Population Dynamics of Africa
May 30, 2013
Pathfinder International's film "Female Condoms Are… Power. Protection. Pleasure," based on their female condom work in Mozambique, has won the international "Female Condoms Are…" film contest.
The winners were announced at the recent Women Deliver conference in Kuala Lumpur. Women Deliver is the largest global meeting of the decade to focus on the health and well-being of women and girls.
"The female condom is still relatively unknown in Mozambique and throughout the world, so providing correct information and overcoming social and cultural barriers are our primary goals." -Candace Lew
Pathfinder's entry was inspired by Pathfinder staff who saw an opportunity to take part in the interesting and engaging conversation on female condoms taking place across the globe. Rita Badiani, Pathfinder's Country Representative in Mozambique said “We have been inspired by the female condom project's interesting approach to disseminating information and increasing use of the female condom through support from female condom user groups and wanted to share that with the world."
Female condoms are the only female-controlled method for preventing pregnancy and sexually transmitted infections, such as HIV. They also help women of all ages better negotiate safe sex in cultures where gender norms often prevent them from doing so.
Women from the communities in which Pathfinder works are invited to participate in monthly meetings to discuss health-issues in a safe, communal setting where they can bond and develop friendships and a sense of solidarity with their peers.
Egypt imports about half of its food; however, its foreign currency reserves have been shrinking dramatically and without more external aid, it's difficult to see how Egypt will manage to feed itself.
Recently Qatar, Turkey, and Libya pledged $6.2 billion so that Egypt could continue to purchase wheat, cooking oil, and other staples, but without a continuous flow of aid, it is hard to see how Egypt survives. Egypt has been trying to negotiate a $4.8 billion loan from the IMF, but the IMF is not an international relief agency; it expects its loans to be repaid and will not extend credit when repayment is not made.
Egypt has more people than Saudi Arabia, Jordan, Palestine, Syria, Lebanon, Libya, and the United Arab Emirates combined. Egypt is also heavily dependent on diesel imports to transport its food and run its agriculture machinery. One-third of its population is under the age of 15, and it is estimated that 40% of Egyptians are living on less than $2 a day. In 13 years or less, Egypt's population, currently 82 million, is projected to reach 102 million, and by 2050, 135 million.
With political instability in recent years, Egypt can no longer rely upon tourism to pay the bills. And without a healthier economy, there's no end in sight to the political unrest.
Egypt's poor and middle class are heavily dependent on government food and fuel subsidies for their economic survival. The IMF is insisting that the government agree to trim them on the claim that they are wasteful. However, trimming them would almost certainly fuel widespread protests and further undermine the government.
President Morsi is banking on the large number of Egyptian young people as a source of potential economic strength, hoping that Egypt will soon join the emerging economies of Brazil, Russia, India, China, and South Africa. Not likely. It would take a whole lot of education and foreign investment to productively employ Egypt's youth; Egypt is just too big.
If Egypt had curbed corruption, educated more girls, empowered women, and instituted economic reforms two or three decades ago, it might have had a fighting chance of turning its demographic corner and joining the BRICS, but its food and foreign currency reserves are steadily shrinking and its population and number of unemployed youth are rising.
In the end, Egypt may be too big and too late to save.
Other countries may see similar dim prospects. Syria is a political nightmare. Yemen's capitol city, Sanaa, could run out of water by the end of this decade. Saudi Arabia is estimated by Citigroup Inc. to be a net oil importer by 2030.
In Africa it was a matter of pride for a man to build his own home at age of 18 and marry. However, with colonialism came imperialism and taxes on people's homes. To escape the taxation, people moved to urban areas where their make-shift dwellings grew into slums. These settlements which lacked proper planning,
With an urbanisation growth exceeding 5% per annum, Uganda is grappling with rural-urban migration with its resultant effects such as high crime rates, unemployment, slums development and poor sanitation.
At independence, Uganda's population was six million. Through the years, however, a steady growth estimated at over one million annually, increased pressure on land, forcing many to open up formerly inhabitable spaces.
From 1964 attempts were made to provide low-income housing and access to infrastructure and services at affordable costs.
Following the UN general assembly resolution of 1987 on the International Year of Shelter for the Homeless, the Government commenced the development of the National Shelter Strategy that was adopted in 1992.
Uganda has been using the strategy for the last 20 years to guide the blossoming housing sector, says Agnes Kalibbala, the director of housing at the lands and housing ministry.
"The strategy is designed to put in place an environment that enables people to access housing, cheap land, housing finance and building materials," Kalibbala said.
Informal settlements have gone on to be a big problem, not helped by overcrowding, considering that a household in Uganda on average boasts five persons.
Today, Uganda has 33 million people, yet land supply is fixed. It is for this reason that settlement around wetlands, forests and mountain ranges has increased, blighted by the soaring demand for land that attracts profitable returns.
With 5.8 million in urban areas and 28.3 million in rural areas, the country has an estimated 6.82 families living in 6.2 million poor housings. Of these, 84% are temporal, while 28% are made in traditional materials, according to the 2009/10 Uganda National Household Survey.
46% of the houses are traditional, constructed out of mud and poles, and 73% of houses have earthen floors. Iron-sheet roof cover 63%, whilst grass thatched roofs cover 35%.
There is a backlog of 1.6 million housing units, comprising sub-standard and structures not intended for human habitation.
To fix the housing problem in Uganda, the Government is in the final stages of developing a National Housing Policy to guide housing development, slum upgrading and prevention and repair and maintenance of existing housing stock in order to fix the runaway housing deficit.
The policy intends to ease land access as land owners who lack the capacity to develop their property will be encouraged to enter joint-ventures with investors, land-sharing schemes or leasing, says Samuel Mabala, the commissioner of urban development in the ministry of Housing and Urban Development.
"We expect positive development in public-private partnerships in the housing sector because the Government does not have resources to fund this," he says.
“The Government will also provide incentives to attract housing and financial institutions and ensure housing cooperatives are started to enable people save and mobilise resources for housing development."
In Malawi women have an average of 5.8 children. 40 years ago the average was 7.2 children. A study by the African Institute for Development Policy and Population Action International noted that Malawi's population grew from 3 million in 1950 to 15 million in 2010, and is projected to reach 50 million by 2050. The study's authors warn that rapid population growth is increasing food insecurity, environmental degradation and poverty levels.
In addition, Malawi has one of the highest maternal mortality rates in the world, with 800 Malawian women dying every day from labour- or pregnancy-related problems, the Aspen Institute's Global Leaders Council for Reproductive Health (GLC) says.
Funding to developing countries for family planning, as a proportion of all overseas health development assistance, fell from 8.2% in 2000 to just 2.6% in 2009, according to GLC.
Despite this decrease in funding, a recent study by USAID found that the percentage of Malawian couples using contraception rose from 7% in 1992 to 42% in 2010. This was attributed to the combined efforts of the government, NGOs and international donors, which, besides increasing access to family planning services, have also helped create a "culture of acceptance" at the community level.
However the urban and rural areas see big differences in family planning services. Rural areas have long distances from health centers, traditional taboos, values that discourage family planning, and poverty to hinder women from accessing family planning services. Many women who are economically dependent on their husbands are unable to make their own decisions, even those relating to their reproductive health.
Most public sector clinics only offer hormonal injections (Depo-Provera), condoms and contraceptive pills, while NGOs provide more choices, such as Marie Stopes International, provides long-acting and permanent methods, including intrauterine devices, implants, tubal ligations and vasectomies, as well as mobile services. Some also offer emergency contraception.
One client says the pill is inconvenient as it has to be taken every day. She ruled out condoms because they are controlled by men. Married with one child, she is using hormonal injections to control the size of her family.
The demographic dividend is often thought to be imminent and within grasp. However, even though child survival has greatly improved in developing countries, birth rates are still high in many of them. These countries will find it difficult to reach their full economic potential unless they act today to increase their commitment and investment in voluntary family planning.
A demographic dividend works if there are fewer births each year, so that a country's young dependent population grows smaller in relation to the working-age population. With fewer people to support, a country has a window of opportunity for rapid economic growth if the right social and economic policies developed and investments made.
In the world's least developed countries, more than 40% of the population is under age 15 and depends on financial support from working-age adults. Another 90 million people between ages 15 and 19 are on their way to becoming financially independent as they enter adulthood. Large numbers of young people can represent great economic potential, but only if families and governments can adequately invest in their health and education and stimulate new economic opportunities for them.
However, if the number of children per woman is high, children and adolescents greatly outnumber working-age adults, and families and governments will not have the resources needed to invest adequately in each child.
25% of women in developing countries want to avoid becoming pregnant or delay or space their births but are not using a modern family planning method, accounting for almost 80% of unintended pregnancies. As a result, the populations of these countries are growing very quickly -- as much as 3% or more per year. Such a high growth rate could double the number of people in these countries in just 23 years.
When women can choose when and how often to become pregnant, they are more likely to have fewer children and are better able to achieve their desired family size.
Population growth can also be slowed by delaying the age at first birth. In countries with the highest fertility rates and lowest average age at marriage (mainly in sub-Saharan Africa and South Asia), growth can be slowed by 15-20% by delaying marriage and childbearing by five years.
Even though some countries with high fertility and low development exhibit relatively high levels of economic growth, the growth has not improved the living standards of most people, due to disparity of wealth. Until these countries have more substantial reductions in fertility and complete a demographic transition, the opportunity for a demographic dividend will be delayed for decades.
In a forum organized by UNFPA Niger, 80 traditional chiefs have signed a statement of commitment to raise awareness of the crucial inter-relationship between literacy, education and reproductive health. The high turnout included three influential Emirs of Niger - the Sultan of Zinder, the Sultan of Dosso, and the Sultan of Matame.
The Declaration is committed to highlighting family planning, to all children receiving at least secondary school-level education, and to the need to end child marriage. It also recognizes the inter-relationship between demographic growth, development and poverty, and calls for boys and men to be involved in reproductive health issues, modelled on the "Husbands' School", a strategy to involve men in health promotion and foster change at community level.
Recently, the UNFPA's State of World Population 2012 report declared, "the use of modern methods of family planning has increased in recent years in Eastern Africa, particularly Ethiopia, Malawi and Rwanda but there has been no increase in use of modern methods in Central and Western Africa."
Arthur Asiimwe of the Rwanda Biomedical Centre/Health Communication Centre, claimed Rwanda's success was due to increased rollout of family planning tools across the country which are freely accessible at all healthy facilities and the use of community health workers to mobilize and sensitize mothers towards family planning. The Centre also came up with new measures like vasectomy. Rwanda decline in pregnancies among adolescents was due to intensified sexual reproduction education within schools, said Asiimwe.
The UN report said that failure to meet sexual and reproductive health needs of adolescents and young people contributed to high rates of unintended pregnancy and HIV. It also reported that births among adolescents were declining in most regions but the rate of decline has slowed in some parts of the world. In sub-Saharan Africa, over half of young women give birth before age, and adolescent fertility in most countries in sub-Saharan Africa has shown little decline since 1990.
The report points out that making voluntary family planning methods available to everyone in developing countries would reduce costs for maternal and newborn healthcare by $11.3 billion annually.
In Malawi, more women are asking for female condoms, which give them options to protect themselves from HIV, and plan their families. They wouldn't have to rely on their partners to initiate condom use. They could have the opportunity to protect their own health.
Unfortunately, many decision makers are stuck on the pervasive myth that no one wants female condoms, and therefore there is not an adequate supply.
The Hunger Project-Malawi (THP-Malawi) began female condom distribution using peer educators. They distribute 30,000 female condoms every three months in the handful of communities they serve. They added male peer educators once they realized that almost half the people asking for female condoms were men. In Zimbabwe, one organization sold 2 million female condoms in 2009. In Nigeria, 1.4 million female condoms were distributed in 2011, approximately eight times the number distributed just two years earlier.
Despite all this proof of demand, advocates find they must still fight to convince donors and governments to invest in female condoms.
South Sudan has been cut off for nearly 50 years by Africa's longest running civil war, and, due to a lack of basic health and education, early marriage, and a culture that values big families have led to alarming child mortality rates, has seen the highest maternal mortality rate in the world. The average woman has seven children and at 1.7%, South Sudan has one of the lowest contraceptive availability rates in the world, plus early pregnancy has increased from one-fifth to one-third of teenagers in recent years.
Now newly-independent South Sudan has been building a health service from scratch with the help of international aid agencies and South Sudanese women are getting the chance to improve their chances for a long life. South Sudan hopes to increase the contraceptive availability rate to 20% by 2015, as the new nation's population grows at three percent a year and it struggles to get a grip on providing basic services. Family planning charity Marie Stopes International (MSI) started programs in South Sudan's three southern states.
One woman is getting a hormone implant that will space her children and give her a five-year break. Another woman has a husband earning a paltry and irregular salary, and she is determined to educate her children in a hope that one may someday lift the family out of poverty.
