Professor Sarah Harper is the first Professor of Gerontology at Oxford University and the Director of the Oxford Institute of Population Ageing, the UK's first population center on the demography and economics of ageing populations. Her current research on demographic change addresses the global and regional impact of falling fertility and increasing longevity, with a particular interest in Asia and Africa. She has focused on women’s education and empowerment in sub-Saharan Africa, and the impact of this on falling fertility rates.
To begin, I’d like to ask you to briefly answer the question your recent book “How Population Change will Transform our World” poses within the context of sub-Saharan Africa. What are the overarching trends in demographic changes you’ve noted in sub-Saharan Africa, and what do you believe the implications of those trends will be?
Sub-Saharan Africa is really interesting because of what is happening to what we call the fertility transition. Our research has suggested that in all other regions of the world, as we allow women to be empowered through education and to have improved health and well-being and more control over decisions, they tend to choose to have fewer children.
The really interesting thing, however, is that desired family size still [remains] high in most Sub-Saharan African countries. We first picked this up while doing some anthropological work in Uganda, where we found that highly educated middle-class women still wanted to have three, four, or five children, even though they were beginning to restrict their childbearing. We then looked at the Demographic and Health Surveys, which is a very large, very robust data set with about over 150 countries in it. And it was very clear that in most sub-Saharan African countries, women who are educated are beginning to control their fertility, but their desired family size is still staying high.
That's really interesting because it means that sub-Saharan Africa will probably go through the full demographic transition maybe later in the 21st century than we thought, given that mortality is coming down and morbidity is beginning to come down as well. And we're seeing a growing number of older adults. This is probably going to coincide with a large number of children still being born [and] a growing number of older adults in the population, so there is going to be a massive youth bulge which is hopefully going to lead to a demographic dividend. It is likely that the population in that part of the world is going to continue to grow and the number of dependents is also going to stay very high, probably far longer into the end of the 21st century than we originally thought.
How have you found women’s education and empowerment to affect the desired family size across the region?
There's a group of people who argue that it's all to do with the availability of modern forms of contraception. And yet, we have data [that] shows very clearly that women in many countries, regardless of their education, are aware of modern forms of contraception. So we know that it isn't that women don't just have an unmet need for contraception. [They don’t] feel that they can take advantage of contraception.
There are two other broad drivers [of fertility]: one is health. We know that as women's health and well-being increase, infant and child mortality tends to go down. Then, women will choose to reduce the number of children they have; they will prefer to have a few [healthy] children rather than many, many children because they know that their children will have a much better chance of surviving through childhood and into adulthood. But overridingly, education seems to be important [to fertility] and that operates in a variety of different ways.
Firstly, it keeps girls out of the marriage market. If we take Nigeria for example, where on average women are still having eight to nine children, we know that particularly in rural areas, two-thirds of the girls leave primary school, and don't really go on to secondary school. They're married by twelve and are having their first child at thirteen or fourteen. Obviously, at that age, it's very, very difficult for those young girls to be able to stand out against [their] society, which at the moment is saying have as many children as you can. And if we can keep girls in school, we can empower them. We can change attitudes to communities, but also we can give them the skills [to] understand that although being a mother is important, there are other things that they can do [to] make an economic contribution and take control of their lives. So improving health [and] giving [women] access to family planning is really important, but education is absolutely vital.
Could you outline the differing attitudes towards aging in sub-Saharan Africa? Have these attitudes influenced demographic changes in the region?
What is interesting is when we say aging, if we think of an old person in North America, for example, we typically nowadays are thinking of someone who's probably over seventy-five [or] eighty. And they haven't been very productive in their lives. [They’re] probably now retired or [they’ve] cut back on their economic production. If we think of an older person in many sub-Saharan African countries, we may be talking about [a person in] in their 50s and that is because the risk of illness, frailty, and morbidity happens so much earlier. And particularly, women may be the mainstays for the family. So it could be that you have a woman in their 50s and they are economically looking after the grandchildren and even the great-grandchildren because that middle generation maybe has died or migrated out.
And therefore, they are a mainstay of the family. So although they're much younger, they're still recognized [as old] in their 50s and 60s. And if something happens to them, then that family in the household can be very significantly affected. So when we think about age, it isn't really chronological. It's more to do with life course and generation and illness and disease.
Do aging populations in sub-Saharan Africa tend to face any specific disparities in trying to access healthcare? If so, how can they be mitigated?
If you grow old in a country that is aging, that's very different from growing old in a young country. Without any doubt, most countries throughout Africa, particularly sub-Saharan Africa, [are] countries of youth. They are countries where there is still huge pressure on conquering child, infant, and maternal mortality, where there are still infectious diseases, or acute medicine is still really important. And that's not to say that the chronic diseases of later life were ignored, but obviously, when you are still a very small percentage of the population, it's more difficult for you to get those resources. Of course, what we're seeing if we look in terms of sheer numbers of older adults [is that] the growth in sub-Saharan Africa in terms of numbers is quite dramatic. But if we look [at it] as a percentage of [the] population, it's still relatively small. And I think, therefore, raising awareness [about] older adults is really important. They are important economically, they're important socially. They're important within a family, and there is just an innate importance of being a person and you don't lose that when you become old. I think that's really, really vital, but it's very difficult.
