to 31 deaths of children under the age of 1 per 1,000 births in Honduras (23) and Nicaragua and Guatemala (31), reflecting poor living conditions and high economic and social vulnerability (United Nations 2019a, Mort/7-3).
– The third group includes four countries, Haiti, Bolivia, Guyana and Suriname, whose female life expectancy at birth is lower than 75 years. These are the poorest countries in Latin America, with many economic and political difficulties, and high social inequality (CEPAL 2019). Infant mortality in Haiti is 64 and in Bolivia it equals 42 deaths of children under the age of 1 per thousand births, which are very high levels (United Nations 2019a, Mort/7-3).
It should be noted that the remarkable progress made in the fight against mortality has been achieved in a coordinated manner. The Pan American Health Organization (PAHO)18, founded in 1902, has organized medical and sanitation programs in all Latin American countries (installation of drinking water, sewage systems, massive vaccination campaigns, fight against yellow fever, malaria, tuberculosis, measles and other infectious and parasitic diseases). From 1950, they effectively reduced infectious and parasitic mortality, as well as infant mortality, regardless of the population’s living standards, by taking advantage of the discoveries of developed countries. However, during the economic crisis of the 1980s (the lost decade), programs to combat mortality experienced funding restrictions, causing the return of malaria and measles (Cosio Zavala 1998, pp. 39–40). With time, new infectious diseases came into existence, such as AIDS, dengue, Zika, chikungunya and Covid-19.
In 2017, the PAHO declared that in Latin America and the Caribbean, the Millennium Development Goals (MDGs) had all been achieved in 2015, except for MDG5 on maternal mortality. The PAHO is also responsible for monitoring the sustainable development goals (SDGs) in progress, including SDG3 on good health and well-being (PAHO 2017).
Figure 1.1. Female life expectancy at birth per 5-year periods, 1950–2020. LAC (Latin America and the Caribbean) group and selected countries
(source: United Nations 2019a, Mort/7-3). For a color version of this figure, see www.iste.co.uk/charbit/demographic.zip
1.5.2 The period of strong population growth
A period of strong growth in the Latin American population began in the mid-20th century, following the decline in mortality. Between 1950 and 1970, natural increase rates rose to over 2.5%, reaching 2.75% per year between 1960 and 1965 (Cosio Zavala 1998). This was a consequence of the decrease in mortality, increase in nuptiality and high fertility. Indeed, a Latin American union boom was observed between 1950 and 196019. The percentages of women in union increased, with particularly early unions and universal nuptiality (as was the case of Nicaragua between 1950 and 1960, where 60% of women between 20 and 24 years old were in union, as well as 97% of women aged 50). It was only in the southern countries of South America (Argentina, Chile, Uruguay) that unions came later, although these increased during the period of the union boom (Camisa 1978).
Fertility in Latin America remained very high before 1965, and all countries showed indicators of between 6 and 7.4 children per woman, with the exception of a few countries with moderate fertility (between three and five children per woman), such as Argentina, Chile, Cuba and Uruguay (United Nations 2019a, Fert/4). High fertility was the result of the association of a lasting marital life, natural fertility in couples (who did not control their births), early and intense nuptiality, the decline in mortality which reduced intrauterine mortality and widowhood (divorce being very rare in those times) and the reduction in the infertility of couples, thanks to medical, nutritional and health progress.
1.5.3. New reproductive behavior
After 1965, fertility was quickly transformed in Latin America and the Caribbean. We can identify four fertility transition models, as follows:
– An early transition that occurred, since 1900, in Argentina and Uruguay, with a total fertility rate in 1960–1965 of 3.1 and 2.9 children per woman, respectively (United Nations 2019a, Fert/4). These countries had a particular history: strong immigration of European origin, fast urbanization and good living conditions since the end of the 19th century. Immigrants from Italy, Spain and Eastern Europe arrived as carriers of the family standards from their home countries, where the fertility transition had already started. Fertility decreased throughout the 20th century, and did so until 2015–2020, slowly but steadily, then accelerated at the end of this period (Figure 1.2).
– A transition that started around 1965 in Cuba20 (4.7 children per woman in 1960–1965) and in Chile (4.6 children per woman in 1960–1965) (United Nations 2019a, Fert/4). High education and urbanization made it possible to reduce fertility, reaching 1.9 and 2.6 children per woman in 1980–1985, with a drop of 60% and 40%, respectively. In the second period (1980–2015), the decline continued in these two countries, but at a slower pace (Figure 1.2).
– An accelerated transition that occurred between 1965 and 2015 in Brazil, Colombia, El Salvador, Ecuador, Mexico, Peru, Panama, Dominican Republic and Venezuela. In this group of countries, fertility in 1960–1965 oscillated between 6 and 7.4 children per woman, then between 3.5 and 5 children per woman in 1980–1985, and finally, in 2015–2020, between 1.7 and 2.5 children per woman. In Colombia and Costa Rica, the reduction in the total fertility rate was 46% between 1960 and 1985, and greater than 30% in Brazil, Mexico, Panama and Venezuela (United Nations 2019a, Fert/4).
– A late and extremely rapid transition that occurred in Bolivia, Guatemala, Haiti, Honduras, Nicaragua and Paraguay. These countries maintained a high fertility level in 1980–1985, with values between five and six children per woman. The decline in fertility after this date reached a reduction equal to or greater than 50%, and fertility in 2015–2020 oscillated between 2.5 and 3 children per woman (United Nations 2019a, Fert/4).
Figure 1.2. Total fertility rate in Latin America and the Caribbean (LAC): 1960–1965, 1980–1985, 2015–2020
(source: United Nations 2019a, Fert/4; LAC group and selected countries). For a color version of this figure, see www.iste.co.uk/charbit/demographic.zip
Consequently, fertility converged in the region after 1965. All countries, regardless of their reproductive history, showed fertility levels between 1.6 and 3 children per woman in 2015–2020, whereas the starting levels in 1960–1965 ranged from 2.9 in Uruguay to 7.4 children per woman in the Dominican Republic. This transformation of Latin America’s fertility rate can be explained by the contraceptive revolution that occurred between 1965 and 1990, and by Malthusian poverty.
In 2019, contraceptive prevalence in Latin America and the Caribbean rose to 58% of women aged between 15 and 49 years using contraception methods. Female sterilization predominated, with 16% users for the whole region, 30% in the Dominican Republic and more than 20% in El Salvador, Colombia, Ecuador and Mexico. The pill follows with 15% for the Latin American average, but 30% in Brazil. Sterilization is the first female method in Cuba (25% of users), and 24% of Cubans use the IUD, in a country where many legal abortions occur21 (United Nations 2019b).
The
