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Health survey points to disconnect with economic thinking of the day

Health Opinion


The Kenya National Bureau of Statistics released the seventh Kenya Demographic and Health Survey for 2022 since it was first issued in 1989 this past week.

As pointed out by the national statistician, the demographic and health indicators are very critical because they ought to inform socio-economic policy choices and prioritisation of government programmes both in the medium and long term.

According to the survey, the country has experienced noticeable improvements in the majority of the key indicators tracked in the survey from 2014, when the previous survey was conducted. In reality, it is not possible to analyse the entire spectrum of indicators emerging from the survey in a single column of a popular national newspaper like this one.

For this article, we’ll narrow down to economic insights that we could deduce from the related Total Fertility Rate (TFR) and Household member indicators.

Not surprisingly, the TFR declined to 3.4 from 3.9 in 2014. This continues the declining trend from 6.7 recorded in 1989 and 8.1 in the Kenya Fertility Survey of 1977-78. The average number of household members in 2022 was 3.7. In simple terms, what this means is that the average number of children women are willing to have in the country has declined to about three in 2022 from about 8 in 1978 over their lifetime.

The household members’ indicator implies that the average family size was four in 2022. This means about two children in a family assuming two parents in that household or three children assuming a family is headed by a single parent. While the population under 15 years stands at 40 per cent, indicating a good position on the future productive capacity for the country, the households headed by a woman seem to be on an increasing trend at 34 per cent in 2022.

With these facts, what do the indicators given that the economy heavily leans on the informal? What do they mean at a time when key sectors of the economy are fighting mechanisation of work in the country? How does this relate to Kenya Kwanza’s narrative of ‘the future is urbanisation’ in driving their affordable housing scheme?

Global context 

The declining fertility rate should not surprise anyone as it is consistent with global trends among developed and developing nations. According to D. Nargurd (2009) in an article on the need for a radical policy re-thinking by developed countries due to declining birth rates, fertility rates tend to be higher in poorly resourced countries. There exists diverse empirical evidence on the reasons for the decline in fertility rates as a country advances economically.

Common reasons why poor countries tend to have higher fertility rates than developed ones include the fact that more children are needed as labour due to low rates of mechanisation of work and the cultural expectation for them to provide care for their parents in old age.

Other reasons are due to the lack of access to contraceptives and generally lower levels of female education. According to literature, birthrates are affected by social structures, religious beliefs, economic prosperity and urbanisation.

Lower fertility rates in developed countries are attributable to lifestyle choices associated with economic affluence, low mortality rate, higher rates of access to birth control, economic drain that comes with taking care of children, and education and career decisions that delay childbirth for women.

Other interesting factors are increasing rates of obesity, increase in Socially Transmitted Diseases and environmental factors associated with urbanisation. Empirical literature in economics documents general correlations among socio-economic variables of women’s education, infant and childhood mortality, GDP per capita and percentage of population living in urban areas with fertility levels in developing countries. The evidence however is inconclusive as to whether these are causal relationships or problems of collinearity of the variables.

John Bonguarts and Dennis Hudgson in an article on the Springer Briefs in population studies in September 2022 find education for women as the most important factor for low fertility rates. The reason why education is the most important factor is that it creates autonomy in decision-making, increases knowledge about reproduction and contraceptives, brings a higher potential for earnings, and rises the opportunity costs of childbearing.

Caldwell in 1980 documents other factors as the reduction of children’s potential to work, rising costs of bringing up children, speeding up of cultural changes, and the propagation of middle-class values. Based on the emerging trends from the demographic and health survey, the quick question that then comes into mind is whether the existing economic thinking is aligned with these underlying shifts at the community level.

Policy disconnects

Quick pointers to the disconnects between the country’s economic thinking and the emerging trends are easily traceable to the fight for mechanisation of work, especially in the agricultural sector; the policy attitude of the informal sector as the default strategy for growth; and the propagation of urbanisation for political ends and not the productive side of it.

Recent economic surveys have consistently indicated a declining role of the agriculture sector in the country’s economy. We have also witnessed highly destructive conflicts in parts of the Rift Valley region between local communities and large multinationals over the mechanisation of tea and horticultural production. Unfortunately, this seems to happen with patronage from the labour unions and highly placed political leaders in the country.

The government on its part does seem to have taken the policy stand of seeing or hearing no evil in the conflict. The land and cultural dimensions do not inspire hope for any sustainable solution to the conflict.

Declining rates

Other data indicates the average age of a farmer in the country is in the regions of 55 years and increasing. This points to a general lack of new entrants into agricultural production that officially still remains the bedrock of the economy. With the evidence of declining fertility rates, where does this leave the future of food production if we are fighting mechanisation? At the policy level, what are we doing to align and adapt to these irreversible shifts at the community level?

The hustlernomics, the official economic policy thinking of the Kenya Kwanza administration promotes increased informality of the economy as opposed to targeted shifts towards the formal sector. For them, the end justifies the means for as long as the current politics suits them.

By default, a large informal sector demands more physical labor due to low levels of adoption of technology and the nature of the available jobs in the sector.

It is more troubling when the top political and bureaucratic elites in the country see no problem with even the more educated youthful population resulting in menial jobs to heck a living. How then do we reconcile the mismatch of an exogenous demographic trend of the declining future supply of labour against the implied future demand for more labourers?

As a progressive and a believer in evidential trends, I am just wondering what sort of economy we’ll gotta have in three decades’ time.

More fundamentally, I struggle with what to make of the universal rule of ‘creative destruction’ in economics that no modern economy can escape from. Who wins in this battle of opportunistic political short-termism and the inalienable rules of economics?

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