while investing in a professional career. The
power of the pill in affecting womens careers was magnified by its impact on the age at first
marriage. The most persuasive evidence for a role of the pill is that its initial diffusion among single

22

women coincided with, and is analytically related to, the increase in the age at first marriage and
the increase in women in professional degree programs.
Oppenheimer (1988) added some spice into the debate by suggesting that the increasing education
of women raises womens aspirations regarding the qualifications they increasingly find essential
when defining their future ideal spouse. This upgrading in itself prolongs the search in the
marriage market and thus postpones marriage or partnership formation, even to the extent of
precluding it entirely should the appropriate partner not appear.
A study conducted using the 1998 Kenya Demographic and Health Survey by Ikamari (2005) shows
that education has a statistically significant and strong positive effect on a womans age at first
marriage. The effect is greater for the younger women, indicating increased postponement of
marriage. These results provide empirical evidence that a womans educational attainment is an
important determinant of a womans age at first marriage in Kenya. Premarital childbearing, as
represented by whether or not a woman had an ex-nuptial child, has a significant effect on age at
first marriage. Having an ex-nuptial birth significantly lowers the probability of marrying early. As
expected, women in more developed provinces are less likely to marry early than women in less
developed provinces. The results indicate that Christian women are more likely to marry later
compared to women belonging to other religions. The effect of religion appears consistent across
generations of women.

3.9

Intergenerational Transfers

The macroeconomic models with overlapping generations sprang from the seminal work of
Samuelson (1958). In addition, a few economic demographers have explored the interface of
demographic models and the overlapping generation models of economists. This section focuses on
inter-age (or intergenerational) transfers, drawing mainly from the overlapping generations models.
As observed by Lee (1994), the human lifecycle has two stages of dependency - childhood and old
age - separated by a long stage of surplus production (see also Kaplan and Robson, 2002).
Dependent age groups are sustained by flows of resources upwards and downwards by age from the
more productive stage in the middle. These resource flows occur through three institutional
channels: the family, the public sector, and financial markets. As fertility and mortality decline, the
population age distribution shifts toward older ages, which changes the terms on which these
resource flows take place.
Normally, the relationship between age and poverty is U shaped, with the incidence of poverty
being higher among younger and older groups (Barrientos, Gorman and Heslop, 2003). Older
workers in low income countries are found predominantly in informal and precarious employment.
Households and social networks are also important to the wellbeing of older people, and their
weakness or absence contributes to poverty and vulnerability.
Lillard and Willis (1997) discuss a number of hypotheses about motives for intergenerational
transfers within the family. They found evidence supporting the hypothesis that children are an
important source of old age security and that old age security is, in part, childrens repayment for
parental investments in their education. There was also evidence of exchange of money for help
with both housework provided by children to their parents and childcare, and housework provided
by the parents to the children.

23

If the sum of childrens consumption needs exceeds their parents time and resource budget, then
parents must seek help from others. When parents reach bottlenecks in the availability of time and
resources, they can meet their familys consumption demands through saving and dis-saving,
public-transfer programs, and familial transfers (increased labor effort of parents, productive
contributions of teenage or older children who are still co-resident, and contributions from related
elders, particularly grandmothers).
In many third world settings, the kin units may be more complex. As observed by Hammel (2005),
parents, children, and grandchildren may continue to co-reside. Even if descendants of the
founding pair do not co-reside in the same house, they often continue to live close by in the same
compound or ward and may maintain strong cooperation in exchange of labor, goods, and services.
Although these exchanges may sometimes look like unilateral unrequited transfers, there is more
often an expectation of reciprocation, even if long delayed. He adds that, in some kinship systems,
these reciprocations continue after death, as sacrifices and graveside gifts from the living are
exchanged for supernatural protection or in gratitude for the gift of life itself.
Ronald Lee et al (2002) reviewed the validity of Cain and Caldwell theories on the childrens
economic roles. According to Caldwell (1976), wealth in traditional societies experiencing high
fertility and mortality rates flows upward from children to their parents, but that it flows from
parents to their children when fertility and mortality rates are low. Cain (1977) was one of the first
to calculate the economic value of children to their parents. He asked at what age the cumulative
value of the childs production minus its consumption would equal zero. Cain (1977) classic study
of a village in Bangladesh found that cumulative production by male children exceeded their
cumulative consumption by age 15, lending support to Caldwells view (see also Robinson, Lee and
Kramer, 2008).
However, the findings by Lee et al (2002) are that children are costly to their parents and that
wealth flows downward from parents to children. The study of Maya males and females showed
that, at age 22, the average age of leaving home and marrying for males, the cumulative balance is
still negative and large, and earlier consumption costs are not fully offset until around age 30.
Females also have a large negative cumulative balance at age 19, the average age at which they
leave home and marry. These results contrast strongly to Cains (1977) original finding that males
paid back their own cumulative consumption by age 15, and their own as well as a sisters by age
22, assuming the sister marries and leaves home by age 15.
Yean-Ju Lee et al (1994) focuses on married childrens financial support for their parents in Taiwan.
The results show that the vast majority of married children (both sons and daughters) provided net
financial support for their parents during the previous year. These patterns question assumptions
that industrialization and its accompanying cultural changes quickly erase most traditional values.
Lin et al (2003) caution about adopting theories developed in Western societies in understanding
Asian ones, especially the inadequacy of a single parent-child dyad to represent a comprehensive
picture of intergenerational support. They examined the patterns and determinants of support
provided by adult children to their parents in Taiwan, with particular attention to differences in
the helping behaviors of sons and daughters. They found that usually only one child in a family
provides help with activities of daily living, but for financial or material support the responsibility
is likely to be shared among siblings. Sons generally carry the major responsibility for taking care of
their older parents, and daughters fulfill the sons roles when sons are not available. Married sons

24

are more likely than unmarried sons to provide support to their parents, but the reverse is true for
daughters. Hermalin and Yang (2004) show that, although the current level of co-residence of the
elderly with children remains high in Taiwan, younger womens expectations about future coresidence have been steadily decreasing.
Ghuman and Ofstedal (2004) examined the nature of economic and social support from children
and siblings for a sample of individuals age 50 and above collected in Matlab, Bangladesh. One half
to two thirds of older adults live with a married child or receive assistance from a non co-resident
child. Sons are considerably more likely than daughters to live with or adjacent to parents, or
provide economic aid. But daughters are not uninvolved in exchanges with parents, and channel
resources to mothers more than fathers. Older persons who do not live with children have regular
contact with and receive assistance from them.

3.10

Children and Parents Labor Supply

The relationship between womens labor force behavior and fertility revolve around answering the
question: Do women limit their fertility in order to have time to pursue their nonfamily-oriented
interests, or do women work if their fertility permits them to do so? (Brewster and Rindfuss, 2000)
Schultz (1985) historical study of Sweden during 1860-1910 identifies demand-induced changes in
the price of a womans time as a factor in determining the fertility transition. The increase in the
price of animal products (butter) relative to grains (rye) improved womens wages relative to mens
and thereby contributed to the decline in fertility. Both men and women were employed in the
production of food grains and dairy products, but dairying and milk processing were largely
considered as womens work.
Costa (2000) argues that the dramatic change in womens social and economic status can only be
understood by looking to the past, as the age of the factory girl set the stage for the unmarried
office girl, who in turn paved the way for the entry of married women into the labor force in the
late 1950s, even though this entry was primarily in dead-end jobs in the clerical sector. In turn, the
married women in the labor force paved the way for the rise of the modern career woman, doing
work that requires a lengthy period of training and that offers genuine opportunities for promotion.
They conclude that the difficulty of combining work and family has slowed womens move to the
top.
Brewster and Rindfuss (2000) discuss the relationship between fertility and labor force activity at
the individual level, and the structural underpinnings of role incompatibility. The association
between fertility and womens labor force activity reflects the incompatibility between caring for
children and participating in economically productive work that typifies industrialized societies. As
industrialization proceeded, childcare and economically productive work became increasingly
incompatible. Thus, women who wish to participate in the labor force must either limit their
fertility or make alternative arrangements for the care of their children.
The estimates reported by Angrist and Evans (1998) show that children lead to a reduction in
female labor supply. However, the effects of children on labor supply appear to be much smaller
and possibly even absent among college-educated women and women whose husbands have huge
salaries. They add that the labor market consequences of childbearing are more likely to be severe

25

for poor and less educated women. Equally important is the finding that husbands change their
labor market behavior very little in response to a change in family size.
Women may also self-select themselves into sectors depending on institutional constraints,
preferences for family-friendly working conditions, and expected wage differences. For example,
using Danish data, Nielsen, Simonsen and Verner (2004) found a severe penalty after birth-related
leave in the non-family-friendly sector, so that women who would be affected by this penalty selfselect into the family-friendly sector. The penalty is a combination of a large human-capital
depreciation effect, a child penalty, and no recovery. This explains the tendency for women to look
for employment in the public sector.
However, fatherhood significantly increases the hourly wage rates and annual hours of work (at
least for the first two children), and mens labor supply and wage rates increase significantly more
in response to the births of sons than to the births of daughters, thus implying that there is a
fatherhood premium (Lundberg and Rose, 2002). Western, Hewitt and Baxter (2005) found a
male marriage premium, especially for men in the middle of the earnings distribution. Korenman
and Neumark (1991) also showed that wages rise after marriage and that marriage premiums appear
to result from a steepening of the earnings profile.
Most studies relate the wage premium for married men to (a) omitted-variables (e.g. years married,
and workers union membership); (b) selection bias (certain men are more desirable as employees
and mates due to some characteristics only observable by employers and women); (c)
specialization (more efficient specialization within the home that allow husbands to concentrate
on market work); and (d) perception by employers that married men are more stable and are
therefore more likely to remain longer with the employer1. A supplementary explanation is
probably implied by Gowin (1915) when he asked: Why do executives find those married, or at
least contributing to the family support, easier to discipline? Married men may be under more
pressure to earn more.

3.11

Externalities of Childbearing

The World Development Report (World Bank, 1984) states that a justification for action by
governments to encourage people to have fewer children is the gap between the private and social
gains from having many children due to existence of externalities. Lee and Miller (1991) define
externalities to childbearing as the gain or loss in utility or welfare that couples would experience if
fertility decisions were decided collectively rather than independently, as parents do not
internalize the costs of their children to society as a whole.

See, Ribar (2004) for a review of quantitative methods employed and evidence gathered to assess the
benefits of marriage and consequences of other family structures on childrens and adults wellbeing.

26

According to Lee (2001) when a family chooses to have a child, they are expressing a preference for
a child over the additional consumption that would otherwise be possible for family members2.
However, there are costs and benefits for the additional child that are not borne directly by the
parents, but are passed on to other families and society as a whole. The sources of these externalities
are public sector inter-age transfers (e.g. education for the young and healthcare and pensions for
the elderly), common resources or collective wealth (e.g. demands on the environment), and
provision of public goods or social infrastructure (Lee and Miller, 1991). It is these externalities that
have made individual household decisions lead to outcomes that are collective failures (Dasgupta,
1995).
As observed by Schultz (1997), fertility, through its effects on the size, growth and age distribution
of the population can have consequences on the macroeconomic system, and social systems can
affect the microeconomic incentives to demand children. Institutions may be established by the
public or private sector that substitute for (or complement) some critical services that children
provide to parents e.g. mandatory wage-based social security systems, and credit markets so that
parents can save for old age. A couples fertility could produce externalities to the economy
through, say, overcrowding, pollution, and depressed wages due to excess labor.

3.12

Feminization of Poverty

It is widely accepted that men and women experience poverty differently and are affected
differently. In particular, women are more vulnerable to poverty because of inequalities in access to
productive resources, and lack of control over their labor and unearned incomes. While some
poverty alleviation initiatives need to identify and address the engendered root causes of poverty
that target both men and women and the values and structures that promote gender inequality,
others should be designed to specifically target poor women so as to initiate the processes of
addressing and redressing the sex-specific imbalances in the causes, experiences and effects of
poverty.
Feminization of poverty consists of two slightly different interpretations: (a) effect of oppression of
women in society, labor market and family, and (b) single parenthood and family dissolution
(Marklund, 1990). The first interpretation means that women are more exposed to poverty whether
single or married and whether mothers or not, with policy directed toward improved conditions for
women at work, increasing labor market participation, childcare provisions and support systems
from fathers. In the second interpretation, women become the prime victims of such a process due
to their reproductive role.

For example, Humphries (2006) shows that British fertility decline in 18 th and 19th centuries was partly due
to the rise of the male breadwinner family, which, by placing the responsibility for supporting women and
children on men, converted them to a preference for smaller families. Where children were numerous,
resources had to be shared around, and this could become hard if they were limited. Children recognized the
negative effect that new babies had on their own diet. Benjamin Brierley gave such sibling rivalry a
humorous turn: Before I was of sufficient age to be sent to school, I had a brother born. I did not give him
the heartiest welcome, as I had fears that he might claim joint possession of my spoon (Brierley, 1886; cited
in Humphries, 2010). See also, de Vries (2008). In Thomas Hardys novel, Jude the Obscure (1895), Judes
eldest son, Young Father Time, killed his little stepbrother and stepsister and hanged himself. A piece of
paper was found upon the floor, on which was written, in the boys hand, with the bit of lead pencil that he
carried: Done because we are too menny.

27

As Blackden and Wodon (2006) suggest, women also face time poverty due to the many
conflicting demands on their time including household work. Thus infrastructure investments need
to be directed in part toward meeting the requirements of household production and the household
economy, and helping women to reduce their time burdens.
The analysis of gender dimensions of poverty interrogates the common assumption that a large part
of the so-called feminization of poverty is due to the progressive feminization of household
headship (Pearce, 1978; and Medeiros and Costa, 2008). However, previous analysis in Kenya has
shown that the common classification of households that does not recognize one family-two
households is inappropriate in the Kenyan environment (Mukui, 1994) see also Weisner (1970),
Abbott (1976), Clark (1984) and Agesa (2004). Northrop (1990) also found the growth of femaleheaded households in the United States as an important factor in the feminization of poverty, the
gap in relative affluence between female-headed and other households was increasing, and that
female-headed households suffered most from economic downturns because of sex segregation in
the workforce. The argument is that the class of female household heads who are single, widowed
or divorced face a different socioeconomic environment compared to those who are married but
their spouses do not usually reside in the household but assist with provisions and visit the
household at frequent intervals.

28

CHAPTER FOUR

POPULATION AND DEVELOPMENT

4.1

Introduction

According to Stone (2001), scholarship on agricultural change has been anchored by two small
books with enormous impacts, both focusing on the relationship between farming and population.
Each model is quite simple, but each provides invaluable starting points from which to address the
complexities of agricultural change.
In 1798, British clergyman Thomas Robert Malthus argued for an intrinsic imbalance between rates
of population increase and food production, concluding that it was the fate of human numbers to be
checked by misery and vice generally in the form of starvation and war. His view of agricultural
production as relatively inelastic, with output increasable chiefly by bringing more land into
tillage, has fared poorly in subsequent comparative agricultural research.
In 1965, Danish agricultural economist Ester Boserup claimed to have overturned the Malthusian
model of agriculture by arguing that, particularly in primitive agricultural systems, farmers tended
to produce well below the maximum because this allowed greater efficiency (output/input ratio).
She maintained that production was intensified and additional technology adopted mainly when
forced by population increase.
This chapter introduces the controversies on the role of population in development, drawing
mainly on works of Thomas Malthus, Ester Boserup, and Coale and Hoover (1958).

4.2

Malthusian Ideas

The debate on population and economic growth rose to prominence with the publication of An
Essay on the Principle of Population by Thomas Malthus in 1798. In the essay, Malthus stated that
population, when unchecked, increases in a geometric ratio. Subsistence increases only in an
arithmetic ratio. A slight acquaintance with numbers will show the immensity of the first power in
comparison of the second. His pessimistic speculations caused the discipline of economics to be
dubbed by Thomas Carlyle as the dismal science (Barber, 1967). Currais (2000) provides a
succinct history of ideas from the Malthusian regime to the demographic transition.
Richerson and Boyd (1998) propose that the long term rate of population growth must normally be
controlled by the rate of improvement in K (the carrying capacity of the earth), and K will in turn
be controlled by the rate of technological progress. They argue that the present situation, in which
technological improvement is increasing at rates above r (the Malthusian intrinsic rate of natural
population increase), is probably unique in human history.
Bhattacharya and Innes (2008) present an empirical study of population growth and environmental
change using cross-section district-level data from South, Central and West India. Among key
findings are that population growth spurs environmental degradation (because child labor is in

29

greater demand in environmentally degraded circumstances) and the environmental depletion in


turn fuels further population growth, and so on, in line with the Malthusian doctrine.

4.3

The Coale-Hoover Ideas

The Malthusian doctrine got a boost from Coale and Hoovers (1958) report on Population Growth
and Economic Development in Low Income Countries. According to Kelley (1988), Coale and
Hoover identified at least three adverse effects of population growth: capital-shallowing effect, agedependency effect, and investment-diversion effect.
Rapid population growth lowers the ratio of capital to labor because there is nothing about
population growth per se that increases the rate of saving, hence the term capital-shallowing
effect. In the age-dependency effect, rapid population growth results in high youth dependency,
which increases requirements for household consumption at the expense of saving, and lowers the
saving rate. In the investment-diversion effect, rapid population growth shifts (mainly) government
spending into areas such as health and education at the expense of more productive, growthoriented investments.
The Coale-Hoover ideas had a profound impact on US foreign policy, and many American
organizations (principally the Ford Foundation and the Population Council) expended substantial
amount of human and capital resources to propagate the neo-Malthusian Coale-Hoover ideas in the
third world (Caldwell and Caldwell, 1986).
Although neo-Malthusianism made high fertility to be viewed as a burden to the family and the
nation, it did not lead to dramatic planned social change, as contraception was considered a white
mans medicine, and people used the English word family to describe it (Hodgson and Watkins,
1997; Watkins and Hodgson, 1999). If diffusion is the process by which (1) an innovation (2) is
communicated through certain channels (3) over time (4) among members of a social system, neoMalthusianism was not seen as a simple innovation but a competing population ideology to
mercantilism, a belief system that was well entrenched in the thinking of much of the Kenyan elite.
Consequently, neo-Malthusianism encountered active opposition in Kenya, much like when the
potato was introduced in France (Cleland, 2001). However, networks of health clinics were built
and long-term development loans granted, which assisted to domesticate family planning to limit
births, and local health professionals became agents of local change themselves.
Chimbwete, Zulu and Watkins (2005) provide a detailed history of the evolution of population
policies in Kenya and Malawi after Independence. The strategies adopted by the global actors to
persuade reluctant governments were quite similar, but the responses of the national elites were
quite different in timing. Both Kenya and Malawi adopted population policies, but with very
different timing: Kenya in 1967, Malawi in 1994. Kenyas fertility began to decline in the late
1980s; Malawis about a decade later.
In retrospect, the debate can be seen as a clear battle between structuralists (who believe that
changed conditions induce individuals to have smaller families) and diffusionists (who view ethnic
and language networks as active agents that spread the inherently attractive innovation of modern
contraception). During the diffusion of neo-Malthusianism, structural preconditions of fertility
decline were not present in most Third World societies at that time.

30

The ambivalence in US foreign policy with respect to population growth was brought forth by the
Reagan Administrations Mexico City statement in 1984 that stated that population is neither a
positive nor a negative factor in development, but is neutral. This policy statement, commonly
referred to as the Global Gag Rule, was associated with the new policy of denying federal funding
to NGOs that performed or promoted abortion as a means of family planning in other nations. This
policy, which had been overturned by President Clinton in 1993, was reinstated by the Bush
Administration in January 2001 (Bogecho and Upreti, 2006).
An NGO from another country would also be restricted from receiving US funds even if they
allowed abortion in accordance with their own countrys laws. US funds would also be restricted if
NGOs used their own funds to provide abortions or to even include information about abortion as
part of family planning. NGOs who do not comply with the Global Gag Rule also face the loss of
access to US donated contraceptives, including condoms. As a result of this executive order, NGOs
are forced to decide whether to forego substantial funding from USAID, or to change their
operations. The Global Gag Rule helps perpetuate unsafe abortion in countries with restrictive
abortion laws and limited access to safe abortion services.
The effects of the Global Gag Rule, compounded by the global shift of funding from family
planning to HIV/AIDS, are far-reaching in Kenya. For example, Kenyas leading reproductive
healthcare providers (Marie Stopes International-Kenya and the Family Planning Association of
Kenya) suffered serious budget cuts and were forced to close some clinics, lay off large numbers of
staff, and scale back programs. After refusing the terms of the Global Gag Rule in 2001, both
organizations lost critical U.S. family planning funds. These organizations provide family planning
(including the provision of emergency contraception), voluntary counseling and testing for
HIV/AIDS, management of sexually transmitted infections, pharmaceutical services, laboratory
services, post-abortion care, maternal and child health services, Pap smear tests, minor surgery, and
wellbaby services. Following the closure of these clinics in 2005, at least 9,000 people primarily
women and children were left with little or no access to healthcare.
A study of cost analysis of reproductive health services in PCEA Chogoria Hospital by Munguti et
al (2006) shows that the faith-based nongovernmental organization also faces a number of
challenges related to sustainability: declining donor support (especially for reproductive health
services), low cost recovery levels, and increasing poverty levels among its clientele. The cost
recovery level across the nine RH services evaluated was 80.3% in FY 2004, and was most
pronounced for the family planning visits (cost recovery 7-8%). For the hospital to continue
providing family planning, VCT and PMTCT services, costs need to be reduced and/or revenues
from these or other services need to increase.

4.4

Ester Boserup on Agrarian Change

An important set of ideas on agrarian change are those inspired by Ester Boserup in her work on
population growth and technical change in agriculture (Boserup, 1965; 1981). Boserups basic
proposition is that more intensive farming technologies tend to occur with rising population
density. Specifically, rural population growth shortens fallow periods, increases investment in land,
switches land preparation from hoe to animal traction, induces manuring in order to maintain soil
fertility, reduces the average cost per inhabitant of rural infrastructure, promotes specialization in
production, shifts land tenure from general to specific use rights, and diminishes per capita
availability of common property resources. Boserup contrasted her ideas with those of Thomas

31

Malthus who expressed extreme pessimism concerning the potential for agricultural output to rise
as fast as population growth, such that lack of food itself, and starvation, would in the end become
the main check on the rate of population increase.
According to Stone (2001), Boserup (1965) brought an important new perspective on agricultural
change. Rather than technological change determining population (via food supply), in this model
population determined technological change (via the optimization of energetics). Boserup held that
extensive agriculture with low overall production concentration is commonly practiced when rural
population density is low enough to allow it, while rising population density requires production
concentration to rise and fallow times to shorten.
The Boserup model has been widely influential, but it neglects many important aspects of
agricultural change, especially ecological, social, and political-economic aspects. In particular, her
model relies heavily on agro-ecological features of fire and fallow that are hardly universal, while
intensification varies with local environment. Farmers have limited ability to intensify agriculture
as they may wish, and thus population pressure may prompt very different patterns of agricultural
change because of differences in farmers ability to invest, withstand risk, and attract subsidy
(Stone, 2001).
Many authors have provided implicit criticism of Boserup, without explicit mention of her works.
For example, the OECD (2001) report acknowledges that increasing farm productivity is generally a
precondition for improving food security and income in rural areas. This can also relieve pressures
to expand farming and grazing into ecologically fragile areas, and reduce reliance on unsustainable
resource extraction activities. Efforts to raise agricultural production by improving crop yields,
technology, access to inputs and markets, and fostering a shift towards higher value crops are thus
often seen as a means of simultaneously addressing growth, equity and environmental issues in
rural areas.
Some of the negative effects include the promotion of monocultures and loss of genetic diversity,
increased dependence on factors that may be ecologically harmful and unaffordable for poor
farmers (e.g. fertilizers), conferring benefits to land-owning farmers in cases where landlessness is
high, and the scope for increasing agricultural yields is limited in many areas. In addition, the
combination of fragile, often steeply sloped terrain, low fertility, crops unsuited to the terrain, lack
of external inputs, and slash-and-burn farming techniques result in serious and rapid soil
exhaustion, erosion and sedimentation.
Turner and Ali (1996) reviewed Malthus and Boserup with a particular eye on Bangladesh, a
country dominated by a small-holder agrarian economy under extreme stress (production
shortfalls, increasing economic polarization, and chronic malnutrition). On average, small-holders
kept pace with the demands on production, although important class and village variations were
evident and the proportion of landless households increased. They conclude that Malthus and
Boserup may be more complementary than the various applications based upon their views imply.
In particular, Malthus and Boserup share various assumptions about the relationships among
population, technology and resource use, but differ primarily in their views of the origins of
technology. Malthus implies that technology development is not necessarily linked into the
population-resource condition, while Boserup grounds this development directly into that
condition.

32

4.5

Reconciling the Pessimists and the Optimists

Experts still do not agree whether population growth restricts, promotes, or is independent of
economic growth.
The theory that rapid population growth restricts economic growth was based on the assumption
that such growth would serve as a brake on economic development. The pessimistic theory
traces its lineage to Thomas Malthus, who viewed the balance between population and income
growth as the great law of our nature. The pessimists have had their day, as some of the advances
in agricultural innovation have been accompanied by vast increases in population that hampered
improvements in living standards. In recent times, potentially negative impact of population
growth on capital intensity has been raised due to its effect on capital per worker. Several writers
have interpreted this link in a simple accounting framework, designated as output-per-worker
growth, which can be translated from per-worker into per-capita terms.
In the early 1980s, economists began to reject the pessimist view, due to advances in technology
and human capital accumulation that partly smoothed out the short-term effects of population
growth. In addition, the Malthusian doomsday scenario had not come to pass. These trends have
supported the views of a group of population optimists who have sought to promote the idea that
population growth can be an economic asset. Ester Boserup used similar arguments to turn the
Malthusian worldview around. The optimists, while refuting the alarmist tendencies of the
pessimists theory, were not dogmatic about the positive impacts of population growth.
The proponents of neutralism have found solace in Adam Smiths (1776) Inquiry into the Nature
and Causes of the Wealth of Nations, who argued that division of labor allowed workers to become
more productive by honing their skills at ever more specialized tasks. The neutralists have therefore
engaged in statistical correlation to test the feedback mechanisms between population and
economic growth. Such empirical studies have found that on balance, slower population growth
would be beneficial to economic development of most developing countries. The idea of neutrality
of population growth to development is thought to be the philosophy behind the Global Gag Rule
initiated by the Reagan administration.

4.6

Evolutionary and Ecological Analysis of Human Fertility

The evolutionary biology of human fertility, parental investment, and mating focuses on the timing
of life events (mainly development, reproduction, and aging), the regulation of reproductive rates
and its relationship to parental investment, and sexual dimorphism (the systematic difference in
form between individuals of different sex in the same species) and its relationship to mating
systems or the so-called mating versus parental effort (Bock, 1999; Kaplan and Lancaster, 2003).
Life history theory recognizes a tradeoff between present and future reproduction (e.g. by birth
spacing) to save energy for future reproduction. The second tradeoff is between quality (measured
by parental investment in the offspring) and quantity of children, where the goal is to maximize
long-term production of descendants. However, the latter tends to create conflict between the
sexes, especially where one parent bears a lesser cost of childrearing. By extension, the sex that
invests is more choosy about when to mate and with whom to mate, and the less investing sex tend
to possess characteristics that increase mating opportunities. Variations in these life histories are

33

shaped by ecological factors such as food supply, mortality hazards, and the effects of body size on
both energy capture and mortality hazards. The impact of the environment is best illustrated by the
slowing down of birth rates if a woman was underfed at childhood, even if food becomes abundant
later in life. High fertility and polygamy in horticultural societies is essentially because each wife is
able to take care of her offspring. Children in such environments are also able to offset some costs
of their rearing.
4.6.1 Cooperative Breeding
Studies have shown that human children benefit from an extended family (especially older
generations), and that kin support can enhance female reproductive success (Kramer, 2005). Whilst
nuclear families can survive and reproduce, they are likely to lose out in competition with those
families that can draw on a more extensive network of kin.
Kramer (2005) study of the Maya suggests that parents only have enough time to support about four
children. In situations where the reproductive rate exceeds this level of fertility, childrens
contributions are an alternate or additional means of maintaining the relatively short birth intervals
characteristic of modern human reproduction. In addition, mothers may receive help from their
spouses, their own mothers, other female kin, and unrelated individuals.
For example, Mace and Sear (2004) show that grandmothers are important, but maternal
grandmothers and other matrilineal kin seem to concentrate on offspring survival but not female
fertility, whereas paternal grandmothers are more interested in increasing the mothers rate of
birth. The authors argue that these different strategies emerge as a response to different relatedness
to the mother, because the costs of maternal mortality differ between the two lineages: patrilineal
kin are less concerned about women paying the high costs of reproduction associated with high
fertility.
Child labor is also valuable to families since horticulture provides a number of relatively lowskilled tasks that older children can perform. In fact, Kramer and Boone (2002) demonstrated that
among Maya horticulturalists, older children contribute at the level of helpers-at-the-nest,
significantly increasing their parents fertility and without whose help their parents could not add
further offspring to the family. Through labor transfers, children appear to play a key role in
subsidizing parents continued reproduction and allowing parents to raise more children than they
might otherwise be able to support.
In most models, sons stay, daughters-in-law move in, and daughters move out, but it may be
necessary to study other types of household formation, especially because kin support could exert
some influence on fertility. For example, Dasgupta (1995) faults the analysis of household
economics, where attention is paid to choices made by single households. The empirical findings
that associates rich countries on average with low fertility rates is also based on conventional
indicators of the standard of living that pertain to commodity production, not to the environment
resource base upon which all production ultimately depends. He also argues that high fertility
could be associated with low parental costs of procreation where sharing the cost of rearing a child
among the kin is commonplace, as in most of sub-Saharan Africa.
4.6.2 Birth Interval and Son Preference
Studies focusing on the evolutionary analysis of reproductive decision-making have found that
birth interval is a major determinant of rates of fertility, and is also a measure of parental
investment in a child. For example, Mace and Sear (1997) analyzed the length of birth interval

34

among Gabbra pastoralists, a traditional group of nomadic camel herders who live in northern
Kenya. Birth intervals after the birth of a boy were significantly longer than after the birth of a girl,
indicating higher parental investment in boys. Birth intervals for women with no son were shorter
than for those with at least one son. First born sons have particularly high reproductive success,
daughters have average reproductive success, and late born sons have low reproductive success. The
birth interval follows a similar trend, suggesting that longer birth intervals represent higher
maternal investment in children of high reproductive potential.
A companion study of the Gabbra by Mace and Sear (1996) has shown a high maternal mortality
ratio of about 599 deaths per 100,000 births, and the proportion of ever-married sisters under 50
years of age who had died from maternal causes was 0.48. The authors argue that this is not
unexpected given that medical care is unavailable in this area.
In traditional societies, there may be no life-history tradeoff between previous and current
reproductive investment, as shown by Sear, Mace and McGregor (2003) in a study of a Gambian
population, where, on the contrary, women of high parity for a given age had higher fertility rates
than those of lower parity (see also Allal, Sear, Prentice and Mace, 2004; and Walker et al, 2006).
4.6.3 Breeding Opportunities and Form of Inheritable Capital
A study conducted in a rural community in Kenya showed womens preferences for men offering
high quality breeding opportunities, with respect to the number of acres available on which to
settle, as there were strong correlations between land ownership and the number of a mans wives
(Borgerhoff-Mulder, 1987; Borgerhoff-Mulder, 1990). Where the inheritable capital is land, those
with big farm sizes in agro-pastoral communities may decide to have more children (BorgerhoffMulder, 2000). However, where the inheritable capital is embodied capital (human skills) to
compete in the labor market, intermediate levels of offspring production are favored.
4.6.4 Adoption of Contraception
Mace et al (2006) examined first use of modern contraception in four Gambian villages in the
previous 25 years. In 1975, a medical centre was opened in one village providing contraceptive
services free of charge to those who wished to use it. The ideal of large family size remains strong,
and those at low parity are significantly less likely to start using contraception than those at high
parity for their age. The study found that, while the general acceptability of modern contraception
appears to be increasing over time, women using contraception actually have higher reproductive
success (i.e. completed fertility) than those that do not. Wealth was also negatively related to the
probability of contraceptive use, with the wealthiest ranked women being the least likely to adopt
the innovation. Within homogeneous groups, where levels of parental investment were
comparable, evolutionary ecological theory would predict a positive relationship between wealth
and reproductive success.
4.6.5 Fertility and Economic Acculturation
Within subsistence communities, the fertility response in the early stages of economic
acculturation (e.g. labor-saving technologies such as mechanized water pumps and grain-mills) may
contradict conventional wisdom. If the time savings from these technological changes is reallocated
to less energy-costly activities, the positive shift in womens energy balance can affect fertility in a
number of ways. For example, the introduction of labor-saving technology among Xculoc Maya
showed that women begin childbearing at a significantly younger age and have a greater annual
probability of giving birth and higher age-specific and completed fertility (Kramer and McMillan,

35

2006). When a change in labor efficiency takes place under these conditions, parents appear to
reallocate the saved time to reproduction rather than to production.
Carr and Pan (2002) examine the determinants of fertility among women in an agricultural frontier
in the Ecuadorian Amazon. They found that many fertility determinants enumerated in the
demographic literature in reference to the developing world in general were largely applicable to
this frontier environment. Fertility is exceptionally high on the frontier, and this paper suggests
that poor infrastructure, availability of child and maternal healthcare, scarce educational
opportunities, and a virtual absence of wage employment for women are some of the potential
causes. Most forest conversion for agriculture is accomplished by small farm families and household
size has been consistently linked as a key determinant of deforestation in such environments. The
results of this study therefore support the notion that improving certain aspects of womens
intellectual and material wellbeing may decrease fertility on the frontier.
Later studies in the same Ecuadorian frontier have shown that fertility has begun to decline (Carr,
Pan and Bilsborrow, 2006). One of the interesting findings is that fertility appears to be positively
related to spatial variables such as distance to the nearest road, market, or community centre,
indicating that these spatial measures ultimately serve as proxies for access to health facilities,
which in the context of the northeast Ecuadorian Amazon are located only in major community
centers.
4.6.6 Demographic Transition in Ecological Focus
Crenshaw, Christenson and Oakey (2000) have argued that the demographic transition theory fails
to accommodate the influence of service economies and the social adaptations attendant on ethnic
heterogeneity and pre-industrial social complexity. For example, the transition theorists do not
interrogate the societys intervening mechanisms e.g. the economic activity that involves the
greatest number of people, employs most women, encourages greater residential density, or forces
the greatest number of interdependent social contacts. The authors contend that the service sector
fits this profile far better than industrialism itself. The service sector has most of these attributes
because it is generally larger, employs more people, and service firms are generally smaller and thus
more dependent on the external business environment and occupational interdependency.
Another relevant ecological principle is the notion of symbiotic unions, which are defined by
complementary exchange relationships. In addition, the ethnic/racial environment influences the
rate of cultural and technological diffusion as well as the level of inter-group competition, both of
which impact fertility through reproductive competition and consensus on family planning
initiatives.
The fusion of human ecology and conventional demographic theory suggests that variables such as
womens education, womens labor force participation, occupational prestige, rural/urban
residence, wealth flows, the timing of pair-bonds, and the sexual division of labor, are symptoms of
more fundamental macro-organizational processes. The demographic transition theory is only a
historically contingent explanation that attempts to explain demographic patterns during the
transition to industrialism.
The ecological reformulation of demographic transition theory may help to resolve some apparent
anomalies. First, certain versions of neo-Malthusianism assert that surplus (i.e. affluence) increases
fertility whereas demographic transition theory posits that surplus brings about fertility decline.
However, whether affluence promotes fertility reduction depends on how the economy is

36

organized and what type of constraints that organization places on individuals and families. While
affluence may boost fertility in a horticultural or agrarian economy, such a demographic response is
unlikely when affluence rests on a set of socially complex (and therefore socially demanding)
arrangements.
The ecological focus has also added a few variables into the menu that are not found in traditional
studies conducted by demographers and economists. For example, other than economic factors, a
study of East African kinship and marriage shows that divorce is common when a wife can filiate
children to her lineage at divorce (Borgerhoff-Mulder, George-Cramer, Eshleman and Ortolani,
2001). In general, these studies show that the traits observed at the regional level are a result of
adaptations to local and institutional features, and historical continuities will therefore disappear as
descendant populations adapt to their new environments.