UNFPA [and] these big UN agencies, they are constantly pointing out that Africa is aging. It's aging slowly, but there are huge numbers of older people. I think as we see, we understand more of the vulnerabilities of older adults to climate change, drought, [and] civil strife. If there is some kind of a crisis, older people often find it very difficult to escape from [the] crisis. They tend to get trapped. I would say at the moment, the really important thing is good research data that points out the needs of older people. The tremendous work that the charity and political international section is doing highlights the importance of older people.
Considering that sub-Saharan Africa has one of the most rapidly aging populations in the world, do you consider the region to be an underrepresented research area? Why or why not?
African gerontology is very young, but I have to say that if you do a review over the last 30 years of the research that has been done, it is booming. It comes from a very, very low base, but really there's a huge amount of interest in this area. The research community has grown so much over the last few decades, and I think more resources are being poured into this area, which is good.
What about these trends and implications are similar to other regions you have studied, and what makes them unique to sub-Saharan Africa?
As I said at the beginning, I mean, the whole idea about aging, of course, isn't just about cooling mortality, which means people are living longer. It is a decrease in the number of children being born. So the average age of your population goes up. So this structural change is really, really important. And you go from a society where there are huge numbers and percentages of younger people and very few older adults to a much more balanced age structure. Africa is going through that very rapidly at the moment but is still predominantly a young part of the world.
And so I think from this perspective, we can say that we're probably looking to the second half of the 21st century before we will really see Africa become an aged region. Asia has been aging very dramatically, [and] at the moment Latin America is too; obviously, the Global North [has] aged already. So the really exciting [thing] is that Africa is aging at a time when we do have climate change, but we also have new technology, and who knows how new technology is going to affect our lives. So for the first time, we're going to see the sort of aging of a [continent] against this very rapid change in technology, and that's going to affect the way we work, the way we live, [and] our healthcare. And so it's a particularly interesting area to study at the moment.
You mentioned a relationship between climate change and aging in Sub-Saharan Africa. How have you already seen this relationship manifested or why do you anticipate it happening?
Yes, so I think one of the problems with climate change is that vulnerable peoples tend to be most affected. And obviously, older people are very susceptible to both heat and cold. They're very susceptible to drought and famine. They find it very difficult if there is a climate event, to be able to escape from that event whether that is a fire or a flood.
And as a consequence, I suppose one of the issues is that the impact on people is going to be particularly acute in Africa as the population ages because obviously, climate change is going to affect that part of the world. We believe we're going to have more and more vulnerable older people. Many older adults simply don't have the educational resources that younger people do. Older people in different parts of the world had a very good education system when they were younger. Of course, in many parts of sub-Saharan Africa, that simply wasn't possible. And so we do have an older population who may, because they're less educated, have [fewer] resources that they can call upon in order to help them, and maybe are much more dependent on sort of traditional ways of thinking which sometimes are very, very good but sometimes make it more difficult. I mean, there has been research which has suggested that there are a whole lot of myths that tend to circulate in a society, and if you're educated, you can stand back and say, “Well, I don't believe that, because my education tells me that that can't be true.” If you haven't had the advantage of education, which broadens your mind and enables you to think in different ways, I think you're more vulnerable to being taken in by certain myths. And so we might see communities of older people behaving in a certain way, refusing vaccinations, refusing medicines, because they are taken in more by the stories and narratives and myths that sometimes falsely arise, and I think that is a problem.
What impact might sub-Saharan African demographic changes have on the world, considering that a much higher proportion of the world's population will come from this region in the future?
I would say the 21st century is certainly African without any doubt at all, particularly the second half. You’re absolutely right. [Among] older populations that growth is slowing everywhere, except in sub-Saharan Africa. I think that's where [to attain] the demographic dividend, which means [benefiting] from the tremendous energy of younger people in your economy. You do need to have a very good framework, you need a good education, you need good health, and you need good governance and financial structures. And all [of] those infrastructures are [typical of] an urban environment which supports good, strong economic growth. But if Africa can do that, then not only [does it have] a huge, bright future, but it also, in theory, will be able to provide many of the skills that the rest of the world needs. Because as we age, not only Europe and North America but also South America and actually parts of Asia are going to have a massive skill shortage. And a vibrant, well-educated, healthy African young population could really help the world cope with the extreme aging that the rest of the world will be going through.
Adamolekun spoke with Harper on March 3, 2023. This interview has been lightly edited for length and clarity.