Over 80% of South Sudan women have no education and 16% are married off by the age of 15.
A clinical officer Jude Omal at one of the clinics said, "When we were beginning, we had a lot of resistance as people think when you provide family planning to a mother, or a lady of reproductive age, she may most likely turn into a prostitute. You say ‘no, these services helps her to have children at a time when she thinks she's ready,' so this family planning is like an empowerment to women and girls of reproductive age."
Note: I don't like to see it called 'population control', but, as you can see, the article is about voluntary family planning.
There has been some concern that the population of Kenyan has increased to the point of adversely affecting the ever dwindling natural resources, and if it continues to grow any further, the existing resources will not be able to sustain the high population numbers.
Parents cannot cope with the cost of bringing up children in healthy environments, hence the vicious cycle of poverty.
For these reasons the government is seeking to control the population growth. On the other hand, if the control is not properly and professionally done, Kenya could end up like some developed countries, which despite the abundant resources don't have enough labour and workforce to exploit these resources.
An effective population control policy needs to balance the population growth and control.
The millennium development goals provide for sustainable population growth and sustainable economic growth. There needs to be a balance between population growth and economic growth.
In order to ensure that it provides for its people good and reasonable standards of living, the government must strike a balance between population growth and the existing economic and natural resources. A very high population will be catastrophic to the economy and quality of life.
This has to be done carefully so as not to violate social, family and human rights of individuals. Each and every person has a right to live their lives freely, and to make personal decisions on the direction their lives should take. The government should therefore employ measures that are acceptable and that will not affect the lives of people.
All population control policies or mechanisms should work in such a way that the family rights are not offended. No one should feel micro-managed by population control policies or any legislation that a nation enacts.
Governments should embrace persuasive ways of controlling the population, in that it is up to the person to decide and weigh if s/he thinks having fewer children is beneficial or not. Getting children should not be criminalised; it should be voluntary.
On Tanzania's western boundary, the Nature Conservancy's Africa program has a project to conserve a vast forested area, including the rugged Mahale Mountain National Park. The area contains about 90% of the chimpanzees in the country and also a significant portion of the Lake Tanganyika coastline. Lake Tanganyika is a true freshwater biodiversity gem. It has not only some of the most spectacular fish diversity on the globe, it also holds - in one lake - nearly as much fresh water as all the U.S. Great Lakes combined. But to successfully conserve the fish and chimps, complex conservation issues must be addressed.
In this remote region, when people can't get enough food from the lake, they turn to the forest for hunting and to clear new land for farming. When there are too many people for the natural resource base, both the lake and the forest suffer. Nature Conservancy conducted a baseline socioeconomic survey of the 50,000 people who live in the area. The numbers were startling:
49% of the population is under the age of 15, among the highest in the world.
The average household size of 6.7 is 29% higher than the 2010 average of 5.2.
130 of every 1,000 children born lin the last half of 2006 did not survive to their 5th birthday, giving the villages an under-age-five mortality among the highest in the world.
The Nature Conservancy concluded: If we can't address rapid human population growth in the area, we will not succeed in conserving the lands and water on which all local life depends.
Rather than continue with the sole focus on more mouths needing more inputs, why not also adopt strategies that result in fewer mouths? South Korea, for example, went from half its population under the age of 15 and 6.3 children per woman in 1960 - much like where we work in Tanzania - to a much more sustainable teardrop shape, with a growth rate at replacement level 30 years later. Colombia, Morocco, and Bangladesh had similar demographic shifts in even less time. These examples of dramatic demographic change show that it is possible to take the fuse out of the population bomb.
A recent report from Lilli Sippel et al. from the Berlin Institute for Population and Development saw that education - in particular educating women - was one of the most significant factors for reducing population growth rates. Education was also found to be the key factor for greater economic development, which is a necessity for sustaining the benefits to an older population.
An analysis of 26 countries from Teresa Castro Martin and Fatima Juarez of over a half century of international development dove-tails with the Sippel findings. In sub-Saharan Africa, $1 invested in primary education returns $1.25 to $1.38 to the community economically. And, when poor women in developing countries earn income, they spend most of it on their families, creating a positive feedback loop that helps the next generation to be more educated and healthy.
One final and important finding: educating women about reproductive health and providing them with family planning options would do more for reducing greenhouse gas emissions than stopping all deforestation, according to the UN in 2009. Education reduces population growth rate, which reduces growth in consumption, which in turn reduces greenhouse gas emissions.
While remoteness in Mahale, Tanzania has helped to protect these special habitats from destructive human development, the people have also been virtually forgotten by government health and education programs.
In Mahale, The Nature Conservancy has a partnership with Pathfinder International, the leading human and reproductive health organization in Tanzania. Priority projects are promoted where population, health, and environment (PHE) actions are developed - collaboratively - from the beginning. Partnerships are important - they should bring knowledge of which strategies have worked best for the socioeconomic situation of each project.
It is also important to support government funding for primary and secondary education for women. Government relations efforts in countries where PHE projects are being advanced should support education in its broadest sense.
Kathleen Mogelgaard on How Malawi Shows the Importance of Considering Population, Food, and Climate TogetherOctober 24 , 2012 By: Carolyn Lamere
On a recent trip to the South African country of Malawi, whose population of 15 million is largely dependent on subsistence, rain-fed agriculture, Kathleen Mogelgaard saw the connections between food, population, and climate change firsthand.
"One in five children in Malawi is currently undernourished." .. "With the change in climate - with increasing temperatures, with shifting rainfall patterns - this is having a significant effect on agricultural productivity in Malawi that farmers are already experiencing," she said. The outlook for maize, for example, is that productivity will decline by 20% by 2030.
The UN projects the country could grow from 15 million people today to between 45 and 55 million by mid-century, making accommodating more and more people a challenge via land scarcity.
The Futures Group does modeling which integrates a climate model, a population model, and a food security model to create scenarios for future development. "When this model was put into place in Ethiopia," Mogelgaard said, "researchers found that a slower population growth path was something that would make up for the caloric shortfall that will be a result of climate change impacts on agriculture." Slower population growth would also "cut the number of undernourished children in half."
Such research can provide the basis for an argument to incorporate population and reproductive health considerations into strategies to address future food security and climate adaptation "in ways that will build the resilience of women and build the resilience of communities around the globe."
Programs that meet unmet need for contraceptives and empower women could help policymakers and development agencies improve food security.
"Certainly agricultural developments, trade, climate change adaptation assistance - all of these things will also play into food security concerns for Malawi in the future. But also the rising demand that comes from population growth will be a significant factor."
Developing countries in Asia have found that movement to cities correlates with more wealth, but it doesn't apply to Africa, according to a chart from the World Bank's World Development Report on jobs. The chart compares the percentage of population living in urban areas with GDP per capita using data from World Development Indicators.
Urbanization usually leads to higher GDP because of higher levels of productivity, but that did not happen for Sub-Saharan Africa. The graph shows a sporadic relationship between urbanization and GDP, perhaps because much of non-farm work in Africa is from microenterprises and household businesses that do not earn much. "These businesses make a significant contribution to gross job creation and destruction," the report says, "although not necessarily to net job creation and productivity growth."
Nigeria's population has gone from 55 million in the 1950s to 88 million in the 1990s, to 167 million today, and is expected to reach nearly 200 million people in 2015, a growth rate that has raised alarm among experts. This has prompted the Federal Government to subtly suggest birth control for its citizens with serious backlash and dichotomy between proponents and opponents.
In the 1990s, the Ibrahim Babaginda military government even attempted compulsory family planning for Nigerians. A policy that was greeted by strong opposition and criticisms.
An increased population for Nigeria will over stretch services and infrastructure. In all the challenges that come with high population density, poor healthcare remains the biggest headache. In the long run, it may lead to total collapsed of the social system. These are the fears being expressed by the government, prompting government officials to conceived the idea of family planning again. Minister of State for Health, Dr. Muhammed Pate at the London Summit on reproductive health and family planning last June said: "we are committed to achieving the goal of a contraceptive prevalence rate of 36 per cent by 2018. Achieving this goal will mean averting at least 31,000 maternal deaths. Over 700,000 mothers will be prevented from injuries or long-term complications due to childbirth."
The minister also said Nigeria has committed an additional $8,350,000 of reproductive health commodities annually over the next four years, in addition $3 million already allocated, making a total of $33,400,000 over the next four years. This additional amount will be programmed within the existing projection for the Subsidy Reinvestment and Empowerment Programme funds for Maternal and Child Health.
"In the case of family planning in Nigeria, women are more than 10 times likely to have access to family planning services (35 versus 3.2 per cent) regardless of geography, ethnicity or religion. We are committed to increasing the awareness and demand for family planning and reproductive health services by women regardless of their socio-economic status. In our quest to save one million lives in Nigeria by 2015, we consider all lives have equal value," Pate said.
The Summit underscored the importance of access to contraceptives as both a right and a transformational health and development priority.
Obviously, selling the programme to the population of Nigerian conservatives is a hard nut to crack. Chief among the opponents of family planning is the Christian community and the Islamic society. The Catholic Church leads the Christian group and is vehemently opposed to birth control. The church itself sees contraceptives as a mismatch to what it considers a presumptive problem in child bearing. Couple with the African belief system, contraceptives and birth control are alien to many Africans, a situation that will hamper the implementation of family planning.
The Catholic Archbishop of Abuja, Most Rev. Jonathan Onaiyekan said the Christian community is not completely against family planning, what it is against is a deliberate and destructive form of family planning and birth control. The Catholic Church is not in anyway promoting irresponsible procreation without reasonable concern in taking care of children. Of course, there ought to be some caution and calculation, but most of these people supporting birth control do not rely on the positive aspect, on this issue of family planning, they should not only calculate on the basis of economics," Onaiyekan said.
"We are not against birth control, what we are against is the wrong way of doing it," the former President of Christian Association of Nigeria said. "We do not believe our country is over populated," ... "The use of condoms, abortion and contraceptive pills by married couples that is what we are against. The billions of dollars they are investing can be use to liberate people from poverty. Why are they not spending these billions to develop our economy," he asked. "Of course, many government officials at the Ministry of Health and non-governmental organisations (NGOs) are hungry to access these funds, they don't care about what it all means, they don't care about killing unborn babies so long as they get millions of dollars as funding," he added.
Government officials reason that an untamed population growth like that of Nigeria is just another social emergency that needs to be addressed squarely through birth control. And with bogus dollars funding across the Atlantic, it is tempting to abstain from doing nothing about birth control. But Nigeria is a tough terrain to market family planning ideology.
Experts from three continents convened last week at UC Berkeley to discuss rapid population growth, climate change and other intractable problems. Before the conference, the Los Angeles Times held an online video discussion with some of the conference attendees.
The article in the Los Angeles Times newspaper explored such issues around the world in its recent five-part series on population growth in the developing world. Among other topics, the "Beyond 7 Billion" series examined chronic hunger and mass migration in East Africa -- trends that Dr. Malcolm Potts believes will soon extend across the Sahel, an arid region of Africa just below the Sahara desert.
Malcom Potts, a UC Berkeley professor of public health who co-organized the conference said, "What you've been seeing from Somalia is going to happen in all those countries, all the way across from the Red Sea to the Atlantic Ocean." .. "You've just seen a fraction of what's going to happen in the next 10 or 20 years." The goal of the online broadcast before the conference was to discuss solutions to the problems facing this part of Africa and other impoverished nations with soaring populations. He was joined by Dr. Ndola Prata of UC Berkeley, William Ryerson of the Population Media Center and Fatima Adamu from Usmanu Danfodiyo University in Sokoto, Nigeria. Kenneth R. Weiss was the moderator.
Dr. Potts: The Sahel is dry dusty region in Africa which is affected by climate change and has rapid population growth, and the status of women is low. It is where there are many cases of drought and famine. Other areas are also in trouble: Afghanistan will double by 2050; people there are growing poppies instead of food. Child brides are a problem in both areas.
Dr. Prata: Women need control over number and timing of their births; Over 200 million women don't want to have a child in the next two years or don't want to have children at all. They need access to family planning. Family planning is very cost effective and has a beneficial impact on maternal and child mortality. Women want to be able to send their children to school, and family planning helps this.
Ryerson - Only 1% of people who don't use contraception cite lack of availability as the reason. 40% of non-users cite religion, husband, or personal, 17% want as many children as possible, a sizable number cite fear of side effects, and another large number are fatalistic - 'God will determine how many children I have'. We must be very careful to avoid cultural imperialism. What is important is people's perception of what is normal. This can be changed. Population Media Center uses serialized entertainment mass media featuring role modes of various types of people. PMC models behavior such as delaying marriage and childbearing until adulthood, prevention of HIV, spacing births, and communication between husbands and wives concerning health and number of children. Of those who were interviewed, 67% of clients of a family planning clinic gave the PMC radio show as the reason for patronizing the clinic.