37

CHAPTER FIVE

DEMOGRAPHIC TRANSITION AND THE DEMOGRAPHIC DIVIDEND

5.1

The Nature of Demographic Transition

The demographic transition is normally characterized by declining mortality and fertility. Initially,
improvements in medicine and public health, nutrition, and the wider practice of healthier
behaviors gradually lead to higher life expectancies and lower infant mortality rates. Early in the
demographic transition, there is a baby boom followed by a bulge of the working age population,
and finally, there is a large cohort of elderly people, who work less or not at all and become
dependent again. When the product of baby boom is between 15 and 64, it is more likely to be
working, thus lowering the ratio of dependents to non-dependents.
The decline in both mortality and fertility jointly form the demographic transition but they are not
synchronized. The lag between the two causes population growth as fertility only begins to decline
after mortality has dropped. The mortality decline is gradually succeeded by equally dramatic
reductions in fertility, since fertility decisions seem to respond strongly to changes in child
mortality as parents realize that they need only give birth to a few children to attain their desired
number of offspring. If children have a higher chance of survival and a long life expectancy, it is
wise to invest intensively in them, and the major form of investment is education, which inevitably
leads to more educated women and thus reinforces the likelihood that families will become smaller
as womens time becomes more valuable. Women are more likely to enter the workforce as family
size declines, and thus increase the incentive for small families.
However, this demographic dividend has to be earned through the right policy environment e.g.
through increased job opportunities, and social security schemes to provide for rising numbers of
old people. In general, the demographic dividend is delivered through a number of mechanisms,
mainly labor supply, savings, and human capital.
Bloom and Canning (2003) recognize that peoples economic needs and contributions vary over
their lifecycle. For example, young people tend to be net consumers, while working-age people
tend to be net producers and savers, with the elderly falling somewhere in between. The
characteristic feature of transition from high to low fertility and mortality rates is that the decline
in mortality occurs before the decline in fertility. The lag causes population growth, but initially it
also swells the youth share of the population. When this generation reaches working age, and if it is
productively employed, a country will experience a demographically-induced economic boost. As
the dependency ratio falls, opportunities for economic growth tend to rise, creating what is now
referred to as a demographic dividend.
Lee, Lee and Mason (2007) present cross-sectional age profiles for a wide range of contemporary
economies, including mature economies, rapidly growing economies, and low-income countries.
The estimated cross-sectional age profiles of labor income are broadly similar, but the peak age at
the hump in the inverted U-shape differ, ranging from 39 years in Brazil and Urban China to 52
years in Japan. They also present consumption profiles over the lifecycle.

38

The demographic and policy implications of the passage of generations/cohorts of differing sizes
across key lifecycle stages seem to be positive and the trends deterministic, and thus have been
termed demographic dividend, although some studies take a more neutral position pointing to a
window of opportunity. The difference is that bonus suggests a very deterministic path, a
virtual certainty; while window of opportunity suggests that some proactive interventions are
required so as to gain from age-structural transitions (AST). A detailed analysis of cohort flow
shows that age-structural transition may not be monotonic and systematic across populations at the
same stage of demographic transition, and may even be disordered.
The gradual rise in the demand for human capital in the process of industrialization led researchers
to argue that the increasing role of human capital in the production process induced households to
increase investment in the human capital of their offspring, ultimately leading to the onset of the
demographic transition (Galor, 2005). Other reinforcing mechanisms were the decline in child
labor (due to emphasis on quality rather than quantity of children through education), rise in life
expectancy (thus increasing the potential rate of return to investments in childrens human capital),
evolution of preferences for offspring quality (which saw increased technological progress), and
decline in the gender gap (rise in womens relative wages and womens relative education) and its
impact on fertility. The creation of capital markets also permitted inter-temporal lending and
borrowing (and thus reduced the valuation of children as assets).
Some of the mechanisms through which the dividend may be realized are labor supply, savings, and
human capital. For economic benefits to materialize, there is need for investment in public health
and access to care; family planning and related reproductive health policies to help families achieve
their desired size; education policies to increase access to schooling; and economic policies that
promote labor-market flexibility, and provide incentives for investment and savings. If appropriate
policies are not formulated, the demographic dividend might in fact be a cost, leading to
unemployment and an unbearable strain on education, health, and old age security.
However, unlike the rest of the world, many parts of sub-Saharan Africa have seen virtually no
decreases in traditionally high fertility rates. While mortality has declined, fertility has not.
Dependency ratios have correspondingly risen. With AIDS now killing large sections of the
working population and bringing average age down in many countries, the region has had no
demographic dividend to reap. Bloom et al (2001) advance various reasons for this continued high
fertility e.g. viewing of children as source of labor and insurance against old age, and decline in life
expectancy due to wars and infectious diseases (e.g. malaria, HIV/AIDS and TB).
Guengant and May (2001) also present a rather pessimistic view that sub-Saharan countries will,
over the next 50 years, catch up with lower levels of fertility experienced in the rest of the world.
The factors that are likely to keep future fertility trends in Africa above replacement levels include
the initial low levels and the slow increases of contraceptive prevalence rates, the contraceptive
usage mostly for birth spacing and not for birth limiting, the dearth of quality reproductive health
and family planning services, the lack of strong policy commitment toward the ideal of family
planning, and the impact of the HIV/AIDS epidemic on attitudes to family planning and fertility.

39

5.2

Population Change and Economic Growth

5.2.1 Age-Structural Transitions


As described in Bloom, Canning and Sevilla (2001), the debate on whether population growth
restricts, promotes, or is independent of economic growth is mainly informed by analysis of
population size. In recent years, the debate has emphasized the age structure of the population,
since peoples economic behavior varies at different stages of life. A high proportion of children is
likely to divert resources to their care, which tends to depress the pace of economic growth. By
contrast, if most of a nations population falls within the working age, the added productivity of
this group can produce a demographic dividend, assuming that policies to take advantage of this
are in place. The combined effect of this large working-age population and health, family, labor,
financial and human capital policies can create virtuous cycles of wealth creation. And if a large
proportion of a nations population consists of the elderly, the effects can be similar to those of a
very young population.
Bloom and Canning (2003) presents cross-country evidence for 1965 to 1995 on the link that runs
from population change to economic growth. The estimates indicate that demographic change is a
powerful determinant of income growth, operating mainly via the effect of changes in age
structure. The estimates also indicate that the benefits of demographic change can be greatly
magnified by a favorable policy environment. A case study of economic growth in Ireland suggests
that the legalization of contraception in 1980 resulted in a sharp decline in fertility and a sizeable
increase in the relative share of the working-age population. This demographic shift, operating in
conjunction with a favorable policy environment, can explain in large measure the birth of the
Celtic Tiger.
5.2.2 Children and Womens Education
Doepke (2004) develops a unified growth model that delivers a transition from stagnation to
growth, accompanied by declining fertility. The model is used to determine whether government
policies that affect the opportunity cost of education can account for cross-country variations in
fertility decline. Among the policies considered, education subsidies are found to have only minor
effects, while accounting for child labor regulation is crucial. The possibility of child labor implies
that the value of a childs time becomes part of the opportunity cost of education. One would
expect free public education to lower the cost of children and lead to higher fertility, but the
converse is true because it raises the full opportunity cost of education including potential child
labor income. Consequently, education and child labor policies have large effects on the fertility
transition, and Doepke proposes that child labor regulations are more difficult to enforce than
compulsory schooling laws.
de la Croix and Doepke (2003) shows that families with less human capital decide to have more
children and invest less in their education. When income inequality is high, large fertility
differentials lower the growth rate of average human capital, since poor families who invest little in
education make up a large fraction of the population in the next generation. The results suggest that
it is not overall population growth, but the distribution of fertility within the population which is
important. In other words, who is having the children matters more than how many children there
are overall.
Breierova and Duflo (2004) take advantage of a massive school construction program that took
place in Indonesia between 1973 and 1978 to estimate the effect of education on fertility and child

40

mortality. The program led to a large increase in the education of women as well as men. This
increase resulted in higher incomes and higher age at marriage, lower number of very early births,
and lower child mortality. The results show that female education is a stronger determinant of age
at marriage and early fertility than male education. However, female and male education seems
equally important factors in reducing child mortality.
Recent studies also suggest that female education has a greater capacity to introduce novel
reproductive ideas and behaviors into rural areas of Africa and thereby transform the demographic
landscape in the region than is currently believed. A study in Ghana showed that, net of her own
characteristics, a womans interest in limiting fertility and using modern contraception increases
with the percentage of women with education in her community (Benefo, 2006).
5.2.3 Fertility and Uncertainty about Child Survival
The positive co-variation of child mortality and fertility might come about through two channels.
The first involves a couple having or hoarding more births than desired because the couple
formed the expectation that some of their children might die. A second involves a replacement
response following a childs death. Other authors have argued that a couples fertility could be high
if the economic cost of children is shared with others e.g. through consumption of common
property resources and kin support in childrearing.
Conley, McCord and Sachs (2007) examined several factors explaining fertility in Africa. The study
showed that child mortality (proxied by infant mortality) is by far the most important factor among
those explaining aggregate total fertility rates, followed by farm productivity. Female literacy (or
schooling) and aggregate income do not seem to matter as much, comparatively. This conclusion
heralds the possibility of a rapid fertility transition in Africa even in a very low income setting.
Similarly, other determinants of fertility, such as adoption of high-yield crop varieties and public
policies in support of family planning, may change in just a few years, in contrast with many
socioeconomic variables. To the extent that malaria ecology affects the demographic transition
(save the children and families will choose to have fewer children) as well as mortality rates, the
high mortality rates would be correlated with an underlying disease ecology which in turn is a
direct contributor to economic performance through its depressing effect on the demographic
transition.
5.2.4 Fertility and Poverty
The relationship between fertility and poverty involves two questions: Is it because they are poor
that they have many children? Or are they poor because they have many children? Although there
may be no clear answers, the reinforcement effect is quite evident.
One of the early studies on the relationship between economic equality and fertility in developing
countries was conducted by Repetto (1979) based on surveys conducted in Puerto Rico, South
Korea and India (see also Kocher, 1973; and Winegarden, 1978). The study found that economic
inequalities work to maintain high fertility and rapid population growth. Among the poor, parents
pin their hopes for the future on the chance that one of their children will manage to prosper
enough to take care of them should the need arise. As household income improves, parents rely
more on their own accumulation of assets. A high level of income inequality implies a larger
number of the poor and therefore high aggregate levels of fertility. He argued that the relationship
was similar in cross-country comparisons as well.

41

Galor and Weil (1996) examine a novel mechanism linking fertility and growth: first, increases in
capital per worker raise womens relative wages, since capital is more complementary to womens
labor input than mens (e.g. in textiles and electronics). Secondly, increasing womens relative
wages reduces fertility by raising the cost of children more than the household income. And
thirdly, lower fertility raises the level of capital per worker, thus completing a positive feedback
loop.
Mason and Lee (2004) note that recent research provides compelling evidence that fertility rates
have an important bearing on poverty, and this conclusion is supported both by micro- and macrolevel studies. The micro-level evidence consistently finds that children are a financial burden in
high fertility settings, while the macro-level evidence complements and reinforces the micro-level
evidence by showing that per capita income grows more rapidly when the number of working-age
adults is growing faster than the number of children because children are mainly consumers, not
producers. The demographic dividend arises, in large part, when the number of producers in the
population grows more rapidly than the number of consumers. Using Indonesian 1996 household
survey data, they estimated the net direct effect of fertility decline on poverty. The effect of a 10%
reduction in the child population is to reduce the level of poverty by 11%.
Eastwood and Lipton (1999) used household survey data for developing and transitional economies
to estimate the effect of fertility (crude birth rate net of infant deaths) on private consumption
poverty incidence and intensity. Cross-national regressions indicate that higher fertility increases
poverty both by retarding economic growth and by skewing distribution against the poor.
Schoumaker (2004) provides an overview of the relationships between poverty and fertility
behavior in sub-Saharan Africa, using data from Demographic and Health Surveys carried out in 25
countries. In all the 25 countries, economic status was related to fertility, contraceptive use and age
at marriage. Overall, the poorest women have a larger number of children, marry younger and are
less likely to use contraceptives, even after controlling for education and place of residence. The
analysis also shows that fertility has decreased among the poorest women in countries where the
fertility transition is well under way.
5.2.5 Relationship between Fertility and Savings
The demographic transition encourages the growth of savings, thus improving a countrys prospects
for investment and growth. So when large numbers of baby boomers start hitting their forties,
national savings will tend to rise. And finally, the demographic transition has significant effects on
investments in human capital, as longer life expectancy changes attitudes to education, family,
retirement, the role of women and work.

5.3

Structural Factors that Influence Fertility

How many children should a couple bear at the beginning of the family or household cycle in order
to be assured, to the greatest degree possible, the optimal number of able-bodied adult offspring at
its end? Winterhalder and Leslie (2002) argue that when long-term reproductive outcomes are
uncertain, risk-sensitive fertility behavior may have a bigger impact on fertility beyond adjustment
for expected or average mortality.
Generally, the empirical testing of demographic transition theory focuses heavily on discovering
the conditions which lead to the onset of the transition, but give much less importance to its

42

progression and, in particular, to its end state. The principal pathways fall under structuralist
factors and diffusion factors, where diffusion relates to the innovation (what was being transmitted)
and on how it was being transmitted. A synthesis of the contrasting paradigms concluded that the
structural transformation of societies is the engine of demographic change and diffusion is the
lubricant. Whereas innovation theory explains how women were able to control fertility, diffusion
theory explains why they are willing to do so. Most of the findings have an interesting resonance:
female education (Kasarda, 1979; Pritchett, 1994).
This section starts by examining the usual explanatory factors of fertility (e.g. womens education),
before investigating additional factors (e.g. mode of production, culture, religion and role of kin).
Some explanations are familiar, others may be new. For example, Jasienska and Ellison (1998) have
argued that the suppression of reproductive function can occur in women engaging in activities
that require high energetic expenses, which could be an important factor influencing reproductive
health in contemporary societies.
5.3.1 Womens Education and Empowerment
Womens labor force behavior lies at the heart of most explanations of fertility and fertility change,
and many nations have formulated policies based on the inverse association between these two
central aspects of womens lives (Brewster and Rindfuss, 2000) see also a detailed review of the
relevant literature in Marshall (1975). Prior to industrialization, work and childrearing tasks could
be performed more or less simultaneously. The association between fertility and womens labor
force activity reflects the incompatibility between caring for children and participating in
economically productive work that typifies industrialized societies. As a result, fertility rates in
most countries are below the level needed for population replacement, and a rising proportion of
children are in non-maternal care while their mothers work.
Gertler and Molyneaux (1994) examine the contribution of family planning programs, economic
development, and womens status to Indonesian fertility decline from 1982 to 1987. The results
show that 75% of the fertility decline resulted from increased contraceptive use, but was induced
primarily through economic development and improved education and economic opportunities for
females. Even so, the dramatic impact of demand-side factors (education and economic
development) on contraceptive use was possible only because there already existed a highly
responsive contraceptive supply delivery system.
The unequal gender relations have tended to compromise fertility objectives even for educated
women. A study conducted in India showed that women in matrilineal kinship systems in
northeast India have the highest fertility in the country, in spite of enjoying a higher level of
female autonomy (Saikia, Steele and Dasvarma, 2001). Consequently, the study suggests that social
norms and values in the traditional tribal societies wield a stronger influence than individual values
in determining the fertility behavior in those societies. In an environment with pro-natalist social
and cultural norms and a strong traditional society, high female autonomy may encourage women
to produce more children.
A study in Uganda also showed that wife-dominated decisions are the most likely to result in
contraceptive use; while joint decisions were more likely to result in traditional reproductive
behavior (see also Zafar, 1996, on similar findings from Pakistan). In addition, in communities
where husband-dominated decision-making is more common, the wife holding autonomous views
does not promote contraceptive use as much as it does in more egalitarian settings (DeRose and
Ezeh, 2007).

43

Partha Dasgupta (1995) suggests that the way to reduce fertility would be to try to identify policies
that would so change the options men and women face that their reasoned choice would be to
lower their fertility. Such options include civil liberties (as political and civil liberties are positively
and significantly correlated with improvements in income per head, life expectancy at birth, and
infant survival rate), family planning services, and measures that empower women. As social norms
break down and traditional support systems falter, a literacy and employment drive for women is
essential to smooth the transition to lower fertility.
5.3.2 Policies that affect the Opportunity Cost of Education
As Doepke (2004) has demonstrated, the speed of the fertility transition depends on policies that
affect the opportunity cost of education, mainly child-labor restrictions. The possibility of child
labor implies that the value of a childs time becomes part of the opportunity cost of education,
which support the findings from several studies which show that fertility fell fastest just at the time
when free public education was introduced. Once we account for the full opportunity cost of
education including potential child labor income, educating a child is costly even if schools are free.
The policies also determine the evolution of income per capita, average education, and the income
distribution of a country during the transition to growth. The study also argues that compulsory
schooling laws often appear to be a more effective constraint on child labor than direct regulation.
In any case, parents are thereafter likely to support the introduction of child labor laws, since they
no longer depend on child labor income.
5.3.3 Modes of Production
Schultz (2005) tested the effects of exogenous fertility change on the health and welfare of children
using Kenyas second (1994) and third (1997) welfare monitoring surveys. The analysis showed that
having one more child is significantly related to diminished consumption per adult, -1.9% per birth
in 1994 and -2.5% in 1997, thus confirming that higher fertility is associated with lower
consumption and greater poverty. Schultz (2005) further argues that it is important to distinguish
among the different sources of income in order to understand the impacts of economic
development on fertility and the timing of the demographic transition in a particular society. In
particular, income that flows from the human capital of the mother and father, and income that
flows from stocks of physical capital, land, and other natural resources, are not likely to contribute
to similar behavioral responses in fertility.
The study showed that household consumption per adult is significantly positively associated with
the ownership of land, and the receipt of agricultural and non-agricultural rents. These three
physical asset sources of income are generally positively related to fertility; but a 10% increase in
household consumption per adult from sources other than the three asset variables is negatively
related to fertility. In other words, the estimated effect of increasing assets is to increase fertility,
whereas increasing other sources of income, such as labor earnings, decreases fertility. An increase
in the mothers schooling attainment by one year is associated with her household consumption per
adult rising by 4.1% in 1994 and by 4.9% in 1997, and these effects are larger than those associated
with the schooling of the father. If the household consumption effect of the womans schooling is
held constant, each additional year of her schooling has an additional effect of reducing her fertility
by 0.12% in both 1994 and 1997. These estimates underscore how different sources of income and
human capital exhibit markedly different partial associations with fertility.
If growth is achieved by increasing the income returns from land, for example, it is likely that
Kenyas fertility will remain high, perhaps because parents view land and the labor of children as

44

complementary factors in their meager production. If economic growth is stimulated by extending


additional education to women, the resulting relative rise in the price of children will favor a
continuing decline in fertility.

5.4

The Role of Religion

According to Anson (2006), both religion and fertility are social processes which occur through the
medium of individual action. High fertility within a religious group does not happen because of any
particular set of religious beliefs, but as a response to the real conditions in which people live and
define their lives, which may then be framed as creed calling for high fertility. The effect of
religion is not therefore different from effects of nationalism or ethnicity (consciousness of a group
for itself, in struggle with others). There is therefore need to view religious, national and ethnic
effects within the context of group struggle.
According to the Centre for Health and Social Policy (2005), the case for involving religions in
sexual and reproductive health and rights is almost self-evident. Through their influence on
individuals, cultures, and policies, religions play a critical role in shaping peoples and governments
attitude toward reproduction and sexuality. Thus, the worlds religions can be an important ally in
the effort to advance sexual and reproductive health and rights (or, conversely, a key obstacle).
However, the study found that few organizations in the United States work directly at the
intersection of religion, and sexual and reproductive health and rights. Similarly only a few scholars
research and write about religion and sexual and reproductive health and rights.
Berman et al (2004) tackle the puzzle of rapid fertility decline in predominantly Catholic Italy,
Spain, and other countries of Southern Europe. The puzzle of rapid transition to an unprecedented
combination of low fertility and low female labor force participation is explained by religious
decline since Vatican II, while reduced services were linked to the large attrition of nuns and
priests that followed the major reforms of Vatican II in the mid-1960s. However, their preliminary
results imply that this decline was not primarily caused by religiously-induced change in
preferences for children, but social effects appear to be more important, such as the loss of schools,
hospitals, daycare, and other child-friendly social services traditionally provided by Catholic
communities.
To Christians, Genesis 3:16-19 introduces gender distinction, biological differences and the
responsibilities for procreation and production. Consequently the body and all its organs and
especially the sex organs, have taken on symbolic meaning of obedience or rebellion (Nkolika,
2005). However, it is pertinent to note that the Bible does not promote gender inequality in sexual
relations within marriage, but emphasizes that the husband should fulfill his marital duty to his
wife, and likewise the wife to her husband. The wifes body does not belong to her alone but also to
her husband. In the same way, the husbands body does not belong to him alone but also to his
wife (1 Corinthians 7:3-4).
Iyer (2002) explores the impact of religion on womens fertility in India. Systematic comparison of
Islam and Hinduism shows little difference in their theological positions on demographic issues,
with the exception of their position on birth control. The findings suggest that perhaps it is not
religious affiliation or religious observance that affects fertility, but rather the manner in which
religion is interpreted to individuals.

45

Kulkarni and Alagarajan (2005) address the issue of religious differentials in population growth in
India and then examine differentials in fertility. The analysis shows that fertility and population
growth are slightly higher and contraceptive practice lower among Muslims compared to Hindus.
In addition, fertility for a religion varies substantially across states. However, the differences appear
to be a passing phase in the process of fertility transition, since all religious communities in India
have experienced substantial fertility declines and contraceptive practice has been well accepted.
They cite the case of the predominantly Catholic countries of southern Europe that exhibited high
fertility in the past but later moved to extremely low fertility.
There are two demographic features about India that receive particular attention. The first is the
small number of females compared to males (the so-called missing women), and the second is that
the fertility rate of Muslim women is considerably higher than that for Hindu women. Although
the higher fertility of Muslim women is blamed on Indian Muslims obeying the tenets of Islam and
the ambition to outnumber Hindus, the adverse sex ratio can be viewed in the context of the
preference that many South and East Asian families have for sons over daughters. Borooah and Iyer
(2004) bring together the two issues of son preference and contraceptive usage to provide a
more benign explanation. Just as sons bring benefits to their parents, daughters impose costs and
complementing a desire to have sons is a desire not to have daughters. The analysis concludes that
higher Muslim fertility compared to Hindus may in reality reflect significantly lower levels of
daughter aversion among this community.
Other authors have studied the concurrent phenomenon of the demographic shift and the return of
religions. For example, Blume et al (2006) observe that worldwide, communities that are still
traditional or have chosen religion generally have more children than secular population sectors.
They argue that by encouraging dialogue and mutual respect of religious freedom, religious
plurality can be dealt with and can unfold its positive aspects (as a demographic stabilizer).
Some religions provide psychic and social rewards to those who have many children, in the form of
approval, social status, and blessings. For example, some religions embody strong pro-natalist
ideologies (which raise the perceived benefits of having an additional child), forbid artificial forms
of contraception, oppose abortion, and increase the costs of family planning. However, if the
spouses are mismatched along some important dimension, such as education or religion, they may
have reasons to believe that their union is fragile and limit their fertility, while spouses belonging
to different faiths may negotiate their fertility differences (Lehrer, 2004).
In Europe, studies have also shown that religious people have a larger number of children, are more
likely to progress to higher parity (3 children plus), and remain less frequently childless, although
these associations are of different intensity in different national and religious contexts
(Berghammer and Philipov, 2007).
Braas-Garza and Neuman (2007) explores the relationship between religiosity and fertility among
Catholics in Spain, thereby answering the question whether the two parallel trends of dramatic
drops in fertility and in religiosity are inter-related. It looks at current religiosity as well as
exposure to religiosity during childhood. The study found that fertility is not related to current
intensity of religiosity, but to religious activities during childhood. This study indicates the
significance of childhood experience in shaping the taste for children.
Blaker (2003) observes that the fertility rates of fundamentalists and evangelicals in America are
considerably higher than those of mainline Protestants. The fundamentalists are less likely to use

46

contraception the first time they have intercourse regardless of marital status, because of their
opposition to birth control. In addition, when hospitals merge with Catholic institutions, many
services are eliminated e.g. family planning, contraceptives (including condoms), sterilization,
fertility treatment, and abortion.

5.5

Diffusion Theories and the Impact of Social Networks

5.5.1 What is Diffusion?


According to Palloni (1998), structural explanations of behavioral changes seek their cause in the
alteration of preferences and opportunities that result from either changes in positions that
individuals occupy or from shuffling of resources associated with a given social position. Diffusion
models attempt to identify a cascading mechanism that leads to cumulative adoption of behaviors
by some individuals, even while their social position, or the resources associated with them, change
only trivially or remain unaltered. The fertility decline in Europe is likely to have combined
structural and diffusion factors, since the countries revealed a marked tendency to proceed along
ethnic, language, and religious boundaries. If non-adopters find that those with fewer children are
better able to support higher or better educational standards, they may decide to imitate fertility
limitation. As the process evolves, the institutional context to satisfy the demand for more and
better education also evolves, thus changing the context where fertility decision-making is taking
place.
There is a tendency to relegate diffusion to the corner of what cannot be explained with indicators
and measures of structural factors, as residual mechanisms that are often confused with cultural
factors. Thus diffusion is normally conceived of as a set of actions, with no apparent rational basis,
and inconsistent with observed social and economic conditions of one sort or another. However,
new research shows that diffusion can be modeled as a positive function of the established social
networks of an individual among those who have (and have not) adopted change, mediated by
social or geographic distance or by other structural characteristics.
The network effects are either linear (based on the aggregate proportion of adopters) or nonlinear
and asymmetric (suggesting that networks provide information primarily through social learning,
rather than by exerting social influence). Distinctions have also been made between blended and
pure theories of diffusion. For example, if what is being diffused is information about family
planning or new ideas and values about its use, then pure theory of diffusion may be plausible. If
information about the costs of children or the benefits of smaller families is being diffused, it may
not be possible to separate the effects of diffusion from those of structural change.
5.5.2 Social Networks as Channels of Diffusion
Kohler (1997) starts from the premise that womens attitude towards contraception and their
willingness to adopt modern birth control are shaped by local culture, social influences, and
particularly the availability of contraceptive information. The paper suggests that regional diversity
and social stratification in contraceptive practices arise due to informal communication, rather than
in-depth discussions about fertility control. Women choose on the basis of private information
about their own characteristics and estimates about the different effectiveness of the available
alternatives. The chance of a woman adopting modern contraception equals the proportion of users
in her social network, on the belief that the prevalence of methods in the population reflects their
different effectiveness. For the design of family planning programs, these findings suggest that the

47

initial number of users is more important than the size of each womans social network for
successful diffusion.
Kohler et al (2000) argue that empirical studies of the diffusion of modern methods of family
planning have increasingly incorporated social interaction within nonlinear models but have not
considered the full implications of these nonlinear specifications. With nonlinear models, the
extent to which a social interaction multiplies program efforts depends on whether the community
is at a low or high level of contraceptive use rather than being independent of the level of
contraceptive use as in linear models.
Behrman et al (2002) investigate the impacts of social networks on changes in contraception in
rural Kenya using special data from a longitudinal household survey. The study shows that the
effects of social networks are particularly large if at least one network partner is perceived to be
using contraceptives, but the inclusion of additional network partners with the same characteristic
generally has much smaller (and insignificant) effects for women.
This suggests that the exchange of information constitutes the primary aspect of social interactions
about family planning (social learning) and not social influence. If there are just a few who initially
adopt an innovation, they have a relatively large influence because they interact with a relatively
large number of individuals who have not yet adopted it. Thus, adoption initially accelerates, but
the marginal influence of yet another adopter eventually starts to decline. The results showed that
men are likely to be more influenced by their network partners than are women. This finding may
reflect cultural patterns of exogamy and patri-locality that result in men having known their
network partners since childhood, whereas women normally alter their network partners after
marriage.

48

CHAPTER SIX

POVERTY AND REPRODUCTIVE HEALTH

6.1

The Elements of Reproductive Health

The 1994 International Conference on Population and Development defined Reproductive Health
as a state of complete physical, mental and social wellbeing, and not merely the absence of disease
or infirmity, in all matters relating to the reproductive system and to its functions and processes;
while reproductive rights embrace certain human rights that are already recognized in national
laws, international human rights documents, and other consensus documents. These rights rest on
the recognition of the basic right of all couples and individuals to decide freely and responsibly on
the number, spacing and timing of their children, to have information and means to do so, and to
have the right to attain the highest standard of sexual and reproductive health.
The following aspects or issues constitute reproductive health:
Family planning services, counseling, information and education
Obstetric care: antenatal care, safe delivery, postnatal care, and the management of complications
of pregnancy and delivery
Post-abortion care
Diagnosis and treatment of RTIs and STIs including HIV/AIDS
Information, Education, Communication and Counseling on human sexuality, reproductive
health and responsible parenthood
Diagnosis and treatment of cervical, breast and other cancers of the reproductive system
Active discouragement of harmful practices such as female genital cutting and gender-related
violence
Prevention of gynecological fistula
Specific male reproductive health services are rare, but are taken to include STI and HIV/AIDS
control, the need for males to play a more supportive role to their spouses, and to behave in a
manner conducive to the promotion of reproductive health.

6.2

Poverty in the Context of Reproductive Health

6.2.1 General Overview


The relationships between investments in reproductive health on one hand, and economic growth
and poverty reduction on the other, can be viewed from demographic, behavioral and health
service delivery perspectives. From the demographic perspective, investments in reproductive
health can be viewed through changes in fertility, mortality and migration. Fertility is likely to
change through changes in sexual behavior and the use of contraception to delay pregnancies or
limit family size; while mortality is likely to change through declines in the risk associated with
sexually transmitted infections and infections of the reproductive organs, as well as pregnancy and
childbirth. These changes, in turn, can result in changes in population growth rate and size, age
structure, and spatial distribution. This type of demographic change may then be expected to have
an impact on the rate of economic growth as the relatively large cohort from the high-fertility
period moves into the most economically productive stage of life, while supporting fewer
dependents.

