Population Growth and Climate Change in the Sahel: an emerging

humanitarian disaster. 

Malcolm Potts MB, BChir, PhD, FRCOGUniversity of California, Berkeley

The OASIS Initiative, School of Public Health &

College of Natural Resources

Take-away messages• The demography of the least developed regions of the world will

dominate global health in the second half of the 21st century.• The most acute crises will be in the Sahel.• Rapid population growth and climate change will give rise to

several hundred million ecological refugees. • A business as usual scenario strongly suggests some of the

advances made in global health over the last 50 years could be reversed in the next 50 years.

• Those interested in global health have two tasks:– Continue to improve the wellbeing of those living on $1.25/day.– Prevent the crises that could unfold in the least developed regions from

spiraling downwards with increased child stunting, rising IMR, and more failed states with escalating conflict and rising extremism and terrorism.

Take-away messages

• Evidence-based ways to ameliorate an unprecedented humanitarian catastrophe exist but:

– Development paradigm must emphasize family planning

– Policy changes and financial investment must be made urgently and on a large scale.

The demography of the least developed regions of the world will dominate global health in the second half of the 21st century.

attributed to Einstein

• Developed regions • 2011 = 1.2 billion2100 = 1.3 billion

• Least developed • 2011 = 0.85 billion• 2100 = 2.7 billion

Numbed by Numbers

Paul Slovic, 2007.Judgment and decision making 2:79-95.

Natural Increase (births – deaths)

World Developed Less developed

Year 86,590,000 1.470,000 85,115,000

Day 237,210 4,000 233,200

Minute 165 3 162

The Sahel: uniquely rapid population growth in an ecologically vulnerable area with weak

governance and patriarchal traditions

Sahel is Arabic for

‘shore’

THE SAHEL: By 2050, rapid population growth and climate change is threatening the lives of more people than currently live in the USA

The OASIS Initiative. Organizing to Advance Solutions in the Sahel. www.oasisinitiative.org

Niger: Total Fertility Rate (TFR) 7.6 children

UN 2010Population in millionsMales Females

“. . . . the Sahel is almost inevitably heading towards an environmental disaster.”

“Meeting the first MDG of halving the number of poor and hungry people by 2015 is “mission impossible.”

United Nations Environment Program

In 2015, 1,700 refugees drown in Mediterranean

“By 2020 an estimated 60 million people could move from the desertified areas of sub-Saharan Africa towards North Africa and Europe.”United Nations Convention to Combat Desertification (2014)

UNHCR report (June 18th 2015)

“By end-2014, 59.5 million individuals were forcibly displaced worldwide as a result of persecution, conflict, generalized violence, or human rights violations. This is 8.3 million persons more than the year before (51.2 million) and the highest annual increase in a single year.”

17

Evolution de la population et de la production agricole depuis 1960 au Niger

19601962

19641966

19681970

19721974

19761978

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20082010

20120

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Population (en milliers d'habitants)

Production céréalière (en milliers de tonnes)En milliers

Années

18

Evolution de la population et de la production agricole depuis 1960 au Niger

19601962

19641966

19681970

19721974

19761978

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20082010

20120

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Population (en milliers d'habitants)Production céréalière (en milliers de tonnes)En milliers

Années

“Population, when unchecked, increases in a geometrical ratio. Subsistence increases only in an arithmetical ratio. A slight acquaintance with numbers will show the immensity of the first power in comparison with the second.” (Malthus 1798)

OASIS: Organizing to Advance Solutions In the Sahel Berkeley, California Sept 21, 2012

Amelioration: Urgent, large scale action to:

1. Adapt farming/pastoralist to climate change 2. Improve access to family planning 3. Keep girls in secondary school/roll back age marriage.

Pathways to Choice: Delaying Marriage through Girls’ Education in Northern Nigeria

Centre for Girls Education:University of California, Berkeley

and Ahmadu Bello University

The UK Independent Commission for Aid Impact

$180 million spent on education reform in Northern Nigeria had “no major improvement in pupil learning.”

Biye Bizara Dambo Jaja M-Guga Tohun Tsibiri U-Rimi0

25

50

75

100

125

150

175

200

Number of girls enroled in secondary school in project communities by school year

2008-092009-102010-112011-122012-132013-14

2.5 years average increase in age of marriage

Kaplan-Meier estimates of proportion of unmarried women for CGE participants compared to the 2007 Demographic and Reproductive Health Survey respondents

Mean age of marriage

Country Mean Age of Marriage1

Chad 15.9

Mali 16.6

Niger 15.5

1. Data Source: Demographic and Health Surveys (Chad, Mali, Niger), 2004-2006. Available at: http://dhsprogram.com/Where-We-Work/Country-List.cfm. Last accessed 14 March 2014.

“Increasing the age at marriage by five years could directly reduce 15 to 20 percent of future population growth.”

Judith Bruce and John Bongaarts (2010).

The development paradigm must emphasize family planning

• 1965 Awareness of ‘population growth – Rapid decline in total fertility rate in Asia and Latin America

associated with making family planning easily available and modest international support

– Economic development (‘Asian Tigers’ = small families)

• 1994 International Conference on Population and Development takes focus off family planning. Silence on population and falling budgets– Huge demographic momentum in least developed countries

such as the Sahel, rising poverty, migration, extremism

The development paradigm must emphasize family planning

• Socio-economic development and reducing the IMR will lower the TFR.

• Least developed countries only one with a population of more than one million (Botswana) has graduated to the developed country category.

• Over the past 50 years 14 high fertility countries have received over $10 billion. In 2011, ten of these countries received one billion dollars.

• Over the past decade only 0.31% was spent on explicit family planning efforts.

Bixby Forum, January 2009

• “ With over 80 million unintended pregnancies each year, there is already a large unmet need for family planning.”