Dr. Adamu - Agrees with the need to give women information and the culturally sensitive way that is needed to introduce these issues. There must be no coercion of any kind. Every woman wants to improve her life. It is important for the woman to have information of where to get services. The majority of our women lack basic information. We must invest in the woman and empower her. Many times religion allows women to space their births.
Dr Potts: The best contraception is 'what the woman wants'. Even illiterate women can get family planning. A woman in the poorest countries have a 1 in 12 chance of dying in childbirth compared 1 in 5,000 for a developed country. Family planning could prevent most of these deaths. The current cost to Americans for international family planning funding is the cost of one hamburger. To provide adequate family planning and reproductive health for all the women who have an unmet need, it would take the cost of two hamburgers. It is shameful that we let so many women die for the cost of a hamburger. And what we avoid by family planning is the great cost of war and the cost of feeding so many people.
Dr. Potts: Education has been considered one of the best contraceptives, but in the Sahel the population is growing so rapidly that schools cannot keep up. But education is not absolutely necessary. The women in Bangladesh were illiterate when they reduced their fertility rate so quickly.
Dr Prada worked in Angola where the birth rate was 5 children per woman. Women want to improve their lives; they want to send their children to school; they want to feed their children. A family planning program will educate to allow women to make the best use of contraception. It is difficult to get contraception on a regular basis. Many want a long-acting injection but all they can get are condoms and pills. Dr. Prada suggests couple counselling before marriage.
Dr. Adamu: Too many girls get married early. We must delay those marriages. The government must be working on poverty reduction and saving the woman's life. Let us not approach it in terms of 'population control' but more for saving lives. No husband wants his wife to die. Dr. Adamu works with adolescent mothers - some are age 12. They work in peer groups and involve the husbands and mother-in-laws. Giving them information on how to control their reproduction and get health care - and that there is a choice - empowers them and gives them the self-esteem to choose the number and the spacing of their children.
Dr Potts: If you respect women and give them a choice, they will tend to have fewer children.
Ryerson: Coercion is a terrible idea. However we must still realize that population is a key threat posing a real threat to human survival. Yet the U.S. Congress tried this year to stop all funding for international family planning.
Dr Adamu: We have to understand the woman in the village where her respect lies in the number of children she has. There is still the question of how many children will survive, and so she values having many.
Ryerson: People need to know that children will survive. Infant mortality rates are continuing to come down, but knowledge of that lags. Part of education must include the health of infants and ways they can survive.
Dr Prada: The desired number of children does come down. Often the number of children a woman has is below the number she said she desired.
Ryerson: The U.S. is not immune to population problems. It has the third largest population in the world and the highest per capita energy consumption. It promotes endless growth which is not possible. We need a whole new paradime for our economy.
51% of Niger children are stunted. One of three children die of hunger. Their graves dot the landscape.
One of every three girls in Niger marries before age 15, one of the highest birth-rates in the world. By marrying off their daughters at such young age, it's one less mouth to feed and it brings in a dowry from the groom's family, money desperately needed to feed the mouths of the many other hungry souls.
Sierra Leone: African Voices: Married and Pregnant at 12, a Wish for a Better Life for Her DaughtersSeptember 12, 2012, One By: Kadiatu Blango
Kadiatu was forced into marriage at age 12 and had a baby a year later. The baby's father left 6 months after she was married and she had no help from her mother or any other relative. She had her second child at age 18.
Her father had died when she was 6 and she had to quit school and go live with her uncle, whose wife treated her like a servant while her other children were allowed to go to school. She was forced into the bondo society, a group that practices female genital cutting. She did not want to. She wanted to go to school, but her mother told her that she couldn't afford to pay school fees, even though she could afford to spend a lot of money on the initiation process. Once initiated, she was forced into marriage.
Kadiatu supports herself and her children by selling wood, potato and cassava leaves. She doesn't want this kind of life for her daughters. "I want them to be free to get an education, and to not be worried about marrying too young or experiencing violence. I want them to grow up to be strong young women who can make their own choices, go to school, own land and control their own lives."
Kadiatu says some of the main challenges faced by women are are: sexual assault and harassment, teenage pregnancy, gender based violence, lack of parental or family support, lack of finances to help support them on their day to day activities, and lack of access to land for farming and agricultural activities.
She would like to see leaders promise to help tackle issues on poverty, teenage pregnancy and early marriage, HIV & AIDS; provide standardized free medical health services for all children and women; provide improved agricultural activities and revised land tenure systems for our community for suckling mothers to have easy access to backyard farming; and microfinance opportunities for women.
She also wants to see help from world leaders in the areas of free education for girls at all levels; corruption, youth employment, and background information.
About 34% of women aged 15 to 19 have either already had a baby or are pregnant. This also often leads to interrupted education, reduced earning potential, poor marital outcomes and reduced health outcomes for surviving children.
In Sierra Leone about one-third of urban and one-sixth of rural 20- to 24-year-olds are out of work, and more than 17% of the urban populations aged 15 to 35 years are unemployed.
Find out more at one.org/africanvoices. Restless Development is an agency that places young people at the forefront of change and development. It works in Africa and Asia to empower young people to take their lives into their own hand and trains, educates and inspires young people to be part of the solution. Find out more at www.restlessdevelopment.org
Speech by H. E. Yoweri Kaguta Museveni, President of the Republic of Uganda at the London Summit, July 11, 2012
The issue of population in Africa must be put in a proper context. Africa is the origin of man (five million years ago) and is also the cradle of civilization (Egypt). About 100,000 years ago, the population in Africa was one million people while that out of Africa was just a few hundreds. However, by 1500 the out of Africa population was 300 million people while the population in Africa was only 47 million people.
Africa is a huge continent of 11 million square miles of land. You can fit the US, China, India, Brazil and the whole of Western Europe in Africa - with some space to spare.
Today the population of Africa is one billion people, less than the population of India which, in land area, is a mere 1/11 of the area of Africa.
Some of the African countries such as DRC, CAR, Congo Brazzaville, Gabon, Zambia, Angola and many others seem to suffer from under population rather than over population.
Africa's population is now about 70 million people. Therefore, the problem is not population per se. The problems are under-development and lack of socio-economic transformation on the one hand and child spacing for the good health of the babies to be born and for the health of the mother.
Africa needs to metamorphose from a pre-capitalist, quasi-feudal society to a middle class, skilled working class society. That social metamorphosis will, inevitably, bring down the population growth rate. Middle class societies and industrial working class societies do not have time or space (in urban areas) to generate children.
The economy of Uganda has been growing at the rate of 6.5% per annum for the last 25 years in spite of inadequate supply of electricity and high transport costs.
This summit gives us the chance to reflect on our efforts to improve adolescents' and women's needs in order to empower them, improve their health and welfare. Young people should be better able to make informed choices for healthy sexual and reproductive health lifestyles.
Uganda has reduced poverty and promoted universal primary and secondary education for both girls and boys thereby increasing literacy rate. Life expectancy in Uganda has increased to 52 years. We have promoted women involvement in all spheres of our national development.
Infant mortality in Uganda has reduced very considerably. However, our progress on MDG 5, improving maternal health, is still not on target.
In developing countries, women continue to die during pregnancy and childbirth. Yet the causes are well known and largely preventable. The use of relatively cheap and available technologies will lead to significant improvement in the living conditions of women. With women lacking access to family planning facilities, concerted efforts must be made to ensure their access, equitable distribution and affordability.
Natural methods should also not be forgotten taking advantage of the fact that days for ovulation are limited in the monthly cycle of a woman.
Nobody should administer family control drugs to rural illiterate women without explaining fully the implications of such an act. Family planning should be out of informed choice not out of manipulation.
In Uganda, we have scaled reproductive health, including antenatal care, youth-friendly services, emergency obstetric care as well as family planning particularly encouraging birth spacing.
Government will increase the government allocation for Family Planning supplies from $3.3m per year currently to $5m per year for the next 5 years and will mobilise an additional $5m from external partners.
Khumbo Kachali, vice president-Malawi - The Malawi government declared its commitment to raise Malawi's Contraceptive Prevalence Rate) to 60% by 2020 with a targeted increase in young people aged 15 to 24 years. It pledged to raise the legal age of marriage to 18 and strengthen institutional arrangements to deliver effective policy leadership for population and family planning.
Nigeria Health minister, Muhammad Ali Pate - His country targeted a Contraceptive Prevalence Rate of 36% by 2018 to avert 31,000 maternal deaths.
Senegal promised to more than double the number of women using contraception to 27% by 2015. The government will also increase its spending on procurement of reproductive health supplies by 100%, and double the budget for its family planning programme, investing in awareness campaigns. The country's minister of health claimed the support of the religious leaders.
Tanzania's president Jakaya Kikwete also pledged to double the Contraceptive Prevalence Rate to 60% by 2015.
Ethiopia recognized that early childbearing is a major contributor to maternal mortality, and put emphasis is on adolescent girls who have the highest unmet need for family planning.
The Zambian government committed to expand its budget for family planning by 100% as well as reaching out to religious leaders opposing contraception initiatives, said Joseph Katema, Zambia's minister of community development and mother and child health.
August 29, 2012
A study titled "The Health Systems Cost of Post-Abortion Care in Ethiopia," by Michael Vlassoff of the Guttmacher Institute, estimated the cost to the health system of providing post-abortion care (PAC), based on research conducted in 2008. PAC consumes a large portion of the total expenditure in reproductive health in Ethiopia. Investing more resources in family planning programs to prevent unwanted pregnancies would be cost-beneficial to the health system.
Ethiopia spent US$7.6 million in 2008 to provide care for post-abortion care complications, an average of $36 per woman treated. The study also found that every dollar spent on family planning services would save $6 in post-abortion care services.
The treatment of incomplete abortions is both the most common and the least costly post-abortion care procedure in Ethiopia, costing an average of $24 per procedure. Treatment of shock and sepsis costs approximately $40, while treating the most serious complications, such as uterine perforation and related illnesses, costs almost $153 per intervention. Women suffering from complications that arise from unsafe abortion pay more than 75% of the total cost of their treatment, a much higher proportion than they pay for other reproductive health services.
While the study only looked at the direct costs of post-abortion care, such as drugs, supplies, personnel and hospitalization fees, the authors noted that including indirect costs, such as capital and overhead, which were not investigated in the study, would bring the national total cost of pos-tabortion care provision to at least $11.5 million.
Of the estimated 382,000 abortions in Ethiopia in 2008, about 75% were carried out under unsafe conditions. The researchers found that 58% of women who had had an abortion experienced complications that required medical treatment. However, many of these women did not receive the medical care they required, indicating that current service provision is insufficient. Also, despite growing modern contraceptive use in Ethiopia, about 1.7 million unintended pregnancies occur every year, largely due to unmet need for contraception.
August 26 , 2012 By: Abela Msikula
Just to give you an idea of the kind of misinformation we are up against ...
Dr Brian Clowes, an American researcher working with Human Life International warned yesterday against a growing campaign to promote the use of contraceptives in family planning, saying it had much to do with profits of pharmaceuticals than benefiting Tanzanian families.
He said Tanzanians needed to learn about the "deadly" health effects of contraceptives, which he calls "a new form of colonialism" and that propagation of birth control pills aims at eliminating young Africans and not nourishing their families because the use of the pills had serious health consequences to human life.
"Family planning through abortion or the use of contraceptives has caused many women and girls to suffer physically and psychologically. A traditional family planning method such as using a calendar is the only safer means," said Clowes.
Mr Emil Hagamu, the Human Life International coordinator for Anglophone Africa and head of Pro Life Tanzania, said it was a wrong to think that having many children accelerated poverty. Instead poverty should actually be linked to unequal distribution of resources as well as poor national income. He called people to reject the imposed culture that aimed at depopulation. He said family planning was the responsibility of the father and mother who should be left to use traditional family planning methods and decide on the number of children they wanted to raise.
"Rejection of children through abortion or contraceptives is not only against God, but also a big threat to women's health. There is scientific evidence that women using contraceptives can easily acquire diseases like HIV/Aids," he said.
August 20, 2012, Daily Times NG
A project based on deployment of mobile phones and focused on improving maternal and child health in Nigeria's Ondo State has seen a 30% reduction in maternal mortality since its launch two years ago, says Ondo State Commissioner for Health, Dr. Dayo Adeyanju.
The Abiye Safe Motherhood Project and the Mother & Child Hospital initiatives enable communication between the nursing or expectant mothers with their health service providers. An earlier study had shown that the number of women who attend and ‘deliver' at the basic health centres were appalling.
Free mobile phones were distributed to the registered expectant women to keep them connected to their health service providers in case they experienced contractions so they could get back to the facility.
The use of the mobiles phones are expected to further reduce maternal mortality rate by 75% by 2015. The project saw nearly 1220 babies delivered in a single year with one maternal death reported. That would mean a maternal mortality rate of only 100 per 100,000 live births compared to Nigeria's current maternal mortality ratio of 545 in 100,000 live births.