49

Depending on womens education, health status, and expectations about roles as mothers, wives
and workers, access to reproductive health services can lead to changes in childbearing patterns;
the availability of modern contraception can result in later age at first birth, longer birth intervals
and/or a lower number of births during a womans reproductive years; and effects can also be seen
in the health status of women, men and children. Other behavioral effects of access to reproductive
health services can be seen in womens decisions about education, investments in child health,
nutrition and education, migration and household structure.
6.2.2 The Place of Reproductive Health in Poverty Reduction
Rani and Lule (2004) used nationally representative Demographic and Health Survey data for 12
countries in three major regions of the developing world (Asia, sub-Saharan Africa and Latin
America) to assess the magnitude of socioeconomic inequalities in reproductive health outcomes
and service utilization among young women, using the poorest and the richest quintiles (fifth of the
population) based on a household wealth index. The results showed that in most countries, young
women from the poorest households were more likely to be married by age 18 and to have had at
least one child by that age; and were less likely to be practicing contraception, to use maternal
health services and to know how to prevent sexual transmission of HIV. In addition, economic
autonomy, school enrollment and regular exposure to mass media were less common among poor
than among rich adolescents. There may therefore be need for alternative strategies to serve the
needs of poor young women (such as community-based outreach programs), as most poor
adolescents may be overlooked by current service delivery modes that rely solely on mass media,
clinics or schools.
6.2.3 Unsafe Abortion
The ICPD Programme of Action stated that women who have unwanted pregnancies should have
ready access to reliable information and compassionate counseling. In circumstances in which
abortion is not against the law, then abortion should be safe. In all cases women should have access
to quality services for management of complication arising from abortion. The ICPD also enjoin the
state parties to consider reviewing laws containing punitive measures against women who have
undergone illegal abortion.
Grimes et al (2006) observe that unsafe abortion threatens women throughout the developing
world. Every year, about 1920 million abortions are done by individuals without the requisite
skills, or in environments below minimum medical standards, or both; and an estimated 68,000
women die as a result, and millions more have complications, many permanent. In addition, the
direct costs of treating abortion complications burden and impoverish healthcare systems, and the
indirect costs drain struggling economies.
The close connections between abortion, poverty, and social inequity are evident from the
distribution of abortion-related maternal mortality. Globally, 85% of deaths due to unsafe abortion
are in the countries of sub-Saharan Africa and South Central Asia countries which also tend to
have the lowest per capita income in the world (Gasman, Blandon and Crane, 2006). Of all age
groups, adolescents are particularly vulnerable: they have a relatively high risk of unwanted
pregnancies and in many countries are least likely to be able to obtain a safe, legal abortion. Her
only alternative to terminate the pregnancy may be to turn to an unskilled provider, putting at risk
her own life and health, and often the lives and health of her other children and the wellbeing of
her family. If a woman experiences complications from an abortion that is incomplete or in other

50

ways unsafe, she is likely to find herself hospitalized, often at high cost to herself and her family
and to the healthcare facility where she is treated.
Unsafe abortion occurs in almost all cases as a result of unplanned pregnancies, which can also be
attributed to a failure of a system in any or a combination of the following circumstances: (a)
womens vulnerability and lack of power to negotiate safe sex; (b) girls being lured into sex because
of poverty; (c) failure of a contraceptive method or lack of access to family planning services; and
(d) lack of information on sex and reproductive health especially to the adolescent girls. All the
above factors also increase the vulnerability and likelihood of HIV and AIDS infection. In Kenya,
women resort to unsafe abortion due to lack of information about reproductive and sexual health
and rights; lack of reproductive health counseling and services; lack of access to safe, affordable and
acceptable contraceptives; and restrictive legal and policy environment.
The Constitution of Kenya guarantees freedom from discrimination. One could argue that the right
to physical integrity ensures freedom from unwanted invasion of ones body, and should therefore
be one of the guarantees envisioned in this provision. However, the fundamental guarantee has
been undermined by the provisions of the Penal Code, Cap 163 of the Laws of Kenya, which
classifies offences against morality to include (a) assistance to procure miscarriage of a woman
(Section 158), (b) for a woman to procure her own miscarriage to herself or with assistance of
others (Section 159), and (c) for any person to supply drugs or instruments knowing that it is
intended to procure abortion (Section 160). However, Section 240 provides for circumstances under
which legal abortion can be undertaken in order to save the life of a pregnant woman. The risk of
prosecution keeps poor women from seeking medical services, which contributes to the high
number of victims of unsafe abortion. A violent robber or a murderer is availed medical services to
save his life, whereas women who are victims of unsafe abortion are turned away from medical
services or keep away in fear of prosecution (Hon. Martha Karua, 2004).
6.2.4 Obstetric Fistula
Obstetric fistula is a preventable and treatable condition, one that no woman should have to
endure. Direct causes of fistula include childbearing at too early an age, malnutrition, and limited
access to emergency obstetric care. The social consequences are severe as many of the women are
abandoned by their partners, forced out of their homes, ostracized by family and friends, and even
disdained by health workers. Some do rarely have the skills to earn a living and may turn to
commercial sex work to procure an income for themselves, further heightening their social and
physical vulnerability. Because of poverty and the stigma associated with their condition, most
women living with fistulas remain invisible to policy makers.
The Ministry of Health commissioned a needs assessment on the obstetric fistula (OF) situation in
selected districts where the condition is suspected to be most prevalent (Kenya, 2004). The
objectives of the survey were to assess socio-cultural factors contributing to fistula incidence,
health seeking behavior in relation to obstetric fistula, availability and utilization of essential
obstetric services, and to make recommendations on prevention and management of obstetric
fistula. The assessment spanned four districts in four provinces, namely, Kwale, Mwingi, West
Pokot and Homa Bay.
The findings indicate that the problem exists and requires attention. Across the board, the rugged
physical and expansive landscape, harmful cultural practices (e.g. early marriage and early sexual
debut), preference to deliver with TBAs, long distances to health facilities, and poverty in the four
study sites interact to precipitate obstetric fistula. It was evident that this is a neglected area of safe

51

motherhood, and that awareness of obstetric fistula is low among health workers and community
members. Experience with fistula repair was very varied across the districts but the common
feature is that all the districts had seen more cases than they had repaired, mostly due to limitations
of resources, skills and time available at health facility-level. The evidence among the Pokot
suggests a link between FGM and the development of fistula, as the Pokot in some cases perform
infibulation type of female circumcision. At delivery, TBAs use arrowheads to perform bilateral
upper episiotomies, which sometimes inadvertently extend to the bladder or to the rectum creating
a fistula. This is similar to the gishiri cut commonly practiced among the Hausa in Nigeria (Wall,
1998).
The recommendations in the Kenya study include training in fistula surgery, prevention of
obstetric fistula (e.g. extending life saving skills training to midwives), integration and visibility of
obstetric fistula within safe motherhood initiatives, quality care and referral, information and
advocacy at community level using appropriate structures, and enhancing partnerships with other
government departments and NGOs.
6.2.5 Maternal Morbidity and Mortality
As observed by Meyerhoefer and Sahn (2006), protecting the health of mothers during
reproduction safeguards their future contributions to society and ensures the health and
productivity of future generations in Africa. If either the health of mothers or their newborn
offspring is compromised, there will be serious negative consequences for their families,
communities, and the entire process of economic and social development at the national level.
There are many ways in which poverty might lead to high maternal morbidity and mortality
(MMM). For example, extreme poverty is often associated with limited access to necessary
antenatal medical care as well as appropriate medical resources during and after delivery.
Furthermore, the lack of access to family planning and reproductive health services may result in a
demographic profile, such as young age at first birth and high overall fertility, which increases the
reproductive risks to mothers and their offspring. The poor may not have access to fresh water, and
may live in substandard dwellings and be at greater risk of contracting malaria or parasitic
infections that compromise a womans immunity during pregnancy. Illness resulting from
childbirth will limit a womans future productivity in the labor market and earning power, thereby
contributing to a cycle of poverty and poor maternal health outcomes. The result is a poverty trap
whereby mothers are more likely to die or become ill during or after pregnancy because they are
poor, and more likely to be poor in the future as a result of negative health shocks during this
period. Likewise, mothers who are sick or die are not able to provide (adequate) care for their
children, thus further contributing to this downward cycle of poor reproductive health outcomes
and poverty.
Maternal mortality ratio is the number of women who die from any cause related to or aggravated
by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and
childbirth or within 42 days (6 weeks) of termination of pregnancy, irrespective of the duration and
site of the pregnancy, per 100,000 live births, i.e. the risk a woman faces each time she gets
pregnant. The maternal mortality ratio incorporates obstetric risks (e.g. hemorrhage and prolonged
or obstructed labor) and frequency of pregnancy (total fertility rate). Fertility is therefore an
important predictor of maternal mortality, with high fertility levels associated with high maternal
mortality.

52

In Kenya, estimates based on WHO/UNICEF suggest that about 14,700 women of reproductive age
die each year due to pregnancy-related complications while 294,000 to 441,000 suffer from
disabilities caused by complications during pregnancy and childbirth. There is lack of reliable
regional differentials in the estimates of maternal mortality but anecdotal evidence suggests wide
regional differentials ranging from about 100 to over 1,200 maternal deaths per 100,000 live births.
The lifetime risk of a woman dying in pregnancy or at childbirth at some point in her life is a
function of both the number of times she becomes pregnant and the chances of her dying each
time. Most maternal deaths are directly related to unsafe abortion and obstetric complications (such
as severe bleeding, infection, hypertensive disorders, and obstructed labor), while indirect causes
include malaria, diabetes, hepatitis, and anemia, which are aggravated by pregnancy.
High maternal mortality among the Hausa of Northern Nigeria was related to an Islamic culture
that undervalues women; a perceived social need for womens reproductive capacities to be under
strict male control; the practice of purdah (wife seclusion), which restricts womens access to
medical care; almost universal female illiteracy; marriage at an early age and pregnancy often
occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly
harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric
emergencies; a deteriorating economy; and a political culture marked by rampant corruption and
inefficiency (Wall, 1998).
6.2.6 Female Genital Cutting
Female genital cutting (FGC) targets the youth as a rite of passage into adulthood, yet the cultural
practice destroys parts of the female reproductive organs, and often causes complicated
pregnancies, difficult births and lifelong emotional pain, among other complications. According to
KDHS 2003 and 1998, FGC is still rampant in many regions in Kenya.
Several studies in Kenya show a trend towards medicalization of FGC, as demonstrated by a study
among the Abagusii of Nyanza Province in western Kenya (Njue and Askew, 2004). However, the
trend towards medicalization is condemned by traditionalists in the community because it is seen as
a violation of the cultural value of the ritual and meaning associated with the practice; while some
people see medicalization as an impediment to the abandonment of FGC.
6.2.7 Contraceptive Use
Many women have more children than they want or have children sooner than they want.
However, women in Kenya are still more likely to report that a pregnancy was mistimed than
unwanted. Unplanned pregnancy is the total proportion of births that are either mistimed or
unwanted. Kenya is one of the countries in sub-Saharan Africa with the highest proportion of
unplanned pregnancy at 45% (Vadnais et al, 2006).
Complications related to pregnancy and delivery poses some of the greatest hazards for womens
health and wellbeing during their childbearing years. The risks of childbirth are known to vary
with the mothers age and may also be linked to her parity and to the interval since the previous
birth. Such high risk births normally occur when the woman is under age 18 at the time of the
birth, is over age 34 at the time of the birth, gives birth within 24 months of a previous birth, or has
already had three or more live births. These risk factors increase the likelihood of serious illness
and premature death among infants and young children as well as their mothers. Trend data
indicate that high risk births have increased in Kenya (CBS, 2004; Vadnais et al, 2006).

53

Contraception is likely to change the age pattern of childbearing, particularly by reducing fertility
at older ages, and will certainly affect parity-specific fertility. The second major contribution of
contraception to reducing obstetric mortality and morbidity is related to its potential to diminish
recourse to unsafe abortion (Marston and Cleland, 2004).
Mburugu and Zulu (1998) studied the trends and correlates of contraceptive use from data collected
in four national surveys conducted in Kenya between 1977 and 1993, a period characterized by
reduction in Kenyas total fertility rate and increase in contraceptive prevalence rate. They
conclude that Kenyas fertility transition was a result of greater availability of family planning
services; socioeconomic progress of the 1960s and 1970s; the economic hardships of the 1980s; and
the substantial increase in the proportion of women with primary and secondary education,
working outside the home, living in urban areas, in monogamous unions, and approving use of
contraception.
6.2.8 Factors Influencing Maternal Health Provision and Access
The factors influencing maternal health provision and access include household and community
characteristics, bio-demographic and other risk factors, malnutrition and infections, health systems
including investments in health, and non-health factors.
The household and community-level factors range from financial situation of the households,
household power relations among the different members, as well as the nature of decision-making
process. Some of the factors linked with poor pregnancy outcomes and maternal health include
social and economic characteristics of both the households and the communities women live in,
and womens social status, as it limits their access to economic resources and basic education and
consequently their ability to make decisions relating to their health and nutrition. Some women are
denied access to care when it is needed, either because of cultural practices of seclusion or because
decision-making is the responsibility of other family members.
Under-nutrition increases the risk of illness and death, threatens pregnancy outcomes, and even
reduces cognitive development. Under-nutrition remains the leading dietary challenge for women
in parts of sub-Saharan Africa; Kenya included (Vadnais et al, 2006).
Bio-demographic and other risk factors (e.g. age, height and parity) affect maternal mortality in
Africa. Adolescents comprise almost one quarter of maternal deaths most of which are due to
complications as a result of unsafe abortion. Very short women are more likely to have obstructed
labor, which is dangerous for both their own health and that of their newborns. Early marriage is
associated with early age at childbearing that increase the potential to have many children and
hence longer exposure to maternal death risks.
The third category of factors is malnutrition and infections, especially protein-energy and
micronutrient deficiencies, anemia, malaria and HIV/AIDS. Malaria, for example, is one of the
greatest killers of human beings in Africa and a major source of complications during pregnancy. In
countries where malaria is endemic, women are more likely to have it during pregnancy than at
any other time. Malaria is also associated with spontaneous abortion and stillbirth, and women who
develop severe anemia from malaria are at increased risk of maternal death. Iron-deficiency anemia
is the most common micronutrient deficiency in the world. In young women, the growth spurt at
puberty and onset of menstruation may exhaust the bodys iron supplies and exacerbate or trigger
anemia. Anemia is associated with a host of health problems in women, especially pregnant and
breastfeeding women. These include poor pregnancy outcomes, lower resistance to infection,

54

decreased work capacity, and poor cognitive development. Micronutrient deficiencies influence
both maternal and neonatal health. HIV and its effects on maternal health pose one of the greatest
challenges, as pregnant mothers who have malaria and are HIV-positive are more likely to pass on
their HIV status to their unborn child.
Health systems refer to all resources, organizations and actors that are involved in the regulation,
financing, and provision of actions whose primary intent is to protect, promote or improve health.
The utilization of a broad range of health interventions requires a functioning health system, which
comprise the human resource base, infrastructure, and their geographical distribution. Maternal
deaths are strongly associated with weak health systems as substandard health services and lack of
medical supplies at labor, delivery, and immediately after birth increases risk of maternal death.
Within Kenya, the presence of a skilled attendant at delivery is the most inequitably distributed
among child and maternal health indicators. Impoverished and rural women are far less likely than
their urban or wealthier counterparts to receive skilled care during childbirth. Inequality between
urban and rural care at delivery is particularly significant. The urban women are over three times
more likely to deliver with health personnel than women in rural areas. Women in the wealthiest
fifth of the population are three times more likely to deliver with a health professional than those
in the poorest fifth. However, these relations may only be associations rather than causations.
Redressing these inequities will require continued analysis of trends through a refocused
conceptualization.
6.2.9 Gender Roles
Gender roles significantly affect maternity care. When complications of pregnancy and childbirth
develop, women are not often able to make decisions about their care. This places male family and
other community members as decision makers. It has been reported that men often make poor
decisions about seeking care during pregnancy and childbirth, in part because they do not
understand the dangers involved.
Gender issues related to HIV/AIDS are manifold and complex. In many societies, women lack the
power to make decisions about how, when and under what conditions they wish to engage in
sexual relationships, which can place them at risk for HIV/AIDS. This is reflected in the high HIV
prevalence among women compared to men. The level of unprotected sex among women is closely
related to poverty. Many poor women end in unprotected commercial or transactional sex as a
result of poverty.
6.2.10 Protection against HIV/AIDS
Cheluget et al (2006) say that the HIV/AIDS epidemic in Kenya has been tracked through annual
sentinel surveillance in antenatal clinics since 1990, and measured through national Demographic
and Health Surveys in 1993, 1998 and 2003. The surveillance data indicate that prevalence has
declined substantially starting in 1998, and adult prevalence has declined from 10% in the late
1990s to about 7% today. Surveys also indicate that both age at first sex and use of condoms are
rising and that the percentage of adults with multiple partners is falling.
Thomsen et al (2004) explore the reasons why men who have sex with sex workers in Kenya refuse
to use condoms. The analysis of the participant observations revealed at least 50 reasons for not
using a condom, which they grouped into six categories: condoms are not pleasurable, condoms are
defective, condoms are harmful, condoms are unnecessary, condoms are too hard to use, and
external forces prohibit using condoms.

55

6.2.11 Adolescent and Youth Sexual and Reproductive Health


Teenage pregnancy poses a threat to the health of both mother and child, often forces girls to drop
out of school, and ultimately narrows womens opportunities in life. Most literature supports the
notion that teenage childbearing is generally associated with higher risk of adverse maternal and
newborn health outcomes. Some studies have argued that the sexual attitudes and behavior of
young adolescents are significantly shaped by socio-cultural and gender norms that send mixed
messages about sexuality and impose different standards of behavior for boys and girls. The
consequences of such gendered actions and socialization patterns have profound impact on the
balance of power in adolescent sexual relationships and on certain kinds of male and female sexual
behavior, because they may prepare young women to accept male dominance in sexual encounters.
Poverty compounds the challenges and risks of adolescence and obliges many parents to put their
children to work, often in harms way. In urban areas, boys may be forced by poverty to survive on
the streets.

6.3

Males and Reproductive Health

6.3.1 Reproduction as a Dual Commitment


As observed by Mbizvo and Bassett (1996), reproduction is a dual commitment, but is often seen as
wholly the womans responsibility. She bears the burden not only of pregnancy and childbirth but
also the threats from excessive childbearing, some responsibility for contraception, infertility
investigation, and often undiagnosed sexually transmitted diseases (STDs) including HIV. Failure to
target men in reproductive health interventions has weakened the impact of reproductive
healthcare programmes. In particular, failure to study and foster change in mens perceptions, as
well as determinants of sexual behavioral change, could be adversely affecting womens
reproductive health. It is also important to recognize the impact of male dominance, as manifested
through reproductive health and sexual decisions, and how such dominance affects interpersonal
support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths. This
includes factors influencing male compliance in, say, condom use.
The role of men in promoting high fertility is well understood. Couples normally have disparate
reproductive goals, with husbands normally wanting more children and to want them sooner
(Bankole and Singh, 1998). Studies conducted in Kenya (e.g. Lasee and Becker, 1997) show that
spousal communication of family planning significantly affects contraceptive use.
Greene et al (2004) observed that clarifying the negative effects of gender norms on mens health
and wellbeing could facilitate the development and implementation of more visionary policies and
more innovative implementation. Mens potential roles in relation to their children tend to be
articulated as obligations rather than rights, and emphasize punitive measures to ensure compliance
(e.g. child support), rather than also helping to create the circumstances that would support men in
positive fathering roles. Gender roles interfere with mens health as well, and dominant masculinity
poses risks to mens health: from drinking to violence to sexual risk-taking.
An issue that has not received sufficient attention is the effect of the male biological clock on the
potential for adverse genetic consequences in offspring (Lambert et al, 2006). In particular,
increasing paternal age at conception is significantly associated with spontaneous abortion (Slama
et al, 2005; Kleinhaus et al, 2006), increased risk of neurodevelopmental disorders during infancy
and childhood such as autism and schizophrenia, as well as with dyslexia and reduced intelligence

56

(Saha et al, 2009), breast cancer in female offspring (Choi et al, 2005), and heart defects, Downs
syndrome and other chromosomal anomalies (Yang et al, 2007).
6.3.2 Sex under Coercive Conditions
As observed by Luke and Kurtz (2002) and Luke (2003), age and economic asymmetries within
sexual relationships are widespread in sub-Saharan Africa, and limit the power of the weaker
partner to carry out safe sexual practices. The cross-generational and transactional sexual relations
are particularly risky for adolescent girls as it is normally associated with unsafe sexual behaviors
(nonuse of condoms) and increased HIV infection. Some such relationships are the result of
deliberate exploitation of the unequal economic power of males and females. However, gifts or
favors among same-age relationships may also be associated with sexual leverage, and the
possibility of remolding a relationship into another form (Kaufman and Stavrou, 2002).
The most disturbing case of gender asymmetry is sex received under coercion and material
inducements. For example, a 2001 population-based survey of married and unmarried males and
females aged 10-24 years in Nyeri, Kenya, showed that 21% of females and 11% of males had
experienced sex under coercive conditions (Erulkar, 2004). Males who had been coerced into sex
were significantly more likely than those who had not to have had a first partner who was older by
at least five years. Therefore, reproductive health programs for young people need to address
nonconsensual sex, including the special needs of males and of married females.
6.3.3 Male Circumcision
A number of recent studies have documented medical benefits of newborn male circumcision,
including protection against infections of the urinary tract in male infants, and HIV and Chlamydia
infection in adolescents and adults (Flynn et al, 2007). The ability of newborn circumcision to
protect against sexually transmitted diseases was also shown in a recent cohort study in New
Zealand. Recent large randomized clinical trials in South Africa, Kenya and Uganda demonstrated
reduction of HIV-acquisition risk by male circumcision performed outside the newborn period,
showing the potential role of adult male circumcision in prevention of STDs in adolescents and
adults. A review of the studies from sub-Saharan Africa showed an estimate of the adjusted relative
risk of HIV acquisition of 0.42 in circumcised compared with uncircumcised male subjects. A
cohort study has also suggested that transmission of HIV to female partners of men with HIV may
be lower when the male partner is circumcised.
However, analysis based on the first five Demographic and Health Surveys to include HIV testing
for a representative sample of the adult population (Burkina Faso, Cameroon, Ghana, Kenya and
Tanzania) has shown that there is no significant negative association between male circumcision
and HIV status, despite recent evidence from a randomized control trial that male circumcision has
a protective effect (de Walque, 2006a; 2006b).
Hankins (2007) has sounded the alarm that in the high HIV prevalence settings in which men may
be offered male circumcision, women will face the challenge of negotiating for safer sex with men
who may mistakenly think that they can stop condom use and other safer sex measures. She argues
that women can contribute to ensuring that male circumcision for HIV prevention is used
appropriately and ethically, and its success in HIV prevention will depend on societal engagement
both within and outside male circumcision services, and in comprehensive HIV prevention
programming.

57

The now conclusive body of epidemiological and biological evidence confirming the strong
association between lack of male circumcision and HIV is increasingly understood to explain much
of the roughly fivefold difference in HIV rates between southern and western Africa (Halperin and
Epstein, 2007). Halperin and Epstein (2007) concurs that expanded and improved male
circumcision services will need to be placed within a broader framework of male reproductive and
sexual health.
Within the Kenyan environment, the policy is likely to face political resistance (as it will only
affect a small proportion of the population), and is likely to be undertaken at home by people with
no previous experience. Studies conducted in Kenya show appalling rates of morbidity associated
with traditional male circumcision, and have recommended its medicalization and training of
traditional circumcisers (Bailey and Egesah, 2006).

6.4

Integrating Family Planning and Maternal and Child Healthcare

At the 1994 ICPD, the international community embraced a new, broad concept of reproductive
health and rights, including family planning and sexual health. It called for integrating family
planning and maternal and child healthcare within a wider set of services including the control of
HIV and sexually transmitted infections (STIs). Expanding access to services and meeting clients
expressed needs and wishes were seen as essential to reducing unintended pregnancies, improving
maternal health and curbing the HIV/AIDS pandemic.
Temmerman et al (1998) studied the burden of disease of reproductive tract infections (RTIs) and
cervical dysplasia in women attending a family planning clinic in Nairobi, Kenya. The results
showed that RTI pathogens were detected in over 20% of women, the majority being
asymptomatic. HIV-1 testing was positive in 10.2%. The diagnosis of cervical dysplasia was made
on 12% of the cytology smears (mild in 5.8%, moderate in 3.5%, severe in 1.2%), and 1.5% had
invasive cervical cancer. The study underlies the need for early detection and treatment of
potentially curable cervical lesions and RTI. In addition, the scope of reproductive health must be
broadened beyond family planning and maternity care to include prevention and management of
reproductive tract infections, screening and management of cervical dysplasia and cancer,
counseling around gynecological and sexual problems, safe motherhood, and reproductive health
education. The approach to reproductive healthcare should be comprehensive and designed as a
supermarket for womens reproductive health, whereby several aspects of reproductive health are
integrated into primary healthcare facilities.
Askew and Maggwa (2002) argue a case for research on the possibility of integrating STI prevention
and management into existing family planning and antenatal care programs in most resource-poor
countries, especially in sub-Saharan Africa. Such strategies for integration of services need to be
rigorously tested to ensure that they are both feasible and effective before they are implemented.
Aloo-Obunga (2003) analyzed the extent to which Kenya has managed its family planning/
reproductive health (FP/RH) and HIV/AIDS programs in the context of the high HIV prevalence.
First, there is an apparent deliberate shift toward the HIV/AIDS program at all levels at the expense
of the FP program. Secondly, the National AIDS and STI Control Programme (NASCOP) and the
Division of Reproductive Health are not working as closely as they should to enhance the
integration of HIV/AIDS and FP/RH. In addition, management of sexually transmitted infections
has increasingly become an HIV/AIDS control strategy rather than an RH component. HIV/AIDS

58

should become a more visible issue, especially to enhance the prevention of mother-to-child
transmission (PMTCT) of HIV through the MCH/FP outlets. Family planning has also fallen off the
agenda in some ways, and sustaining and/or improving current levels of contraceptive prevalence
rate will be difficult if donor support wanes.
A study by Family Health International (2004) found that there was a dramatic shift in priorities
and resources to HIV/AIDS programs that threaten to reverse the historic gains made over the past
two decades by Kenyas once-strong family planning program, and recommended an integration of
family planning and HIV/AIDS services to make the best use of available financial and human
resources. In addition, most policies that require implementation at the district level are vertical,
leaving little room for the integration of family planning and HIV/AIDS services. Policies and
guidelines do not also clearly address private and public sector partnerships, although charitable
bodies, faith-based organizations and the private sector are the source of health services for about
half of all Kenyans seeking care.

59

CHAPTER SEVEN

HIV-AIDS AND RURAL POVERTY


We need to condomise the Kenyan nation. There should be no fear in discussing how

to use it, which should not be taken to mean advocating rampant sexual behavior. When
two adults consent to sexual intercourse, let them use condoms to prevent AIDS. - Prof.
Peter Anyang Nyongo, Minister for Planning and National Development, during the
launch of the State of the World Population Report 2004

7.1

Introduction

This chapter looks at HIV/AIDS in the context of rural poverty, with examples of HIV/AIDS and
rural livelihoods, effect of prime-age adult mortality, forestry sector, water sector, fertility, and
evolution of family structure (mainly grandparent and child-headed households).
Given the semi-aridity of much of Eastern and Southern Africa, the extended droughts, and
aggravated food crises, the hypothesis of New Variant Famine (de Waal and Whiteside, 2003) was
put forth to raise concern that AIDS is aggravating food insecurity. The intersection of AIDS and
the water sector is, however, much ignored, with only one exception (Kamminga and Schuringa,
2005). The studies on the New Variant Famine (NVF) and the intersection of AIDS and the water
sector are two recent additions to the literature covered in this chapter.

7.2

Links between HIV-AIDS and Poverty in Rural Households

This section is based on several reports, including one by SIDA titled The Environment, Natural
Resources and HIV/AIDS (2003). It touches on several issues that are also briefly covered in
Chapter 8.
Despite the fact that the estimated loss of labor in the agricultural and rural sector is probably lower
than in other sectors, there is a great deal which indicates that the sector is affected more seriously
than other sectors by the AIDS epidemic. This is due to the fact that farmers have greater
difficulties in tackling the labor losses caused by the epidemic. Some of the immediate linkages
between HIV/AIDS, rural livelihoods, human capacity and the environment include:
Overuse of natural resources including medicinal plants to treat AIDS side-effects; timber for
coffins; wildlife for food and wood for charcoal-making as alternative livelihood sources
Changes in land use as agricultural practices change with falling capacity for heavy labor
Changes in access to resources and land especially when widows and orphans cannot inherit
land
Loss of traditional knowledge of sustainable land and resource management practices
Loss of human capacity for natural resource management in government, nongovernmental
organizations, academic institutions, communities, donor organizations, and private sector
Increased vulnerability of community-based natural resource management programs as
communities lose leadership and capacity, and HIV/AIDS issues take priority
Diversion of conservation funds to HIV/AIDS related costs.

60

7.2.1 Diminishing Availability of Labor and Falling Incomes


For households that are affected by AIDS, incomes fall while the use of medicines and money for
funeral expenses increase. The acute need for resources can make the sale of agricultural
implements, livestock or other assets necessary, and therefore make farming difficult. Due to the
necessity of providing care, the amount of time that other members of the family spend on farming
and other activities decreases. The workload mainly falls on women and girls, and children
(primarily girls) are taken out of school to nurse the sick, help with the farming and do household
work. In households affected by AIDS, daughters are married off since the dowry received can offer
an important means of relieving an acute shortage of resources.
When households lose adult members, they also lose the knowledge and experience of local
conditions for farming and natural resources possessed by those who died. When the transfer of
knowledge from parents to children breaks down, the latter will eventually find it very difficult to
farm rationally and sustainably. This can lead to serious, long-term effects on agricultural
production that will be particularly acute in areas with a large and rapidly growing number of
orphans. When a male family head dies, there is loss of knowledge of distributing and selling
products, and sometimes fewer contacts with agricultural extension workers and other
organizations.
7.2.2 HIV/AIDS and Agriculture
According to Hunter (2007) rural households experience HIV/AIDS in ways that are specific to
their setting and distinct from their urban counterparts. These distinct impacts are often related to
the high level of dependence on agricultural production as the primary food supply for rural
households. Subsistence farming systems also rely heavily on humans, most often women, for
tilling and tending crops, and therefore HIV/AIDS illness or death places considerable strain on
rural agricultural production.
A reduction in the availability of labor due to AIDS may lead to reduction in area under cultivation,
a reduction in number of crops for sale, and a process of transition to crops that require less labor
and storage facilities, for example, cassava.
HIV/AIDS leads to difficulties in looking after different types of perennial crops produced for sale
e.g. coffee, and can have the consequence that production diminishes or comes to a complete halt.
It is common that households affected by AIDS are forced to sell livestock in order to pay for
medical care and funeral expenses. There is also a decline in livestock production since less time is
spent on tending animals and often less qualified labor is used for the purpose. There is normally a
transition to smaller animals, such as goats and poultry, whose care requires less time and
knowledge. In addition to a reduction in income (for example from sales of milk), a reduction in
livestock production leads to a reduction in the availability of manure, or to none at all. The loss of
draught animals for ploughing reduces the area that can be cultivated and even the possibility of
doing farming work at the right time. The reduction in livestock production has the consequence
that the nutritional standards of the household deteriorate.
Lack of labor leads to a situation in which people spend less time on the type of soil conservation
work that contribute to increasing production and to reducing erosion.
Is there any positive news about AIDS in Africa? Some qualitative, in-depth research suggests that
HIV/AIDS has made kitchen gardens make a comeback in villages in Bungoma district, Kenya (e.g.

61

spider-plant, amaranth, cowpeas, and grains such as millet and sorghum) as they require fewer
adults (Murphy, 2006).
7.2.3 HIV/AIDS and the Forest Sector
When rural households lose adult members, they are also forced to make adjustments to their use
of forest products. In such situations, there may be little regard for traditional control systems for
common property natural resources. For example, people are forced to fetch firewood where it is
most easily available, even if there is a risk for serious long-term effects for both the land and the
water sources.
Another effect of the reduction in the ability of the household to farm is that they are forced into
using unsustainable methods for collecting wild plants and other forest products for sale and food.
Commercial forestry is also affected negatively by HIV/AIDS, since forest workers and technicians
are affected by higher rates of ill-health and mortality, since they normally work away from their
families or partners. When experienced and educated personnel in the forestry sector are affected
in this way, capacity problems are created, which can weaken the agencys institutional memory
and reduce enforcement of rules for land use, felling and other forms of exploitation.
The AIDS epidemic also affects the demand for timber. When an increasing number of adults and
children die, more timber is required to make coffins.
7.2.4 Other Effects
The fact that HIV is transmitted through sexual contact means that more members of the family get
infected, and this process can lead to dissolution disappearance of the household.
The deterioration in services, increase in poverty, increase in the number of orphans and other
effects of HIV/AIDS have negative consequences for far more households than the one directly
affected by the epidemic. An increase in poverty makes economic activity difficult, and has
negative consequences on local sales of agricultural products and on the distribution of capital
goods to the agricultural sector.
In many farming communities, women are not entitled to land in the same way as men, and the
living conditions of surviving widows and their children are drastically impaired. Even in cases
where the household is not deprived of its land, it can sell the land, or parts of it.
The AIDS epidemic also affects those working in agricultural extension services and other forms of
public service in rural areas.
An interesting perspective on migration and poverty is provided briefly by Turner (2004), who says
that international organizations advocating development through exploiting national resources,
selling goods for export, and encouraging foreign investment may be creating jobs that are high risk
for HIV, namely, miners, truck drivers and international businessmen.
7.2.5 Difficulties in distinguishing the effects of HIV/AIDS
Food production by small farmers is constantly subjected to sudden changes and to changes that
have a slow effect. The AIDS epidemic superposes normal factors of change such as national
agricultural policies, rules and laws for access to land, climate, prices of products and capital goods,
or diseases that affect people, animals and crops. It can often be difficult to know whether reported

62

changes are chiefly due to HIV/AIDS, whether the epidemic is a main contributory cause, or
whether the causes of the change are entirely different. However, it is always wise to give
consideration to the importance of HIV/AIDS in areas with an extensive epidemic.
There has been little research demonstrating how HIV/AIDS impacts on household resource and
livelihood strategies that differ from the loss of an adult household member from other causes of
mortality. However, with regard to HIV/AIDS, it is logical to consider that household experience
with protracted adult illness may exacerbate the impacts of eventual mortality, while the stigma
associated with AIDS might also lessen assistance in times of household crisis.
Barnett and Whiteside (2003), cited in Murphy (2006), argued that AIDS morbidity and mortality
differ from illness and death due to, for example, malaria. The differences include:
The long incubation period means the disease remains invisible while it spreads and the burden
cumulates
Stigma, which manifests itself in a range of forms of denial (from village to national levels),
discrimination (land-grabbing, loss of work, loss of income as vendors are shunned) and
psychosocial stress (depression)
The lack of treatment or even adequate care for the ill, aggravating the burdens on others and
speeding up the progression to late-stage AIDS
Concentration in a household: sex is the primary mode of transmission, making prevention
difficult because it is incompatible with aims of fertility and general unacceptability of condom
use within marriage
The disease affects the community through burdens of care, funerals, orphans and the elderly,
and breakdown of network and work groups
Since it affects adults, it generates orphans, which poses a challenge to long-term viability of
livelihoods, as children are pulled out of school, lose land and inheritance, and move to other
relatives.

7.3

The Effects of Prime-Age Mortality

The Michigan State Universitys Agricultural Economics research program on Prime-Age Mortality
in Kenya, Mozambique and Rwanda (Donovan et al, 2003; Mather et al, 2004; Yamano and Jayne,
2004) have summarized methodological concerns around the use of survey techniques to capture
(AIDS-related) prime-age adult mortality on rural households. These studies do identify many
negative impacts of AIDS (loss of labor, shifts in cropping, asset stripping), but provide finer
distinction to the often stereotypical model of household decline.
7.3.1 Kenya
Yamano and Jayne (2004) conducted a panel study of Kenyan households in an effort to measure
the impacts of working-age adult mortality on small-scale farm households. Results suggest that
livelihood impacts vary quite dramatically according to the deceaseds position in the household,
especially as related to gender and age.
The study highlights several major findings. First, there are important gender differences in the
incidence of adult death. About half of the deceased working-age men are in the highest per capita
income quartile, which is consistent with findings from earlier studies showing a positive
correlation between male HIV infection and socioeconomic status, such as education and income.