• “Ready access to contraception and safe abortion has decreased family size, even in illiterate communities living on less than a dollar a day.”

The Impact of Population Growth on Tomorrow’s World. (2009)Philosophical Transactions of the Royal Society B. 364: page 2975.

World in 2050• Meeting the unmet need for family

planning has been highly successful in slowing rapid population growth. Unconstrained access to contraception and safe abortion has lowered family size, even in illiterate communities living less than a dollar a day. Education makes a crucial contribution to development, but rapidly growing countries can seldom expand education fast enough to keep up with the greater number of children born each year than the year before.

 

Iran 1989-1994-

Total Fertility Rate by economic quintile: the Philippines and Bangladesh

One Two Three Four Five0

1

2

3

4

5

6

PhilippinesBangladesh

Richest Wealth quintiles Poorest

Barriers to contraception• Lack of choice:19/98 countries no access pill; 30/98 no IUD; 61/98

no vasectomy

• Non-evidence based medical rules:– wont give FP unless women menstruating– refuse sterilization unless age X parity = 120

• Cost – Travel– Senegal OC tests + 5 month income

• Provider bias• Misinformation: 50-70% think the pill poses considerable

health risks or more dangerous than childbirth.

Campbell et al. Barriers to fertility regulation. Studies in family Planning 37:87-98. 2006

Social Sector Savings are Two and a Half Times the Costs of Meeting Unmet Need for Family Planning, Mauritania, 2010-2012.

In the least developed, highest fertility countries in the past decade only

0.31% was spent on explicit family planning efforts

Population Matters

8.12 87.6

7.2

6.5

5.45 5

5.21

3

4

5

6

7

8

9

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Total Fertility Rate Kenya

Weak family planning

Strong family planning

Family planning emphasized

Family planning submerged

When barriers increase, family size rises

“One reason for the poverty trap is the demographic trap, is that impoverished families choose to have lots of children. . . Because the parents are risk averse, and want to assure with a high probability of the least one child surviving … they overcompensated in a statistical sense.”

44

Jeffry Sachsgot it wrong

Do economists have frequent sex?

• The default position for any human sexual partnership is a large family

• The only way to have a smaller family is to have the information and means to separate sex from childbearing

Country GNIppp Sex/yrUSA 53,960 118

France 37,590 144

Hungary 20,930 152

Vietnam 5,030 104

Queen Victoria• Born 1819• Married 1840

• Daughter 1840• Son 1841• Daughter 1843• Son 1844• Daughter 1846• Daughter 1848• Son 1850• Son 1853 • Daughter 1857

• Husband died 1861• Died 1901

47

The default position for human reproduction is a large family

Whether you live in Buckingham Palace (TFR 9) or Burkina Faso (TFR 6) unless you have the information and means to separate sex from child bearing you will have a large family.

Bill Gates’ First Annual Letter, 2009

“reducing the number of child deaths actually reduces population growth”

Bill Gates First Annual Letter, 2009

Not allcorrelationsare causal

0

50

100

150

200

250

1940 1960 1980 2000 2020

Deat

hs p

er 1

000

birt

hs

Infant mortality rate

Bangladesh

Indonesia

India

Vietnam

0

1

2

3

4

5

6

7

8

1940 1960 1980 2000 2020

Birt

hs/w

oman

Total fertility rate

Bangladesh

Indonesia

India

Vietnam

Asia’s demographic transition

0

50

100

150

200

250

1940 1960 1980 2000 2020

Det

ahs

per 1

000

birt

hs

Infant mortality rate

Burkina Faso

Chad

Niger

Uganda

0123456789

1940 1960 1980 2000 2020

Birt

hs p

er w

oman

Total fertility rate

Burkina Faso

Chad

Niger

Uganda

Africa’s stalling fertility decline

52

Slow increases in contraceptive prevalence rates

1970 1975 1980 1985 1990 1995 2000 2005 20100

10

20

30

40

50

60

70

BangladeshEgypteIndonésieIranMarocMaliBurkinaCameroonNigerNigeriaSenegalLogarithmic (Senegal)ChadExponential (Chad)GhanaPolynomial (Ghana)

Mar

ried

wom

en u

sing

at l

east

on

e m

oder

n co

ntra

cept

ive

(%)

Can the world feed 9 billion people?

• 800 million people are chronically hungry • There is little additional arable land to be brought into

cultivation• Ground water levels are falling in more than half of

India’s wells.• Himalayan glaciers are retreating and could threaten

water availability for 1.5 billion people.• Initially, in Africa global warming could increase rainfall,

but later it will cut crop yields, especially in Africa (e.g. sorghum down by 20%).

There can be no permanent progress in the battle against hunger until the agencies that fight for increased food production and those that fight for population control unitein a common effort.

Norman Borlaug, Nobel Peace Prize1970

The Pill is Mightier than the Sword

9/11 Commission Report

• “…high birthrates and declining rates of infant mortality had produced a common problem throughout the Muslim world: a large, steadily increasing population of young men without any reasonable expectation to suitable or steady employment – a sure prescription for social turbulence.”

Young-adult proportion

Murder Rate

United States M

urders per 100,000 population

Youn

g A

dults

(15-

29)

i

n th

e w

orki

ng-a

ge p

opul

atio

n (1

5-64

)

UN high-variant projection: 16.6 billion (half a child MORE than the medium variant).

Medium variant: 10.9 billion.

Low variant: 8.3 billion (half a child FEWER than the medium variant).

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

1955

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1985

1988

1990

1992

1995

1996

2000

2002

2003

2004

2006

TFR 2 per. Mov. Avg. (TFR- Iran)

2 per. Mov. Avg. (TFR- China)

Voluntary FP

One-child policy

Voluntary family planning

When barriers are removed, family size falls