August 09, 2012
In their article "Water Sustainability for China and Beyond," Jianguo "Jack" Liu, director of Michigan State University's Center for Systems Integration and Sustainability, and doctoral student Wu Yang outline China's water crisis and recent leapfrog investment in water conservancy, and suggest addressing complex human-nature interactions for long-term water supply and quality.
Two-thirds of China's 669 cities have water shortages, more than 40% of its rivers are severely polluted, 80% of its lakes suffer from eutrophication - an over abundance of nutrients - and about 300 million rural residents lack access to safe drinking water.
China also suffers floods. A flood in Beijing in July overwhelmed drainage systems, resulting in scores of deaths. China has dedicated $635 billion for engineering measures to manage water.
Water shortages also may have contributed to recent massive power outages in India as rural farmers stressed a fragile grid by pumping water for irrigation during drought.
There needs to be, Liu and Yang say, a big picture view of water beyond engineering measures. "There is an inescapable complexity with water," Liu said. "When you generate energy, you need water; when you produce food, you need water. However, to provide more water, more energy and more land are needed, thus creating more challenges for energy and food production, which in turn use more water and pollute more water.
Liu, who holds the Rachel Carson Chair in Sustainability, says solutions come from looking at issues from multiple points of view at the same time. His suggestions include:
* Shore up laws and policies with cross-organizational coordination to clarify who is in charge, and who has enforcement powers.
* Get proactive., evaluate initiatives, set performance criteria and engage the public in planning Use social science to strengthen long-term plans by predicting people's behaviors and taking values into account.
July 31 , 2012, Friends of UNFPA
In Guinea-Bissau, a country in West Africa, 98 of 114 health centers now offer family planning services and 10% of women use contraception, which, while low, is an improvement. As access to reproductive and infant healthcare improves and family planning messages start to sink in, the contraceptive rate rises.
Having access to modern contraception could prevent 40% of maternal deaths worldwide, says the UNFPA That could save the lives of many women in this country, where 1 in 13 dies in pregnancy or childbirth - one of the highest rates of maternal mortality in the world.
The birth control pill, condoms and contraceptive implants are offered.
UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.
Health workers in San Domingos speak to teenagers in schools about the dangers of starting a family too soon and suggest contraception options to women who have come to the hospital with pregnancy-related or birthing problems.
"Women want family planning here - we meet with very little resistance to our messages."
But with inconsistent stocks the hospital cannot guarantee contraception to all who want it.
Economics increasingly sways urban families' decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health. People in towns want fewer children because they understand life is expensive. But also improvements in reproductive and infant health give people more faith that medicine works, so they are starting to think their babies won't necessarily die.
Maternal and under-five mortality is declining across the country. However the under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates.
July 05, 2012, Salon.com
Women in a Kenyan Laikipia health clinic were asked if any of them have friends who had died of illegal abortions. Three out of the four said they did. In fact , unsafe abortion has led to 30 to 40% of maternal deaths in Kenya.
In 2010 Kenyans approved a constitution that moderately eases the country's abortion restrictions. Whereas abortion was previously allowed only with permission from three doctors - one of whom had to be a psychiatrist, an impossibility in most parts of the country - now a single medical professional can certify that an abortion is necessary for a woman's life or health, which can be broadly construed.
Charlotte Smith, director of policy at Ipas, which advocates for safe abortion worldwide and is providing technical support to the government's transition said "I imagine that as in any place that has over 150 years of a very restrictive abortion law, it's going to take a lot of providers a lot of time to feel that they would be protected," even if they support abortion rights.
A few days ago Rio+20, the global mega-gathering on the planet's sustainable future, published an outcome document that contains no reference to population or to family planning.
Now the president of Nigeria, Goodluck Jonathan, a former environmental protection officer, has risked controversy by calling on Nigerians to limit the number of children they have to what they can afford. Managing population growth is essential to economic planning and the government should adopt policies aimed at curbing rapid population growth and encouraging ‘birth control', he said.
Nigeria is growing at 2.5 to 3.2% a year, with it 's population expected to grow from 160 million today to 300 million by 2030, 400 million by 2050, and perhaps 730 million by 2100, according to the UN. The country's average family size is over five children. Jeffrey Sachs - special adviser to the UN - says "It is not healthy. Nigeria should work towards attaining a maximum of three children per family."
Nigeria is a very religious country with high infant mortality and a widespread belief that children are ‘given by God'.
At the 1994 Cairo Conference on Population and Development the case for more investment in family planning and reproductive health, alongside a much greater effort to educate women and girls (as well as men) was set out most clearly - and agreed with detailed funding pledges - only to be largely forgotten in the years that followed.
Peter Adamson, for 15 years the author of UNICEF's annual State of' the World's Children Report and senior adviser to the executive director, James Grant, wrote: "The responsible planning of births is one of the most effective and least expensive ways of improving the quality of life on earth -both now and in the future -and one of the greatest mistakes of our times is the failure to realise that potential." "Family planning could bring more benefits to more people at less cost than any other single ‘technology' now available to the human race. But it is not appreciated widely enough that this would still be true even if there were no such thing as a population problem."
"In part, an awareness of the full range of benefits available from the responsible planning of births has been hidden from the public by the clouds of controversy which have long hung over this issue. But such is the range of methods now available and such the experience that has been gained in recent years, that family planning can now be promoted and practised in ways which are sensitive to the religion and culture of almost all societies. The benefits of family planning need be denied to no-one."
Adamson said: Family planning can:
* Save the lives one quarter to one third of the 500,000 women who now die every year from causes related to pregnancy and giving birth. It could also prevent unknown millions of disabilities - many of them painful , permanent, embarrassing, and secret - which are the common consequences of high-risk - and often unwanted births.
* Prevent many if not most of the more than 50,000 illegal abortions which are now performed on women every single day and which result in the death s of 150,000 young women every year.
* Drastically improve the quality of women's lives - in both short and long-term - by reducing the physical and mental burden of having too many children too close together, or at too early an age. It can increase the time available for women's education, for vocational training, for earning incomes, for improving child care, for community activities, for personal development, and for the rest and leisure which is virtually unknown to millions of women in the developing world today.
* Save the lives of several million children each year. Family planning would prevent, predominantly, those births known to be high risk - births that are within two years of a previous birth, or to mothers who are under 18 or over 35, or who already have three or four more children. Because the great majority if child deaths are associated with these risk factors, the well-informed timing and spacing of births would result in a far more proportionate reduction in child deaths.
* Significantly improve the nutritional health of children throughout the developing world. Fewer and more widely spaced births allow mothers more time for breast-feeding and weaning, and helps to prevent the low birth weights which are strongly associated with malnutrition throughout the earliest years if life.
* Improve the quality of life for children. The quality of child care -- including play and stimulation as well as health and education - inevitably arises as parents are able to invest more of their time, energy and money in bringing up a smaller number of children.
"These benefits alone would be sufficient to justify the claim of ‘family planning for all' to a special priority. It would, of course, also help to resolve one of the other great problems on the human agenda - the problem of rapid population growth."
In the intervening years some of Adamson's figures have been better researched and estimates more accurately made, but the reasoning is unchanged. The latest report from the Guttmacher Institute and the UNFPA shows just how big the need for family planning still is and how long a way there is to go.
There are still an estimated 222 million women in the developing world who want to avoid a pregnancy in the next two years, but who are not using a modern contraceptive method.
In the 69 poorest countries there was no decline in the number of women with an ‘unmet need'. In fact in sub-Saharan Africa that figure went up from 50 million to 53 million in 2012.
This article tells the story of Joventa, a young unmarried woman whose boyfriend left after she became pregnant at age 17, and just days later, learned she was HIV positive. Joventa had to leave school to take care of her son and was ostracised by many in her community, She had to give up her dreams of becoming a teacher.
Thankfully her son is not HIV positive. Many teenage girls in her circumstances fare worse: unintended pregnancy is the biggest killer of teenage girls in the developing world, with young women 15-19 twice as likely to die from complications in pregnancy as are women in their twenties. For mothers under 18, their babies' chance of dying in the first year of life is 60% greater.
The good news is that Joventa is in line at a UN-funded family planning clinic, ready to be injected with a contraceptive implant, inserted under the skin of her upper arm, that will protect her from the risk of another unwanted pregnancy for the next three years. She will no longer be one of the 215 million women in the world with cannot choose when they have their children. These women account for 82% of the 75 million unintended pregnancies that occur globally every year. Access to family planning services could reduce the number of maternal deaths by a third. "Life is starting to normalise," Joventa says as she leaves. "Finally, I have control over my decisions."
The upcoming summit in July, sponsored by the British government and the Bill and Melinda Gates Foundation will aim to provide 120 million of the world's poorest women with access to contraception over the next eight years, at an estimated cost of almost £2.6billion.
In sub-Saharan Africa less than 20% of women of childbearing age have access to contraception. If current trends continue, east Africa will not reach 60% for 45 years and central and western African will wait a startling 500 years to reach 60%, according to the reproductive health charity Marie Stopes International.
In the West, pregnancy is not primarily a matter of lifestyle. In Uganda, it is a life and death issue. According to Marie Stopes International, "Every year 358,000 women die due to pregnancy or childbirth. ... Many of those women did not plan to be pregnant. Equally tragic is that 47,000 women die every year because of unsafe abortions."
In 2002, the Bush administration withdrew US money for the UNFPA claiming it financed forced abortions. The Obama administration restored the funding; it is estimated that an additional 90,000 lives could still be saved every year if there was more family planning provided.
Babatunde Osotimehin, executive director of the UNFPA, advised that "In most African countries, 60-70 per cent of the population are under the age of 30. Family planning is the most important human development intervention there is: it enables young people to make choices about their lives; it ensures women can have the number of children they want and can look after; and it gives them the possibility to protect themselves from infectious diseases."
In some areas a quarter of all teenage girls are mothers. Unfortunately there is a stigma to supplying contraceptives to teens, getting them into the clinics and dispelling the myths that surround the services. Around 10% of births in Uganda involve girls under 15.
More than six million people in landlocked Niger, and eighteen million across West Africa, currently face real hunger, according to the Save the Children. The immediate cause is a failed harvest caused by pest infections and erratic rainfall, following years of drought. This is made worse by high food prices, regional conflict, weak governments, child marriage and chronic poverty.
We should respond to the immediate crisis. However, this follows widespread food shortages in 2010 and 2005. Even before the current crisis, one in five children under two in Niger was malnourished. So, we also need to take action to prevent future crises. On one widely accepted measure of development, the United Nations Human Development Index, Niger ranks at 186 place, second from the bottom. It has the world's highest child mortality rate, due to poor nutrition and lack of heath and maternal education services. It also has the world's highest birth rate, with an average of 7.2 births per woman. The results have been dramatic. The population, only 2.5 million as recently as 1950, has increased six-fold in the last sixty years, and now stands at 15.5 million.
The future looks grim. Niger and West Africa as a whole are gravely exposed to the effects of climate change, which will increase the already high temperatures and make rainfall even less predictable. And with half the population under 15 years of age, the population will keep growing. The UN predicts that the population will grow a further three fold to 55 million by 2050 and nine fold by the end of the century to 139 million. Even this enormous increase is limited by the assumption that the birth rate will fall to two to three children per woman by that time.
In the most recent survey of Niger, only one in twenty women was using a modern contraceptive method and only one in ten was using any method at all. One in six women would like to delay or prevent another conception but had no access to family planning.
Commented Simon Ross, Population Matters chief executive: "Niger is an extreme case but the story is similar across many of the world's poorest countries. They face multiple issues and need help with development across the board. However, slowing population growth is critical. As we approach the Rio+20 Earth summit on sustainable development, we ask delegates to accept that only by funding the additional $3.6bn cost of meeting the unmet need for family planning and by promoting the case for smaller families, can we avoid future crises."
African Child Mortality - the Best Story in Development; Africa is Experiencing Some of the Biggest Falls in Child Mortality Ever Seen, AnywhereMay 19, 2012, Economist
According to Mr Demombynes and Karina Trommlerova, of the World Bank, 16 of the 20 African countries which have had detailed surveys of living conditions since 2005 reported falls in their child-mortality rates. Twelve had falls of over 4.4% a year, which is the rate of decline that is needed to meet the millennium development goal (MDG) of cutting by two-thirds the child-mortality rate between 1990 and 2015. Three countries - Senegal, Rwanda and Kenya - have seen falls of more than 8% a year, almost twice the MDG rate and enough to halve child mortality in about a decade. These three now have the same level of child mortality as India, one of the most successful economies in the world during the past decade.
The average fall in infant mortality rate is faster than it was in China in the early 1980s, when child mortality was declining around 3% a year.
The declines have happened in countries large and small, Muslim and Christian, and in every corner of the continent. The three biggest successes are in east, west and central Africa, and especially in Africa's two most populous countries, Nigeria and Ethiopia.
