Urban and Rural Disparities Remain Despite Progress in Closing Health and Development Gaps

A majority of the world’s people live in urban areas, a milestone that was reached only within the last decade. The world continues to become more urban, yet in Africa and Asia, the majority of the population is still rural. Africa will remain majority rural for about a generation.

A new data sheet, The Urban-Rural Divide in Health and Development, looks at the gaps in key development indicators between urban and rural dwellers in many low- and middle-income countries.

Across indicators, those living in urban areas usually fare better than their rural counterparts—young people are more likely to stay in school longer; women marry later and have smaller families; and fewer infants die in their first year. However, rural populations in some countries are closing gaps. Rates of modern contraceptive use in urban and rural areas of Rwanda are nearly level at 47 percent and 45 percent, respectively. In Bangladesh, the urban-rural gap for lower secondary school completion is relatively narrow; likewise, the gender gap in completion within urban and rural areas has virtually closed.

Nevertheless, progress can vary significantly by country, even in the same region. For example, in sub-Saharan Africa, the urban-rural divide in rates of early childbearing are glaring. At the extremes, more than half of young women ages 15 to 19 in rural areas in the Central African Republic have begun childbearing, compared to only 4 percent of young urban women in Ethiopia. In Asia, the total fertility rate ranges from 6.0 lifetime births per woman in rural Timor-Leste to 1.5 in urban Thailand.

Country-level data, however, can mask further disparities within urban areas, where the gaps between the poor and the rich can be striking. The urban poor frequently remain marginalized and may fare no better than rural dwellers. In many developing countries where urbanization is occurring rapidly, infrastructure and services, including health care, and water and sanitation, cannot keep pace, leaving the urban poor unable to find or afford services. Often, the poorest urban children are at least twice as likely to die before they reach their fifth birthday as the richest urban children.1

In Delhi, India, only 19 percent of the poorest fifth of women have a skilled attendant at birth, compared to 99 percent among the wealthiest women. Yet, data at the national level in India show skilled attendance at delivery in urban and rural areas at 76 percent and 43 percent, respectively. In metropolitan Port au Prince, Haiti, only 36 percent of the poorest women receive the recommended minimum number of four antenatal care visits, while 87 percent of the wealthiest women receive at least four visits.2

Looking toward the post-2015 development agenda, the international community is emphasizing the beneficial effects of family planning on maternal and child health and the economic well-being of individuals, families, and nations.

As a measure of progress in family planning, experts are tracking a benchmark indicator—the percent demand for family planning satisfied by modern contraceptives—to better support improvements in policies and programs. This indicator is defined as the percent of women (or their partners) who desire to have no further children or to postpone the next child who are currently using a modern method of contraception. In many of the most economically advanced countries, more than three-fourths of the demand for family planning is satisfied with modern contraceptives.3 Although most low- and middle-income countries lag behind, especially in sub-Saharan Africa, in the urban areas of Kenya and Zambia, rates are hovering around 75 percent, comparable to the rates in the economically advanced countries.


  1. Save the Children, State of the World’s Mothers 2015: The Urban Disadvantage (Connecticut, USA: Save the Children, 2015).
  2. State of the World’s Mothers 2015.
  3. Madeleine S. Fabic et al., “Meeting Demand for Family Planning Within a Generation: The Post-2015 Agenda,” Lancet 385, no. 9981 (2015): 1928-31.