What’s Pashto for the pill?

THIS is a story from Afghanistan which is not all about fighting, bombs or the Taliban. It also contains a modicum of good news. It is about demography and fertility. Afghanistan has traditionally been seen as a demographic outlier. Its fertility rate was 6.6 in 2005-10, according to the United Nations. That was the second highest rate in the world, exceeded only by Niger (the fertility rate is the number of children a woman can expect to have during her lifetime). It put Afghanistan into the same category as the poorest countries of Africa. In contrast, fertility rates among its South Asian neighbours ranged from 4 (Pakistan) to below 3 (Bangladesh, India and Sri Lanka). Afghanistan’s exceptional fertility rate was the clearest sign that the country was trapped in a unique and dysfunctional course of development, characterised by war, the Taliban and the under-education of women. But the figure was always something of a guess. The last census had been in 1979, the year of the Soviet invasion. An entire generation had grown up since then, much of it in conditions of pervasive violence and uncertainty. It was hard to know how fertility had changed over such a long period. Now, along comes the Afghanistan Mortality Survey, based on interviews conducted with nearly 48,000 Afghan women aged 12 to 49 in 2010 (and reported by Elizabeth Leahy Madsen of the Wilson Centre, a Washington think-tank). This is the first time in 30 years that the world has got a first-hand picture of what is happening in most of the country. The picture the survey paints is surprising and not entirely depressing. It says Afghanistan’s fertility rate is 5.1, one and a half points less than the UN estimate (and similar ones by the US Census Bureau). That might not like sound much. But 1.5 points is a lot in demography. It takes Afghanistan from off the scale to the merely high. Its new fertility rate lies between Senegal and Iraq. High, but no longer exceptional. The survey is imperfect, as you might expect. About 13% of the population could not be reached because it was too dangerous, so the provinces of Kandahar, Helmand and Zabul had to be excluded. But it does include most of the things you need to know to understand what is happening to the health of a population, including mortality, fertility. family planning and maternal health. For the most part, these other indicators suggest that the population’s health and well-being are improving slightly. The median age of marriage is rising, though it is still only 18. The use of contraception is low (only a fifth of married women use a modern method), but in rural areas it is increasing rapidly and it is about four points higher than the average in African. The big exception is female education: the survey found that 76% of women had never been to school, an unusually high proportion. The fall in fertility does not mean the rise in the population is going to come to an end any time soon. Because of years of high birth rates, Afghanistan remains a very young country, with half the population under 15. Even if fertility continues to fall steadily, says Ms Madsen, the number of children will grow by 5m over the next 15 years, or over 30%. Households are large, averaging eight people, so extended families or more than one family typically live together. So why has fertility fallen? The survey itself credits urbanisation and greater access to family planning. Carl Haub, a demographer with the Population Reference Bureau, another Washington think-tank, points out that the government introduced a basic package of health care—including family planning—in 2003, spreading it throughout the country. It sometimes seems as if the Afghan government and its Western supporters have done practically nothing in the past ten years except cling on by the skin of their teeth. But that is not quite right.