Remarkably Kenya and Uganda, who also did well on child deaths, have seen their fertility declines stalled recently. Low-fertility places such as Namibia and Lesotho also did poorly on child mortality, showing the link between mortality and broader demographic change seems weak.
Mr Demombynes argues the difference is made from some combination of broad economic growth and specific public-health policies, notably the increase in the use of insecticide-treated bednets (ITNs) which discourage mosquitoes, which cause malaria.
Ethiopia, Ghana, Rwanda and Uganda have been among Africa's star economic performers recently, with annual GDP growth averaging over 6.5% in 2005-10. At the other end of the scale, Zimbabwe saw its GDP fall and mortality rise.
But growth offers no guarantees. High-mortality Liberia actually saw impressive GDP increases whereas Senegal, whose record in child mortality is second to none, had a rather anaemic growth rate by recent African standards (3.8% a year, half that of Rwanda). That what Mr Demombynes calls "the miracle of low mortality" has taken place in different circumstances suggests there can be no single cause.
Kenya has cut the rate of infant mortality by more than any other country. It has had healthy economic growth (4.8% a year in 2005-10) and is a functioning democracy. Kenya also increased the use of treated bednets from 8% of all households in 2003 to 60% in 2008. Half the overall drop in Kenya's infant mortality can be explained by the huge rise in the use of ITNs in areas where malaria is endemic.
In Nigeria whole families often squeeze into 7-by-11-foot rooms along a narrow corridor, with up to 50 people sharing a kitchen, toilet and sink. Over 100 students cram into most classrooms, two to a desk.
Nigeria's unemployment rate is nearly 50% for people in urban areas ages 15 to 24 - driving crime and discontent. For middle-class people with jobs, commutes from even nearby suburbs can run two to three hours.
With the global population having breached seven billion, natural resources will be taxed if countries cannot better manage the growth. Nearly all of the increase is in sub-Saharan Africa, where the population rise far outstrips economic expansion. Of the roughly 20 countries where women average more than five children, almost all are in the region.
Sub-Saharan Africa accounts for 12% of the world's population, will account for more than a third by 2100.
Everywhere else in the developing world fertility rates have fallen sharply in recent generations and now resemble those in the United States - just above two children per woman. That transformation was driven in each country by a mix of educational and employment opportunities for women, access to contraception, urbanization and an evolving middle class.
It is unclear whether similar forces will defuse the population bomb in sub-Sarahan Africa..
"The pace of growth in Africa is unlike anything else ever in history and a critical problem," said Joel E. Cohen, a professor of population at Rockefeller University in New York City. "What is effective in the context of these countries may not be what worked in Latin America or Kerala or Bangladesh."
Alarmed governments in sub-Saharan Africa have begun to act. Nigeria made contraceptives free last year, and officials are promoting smaller families as a key to economic salvation, holding up the financial gains in nations like Thailand as inspiration.
Nigeria is the world's sixth most populous nation at 167 million people. If this large nation rich with oil cannot control its growth, what hope is there for the many smaller, poorer countries?
The Nigerian government's effort to rapidly build infrastructure but cannot keep up with population growth, but even though Nigeria has recommended that families limit themselves to four children for 20 years, there has been little effect.
Parfait M. Eloundou-Enyegue, a professor of development sociology at Cornell University, said, "Many countries only get religion when faced with food riots or being told they have the highest fertility rate in the world or start worrying about political unrest."
The swelling ranks of unemployed Nigerian youths have fed the growth of the radical Islamist group Boko Haram, which has bombed or burned more than a dozen churches and schools this year. The African population boom has fueled illegal immigration into Europe and the United States.
Even though Nigeria, like many sub-Saharan African countries, has experienced a decline in average fertility rates, from 6.8 in 1975 to about 5.5 last year, this is not enough: this level of fertility, combined with an extremely young population, still puts such countries on a steep and disastrous growth curve. Half of Nigerian women are under 19, just entering their peak childbearing years.
High fertility rates were desirable when Africa was agriculturally based and sparsely populated, and so family planning, introduced in the 1970s by USAID was initially regarded as foreign, and later on, money and attention were diverted from family planning to Africa's AIDS crisis. The drastic transition from high to low birthrates that took place in poor countries in Asia, Latin America and North Africa has yet to happen in Sub-Saharan Africa.
World Bank population specialist Eduard Bos tells us that such a transition often brings substantial economic benefits, As the last large population group reaches working age, the number of adults in the labor force is high relative to more dependent groups - the young and the elderly - for a time. If managed well, that creates capital that can be used to improve health and education and to develop new industries. Such a transition increased per-capita gross domestic product in Latin America, Asia and North Africa between three and six times as population was brought under control.
In Nigeria, policymakers are studying how to foster the transition, and its attendant financial benefits, Many young adults, particularly educated women, now want two to four children. But the preferences of men, particularly older men, have been slower to change - crucial in a patriarchal culture where polygamy is widespread. One man explained that it was "God's will" for him to have 12 children by his three wives, calling each child a "blessing" because so many of his own siblings had died.
Posters promote "birth spacing," which is acceptable, not "birth control, " which is often not.
In many sub-Saharan African nations, contraceptive use is under 20%. "At this pace it will take 100-plus years to arrive at a point where fertility is controlled," Dr. Guengant said.
The average number of children per woman increased to 7.3 in the predominantly Muslim north, where women often cannot go to a family planning clinic unless accompanied by a man.
But Dr. Peter Ogunjuyigbe, a demographer at Obafemi Awolowo University, sees a change. As Nigeria urbanizes, children's help is not needed in fields; the extended families have broken down. "Children were seen as a kind of insurance for the future; now they are a liability for life," he said.
In Niger, Nigeria's desperately poor neighbor, women have on average more than 7 children, and men consider their ideal to be more than 12. But with land divided among so many sons, the size of a typical family plot has fallen by more than a third since 2005, meaning there is little long-term hope for feeding children, said Amadou Sayo, of the aid group CARE.
Babatunde Osotimehin, executive director of the United Nations Population Fund and a former Nigerian health minister, said he is optimistic for a turnaround if governments better support education for girls and contraceptive services. "We can see rapid changes, but that's up in the air, because you have to be aggressive and consistent."
Birthrates have edged down to about four children per woman in Kenya, Ethiopia and Ghana.
The United Nations estimates that the global population will stabilize at 10 billion in 2100, assuming that declining birthrates will eventually yield a global average of 2.1 children per woman. At a rate of even 2.6, Dr. Guengant said, the number becomes 16 billion.
High school for girls leads to smaller families. Experts such as Peter Ogunjuyigbe, a demographer in the city of Ile-Ife, Nigeria, who is studying population growth with financing from the Gates Foundation and the Bloomberg School of Public Health at Johns Hopkins University, Parfait M. Eloundou-Enyegue, a development sociologist at Cornell, and Babatunde Osotimehin, the executive director of the United Nations Population Fund all see population stabilization as tightly linked to female empowerment.
"There are countries where the population is growing faster than the economy," Mr. Osotimehin, a former Nigerian health minister, said in an interview in New York. "We try to work with these countries to make sure girls have access to education to empower women to participate in politics and the economy."
At some point along the population growth curve in much of Sub-Saharan Africa, too many people means not enough resources, marked declines in human health and the destruction of critical natural habitat.
In many African nations, girls usually end their schooling around age 12 when they get ready to be married off and start having babies. Not surprisingly, low rates of education for women consistently correlates with high fertility rates. In West and Central Africa over all, 44% of girls are married before they turn 18, while it is 76% in Niger, where the fertility rate is the highest in the world (7.3 babies per woman) and many women marry in early adolescence. Going to high school gives girls skills that make them more likely to be employable and capable of attaining a measure of financial independence. They are more likely to make marriage decisions on their own rather than having their families rush to marry them off.
In elementary school education on sex and family planning is less effective because girls at that age are be too immature physically and emotionally to process the information.
"If you educate girls to the secondary level, then exposure to pregnancy doesn't happen until they are mature and can made choices," Dr. Osotimehin said.
Leymah Gbowee's father protected her and her four sisters from the secret cutting ritual that would serve to bind them to their village. FGM plagues over 100 million women and girls around the world..
"My upbringing defied what the typical African setting would say I went through," said Gbowee.
Growing up in a poor, middle-class - she calls it - village in Liberia, her upbringing was different, molding her into a feminist, an activist, a peace-builder and the 2011 Nobel Peace Prize laureate.
When a bloody civil war ravaged her country from 1980 to 2003, Gbowee realized it was women who would have to bear the greatest burden in ending the conflict. She began organizing Christian and Muslim women to demonstrate together, founding Liberian Mass Action for Peace. They used non-violent protests and a sex strike.
She wrote a book and held peace-building workshops in and around her country, teaching women to understand the great power they held - in both mind and body.
Pray the Devil Back to Hell is an inspiring documentary film about Gbowee's part in helping to oust Liberian president Charles Taylor. Gbowee is a single mother of six, including one adopted daughter, and is based in Accra, Ghana, where she is the executive director of the Women Peace and Security Network (WIPSEN-Africa).
\Women living in conflict regions of the world are victims of rape, sex trafficking, disease, infant mortality and other atrocities. Yet, these issues are many times swept under the proverbial rug as heads of state or humanitarian groups take great pains in dealing with other facets of a country's rehabilitation.
"Liberia has 994 deaths per every 100,000 births. Sierra Leone is even worse. 1200 to every 100,000. In this day and age, we shouldn't have these numbers," said Gbowee. "It was because when we started rehabilitating our countries, we did not make maternal health a priority."
Nearly 240 million people in sub-Saharan Africa, or one person in every four, lack adequate food for a healthy and active life, and record food prices and drought are pushing more people into poverty and hunger.
Now, with a world population of 7 billion, news headlines are beginning to ask, "How many will there be to feed?"
Investments in women and family planning are necessary to fulfill future food needs. Food security and nutrition advocates must add their voices to support investments in women and girls and voluntary family planning as essential complements to agriculture and food policy solutions.
Although progress has been made in achieving MDG 1, the absolute number of underweight children has risen steadily since 2000. Food security exists when all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life.
To meet these needs, sufficient quantities of appropriate foods must be consistently available; individuals must have adequate incomes or other resources to purchase or barter for food; food must be properly processed and stored; and individuals must have sound knowledge of nutrition and child care that they put to good use, and have access to adequate health and sanitation services.
More than 60 countries are making great progress toward achieving the MDG hunger target to halve, from 1990 to 2015, the proportion of people who suffer from hunger. However, in sub-Saharan Africa, despite some advances, most of the region is not on track to reach the MDG hunger target, and rapid population growth makes tackling hunger even more challenging.
Since 1990, the prevalence of underweight children in sub-Saharan Africa has decreased from 27% to 22%. However, due to high fertility and limited reproductive health information and services, the region has 50% more children than it did in 1990, leaving 30 million children (one in five) in sub-Saharan Africa who are underweight -- 5.5 million more than 20 years ago.
Population growth will greatly increase the amount of food needed to adequately feed sub-Saharan Africa's people.
Women there have 5.1 children, on average, a decline from 6.7 children in 1970 but still over twice the global average of 2.5 children. Also, nearly 40% of the area's population is under age 15 and have yet to enter their reproductive years. The reproductive choices of today's young people will greatly influence future population size and food needs in the region, but women's reproductive health is lacking.
The population of Sub-Saharan Africa is expected to go from 856 million today to about 2 billion in 2050, assuming birth rates come down to 3.0 by 2050.
Fertility declines when women and their partners desire a smaller family and choose to delay or space their births, and when they know about and can access a variety of contraceptive methods. Economic development and women's education foster the use of family planning and smaller families.
However, in many countries, high child mortality and traditional cultural views contribute to couples still preferring large families. Gender inequities result in many girls having children early in adolescence and having little power over the number of children they bear. Also, current levels of funding for family planning and reproductive health from donors and African governments fail to meet current needs, much less the future needs of the growing number of people entering their reproductive years.
Failure to provide this funding will further delay reproductive health gains and fertility declines and could result in a far larger population and thus greater-than-anticipated food needs in sub-Saharan Africa by 2050.
The United Nations (UN) medium projection for sub-Saharan Africa is almost 2 billion by 2050. That is, if fertility reaches 3.0 children by 2050, down from the current 5.1. However, it will reach 2.2 billion people by 2050 if the fertility only declines to 3.5 children. In order to reduce fertility more quickly, significant investments in women and girls such as education and improved access to family planning information and services.
The UN is assuming that fertility rates in developing countries will follow the path of developed countries, expecting them to decline to approximately two children per woman on average or less by 2100. For example, medium projections assume that the average number of children a woman in the Democratic Republic of Congo (DRC) will have will decline from 6.3 today to 2.7 in 2050. For fertility to decline to 2.7, the use of modern contraceptive methods would need to grow from 6% of women in the DRC today to more than 70% by 2050. Even if contraceptives were to increase that much, population in the DRC would still increase 120% by 2050, growing from 66 million today to 148 million.
