Before HIV: sexuality, fertility and mortality in East Africa, 1900–1980 by Shane Doyle (review)

Throughout most of the twentieth century, Africa experienced spectacular population growth. Indeed, as Shane Doyle identifies here, from the 1920s to the 1960s, one corner of the continent – the former District of Ankole, in south-western Uganda – even experienced the fastest rate of demographic increase ever recorded in human history. Yet if demographers and historians have long recognized this extraordinary growth, they have also disagreed as to precisely what caused it. Specifically, argument has generally divided into two camps, between those who, on the one hand, emphasize the effects of early colonial maternal and child healthcare in raising fertility, and those who, on the other, focus upon a wide range of factors – from healthcare, to new economic opportunities, to education, and so on – that brought about declining mortality. For the latter scholars, African fertility has been always very high anyway, and so is not particularly useful for trying to explain any patterns of population change.

Doyle’s study makes an important intervention in these debates. It begins with the observation that previous discussions on Africa’s twentieth-century population growth have tended to rely on country-level data, and have thus failed to adequately identify or explain sub-national variations. Furthermore, it argues that, despite the at times vitriolic debate between the two camps identified above, they have in fact shared much more in common than is usually recognized – in particular a general agreement that Africa’s twentieth-century rapid population growth was in some way an outcome of the wider transformations of ‘modernization’. In addition, both sides have been too reliant upon crude characterization of a general ‘African sexuality’, and have thus failed to pay adequate attention to the ways in which fertility rates may have changed in different places, and at different times, in line with changes in patterns of sexual attitudes and behaviours.

Against all of this, Doyle’s study is framed as a comparison of three sub-national regions – the aforementioned Ankole; the region of Buganda in central Uganda, including the capital Kampala; and Buhaya in north-western Tanzania – which is used to show how, at this regional level, the relationship between population change, modernization and fertility was, throughout the twentieth century, much more complicated than has previously been recognized. Specifically, all of these areas, despite their many similarities and historic interconnections with each other, had quite different and changing experiences of twentieth-century modernization, defined in terms of new systems of healthcare and education, the introduction of cash cropping, new forms of economic migration, and an expansion of urban centres. Between Idi Amin’s economic reforms and Tanzania’s socialism, they also experienced different independent histories. As a result, the three regions went through different shifts in sexual attitudes and practices at different times, which in turn had differential (and at times counterintuitive) effects upon patterns of fertility.

To cite just a few examples from this complex and changing landscape, between 1920 and 1960, Ankole had relatively little exposure to the various elements of modernization, as a result of which its more conservative traditions of sexual control remained largely intact. Ironically, however, this is what explains the massive population growth that the region experienced during that period. Elsewhere, during the 1960s and 1970s, central Buganda experienced rapid urbanization and new forms of urban sociality, which in turn significantly expanded sexual freedoms for both men and women. However, these resulted in a decline in fertility, gradually at first and more rapidly as the 1970s progressed. Meanwhile, between 1925 and 1969 in Buhaya, the pattern was different again, with increased cash cropping generating land shortages, which forced young men to delay marriage and eventually led to a rapid expansion of commercialized sexual relations. Yet the effects of this upon fertility were more complicated, and varied over time.

In addition to the wider contribution it makes to demographic history, the major significance of this book...