63

Deceased working-age women were distributed more evenly through all income quartiles.
Secondly, the prevalence of adult mortality is concentrated in particular districts included in the
study, mainly Kisumu and Siaya districts.
Thirdly, the effects of adult death on crop production are sensitive to the gender, position, and age
of deceased members. For example, the death of a male household head between 16 and 59 years is
associated with a 68% reduction in the net value of the households crop production. Effects are less
dramatic for other working-age family members. The gender of the deceased adult affects the type
of crop suffering a shortfall, with grain crops being adversely affected in the case of adult female
mortality; and cash crops such as coffee, tea and sugarcane being most adversely affected in the case
of adult male mortality.
Fourth, households seem to cope with working-age adult mortality by selling particular types of
assets, mainly small animals. The death of working-age men is also associated with a reduction in
the value of farm equipment. Fifth, household off-farm income appears to suffer greatly from the
death of a working-age male head. Sixth, there is little indication that households are able to
recover quickly from the effects of adult mortality (at least over the three-year study period).
A companion report (Yamano and Jayne, 2005) found that the effects of working-age adult
mortality on child school attendance are sensitive to the sex of the child, the initial wealth of the
household, and the timing of the death. For example, only 54.7% of girls in initially poor
households experiencing working-age adult mortality between 2000 and 2002 were predicted to be
in school in 2000, compared with 88.4% of girls in relatively poor households not experiencing
adult mortality. By contrast, no clear effects were found among children in households in the top
half of the asset distribution in the initial survey, either before or after the timing of the death.
There is therefore the risk that the AIDS epidemic may produce intergenerational consequences on
human capital development that might have been mitigated if understood and addressed earlier.
7.3.2 Mozambique
Mather et al (2004) used nationally representative rural household survey data from Mozambique
to evaluate the characteristics of affected individuals and households, household demographic
changes, and livelihood adjustment strategies taken in response to prime-age death. The analysis
demonstrates that affected households do not uniformly appear to have less available prime-age
(PA) labor than non-affected households, either because affected households are able to attract new
PA members or because they had more PA adults prior to death.
In contrast to the general assumption that HIV-related mortality is typically associated with
household heads/spouses, the Mozambique survey show that only one-third of affected PA adults
were household heads/spouses, while two-thirds of non-affected PA adults were household
heads/spouses. This would suggest that the potential magnitude of rural PA mortality on agriculture
and orphaning rates may be less than those predicted by some of the literature. A reported 44% of
affected households indicated crop area reduction while 22% indicated reduced weeding as
adjustment strategies, suggesting that not all affected households appear to face a binding labor
constraint in agriculture.
Both the demographic change results and those of response strategy choice with respect to area
cultivated and weeding labor suggest that the loss of family labor due to a death in the household
may not necessarily mean that agricultural labor becomes the limiting input in agricultural
production. These results suggest a need for an appropriate balance between (a) investments that

64

increase long-term productivity in agriculture, and (b) labor-saving technologies for agriculture and
those that reduce labor demands for household domestic tasks such as food processing (hammer
mills or other food processing technologies for maize and cassava) and gathering water and fuel
(e.g. community well, fuel-efficient stoves).
7.3.3 Rural South Africa
Within the rural African context, natural resources act as a buffer against household shocks
offering both sustenance and income-generating potential. Hunter, Twine and Patterson (2007)
focus on adult mortality as a household shock in a community in rural South Africa. The study
found significant differences in both patterns of usage of the natural environment as well as levels
of food security between mortality-impacted and non-mortality households, and that the
association between mortality and household use of local environmental resources is shaped by
gender of the deceased and time elapsed.
In particular, lost human capital often results in lowered household productivity, while individual
household members time allocation often shifts as the labor of healthy individuals is diverted to
different household chores. Households experiencing an adult mortality particularly a male
mortality were significantly more prone to food insecurity than were the non-mortality
households.
7.3.4 Tanzania
Analysis of farm and chore hours across demographic groups in a Tanzanian community (Beegle,
2005) generally found small and insignificant changes in labor supply of individuals in households
experiencing a prime-age adult death. This may reflect the point that some of the areas in the
region around Lake Victoria that are most affected by the HIV/AIDS epidemic are those least
vulnerable to labor shortages. The analysis found that participation of individuals in coffee and
banana farming or other subsistence food crops (maize, cassava and beans) in households with a
male death in the previous 712 months declined. The effect of adult death on coffee farming was
only lower for households with a death within 6 months but not for deaths after 6 months.
Childhood orphanhood is a major risk factor for poverty in adulthood, through, among other
channels, shortfalls in human capital investments in children. As demonstrated by a study
conducted in Tanzania (Beegle, de Weerdt and Dercon, 2006), orphanhood is expected to influence
schooling due to income effects. Orphanhood is also associated with an increased value of the
childs time in home production (as a substitute for adult labor) which results in less schooling.
There may be discrimination against orphans and favoritism toward biological children for double
orphans or among single orphans who do not reside with their surviving parent. The authors also
found robust evidence that an affected household will see consumption drop by 7% within the first
five years after the adult death, and these effects are particularly severe for female adult death
(Beegle, de Weerdt and Dercon, 2008). Adult mortality can also have significant effects on children
by influencing the timing of marriage, as shown in the Tanzanian study where girls who became
paternal orphans married at significantly younger ages, while non-parental deaths in the household
affect the timing of marriage for boys (Beegle and Krutikova, 2008).

7.4

A New Type of Famine

In most of sub-Saharan Africa, about two-thirds of the power for land preparation is provided by
people, and consequently agricultural production depends on available human labor in regions with

65

fewer technological inputs. In such settings, HIV/AIDS retards agricultural production and
threatens food security, through what Alex de Waal and Alan Whiteside (2003) ascribe the term
new variant famine. They argue that the HIV/AIDS pandemic is resulting in unique pressures on
agriculture systems related to, for example, the loss of labor and the loss of other forms of
household assets.
de Waal and Whiteside (2003) argued that the causes of food crisis in Southern Africa include
familiar suspects such as drought and the mismanagement of national food strategies. However, this
crisis is distinct from conventional drought-induced food shortages, in the profile of those who are
vulnerable to starvation, and the trajectory of impoverishment and recovery. The paper proposes
that HIV/AIDS has such far-reaching adverse implications that we are facing a new variant
famine. The four key dimensions of the new variant famine hypothesis are changes in
dependency patterns, loss of assets and skills associated with adult mortality, the burden of care for
sick adults and orphaned children, and the vicious interaction between malnutrition and HIV
infection.
The disease affects the potential labor provided by infected individuals, yet it also influences the
availability of other household members, because they must care for the sick individuals. Culturally
mandated mourning periods further reduce labor available for agricultural activities.
Reductions in available human labor influence household agricultural production and related food
security in several ways. First, previously tended land may be left fallow (resulting in less food
production), important tasks such as weeding may be postponed (reducing yields), and labor
shortages can change what crops are planted. In Kenya, the effect of adult mortality on cropping
patterns largely depends upon the role of the deceased in the household. In many cultures, men are
more likely to engage in production of cash crops (such as coffee, tea and sugar), while the death of
an adult female is likely to cause shortfalls in grain crops. In both situations, HIV/AIDS mortality
shapes food security and hunger through reduced income from the market and own consumption
of grain crops.
HIV/AIDS-related changes in crop production may also threaten access to agricultural land itself.
In regions where land tenure is not secure, households may lose rights to land not regularly used,
especially for widows and child-headed households.
HIV/AIDS may exacerbate poverty by altering the use of other household assets that affect
agricultural production and food security. If the infected individual was a wage-earner, the loss
would include lost wages, new expenses related to healthcare and funerals, reduced access to
purchased agricultural inputs (e.g. fertilizers), sale of productive assets (e.g. livestock resulting in
lower household use of milk and manure, and ploughing potential in case of sale of the last ox), and
loss of agricultural knowledge in case of death of prime-age adults.
The new variant famine hypothesis is a plausible new paradigm for analyzing the causes and
trajectories of food insecurity in southern African societies afflicted by a combination of shocks
including a generalized AIDS epidemic, drought and poverty. HIV/AIDS has created a new
category of highly vulnerable households, namely, those suffering adult morbidity or mortality.
The general burden of care in both AIDS-affected and non-AIDS affected households has reduced
the viability of agrarian livelihoods. The sensitivity of rural communities to external shocks such as
drought has increased, and their resilience has declined. The prospects for a sharp decline into

66

severe famine are increased, and the possibilities for recovery reduced. The hypothesis is supported
by the growing number of household-level studies on the impact of AIDS.
Gibbs (2006) undertook a study to interrogate the concept of NVF to explain the Malawi food crisis
of 2001/02. He concluded that there is limited, but supportive evidence to suggest that the NVF
framework explains the food crisis. However, NVF cannot be adequately understood outside of
gender relations in Malawi. In particular, female-headed households disproportionately dominated
the new profile of vulnerability that emerged in Malawis food crisis of 2001/02, and the increase in
HIV/AIDS prevalence during the food crisis is more likely to have been mainly among women.

7.5

Links between HIV/AIDS and Water Supply

For the water and sanitation sector, the HIV/AIDS epidemic jeopardizes the Millennium
Development Goal to halve the proportion of people unable to reach or afford safe drinking water,
and the goal set in the 2003 World Summit on Sustainable Development to halve the number of
people without access to improved sanitation.
The relationship between HIV/AIDS and water, sanitation and hygiene is rather complex.
Kamminga and Schuringa (2005) present several perspectives to the issue, namely, the consumer
perspective, the health perspective, the gender perspective, and the community-management
perspective.
7.5.1 The Consumer Perspective
Easy access to safe and sufficient water and sanitation is indispensable for people living with
HIV/AIDS and for the provision of home-based care to AIDS patients. Cultural preferences mean
that the majority of AIDS patients are being cared for within their local communities. Water is
needed for bathing patients and washing soiled clothing and linen. Safe drinking water is necessary
for taking medicines, while nearby latrines make life more tolerable for weak patients. Finally,
water is needed to keep the house environment and latrine clean in order to reduce the risk of
opportunistic infections. Water and sanitation provision increases the sense of dignity of both
patients and caregivers.
Public health systems in many high prevalence countries have difficulties coping with the
increased demand for health services. The burden of care is made even heavier when activities such
as fetching water and laundry are done far from the home.
Consumers living with HIV/AIDS have even more urgent water needs, in terms of both quality and
quantity. However, they are often impoverished (their ability to pay for water services decrease),
while they lack voice to influence water supply decisions due to marginalization, discrimination
and stigmatization.
7.5.2 The Health Perspective
With HIV/AIDS, providing access to safe water supply and sanitation becomes more pertinent
because diarrhea and skin diseases are among the most common opportunistic infections. In order
for HIV infected people to remain healthy as long as possible and for people with AIDS to reduce
their chances of getting diarrhea and skin diseases, adequate water supply and sanitary facilities are
of utmost importance. Clean water is also needed to take medicines.

67

Access to water and latrines: In a HIV/AIDS context, it is especially important that water supply
points and latrines are easily accessible and close to where they are needed. This reduces the
burden of long-distance water collection (for caregivers or those who are weak), and cuts the risk of
girls and women being raped while fetching water or relieving themselves in remote places (and
thus reduces vulnerability to infection with HIV). In addition, water collection tasks are
increasingly falling on children and the elderly as a consequence of AIDS.
Infant feeding: If a mother is HIV positive, there is a one in three risk that she may transmit the
virus to her baby through breast-milk, even if the child was born HIV negative. Whether
breastfeeding or not, clean water is crucial for infant feeding and HIV positive babies need to be
protected even more from unsafe water because it will weaken their resistance and shorten their
lives.
Incorrect health beliefs: The incorrect health beliefs that contribute to stigmatization of people
living with HIV/AIDS include misconceptions that people can become infected with HIV/AIDS
due to groundwater pollution near burial sites or by washing of sanitary napkins; and people
(playing children) can become HIV infected through poor waste disposal practices such as condoms
and sanitary napkins.
7.5.3 The Gender Perspective
Gender roles and gender relations influence the extent to which women and men, girls and boys
are vulnerable to HIV infection, can access quality treatment and care, and are affected by the
negative social and economic consequences of HIV/AIDS. Unequal power relations between men
and women are a major factor contributing to the spread of HIV/AIDS. Sex is often not consensual,
and women and girls are often not in a position to persuade their sexual partner to use a condom.
Womens anatomy and some cultural practices (e.g. infibulation and dry sex) make them more
susceptible than men to infection by the virus.
There is also gender imbalance in the social, economic and political impacts of the HIV/AIDS
epidemic. Women and girls are affected disproportionately because of their socially defined roles
e.g. they take care of others (children, beyond their own children, partners, parents and friends),
and elderly women are taking an increasing burden of care of AIDS orphans. One consequence is
time poverty, whereby water collection and other reproductive tasks become increasingly
burdensome, and reduce time available for other activities. This is particularly problematic for
women who are elderly or suffer from ill health and girls needing time to go to school. The
consequent inability of girls to attend school decreases access to information, knowledge and
income generating opportunities, which can in turn increase susceptibility to infection.
7.5.4 The Community-Management Perspective
There is a relationship between the level of community organization, empowerment and autonomy
and the level of sustainability of water and sanitation interventions. Important factors include
measures that promote gender equality, greater socioeconomic equity, community cohesion, stable
traditional leadership, and respect for ethnic differences. These same factors also define the ability
of communities to cope with the impact of HIV/AIDS and to prevent new infections. Strong
community-based organizations that are dedicated to social equity, essential social service provision
(e.g. water supply) and community health promotion are the main pillars of HIV competence.
Activities to promote community-based prevention of HIV infection and hygiene promotion make
use of similar methods.

68

7.5.5 The Poverty Alleviation Perspective


HIV/AIDS is one of the biggest obstacles for reaching global poverty reduction targets and
development goals. Conditions related to poverty, such as unemployment, low sense of self-worth
and a sense of fatalism, are enormously significant in vulnerability to HIV infection. Similarly, poor
access to basic services such as education, healthcare and water and sanitation that are themselves
indicators of poverty also increase vulnerability to HIV infection.
Poor households often adopt coping strategies that are irreversible and will affect the survival of the
household members left behind (e.g. sale of productive assets). In addition, some coping strategies
such as migration may increase the individuals risk of infection, while poverty increases poor
womens vulnerability to infection through transactional sex.
7.5.6 The Impact of HIV/AIDS on Service Provision
HIV/AIDS also has a big impact on water and sanitation organizations and service provision.
Government agencies may face difficulties in responding to the challenges posed by HIV/AIDS,
partly caused by staff infection rates. The direct and/or indirect effects of HIV/AIDS on the
sustainability of water and sanitation systems include reduced ability of water users to pay water
fees due to affected households losing their primary breadwinners, reduced ability of water users
(especially women) to spend time and energy on management activities, and erosion of
community-management capacities due to loss of social capital (loss of knowledge and skills).

7.6

HIV/AIDS and Education

The study by the Kenya Government and UNICEF (2000) shows that HIV/AIDS has had
widespread effects on childrens learning experiences. Children are increasingly lacking basic needs
such as food, clothing, shelter, healthcare and even education. The study further revealed that
childrens learning has been affected by HIV/AIDS in many ways: pupils themselves are getting
infected; attendance and performance in schools is affected; and pupils are dropping out of school.
The teaching force has been affected by HIV/AIDS. The results also indicate that the resources
available to support education have increasingly been diverted to meet HIV/AIDS-related needs.

7.7

HIV/AIDS and Fertility

The relationship between HIV/AIDS and fertility is the outcome of a conflict between the
acceleration of childbearing to meet reproductive goals, and decrease in childbearing as parents opt
to avoid the risk of transmitting the virus. Several studies, e.g. in Malawi (Nol-Miller, 2003), have
found some evidence to support the hypothesis of reduced childbearing in the presence of high
levels of worry regarding HIV/AIDS.
Several authors have presented evidence on a specific mechanism through which the demographic
transition affects economic growth e.g. that precautionary demand for children exists in the face of
uncertainty about child survival (Davis and Blake, 1956). Using 1985-2000 panel data for some
African countries, Kalemli-Ozcan (2006) shows that HIV/AIDS affects total fertility rates positively
and school enrollment rates negatively. Parents who are faced with a high mortality environment
for young adults due to HIV/AIDS choose to have more children and provide each of them with
less education, leading to a reversal in the fertility transition and a reduction in the aggregate
amount of human capital investment. The results imply that, in the coming decades, AIDS can

69

cause a reversal in the fertility transition and a substantial decrease in human capital investment,
implying a tremendous negative effect on economic development.
Bongaarts (2007) assesses the potential roles of late age at marriage and a long period of premarital
sexual activity as population risk factors for HIV infection in 33 sub-Saharan African countries. The
ecological analysis finds a significant positive correlation between HIV prevalence and the median
age at first marriage, and between HIV prevalence and the interval between first sex and first
marriage. In the individual-level analysis, the risk for HIV infection per year of exposure among
sexually active women is higher before than after first marriage. These findings support the
hypothesis that a high average age at marriage in a population leads to a long period of premarital
sex during which partner changes are relatively common, thus facilitating the spread of HIV.
In most of the literature, it is generally accepted that the AIDS epidemic has a detrimental impact
on the human capital accumulation of orphaned children and lowers fertility, directly through a
reduction in the willingness to engage in unprotected sexual activity, and indirectly by increasing
the scarcity of labor and the value of a womans time. It is therefore possible to argue that, the
AIDS epidemic, on net, can enhance the future per capita consumption possibilities of a country
(Young, 2005).

7.8

Impact of HIV/AIDS on Poverty and Inequality

Using data on the distribution of HIV/AIDS prevalence across population groups for four subSaharan African countries (Ghana, Kenya, Swaziland and Zambia) and transposing this information
to household income and expenditure surveys, Salinas and Haacker (2006) simulate the impact of
HIV/AIDS on poverty and inequality. In three of the four countries, poverty incidence and the
poverty gap increase more than would be expected from the decline in income per capita. This
disproportionate increase in poverty reflects the large share of the population living on the
threshold of poverty and the higher HIV prevalence rates in those segments of the population.
Thus, the disease can throw a considerable share of the population into poverty even in cases where
researchers do not expect a significant fall in income per capita. The analysis has implications for
the design of social safety nets. Since the burden of providing support to households primarily
affected by HIV/AIDS can drag households providing support below the poverty line, the capacities
of informal social support networks between households with similar income levels to mitigate the
impact of HIV/AIDS on poverty are limited.
Using longitudinal survey data collected in collaboration with a treatment program, Thirumurthy,
Zivin and Goldstein (2008) estimate the economic impacts of antiretroviral treatment in Africa,
focusing on labor supply of adult AIDS patients receiving treatment, and labor supply of children
and adults living in the patients households. They found that within six months after the initiation
of treatment, there is a 20% increase in the likelihood of the patient participating in the labor force
and a 35% increase in weekly hours worked. The responses in the labor supply of patients
household members are heterogeneous: young boys and women work considerably less after
initiation of treatment, while girls and men do not change their labor supply. A companion study
(Zivin, Thirumurthy and Goldstein, 2006) showed that childrens weekly hours of school
attendance increase by over 20% and young childrens short-term nutritional status improves
dramatically. They conclude that such improvements in childrens schooling and nutrition at these
critical early ages will affect their socioeconomic outcomes in adulthood, and hence the widespread
provision of ARV treatment is likely to generate significant long-run macroeconomic benefits.

70

7.9

Impact of HIV/AIDS Deaths on Living Arrangements of Orphans

A study of living arrangements of persons aged 60 and older in 16 countries in sub-Saharan Africa
(Zimmer and Dayton, 2003) shows that those living in countries characterized by high levels of
AIDS-related mortality are more likely to be living with grandchildren, with grandchildren but no
children in the household, and with orphaned grandchildren. The percentage living with one or
more double-orphaned grandchildren is strongly associated with AIDS-related mortality,
suggesting that the epidemic may be having adverse influences on the living situations of older
adults.
Several authors have examined the impact of orphanhood on the living arrangements and school
enrollment of children in sub-Saharan Africa. For example, using data from 19 Demographic and
Health Surveys conducted in 10 countries between 1992 and 2000, Case, Paxson and Ableidinger
(2004) found that orphans in Africa on average live in poorer households than non-orphans, and
are significantly less likely than non-orphans to be enrolled in school. However, orphans lower
school enrollment is not explained by their poverty: orphans are equally less likely to be enrolled in
school relative both to non-orphans as a group and to the non-orphans with whom they live. The
outcomes for orphans depend largely on the degree of relatedness of the orphan to the household
head.
A study by Evans and Miguel (2007) in rural western Kenya also found that parent death leads to a
moderate decrease in school participation, with larger effects for children from poor households.
Impacts are not significantly different by child gender, nor do they significantly depend on local
orphan rates.

71

CHAPTER EIGHT

POVERTY AND THE ENVIRONMENT

I reflect on my childhood experience when I would visit a stream next to our home to fetch water

for my mother. I would drink water straight from the stream This is the world I inherited from
my parents. Today, over 50 years later, the stream has dried up, women walk long distances for
water, which is not always clean, and children will never know what they have lost. - Wangari
Maathai, Nobel Lecture, Oslo, December 10, 2004

8.1

Introduction

Kenya is one of the poorest countries in the world, as measured by GDP per capita and UNDPs
Human Development Index. Poverty is mostly a rural phenomenon, and is also true of the most
densely populated high-potential areas, where the most fertile soils and the most intensive
agriculture are found. Poverty is partly linked in a complex way to the rural households large
dependence on natural resources (mainly soils, biological and forest resources), inefficient
agricultural practices, land degradation, declining food production, rapid population growth, and
land fragmentation.
The HIV/AIDS pandemic is having effects on the economy, socially (health, education), and on
agricultural production and the real possibilities to manage the land properly, prevent soil erosion
and keep up the yields. With declining labor supply due to HIV/AIDS and other mortal diseases,
soils will continue to degrade and yields decline. Water and air pollution (e.g. emissions of organic
water pollutants) have been on the increase, while access to safe water is low. In addition, the
sanitary and health conditions in the mushrooming slum areas in the major cities are particularly
serious. Urban air pollution is a growing problem, resulting in increased incidence of respiratory
diseases.
Kenyas economy is largely natural resource-dependent, based on agriculture, forestry,
nature/wildlife, tourism and basic manufacturing. Currently, land degradation and soil erosion in
particular is one of the most important environmental problems posing threat to sustained food
production and Kenyas development in general. Population growth has put scarce natural
resources under stress, both in rural and urban areas. Kenya has also suffered conflicts over arable
lands, and is largely vulnerable to recurring droughts and floods.
The Kenya Government policy framework recognizes the link between poverty and environment.
For example, the Kenya Government has, with the assistance of development partners, produced an
atlas of Kenya that will improve understanding of the relationships between poverty and the
environment, and lead to new approaches to better integrate poverty-ecosystem relationships in
national policies and decision-making (World Resources Institute, Kenya Department of Resource
Surveys and Remote Sensing, Kenya National Bureau of Statistics, and the International Livestock
Research Institute, 2007).

72

8.2

The Environment and MDGs

The MDG target relevant to this chapter is the need to integrate the principles of sustainable
development into countrys policies and programs and reverse loss of environmental resources.
Preserving the environment means safeguarding food production (soil to grow food), sustaining
livelihoods (water to drink and air to breathe), and preserving health (natural food and medicinal
products). Environmental sustainability emphasizes the proper use of natural resources and
regeneration of the ecosystem so that future generations have the same opportunities as the present
ones.
The main elements of environment affecting health and economic wellbeing are agricultural
production systems, forests, freshwater resources and ecosystems, fisheries and marine ecosystems,
air and water pollution, and global climate change.
The environment-based targets are closely linked to the attainment of other goals. For example, the
poor depend on functioning ecosystems and diversity of goods and ecological services for their
survival, and are more likely to have insecure rights to environmental resources. The rich can buy
clean water or the equipment to filter and purify water if it is contaminated, while the poor usually
depend on natural water systems. The same can also be said of extreme natural events like floods
and tropical storms, which tend to have a bigger impact on the poor who do not have the resources
to build appropriate shelters or usually have their homes built on land prone to landslides and
floods.
Achievement of universal basic education, especially for girls, can be hampered by the time
children take to collect water and fuel wood.
Heavy reliance on common property resources (CPRs) makes poor women particularly vulnerable
to their degradation, depletion, and appropriation or conversion to other uses. Empowerment of
women can be compromised by the time they take to collect water and fuel wood and the unequal
ownership and usufruct rights of access to land and other natural resources. Where women do not
have the voice to directly influence decisions affecting the uses of CPRs, their exclusion from
decision-making can result in resource uses which negatively affect them (OECD, 2001).
Water and sanitation-related diseases and acute respiratory infections from air pollution are a
leading cause of child mortality.
The environment is important for combating diseases, since environmental risk factors are a major
cause of poor health. Many of the poor rely on traditional medicines for some of the ailments they
suffer, and one of the unique characteristics of traditional medicine is the variety of flora and fauna
it needs. A direct causality has also been established between malaria and deteriorating ecosystems,
and there has been an emergence of other infectious diseases in combination with ecosystem
changes (Pattanayak and Yasuoka, 2008; Patz and Confalonieri, 2005). Malaria is known to flare up
in ecological systems which have their regulation component altered by irrigation projects, dams,
construction sites, standing water and poorly drained areas (UNEP, 2004).
Many environmental problems (such as climate change, loss of species diversity) can only be solved
through global partnerships of developed and developing countries (the Kyoto protocol is a good

73

example), since rich countries consume far more environmental resources and produce more waste
than poor countries.
Thus, the millennium development goals implicitly recognize the link between poverty, population
and environment. According to OECD (2001), poverty affects the population through (a) limited
access to water supply, fuel and labor-saving devices which increases the need for children to help
in fields and homes; (b) low asset base increases demand for children as insurance against illness
and old age; (c) low level of education means less awareness of family planning methods; and (d)
low status of women means that they have limited power to control fertility. Population affects
poverty through increasing landlessness and overstretching available social services, schools, health
centers, family planning clinics, and water and sanitation services. In general, population affects
environment through (a) increasing pressure on marginal lands, overexploitation of soils and
forests, overgrazing; (b) soil erosion, silting, flooding; and (c) migration to overcrowded slums,
problems of water supply and sanitation, industrial waste, indoor air pollution, and mudslides
(OECD, 2001).

8.3

The Precarious State of Kenyas Environment

8.3.1 Kenyas Environmental Resource Base


Kenyas economy and the livelihoods of her people are dependent on the natural resources such as
water, land, air, plants and animals. These natural resources are increasingly under pressure from
unsustainable use resulting in environmental degradation. This section looks at the state of Kenyas
environment, with examples from water, forests, energy services, and externalities generated by
pollution and inefficient waste disposal. Most of this information has been culled from the National
Environmental Management Authority (2003) and the Ministry of Environment and Mineral
Resources websites.
Forests
Kenyas gazetted forests cover a total of 1.4 million ha, representing about 1.7% of total land area.
This compares unfavorably to the internationally recommended minimum of 10% forest cover.
There are pockets of indigenous forest in private farms and county council land whose extent and
distribution are not known but have significant biodiversity functions. Forests provide utility
products such as timber for the construction sector, transmission poles for the energy and
communication sector, wood fuel for the tea industry among other uses, subsistence utilization by
the communities, and paper for the education and print media sectors. They are important in
conservation of biological diversity, regulation of water supplies, and carbon sequestration in
addition to being a major habitat for wildlife, which promotes tourism. The hydroelectric power
stations are located in major forest water catchments areas. Moreover, these major rivers provide
water to support irrigation schemes that are important for agricultural sector development.
Many societies, especially rural communities in developing countries, worship many of the natural
elements found in ecosystems. These can vary from flora and fauna to rivers, mountains and other
inanimate objects. The Kaya forests, the relict forest patches situated in the coastal plains of Kenya,
are regarded as sacred by the coastal Mijikenda communities.
Much of the closed canopy forest has been depleted due to internal and external influences. The
external influence is due to the need for more agricultural land, short-term political interests

74

leading to invasion of gazetted forests, conflicts on resource use as well unwarranted land use
changes paving the way to degradation. Due to the rapid increase in population, the forestry
resources are facing overexploitation and depletion. The demand for land for growing food has also
increased and this has led to permanent losses of forested land through excision, encroachment and
frequent disasters such as fires. The removal of forest cover for commercial and/or subsistence
activities leaves hillsides vulnerable to soil erosion and increases the probability of landslides as
well as floods.
The main issues affecting forests include excision and change in land use, timber harvesting,
charcoal burning, encroachment and squatter problems, fires, resource constraints (funds and
human resources in the forest department), and subdivision of trust lands.
Surface Water
It is estimated that Kenya has 19,500 million m3 of renewable surface water converting to 650 m3
per capita. This is expected to drop to 250 m3 per capita by 2025 when the population is projected
to grow to 60 million. This is against a global recommendation of 1,000 m3 per capita and puts the
country in the category of chronically water scarce countries. This presents serious challenges in as
far as water supply coverage for all uses is concerned, and in meeting the Millennium Development
Goal of halving the number of people without access to water and sanitation by the year 2015.
The impact of pollution on water resources is manifested by water of poor quality, which gives rise
to water toxicity to mammals and aquatic life; loss of aesthetic value by becoming unsuitable for
recreational activities; and high cost of water supply as polluted water is expensive to treat. Cases of
water use conflicts between the riparian communities are common.
Energy Sources
The environment provides natural resources that are raw materials for the energy industry. These
include wood fuels, fossil fuels, hydro and geothermal power. On the other hand, the environment
is the recipient of the residues of thermal energy and solids, liquids and airborne wastes produced
by other energy systems. Activities related to energy production, distribution and consumption are
perhaps the largest single category of benign sources of adverse anthropogenic impacts on the
environment.
Pollution
Pollution of the atmosphere, especially indoor air pollution, has been linked to acute respiratory
tract infections. Among the causes of such infections are sulphurous emissions and particulates
from energy systems. Fossil fuels contribute to air pollution owing to the large amounts of
emissions they release into the environment when they are burnt.
Generation of solid, liquid and gaseous wastes has been increasing at the same rate as industrial
development and the diversification of consumption patterns. Complexity of wastes has introduced
large portions of non-degradable wastes to the environment. These include plastics, scrap metals
and other goods. Agrochemicals have also been extensively used for agricultural production
without satisfactory management of their health and environmental impacts. Utilization of these
chemicals results in emissions, improper dispersal and retention of poisonous substances in the air,
water, soil and the human food chain.

75

8.3.2 Population Dynamics, Human Settlements and Poverty in Kenya


In Kenyas case, the link between population dynamics, human settlements and poverty is already
evident. The high population growth has had adverse effects on the environment that includes
encroachment of marginal lands, overconsumption of wood fuel resources as well as generation of
waste products. Rapid population growth and urbanization have resulted in a shortage of
appropriate housing, inadequate water and sanitation services, deteriorating road and transport
system as well as shortage of energy supplies. The impacts are falling living standards, polluted air
and water, unsanitary living conditions, increasing informal settlements and slums, wood fuel
depletion, increased soil erosion and land degradation.
The relationship between poverty and environment is complex. The poor are often the victims of
environmental degradation, and often engage in livelihood activities that result in environmental
degradation. Poverty leads to overuse and destruction of natural resources where short-term
development goals are pursued at the expense of long-term environmental sustainability.
Environmental concerns in Kenya are mainly due to charcoal burning, overreliance on firewood,
tree logging and mining activities in rural areas; and the impact of increased population, industries,
traffic and slums in urban centers. The combined effects of these activities negatively affect the
environment and reduce land potential, especially in the arid and semi-arid areas. This makes the
struggle for survival hard and leads to overexploitation of land and water resources. Kenyans, both
in the rural and urban areas, face serious environmental problems that aggravate the poverty
situation and make sustainable development an elusive goal.
The elusive peace and security in the neighboring countries results in an influx of refugees, whose
camps in fragile ecosystems in the arid and semi-arid areas can impact negatively on the
environment and the societies affected.
The resource stress has also produced environmental refugees: people who can no longer gain a
secure livelihood in their homelands because of drought, soil erosion, desertification, deforestation
and other environmental problems. They have sought sanctuary elsewhere, and have abandoned
their homelands on a semi-permanent if not permanent basis, with little hope of a foreseeable
return. A good example is the migration of people from northern Kenya to small urban centers in
the north (and even major towns) due to environmental stress, poor conflict management in fragile
ecosystems, and population pressure.

8.4

Poverty, Environment and Natural Resources

8.4.1 Ecosystem Services


An ecosystem is defined as a spatially explicit unit of the earth that includes all of the organisms,
along with all components of the abiotic environment within its boundaries. Ecosystem services are
the conditions and processes through which natural ecosystems, and the species that make them
up, sustain and fulfill human life.
Ecosystems provide goods for humans, critical life-supporting services, and cultural and spiritual
values for human societies (Daily, 1997). The various services ecosystems provide include
provisioning, regulation, and enriching/cultural. Provisioning covers natural resources that are
primarily used for economic activities e.g. food; microorganisms, plant and animal products; genetic

76

material, biochemicals and pharmaceuticals; fuels/energy; fiber; non-living materials; and fresh
water. Regulating is the actual life-supporting functions ecosystems provide for the existence of
humans e.g. purification of air and water; mitigation of floods and droughts; detoxification and
decomposition of wastes; generation or renewal of soil and soil fertility; pollination of crops and
natural vegetation; control of a vast majority of potential agricultural pests; maintenance of
biodiversity, from which humanity has derived key elements of its agricultural, medicinal and
industrial enterprise; and protection from the suns harmful ultraviolet rays. Cultural or enriching
services of ecosystems include spiritual components and the relationship of people to land and
water; aesthetic values; social relations and values; and education and scientific values.
The poverty-environmental linkages take different forms in rural and urban contexts, where in
rural areas it relates to access to land, forests or fisheries (OECD, 2001). In urban areas, questions
relate to use of natural resources such as water or air as sinks for the disposal of human and
industrial wastes. However, urban and rural environments cannot be considered in isolation. For
example, urban-based activities provide the rural poor with income diversification opportunities;
seasonal migration to seek work in urban centers is a common feature of the livelihood strategies of
rural families; urban-based activities often transfer pollution or waste; converting surrounding
agricultural land to urban uses; and overexploiting neighboring forests through the collection of
fuel wood.
8.4.2 Classification of Natural Resources
Natural resources are normally classified into two groups based on (a) physical properties of the
resource, and (b) the time scale of the relevant adjustment processes (Sweeney, 1992). Based on
physical characteristics, natural resources can be divided into biological (fish, wild animals, flowers,
whales, insects, and most agricultural products), non-energy mineral (gold, iron ore, salt, or soil),
energy (solar radiation, wood used for burning, and natural gas), and environmental resources (air,
water, forests, the ozone layer, or a virgin wilderness). Based on the time scale of the relevant
adjustment processes, the resources can be classified as expendable, renewable, or depletable. Each
physical class of resources depicts a different adjustment speed.
Depletable resources are those whose adjustment speed is so slow that we can meaningfully model
them as made available once and only once by nature e.g. crude oil or natural gas deposits.
Renewable resources adjust more rapidly so that they are self-renewing within a time scale e.g.
populations of fish or wild animals and ground water deposits. Expendable resources are those
whose adjustment is fast e.g. noise pollution and particulates in the air, solar radiation, as well as
much agricultural production.
The theoretical basis for the merits and evidence of regularity between environmental quality and
growth was brought into prominence by the World Banks 1992 World Development Report and
papers prepared in connection with that report (see especially Shafik and Bandyopadhyay, 1992;
and Bilsborrow, 1992). The World Bank report, together with the article by Devarajan and Fisher
(1981), also revived academic and policy interest in the economics of exhaustible resources first
formulated by Harold Hotelling (1931).
For example, Mink (1992), in a background paper for the 1992 World Development Report,
addressed several of the links among poverty, population and the environment. First, locations
inhabited by the poor are often environmentally vulnerable or degraded, whether erosion-prone
hillsides in rural areas or urban neighborhoods with inadequate water and sanitation infrastructure.
Secondly, pollution damages the health of the poor e.g. pollution of water by disease vectors that

77

cause infectious and parasitic illnesses, indoor air pollution from the use of biomass as a household
energy source, and outdoor air pollution. The poor rely on biomass fuels such as wood, crop
residues and dung because these are the cheapest and most available option, but which produce
many combustion pollutants. Kerosene, LPG and electricity are more expensive but provide energy
more efficiently and cleanly, but most poor households cannot afford these fuels. Environmental
degradation also depresses the ability of the poor to generate income through diverting an
increasing share of their labor to routine household tasks such as fuel wood collection, and
decreasing the productivity of those natural resources from which the poor wrest their livelihood.
Examples of the latter include the destruction of inland and coastal fisheries by industrial water
pollution and municipal sewage, and the degradation of wetlands and flood plain soils as a result of
upstream dam construction.
Poverty generates significant household incentives to raise large families, and environmental
degradation appears to reinforce several links between poverty and high fertility. Degradation of
tree, range and drinking water resources can increase the time cost of fuel wood gathering,
livestock pasturing and water-fetching activities that children can undertake, and that
consequently increase their value to parents.
In the literature, natural resources are considered necessary production inputs, and environmental
quality is considered a welfare determinant. The effects of natural resources endowment on
economic growth are mainly analyzed through the so-called Resource Curse Hypothesis (RCH)
whereas the effects of economic growth on environmental quality are part of the Environmental
Kuznets Curve (EKC).
8.4.3 The Resource Curse Hypothesis
The Resource Curse Hypothesis maintains that countries with high natural resource endowments
have experienced lower economic growth rates than countries with scarce stocks of natural
resources. They cite the fact that countries rich in commercial natural resources (e.g. Russia,
Nigeria and Venezuela) have experienced economic growth that was lower than other countries
with scarce resources. In addition, most of the states in World Banks most troubled category
severely indebted low-income countries are primary commodity exporters.
Sachs and Warner (1995; 2001) examined 97 countries over a 19-year period to measure the impact
of mineral and other resource exports on GDP growth. Their study shows that states with a high
ratio of natural resource exports to GDP in 1971 had abnormally slow growth rates between 1971
and 1989. The correlation remained significant even after the authors controlled for a wide range of
growth-related variables, including initial per capita income, trade policy, investment rates,
regions, bureaucratic efficiency, terms of trade volatility, and income distribution.
According to several authors, much of the variance between resource and non-resource exports can
almost certainly be tied to international economic factors, including a decline in terms of trade for
primary commodities and the instability of commodity markets (Mikesell, 1997). The main body of
literature suggests five different explanations: Dutch disease3, misallocation of revenues from
resource exploitation, rent seeking behavior, quality of institutions, and neglect of human capital
development (education). As observed by Gylfason (2001), public expenditure on education relative
3

The term Dutch disease was coined by The Economist (November 26, 1977) in reference to decline in the
manufacturing sector in the Netherlands after the discovery of a large natural gas field in 1959 (see also,
Corden and Neary, 1982; Corden, 1984; van Wijnbergen, 1984a; and van Wijnbergen, 1984b).