Senate President, Dr. Jean Damascene Ntawukuliryayo, has urged the Rwandan Network of Parliamentarians on Population and Development (RPRPD) to double their efforts if the country's population is to be controlled.
At the RPRPD general assembly, Dr. Ntawukuliryayo, reminded fellow lawmakers that in spite of Parliament being engaged in solving the problem, the network does not seem to be putting in the necessary efforts.
"The problem of population explosion stops us from moving as fast as we want to," Dr. Ntawukuliryayo observed.
Surveys show the first phase of the Economic Development and Poverty Reduction Strategy (EDPRS) was implemented by up to 90%. Dr. Ntawukuliryayo pointed out that a rapidly growing population would ruin the achievements, hence the need to adopt measures to restrain it. "We are working for tomorrow's generation. As members of RPRPD" ... "If we continue with the fertility rate of 4.6, we are in trouble."
Rwanda's fertility rate is down from 6.1 in the past few years, but a fertility rate of 2.1 is ideal.
The government does not want to forcefully restrict Rwandans on the number of children people can bear and has opted for wide sensitisation. Plans include increasing the reproductive health level of the population and family planning, reducing HIV/AIDS incidence and other neglected diseases, gender equality, and research.
In Nigeria, Tuareg rebel fighters want to create an independent state across the regions of Gao, Kidal and Timbuktu and have been using weapons released from the Libya conflict in a fresh campaign against the Malian army, causing many villagers to flee their homes, and an estimated 7,000 Malians taking refuge in western areas of Niger, and putting a strain on neighboring areas.
Villagers in the Tiallabéri region have been hit hard by the drought of 2011 and are facing increasing food insecurity. Niger's government has already asked for assistance from the international community, predicting nearly half its population will face food shortages in 2012. Some agencies have sent emergency supplies to western Niger, but there would only be enough "to meet immediate needs".
With the effects of climate change making for unpredictable harvests and a growing population, Niger has frequently faced food shortages. But now severe droughts are happening more frequently. Religious leaders - seeing the looming food shortages and how population has grown from 2 to 15 million over the last five decades - are now openly addressing the topic of family planning as a way to ensure a healthier population, which can be sustained by Niger's fragile resources.
A humanitarian-aid commissioner visiting the country after a space of two years, expressed her surprise at finding local Imams in favour of gaps between children as both healthier for mothers and offspring, and in keeping with the Koran. The commissioner also found an openness at the government level in discussing Niger's annual 3.3% population growth. The topic is no longer taboo. The commissioner says that, while making links between food shortages and population growth is a sensitive and complex subject, especially where poor families rely on having many children to help farm land, it is recognized that another food crisis looming across the Sahel region, and it is an important time to explore how countries with fragile environments can best look after their populations.
Until recently the subject of family planning in Niger was taboo, but commissioner Kristalina Georgieva, the European Union's top humanitarian-aid official, was pleasantly surprised this time to see a project teaching women about contraception and the importance of spacing births.
The local Imam where she visited "was quoting the Koran saying there's a verse that says there has to be time between the birth of children so the children and mother can recover and be strong."
The support of the local religious leaders at the health centre she visited in Bambey, in western Niger, was crucial for bringing down the high rate of population growth, she said. The growth was putting a strain on a country that is among the poorest in the world, that struggles with a harsh climate and is vulnerable to the effects of climate change.
Since independence in 1960, Niger's population has risen from less than 2 million to 15 million plus.
Now there is "remarkable openness to address family planning". "At the level of the president, prime minister, ministers and cabinet there's an openness to discussing family planning. There's an openness that 3.3-percent population growth is not sustainable," she added.
"There are already activities on the ground (for) family planning in a very community-based and respectful manner … The topic is not taboo anymore."
Mothers need to space their children to avoid back-to-back pregnancies which contribute to malnutrition and keep mothers weak. "That's where there is potential to work hand in hand with community leaders and religious leaders. It has to be culturally acceptable to work."
The annual hungry season in Africa's Sahel countries is expected to begin in late February or early March - several months earlier than usual. Aid agencies say between five and nine million people are at risk.
Talking about population growth in relation to food shortages is a sensitive issue, partly because large families are considered important in many cultures, particularly where people rely on their children to help on the land and to support them in old age.
Many argue that the real causes of food shortages are political and economic. Georgieva says a food crisis is looming in the Sahel due to poor rains, bad harvests, food-price hikes and the return of migrants from Libya, among other factors.
But she also argues more generally that it is time for the world to pay more attention to managing population growth in fragile environments. When she visited Kenya last year she realised that in 1963 it had more or less the same population as her own country Bulgaria - well below 10 million. Today Bulgaria is at 7.5 million whereas Kenya's has soared to 40 million.
The populations of other affected countries had also grown five times and this meant that when there were droughts the impact was all the more severe.
For a very readable look at some of the arguments on why population growth is not the cause of famine, take a look at this article published by Al Jazeera: Famine in the Horn of Africa: Malthus beware. http://www.aljazeera.com/indepth/opinion/2011/08/20118178844125460.html
Leymah Gbowee, a 2011 Nobel peace prize co-laureate and Liberian peace activist, called for recognition of the crucial role and valuable experience of women during times of conflict.
It is women who provide basic services, in the form of food and shelter, to those internally displaced by civil war. It is also women who negotiate and secure safe passage through checkpoints set up by rival factions. And, thirdly, women negotiate peace on behalf of their communities by identifying and validating those that are members of the community. Women carry out these roles in the face of the constant threats of kidnapping, rape and murder.
Yet it is a paradox that women find themselves empowered during times of conflict to the same degree that they are disempowered in times of peace. When conflicts end, women are dismissed as underqualified and so excluded from formal peace negotiations.
Gbowe's efforts as an activist involve encouraging female participation in elections. The fact that conflict affects men and women differently has only recently begun to influence the peacekeeping and development efforts of foreign governments and NGOs. The constant threat of rape directly inhibits the ability of women to carry out their peace-facilitating roles.
Gry Larsen, the Norwegian state secretary for Foreign Affairs, spoke of the importance of gender-appropriate post-conflict development and aid project strategies. It is often a simple considerations of logistics, management and communication. Placing food stores, medical tents and toilets, for example, closer to communities, along well-travelled routes or in open spaces significantly reduces the risk of rape. And information relating to when and where fresh aid supplies will be delivered allow women, who most often collect the aid, to arrange safe travel.
In the Sahel region, Niger, Senegal, Mali, Mauritania, Chad, Cameroon, Burkina Faso and Nigeria are suffering failed harvests and lack of rain, affecting millions of people, with up to 500,000 on the brink of starvation.
The crisis is made worse by rising food prices and the return of 200,000 migrant workers to West Africa because of the civil wars in Libya and Ivory Coast. These workers are no longer able to send money home from their foreign jobs.
Now the question is whether the world's wealthy nations will respond in time - or whether they will repeat the disaster of the Somalia famine last year, when early warnings were ignored for nearly a year and thousands died needlessly before massive aid was finally sent.
The Sahel is a vast, sprawling, arid region, with villages often in remote and inaccessible places, making it difficult to distribute food to them.
Unlike Somalia, the Sahel is not in the grip of war, and it is not controlled by a militant group blocking aid from reaching much of Somalia.
UNICEF says it needs $100-million this year to save the lives of 500,000 children in the Sahel. It wants to provide food to a million people in the region, and so far it only has the resources to feed half of them.
David Gressly, the regional director of UNICEF in West Africa said: "Everyone has learned a lesson from the Horn of Africa famine. We're acting much more quickly this time. We're going to react in time and save a large number of lives."
The latest UNICEF surveys have forecast that more than a million children will suffer acute malnutrition in the Sahel crisis. As many as 60% of malnourished children can die in a food crisis, but the death rate in the Sahel could be higher than usual because the region has still not recovered from a serious drought in 2010.
Climate change is believed to be one of the reasons for the rising number of food crises in the Sahel, but high fertility rates and rising populations are contributing to the problem by putting huge pressure on the Sahel's arid farmland, which can't support many people.
Niger, for example, endured devastating droughts in 2005, 2010, and again this year. "The death rates could be higher this time because households are still under stress. It takes households that are on the edge and it pushes them over the edge. We've seen families starting to withdraw their children from school as a coping mechanism," Gressly said.
Emergency aid for the Sahel should be followed by long-term programs to strengthen the communities and help them prevent such crises in the future. It costs $80 a day to treat a malnourished child, yet it would have cost only $1 a day to prevent the child's malnutrition if the money had been invested in development programs in advance.
There is a zone of human pain in the failed, and failing states along the Sahel on the edge of the Sahara desert, and across to Somalia, Yemen and Afghanistan, says Professor Malcolm Potts.
Rapid population growth, global warming, poor governance and a hideous mistreatment of women are combining in a perfect storm which could lead to unprecedented levels of environmental stress, starvation, escalating conflict and massive waves of migration. The scale of these problems goes beyond the usual response to a potential humanitarian disaster. Unless strong action is taken, the catastrophe now unfolding in the Sahel has the potential to kill as many tens of millions of people.
This is a global problem and it needs a global understanding and a global response. New international strategies need to be built about food security, family planning, gender equity and governance that have major geopolitical implications for the rest of the twenty-first century. A proper response will require billions of dollars , which would likely come primarily from the World Bank, regional development banks and other traditional donors.
Today's extremes of drought, caused by climate change, could become averages by 2050. Overgrazing, poor agricultural practices, lack of infrastructure and uneven governance could result in inefficient use of natural resources including soil, water and ecosystem-based services. Soil erosion and destruction of trees for firewood are about to collide with climate change turning serious problems into a catastrophe.
From October to May there is no rain and temperatures can exceed 120° Fahrenheit (49° C). Tremendous dust storms cover huge areas of the Sahel and Northern Nigeria. Climate change will make a bad situation worse. Droughts that used to occur every 10 years are already happening every five and they will be interspersed with torrential downpours leading to flash floods that wash away homes and crops.
Already agricultural output cannot keep pace with population growth. The UN Environment Programme sees the Sahel as "heading towards an environmental disaster" and feeding tens of millions of people as "mission impossible."
44% of children in Niger are stunted and face a life-long penalty in stunted growth and inhibited brain development if they survive.
The third largest city in Kenya, after Nairobi and Mombasa is now a refugee camp of drought victims in the north. It was built for 400,000 refugees, but every day an additional 1,500 women and children, fleeing from drought in Somalia and Ethiopia, arrive.
The worst drought in 60 years is hitting the Horn of Africa; 13 million people are already hungry. "750,000 could die in the next six months unless aid efforts were scaled up" says the New York Times. But this is just a sign of things to come. We must recognize the nature and the scale of the problem and focus on outcomes not process.
50 million people live in the Sahel. In Niger population is projected by the UN to rise from 16 million today to almost 60 million or possibly even higher in 2050 and an implausible 139 million by 2100 million, implausible since death rates may rise due to starvation or disease.
Burkina Faso is projected to go from 16 to almost 50 million people by 2050, Chad from 11 to almost 30 million. Mali is projected to more than double from 15 to 35 million and Somalia from under 10 to over 20 million.
Until recently, the UN's World Population estimates assumed that most countries would reach 2.05 children per women by 2050, and that least developed countries would fall to 2.41, but demographers have recently accepted that birth rates in the high fertility countries will not reach replacement level fertility any time soon. The highest world projection for the end of the century is now 15.8 billion ( the lowest 6.2 million) at the century's end. These few high fertility countries (averaging from 4 to over 7 children per woman) with a total population of 1.2 billion today, are projected to be the largest population block in the world by 2100.
Delay in raising the age of marriage and in instituting family planning will be as lethal in a country like Niger, as was the delay in instituting HIV prevention in Africa in the 1980s. Today in Niger, only one in 1000 women completes secondary education. In the Sahlel, few people are educated, making non-agricultural employment virtually impossible. Few girls enter secondary school and virtually none complete it.
Unless investments are made today in education, especially for girls, and in family planning in these high fertility regions then the world will become even more divided than it is today between rich and poor and between stable democratic nations and failed states. The Sahel presents the most immediate, and also the most easy to document, set of problems.
We must make family planning easy to obtain. In the case of family planning we have half a century of robust evidence of what works. We must meet the unmet need for family planning. Even failed states have markets than can be tapped into. We must knock down uninformed medical barriers to family planning. We must recognize how common misinformation is leading women to believe family planning is dangerous.
In Cambodia after the fall of Pol Pot, in refugee camps along the Thai border, neither UNICEF nor Doctors Without Borders were supplying contraception in the camps. But when this was done by another NGO, use of contraceptives jumped from zero to 52% of married women in one month.
Sahlel countries see a very high rate of child marriage. Increasing the age of marriage by five years reduces population growth by 15 to 20%, according to demographers. High fertility countries will not slow population growth rate until the average age of the first birth is raised. In Niger, the average age of marriage is under 16.
