Will Urban and Rural Mortality Converge in Africa?

During colonization and the first decades of independence, mortality underwent a major transition in Africa, from very low levels of life expectancy to average levels for the period. At the same time, urbanization developed rapidly from very low levels to about 40 % in recent years. Because of data availability, mortality changes are better documented for infants and children but they also affected young adults. In almost all countries for the 1950–1985 period, mortality decline was faster in urban areas than in rural areas. This occurred for a variety of reasons, and mainly because the city concentrated health services, basic hygiene, wealth and modern education. However, since the mid-1980s, mortality changes were more contrasted, and a number of cases of “health regressions” were noted, characterized by stagnating or increasing under-five mortality. On average, over the past 25 years, urban mortality stagnated while rural mortality continued to decline for the continent as a whole, with large differences by country. The study builds on an earlier reconstruction of under-five mortality trends in urban and rural areas in 37 countries of sub-Saharan Africa. It focuses on cases where urban and rural mortality tended to converge in the recent years, after years of faster decline in cities and towns. Three countries where rural mortality became lower than urban mortality in recent years are further investigated: Sierra Leone, Tanzania and Zambia. Reasons for these cases of convergence are investigated, in particular health policies and disease control programs, emerging diseases (e.g. HIV/AIDS), macro-economic policies (e.g. structural adjustment policies), and the dynamics of socio-economic correlates (urban poverty and rural education).