78

to national income, expected years of schooling for girls, and gross secondary-school enrolment are
all inversely related to the share of natural capital in national wealth across countries. In the case of
Nigeria, Sala-i-Martin and Subramanian (2003) found that oil exerts a negative impact on growth
via its deleterious impact on institutional quality (including corruption, weak governance, rentseeking, plunder and waste) rather than Dutch disease.
Several studies have also found a link between the environment and conflict, as access and use of
natural resources can trigger violent conflict within states and across sub-regions. First, tensions
over the use and availability of water and land can drive conflict, which may spill over into wider
conflict if manipulated for political ends at the macro level. Secondly, wealth derived from natural
resources may be used to finance patronage networks, militias or arms purchases. Thirdly,
environmental damage and degradation (caused, for example, by extraction activities) may threaten
livelihoods and thus cause or aggravate tensions and increase the risk of disasters. In addition,
conservation and sustainable-management activities to tackle environmental degradation can have
indirect benefits for development, but also risk driving conflict if the community is not properly
sensitized of the need to conserve the resource.
At the very extreme, natural resources in particular, oil and gemstones play a key role in
triggering and prolonging localized or regional wars. Ross (2004), for example, explains four ways
that resources increase the hazard of civil war: by harming a countrys economic performance; by
making its government weaker, more corrupt, and less accountable; by giving people who live in
resource-rich regions an incentive to form an independent state; and by helping finance rebel
movements. These patterns help explain the unusually high rate of civil wars in sub-Saharan Africa,
a region with many resource-dependent states.
8.4.4 The Environmental Kuznets Curve
In 1955, Simon Kuznets hypothesized that while developing, a country would first experience an
increase and then a decrease in inequality, following an inverse U-shape pattern. Grossman and
Krueger (1993) examined the relationship between various environmental indicators and the level
of a countrys per capita income. The study covered four types of indicators: concentration of urban
air pollution; measures of the state of oxygen regime in river basins; concentrations of fecal
contaminants in river basins; and concentration of heavy metals in river basins. For most indicators,
economic growth brings an initial phase of deterioration followed by a subsequent phase of
improvement. The turning points for the different pollutants vary, but in most cases they came
before a country reaches a per capita income of $8,000. This relationship has been defined as the
Environmental Kuznets Curve, after Simon Kuznets who first observed a similar relationship
between income and inequality (Grossman and Krueger, 1993).
According to Dasgupta, Laplante, Wang and Wheeler (2002), pollution in the environmental
Kuznets curve world grows rapidly because people are more interested in jobs and income than
clean air and water, communities are too poor to pay for abatement, and environmental regulation
is correspondingly weak. The balance shifts as income rises. Leading industrial sectors become
cleaner, people value the environment more highly, and regulatory institutions become more
effective. Along the curve, pollution levels off in the middle-income range and then falls towards
pre-industrial levels in wealthy societies.
The two main arguments that have been used to explain the EKC are the role of public opinion in
requiring policy actions to reduce environmental degradation, and to structural changes (from basic
industries to high-tech services) that lead to reduction in polluting emissions (Costantini and

79

Monni, 2008). Empirical studies support the environmental Kuznets curve for some local pollutants
that have an immediate adverse effect on the environment and human health (e.g. arsenic,
cadmium, lead, smoke, sulphur dioxide, and nitrogen oxides) and reject it for other cases (see
Bradford et al, 2005). Andreoni and Levinson (2001) say that the observed income-environment
relationship is perfectly reasonable, and may result from simple and natural features of the
abatement technology. Several recent empirical studies have also found that household-level
pollution follows an inverse-U (Pfaff, Chaudhuri and Nye, 2004).
The Environmental Kuznets Curve may have demand and supply side explanations. A crucial
element in the demand side explanation is the hypothesis that consumers willingness to pay (WTP)
for it gets higher as far as per capita income grows, as shown in a cross-country study for pollutants
such as carbon dioxide (Auci, 2006).
However, the studies on EKC have been criticized for using a cross-country approach that merely
juxtapose developing and industrialized countries, rather than describing the evolution followed by
a single economy over time (Borghesi, 1999). Conceptually, an inverted U-shaped relation may
exist between a few selected pollutants and income, but not necessarily at an aggregative level. In
addition, there is nothing inevitable about the link between economic growth and environmental
degradation, as policies and institutions can significantly influence the EKC e.g. internalization of
externalities (polluter-pay-principle). For example, emissions-reducing technological change and
effects of trade restrictions (e.g. EU on flower exports) can overcome the scale effect of rising
income per capita on emissions (Stern, 2004).
8.4.5 The Environment and the Poor
Poor people are both victims and unwilling agents of resource degradation. In addition, the links
between poverty and environmental change are mediated by a diverse set of factors that affect the
range of available options and decisions that poor people make. Poor peoples resource entitlements
depend on a range of factors including tenure arrangements, social relations (including gender),
capital endowments, and technology. Environmental degradation and declining resource
entitlements reduce the productivity of poor peoples assets, but environmentally damaging
behavior on the part of the poor themselves is usually a result of a lack of alternative choices.
Poor peoples economic incentives to invest in protecting or expanding their environmental
entitlements depend on several factors, such as availability of alternative technological options that
bring higher returns in the short term and stabilize livelihoods, access to markets, relative returns
to labor in agriculture and other activities, resource use rights, skills in managing the resource, and
enabling policies and institutional arrangements.
In the context of the marginal areas of the semi-arid tropics, the concept of environmental
entitlements indicates the importance of vulnerability of communities to shocks and stresses that
influence resource stocks and livelihoods.

8.5

Population Dynamics and the Environment

de Sherbinin et al (2008) explain that early research on population and the environment generally
assessed aggregate population impacts on the environment and natural resources. The emphasis was
on population size, growth and density, and how these interacted with various resources such as
forests, freshwater, land and soils, or alternatively, how they caused environmental degradation in

80

the form of pollution or overuse of resources. In the early 1990s, new research approaches were
developed that began to couple economists and demographers understanding of the household
economy and population dynamics. de Sherbinin et al (2008) examine the evidence for linkages
among household population dynamics, livelihoods, and the environment in four specific areas:
fertility, migration, morbidity and mortality, and household lifecycle.
According to de Sherbinin et al (2008), one popular theory to explain the existence of sustained
high fertility in the face of declining environmental resources is the vicious cycle model, where a
number of positive feedback loops contribute to a downward spiral of resource depletion,
growing poverty, and high fertility. The model describes the following causal connections: poverty
leads to high fertility through mechanisms such as demand for farm labor, insurance births owing
to high infant mortality, and low womens status; high fertility contributes to population growth
which further increases demands for food and resources from an essentially static resource base; the
declining per capita resource base reinforces poverty through soil fertility loss, declining yields, and
poor environmental sanitation; and poverty, in turn, contributes to land degradation by increasing
incentives for short-term exploitation (versus long-term stewardship) and because poor farmers
lack access to costly fertilizers and appropriate technologies. As communal resources (such as fuel
wood and water) become scarce each additional child provides a marginal benefit through his or
her labor. This suggests that resource dependency will result in higher fertility.
For example, Filmer and Pritchett (1997) explored the hypothesis on the link between the demand
for children and local resource depletion due to the role of children in collection of environmental
goods (firewood, water, grazing). Using a large scale household data set from Pakistan, the study
established that collection activities absorb a substantial part of total household resources, children
are relatively devoted to collection activities, women benefit from the presence of older children
(at least the female children) in the household, and firewood availability does seem to be related to
fertility.
Hunter (2001) discusses (a) the relationship between population factors (size, distribution and
composition) and environmental change, and (b) the primary forces that mediate this relationship
(technology, the institutional and policy contexts, and cultural factors). Population size is
inherently linked to the environment as a result of individual resource needs and individual
contributions to pollution. Population distribution and higher fertility in poorer regions lead to
pressure on local environments, migration, and urbanization through a process of population
arbitrage (the positive relationship between resource potential and population density due to
migration from low to high potential areas). Population composition also affects migration, as
younger people are more likely to migrate.
Technology affects efficiency of resource use and abatement of polluting production processes.
Institutional and policy contexts include global protocols e.g. the 1987 Montreal Protocol on
emissions of chlorofluorocarbons and local regulatory environmental agencies (e.g. Kenyas
National Environmental Management Authority). Cultural factors include consumption patterns
and attitudes towards wildlife.
Other studies have shown that environmental perceptions affect fertility behavior in a less
developed setting. For example, using multiple data sets from the Chitwan Valley Family Study in
Nepal, Ghimire and Mohai (2005) examine the impact of environmental perceptions on
contraceptive use in a rural agricultural setting. The results show that perceptions about certain
aspects of the environment are related to individuals subsequent use of contraceptives. Specifically,

81

those individuals who think that their environment (agricultural productivity and biodiversity) has
deteriorated are more likely to use contraceptives than those who think that their environment has
improved or has remained about the same.

8.6

Environment and HIV/AIDS

This section has some deliberate overlaps with Chapter 7 (HIV-AIDS and rural poverty), so as to
make this chapter self-contained. As stated earlier, some of the immediate linkages between
HIV/AIDS, rural livelihoods, human capacity and the environment include:
Overuse of natural resources including medicinal plants to treat AIDS side-effects; timber for
coffins; wildlife for food and wood for charcoal-making as alternative livelihood sources
Changes in land use as agricultural practices change with falling capacity for heavy labor
Changes in access to resources and land especially when widows and orphans cannot inherit
land
Loss of traditional knowledge of sustainable land and resource management practices
Loss of human capacity for natural resource management in government, nongovernmental
organizations, academic institutions, communities, donor organizations, and the private sector.
Increased vulnerability of community-based natural resource management programs as
communities lose leadership and capacity, and HIV/AIDS issues take priority
Diversion of conservation funds to HIV/AIDS related costs.
Hunter and Twine (2006) enumerate several ways in which HIV/AIDS mortality may shape
household selection, use, collection, and level of consumption of natural resources. For instance,
mortality-induced changes in natural resource selection have been observed as afflicted households
turn to natural resources (e.g. wild foods) as alternatives to purchased items, mainly due to
diminished labor capacity and the resultant reallocation of money and time.
Natural resource use strategies are decisions regarding the purpose of the selected natural resources
e.g. using dung as fuel rather than as fertilizer, sale of natural resources otherwise used for
household consumption in an effort to raise much needed income, or decisions on land use (e.g. to
leave land fallow).
Natural resource collection strategies involve those decisions regarding where natural resources are
to be collected (including formal and informal markets), who (in terms of household position) will
do the collecting, and the associated costs of collection in terms of time, money and/or bartered
assets. For example, natural resource collection may take place within communal lands, within a
homestead garden, and/or natural resources may be purchased or received as gifts. Research has
also suggested that fertility rates may rise in response to resource scarcity due to an increase in the
relative value of children as resource collectors, and create a vicious circle of increasing population
and natural resource scarcity.
As related to mortality experience, changes in the natural resource collection strategies frequently
involve unsustainable collection practices. The death of a prime-aged adult often represents the loss
of a skilled and knowledgeable natural resource collector, and children and inexperienced natural
resource collectors are more likely to employ unsustainable collection practices due to lack of
knowledge.

82

The increases in time spent on natural resource collection as a result of an adult collectors death
takes time that would have been spent on other activities e.g. in school or studying. Additionally,
there is begging and a greater reliance on family and charitable organizations, following the death
of a household member.
Natural resource consumption strategies refer to changes in quantities of resources consumed. For
example, households may reduce their overall level of consumption of natural resources in
conjunction with related changes in natural resource selection and collection strategies.
In general, HIV/AIDS strips individuals, households, networks, and communities of assets, and the
sustainability of natural capital may also be undermined. Such threats may take the form of
lessened ability of communities and user groups to collectively manage common property resources
such as rangelands, and the loss of prime-age labor. Less labor-intensive and less nutritious crops
may be farmed, or land may lay fallow thereby threatening tenure.
There has been little research demonstrating HIV/AIDS impacts on household resource and
livelihood strategies that differ from the loss of an adult household member from other causes of
mortality. With regard to HIV/AIDS, it is logical to consider that household experience with
protracted adult illness may exacerbate the impacts of eventual mortality, while the stigma
associated with AIDS might also lessen assistance in times of household crisis.

8.7

Environment and Child Survival

As observed by Franz and FitzRoy (2006), economic welfare, measured most commonly by GDP
per capita, is accepted as a strong indicator of a countrys overall welfare. This traditional measure
of a countrys wealth reflects neither loss (often non-recoverable) incurred through domestic
resource consumption, nor negative externalities associated with their use. The most important and
immediate consequence of environmental degradation in the developing world takes the form of
damage to human health. Like GDP, infant and child mortality are foremost indicators of
population wellbeing. Infants and children are highly susceptible to negative externalities
associated with environmental degradation, thus making infant mortality a useful indicator in
exploring the link between environmental and population health outcomes. The most widely tested
environmental health indicators are access to clean water and sanitation. The literature on
determinants of mortality finds a strong positive correlation between access to water, improved
sanitation and child survival.
For example, in a study in four Nairobi informal settlements in 2002, community members
identified respiratory tract infections, diarrhea, malaria, skin problems and malnutrition as the five
leading illnesses among children under 5 years (Amuyunzu-Nyamongo and Taffa, 2003). The
mothers linked these illnesses to lack of adequate and clean water, unsafe waste disposal systems,
lack of adequate and nutritious food, and air pollution. The ability of the mothers to make these
linkages shows that their childrens illnesses could mainly be due to the impoverished status and
environments rather than mothers lack of biomedical conceptualization of disease processes.
Communitys knowledge of their childrens illness and the link between environment and child
health outcomes create opportunities to design and implement effective and sustainable child
survival programs.

83

CHAPTER NINE

POVERTY AND DEMOGRAPHIC CHARACTERISTICS IN KENYA

9.1

Background

The main demographic characteristics captured by the Kenya Integrated Household Budget Survey
2005/06 include household roster (e.g. age, gender, and marital status), children ever born and
children dead. On the basis of these variables, analysis has been conducted to produce certain
demographic indicators, namely, population age structure/composition, dependency ratios (child,
aged and total dependency ratio), infant and child mortality, age-specific fertility rates, general
fertility rates, and total fertility rates. All these demographic indicators have been cross-tabulated
by place of residence (rural/urban), region (province) and poverty status.
The poverty lines were derived from the KIHBS data using the Cost of Basic Needs (CBN) method,
where the overall poverty lines were KShs 1,562 and KShs 2,913 for rural and urban areas,
respectively. The food poverty line for Kenya was estimated as the cost of consuming 2,250
kilocalories per day per adult equivalent. The food poverty lines in monthly adult equivalent terms
were computed as KShs 988 and KShs 1,474 for rural and urban areas, respectively. Households
were deemed to be hard-core poor if they cannot afford to meet their basic food requirements with
their total expenditures (food and non-food).
The mortality estimates from KIHBS 2005/06 are low compared with estimates based on the KDHS
2003 and the 1999 Population Census, probably because KIHBS was not specifically designed for
fertility and mortality estimates. The reader should therefore place more emphasis on the
comparison of estimates by various post-stratification criteria e.g. poverty, region, and
characteristics of the mother (e.g. education), rather than the absolute magnitudes. More reliable
estimates will be available from the Kenya Demographic and Health Survey 2008/09. The estimates
from KIHBS 2005/06 presented in this chapter are provisional.

9.2

Population Structure

Peoples economic behavior and needs change at different stages of life. Thus, changes in a
countrys age structure can have significant effects on its economic performance. In developing
countries that have not yet gone through a demographic transition, high fertility and mortality
indicates high child-dependency and low old-age dependency ratios. As the demographic transition
begins to take place, mortality begins to decline causing an increase in the proportion of children in
the population, which increases the child-dependency ratio. Fertility then begins to decline, which
initiates a period of declining child-dependency and total dependency ratios. Finally, the elderly
population begins to increase and old-age dependency ratios rise.
During the time when a high proportion of a countrys population falls within the working-age
group, the added productivity of the working group can produce a demographic dividend or
window of economic opportunity. The demographic dividend depends on the duration and pace of
fertility decline and, to a lesser extent, the way in which mortality decline affects infants and
children. The demographic bonus is not a permanent state, but an opportunity that must be seized

84

over a relatively short period of time before population aging sets in. This section discusses the agesex structure of the population and the mean household size.
9.2.1 Age-sex Composition of the Population
The age-sex structure of a population is the cumulative result of past trends in fertility, mortality,
and migration. On the basis of the KIHBS 2005/06, Kenyas population was projected at 35.51
million comprising 79.9% rural and 20.1% urban, compared with urban shares of 18% in 1989, 15%
in 1979 and 8% in 1969. In both rural and urban areas, females invariably account for slightly over
a half of the total population. Table 9.1 tabulates the age-sex distribution of the population by place
of residence and poverty status, Table 9.2 tabulates the age-sex distribution of the population by
region and poverty status, while Table 9.3 shows the mean and median age by region and place of
residence.
The Kenyan population still largely exhibits a youthful age structure with 54% of the population
being under 19 years (compared with 58% in 1999) and only about 3.7% aged 65 years and over.
The rural population has a higher proportion of the young compared to the urban population. In
both rural and urban areas, the proportion in age group 0-15 was higher among the poor than
among the non-poor, while the converse was true for age group 20-59. For all regions, the poor
depict invariably higher proportions of young people compared to the non-poor.
Table 9.1: Age-sex Distribution of the Population by Place of Residence and Poverty Status, 2005/6
(%)
Age group
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
Total
Memo items
0-19 years (%)
Household size

Poor
13.6
16.6
15.0
14.4
8.6
5.6
4.4
3.6
3.9
3.3
2.7
2.2
1.7
1.5
1.0
0.8
1.1
100.0

Rural
Non-poor
13.4
14.3
12.6
12.5
9.8
7.6
6.3
4.7
4.4
3.4
2.8
2.3
1.8
1.4
1.1
0.9
1.0
100.0

Total
13.5
15.4
13.8
13.5
9.2
6.6
5.4
4.2
4.2
3.3
2.7
2.2
1.7
1.4
1.1
0.8
1.0
100.0

Poor
13.1
14.6
12.6
12.7
11.6
8.4
6.9
5.6
3.9
3.6
1.9
1.6
1.3
0.5
0.6
0.3
0.7
100.0

Urban
Non-poor
12.4
11.4
8.9
9.2
14.2
13.8
9.0
6.9
4.6
3.6
2.1
1.8
0.6
0.5
0.2
0.2
0.5
100.0

Total
12.6
12.5
10.2
10.4
13.3
12.0
8.3
6.5
4.3
3.6
2.0
1.7
0.9
0.5
0.4
0.2
0.6
100.0

Poor
13.5
16.3
14.6
14.2
9.0
6.0
4.8
3.9
3.9
3.3
2.6
2.1
1.6
1.3
1.0
0.7
1.0
100.0

Total
Non-poor
13.1
13.5
11.6
11.7
10.9
9.1
7.0
5.2
4.5
3.4
2.6
2.2
1.5
1.2
0.9
0.7
0.8
100.0

Total
13.3
14.8
13.0
12.9
10.0
7.7
6.0
4.6
4.2
3.4
2.6
2.1
1.6
1.2
0.9
0.7
0.9
100.0

59.6
6.5

52.7
4.8

56.1
5.6

53.0
5.4

41.9
3.6

45.7
4.1

58.6
6.2

50.0
4.3

54.0
5.1

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06
The mean age for the population was 22.5 years, while the median was 18 years. In both rural and
urban areas, the mean and median ages for the non-poor were higher than for the poor. The rural
poor have a lower median age (16 years) compared to their urban counterparts (18 years). However,

85

these national averages conceal huge spatial variations. At the regional level, the median age varies
widely from a low of 13 years in North Eastern province to a high of 23 years in Nairobi. The poor
also depict lower median ages across all provinces compared to the non-poor. Among the districts,
median age varies extensively from a low of 12 years in Mandera district to a high of 23 years in
Nairobi, Kirinyaga and Muranga. The poor in rural areas and most of the population in some
marginal districts are characterized by very young persons who are likely to be young adults or
children not eligible for work.
Table 9.2: Age-Sex Distribution of the Population by Region and Poverty Status, 2005/06 (%)
Nairobi
Age
group
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
Total
Memo
item
0-19
Househol
d size
Overall
household
size

Poor

Central
Poor

3.0
3.2
2.7
1.9
2.2
2.0
2.0
1.8
1.0
1.2
0.1
0.5
0.2
0.0
0.1
0.2
22.0
100.
0

Non
poor
11.9
11.6
7.7
8.2
14.3
15.6
9.3
7.0
4.7
3.3
2.1
1.9
0.9
0.6
0.3
0.2
0.3
100.
0

10.8
4.2

39.4
3.7
3.8

Coast
Poor

9.5
14.8
15.2
14.4
8.9
6.7
4.7
4.8
4.9
3.4
2.7
2.0
2.3
2.1
1.2
1.1
1.3
100.
0

Non
poor
11.0
11.8
10.4
12.5
9.9
8.8
6.2
5.9
5.8
4.0
3.2
3.0
2.0
1.8
1.3
1.2
1.3
100.
0

53.9
5.2

45.7
3.8
4.2

Eastern
Poor

13.1
16.8
14.9
15.0
7.9
5.9
4.4
3.9
3.5
4.1
3.4
2.3
1.5
1.0
0.9
0.8
0.6
100.
0

Non
poor
13.3
13.2
11.9
9.9
10.5
9.7
7.6
6.5
4.1
4.2
3.1
2.4
1.1
1.0
0.6
0.4
0.5
100.
0

12.7
15.3
14.3
14.7
8.9
6.0
4.5
3.6
4.4
3.4
3.0
2.4
1.7
1.3
0.9
1.4
1.5
100.
0

Non
poor
12.5
12.9
12.7
12.1
10.5
7.9
6.9
4.7
5.2
3.3
2.9
2.1
1.5
1.4
0.8
1.1
1.1
100.
0

59.9
7.0

48.3
4.2

57.0
6.3

50.3
4.4

5.4

5.2

North
Eastern
Poor Non
poor
14.9
21.5
22.0
15.0
17.4
13.6
11.8
9.5
5.5
7.7
4.7
9.2
5.0
5.7
3.0
4.0
4.5
4.0
2.4
1.4
2.0
3.0
0.7
1.2
1.9
1.2
0.9
0.7
1.5
0.5
0.6
0.6
1.2
1.3
100.
100.
0
0
66.1
6.9

59.6
4.6
6.2

Nyanza
Poor

Rift Valley
Poor

13.8
15.2
13.9
14.6
10.6
6.2
4.3
3.8
3.4
3.0
2.5
2.4
1.8
1.6
1.4
0.8
0.8
100.
0

Non
poor
14.1
14.8
12.7
13.2
11.0
6.9
6.6
4.1
3.8
3.1
2.4
2.2
1.7
1.0
1.1
0.8
0.4
100.
0

57.4
5.5

54.7
4.3
4.8

Western
Poor

14.3
16.1
14.8
13.9
10.0
6.0
5.1
3.8
3.6
2.9
2.5
2.1
1.6
1.2
0.7
0.5
1.0
100.
0

Non
poor
13.9
14.6
12.7
11.5
10.8
8.9
7.6
5.0
3.9
3.3
2.2
1.8
1.1
0.8
0.5
0.5
1.0
100.
0

15.0
17.9
14.5
15.1
7.8
5.4
4.4
3.6
3.6
3.6
2.1
1.7
1.2
1.7
1.1
0.4
1.0
100.
0

Non
poor
14.3
15.3
11.9
13.6
9.9
7.3
4.6
4.6
3.7
3.3
2.7
2.0
2.3
1.6
1.6
0.6
0.8
100.
0

59.1
6.2

52.7
4.5

62.5
6.3

55.1
4.8

5.2

5.5

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06
9.2.2 Mean Household Size
In Kenya, most poor households turned out to have the largest families. The average household size
for urban residents was about 4.1 people, while rural households average 5.6 people, with higher
household sizes among the poor compared with the non-poor. Average household size is generally
larger in the same areas where poverty incidence is highest. The national average masks wide
regional variations in mean household size. Regionally, mean household size varies from a low of
3.8 members in Nairobi to a high of 6.2 members in North Eastern province.

86

Table 9.3: Mean and Median Age by Region and Place of Residence, 2005/06
KENYA
Rural
Urban
NAIROBI
CENTRAL
Kiambu
Kirinyaga
Muranga
Nyandarua
Nyeri
Thika
Maragua
COAST
Kilifi
Kwale
Lamu
Mombasa
Taita Taveta
Tana River
Malindi
EASTERN
Embu
Isiolo
Kitui
Makueni
Machakos
Marsabit
Mbeere
Meru Central
Moyale
Mwingi
Nyambene
Tharaka
Meru South
NORTH EASTERN
Garissa
Mandera
Wajir
NYANZA
Gucha
Homa Bay
Kisii
Kisumu
Kuria
Migori
Nyamira
Rachuonyo
Siaya
Suba
Bondo
Nyando
RIFT VALLEY
Baringo
Bomet
Keiyo
Kajiado
Kericho
Koibatek
Laikipia
Marakwet
Nakuru

All
Median Age
Mean Age
18
22.5
17
22.5
21
22.4
23
20
19
23
23
19
21
20
20
18
16
16
17
21
19
15
16
18
21
16
16
18
18
15
18
20
15
17
17
16
22
13
14
12
13
17
19
17
16
19
15
16
18
16
17
17
17
17
17
16
15
18
18
17
18
19
16
18

Poor
Median Age
Mean Age
16
21.7
16
21.8
18
21.4

23.1
25.5
23.9
25.5
30.1
23.7
26.7
24.4
27.1
22.2
22.3
21.3
21.7
22.8
25.7
21.3
20.6
23.5
26.1
21.0
22.2
23.7
24.2
21.2
23.9
24.5
20.9
21.8
21.8
21.5
27.0
19.4
19.9
18.2
20.0
22.0
23.1
22.1
20.6
22.3
20.6
20.5
22.2
22.0
23.2
22.1
23.8
22.2
21.3
21.0
20.2
22.9
20.3
20.4
23.2
23.7
20.7
21.7

20
18
18
22
22
17
17
16
20
16
15
15
17
19
18
15
15
17
20
15
16
18
17
15
18
17
15
16
15
15
22
13
14
12
13
17
18
17
13
18
16
17
18
16
17
17
17
16
16
16
15
18
15
15
17
17
16
17

87

22.0
24.3
23.0
24.1
31.8
22.9
24.3
22.7
25.8
21.7
21.5
21.1
22.1
22.6
25.1
21.4
19.9
23.1
26.5
20.8
21.9
23.8
23.8
20.9
24.1
24.1
22.3
21.0
20.9
21.7
27.5
19.4
20.0
18.4
19.8
22.1
22.9
23.5
19.2
21.9
21.2
22.2
23.2
22.6
22.4
22.0
23.8
22.3
20.9
21.8
20.6
23.5
19.9
18.8
22.2
23.3
21.2
20.6

Non-poor
Median Age
Mean Age
19
23.1
18
23.2
22
22.9
23
22
20
24
23
20
23
22
20
20
18
19
17
22
21
15
19
19
22
17
18
19
20
19
19
22
14
18
18
17
22
14
15
12
15
18
20
17
18
20
14
15
17
16
18
18
17
18
18
16
15
19
18
20
19
21
16
20

23.3
26.1
24.2
26.0
29.4
24.5
27.8
25.3
27.7
23.1
24.0
21.6
21.5
23.0
26.4
20.8
22.3
23.9
25.8
21.3
22.7
23.3
24.8
23.9
23.8
24.6
18.9
23.1
22.2
21.4
26.8
19.5
19.7
16.8
21.1
22.0
23.5
21.1
22.2
22.6
19.9
19.2
21.2
21.6
23.8
22.2
23.8
22.1
21.6
19.8
19.6
22.4
20.4
21.6
24.5
24.0
19.8
22.5

Nandi
Narok
Samburu
Trans Mara
Trans Nzoia
Turkana
Uasin Gishu
West Pokot
Buret
WESTERN
Bungoma
Busia
Mt. Elgon
Kakamega
Lugari
Teso
Vihiga
Butere/Mumias

All
Median Age
Mean Age
17
22.4
14
19.6
13
19.5
14
18.7
18
22.4
16
20.1
19
22.1
15
20.2
17
20.4
16
21.6
16
20.5
15
21.1
15
19.4
16
22.4
18
22.3
16
20.8
17
23.7
16
21.9

Poor
Median Age
Mean Age
16
21.3
14
20.3
13
19.9
14
19.5
17
22.0
16
20.2
17
21.4
15
19.8
15
19.7
15
20.5
15
20.0
15
20.4
14
18.8
16
21.4
16
20.9
15
20.4
16
21.4
15
20.9

Non-poor
Median Age
Mean Age
17
23.3
14
19.4
13
18.2
14
17.9
19
22.7
15
18.2
20
22.7
17
21.0
18
20.8
18
22.8
16
21.1
17
22.6
16
20.3
18
23.6
19
23.7
16
21.3
19
25.3
18
23.1

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06
9.2.3 Household Headship
The sex of household head has become very important in the literature on gender and
development, mainly because female-headed households have been found to be at a disadvantage.
However, there are a number of problems with the concept of household headship in general.
These derive from ideological biases related to a history of patriarchal institutions of family
governance in both developed and developing countries. There is little clarity about what headship
means. Is headship defined by authority, economic contribution or other factors? The lack of clarity
in the definition of headship undermines comparability between studies undertaken in different
contexts. The concept of a single household head is also problematic because there may be multiple
earners in a household.
Frequently, woman-headed households are identified on the basis of the absence of a male spouse
in the household. At the analytical level, there is need to separate female-headed households into
those where there is a male head/spouse who does not reside in the household on a regular basis
and other female headed households (single, separated and divorced). This study identifies a de
jure woman-headed household by lack of adult male/spouse in the household. Table 9.4 classifies de
jure male-headed households as all households which have a male spouse, whether living regularly
in the household or not. The de jure female-headed households are defined as those headed by
women who are not in a marriage union.
By the above definition, Table 9.4 shows that 81.1% of households have a head and a spouse, while
18.9% are de jure female-headed households. The percentages do not differ widely by province,
mainly because the definition of male-headed households used here include couples in union but
the man or woman does not live in the household regularly. However, de jure female-headed
households have a higher incidence of poverty at 40.8% compared with de facto male-headed
households at 37.7%.

88

Table 9.4: Household Poverty Incidence by Household Headship, 2005/06 (%)


De jure male-headed
De jure female-headed
Kenya
Rural
Urban
Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western
Poor
Non-poor

Row %
81.1
80.7
82.1
83.6
77.8
79.3
82.2
82.6
76.6
83.4
83.1
79.8
81.8

Column %
100.0
74.2
25.8
10.8
13.6
8.3
15.4
2.7
13.7
24.4
11.1
37.7
62.3

Row %
18.9
19.3
17.9
16.4
22.2
20.7
17.8
17.4
23.4
16.6
16.9
20.2
18.2

Column %
100.0
76.0
24.0
9.1
16.7
9.3
14.2
2.4
17.9
20.8
9.6
40.8
59.2

Total
Column %
100.0
74.5
25.5
10.5
14.2
8.5
15.1
2.6
14.5
23.7
10.8
38.3
61.7

N
6,968,087
5,192,897
1,775,190
730,917
990,331
594,176
1,054,939
182,371
1,009,658
1,650,747
754,948
2,668,313
4,299,774

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06

9.2.4 Levels and Trends in Educational Attainment


Table 9.5 shows the distribution of the population aged 20-49 years by educational attainment.
Those classified as having no education comprise those who have not attended school and those
who did not complete the primary school cycle, while those classified as primary have a primary
level certificate and/or have attended secondary school but had not completed the secondary
education cycle. Those classified as secondary+ have a secondary school certificate and/or have
post-secondary education. This classification of education level as completion of an education cycle
rather than attendance has been used throughout the report, including tables that tabulate various
outcomes by education of the mother.
Table 9.5 shows that there are more women with no education (45.4%) compared with men at
35.1%. For both men and women, the proportions with primary education decrease with age of
household member, but the decrease is slightly steeper among women, which is a sign of relative
improvement in female education. The proportion of women with secondary education is on the
increase, while that of men has declined. The improvement in female education is expected to have
an impact on fertility, if the constraints in contraceptive supply and access are addressed.