Under-age girls are married off to older men every day. Most child brides either never go to school, or drop out when they marry. Compared with mature women, these girls are twice as likely to be beaten by their husbands and five times as likely to die in childbirth.
Poor soils and unpredictable weather are outside human control. We don't know how to ameliorate corruption in contemporary governments. Subsidies to American farmers depress African markets unfairly, but they are unlikely to change soon. But addressing population through access to family planning, eliminating forced marriage for young girls and raising the age of the first birth have more promising solutions.
In a project involving a polygamous society on the border with Niger, where the average aged of marriage is 14.5, we found that a small educational grant of $196, spread over six years, had resulted in between 82% and 92% of girls remaining in school.
Writer Richard Mills in a recent article, "An Argument for a Contrarian Investment" wrote:
"…the most investable trend over the next 20 years is going to be in the resource sector, the renewable and non-renewable resources, the minerals, ores, fossil fuels and biomass a wealthier and growing global population is increasingly demanding from finite supplies and already strained production capabilities."
Potash and uranium are two good candidates for investment. Here is why...
There are an estimated 326 million trillion gallons of water on earth, but 780 million to one billion people are without basic and reliable water supplies and over two billion people lack the requirements for basic sanitation. Peter Voser the chief executive of Royal Dutch Shell said in June 2011, that global demand for fresh water may outstrip supply by as much as 40% in 20 years if current fresh-water consumption trends continue.
70% of earth is covered in ocean and 98% of the worlds water is in the oceans - which makes it unfit for drinking or irrigation because of salt. Only 2% is fresh water, but 1.6% of that is locked up in polar ice caps and glaciers.
Freshwater aquifers are one of the most important natural resources in the world today, but in recent decades the rate at which we're pumping them dry has more than doubled. If water was pumped as rapidly from the Great Lakes they would be dry in roughly 80 years.
There is another problem that, if too much groundwater is pumped out from coastal aquifers, saltwater may flow into them causing contamination of the aquifer. In addition, lowering water levels in aquifers is being reflected in reduced amounts of water flowing at the surface, in streams, rivers and lakes.. Groundwater depletion is also responsible for the Yellow River in China not reaching the ocean for months at a time, the failure of the Colorado River, also along the U.S. Atlantic Coastal Plain, and the Indus River in Pakistan failing to reach the ocean every day.
There is also widespread surface and groundwater contamination that makes valuable water supplies unfit for other uses.
If the predicted 40% shortfall occurs, and United Nations (UN) population growth estimates of 9 billion are correct, how will we share this less than half a per cent of usable freshwater to feed our increasing population?
In addition to finite water resources, relentless population growth, changing diets, a lack of investment in water infrastructure, we have increased urban, agricultural and industrial water usage.
Then there is climate change. Our climate and biosphere has been in flux for millennia. Presently we're at year 18,000 of a current warm spell. Recent climate models say the next ice age will not come within the next ten thousand years. A recent study "Climate Trends and Global Crop Production Since 1980" using yield figures FAO indicated average global yields for wheat, corn, and barley were reduced by warming by 40 million metric tons per year, from 1981 - 2002.
Arable land is another consideration in the production of food. Arable land covers only 3% of the world's surface and decreases by 25 million acres annually caused by desertification and urbanization.
Nigeria, Africa's most populous country, is losing almost 900,000 acres of cropland per year to desertification because of increased livestock foraging and human needs.
Urbanization is growing in Africa, and with it the newly prosperous add more meat to their diet; this is the most important factor stoking the rise in global food demand. It takes up to 8 kilograms of grain to produce one pound of beef - less for pork, chicken, milk or eggs - between 2kg and 6kg. As meat consumption soars, more grain is needed to feed more livestock. Chinese consumption of meat has risen from 25kg of meat per person in 1995 to 53kg in 2007.
The more people on this planet, plus more people who eat a western style diet, the more crops this planet must produce. Whether or not humanity can achieve and sustain the enormous harvest we need from this planet to feed ourselves is the central issue, not climate change.
We must a) place more of the world's land under cultivation or b) increase yields on existing usable land or c) both of the above. To grow more food on the productive land we have, we need to invest in water infrastructure, fertilizer production and nuclear energy. There are three types of macronutrients (fertilizer): nitrogen, phosphorus and potassium. The availability of nitrogen, phosphorus and potassium in the soil, in a readily available form, is the biggest limiter to plant growth.
Potassium is the scarcest of the three, but also very important for plant growth. Potash is a major source of potassium. A huge increase in the application of potash-rich fertilizers will have to happen to increase crop yields.
To supply the fresh water we're going to need to for drinking, irrigation and sanitation of the world's growing population, uranium, or rather the nuclear power generated by uranium to run seawater desalinization plants we will need uranium to provide the power. It's going to be impossible to meet the global, growing demand for energy and cut carbon dioxide emissions without nuclear energy.
Energy use accounts for between 35 and 45% of the total cost of producing desalinated water using reverse osmosis . On the other hand, evaporative desalination could be the least expensive approach to generating fresh water because of the free heat energy available as a by-product of electricity generation using nuclear power.
Remote rural communities in developing countries typically face the related challenges of extreme poverty, poor health, and environmental degradation. And population growth often exacerbates these challenges. In communities that face environmental challenges along with high fertility and high maternal and child mortality, health programs that include family planing can have great benefits for the health and well-being of women and families, with positive influences on the local environment. Meeting the reproductive health needs of women and ensuring environmental sustainability by connecting family planning with environment programs has proven to be a "win-win" strategy. Yet this connection has often been seen as controversial or irrelevant to environmental policymaking.
Developing countries, with their faster rates of population growth, are contributing a growing share of CO2 emissions, due to rapid deforestation which releases large amounts of carbon dioxide into the atmosphere.
The UNDP says that developing countries face a double burden of being more vulnerable to wider environmental challenges such as climate change but also having to cope with immediate environmental problems such as resource depletion and poor water quality.
Family planning is a response to an existing need, and it gives women autonomy and equity. A 2008 study found that unintended pregnancy accounts for up to 41% of all births worldwide and over 200 million women worldwide have an unmet need for family planning. Family planning is "the factor in population growth most amenable to program and policy interventions," according to the UNFPA.
Researchers estimate that the demand for contraception will grow by 40% over the next 15 years. The context of family planning has shifted from population control decades ago to individual rights. And the impetus for programs is coming from local communities and developing countries.
In Democratic Republic of Congo, the World Wildlife Fund, through partnerships with local nongovernmental organizations and the Ministry of Health in the Democratic Republic of Congo, is working to improve access to family planning in rural areas with existing conservation programs to give women more autonomy to limit their births and improve maternal and under-5 mortality.
The family planning projects began with women reporting no access to family planning services in remote areas. The closest health center to either give birth or access other health services is up to 30 kilometers away and has few personnel, very limited equipment, and often no medicines. Because of this challenge, the programs focus on training community-based health workers who distribute contraceptives and provide guidance and counseling in rural villages. Public awareness campaigns, based on face-to-face dialogue, focuses on the benefits of family planning on women's health and income and how these benefits extend to children, families, and the entire community. Women with access to family planning services will know how to space births, have the time to recover from childbirth, and have the strength to work in their own businesses or in agriculture, leading to more income.
Women also participate in land management training. With access to reproductive health, women are healthier to participate in conservation activities, decreasing the population pressure on the environment.
Madagascar, off the coast of Eastern Africa, is home to 5% of global biodiversity and 80% of its flora and fauna are found nowhere else in the world. With a per capita GDP of only US$438, it is a "least developed country," . Its population of 21 million is projected to reach 29 million by 2025. Maternal mortality is extremely high, and only 29% of married women are using modern contraception.
In a coastal area that depends on fishing, women average six to seven children each, the closest facility that provides reproductive health care is 50 kilometers away through a desert, and high fertility and unmet need for family planning is stressing the environment. The number of fishermen in some areas has almost tripled from 535 to 1,510 in 20 years. And in 2011, 60% of the fish caught were juveniles, a trend that points to unsustainable fishing practices.
On the other hand, Blue Ventures, a UK-based marine conservation organization dedicated to conservation, education, and sustainable development in tropical coastal communities, started the Velondriake marine conservation program in a remote area on Madagascar to support sustainable resource use and in 2007, and opened regional family planning clinics serving 40 villages by 2011. The clinics focus on peer-led education campaigns, group discussions, educational films, and community events such as theater, sports, and cultural activities. The contraceptive prevalence has risen from under 10% in January 2007 to almost 35% by January 2011, and the fertility rate has fallen by about one-third since the start of the project.
African is the only continent that is estimated to double in size, reaching 2 billion people by 2045 at current rates. Liberia and Niger are expected to double in size in less than 20 years—a stunning increase that is causing forecasts of Malthusian disaster for countries that cannot feed themselves.
Yet in north Africa families of two are the norm. In southern Africa, families of three prevail. Big cities, such as Zambia's Lusaka and Congo's Kinshasa, have fertility rates below four; the rate in Ethiopia's Addis Ababa is probably just two. Evidence of lower fertility is raising hopes that Africa can reap a "demographic dividend", the economic benefit countries get when the share of the working-age population rises relative to children and old people.
When fertility started to fall in Asia after 1960 and Latin America after 1970, the number of children a woman could expect in her lifetime fell from six to two in a generation. And contraceptive use spread rapidly. Family planners were amazed to discover that only a year or two after contraceptives had appeared in cities, illiterate women were using them in remote villages.
But in Niger and Uganda, the fall in fertility has barely begun. Where it has started, the decline is usually slower than it was in Asia. East Asian fertility fell by more than half in the 20 years to 1985. In Cameroon fertility has fallen only one point (from 5.7 to 4.7) in the past 20 years. And in eight African countries, including Ghana and Kenya, the decline has stalled—that is, after falling for a while, the rate got stuck at about five.
But fertility stalls happen: Argentina's fertility remained at three for decades; South Korea and Costa Rica also experienced hiccups. But Africa has experience more stalls than other countries, and so early in the process of decline.
In the 1970s the extended family played a big role in African life; children are often brought up by cousins or aunts. This reduces the burden of child-rearing on the parents and cuts the implicit cost of children.
Family planning is much less readily available in Africa than it was in Asia. By some estimates, a quarter of married women want contraceptives but cannot get them. That reflects reduced aid for family planning in the past 15 years and political ambivalence about cutting fertility in Africa itself.
Uganda's president once told a student gathering "your job is to produce children"; a Ugandan village chief says “to avoid having intruders grab our land we must keep producing many children."
Malawi increased modern contraceptive use from 17% of women in 1998 to 42% in 2010 but fertility fell only a bit,. Many Africans have traditionally used birth control to space their children, while still planning large families. The average lapse between first and second births in South Africa is almost four years. This method of control does cut fertility, but not as much as the other.
Infant mortality in Africa remains stubbornly high: 85 babies die for every 1,000 live births. True, that is half the level of the 1950s, but more than four times East Asia's current rate. By increasing mortality, the spread of HIV/AIDS probably kept fertility higher than it would have been. Last, female education in Africa, like contraceptive use, has lagged behind the rest of the world, and there is a close connection between educating girls and having fewer children.
The decline could accelerate if Africa were to get the conditions right. Africa's demographic transition may end up different it will be patchier (with occasional fertility stalls) and led by cities and a few countries (South Africa, Rwanda). Until Africa reduces rural fertility, it will not reach replacement levels.
As a result of Arab Spring, Egypt is seeing its first democratic elections in decades. At stake is the price of food, among other things. High prices -- for bread, in particular -- helped fuel the protests in Tahrir Square back in January. Experts say that if Egypt's going to have any chance at feeding its 85 million people, it needs a food policy do-over. The PBS series, Food for 9 Billion, is about the global challenge of feeding a growing world.
Market Place's Sandy Tolan says: Egyptians are proud to say that their revolution, swelling up from here in Tahrir Square, was about dignity, and shaking off a dictator. The groundwork for the revolution goes back to the international food crisis of 2008. As global commodity and petroleum prices rose, cooking oil, tomatoes, lentils, rice and wheat soared out of reach for many families. Riots and protests broke out around the world. In Egypt, fights erupted in bread lines and some Egyptians died.
Qotb's family comes from more than a hundred generations who grew Egypt's food in the fertile Nile silt. Now Qotb is one of more than a million Egyptians who've quit the land. Some estimate the number is closer to four million. No longer growing food, his family spends more than half its income on it.
Today Egypt imports more than half its wheat. Entrepreneurs are using up Egypt's underground water to grow grapes and strawberries for Europe. This came out of what the U.S. Agency for International Development promoted: Grow what you can for domestic consumption, and import the rest using cash from these high-value export crops. But this was no free market: The model under Mubarak was distorted, built on favors, under Mubarak's crony capitalism ruled. And cash never really trickled down to the farmers. They've been capitalizing on connections that the average farmer cannot have in terms of marketing, economy of scale, access to water, access to technology, access to subsidized fuel, access to subsidized fertilizers.
