Tag Archives: birth control

A commentary on population and development in Kenya

The theme of Kenya’s National Leaders’ Conference on Population and Development, November 15-17, 2010 is “managing population to achieve Kenya Vision 2030”. Vision 2030 is the national blueprint for long-term development which aims to transform Kenya into “a newly-industrialising, middle income country providing a high quality of life to all its citizens in a clean and secure environment”. The Vision is anchored on three key pillars: Economic; Social; and Political Governance. This conference comes in the wake of the release of the 2009 Population & Housing Census , in which Kenya’s population is estimated at 39 million, with the population growth rate calculated at 2.5 percent over the period 1999-2009. A lot of concern has been expressed on the revelation that Kenya’s population increased by about a million people annually over that period, and that the population is projected to reach 64 million by 2030.

Kenya’s population growth rate increased steadily from 2.5 percent in 1948, peaking at 3.8 percent in 1979, this being one of the highest growth rates ever recorded. In 1989 the population growth rate began to decline, to 3.4 percent and further down to 2.5 percent in 1999, a level that has been sustained to 2009. The current population growth rate (of 2.5 percent), is still considered to be high, and owing to the past growth rates the population is still youthful with nearly half being aged 18 years or below. This is what has been dubbed demographic momentum– a phenomenon of continued population increase despite reducing fertility rates, which is brought about by waves of large populations of young persons entering reproductive age in successive years. This may in part explain the addition of one million people annually to Kenya’s population, as referred to above.

From the above, it is indeed a disconcerting thought for family planning advocates; to realize that there is a limit as to what birth control per se can do to significantly curtail Kenya’s population increasing trend over several decades! Perhaps the attention should change to finding out how to take advantage of the population momentum to improve our economy, so as to provide a high quality of life to all Kenyans, as envisioned in Vision 2030. Nevertheless, family planning will continue to play a central role in measures taken to improve the economy.

Can Kenya make use of the demographic momentum; make it a source of strength, not a threat? This is exactly what the so-called Asian Tigers did. They were faced with a situation similar to Kenya’s- coming from decades of high fertility that had generated huge population momentum. With better planning and viable economic policies they were able to unleash a healthy and better-educated workforce with fewer children to support and no elderly parents totally dependent on them. It can happen here; with adoption of social, economic, and political policies that allow realisation of the growth potential of our youth across the country, Kenya’s large youthful population can become our boon not our bane. To that end, family planning will remain a key driver of Kenya’s sustainable economic growth now and in the foreseeable future.

The government statement that “critical investment will be required in family planning services, health and other social and economic sectors to improve the welfare of Kenyans” is welcome. However, it needs to be followed by a critical review of the factors that have interfered with the effectiveness of Kenya’s Family Planning Programme; there is need to ask ‘what went wrong? In my view, these factors fall in two broad categories: First, an uncertain environment for effective promotion of birth control measures (political commitment; gender equity; child survival, among others), and second, serious chronic institutional weaknesses that interfere with effectiveness of the family planning programme (coverage of FP services; commodity security; quality of services and care, among others). Hopefully, the Leaders’ Conference may address these issues.

Related link

Kenya’s Rapid Population Increase: Our bane, boon or both

A commentary on Unsafe Abortion in Africa

Unsafe abortion remains a major contributor to the unacceptably high levels of maternal morbidity and mortality rates that prevail in Africa. It also continues to be one of the formidable challenges to the achievement of Millennium Development Goal 5 of improving maternal health by 2015. This is despite the many meetings and conferences that have addressed the issue over the last four decades, one of the earliest being the IPPF Regional Conference on Family Welfare and Development in Africa, Ibadan, Nigeria, August/September, 1976, where I was privileged to present a paper entitled Abortion in Africa[1]. Perhaps the most recent meeting is the Ipas[2] sponsored conference in Ghana (November 8-11, 2010), entitled “Keeping Our Promise: Addressing Unsafe Abortion in Africa”.

The persistence of unsafe abortion in Africa is, ultimately, perpetuated by two key factors: (a) the restrictive laws against termination of pregnancy; and (b) the limited or lack of access to adequate abortion services. Criminalisation of abortion in majority of African countries is something inherited from the colonial laws, despite the fact that the law has since decriminalised the procedure in the colonial “mother countries” (United Kingdom 1967; France 1975; Italy 1978; Spain 1985; Belgium 1990). On the other hand, it can be observed that passing of laws for or against abortion has little effect on the numbers of abortions that take place; in fact, the only difference is that the patterns of morbidity and mortality associated with abortion change. Stringent laws against abortion will not deter women in need from going through with an abortion, the only thing such laws achieve is to push many of them to undergo unsafe procedures with consequent high rates of morbidity and mortality. The procedure of medical termination of pregnancy is simple, short and safe when undertaken in the open, by trained persons; however, carried out in secrecy, usually by unskilled operators, it is expensive, unsafe and life threatening.

Obviously, like many other freedoms- legalisation of abortion may be abused, when abortion becomes a primary method of birth control, as happened in the former USSR. Increased access to contraception since the collapse of the Soviet Union, has led to a reduction in the numbers of abortions in Russia. However, it should be realised that induced abortion may still be the only means of birth control for many women in some parts of Africa, i.e. women who have very limited access to contraception, including adolescents and youths who are denied not only the services but also information on sexuality, on moralistic grounds. For such women, the desire to do away with an unwanted pregnancy can be so intense that they will avail themselves of this last resort despite the law, or the attendant risk to their lives. Sadly, many of these women live in countries where penal codes do sanction abortion under certain conditions but they are unaware of this provision; or, for various reasons, they cannot access safe abortion services in their countries.

Evidence from the Demographic and Health Surveys, over the last three decades, shows that women (and men) in most parts of Africa have increasingly taken to contraceptive practice. For anyone who chooses to practice contraception the hope is that it would not fail her or him. The shock of the discovery that this is not so, though infrequent, can drive the hapless individual seeking termination of the pregnancy. For most people it follows logic that if contraception is acceptable, then consideration for abortion should follow where there is failure- this is why in many countries medical termination of pregnancy is an accepted second line of defence against unwanted pregnancy.

Finally, in addressing the issue of unsafe abortion particular focus is needed on ensuring equity in access to health care, especially for the poor and marginalised communities, who are the main victims of quacks in backstreet clinics. Despite the absence of supportive data at this moment, it is highly possible that in many African countries, considerably more induced abortions occur among the wealthier and more mature women than among the poor young single women, that are often reported from public institutions. It is the latter that sustain Africa’s high abortion-related maternal mortality rates, and who will make it impossible to attain national and international goals, if they are left ‘out of the loop’.

Related Link

On The Abortion Question

[1] Mati JKG. Abortion in Africa. In Family Welfare and Development  in Africa. Proceedings of IPPF Regional Conference, Ibadan, Nigeria, August/September,1976.

[2] http://www.ipas.org/Library/News/News_Items/Keeping_Our_Promise_Addressing_Unsafe_Abortion_in_Africa.aspx Conference co-sponsored by FEMNET, Ghana Ministry of Health, IPPF Africa Regional Office, Marie Stopes International and the United Nations Economic Commission for Africa. A BBC interview on this conference is available on http://www.bbc.co.uk/worldservice/africa/2010/11/101109_ghana_abortion_conference.shtml

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