89

Table 9.5: Distribution of Women and Men Aged 20-49 Years by Educational Attainment, 2005/6
(%)

Kenya
Age Group

Residence
Province

20-29
30-39
40-49
Rural
Urban
Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western

None
45.4
40.2
46.4
56.0
51.6
27.6
20.9
28.2
61.8
48.1
96.4
45.7
50.4
50.6

WOMEN
Primary
Secondary+
31.3
23.2
34.3
25.5
29.3
24.3
27.4
16.7
31.5
16.9
30.9
41.6
29.0
50.1
40.1
31.8
23.6
14.6
34.6
17.3
2.3
1.4
33.7
20.6
30.2
19.4
30.9
18.5

None
35.1
34.8
33.3
38.3
41.8
17.9
10.5
27.8
40.7
44.9
73.4
28.9
39.6
41.7

MEN
Primary
32.9
35.3
31.8
29.3
33.3
32.0
33.5
36.6
31.1
31.8
16.7
36.6
31.1
34.9

Secondary+
32.0
29.9
34.9
32.4
24.8
50.2
56.0
35.6
28.3
23.3
9.9
34.5
29.4
23.4

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06

9.3

Dependency Ratios

Dependency ratio refers to the fraction of a population that is dependent on the rest of the
population, which has generally been considered to be the fraction under 15 years or over 65 years,
and are expected to depend on people of working-age population (15 to 64 years). The dependency
ratio is often used as an indicator of the economic burden the productive portion of a population
must carry, even though some persons defined as dependent are producers and some persons in
the productive ages are economically dependent. The three dependency ratios normally used are
total dependency ratio, child dependency ratio and aged dependency ratio.
9.3.1 Total Dependency Ratio
The total dependency ratio is the total number of persons under 15 years or over 65, divided by the
total working-age population (15-64 years). Table 9.6 presents the estimates of dependency ratios
by place of residence, province, district, and poverty status. Overall, total dependency ratio is about
81, implying that 81 people in the age range 0-14 and 65 plus years depend on 100 people in the age
range 15 to 64 years.
However, this national average masks wide spatial differences. Regionally, the highest dependency
ratio was in North Eastern province (132.3), while the lowest was in Nairobi (52.7). Among the
districts, the highest dependency ratio was among residents of Mandera district (141.7) in North
Eastern province, while the lowest was in Kirinyaga district (56.1) in Central province. The
dependency ratios are highest in the same areas that have largest household sizes and the highest
proportions of households below the poverty line. North Eastern province has the highest poverty
incidence and the highest mean household size.
The rural poor depict relatively higher dependency ratio of 98.0 compared to rural non-poor at
79.6. Similarly, the urban poor had higher total dependency ratio of 73.2 compared to urban non-

90

poor with 51.5. This means that there is one non-worker for every two workers among urban nonpoor, which is quite different from much of the rest of Kenya, where most regions have about one
worker for every one non-worker. Interestingly, the rural non-poor have a higher total
dependency ratio (79.6) when compared to the urban poor (73.6).
Table 9.6: Dependency Ratios by Region and Poverty Status, 2005/06

Kenya
Rural
Urban
NAIROBI
CENTRAL
Kiambu
Kirinyaga
Muranga
Nyandarua
Nyeri
Thika
Maragua
COAST
Kilifi
Kwale
Lamu
Mombasa
Taita Taveta
Tana River
Malindi
EASTERN
Embu
Isiolo
Kitui
Makueni
Machakos
Marsabit
Mbeere
Meru Central
Moyale
Mwingi
Nyambene
Tharaka
Meru South
NORTH EASTERN
Garissa
Mandera
Wajir
NYANZA
Gucha
Homa Bay
Kisii
Kisumu

Child Dependency Ratio


74.8
80.5
56.1
50.8
59.3
64.7
50.8
48.1
72.0
51.9
63.7
60.2
77.1
89.1
90.3
82.1
54.3
64.4
104.0
91.2
73.3
48.7
93.0
88.6
70.1
72.5
101.2
74.9
58.7
99.1
83.6
83.8
94.7
52.7
123.8
112.1
133.5
129.0
78.3
64.7
92.5
86.6
61.0

Aged Dependency Ratio


6.6
7.9
2.2
1.8
9.2
7.7
5.3
17.7
9.9
8.1
7.2
14.2
5.3
6.3
6.2
5.9
2.5
9.4
7.7
4.6
8.5
8.7
6.3
10.3
8.6
9.4
7.7
10.2
7.0
9.8
6.8
7.1
7.3
9.5
8.5
6.9
8.2
10.6
7.0
6.1
10.9
7.2
3.2

91

Total Dependency Ratio


81.4
88.3
58.3
52.7
68.5
72.4
56.1
65.9
81.9
60.0
70.9
74.5
82.4
95.4
96.5
88.0
56.8
73.8
111.8
95.8
81.8
57.4
99.3
98.9
78.7
81.8
108.8
85.2
65.8
108.9
90.4
90.9
102.0
62.2
132.3
119.0
141.7
139.6
85.3
70.8
103.4
93.8
64.1

Kuria
Migori
Nyamira
Rachuonyo
Siaya
Suba
Bondo
Nyando
RIFT VALLEY
Baringo
Bomet
Keiyo
Kajiado
Kericho
Koibatek
Laikipia
Marakwet
Nakuru
Nandi
Narok
Samburu
Trans Mara
Trans Nzoia
Turkana
Uasin Gishu
West Pokot
Buret
WESTERN
Bungoma
Busia
Mt. Elgon
Kakamega
Lugari
Teso
Vihiga
Butere/Mumias

Child Dependency Ratio


92.6
93.6
74.0
87.5
79.4
81.0
78.9
75.7
80.2
81.0
97.7
69.3
82.9
84.2
71.8
68.1
92.5
69.3
82.0
112.2
124.8
117.4
66.7
85.8
63.3
99.0
84.8
87.3
86.9
96.1
100.4
86.2
71.3
93.8
77.3
93.4

Aged Dependency Ratio


5.4
5.9
7.3
7.8
9.4
8.8
12.4
6.2
5.0
4.4
4.3
4.9
4.2
2.2
7.9
7.3
7.2
4.0
7.5
5.9
8.0
3.8
5.7
3.1
4.8
5.8
3.3
8.1
4.5
8.3
5.2
9.3
7.0
7.0
13.4
10.6

Total Dependency Ratio


98.0
99.5
81.3
95.3
88.8
89.8
91.3
81.9
85.2
85.4
102.0
74.1
87.1
86.4
79.7
75.3
99.7
73.3
89.5
118.1
132.8
121.2
72.4
88.9
68.2
104.8
88.1
95.4
91.4
104.4
105.5
95.5
78.3
100.8
90.7
104.0

Rural Poor
Rural Non Poor
Urban Poor
Urban Non Poor

89.6
72.3
70.0
49.7

8.4
7.4
3.1
1.8

98.0
79.6
73.2
51.5

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06
9.3.2 Child Dependency Ratio
Child dependency ratio is the number of children aged 0-14 relative to the total number of people
aged 15-64 years. Nationally, the child dependency ratio is about 75, with rural areas experiencing
a much higher child dependency ratio (80.5) when contrasted to their urban counterparts (56.1). At
the provincial level, child dependency ratios fluctuate widely from a low of 50.8 persons in Nairobi
to a high of 123.8 in North Eastern province. At the district level, the child dependency ratio
oscillates from a low of 48 in Muranga and Embu districts to a high of 133.5 in Mandera district in

92

North Eastern province. Within the rural areas, the rural poor display significantly higher child
dependency ratio (89.6) than the rural non-poor at 72.3. Likewise, the urban poor depict a higher
child dependency ratio of 70.0 while the urban non-poor have about 20 children less dependent on
100 in the working-age group.
9.3.3 Aged Dependency Ratio
Aged dependency ratio refers to the number of people aged 65 years and over relative to the total
number of people aged 15-64 years. At the national level, the aged dependency ratio is about 6.6
implying that about seven persons aged over 65 years depend on 100 persons in the working-age
group (15-64). Rural areas have a higher aged dependency ratio (7.9) compared to their urban
counterparts (2.2). Regionally, the aged dependency ratio varies widely from a low of 1.8 persons in
Nairobi to a high of 9.2 persons in Central province. Among the districts, the aged dependency
ratio varies from a low of 2.2 in Kericho district in Rift valley to a high of 17.7 in Muranga district
in Central province. Within the rural areas, the rural poor have one old person more than their
corresponding rural non-poor (8.4 versus 7.4) for every 100 working-age persons. Similarly, the
urban poor depict an aged dependency ratio of 3.1 persons while the urban non-poor have about
two persons (1.8) for every 100 working-age persons.

9.4

Mortality

Infant and under-five mortality rates are leading indicators of general child health and overall
development of a country or region. The infant mortality rate is an important measure of the
wellbeing of infants and pregnant women because it is associated with a variety of factors such as
maternal health, quality and access to medical care, and socioeconomic conditions of the
household.
Infant mortality rate (IMR) is the probability (expressed as a rate per 1000 live births) of a child
born in a specific year dying before reaching the age of one, if subject to current age-specific
mortality rates. Child mortality rate is the probability of a child aged one year dying before
reaching the age of five, if subject to age-specific mortality rates of that period. Under-five
mortality rate is the probability (expressed as a rate per 1000 live births) of a child born in a specific
year dying before reaching the age of five, if subject to current age-specific mortality rates.
9.4.1 Levels and Trends in Infant and Under-five Mortality
As shown in Table 9.7, the mortality rates are highest among male children, where 74 out of 1000
male children die within their first birthday and 114 die before their fifth birthday. For female
children, 65 out of 1000 die before the first birthday and 104 die before the fifth birthday.

93

Table 9.7: Infant, Under-five and Child Mortality Rates by Region and Demographic
Characteristics of the Mother, based on North Model

SEX
REGION

RESIDENCE
MOTHERS EDUCATION

MARITAL STATUS

POVERTY STATUS
HARDCORE-POVERTY STATUS
TOTAL

Male
Female
Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western
Rural
Urban
None
Primary
Secondary+
Never Married
Currently Married
Formerly Married
Not Stated
Poor
Non Poor
Hardcore Poor
Hardcore Non-poor
Total

Infant
Mortality
Rate
74
65
53
36
77
77
72
97
57
80
70
68
75
64
57
70
67
63
61
74
66
74
69
70

Child
Mortality
Rate
43
42
28
14
49
49
44
68
31
51
42
41
47
37
32
42
40
36
39
46
39
46
41
42

Under-five
Mortality Rate
114
104
79
49
123
123
113
158
87
127
109
107
118
99
87
109
104
97
96
117
102
117
107
109

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06
Table 9.8 shows a decline in both infant and under-five mortality, in comparison with the 1999
Population and Housing Census and the 2003 Kenya Demographic and Health Survey. The 1999
census and the 2003 KDHS showed a stagnation of infant mortality rate at 77, while the 2005/06
KIHBS shows a much lower level at 70. Similarly, the under-five mortality has recorded a decline
from 116 in the 1999 census and 115 in the 2003 KDHS to 109 in the KIHBS. In general, there is a
marked reduction in mortality rates among children compared with the 1999 population census
and the 2003 KDHS.
Table 9.8: Infant and Under-five Mortality Rates, 1999, 2003 and 2005/6
1999 Census
2003 KDHS
Infant Mortality
77
77
Under-five mortality
116
115

2005/6 KIHBS
70
109

9.4.2 Infant and Under-five Mortality by Place of Residence of the Mother


Table 9.9 shows the infant and under-five mortality rates based on the 2003 KDHS and 2005/6
KIHBS. It is evident that children are more vulnerable to death in their first year of life. Regionally,
the highest infant and under-five mortality rates were recorded in Nyanza province and the lowest

94

in Central Province. Nyanza, North Eastern and Western province have consistently shown higher
levels of mortality among children, which may be explained by the high prevalence of malaria in
these provinces. In particular, the under-five mortality rates for Coast and Eastern provinces seem
to be on the rise. This is alarming since all the other provinces have registered considerable declines
in under-five mortality. For both 2003 and 2005/06, mortality rates are higher in rural than urban
areas, although the rural-urban gap was narrower in 2005/06 compared to 2003.
Table 9.9: Infant and Under-five Mortality Rates by Place of Residence of the Mother, 2003 and
2005/06

Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western
Urban
Rural
Kenya

2003 KDHS
Infant Mortality
Under-five Mortality
67
95
44
54
78
116
56
84
91
163
133
206
61
77
80
144
61
93
79
117
77
116

2005/06 KIHBS
Infant Mortality
Under-five Mortality
53
79
36
49
77
123
77
123
72
113
97
158
57
87
80
127
68
107
70
109
70
109

9.4.3 Infant and Under-Five Mortality by Selected Characteristics of the Mother


The welfare of the mother plays a significant role in child mortality, and some of the important
factors that influence the welfare of the mother are education, poverty status, marital status and
region of residence. As is shown in Table 9.7, both infant and under-five mortality rates decline as
mothers education improves. The infant mortality rate among children whose mothers have no
education was 75 compared to 57 for those whose mothers have completed secondary education.
Similarly, the under-five mortality for children whose mothers have no education was estimated at
118 compared to those whose mothers have completed secondary education at 87 deaths per 1000
live births.
It would be expected that women currently married would be in an environment more conducive
to the survival of their children. However, the results from KIHBS 2005/06 seem to suggest that the
infant and under-five mortality rates are highest among women whose marital status is never
married, followed by those who are currently married, while the lowest are observed for those who
were formerly married (divorced, separated, widowed). The marital status of the mother seems not
to play a very significant role, especially because those who were formerly married recorded higher
survival rates for their children compared with those who are currently married.
However, poverty levels play a significant role in child mortality. Children whose mothers fall in
poor households are more likely to die before their fifth birthday than those born to mothers in
non-poor households.

95

9.5

Fertility

9.5.1 Concepts and Definitions


The fertility indicators used were Age-Specific Fertility Rate (ASFR), Total Fertility Rate (TFR) and
General Fertility Rate (GFR).
The age-specific fertility rate is the number of births per woman within a specific age interval
during a specified time. The age cohort with the highest rate tells you when childbearing most
commonly occurs in a womans life within a given area or environment.
The total fertility rate is the number of children that would be born to a woman if she were to live
to the end of her child-bearing years and bear children at each age in accordance with prevailing
age-specific fertility rates. The TFR is therefore a measure of the fertility of an imaginary woman
who passes through her reproductive life subject to all the age-specific fertility rates for ages 15-49
that were recorded for a given population in a given year. In particular, the TFR does not
necessarily predict how many children young women now will eventually have, as their fertility
rates in years to come may change from those of older women now.
The general fertility rate refers to the number of live births per 1000 women in ages 15-49 years in
a given year.
The ASFR is calculated for the three years preceding the date of the survey. The coverage for this
computation is normally all women aged 15-49 years grouped into seven five-year age groups. The
window of observation of births for the computation of the ASFR is defined as the exposure period
for the women. The beginning of this exposure period starts 36 months before the survey date or
when a woman turns 15 years, whichever is later, and ends a month before the end of the survey. A
woman may contribute events and exposure to up to four different ages. Each age a woman
contributes within the exposure period constitutes a segment and starts at the beginning of the
exposure period and ends a year later. The total woman-years lived in the exposure period within
the window of observation is the sum of all years contributed by the woman in the exposure
window. ASFR is then defined as the ratio of births to exposure. The methodology used to compute
the ASFR was adopted from Rodrguez (2006).
The numerator of the age-specific fertility rates are calculated by summing the number of live
births that occurred in the period 1-36 months preceding the survey (determined by the date of
interview and the date of birth of the child), and classifying them by the age (in five-year groups)
of the mother at the time of the childs birth (determined by the mothers date of birth). The
denominators of the fertility rates, including total fertility rate and general fertility rate, are the
number of woman-years lived in each of the specified five-year age groups.
To calculate ASFR, all births recorded within the exposure period are added together by each
group. The ASFR is calculated as the quotient of the number of births by the total woman years
(exposure) in each age group. The Total Fertility Rate is then calculated as the total sum of all
ASFRs in all age groups, while the General Fertility Rate is calculated as the quotient of all births
by total woman-years.

96

9.5.2 Computation of Fertility Rates from the Kenya Integrated Household Budget Survey
The estimates of fertility are normally based on the reports of women aged 15-49 years using the
reproductive histories of these women. Each woman is normally asked to give information on the
number of all births, month and year of each birth, sex of the child, and its survival status (dead or
alive). For children who have died, information on age at death is also collected. The birth history
data of each woman is then analyzed to provide fertility levels, trends and differentials. However,
the KIHBS did not collect the birth history of women as required for the computation of fertility
levels and trends.
The Kenya Integrated Household Budget Survey 2005/06 collected information on the number of
children ever born, children surviving (both at home and away) and children dead, and date of
birth of the last born child and its survival status. Consequently, the KIHBS dataset used for
estimating fertility rates was reconstructed from two separate modules in the questionnaire:
household member roster (Section B) and fertility (Section D).
To reconstruct the birth history of each woman, information in the household roster used was age
of the household member, date of birth for each household member, and the line number linking
the biological mother with the child within the household. In reconstructing the birth histories,
the following steps were followed:
i.
A file containing all women aged 15-49 years was created from the file containing all
women aged 12-49 years in the fertility section of the questionnaire.
ii.
A file containing all children with the mother residing within the household was created
by linking the biological mother and the child in the household listing form. This group of women
represented about 60% of all women aged 15-49 years.
iii.
Among the remaining 40% of the women from step two, about 87% of them had never
given birth. The remaining 13% were identified as women who have ever given birth and their last
birth recorded in the fertility section of the questionnaire. All these women were merged with the
other women in step two.
iv.
From the data file created in step two, a comparison between the date of birth of the last
born and survival in the fertility section and the date of birth for children listed in the household
member roster was done. All non-surviving births were separated and treated as additional births to
this group of women.
The data from step two to step four were combined to give the birth history of each woman aged
15-49 years participating in the survey.
9.5.3 Levels and Trends in Age Specific Fertility Rates
Table 9.10 presents age-specific fertility rates for Kenyan women of reproductive age based on data
from the 1977/78 Kenya Fertility Survey (KFS), various Demographic and Health Surveys (1989,
1993, 1998 and 2003), the 1999 Population and Housing Census, and the Kenya Integrated
Household Budget Survey 2005/06.

97

Table 9.10: Trends in Age Specific Fertility Rates for Kenyan Women aged 15-49
Age
Group
15-19
20-24
25-29
30-34
35-39
40-44
45-49
TFR

1977/78
KFS
168
342
357
293
239
145
59
8.1

1989
KDHS
152
314
303
255
183
99
35
6.7

1993
KDHS
110
257
241
197
154
70
50
5.4

1998
KDHS
111
248
218
188
109
51
16
4.7

1999
Census
142
254
236
185
127
56
7
5.0

2003
KDHS
114
243
231
196
123
55
15
4.9

2005/06
KIHBS
92
204
230
187
147
81
51
5.0

Sources: Kenya Fertility Survey 1977/78; Kenya Demographic and Health Survey, 1989, 1993, 1998,
2003; Kenya Population and Housing Census 1999; Kenya Integrated Household Budget Survey
2005/06.
9.5.4 Levels and Trends in General Fertility Rates
Table 9.11 shows the distribution of general fertility rates by place of residence, region, education
level of the mother, marital status and poverty level. The data shows that GFR stood at 160 as of
2005/6, which means that every 1000 women in the reproductive age range 15-49 give birth to
about 160 children. This measure varies widely at the regional level from about 108/1000 in Central
province to around 222/1000 in North Eastern province. Generally, the level of education of the
mother is inversely related to GFR, and is higher in rural areas compared to urban areas. For all age
groups and region (except North Eastern province), the general fertility rate is higher among the
poor compared with the non-poor.
Table 9.11: General Fertility Rates, 2005/06 (Weighted)
Kenya
AGE GROUP
15-19
20-24
25-29
30-34
35-39
40-44
PROVINCE
Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western
RESIDENCE
Rural
Urban
EDUCATION LEVEL OF THE MOTHER
None
Primary
Secondary+

ALL
160

POOR
182

NON-POOR

92
204
230
187
147
85

92
228
275
231
201
109

92
190
203
156
103
62

109
108
164
157
222
177
182
190

143
108
183
179
214
186
202
193

104
107
140
138
237
169
167
188

173
120

190
141

159
113

200
145
100

209
152
95

189
141
101

Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06

98

145

9.5.5

Levels and Trends in Total Fertility Rates

Tables 9.12, 9.13 and 9.14 show total fertility rates by place of residence, region, education of the
mother, and poverty status. Overall the TFR recorded by KIHBS is about 5.0 children, with rural
women having a higher TFR of 5.5 compared to their urban counterparts at 3.2 children. Women
in poor households in rural areas have almost two more children when compared with the rural
non-poor. Among urban women, women from poor households have slightly more than one child
compared with those from non-poor households. Women in rural poor households have more than
two more children compared to women from poor urban households. Education has an inverse
relationship with TFR for both rural and urban women.
Table 9.12: Total Fertility Rates for Kenya, 2005/06

KENYA
Rural
Urban
PROVINCE
Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western
EDUCATION LEVEL OF THE MOTHER
None
Primary
Secondary+

All
5.2
6.0
3.6

UNWEIGHTED
Poor
Non-poor
6.4
4.2
7.0
5.0
4.7
3.0

All
5.0
5.5
3.2

WEIGHTED
Poor
Non-poor
6.1
4.1
6.5
4.6
4.1
2.9

2.4
3.1
5.7
5.4
6.4
5.2
5.9
5.7

3.7
3.5
6.6
6.8
6.1
6.2
7.0
6.2

2.3
2.9
4.5
4.2
7.0
4.6
4.9
5.0

2.8
3.2
5.6
5.0
7.2
5.4
5.8
5.8

3.5
3.6
6.5
6.1
7.2
6.2
6.9
6.3

2.6
3.0
4.2
4.0
7.0
4.7
4.9
5.3

6.7
4.5
2.8

7.2
5.0
3.1

5.8
4.1
2.8

6.3
4.6
2.8

6.9
5.3
3.0

5.5
4.2
2.8

Note: When the analytical methodology was applied to the KDHS 2003 database, the TFR
generated for Rift Valley was 5.7, instead of the 5.8 in the Kenya Demographic and Health Survey
2003 report.
Source: Kenya National Bureau of Statistics, Kenya Integrated Household Budget Survey 2005/06

Among the poor and the non-poor, the level of educational attainment of the mother has an inverse
relationship with fertility. In Nairobi and Central province, those who have completed primary
education have slightly higher fertility rates than those with no education, and fertility only
declines for those who have completed secondary education. Western province has the highest
fertility among those who have completed secondary education (4.4) compared with the national
average of 2.8. The low figure for North Eastern province is probably due to the small number of
observations.
The statistics on fertility in Kenya confirms a decline in total fertility rates since the 1980s. The
striking feature of the decline in fertility between 1969-79 and 2005/06 is that the highest decline
was recorded for mothers with primary education (3.3), followed by those who have completed
secondary education (2.6) and lowest for those with no education (1.5). The surveys and censuses

99

conducted at different points in time shows that women with no education exhibited the highest
fertility rates.
Table 9.13: Total Fertility Rates (TFR) by Level of Education Attained, 2005/06
None

Primary

Secondary+

Kenya

6.3

4.6

2.8

Rural
Urban

6.7
4.0

4.8
4.0

3.3
2.3

Nairobi
Central
Coast
Eastern
North Eastern
Nyanza
Rift Valley
Western

3.6
3.2
6.6
6.1
7.1
6.1
7.3
7.2

3.9
3.8
3.8
4.8
4.1
5.7
4.9
4.9

1.9
2.8
2.8
2.3
1.0
3.3
3.2
4.4

Poor
Non-poor

6.9
5.5

5.3
4.2

3.1
2.8

Education influences fertility both directly (through changes in attitudes, values and beliefs
towards family size) and indirectly by delaying marriage, promoting couple communication,
lowering infant and child mortality, and increasing contraceptive use. In general, urban women
have lower fertility levels compared to rural women. This is not surprising since urban women
usually have better access to education, higher social mobility, better access to maternal healthcare,
marry later, and generally face higher costs of raising children.
Table 9.14: Trends in Total Fertility Rates by Mothers Education
Level
Education
None
Primary
Secondary+

of

1969-79
Census
7.8
7.9
5.4

1979-89
census
7.5
7.1
5.0

1989-99
census
6.8
6.5
4.8

100

2005/06
KIHBS-all
6.3
4.6
2.8

Decline between 1969-79 and


2005/06
1.5
3.3
2.6

CHAPTER TEN

SUMMARY OF MAIN FINDINGS AND EMERGING ISSUES

10.1

Background

The UN Millennium Summit held in 2000 and the International Conference on Population and
Development of 1994 agreed on a series of goals intended to improve reproductive health outcomes
and halve the number of people living in poverty by 2015. The first seven (of the eight) Millennium
Development Goals cannot be delivered without the provision of good reproductive health services,
as there is a strong correlation between large family size and instances of poverty.
The ICPD did not adopt or recommend demographic targets, such as specific reductions in birth
rates or family size, since experience in some countries had shown that such targets could lead to
human rights abuses by overzealous administrators. Instead, the emphasis was on personal choice
and on the quality of reproductive health/family planning services.
The United Nations Population Fund is expected to play a key role in ensuring that countries attain
the MDGs, and therefore supports efforts to determine evidence-based linkages between
population, development and poverty. It is against this background that the assessment of
population and poverty linkages was undertaken in Kenya.

10.2

Summary of Main Findings

Kenya was one of the first countries in sub-Saharan Africa to experience a demographic transition
in the early 1980s. However, the current situation indicates a stall in fertility decline and an
upsurge in mortality particularly at infancy. Kenyas fertility rate is about twice the global average
(2.53), although it is slightly lower than for sub-Saharan Africa combined (5.19). The Kenyan
population exhibits a youthful age structure with 54% of the population being under 19 years, with
a mean age of the population at 22.5 years and the median age at 18 years.
The study has shown that children are costly to their parents, and there are costs for an additional
child that are not borne directly by the parents, but are passed on to other families and society as a
whole e.g. public sector inter-age transfers (e.g. education for the young and healthcare and
pensions for the elderly), common resources or collective wealth (e.g. environmental goods),
provision of public goods or social infrastructure, and depressed wages due to excess labor.
Some of the factors that influence the demographic transition are womens education, labor force
activity and empowerment (due to its effects on age at first marriage, adoption of contraception);
gender relations (as they adversely affect fertility decisions); uncertainty about child survival
(proxied by infant mortality); income inequality and poverty; the share of income derived from the
stocks of physical capital, land, and other natural resources (as opposed to wage income); and the
role of religion through pro-natalist attitudes e.g. by forbidding abortion and artificial forms of
contraception.

101

Access to reproductive health services has been constrained by individual and household level
poverty, the quality of healthcare systems especially prenatal and peri-natal care, and the shift of
human and financial resources from family planning to HIV/AIDS. The contraceptive delivery
system is weak, hence the need for outreach programs and integration of HIV/AIDS services with
family planning programs.
The other main obstacle to better reproductive health is the international taboo that accompanies
discussion of the population factor. Although people are comfortable discussing scarcity of water,
land, food, medicines, education, the disappearance of forests, the depletion in fish stocks, trade and
sustainable development, they do not talk about population growth in the same way.
HIV/AIDS has undermined households ability to provide for basic needs (e.g. food), and the
subsequent loss of prime-age labor destroys existing human capital and weakens future generations,
as children are left orphaned, with little or no schooling. HIV/AIDS can either increase fertility due
to the parents desire to increase the number of children in the face of high AIDS deaths or reduce
fertility to avoid the risk of contracting or transmitting the virus.
The high population growth in Kenya has had adverse effects on the environment. In particular, it
has led to the encroachment of marginal lands, overconsumption of wood fuel resources, poor
disposal of waste products, inadequate water and sanitation services, shortage of energy supplies,
increased soil erosion, and land degradation. However, reproductive health and environment both
appear as orphans in the national development agenda despite their centrality in the achievement
of MDGs.
In the remote past, mankind was probably in the middle of the animal food chain, as predator to
the small herbivores and as prey to the big members of the cat family. Mankinds self-exemption
from the food chain has brought about human population-natural resource imbalance, as fertility
regulation has not reduced population growth to sustainable levels.

10.3

Areas for Priority Action

Some possible areas of policy intervention include:


Addressing structural factors that limit access to reproductive health services such as poverty and
womens education and empowerment
Influencing the inhibiting factors such as religion, harmful cultural practices, and gender
discrimination
Addressing supply-side constraints through integrated family planning and HIV/AIDS services,
and an efficient contraceptive supply chain
Reducing interpersonal and regional disparities to address the observed relationship between
fertility and poverty/inequality, and
Creating relevant and positive messages about reproductive health, and desired number of
children based on optimal investment in children.

10.4

The Cost of Inaction

The Kenyas development blueprint to the year 2030 (Vision 2030) is silent about the role of the
high population growth rate on the achievement of the development targets contained in the

102

blueprint, other than for the targets on the proportion of women using family planning methods
and the proportion of births attended by skilled health personnel (Kenya, 2008, page 113).
However, the stall in fertility decline especially for poor households will make it difficult for Kenya
to maintain the high economic growth rate achieved in the recent past. The high population
growth rate and the bulge in the share of the young population have already created a big demand
for investment in the social sectors (principally health and education). In addition, the high
reliance on intensive cultivation of declining land holdings and the use of biomass as a source
energy (e.g. wood fuel) will continue to put stress on the environmental and natural resources in
the form of food insecurity, environmental degradation, unemployment, overcrowded urban areas,
and conflict over access to resources (e.g. forest land, water and pasture). Indeed, the epicenter of
the recent post-election violence was in the three provinces where the total fertility rate is
estimated at around 5.8, compared with about 4.0 for the rest for the country.

103

BIBLIOGRAPHY
Abbott, Susan, Full-Time Farmers and Week-End Wives: An Analysis of Altering Conjugal Roles,
Journal of Marriage and the Family, 38(1), February 1976
Abdullah, Mohammed, The Effect of Seasonality on Intrahousehold Food Distribution and
Nutrition in Bangladesh, In: David E. Sahn (ed.), Seasonal Variability in Third World Agriculture:
The consequences for food security, IFPRI, Johns Hopkins University Press, 1989
Adsera, Alicia, Marital fertility and religion in Spain, 1985 and 1999, Population Studies, 60(2),
July 2006
Agesa, Richard U., One family, two households: Rural to urban migration in Kenya, Review of
Economics of the Household, 2(2), June 2004
Akerlof, George A., J.L. Yellen and M.L. Katz, An analysis of out-of-wedlock childbearing in the
United States, Quarterly Journal of Economics, 111(2), May 1996
Alderman, Harold, Pierre-Andre Chiappori, Lawrence Haddad, John Hoddinott, and Ravi Kanbur,
Unitary Versus Collective Models of the Household: Is it time to shift the burden of proof? World
Bank Research Observer, 10(1), February 1995
Allal, N., R. Sear, A.M. Prentice, and R. Mace, An evolutionary model of stature, age at first birth
and reproductive success in Gambian women, Proceedings of the Royal Society: Biological
Sciences, 2004
Aloo-Obunga, Colette, Country Analysis of Family Planning and HIV/AIDS: Kenya, POLICY
Project, March 2003
Amuyunzu-Nyamongo, Mary, and Negussie Taffa, The triad of poverty, environment and child
health in Nairobi informal settlements, Working Paper No. 9, African Population and Health
Research Center, 2003; published in: Journal of Health and Population in Developing Countries, 8
January 2004
Andreoni, James, and Arik Levinson, The Simple Analytics of the Environmental Kuznets Curve,
Journal of Public Economics, 80(2), May 2001
Angrist, Joshua D., and William N. Evans, Children and their Parents Labour Supply: Evidence
from exogenous variation in family size, American Economic Review, 88(3), June 1998
Anson, Jon, Religion, Nationalism and Demography: False consciousness, real consequences,
Department of Social Work, Ben Gurion University of the Negev, Israel, 2006
Antecol, Heather, Kelly Bedard, and Eric Helland, Does Single Parenthood Increase the
Probability of Teenage Promiscuity, Substance Use, and Crime? Journal of Population Economics,
20(1), February 2007

104

Ashenfelter, Orley, and Alan Krueger, Estimates of the Economic Return to Schooling from a New
Sample of Twins, American Economic Review, 84(5), December 1994
Ashenfelter, Orley, and David J. Zimmerman, Estimates of the Returns to Schooling from Sibling
Data: Fathers, sons, and brothers, The Review of Economics and Statistics, 79(1), February 1997
Askew, Ian, and Ndugga Baker Maggwa, Integration of STI Prevention and Management with
Family Planning and Antenatal Care in sub-Saharan Africa - What more do we need to know?
International Family Planning Perspectives, 28(2), June 2002
Auci, Sabrina, Leonardo Becchetti, and Luca Rando, Testing crucial model assumptions: The
income/willingness to pay for the environment nexus in the environmental Kuznets curve,
Departmental Working Paper 239, Tor Vergata University, September 2006
Bailey, Robert C., and Omar Egesah, Assessment of Clinical and Traditional Male Circumcision
Services in Bungoma District, Kenya: Complication rates and operational needs, Report for
USAID/PSI, April 2006
Bankole, Akinrinola, and Susheela Singh, Couples Fertility and Contraceptive decision-making in
Developing Countries: Hearing the mans voice, International Family Planning Perspectives, 24(1),
March 1998
Barber, W., A History of Economic Thought, Penguin Books, 1967
Barnett, Tony, and Alan Whiteside, AIDS in the 21st Century: Disease and Globalization, Palgrave
Macmillan, 2003
Barrientos, Armando, Mark Gorman, and Amanda Heslop, Old Age Poverty in Developing
Countries: Contributions and dependence in later life, World Development, 31(3), March 2003
Barro, Robert J., and Rachel M. McCleary, Religion and Economic Growth, Working Paper 9682,
National Bureau of Economic Research, May 2003
Batini, Nicoletta, Tim Callen, and Warwick McKibbin, The Global Impact of Demographic
Change, Research Department Working Paper 06/9, International Monetary Fund, January 2006
Bauni, Evasius K., and Ben Obonyo Jarabi, The Low Acceptability and Use of Condoms within
Marriage: Evidence from Nakuru district, Kenya, African Population Studies, 18(1), April 2003
Bawah, Ayaga A., James F. Phillips, Martin Adjuik, Maya Vaughan-Smith, Bruce MacLeod, and
Fred N. Binka, The Impact of Immunization on the Association between Poverty and Child
Survival: Evidence from Kassena-Nankana District of Northern Ghana, Population Council, New
York, 2006
Becker, Garry S., Nobel Lecture: The Economic Way of Looking at Behavior, Journal of Political
Economy, 101(3), June 1993
Becker, Garry S., A Treatise on the Family: Enlarged Edition (Chapters 5: The Demand for
Children; and 8: Altruism in the Family), Harvard University Press, 1991

