Albania: Trends and patterns, proximate determinants

For a very long time, Albania has had one of the highest levels of fertility in Europe: in 2002 the total fertility rate of 2.2 children per woman was the highest in Europe. Although this current level is high, the country has experienced a rapid fertility reduction during the last 50 years: a TFR decline from 7 to 2.2. This reduction has occurred in the absence of modern contraception and abortion, which indicates the significance of investments in the social agenda during the communist regime that produced policies with indirect effects on fertility. Most significant of these were policies focused on education, in particular on female education. Social and demographic settings for a further fertility reduction in Albania have been present since 1990. Contraception and abortion have been legalized and available since the early 1990s, but knowledge of their use is still not widespread in the country, largely due to the interplay between traditional and modern norms of Albanian society. This chapter points out that future fertility levels will be determined not only by new policies that might be introduced, but predominantly by the balance of this interplay. 1 London School of Economics. E-mail: [email protected] 2 Bocconi University. E-mail: [email protected] 3 University of Torino. E-mail: [email protected] Gjonca, Aassve & Mencarini: Albania: Trends and patterns, proximate determinants and policies 262 http://www.demographic-research.org 1. Socio-economic development in communist Albania 1950-1990 It is difficult to understand any achievements or setbacks in the development of Albania without considering the impact of communist rule in the second half of the twentieth century. In the aftermath of the Second World War, the communist regime faced an unparalleled task: not only did it have to re-build a country destroyed by the war, it also had to create a modern country from the ruins of a semi-feudal society. The economy was in a shambles: farming was the main economic activity, involving about 85% of the population; heavy industry was limited and focused primarily on the extraction of a few minerals, despite the country’s wider wealth of mineral deposits. The country had no large industrial establishments; instead it had primitive forms of cottage industry supplementing agriculture or stock-raising activities (Mason et al. 1945). Industrial output had made an insignificant contribution to the country’s economy since the start of the Italian occupation in the late 1930s. The post-war Albanian government followed a policy not unlike that of other socialist countries in order to accomplish its development strategy. Emphasis was placed on the development of an industrial base to bring about basic structural changes and a balanced development of agriculture. The country’s goal was set as the transformation of Albania from an agricultural society (85% of the population being rural in 1939) to a developed industrial-agricultural one. Although the Albanian government tried to keep a balance in its policy of development between agriculture and industry, the main focus of its development for 50 years was the industrialization of the country. The government based its policy on the Stalinist model of rapid industrialization, developing both light and heavy industry, and the principle of longterm economic planning was adopted. At the end of the second five-year plan in 1955, it was announced that a light industrial base was to be created, and that Albania had now become an agricultural-industrial country. The total output of the mineral industry increased dramatically. In the later Albanian economic plans the focus remained the intensification of industry, but now with a more difficult priority the development of heavy industry for Albania. Until the mid-1970s, the Albanian government was moderately successful in industrializing the economy and the income per capita increased rapidly at an average of more than 8.2% a year (Gjonça, Wilson, and Falkingham 1997). The government’s rapid industrialization policy led to the creation of a relatively modern multi-branched industrial sector, which by 1985 was generating 43.3% of the total national income (Golemi and Misja 1987). After the break with China in the late 1970s, however, the industrial sector and the rest of the economy soon showed signs of decline. Despite the progress of the early decades, by the end of communist regime Albania emerged as the Demographic Research: Volume 19, Article 11 http://www.demographic-research.org 263 poorest country in Europe with a gross national product (GNP) per capita of about US$380 (World Bank 1996). There were two significant demographic consequences of the industrialization of the Albanian economy. The first was the change in the rural-urban ratio. The urban population grew from 15% in 1938 to 36% in 1989, and to almost 50% by 2001. The industrialization brought important changes in the working pattern for women, who made up 47% of the total labour force in 1989 (INSTAT 1992). A new social system was needed for a patriarchal and agrarian society, in which more than 80% of the population lived in extreme poverty (Mason et al. 1945). The health of the population was extremely poor, with malaria and tuberculosis being widespread: twenty percent of the population was infected with malaria (Skendi 1956), while tuberculosis accounted for 17.8% of all deaths (Gjonça 2001). Other infectious diseases (such as smallpox, typhus fever, and syphilis) were prevalent across the country. Just after the Second World War, life expectancy at birth was no more than 50 years for both sexes. Infant mortality was at unprecedented levels for the region at 148 infant deaths per 1000 live births. This was higher than that of any of the neighboring Balkan countries, such as Greece, Yugoslavia, Romania, and Bulgaria. By the end of the 1990s the communist government could rightly claim a success story with respect to improvements in the health and survival of the population. Life expectancy at birth had improved to 70.7 years and the infant mortality rate was reduced to 45.4 deaths per 1000 live births (Gjonça 2001). By 2000 these figures had further improved, with life expectancy for both sexes reaching 74.4 years and infant mortality further reduced to just 22 deaths per 1000 live births. The social system in Albania in the aftermath of World War II (WWII) was also in a dreadful state. Large regions of the country did not have access to basic standards of hygiene, medical needs, or education. There was no access to safe drinking water in most areas of the country and only a few cities had a central water provision. For the majority of households drinking water was obtained from private wells. There were only ten hospitals in the country and they could not even cope with the needs of the populations of the main cities. Most of the country’s population did not have access to a medical doctor in their own locality, and going to a hospital would involve traveling, sometimes for a whole week. The number of medical personnel was very low. There were about 1.1 doctors per 10,000 people, and the investment in health was only 1% of the state budget. The total investment in the social agenda was very low. Illiteracy was widespread. More than 80% of the population was illiterate and female illiteracy stood at 92% (Publishing House 8 Nentori 1982). It was more widespread in the rural areas and the undeveloped north-eastern part of the country. The communist government took improvements in education seriously and a campaign against illiteracy was one of the first to be introduced in 1947: in a very short period of Gjonca, Aassve & Mencarini: Albania: Trends and patterns, proximate determinants and policies 264 http://www.demographic-research.org time, by the start of the 1970s, illiteracy was eliminated for people under 40 years of age; by 1989 the proportion of illiterates in the population was less than 8%; and by 2001 it was 5.6% (INSTAT 2004b). The social organization was based on a patriarchal system that disadvantaged women in all aspects of their social life. The social structure was basically tribal in the north and semi-feudal in the centre and south of the country, with kinship and descent playing central roles. The basic unit of society was the extended family: a married couple with their married sons and their offspring, as well as any unmarried daughters. This extended family was the basic single residential unit and the basic economic entity. The size of these families was very large, and by the end of WWII some numbered as many as 60 to 70 members. There was no social security system at the end of WWII: it was first introduced in 1947. While it initially covered only a fragment of the population, by 1967 the social insurance program covered most of the population.