III. Impact of urbanization on demographic changes

Rarely does one come across detailed studies on the impact of urbanization on demographic changes. Even studies on the population-development interrelation, and particularly those on the demographic impact of development projects ignore the subject, presumably because urbanization helps to shape the desired demographic changes. Studies of population dynamics in large cities, such as that of the large cities of Latin America and the Caribbean (ECLAC, 1994), are therefore infrequent. This section examines the impact of urbanization on: (a) fertility trends; (b) mortality and access to medical services and facilities; and (c) family size, which is a product of fertility-mortality behaviour. Both the World Fertility Survey (WFS) of the 1970s and a series of national Demographic and Health Surveys (DHS) of the late 1980s and early 1990s, report urban-rural differentials in demographic parameters.

A. Urbanization and fertility trends

In the developed countries the demographic transition in the context of modernization and socio-economic development was closely associated with urbanization and the new environment it created for demographic processes. Many studies posit that "urban morality" rather than mere residence in cities, in the long run, creates an environment conducive to fertility reduction, hence the clear distinction between low urban fertility and high and resilient rural fertility. A case in point is France where steeper fertility decline was observed than that of England at a time the latter was more urbanized. In France, urban dwellers were more closely linked to rural residents, thereby exchanging certain norms, while the English migrants into the cities, who were relatively distant from their rural relations, required more time to adjust to urban life. Moreover, the "poor laws" and child labour in England made children invaluable "economic goods". The German urban birth rate also remained high for some time following massive rural-urban migration. In the United States the 1800 census reported a marked difference between agricultural and industrial states (United Nations, 1973: 91). These historical occurrences eventually resulted in low fertility which became the norm rather than the exception in these countries.

Empirical evidence suggests that urban-rural fertility differences became progressively larger during the period of fertility decline, but narrowed during the period of recovery following the Second World War. In Japan rural fertility exceeded urban fertility by some 20 per cent around 1960. The situation in the former Soviet Union and the former socialist European countries was different as urban-rural fertility differences widened in the 1950s (United Nations, 1973: 97).

The World Fertility Survey reports some very pertinent results. In the United States and practically all European countries in which the Survey was carried out, urban fertility is lower than rural fertility (see table 2). The result is consistent for different sizes of residence, both the village and the small town having nearly high and virtually identical fertility and both the large town and the city recording much lower fertility. The conclusion, therefore, is that urbanization has been responsible for fertility decline in the developed countries.

In the developing countries total fertility rate (TFR) remains high, although the picture varies considerably across the regions. Table 2 provides a vivid picture of selected countries in Africa, Asia and the Pacific, Latin America and the Caribbean and one European country (Portugal) still in a comparable stage with some of these countries.

Table 2. Summary fertility measures in the developing world, by type of place of current residence

Table 3. Average number of live births, standardized by duration of marriage in some European countries, by type of current residence and size of place of current residence

Except for the North African countries, sub-Saharan African countries exhibited uniformity in fertility levels in the 1970s. In Asia and the Pacific, Jordan and the Syrian Arab Republic emerged as atypical cases, with some of the highest TFRs recorded during the period under review. The Americas had the lowest fertility levels, but fertility was unusually high in Peru and Venezuela. Every case reported in the table shows that TFR occurring within marital unions did not differ substantially from the general TFR.

Analysis of DHS data undertaken so far indicates that drastic fertility declines have not yet occurred in the developing countries. In the vast majority of countries, fertility decline is reported (with clear urban-rural differentials) but not massive enough to generate enthusiasm.

Table 4 reports fertility levels, desired family size and infant mortality rate (IMR) in selected Latin American cities. It is evident from the table that TFR has declined during the two decades 197()-199(); the correlation between TFR and desired family size as well as IMR is all too clear to necessitate further elaboration.

Some writers have cautioned, however, that urbanization (as a way of life), like education, does not in itself influence fertility change. Rather, it is behavioural and lifestyle changes that accompany or result from urbanization, and which distinguish urban from rural areas. These include education, age at first marriage, female employment opportunities in the modern sector and husband's socio-economic and occupational status and contraceptive use, which differ markedly between urban and rural areas. If urbanization in itself dictated terms, Lagos and Ibadan should not have registered higher fertility than the surrounding rural areas (Morgan, 1975), a situation which also obtains in Uganda (Thomson, 1978). Ruralurban migration also plays an important part because it selects younger and more educated persons who are more predisposed to lower fertility than their rural relations (Ogawa and Hodge, 1986), although this may not apply in most developed countries.

There are differences between urban and rural population growth patterns. According to a recent United Nations Study on Fertility Behaviour in the Context of Development, based on the World Fertility Survey, urban/rural fertility differentials have widened, owing to rapid declines in fertility in urban areas. Several factors account for this phenomenon; women in urban areas desire smaller families, marry later and use contraceptives more often and possibly more efficiently.

Experts have also theorized on the magnitude of rural/urban differences in fertility changes in the course of the demographic transition. It is thought that at the initial stage, urban/rural differences are small. Gradually couples develop preferences for smaller families, and the use of various methods of fertility control spreads among the urban population. Then at the last stage of the transition, urban attitudes and values concerning fertility levels converge and stabilize around low levels. Thus, urbanization has a farreaching effect on the reduction of natural population growth rates, not only in urban areas, but also in rural areas. Paradoxically, urbanization might be the most powerful long-term factor of spontaneous decrease in overall-all rates of population growth.

By having lower fertility, urban areas have improved the lives of urban populations, as they clamour for "quality families" rather than, as in rural areas, quantity. The dictates of urbanization have played an important role in this process and are an encouraging sign; increased urbanization in the developing countries augurs well for the already registered take-off of fertility decline.