105

Becker, Gary S., Altruism in the Family and Selfishness in the Market Place, Economica, 48(189),
February 1981
Becker, Gary S., Altruism, egoism, and genetic fitness: Economics and Sociobiology, Journal of
Economic Literature, 14(3), September 1976
Becker, Gary, A Theory of Social Interactions, Journal of Political Economy, 82(6), December
1974
Becker, Gary S., An economic analysis of fertility, In: Demographic and Economic Change in
Developed Countries, Princeton University Press, 1960
Beegle, Kathleen, Labour Effects of Adult Mortality in Tanzanian Households, Economic
Development and Cultural Change, 53(3), April 2005
Beegle, Kathleen, and Sofya Krutikova, Adult Mortality and Childrens Transition into Marriage,
Demographic Research, Volume 19, Article 42, 2 September 2008
Beegle, Kathleen, Joachim de Weerdt, and Stefan Dercon, Adult Mortality and Consumption
Growth in the Age of HIV/AIDS, Economic Development and Cultural Change, 56(2), January
2008
Beegle, Kathleen, Joachim de Weerdt, and Stefan Dercon, Orphanhood and the Long-Run Impact
on Children, American Journal of Agricultural Economics, 88(5), December 2006
Behrman, Jere R., and J.C. Knowles, Population and Reproductive Health: An Economic
Framework for Policy Evaluation, Population and Development Review, 24(4), December 1998
Behrman, Jere R., Hans-Peter Kohler, and Susan Cotts Watkins, Social Networks and Changes in
Contraceptive Use over Time: Evidence from a longitudinal study in rural Kenya, Demography,
39(4), November 2002
Behrman, Jere R., and Mark R. Rosenzweig, Does Increased Women Schooling Raise the Schooling
of the Next Generation, American Economic Review, 92(1), March 2002
Behrman, Jere R., M.R. Rosenzweig, and Paul Taubman, Endowments and the Allocation of
Schooling in the Family and in the Marriage Market: The twin experiment, Journal of Political
Economy, 102(6), December 1994
Bell, Clive, Ramona Bruhns, and Hans Gersbach, Economic Growth, Education, and AIDS in
Kenya: A long-run analysis, Policy Research Working Paper 4025, World Bank, October 2006
Benefo, Kofi D., The Community-level Effects of Womens Education on Reproductive Behaviour
in Rural Ghana, Demographic Research, Volume 14, Article 20, 2 June 2006
Berghammer, Caroline, and Dimiter Philipov, Religion and Fertility Ideals, Intentions and
Behavior: A Comparative Study of European Countries, in: Vienna Yearbook of Population
Research, Vienna Institute of Demography, 2007

106

Bergstrom, Theodore C., A survey of Theories of the Family, In: M.R. Rosenzweig and Oded Stark
(eds.), Handbook of Population and Family Economics, Elsevier, 1997
Bergstrom, Theodore C., Economics in a Family Way, Journal of Economic Literature, 34(4),
December 1996
Berman, Eli, Laurence R. Iannaccone, and Giuseppe Ragusa, From Empty Pews to Empty Cradles:
Fertility decline among European Catholics, October 2004
Bethke, Lynne, and Gary Sandefur, Disruptive Events during the High School Years and
Educational Attainment, Discussion Paper No. 1168-98, Institute for Research on Poverty, August
1998
Bhattacharya, Haimanti, and Robert Innes, An Empirical Exploration of the PopulationEnvironment Nexus in India, American Journal of Agricultural Economics, 90(4), November 2008
Bianchi, Suzanne M., and Lynne M. Casper, 2000, American Families, Population Bulletin, 55(4),
December 2000
Billari, Francesco C., Alexia Prskawetz, Belinda Aparicio Diaz, and Thomas Fent, The WeddingRing: An agent-based marriage model based on social interaction, Demographic Research, Volume
17, Article 3, 3 August 2007
Bilsborrow, Richard E., Rural poverty, migration, and the environment in developing countries:
Three case studies, Policy Research Working Paper 1017, World Bank, November 1992
Bjrklund, Anders, Donna K. Ginther, and Marianne Sundstrm, Family Structure and Child
Outcomes in the United States and Sweden, Discussion Paper No. 1259, Institute for the Study of
Labour (IZA), August 2004
Blackden, C. Mark, and Quentin Wodon (eds.), Gender, Time Use, and Poverty in sub-Saharan
Africa, Working Paper No. 73, World Bank, January 2006
Blacker, John, Kenyas Fertility Transition: How low will it go? Centre for Population Studies,
London, 2002
Blacker, John, and Basia Zaba, HIV Prevalence and Lifetime Risk of Dying of AIDS, Health
Transition Review, Supplement 2 to Volume 7, 1997
Blaker, Kimberly (ed.), The Fundamentals of Extremism: The Christian Right in America, New
Boston Books, Inc., Michigan, 2003
Bloom, David E., and David Canning, The Health and Wealth of Africa, World Economics, 5(2),
April-June 2004
Bloom, David E., and David Canning, Contraception and the Celtic Tiger, Economic and Social
Review, 34(3), Winter 2003

107

Bloom, David E., David Canning, and Jaypee Sevilla, Economic Growth and the Demographic
Transition, Working Paper 8685, National Bureau of Economic Research, December 2001
Bloom, David E., Jeffrey D. Sachs, Geography, Demography and Economic Growth in Africa,
Brookings Papers on Economic Activity, 29(2), 1998
Blume, Michael, Carsten Ramsel, and Sven Graupner, Religiosity as a Demographic Factor - An
underestimated connection? Marburg Journal of Religion, 11(1), June 2006
Bock, John, Evolutionary approaches to population: Implications for research and policy,
Population and Environment: A Journal of Interdisciplinary Studies, 21(2), November 1999
Bogecho, Dina, and Melissa Upreti, The Global Gag Rule An Antithesis to the Rights-Based
Approach to Health, Health and Human Rights, 9(1), June 2006 [http://www.hhrjournal.org/wpcontent/uploads/sites/13/2013/07/4-Bogecho1.pdf]
Bongaarts, John, Late Marriage and the HIV Epidemic in sub-Saharan Africa, Population Studies,
61(1), March 2007
Bongaarts, John, The Causes of Stalling Fertility Transitions, Studies in Family Planning, 37(1),
March 2006
Booth, Alison, and Hiau Joo Kee, Birth Order Matters: The Effect of Family Size and Birth Order
on Educational Attainment, Journal of Population Economics, 22(2), April 2009
Borgerhoff-Mulder, Monique, Optimizing offspring: The quantity-quality tradeoff in agropastoral
Kipsigis, Evolution and Human Behaviour, 21(6), November 2000
Borgerhoff-Mulder, Monique, The demographic transition: Are we any closer to an evolutionary
explanation? TREE, 13(7), July 1998
Borgerhoff-Mulder, Monique, Kipsigis womens preferences for wealthy men: Evidence for female
choice in mammals? Behavioural Ecology and Sociobiology, 27(4), October 1990
Borgerhoff-Mulder, Monique, Margaret George-Cramer, Jason Eshleman, and Alessia Ortolani, A
study of East African kinship and marriage using a phylogenetically based comparative method,
American Anthropologist, 103(4), December 2001
Borghesi, Simone, The Environmental Kuznets Curve: A survey of the literature, FEEM Working
Paper 85-99, 1999
Borooah, Vani, and Sriya Iyer, Religion and Fertility in India: The role of son preference and
daughter aversion, Economics Working Paper No. 0436, University of Cambridge, July 2004
Boserup, Ester, The impact of Scarcity and Plenty on Development, Journal of Interdisciplinary
History, 14(2), Autumn 1983
Boserup, Ester, Population and Technological Change: A study of long term trends, University of
Chicago Press, 1981

108

Boserup, Ester, The Conditions of Agricultural Growth: The economics of agrarian change under
population pressure, Aldine, New York, 1965
Bradford, David F., Rebecca Schlieckert, Stephen H. Shore, and Martin Wagner, The
Environmental Kuznets Curve: Exploring a fresh specification, Contributions to Economic
Analysis and Policy, Berkeley Electronic Press, 4(1), 2005
Braas-Garza, Pablo, and Shoshana Neuman, Parental Religiosity and Daughters Fertility: The case
of Catholics in southern Europe, Review of Economics of the Household, 5(3), September 2007
Breierova, Lucia, and Esther Duflo, The Impact of Education on Fertility and Child Mortality: Do
fathers really matter less than mothers? Working Paper No. 10513, National Bureau of Economic
Research, May 2004
Brewster, Karin L., and R.R. Rindfuss, Fertility and Womens Employment in Industrialized
Nations, Annual Review of Sociology, 26, 2000
Brierley, Benjamin, Home Memories, and Recollections of a Life, Manchester, Abel Heywood &
Son, Manchester, 1886
Butcher, Kristin F., and Anne Case, The Effect of Sibling Composition on Womens Education and
Earnings, Quarterly Journal of Economics, 109(3), August 1994
Cain, Mead, The Economic Activities of Children in a Village in Bangladesh, Population and
Development Review, 3(3), September 1977
Caldwell, John C., Rethinking the African AIDS Pandemic, Population and Development Review,
26(1), March 2000
Caldwell, John C., The Soft Underbelly of Development: Demographic Transition in Conditions of
Limited Economic Change, in: Proceedings of the World Bank Annual Conference on
Development Economics 1990, World Bank, Washington, D.C., 1991
Caldwell, John C., Toward a restatement of Demographic Transition Theory, Population and
Development Review, 2(3/4), September-December 1976
Caldwell, John C., and Pat Caldwell, Limiting Population Growth and the Ford Foundation
Contribution, Ford Foundation, Frances Pinter (publishers), 1986
Campbell, A., The role of Family Planning in the Reduction of Poverty, Journal of Marriage and
the Family, 30(2), May 1968
Canning, David, The Economics of HIV/AIDS in Low-Income Countries: The case for prevention,
Journal of Economic Perspectives, 20(3), Summer 2006
Carr, David L., and William Pan, Fertility Determinants on the Frontier: Longitudinal evidence
from the Ecuadorian Amazon, Association of American Geographers Annual Meeting, Los Angles,
March 2002

109

Carr, David L., William K.Y. Pan, and Richard E. Bilsborrow, Declining Fertility on the Frontier:
The Ecuadorian Amazon, Population and Environment, 28(1), September 2006
Casale, Marisa, and Alan Whiteside, The Impact of HIV/AIDS on Poverty, Inequality and
Economic Growth, Working Papers on Globalization, Growth and Poverty, Paper Number 3,
International Development Research Centre (IDRC), March 2006
Case, Anne, I-Fen Lin, and Sara McLanahan, Educational Attainment in Blended Families,
Working Paper 7874, National Bureau of Economic Research, September 2000
Case, Anne, and Christina Paxson, Stature and Status: Height, ability, and labour market
outcomes, Journal of Political Economy, 116(3), June 2008
Case, Anne, Christina Paxson, and Joseph Ableidinger, Orphans in Africa: Parental death, poverty
and school enrolment, Demography, 41(3), August 2004
Cavendish, William, Empirical Regularities in the Poverty-Environment Relationship of African
Rural Households: Evidence from Zimbabwe, World Development, 28(11), November 2000
Cavendish, William, Poverty, Inequality and Environmental Resources: Quantitative analysis of
rural households, Working Paper 99-9, Centre for the Study of African Economies, February 1999
Central Bureau of Statistics, Ministry of Health, and ORC Macro, Kenya Demographic and Health
Survey 2003, [2004]
Centre for Health and Social Policy, Religion and Sexual and Reproductive Health and Rights: An
inventory of organizations, scholars, and foundations, A report prepared for John D. and Catherine
T. MacArthur Foundation and the Ford Foundation, January 2005
Centre for Reproductive Rights, Breaking the Silence: The Global Gag Rules Impact on Unsafe
Abortion, New York, 2003
Cheluget, B., G. Baltazar, P. Orege, M. Ibrahim, L.H. Marum, and J. Stover, Evidence for
Population Level Declines in Adult HIV Prevalence in Kenya, Sexually Transmitted Infections,
82(1), April 2006
Chimbwete, Chiweni, Eliya Zulu, and Susan Cotts Watkins, The Evolution of Population Policies
in Kenya and Malawi, Population Research and Policy Review, 24(1), January 2005
Choe, Minja Kim, Shyam Thapa, and Vinod Mishra, Early Marriage and Early Motherhood in
Nepal, Journal of Biosocial Science, 37(2), March 2005
Choi, Ji-Yeob, Kyoung-Mu Lee, Sue Kyung Park, Dong-Young Noh, Sei-Hyun Ahn, Keun-Young
Yoo, and Daehee Kang, Association of paternal age at birth and the risk of breast cancer in
offspring: A case control study, BMC Cancer, October 2005
Cincotta, Richard P., Robert Engelman, and Danielle Anastasion, The Security Demographic:
Population and Civil Conflict after the Cold War, Population Action International, 2003

110

Clark, Mari H., Woman-Headed Households and Poverty: Insights from Kenya, Signs, 10(2),
Winter 1984
Cleland, John, Potatoes and pills: An overview of innovation-diffusion contributions to
explanations of fertility decline, in: John B. Casterline (ed.), Diffusion Processes and Fertility
Transition: Selected Perspectives, National Academy Press, Washington, D.C., 2001
Cleland, John, Stan Bernstein, Alex Ezeh, Anibal Faundes, Anna Glasier, and Jolene Innis, Family
planning: The unfinished agenda, The Lancet, 368(9549), 18 November 2006
Coale, Ansley J., and Edgar M. Hoover, Population Growth and Economic Development in LowIncome Countries, Princeton University Press, 1958
Comanor, William S., and Llad Phillips, The Impact of Income and Family Structure on
Delinquency, Journal of Applied Economics, 5(2), November 2002
Conley, Dalton, Gordon C. McCord, and Jeffrey D. Sachs, Africas Lagging Demographic
Transition: Evidence from exogenous impacts of malaria ecology and agricultural technology,
Working Paper 12892, National Bureau of Economic Research, February 2007
Corden, W. Max, Booming Sector and Dutch Disease Economics: Survey and Consolidation,
Oxford Economic Papers, 36(3), November 1984
Corden, W. Max, and J. Peter Neary, Booming Sector and De-industrialisation in a Small Open
Economy, Economic Journal, 92(368), December 1982
Costa, Dora L., From Mill Town to Board Room: The Rise of Womens Paid Labour, Journal of
Economic Perspectives, 14(4), Fall 2000
Costantini, Valeria, and Salvatore Monni, Environment, Human Development and Economic
Growth, Ecological Economics, 64(4), February 2008
Crenshaw, Edward M., Matthew Christenson, and Doyle Ray Oakey, Demographic Transition in
Ecological Focus, American Sociological Review, 65(3), June 2000
Currais, Luis, From the Malthusian Regime to the Demographic Transition: Contemporary
research and beyond, Economica, 2(3), June 2000
Dahl, Gordon B., and Enrico Moretti, The Demand for Sons: Evidence from divorce, fertility, and
shotgun marriage, Review of Economic Studies, 75(4), October 2008
Daily, G.C. (ed.), Natures Services: Societal dependence on natural ecosystems, Island Press,
Washington, D.C., 1997
Dasgupta, Partha, Population, Poverty, and the Natural Environment, in: K.G. Mler and J.R.
Vincent (eds.), Handbook of Environmental Economics, Volume 1, Elsevier Science, 2003

111

Dasgupta, Partha, Population and Resources: An Exploration of Reproductive and Environmental


Externalities, Population and Development Review, 26(4), December 2000
Dasgupta, Partha, The Population Problem: Theory and Evidence, Journal of Economic
Literature, 33(4), December 1995
Dasgupta, Partha, and Karl-Gran Mler, Environmental and resource economics: Some recent
developments, Discussion Paper 186, Beijer International Institute of Ecological Economics,
Stockholm, July 2004
Dasgupta, Partha, and Karl-Gran Mler, The Environment and Emerging Development Issues,
in: Proceedings of the World Bank Annual Conference on Development Economics 1990, World
Bank, Washington, D.C., 1991
Dasgupta, Susmita, Benoit Laplante, Hua Wang, and David Wheeler, Confronting the
Environmental Kuznets Curve, Journal of Economic Perspectives, 16(1), Winter 2002
Davis, Kingsley, and Judith Blake, Social structure and fertility: An analytic framework,
Economic Development and Cultural Change, 4(3), April 1956
de la Croix, David, and Matthias Doepke, Inequality and Growth: Why differential fertility
matters, American Economic Review, 93(4), September 2003
de Sherbinin, Alexander, Leah VanWey, Kendra McSweeney, Rimjhim Aggarwal, Alisson Barbieri,
Sabina Henry, Lori Hunter, Wayne Twine, and Robert Walker, Rural Household MicroDemographics, Livelihoods and the Environment, Global Environmental Change, 18(1), February
2008
de Waal, Alex, and Alan Whiteside, New Variant Famine: AIDS and Food Crisis in Southern
Africa, The Lancet, 362(9391), 11 October 2003
de Walque, Damien, Discordant couples: HIV infection among couples in Burkina Faso,
Cameroon, Ghana, Kenya, and Tanzania, Policy Research Working Paper 3956, World Bank, June
2006a
de Walque, Damien, Who Gets AIDS and How? The determinants of HIV infection and sexual
behaviors in Burkina Faso, Cameroon, Ghana, Kenya and Tanzania, Policy Research Working
Paper 3844, World Bank, February 2006b
Deacon, Robert T., and Catherine S. Norman, Is the environmental Kuznets curve an empirical
regularity? In: Robert Halvorsen and David F. Layton (eds.), Explorations in Environmental and
Natural Resource Economics, Edward Elgar Publishing, 2006
Department for International Development (DFID), European Commission (EC), United Nations
Development Programme (UNDP) and World Bank, Linking Poverty Reduction and
Environmental Management: Policy Challenges and Opportunities, July 2002
DeRose, Laurie F., and Alex C. Ezeh, Decision-Making Patterns and Contraceptive Use: Evidence
from Uganda, presented at the Population Association of America annual meeting, 2007

112

DeRose, Laurie F., F. Nii-Amoo Dodoo, Alex C. Ezeh, and Tom O. Owuor, Does Discussion of
Family Planning Improve Knowledge of Partners Attitude toward Contraceptives? International
Family Planning Perspectives, 30(2), June 2004
Devarajan, Shantayanan, and Anthony C. Fisher, Hotellings Economics of Exhaustible Resources:
Fifty Years Later, Journal of Economic Literature, 19(1), March 1981
Diamond, Peter, National debt in a neoclassical growth model, American Economic Review,
55(5), December 1965
Doepke, Matthias, Accounting for Fertility Decline during the Transition to Growth, Journal of
Economic Growth, 9(3), September 2004
Donovan, Cynthia, Linda Bailey, Edson Mpyisi, and Michael Weber, Prime-Age Adult Morbidity
and Mortality in Rural Rwanda: Which households are affected and what are their strategies for
adjustment, proceedings of the 25th International Conference of Agricultural Economists, 16-22
August 2003
Ducker, Clare Louise, Population Policy Position Paper: The Kenyan fertility decline, 23rd
September 2006
Duflo, Esther, Pascaline Dupas, Michael Kremer, and Samuel Sinei, Education and HIV/AIDS
Prevention: Evidence from a randomized evaluation in Western Kenya, Policy Research Working
Paper 4024, World Bank, October 2006
Eastwood, Robert, and Michael Lipton, Demographic Transition and Poverty: Effects via economic
growth, distribution and conversion, in: Nancy Birdsall, Allen C. Kelley and Steven W. Sinding
(eds.), Population does matter: Demographic change, economic growth, and poverty in the
developing world, Oxford University Press, 2001
Eastwood, Robert, and Michael Lipton, Impact of Changes in Human Fertility on Poverty, Journal
of Development Studies, 36(1), October 1999
Eberstadt, Nicholas, P. T. Bauer on the Population Question, Cato Journal, 25(3), September 2005
Edmonds, Eric V., Understanding Sibling Differences in Child Labour, Journal of Population
Economics, 19(4), October 2006
Ejrns, Mette, and Claus C. Portner, Birth Order and the Intrahousehold Allocation of Time and
Education, Review of Economics and Statistics, 86(4), November 2004
Erulkar, Annabel S., The Experience of Sexual Coercion among Young People in Kenya,
International Family Planning Perspectives, 30(4), December 2004
Erulkar, Annabel S., Charles J. Onoka, and Alford Phiri, What is Youth-Friendly? Adolescents
preferences for reproductive health services in Kenya and Zimbabwe, African Journal of
Reproductive Health, 9(3), December 2005

113

Evans, David, and Edward Miguel, Orphans and Schooling in Africa: A longitudinal analysis,
Demography, 44(1), February 2007
Family Health International (FHI), Country Assessment: Kenya Family Planning Needs in the
Context of the HIV/AIDS Epidemic, October 2004
Filmer, Deon, and Lant Pritchett, Environmental Degradation and the Demand for Children:
Searching for the vicious circle, Policy Research Working Paper 1623, World Bank, June 1997
Flynn, Patricia, Peter Havens, Michael Brady, Patricia Emmanuel, Jennifer Read, Laura Hoyt, Lisa
Henry-Reid, Russell Van Dyke, and Lynne Mofenson, Male Circumcision for Prevention of HIV
and other Sexually Transmitted Diseases, Pediatrics, 119(4), April 2007
Frankel, Jeffrey A., The Environment and Globalization, Working Paper 10090, National Bureau
of Economic Research, November 2003
Franz, Jennifer, and Felix FitzRoy, Child Mortality, Poverty and Environment in Developing
Countries, Discussion Paper 0518, Department of Economics, University of St. Andrews, January
2006
Galor, Oded, The Demographic Transition and the Emergence of Sustained Economic Growth,
Journal of the European Economic Association, 3(2-3), April-May 2005
Galor, Oded, and David N. Weil, The Gender Gap, Fertility, and Growth, American Economic
Review, 86(3), June 1996
Garg, Ashish, and Jonathan Morduch, Sibling Rivalry and the Gender Gap: Evidence from child
health outcomes in Ghana, Journal of Population Economics, 11(4), December 1998
Gasman, N., M.M. Blandon, and B.B. Crane, Abortion, Social Inequity, and Womens Health:
Obstetrician-gynecologists as agents of change, International Journal of Gynecology and
Obstetrics, 94(3), 13 July 2006
Geronimus, A.T., and S. Korenman, 1992, The Socioeconomic Consequences of Teen Childbearing
Reconsidered, Quarterly Journal of Economics, 107(4), November 1992
Gertler, Paul J., and John W. Molyneaux, How Economic Development and Family Planning
Programs combined to reduce Indonesian Fertility, Demography, 31(1), February 1994
Ghimire, Dirgha J., and Paul Mohai, Environmentalism and Contraceptive Use: How people in less
developed settings approach environmental issues, Population and Environment, 27(1), September
2005
Ghuman, Sharon, and Mary Beth Ofstedal, Gender and Family Support for Older Adults in
Bangladesh, Research Report No. 04-563, Population Studies Centre at the Institute for Social
Research, University of Michigan, August 2004
Gibbs, Andrew, New Variant Famine: Reassessing its validity, MSc dissertation, London School of
Economics, 2006

114

Ginther, Donna K., and Robert A. Pollak, Family Structure and Childrens Educational Outcomes:
Blended families, stylized facts, and descriptive regressions, Demography, 41(4), November 2004
Goldin, Claudia, and Lawrence F. Katz, The Power of the Pill: Oral contraceptives and womens
career and marriage decisions, Journal of Political Economy, 110(4), August 2002
Gowin, E.B., The Executive and His Control of Men: A study in personal efficiency, The Macmillan
Company, New York, 1915
Greene, Margaret E., Manisha Mehta, Julie Pulerwitz, Deirdre Wulf, Akinrinola Bankole, and
Susheela Singh, Involving Men in Reproductive Health: Contributions to Development,
Background paper to the report: Public Choices, Private Decisions: Sexual and Reproductive Health
and the Millennium Development Goals, UN Millennium Project, 2004
Greene, Margaret E., and Thomas Merrick, Poverty Reduction: Does reproductive health matter?
Health, Nutrition and Population (HNP) Discussion Paper, World Bank, July 2005
Grimes, David A., Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E.
Okonofua, and Iqbal H. Shah, Unsafe Abortion: The preventable pandemic, The Lancet,
368(9550), 25 November 2006
Grossman, Gene M., and Alan B. Krueger, Economic Growth and the Environment, Quarterly
Journal of Economics, 110(2), May 1995
Guengant, Jean-Pierre, and John F. May, Impact of the proximate determinants on the future
course of fertility in sub-Saharan Africa, In: The Future of High Fertility, Population Bulletin of
the United Nations, Special Issue Nos. 46/47, 2002
Guengant, Jean-Pierre, and John F. May, Revisiting the African Fertility Exception, Presented at
the 2001 Annual Meeting of the Population Association of America, March 29-31, 2001
Gustafsson, Siv, Optimal age at Motherhood: Theoretical and empirical considerations on
postponement of maternity in Europe, Journal of Population Economics, 14(2), June 2001
Gylfason, Thorvaldur, Natural resources, education, and economic development, European
Economic Review, 45(4-6), May 2001
Halperin, Daniel T., and Helen Epstein, Why is HIV Prevalence so Severe in Southern Africa? The
role of multiple concurrent partnerships and lack of male circumcision implications for AIDS
prevention, Southern African Journal of HIV Medicine, March 2007
Hammel, E.A., Chayanov revisited: A Model for the Economics of Complex Kin Units, PNAS,
102(19), March 2005
Hankins, Catherine, Male Circumcision: Implications for women as sexual partners and parents,
Reproductive Health Matters, 15(29), May 2007

115

Harbaugh, William, Arik Levinson, and David Wilson, Reexamining the Empirical Evidence for
an Environmental Kuznets Curve, Review of Economics and Statistics, 84(3), August 2002
Hardy, Thomas, Jude the Obscure, Harmondsworth, Penguin Popular Classics, 1998 [first published
1895]
Harris, Bernard, Commentary: The child is the father of the man. The relationship between child
health and adult mortality in the 19th and 20th centuries, International Journal of Epidemiology,
30(4), August 2001
Heiland, Frank, and Shirley H. Liu, Family Structure and Wellbeing of out-of-wedlock Children:
The significance of the biological parents relationship, Demographic Research, Volume 15, Article
4, 6 September 2006
Heineck, Guido, The Relationship between Religion and Fertility: Evidence for Austria,
University of Erlangen-Nuremberg, 2006
Henrich, Joseph, Robert Boyd, Samuel Bowles, Colin Camerer, Ernt Fehr, Hebert Gintis, and
Richard McElreath, In search of Homo Economicus: Behavioural experiments in 15 small-scale
societies, American Economic Review, 91(2), May 2001
Hermalin, Albert I., and Li-Shou Yang, Levels of Support from Children in Taiwan: Expectations
versus Reality, 196599, Population and Development Review, 30(3), September 2004
Hildyard, Nicholas, Scarcity as Political Strategy: Reflections on Three Hanging Children, paper
presented at Scarcity and the Politics of Allocation workshop held at Institute of Development
Studies, University of Brighton, UK, 6-7 June 2005
Hodgson, Dennis, and Susan Cotts Watkins, Feminists and Neo-Malthusians: Past and present
alliances, Population and Development Review, 23(3), September 1997
Horrell, Sarah, and Jane Humphries, Womens Labour Force Participation and the Transition to
the Male-breadwinner Family, 1790-1865, The Economic History Review, 48(1), February 2005
Hotelling, Harold, The Economics of Exhaustible Resources, Journal of Political Economy, 39(2),
April 1931
Hotz, Joseph, Jacob Alex Klerman, and Robert J. Willis, The Economics of Fertility in Developed
Countries, in: M.R. Rosenzweig and Oded Stark (eds.), Handbook of Population and Family
Economics, Elsevier, 1997
Hotz, V. Joseph, Susan Williams McElroy, and Seth G. Sanders, Consequences of Teen
Childbearing for Mothers, in: Saul D. Hofman and Rebecca A. Maynard (eds.), Kids having Kids:
Economic costs and social consequences of teen pregnancy, The Urban Institute Press, 2008
Howe, Charles W., Natural Resource Economics: Issues, analysis and policy, John Wiley & Sons,
New York, 1978

116

Humphries, Jane, Childhood and Child Labour in the British Industrial Revolution, Cambridge
University Press, 2010
Humphries, Jane, Because They are too Menny Children, Mothers, and Fertility Decline: The
evidence from working-class autobiographies of the eighteenth and nineteenth centuries,
Discussion Papers in Economic and Social History, Number 64, University of Oxford, September
2006
Humphries, Jane, Lurking in the Wings...: Women in the Historiography of the Industrial
Revolution, Business and Economic History, 20, November 1991
Hunter, Lori M., Understanding How HIV/AIDS, Agricultural Systems, and Food Security Are
Linked, Population Reference Bureau, April 2007
Hunter, Lori M., The Environmental Implications of Population Dynamics, Rand Corporation,
2001
Hunter, Lori M., and Wayne Twine, HIV/AIDS Mortality and Household Use of Natural
Resources: Critical linkages and remaining questions, Panel Contribution to the Population
Environment Research Networks Cyberseminar on Household Micro-Demographics, Livelihoods
and the Environment, April 2006
Hunter, Lori M., Wayne Twine, and Laura Patterson, Locusts are Now Our Beef: Adult mortality
and household dietary use of local environmental resources in rural South Africa, Scandinavian
Journal of Public Health, 35(3), August 2007
Hurd, Michael D., Research on the Elderly: Economic status, retirement, and consumption and
saving, Journal of Economic Literature, 28(2), June 1990
Ikamari, Lawrence D.E., The Effect of Education on the Timing of Marriage in Kenya,
Demographic Research, Volume 12, Article 1, 23 February 2005
Intermediate Technology Development Group Eastern Africa, Impact of HIV/AIDS among
Pastoral Communities in Kenya, for Futures Group Europe, January 2005
Issa, Haitham, Human capital, demographic transition and economic growth, Journal of
Economic Development, 30(2), December 2005
Iyer, Sriya, Understanding Religion and the Economics of Fertility in India, Occasional Paper 2,
Centre of South Asia Studies, Cambridge, 2002
Jasienska, G., and P.T. Ellison, Physical work causes suppression of ovarian function in women,
Proceedings: Biological Sciences, 265(1408), Royal Society, London, October 1998
Jones, Larry E., and Michele Tertilt, An Economic History of the Relationship between
Occupation and Fertility in the US: 1826-1960, Working Paper 12796, National Bureau of
Economic Research, December 2006

117

Joshi, Shareen, Female Household-Headship in Rural Bangladesh: Incidence, determinants and


impact on childrens schooling, Discussion Paper 894, Economic Growth Center, Yale University,
September 2004
Kabubo-Mariara, Jane, Rural Poverty, Property Rights and Environmental Resource Management
in Kenya, Department of Economics, University of Nairobi, May 2002
Kahuthu, A., Economic Growth and Environmental Degradation in a Global Context,
Environment, Development and Sustainability, 8(1), February 2006
Kalemli-Ozcan, Sebnem, AIDS, Reversal of the Demographic Transition and Economic
Development: Evidence from Africa, Working Paper No. 12181, National Bureau of Economic
Research, May 2006
Kamminga, Evelien, and Madeleen Wegelin Schuringa, HIV/AIDS and Water, Sanitation and
Hygiene: Thematic Overview Paper, Royal Tropical Institute KIT, 2005
Kaplan, Hillard S., and Jane B. Lancaster, An evolutionary and Ecological Analysis of Human
Fertility, Mating Patterns, and Parental Investment, In: K.W. Wachter and R.A. Bulato (eds.),
Offspring: Human fertility behavior in biodemographic perspective, National Academies Press,
2003
Kaplan, Hillard S., and Arthur J. Robson, The emergence of humans: The coevolution of
intelligence and longevity with intergenerational transfers, Proceedings of the National Academy
of Sciences of the United States of America, 99(15), July 2002
Karua, Martha (Hon.), Abortion under the Kenyan Law: Legal status of abortion and judicial
interpretation, Minister for Water Resources and Management, Kenya Government, 2004
Kasarda, John D., How female education reduces fertility: Models and needed research, MidAmerican
Review
of
Sociology,
4(1),
1979
[http://kuscholarworks.ku.edu/dspace/bitstream/1808/6082/3/MARSV4N1A1.pdf ]
Kaufman, Carol E., and Stavros E. Stavrou, Bus fare, please: The economics of sex and gifts among
adolescents in urban South Africa, Policy Research Division Working Paper 166, Population
Council, New York, 2002
Kaufman, Carol E., Thea de Wet, and Jonathan Stadler, Adolescent Pregnancy and Parenthood in
South Africa, Studies in Family Planning, 32(2), June 2001
Kelley, Allen C., Economic consequences of population change in the Third World, Journal of
Economic Literature, 26(4), December 1988
Kenya, Kenya Vision 2030: A Globally Competitive and Prosperous Kenya, 2008
Kenya, Ministry of Health, Division of Reproductive Health and UNFPA, Kenya: Needs Assessment
of Obstetric Fistula in Kenya, February 2004

118

Kenya, The Impact of HIV/AIDS on Education in Kenya, and the Potential for Using Education in
the Widest Sense for the Prevention and Control of HIV/AIDS, Government of Kenya and
UNICEF-Kenya Country Office, November 2000
Kim, Jungho, Henriette Engelhardt, Alexia Prskawetz, and Arnstein Aassve, Does Fertility
Decrease the Welfare of Households? An analysis of poverty dynamics and fertility in Indonesia,
Working Paper 06/2005, Vienna Institute of Demography, Austrian Academy of Sciences, 2005
Krdar, Murat G., Meltem Dayoglu and Ayst Tansel, Impact of Sibship Size, Birth Order, and Sex
Composition on School Enrollment in Urban Turkey, MPRA Paper No. 2755, Middle East
Technical University, April 2007
Kleinhaus, K., M. Perrin, Y. Friedlander, O. Paltiel, D. Malaspina, and S. Harlap, Paternal Age and
Spontaneous Abortion, Obstetrics & Gynecology, 108(2), August 2006
Kocher, James, Rural Development, Income Distribution, and Fertility Decline, Population Council,
New York, 1973
Kohler, Hans-Peter, Learning in Social Networks and Contraceptive Choice, Demography, 34(3)
August 1997
Kohler, Hans-Peter, J. R. Behrman, and S. C. Watkins, The Density of Social Networks and
Fertility Decisions: Evidence from South Nyanza district, Kenya, Demography, 38(1), February
2001
Kohler, Hans-Peter, Jere R. Behrman, and Susan Cotts Watkins, Empirical Assessments of Social
Networks, Fertility and Family Planning Programs: Nonlinearities and their Implications,
Demographic Research, Volume 3, Article 7, 20 September 2000
Kohler, Hans-Peter, Francesco C. Billari, and Jos Antonio Ortega, The Emergence of Lowest-Low
Fertility in Europe during the 1990s, Population and Development Review, 28(4), December 2002
Kolm, Serge-Christophe, and Jean Mercier Ythier (eds.), Handbook of the Economics of Giving,
Altruism and Reciprocity, Volumes 1 and 2, Elsevier, 2006
Korenman, Sanders, and David Neumark, Does marriage really make men more productive?
Journal of Human Resources, 26(2), Spring 1991
Kramer, Karen L., Childrens Help and the Pace of Reproduction: Cooperative breeding in
humans, Evolutionary Anthropology, 14(6), November/December 2005
Kramer, Karen L., and James L. Boone, Why Intensive Agriculturalists Have Higher Fertility: A
household energy budget approach, Current Anthropology, 43(3), June 2002
Kramer, Karen L., and Garnett P. McMillan, The Effect of Labour-Saving Technology on
Longitudinal Fertility Changes, Current Anthropology, 47(1), February 2006
Kulkarni, P.M., and Manoj Alagarajan, Population Growth, Fertility, and Religion in India,
Economic and Political Weekly, January 29, 2005