Table 4. Latin America: total rate, desired family size, contraceptive use and infant mortality rate in selected countries and large cities (1970-1979 and 1980-1990)

B. Urbanization and mortality in the context of Improved health services

The presumption that urbanization reduces mortality drastically is by no means obvious in empirical studies carried out in different settings. The whole puzzle depends on the size of the population of those without easy access to or who cannot afford urban health services.

Available evidence suggests that in most industrialised countries, mortality differences between urban and rural areas are rather small. This is so, presumably, because both urban and rural areas enjoy virtually similar infrastructure and facilities, those pertaining to health being no exception. In countries such as Denmark, Finland, Poland, Sweden, and the United States there has been in the past an excess of male over female mortality, which has been greater in urban than rural areas (United Nations, 1973: 132). That situation is attributable to heavier male than female rural-urban migration and high sex ratios in urban areas. Another factor is the likelihood of greater numbers of male accidental deaths in urban industries and, indeed, urban areas in general. The unhygienic conditions and complete disregard of environmental sanitation and hygiene in cities of industrialized countries were also an important deterrent; life in rural communities was much better.

As life expectancy at birth points to the health regime of a population, statistics for some developed countries are in order here to show the small urban-rural mortality differential.

Figure 3 shows clearly the trend in two European countries at different historical epochs since the late nineteenth century. Sweden had a steeper rise in life expectancy at birth than Poland, but in both cases the urban-rural differential was small. That for Sweden was 8.2 years between 1881 - 1890 and a mere 0.1 years between 1951-1960, while that for Poland was 2.9 years for males and 5.6 years for females between 1931 - 1932, decreasing to 0.1 years and 0.8 years respectively between 1963- 1965 (United Nations, 1973: 133).

The same trend has been observed for standardized death rates per 1000 population (see figure 4). The urban-rural differential for Norway was 5.8 years for males and 3.4 years for females in 1889- 1892 and 1.5 years and 0.1 years respectively in 1949-1952. For Japan, the differential was 0.9 years in 1920 and non-existent in 1935 (United Nations, 1973: 133) (see figure 4). In both countries, urban death rates exceeded rural death rates. Prior to the twentieth century mortality was generally higher in urban than rural areas of European and North American countries. Finally, infant mortality rate (IMR), which is an indicator of the size of the adult population in the future, has shown a similar trend. Bulgaria recorded an urban IMR of 157.4 compared with a rural one of 155.5 in 1921-1925, which dropped to 26.5 and 38.8 respectively in 1966-1967; Norway's IMR dropped from 135.0 (urban) and 95.1 (rural) in 1856-1860 to 16.4 and 17.8 respectively in 1964 (United Nations, 1973: 134). Again, these confirm the past cases of higher urban than rural IMR.

In the developing countries, lower urban than rural mortality is theoretically possible due to the fact that there is greater concentration of medical facilities and public health services in cities and because of some positive characteristics of urban populations, such as better education, higher incomes, awareness of health problems and better access to medical facilities. But the negative side of the same coin consists of problems of waste and sewage disposal, contamination of drinking water, poor housing conditions and inability of the urban poor to meet the cost of health services, which may increase urban mortality. It is, therefore, difficult to establish the size and direction of urban-rural mortality with certainty.

In Latin America, Asia and Africa, lower urban than rural fertility has been established. Life expectancy at birth is higher in urban than in rural areas. Ghana and Kenya in Africa, Nepal and Sri Lanka in Asia, and Chile and Peru in Latin America exhibit the lowest standardized mortality ratio in capital cities (United Nations, 1985: 253). Results of a series of sample surveys conducted in some French-speaking African countries in the early 1960s showed a consistent picture of lower urban than rural fertility. The Mysore Population Study in India found mortality in Bangalore city to be lower than in rural areas of Mysore State (United Nations, 1973: 136). Indeed, the consistent results are reinforced by the large urban-rural gap in health infrastructure in the developing countries. On controlling for income or education, one is likely to estimate a much larger urban-rural mortality differential. But there are considerable regional variations in each country, depending on the size and infrastructural base of urban centres.

Figure 3. Expectations of life at birth for both sexes in Sweden (1881-1960)

Figure 3. Expectations of life at birth for both sexes in Poland, (1931-1965)

Source: United Nations (1973), table V.15, p.133

Figure 4. Standardized death rates per 1000 population - Norway

Figure 4. Standardized death rates per 1000 population - Japan

Source: United Nations (1973), table V.15, p.133

From the foregoing, it is clear that whereas the impact of urbanization in the developed countries is far from definitive, that in the developing counties is definitely positive. Table 4 shows a steep decline of infant mortality rates in selected Latin American cities in the two decades 1970-1990, which implies the positive contribution of urbanization and all that it triggers.

C. Urbanization and family size

The relationship between urbanization and family size has implicitly been considered in section A above. As can be seen from table 4, in Latin America the desired family size in cities is small and has dropped from the time of the World Fertility Survey to that of the Demographic and Health Survey. It is likely that in urban areas the cost of living, housing limitations and the cost of caring for the diverse needs of children depresses the desire for large families.

Table 5 presents desired family size in the 14 developed countries for which fertility has been reported, based on the World Fertility Survey. Clearly, there is little difference in family size between urban and rural areas, or between the small town and the medium-sized town. There is, however, a clear difference between these categories of residence and the large town and the city, but no clear difference exists between these last two. The pattern of family size in the developing countries follows that of fertility already discussed.

Table 5. Ultimate expected number of children in selected developed countries, by current residence