119

Kuznets, Simon, Economic Growth and Income Inequality, American Economic Review, 45(1),
March 1955
Lachaud, Jean-Pierre, HIV Prevalence and Poverty in Africa: Micro- and macro-econometric
evidences applied to Burkina Faso, Journal of Health Economics, 26(3), November 2006
Ladakh, Veena Bhasin, and Shampa Nag, Population Dynamics, Problems and Prospects of High
Altitude Area, Chapter 2, Anthropologist, Special Issue No. 1, 2002
Laitner, John, Intergenerational and Interhousehold Economic Links, in: M.R. Rosenzweig and O.
Stark (eds.), Handbook of Population and Family Economics, Elsevier Science, 1997
Lambert, Sarah M., Puneet Masson, and Harry Fisch, The male biological clock, World Journal of
Urology, 24(6), November 2006
Lasee, Ashraf, and Stan Becker, Husband-wife Communication about Family Planning and
Contraceptive Use in Kenya, International Family Planning Perspectives, 23(1), March 1997
Lederman, Daniel, William F. Maloney (eds.), Natural Resources: Neither curse nor destiny,
Stanford University Press and World Bank, 2007
Lee, Ronald D., Externalities to Childbearing, in: Neil J. Smelser and Paul B. Baltes (eds.),
International Encyclopedia of the Social Sciences, Volume 3, Elsevier, 2001
Lee, Ronald D., The Formal Demography of Population Aging, Transfers, and the Economic Life
Cycle, in: L. Martin and S. Preston (eds.), The Demography of Aging, National Academy Press,
1994
Lee, Ronald D., and Karen L. Kramer, Childrens Economic Roles in the Maya Family Life Cycle:
Cain, Caldwell, and Chayanov Revisited, Population and Development Review, 28(3), September
2002
Lee, Ronald D., Sang-Hyop Lee, and Andrew Mason, Charting the Economic Life Cycle in: Alexia
Prskawetz, David E. Bloom and Wolfgang Lutz (eds.), Population Aging, Human Capital
Accumulation, and Productivity Growth, supplement to Population and Development Review,
volume 33, 2007
Lee, Ronald D., and Timothy Miller Population Growth, Externalities to Childbearing, and
Fertility Policy in Developing Countries, in: Proceedings of the World Bank Annual Conference
on Development Economics 1990, World Bank, Washington, D.C., 1991
Lee, Yean-Ju, William L. Parish, and Robert J. Willis, Sons, Daughters and Intergenerational
Support in Taiwan, American Journal of Sociology, 99(4), January 1994
Lehrer, Evelyn L., Religion as a Determinant of Economic and Demographic Behaviour in the
United States, Population and Development Review, 30(4), December 2004

120

Li, Hongbin, Junsen Zhang, and Yi Zhu, The Quantity-Quality Trade-off of Children in a
Developing Country: Identification Using Chinese twins, Demography, 45(1), February 2008
Lillard, Lee A., and Robert J. Willis, Motives for Intergenerational transfers: Evidence from
Malaysia, Demography, 34(1), February 1997
Lin, I-Fen, Noreen Goldman, Maxine Weinstein, Yu-Hsuan Lin, Tristan Gorrindo, and Teresa
Seeman, Gender Differences in Adult Childrens Support of Their Parents in Taiwan, Journal of
Marriage and Family, 65(1), February 2003
Lloyd, C.B. (ed.), Growing Up Global: The Changing Transitions to Adulthood in Developing
Countries, National Research Council, Washington, D.C., 2005
Lloyd, Cynthia B., Carol E. Kaufman, and Paul Hewett, The Spread of Primary Schooling in subSaharan Africa: Implications for fertility change, Population and Development Review, 26(3),
September 2000
Loefler, Imre, The Population Trap, British Medical Journal, 326(1), March 2003
Luke, Nancy, Confronting the Sugar Daddy Stereotype: Age and economic asymmetries and risky
sexual behaviour in urban Kenya, International Family Planning Perspectives, 31(1), March 2005
Luke, Nancy, Age and Economic Asymmetries in the Sexual Relationships of Adolescent Girls in
sub-Saharan Africa, Studies in Family Planning, 34(2), June 2003
Luke, Nancy, and Kathleen M. Kurz, Cross-generational and Transactional Sexual Relations in
sub-Saharan Africa: Prevalence of behaviour and implications for negotiating safer sexual
practices, International Center for Research on Women (ICRW), September 2002
Luke, Nancy, and Susan Cotts Watkins, Reactions of Developing Country Elites to International
Population Policy, Population and Development Review, 28(4), December 2002
Luker, Kristin, Dubious Conceptions: Politics of the Teenage Pregnancy Crisis, Harvard University
Press, 1996
Luker, Kristin, Dubious conceptions: The controversy over teen pregnancy, The American
Prospect, 5, Spring 1991
Lundberg, Shelley, and Robert A. Pollak, Bargaining and Distribution in Marriage, Journal of
Economic Perspectives, 10(4), Autumn 1996
Lundberg, Shelly, and Elaina Rose, The Effects of Sons and Daughters on Mens Labour Supply and
Wages, Review of Economics and Statistics, 84(2), May 2002
Maasoumi, Esfandiar, Daniel L. Millimet, and Dipanwita Sarkar, Who Benefits from Marriage?,
Oxford Bulletin of Economics and Statistics, 71(1), February 2009

121

Mace, Ruth, Nadine Allal, Rebecca Sear and Andrew Prentice, The Uptake of Modern
Contraception in a Gambian Community: The diffusion of an innovation over 25 years, in: J.C.K.
Wells et al (eds.), Social Information Transmission and Human Biology, 2006
Mace, Ruth, and Rebecca Sear, Are Humans Cooperative Breeders?, in: E. Voland, A. Chasiotis
and W. Schiefenhoevel (eds.), Grandmotherhood the Evolutionary Significance of the Second
Half of Female Life, Rutgers University Press, 2004
Mace, Ruth, and Rebecca Sear, Birth Interval and the Sex of Children in a Traditional African
Population: An evolutionary analysis, Journal of Biosocial Science, 29(4), November 1997
Mace, Ruth, and Rebecca Sear, Maternal Mortality in a Kenyan Pastoralist Population,
International Journal of Gynecology and Obstetrics, 54(2), 1996
MacKellar, F. Landis, The Predicament of Population Aging: A review essay, Population and
Development Review, 26(2), June 2000
Mackenzie, W.S., The Health of the School Child, Methuen & Co, London, 1906
Macunovich, Diane J., Fertility and the Easterlin Hypothesis: An assessment of the literature,
Journal of Population Economics, 11(1), March 1998
Madulu, Ndalahwa F., Assessment of Linkages between Population Dynamics and Environmental
Change in Tanzania, AJEAM-RAGEE, Volume 9, October 2004, Institute of Resource Assessment,
University of Dar es Salaam, Tanzania
Malthus, Thomas Robert, An Essay on the Principle of Population, J. Johnson, London, 1798
Manser, Marilyn, and Murray Brown, Marriage and Household Decision-Making: A Bargaining
Analysis, International Economic Review, 21(1), February 1980
Manski, Charles F., Gary D. Sandefur, Sara McLanahan, and Daniel Powers, Alternative Estimates
of the Effect of Family Structure During Adolescence on High School Graduation, Journal of the
American Statistical Association, 87(417), March 1992
Maralani, Vida, The Changing Relationship between Family Size and Educational Attainment over
the Course of Socioeconomic Development: Evidence from Indonesia, California Centre for
Population Research, May 2007
Marklund, Staffan Structures of Modern Poverty, Acta Sociologica, 33(2), 1990
Marshall, Kimball P., Female Participation in the Labor Force and Fertility: Cross-Sectional and
Longitudinal Perspectives, PhD thesis, University of Florida, 1975
Marston, Cicely, and John Cleland, The Effects of Contraception on Obstetric Outcomes,
Department of Reproductive Health and Research, World Health Organization, 2004
Mason, Andrew, Economic Demography, in: Michael Micklin and Dudley Poston (eds.),
Handbook on Population, Klewer Academic/Plenum Publishers (chapter 18), Springer, 2005

122

Mason, Andrew, and Sang-Hyop Lee, The Demographic Dividend and Poverty Reduction,
Seminar on the Relevance of Population Aspects for the Achievement of the Millennium
Development Goals, Population Division, Department of Economic and Social Affairs, United
Nations, New York, 17-19 November 2004
Mather, David, Cynthia Donovan, Michael Weber, Higino Marrule, and Albertina Alage,
Household Responses to Prime Age Adult Mortality in Rural Mozambique: Implications for
HIV/AIDS mitigation efforts and rural economic development policies, Michigan State University,
2004
Mbizvo, M.T., and M.T. Bassett, Reproductive Health and AIDS Prevention in sub-Saharan Africa:
The case for increased male participation, Health Policy and Planning, 11(1), March 1996
Mburugu, E., and E.M. Zulu, Trends and Correlates of Contraceptive use in Kenya: 1977-1993,
Working Paper No. 4, African Population Policy Research Center, 1998
McPeak, John G., and Cheryl R. Doss, Are Household Production Decisions Cooperative?
Evidence on pastoral migration and milk sales from northern Kenya, American Journal of
Agricultural Economics, 88(3), August 2006
Medeiros, Marcelo, and Joana Costa, Is There a Feminization of Poverty in Latin America? World
Development, 36(1), January 2008
Meekers, Dominique, and Anne-Emmanule Calvs, Main Girlfriends, Girlfriends, Marriage, and
Money: The social context of HIV risk behaviour in sub-Saharan Africa, Health Transition Review,
Supplement to Volume 7, 1997
Meeks, Thomas J., and Bun Song Lee, The Relationship of Fertility to Income and Wealth in Rural
Development, US Agency for International Development, Office of Rural Development and
Development Administration, June 1979
Merrick, Thomas W., Population and Poverty: New Views on an Old Controversy, International
Family Planning Perspectives, 28(1), March 2002
Meyerhoefer, Chad D., and David E. Sahn, The Relationship between Poverty and Maternal
Morbidity and Mortality in sub-Saharan Africa, Working Paper 213, Agency for Healthcare
Research and Quality, December 2006
Mikesell, R.F., Explaining the Resource Curse, with special reference to mineral-exporting
countries, Resources Policy, 23(4), December 1997
Mink, Stephen D., Poverty, Population, and the Environment, Discussion Paper 189, World
Bank, 1993
Mitchell, Ellen M.H., Carolyn Tucker Halpern, Eva Muthuuri Kamathi, and Shirley Owino, Social
Scripts and Stark Realities: Kenyan adolescents abortion discourse, Culture, Health & Sexuality,
8(6), November-December 2006

123

Montgomery, Mark R., The Place of the Urban Poor in the Cairo Programme of Action and the
Millennium Development Goals, Paper presented at the seminar on the Relevance of Population
Aspects for the Achievement of the Millennium Development Goals, Population Division,
Department of Economic and Social Affairs, United Nations, November 2004
Morgan, S. Philip, Characteristic Features of Modern American Fertility, Population and
Development Review, 22 (Supplement), June 1996
Morton, Susan M.B., Commentary: The child is the mother of the woman: Intergenerational
associations in maternal anthropometry, International Journal of Epidemiology, 33(6), October
2004 [http://ije.oxfordjournals.org/content/33/6/1249.full.pdf+html]
Moseley, Tolly, An Emancipated, Intellectualized Bundle of Nerves: New Woman Identity and
Hysteria in Nineteenth Century England, Brown Working Papers in Arts and Sciences,
Southwestern University, 2005
Muhwava, William, Patterns of Contraceptive Use at the Edge of Fertility Transition in
Zimbabwe, African Population Studies, 18(1), April/May 2003
Mukui, John T., Kenya: Poverty Profiles, 1982-92, Consultant Report Prepared for the World Bank
and Ministry of Planning and National Development, Nairobi, Kenya, 1994
Munguti, Nzoya, Moses Mokua, Rick Homan, and Harriet Birungi, Cost Analysis of Reproductive
Health Services in PCEA Chogoria Hospital, Kenya, June 2006
Murphy, Laura, Comment on AIDS-related Morbidity, Mortality and the Environment, Panel
Contribution to the Population-Environment Research Network Cyberseminar on Rural Household
Micro-Demographics, Livelihoods and the Environment, April 2006
Mutangadura, Gladys B., Gender, HIV/AIDS and Rural Livelihoods in Southern Africa: Addressing
the challenges, JENDA: A Journal of Culture and African Women Studies, Issue 7, 2005
National Coordinating Agency for Population and Development, Ministry of Health, Central
Bureau of Statistics and ORC Macro, Kenya Service Provision Assessment 2004, Nairobi, Kenya,
2005
National Coordinating Agency for Population and Development, Ministry of Health, Central
Bureau of Statistics and ORC Macro, Kenya Service Provision Assessment 1999, Nairobi. Kenya,
2000
National Council for Population and Development, Central Bureau of Statistics, and Macro
International Inc., Kenya Demographic and Health Survey 1998, Calverton, Maryland [1999]
National Council for Population and Development, Central Bureau of Statistics, and Macro
International Inc., Kenya Demographic and Health Survey 1993, Calverton, Maryland, 1994
National Environmental Management Authority (NEMA), State of Environment Report for Kenya,
2003

124

Ngom, Pierre, Monica A. Magadi, and Tom Owuor, Parental Presence and Adolescent
Reproductive Health among the Nairobi Urban Poor, Working Paper 28, African Population and
Health Research Centre, 2003
Nielsen, Helena Skyt, Marianne Simonsen, and Mette Verner, Does the Gap in Family-friendly
Policies Drive the Family Gap? Scandinavian Journal of Economics, 106(4), December 2004
Njue, Carolyne, and Ian Askew, Medicalization of Female Genital Cutting among the Abagusii in
Nyanza Province, Kenya, Frontiers in Reproductive Health Program, Population Council,
December 2004
Nkolika, Aniekwu (discussant), Comments on Religion and Sexuality: Individuality, Choice and
Sexual Rights in Nigerian Christianity, Africa Regional Sexuality Resource Centre, Understanding
Human Sexuality Seminar Series 4, June 9, 2005, Lagos, Nigeria
Nol-Miller, Claire M., Concern Regarding the HIV/AIDS Epidemic and Individual Childbearing:
Evidence from Rural Malawi, Demographic Research, Special Collection 1, Article 10, 19
September 2003
Northrop, E.M., The feminization of poverty: The demographic factor and the composition of
economic growth, Journal of Economic Issues, 24(1), March 1990
Nour, N.M., Health Consequences of Child Marriage in Africa, Emerging Infectious Diseases,
12(11), CDC, November 2006
Ofstedal, Mary Beth, Erin Reidy and John Knodel, Gender Differences in Economic Support and
Well-being of Older Asians, Journal of Cross-Cultural Gerontology, 19(3), September 2004
Oppenheimer, Valerie Kincade, A Theory of Marriage Timing, American Journal of Sociology,
94(3), November 1988
Organisation for Economic Cooperation and Development (OECD), Poverty-Environment-Gender
Linkages, DAC Journal, 2(4), 2001
Oster, Emily, HIV and Sexual Behaviour Change: Why Not Africa? Working Paper No. 13049,
National Bureau of Economic Research, April 2007
Otieno-Nyunya, B., Are Womens Lives Worth Saving at All? A case for review of laws and
policies governing abortion, Proceedings of a three-day workshop held in Nairobi, Kenya,
November 2004, organized by Kenya Medical Association (KMA) and Kenya Obstetrical and
Gynaecological Society (KOGS)
Otoo-Oyortey, Naana and Sonita Pobi, Early Marriage and Poverty: Exploring links and key
issues, Gender and Development, 11(2), July 2003
Palloni, Alberto, Theories and Models of Diffusion in Sociology, Working Paper No. 98-11,
Centre for Demography and Ecology (CDE), University of Wisconsin-Madison, 1998

125

Panayotou, Theodore, Economic Growth and the Environment, Chapter 2, In: Economic Survey
of Europe, No. 2, 2003
Pattanayak, Subhrendu K., and Junko Yasuoka, Deforestation and malaria: Revisiting the human
ecology perspective, in: C.J.P. Colfer (ed.), People, Health, and Forests: A Global Interdisciplinary
Overview, Earthscan, 2008
Patz, Jonathan A., Ulisses E.C. Confalonieri, Human Health: Ecosystem Regulation of Infectious
Diseases, In: Rashid Hassan, Robert Scholes and Neville Ash (eds.), Ecosystems and Human Wellbeing: Current State and Trends, Volume 1, Findings of the Condition and Trends Working Group
of the Millennium Ecosystem Assessment, Washington, Island Press, 2005
Pearce, Diane M., The Feminization of Poverty: Women, Work, and Welfare, Urban and Social
Change Review, 11(1-2), February 1978
Perman, Roger, Yue Ma, and James McGilvray, Natural Resource and Environmental Economics,
Longman, 1996
Pfaff, Alexander S.P., Shubham Chaudhuri, and Howard L.M. Nye, Household Production and
Environmental Kuznets Curves: Examining the desirability and feasibility of substitution,
Environmental and Resource Economics, 27(2), February 2004
Pool, Ian Laura, R. Wong, and ric Vilquin (eds.), Age-Structural Transitions: Challenges for
development, Committee for International Cooperation in National Research in Demography,
Paris, 2006
Population Action International, Access Denied: The Impact of the Global Gag Rule in Kenya,
2006
Population Reference Bureau (PRB), 2007 World Population Data Sheet, Washington, D.C., 2007
Population Reference Bureau, Critical Links: Population, Health, and the Environment,
Population Bulletin, 58(3), September 2003
Pritchett, Lant H., Desired fertility and the impact of population policies, Population and
Development Review, 20(1), March 1994
Qian, Nancy, Missing Women and the Price of Tea in China: The Effect of Sex-Specific Earnings
on Sex Imbalance, Quarterly Journal of Economics, 123(3), August 2008
Rani, Manju, and Elizabeth Lule, Exploring the Socioeconomic Dimension of Adolescent
Reproductive Health: A multicountry analysis, International Family Planning Perspectives, 30(3),
September 2004
Ravallion, Martin, On the Contribution of Demographic Change to Aggregate Poverty Measures
for the Developing World, Working Paper 3580, Development Research Group, World Bank,
April 2005

126

Regassa, Nigatu, Socio-economic Correlates of High Fertility among Low Contraceptive


Communities of Southern Ethiopia, Journal of Human Ecology, 21(3), 2007
Repetto, Robert, Economic Equality and Fertility in Developing Countries, Johns Hopkins
University Press, Baltimore, 1979
Ribar, David C., What do social scientists know about the benefits of marriage? A review of
quantitative methodologies, Discussion Paper No. 998, Institute for the Study of Labor (IZA),
January 2004
Richerson, Peter J., and Robert Boyd, Homage to Malthus, Ricardo, and Boserup: Toward a
General Theory of Population, Economic Growth, Environmental Deterioration, Wealth, and
Poverty, Human Ecology Review, 4(2), Winter 1997/98
Robinson, Rachel Sullivan, Ronald Lee, and Karen Kramer Counting Womens Labor: A reanalysis
of childrens net production in Mead Cains Bangladeshi Village, Population Studies, 62(1), March
2008
Rodrguez,

G.,

Lecture

notes

on

research

methods

in

demography:

http://data.

princeton.edu/eco572/, 2006
Rosenzweig, Mark R., and Kenneth I. Wolpin, Natural Natural Experiments in Economics,
Journal of Economic Literature, 38(4), December 2000
Ross, Michael, How do Natural Resources influence Civil War: Evidence from thirteen cases,
International Organization, 58(1), March 2004
Ross, Michael L., The Political Economy of the Resource Curse, World Politics, 51(2), January
1999
Rothschild, Emma, Economic Sentiments: Adam Smith, Condorcet, and the Enlightenment,
Harvard University Press, 2001
Rubalcava, Luis, and Dante Contreras, Does Gender and Birth Order matter when Parents
Specialize in Childs Nutrition: Evidence from Chile, Journal of Applied Economics, 3(2)
November 2000
Sachs, Jeffrey D., and Andrew M. Warner, The Curse of Natural Resources, European Economic
Review, 45(4-6), May 2001
Sachs, Jeffrey D., and Andrew M. Warner, Natural Resource Abundance and Economic Growth,
Working Paper 5398, National Bureau of Economic Research, December 1995
Saha, Sukanta, Adrian G. Barnett, Claire Foldi, Thomas H. Burne, Darryl W. Eyles, Stephen L.
Buka, and John J. McGrath, Advanced paternal age is associated with impaired neurocognitive
outcomes during infancy and childhood, PLoS Med, 6(3), March 2009
Sai, Fred, International Commitments and Guidance on Unsafe Abortion, African Journal of
Reproductive Health, 8(1), April 2004

127

Saikia, Udoy Sankar, Ross Steele, and Gour Dasvarma, Culture, Religion and Reproductive
Behaviour in Two Indigenous Communities of North Eastern India: A Discussion of some
preliminary findings, Paper presented on XXIV IUSSP General Conference, Salvador, 18-24
August 2001
Sala-i-Martin, Xavier, and Arvind Subramanian, Addressing the Natural Resource Curse: An
illustration from Nigeria, Working Paper 9804, National Bureau of Economic Research, June 2003
Salant, Stephen W., The Economics of Natural Resource Extraction: A Primer for development
economists, World Bank Research Observer, 10(1), February 1995
Salinas, Gonzalo, and Markus Haacker, HIV/AIDS: The Impact on Poverty and Inequality,
Working Paper 06/126, International Monetary Fund, May 2006
Samuelson, Paul, An Exact Consumption-Loan Model of Interest with or without the Social
Contrivance of Money, Journal of Political Economy, 68(6), December 1958
Sanders, Seth G., V. Joseph Hotz and Susan Williams McElroy, Teenage Childbearing and its Life
Cycle Consequences: Exploiting a Natural Experiment, Journal of Human Resources, 40(3), June
2005
Schoumaker, Bruno, Poverty and Fertility in sub-Saharan Africa: Evidence from 25 countries,
Population Association of America Meeting, Boston, April 1-3, 2004
Schultz, T. Paul, Fertility and Income, Discussion Paper No. 925, Economic Growth Centre, Yale
University, October 2005
Schultz, T. Paul, Demand for Children in Low Income Countries, In: M.R. Rosenzweig and Oded
Stark (eds.), Handbook of Population and Family Economics, Elsevier, 1997
Schultz, T. Paul, Changing World Prices, Womens Wages, and the Fertility Transition: Sweden,
1860-1910, Journal of Political Economy, 93(6), December 1985
Sear, Rebecca, Ruth Mace & Ian A. McGregor, A Life History Approach to Fertility Rates in Rural
Gambia: Evidence for trade-offs or phenotypic correlations? In: J. Rodgers and H-P Kohler (eds.),
Biodemography of Human Reproduction and Fertility, Kluwer Press, 2003
Shackelford, Todd K., and Viviana A. Weekes-Shackelford, Why dont men pay child support?
Insights from evolutionary psychology, in: Charles Crawford and Catherine Salmon (eds.),
Evolutionary Psychology, Public Policy and Personal Decisions, Lawrence Erlbaum Associates,
Publishers, 2004
Shafik, Nemat, and Sushenjit Bandyopadhyay, Economic Growth and Environmental Quality:
Time-series and cross-country evidence, Background Paper for World Development Report 1992,
Working Paper 904, World Bank, June 1992

128

Shiferaw, Bekele, Poverty and Natural Resource Management in the Semi-Arid Tropics: Revisiting
Challenges and Conceptual Issues, International Crops Research Institute for Semi-Arid Tropics
(ICRISAT), India, 2001
SIDA, The Environment, Natural Resources and HIV/AIDS, Environment Policy Division, by
Mikael Hammarskjld, December 2003
Slama, Remy, Jean Bouyer, Gayle Windham, Laura Fenster, Axel Werwatz, and Shanna H. Swan,
Influence of Paternal Age on the Risk of Spontaneous Abortion, American Journal of
Epidemiology, 161(9), May 2005
Smith, Adam, Inquiry into the Nature and Causes of the Wealth of Nations, 1776
Smith, Adam, The Theory of Moral Sentiments, 1759
Smith, James P., Healthy Bodies and Thick Wallets: The dual relation between health and
economic status, Journal of Economic Perspectives, 13(2), Spring 1999
Speizer, Ilene S., Using Strength of Fertility Motivations to Identify Family Planning Program
Strategies, International Family Planning Perspectives, 32(4), December 2006
Steckel, Richard H., Stature and the standard of living, Journal of Economic Literature, 33(4),
December 1995
Stern, David I., The Rise and fall of the Environmental Kuznets Curve, World Development,
32(8), August 2004
Stevenson, Betsey, and Justin Wolfers, Marriage and divorce: Changes and their driving forces,
Journal of Economic Perspectives, 21(2), Spring 2007
Stone, G.D., Agricultural Change Theory, In: International Encyclopedia of the Social and
Behavioral Sciences, Elsevier Science, 2001
Strauss, John, and Duncan Thomas, Health, nutrition, and economic development, Journal of
Economic Literature, 36(2), June 1998
Sweeney, James L., Economic Theory of Depletable Resources: An Introduction, In: Allen V.
Kneese and James L. Sweeney (eds.), Handbook of Natural Resource and Energy Economics,
Volume 3, Elsevier, 1992
Temmerman, M., N. Kidula, M. Tyndall, R. Rukaria-Kaumbutho, L. Muchiri, and J.O. NdinyaAchola, The supermarket for womens reproductive health: The burden of genital infections in a
family planning clinic in Nairobi, Kenya, Sexually Transmitted Infections, 74(3), June 1998
Thirumurthy, Harsha, Joshua Graff Zivin, and Markus Goldstein, The Economic Impact of AIDS
Treatment: Labour supply in western Kenya, Journal of Human Resources, 43(3), Summer 2008
Thomas, Duncan, Like Father, like Son; Like Mother, like Daughter: Parental resources and child
height, Journal of Human Resources, 29(4), Autumn 1994

129

Thomas, Duncan, Intra-household Resource Allocation: An inferential approach, Journal of


Human Resources, 25(4), Autumn 1990
Thomsen, S., M. Stalker, and C. Toroitich-Ruto, Fifty ways to leave your rubber: how men in
Mombasa rationalise unsafe sex, Sexually Transmitted Infections, 80(6), December 2004
Turner, B.L., and A.M. Shajaat Ali, Induced Intensification: Agricultural change in Bangladesh
with implications for Malthus and Boserup, Proceedings of the National Academy of Sciences,
USA, 93(25), December 1996
Turner, Daniel, Spatial Variations in HIV/AIDS: A Case Study of Kenya within sub-Saharan
Africa, 2004
Undie, Chi-Chi, and Kabwe Benaya, The State of Knowledge on Sexuality in sub-Saharan Africa: A
synthesis of literature, JENDA: A Journal of Culture and African Women Studies, Issue 8, 2006
UNFPA, Workshop on Integrating Population Issues into MDG-Based National Development
Frameworks, Country Technical Services Team, Addis Ababa, 22-26th May 2006
UNFPA, Proceedings of the Workshop on Mainstreaming Population, Gender and Reproductive
Health in MDG-based PRSP, Country Technical Services Team, Addis Ababa, 19-23 September
2005
United Nations Environment Programme and the International Institute for Sustainable
Development, Exploring the Links: Human well-being, poverty and ecosystem services, 2004
Vadnais, Daniel, Adrienne Kols, and Noureddine Abderahim, Womens Lives and Experiences:
Changes in the past ten years, ORC Macro, Calverton Maryland, 2006
van Wijnbergen, Sweder, The Dutch Disease: A Disease after All? Economic Journal, 94(373),
March 1984a
van Wijnbergen, Sweder, Inflation, Employment and the Dutch Disease in oil-exporting countries:
A short-run Disequilibrium analysis, Quarterly Journal of Economics, 99(2), May 1984b
Vitzthum, V.J., The Home Team Advantage: Reproduction in women indigenous to high altitude,
The Journal of Experimental Biology, 204(18), September 15, 2001
Voth, Hans-Joachim, Living Standards during the Industrial Revolution: An economists guide,
American Economic Review, 93(2), May 2003
Walker, Robert, Michael Gurven, Kim Hill, Andrea Migliano, Napoleon Chagnon, Roberta De
Souza, Gradimir Djurovic, Raymond Hames, A. Magdalena Hurtado, Hillard Kaplan, Karen Kramer,
William J. Oliver, Claudia Valeggia, and Taro Yamauchi, Growth rates and life histories in twentytwo small-scale societies, American Journal of Human Biology, 18(3), May/June 2006

130

Wall, L. Lewis, Dead Mothers and Injured Wives: The social context of maternal morbidity and
mortality among the Hausa of Northern Nigeria, Studies in Family Planning, 29(4), December
1998
Waszak, Cynthia, Shyam Thapa and Jessica Davey, The Influence of Gender Norms on the
Reproductive Health of Adolescents in Nepal Perspectives of Youth In Sarah Bott et al (eds.)
Towards Adulthood: Exploring the sexual and reproductive health of adolescents in South Asia,
World Health Organization, 2003
Watkins, Susan Cotts, and Dennis Hodgson, From Mercantilists to Neo-Malthusians: The
international population movement and the transformation of population ideology in Kenya,
prepared for workshop on Social Processes Underlying Fertility Change in Developing Countries,
National Academy of Sciences, September 1999
Wegelin-Schuringa, Madeleen, Evelien Kamminga, and Sascha de Graaf, HIV/AIDS and its
Implications for the Water and Sanitation, 29th WEDC International Conference: Towards the
Millennium Development Goals, Abuja, Nigeria, 2003
Weisner, Thomas S., One Family, Two Households: Rural-Urban Kin Networks in Nairobi,
University of Nairobi, 1970
Weiss, Yoram, The Formation and Dissolution of Families: Why marry? Who marries whom? And
what happens upon divorce? In: M.R. Rosenzweig and Oded Stark (eds.), Handbook of Population
and Family Economics, Elsevier, 1997
Western, Mark, Belinda Hewitt, and Janeen Baxter, Marriage and Money: Variations across the
earnings distribution, Australian Journal of Labour Economics, 8(2), June 2005
Westoff, Charles F., and Anne R. Cross, The Stall in the Fertility Transition in Kenya, DHS
Analytical Studies No. 9, Office of Population Research, Princeton University and ORC Macro,
May 2006
Whyte, S.R., and P.W. Kariuki, Malnutrition and Gender Relations in Western Kenya, Health
Transition Review, 1(2), October 1991
Wilcox, W. Bradford, and Nicholas H. Wolfinger, Then Comes Marriage? Religion, race, and
marriage in urban America, Social Science Research, 36(2), June 2007
Willis, Robert J., A Theory of Out-of-Wedlock Childbearing, Journal of Political Economy,
107(6), December 1999
Wilson, Margo, and Martin Daly, Marital cooperation and conflict, in: Charles Crawford and
Catherine Salmon (eds.), Evolutionary Psychology, Public Policy and Personal Decisions, Lawrence
Erlbaum Associates, Publishers, 2004
Winegarden, Calman R., A simultaneous-equations model of population growth and income
distribution, Applied Economics, 10(2), 1978

131

Winterhalder, Bruce, and Paul Leslie, Risk-sensitive Fertility: The variance compensation
hypothesis, Evolution and Human Behaviour, 23(1), January 2002
Wolfson, Michael, George Kaplan, John Lynch, Nancy Ross, and Eric Backlund, Relation between
Income Inequality and Mortality: Empirical demonstration, British Medical Journal, 319(9), 9
October 1999
Wordsworth, William, The complete poetical works of William Wordsworth, volume 4, Houghton
Mifflin Company, Boston and New York, 1911
World Bank, World Development Report: Development and the Environment, Oxford University
Press, New York, 1992
World Bank, World Development Report 1984, Oxford University Press, New York, 1984
World Health Organization, Programming for Male Involvement in Reproductive Health, Report
of the meeting of WHO Regional Advisers in Reproductive Health, 5-7 September 2001 [2002]
World Resources Institute, Kenya Department of Resource Surveys and Remote Sensing, Kenya
National Bureau of Statistics, and the International Livestock Research Institute, Natures Benefits
in Kenya: An Atlas of Ecosystems and Human Well-Being, 2007
Yamano, Takashi, and T.S. Jayne, Working-Age Adult Mortality and Primary School Attendance
in Rural Kenya, Economic Development and Cultural Change, 53(3), April 2005
Yamano, Takashi, and T.S. Jayne, Measuring the Impacts of Working-Age Adult Mortality on
Small-Scale Farm Households in Kenya, World Development, 32(1), January 2004
Yang, Q., S.W. Wen, A. Leader, X.K. Chen, J.Lipson, and M.Walker, Paternal age and birth
defects: how strong is the association? Human Reproduction, 22(3), March 2007
Yotopoulos, Pan A., Population and agricultural development models: The promise of the third
generation, Pakistan Development Review, 19(2), Summer 1980
Young, Alwyn, The Gift of the Dying: The Tragedy of AIDS and the Welfare of Future African
Generations, Quarterly Journal of Economics, 120(2), May 2005
Zafar, Muhammad Iqbal, Husband-wife roles as a correlate of contraceptive and fertility
behaviour, Pakistan Development Review, 35(2), Summer 1996
Zimmer, Zachary, and Julia Dayton, The Living Arrangements of Older Adults in sub-Saharan
Africa in a Time of HIV/AIDS, Working Paper 169, Population Council, New York, 2003
Zivin, Joshua S. Graff, Harsha Thirumurthy, and Markus Goldstein, AIDS Treatment and Intrahousehold Resource Allocations: Childrens nutrition and schooling in Kenya, Working Paper
12689, National Bureau of Economic Research, November 2006

132

BACK PAGE
The study examines the linkages between poverty,
population growth and the environment, as a basis for
policy
design
that
integrates
population
and
environmental issues in a countrys national development
plans.
The report essentially links Cairo (1994 UN Conference on
Population and Development) with Johannesburg (2003
World Summit on Sustainable Development).
The study shows that there are explicit links between
population change and poverty reduction, and that slower
population growth improves investment and savings and
has a positive effect on the quality of life. The report also
that shows high population growth has adverse effects on
the environment, as it leads to encroachment of marginal
lands, overconsumption of wood fuel, poor disposal of
waste, inadequate water and sanitation, shortage of energy
supplies, increased soil erosion, and land degradation.
The report
draws evidence
from
anthropology,
demography and economics to inform national debates
concerning the implementation of programs aimed at
achieving the reproductive health priorities set forth in
the ICPD Programme of Action. The supporting evidence
provided by a human capital approach to the promotion
of reproductive health may help strengthen the case for
adopting policies that will make the right to reproductive
health services and information a reality.

133