Millions of farmers were off the land for various reasons: Families grew too big for a single plot; fertilizer got too expensive; and under Mubarak-era laws, land rents got so high that farmers couldn't afford them anymore, and Mubarak's police state took it away that had been given to to farmers and gave it back to the original landlords.
Part of the Arab Spring revolution was farmers demanding help to stay on the land and grow food for Egyptians. That is the only way you can save the future agriculture of Egypt. Then you can cultivate the crops you need to minimize the gap between what we need and what we produce.
Also the country will need to modernize: More efficient irrigation, larger land plots through farmer cooperatives, criminalizing land grabs around the fertile delta. Otherwise the country will be vulnerable to price spikes in the global food supply, and to the political agendas of wheat- exporting countries like Russia and the United States.
Unfortunately food is not exactly the top item on Egypt's political agenda -- not when a new parliament will be fighting simply to implement democracy amidst military control. But citizens groups and some national leaders around the world link food self-suffiency with national security. They say the international markets have failed. It's time to grow more of our own at home.
Burkina Faso: Burkinabe Women Experience High Rates of Unintended Pregnancy. Some 64% of Women Who Want to Avoid Pregnancy Do Not Use Modern ContraceptivesDecember 5, 2011, Guttmacher Institute
A new report from the Guttmacher Institute and the Institut de Recherches en Sciences de la Santé, "Benefits of Meeting the Contraceptive Needs in Burkina Faso," notes that 64% of Burkinabe women who want to avoid pregnancy have an unmet need for modern contraception. Approximately 70% of these women want to postpone a birth for at least two years, while 29% want no more children.
One-third of all pregnancies in Burkina Faso are unintended, contributing to the country's high rates of maternal mortality and ill-health: 25% of the approximately 3,600 women who die every year from maternal causes had not intended to be pregnant. Furthermore, 87,000 Burkinabe women who experience unintended pregnancies have abortions every year, and approximately 43% of them suffer complications serious enough to require facility-based care.
If the need for modern contraceptive methods were fully met, there would be nearly 232,000 fewer unintended pregnancies than currently occur, which would reduce unplanned births and unsafe abortions by 85-87%.
Meeting women's need for modern contraceptives and reducing unintended pregnancies also saves money, most immediately by reducing spending on maternal and newborn health costs. Meeting half of the need for modern contraceptives would result in net savings of US$18 million (FCFA 8.6 billion), while fulfilling all unmet need would generate a net savings of $32 million (FCFA 15 billion).
"Ensuring that Burkinabe women have full access to family planning services allows them to make the best decisions for themselves and their families. It improves their health, their productivity and their ability to care for their families," said Dr. Danielle Yugbaré/Belemsaga of the IRRS and coauthor of the report. "It also makes perfect economic sense, in that the money saved by averting unintended pregnancies can be reallocated to other critical areas and ultimately accelerates Burkina Faso's ability to meet the Millennium Development Goals."
Ethiopia's low use of family planning had led to high fertility rates and one of the highest rates of maternal mortality in the world. However, the contraceptive prevalence rate has increased from 8% in 2000 to 15% in 2005 and then on to 29% last year, Pathfinder's Deputy Country Representative in Ethiopia Dr. Mengistu Asnake said. "It's a significant accomplishment for Ethiopia and shows that investments in family planning pay off. Unmet need for family planning has declined, as have maternal mortality and total fertility rates."
Six years ago, the Ethiopian government began a bold initiative to improve health services by training and deploying more than 34,000 rural health extension workers. This community outreach model, combined with the Ethiopian Federal Ministry of Health's skillful mobilization of community, government, and donor resources to construct 15,000 health posts in rural villages, has increased access to preventative education and health services, including family planning.
With generous financial support from USAID and other donors, including CDC, the David and Lucile Packard Foundation, the Swedish International Development Agency and others, Pathfinder International managed - in partnership with John Snow, Inc., and a local NGO, the Consortium of Reproductive Health Associations, - the Integrated Family Health Program. Through this program, access to Implanon, a popular one-rod implant that provides three years of contraception has been expanded, particularly in rural, hard-to-reach areas where health clinics are scarce or hard to reach. Nearly 400,000 rods were implanted. Prior to the start of the Implanon program in 2009, both the Integrated Family Health Program and the Pathfinder-led Reproductive Health and Family Planning Project had implemented practical training and support to the health extension workers, enabling them to provide family planning counseling and services, including injectable contraceptives. The health extension workers also distributed contraceptive pills and condoms for dual protection.
"While further studies are underway, we are seeing that Ethiopian women are increasingly having more say in decisions about whether and when to have children, and how to plan their fertility," noted Tilahun Giday, Pathfinder's Country Representative in Ethiopia. "We applaud the government's bold measures to address women's health. These changes are already having an impact on women's lives today. Our hope is that this will provide a continuing, positive trend for the women we serve, their families, and their communities."
Pathfinder tells the story of Georgette, a mother in the Democratic Republic of Congo had been pregnant 20 times and lost 7 of her babies to starvation. Then she met a Pathfinder-trained community health worker. Empowered with information about family planning, Georgette was finally able to make decisions about her body and her future. She told one of Pathfinder's staff, "family planning saved my life."
In the first six months of 2011, Pathfinder was able to provide much-needed services through more than 9.4 million visits and contacts with Pathfinder-supported health providers.
By Tewodros Melesse,
Nearly all of the growth in the world - 97% - is occurring in less developed countries. Africa's rapid population growth -- 2.3% a year, double the rate of Asia's -- puts pressure on its economies as governments struggle to provide education and health services.
In sub-Saharan Africa the population issue is due to too many women lacking the freedom to exercise choice when it comes to childbearing. In remote locations women are forced to walk many kilometers to obtain contraceptives, and in some areas they are simply not available.
Globally two in five pregnancies are unplanned. Clearly 'unmet need' for contraception is a wasted opportunity to boost development and stabilize population growth through something women want and need: the ability to decide when to become pregnant.
Women are often required to have large families to improve their social standing and ensure their economic survival. In many countries girls marry at a very young age, become pregnant too early and cut short their education to take care of their young family. Poorly educated and unable to work they have no income, adding to the cycle of poverty. In addition, young mothers face terrible threats to their health such as fistula - a hole in the birth canal caused by prolonged labor without prompt medical intervention, leading to chronic incontinence and ostracization.
Women must be empowered to be able to make their own decisions free from fear of coercion or pressure from partners, family, and society. Their sense of self-worth should not depend on the number of children they have. They must have easy access to a range of safe, effective, and affordable contraceptives and the information and counseling needed to use them.
Contraceptive access needs to be backed by better health infrastructure - we have abundant evidence that when parents are confident that their children will survive, they will have fewer and invest more in each of them.
Experience has shown us that education for girls, legal reform and access to family planning have made a difference in many countries. While it's true that economic and social development leads to women having smaller families, the converse is also true -- that the gains that contraception has made possible in women's health make family planning one of the most successful international development stories.
Pronto is a condom that claims to go from package to shaft within three seconds. The inventor of South African Willem van Renburg, who sought to develop a barrier method that didn't "kill the mood" with all that awkward fumbling. South Africa has the world's highest population of HIV-positive people.
Men refusing to wear condoms is a major factor in the global spread of HIV. Traditional rubbers present problems of smell, fit, feel, the length of time and difficulty in putting them on. Reducing that process to a second could go a long way in convincing some couples to stay safe.
Talking Their Way Out of a Population Crisis: by Emboldening Women, Evangelical Churches in Africa Help Them Overcome Traditional Resistance to Family Planning.October 22, 2011, New York Times
The world is soon to reach 7 billion people and cound see 10 billion by the end of the century, according to the U.N. Most of these additional people will be born in Africa, where women in some countries bear seven children each on average, and only 1 in 10 uses contraception. With mortality rates from disease falling, the population of some countries could increase eightfold in the next century.
In many parts of Africa, people already scramble to obtain food, land and water, and discontent provides fertile ground for extremism. So it is important to think carefully about the response to Africa's exploding population.
Researchers have found that relaxed, trusting and frank conversations between men and women may be the most effective contraceptive of all.
We learned this lesson from Western history. In Europe and the United States, birthrates plummeted between the late 18th and early 20th centuries. This had nothing to do with modern contraceptives, which had not yet been invented, or with government policies, a research team led by Ansley J. Coale of Princeton University found in the 1980s. Australian demographer John Caldwell speculated that is was due to the idea that childbearing was something couples could discuss openly and decide for themselves.
Many researchers have more recently found that spousal communication is a powerful predictor of both contraceptive use and smaller family size. On the other hand, wherever such discussions are silenced by churches, governments, patriarchy or puritanism, birthrates remain high.
Such a "cure" might work in Africa, as seen in what is happening in Africa's evangelical churches, long seen as the bane of family planning programs everywhere.
10 years ago a Columbia University demographer, James F. Phillips, discovered this when he and a group of Ghanaian colleagues had spent a decade trying to encourage contraceptive use in the Kassena-Nankana district of northern Ghana, with little success. When they started on the project, the people were among the poorest in the world and losing one child in four to disease and malnutrition. Large families were considered an asset.
Women who refused to have sex with their husbands, or who tried to use contraception secretly, were beaten. When asked about family planning, another woman said, "If you talk about such issues, you are a fool."
A program where nurses went from hut to hut on motorized scooters treating sick children and pregnant women and offering contraceptive pills and injections resulted in a decrease in child mortality by 70%, but most women were still afraid to even discuss family planning.
They organized all-male political gatherings presided over by the village chief to help explain to men that family planning would make their women and children healthier and stronger. These efforts weren't very successful.
But suddenly data showed that large numbers of women were having fewer children, whether or not they lived near the experimental family planning programs. And at the same time large numbers of evangelical preachers were establishing churches in the Ghanaian hinterlands to which, every Sunday, Kassena-Nankana women dressed in Western-style finery headed in droves.
Dr. Phillips and his team found that female Christian converts were three times as likely to use family planning as women who retained their traditional African faith, and had significantly smaller families, even though the churches didn't promote family planning. It turned out that many churches were giving women a voice denied them by their own culture.
The born-again women were forming committees, making speeches and organizing outings, fund-raisers and other activities. Traditional religion forbids women to communicate with ancestors and other spiritual beings, but the Christian women were speaking directly to Jesus about their problems. He was, many of them may have felt, the first man ever to listen. This may have given them a language for speaking to mortal men as well, even about such sensitive matters as contraception.
Then Dr. Phillips and his colleagues urged elders there to admit women to the traditionally male-only health and family planning meetings.
At one of the first events, a woman spoke of the burden placed on women by men who demanded that they produce so many children. The local women in the crowd went wild with enthusiasm.
Men who beat their wives were urged to stop. Since the start of the program wife beating has declined and the fertility rate has fallen to 3.5 children per woman, a drop of more than one birth.
Being able to express oneself and exchange ideas without fear of reprisal may be the very essence of empowerment, and potentially more important to lowering birthrates than money or access to health services, or even education. This ability for self-expression may be a path to Africa's broader political and economic development as well.
Cairo is Africa's largest city, but Lagos, Nigeria, where problems with traffic congestion, sanitation, electrical power and water supplies are staggering and two-thirds of the residents live in poverty, is expected to overtake Cairo.
Nigeria itself is growing at somewhere between 2% to 3.2%. Already it is Africa's most populous country with more than 160 million people. Ndyanabangi Bannet, the U.N. Population Fund's deputy representative in Nigeria, notes that 60% of the population is under 30 and needs to be accommodated with education, training and health care. If this youth budge is not taken advantage of, if it is not harnessed, "it can be a challenge, because imagine what hordes of unemployed young people can do," he said.
Uganda's President Yoweri Museveni, used to be disdainful of population control and urged Ugandans, especially in rural areas, to continue having large families. But the government has recently conceded that its 3.2% population growth rate must be curbed because the economy can't keep pace, and is convinced that unless it invests in reproductive health, Uganda is destined to a crisis.
Earlier this year, anti-government protests by unemployed youths and other aggrieved Ugandans flared in several communities, and nine marchers were killed in confrontations with police.
One father of nine said: "I never intended to have such a big number." ... "I with my wife had no knowledge of family planning and ended up producing one child after another. Now I cannot properly feed them." ... “The environment is being destroyed by the growing population. Trees are being cut down in big numbers and even now we can't get enough firewood to cook food," he said. “In the near future, we will starve."
Burundi, with 8.6 million people, is another fast-growing country. It's the second most densely populated African country after Rwanda.
High growth coincides with dwindling natural resources, according to Omer Ndayishimiye, head of Burundi's Population Department. Land suitable for farming will decline, and poverty will be rampant. 90% of the population live in rural areas and rely on farming to survive. The government has been trying to raise awareness among the clergy, civic leaders and the general public, suggesting to couples to go to health clinics to get taught different birth control methods, but "many Burundians still see children as source of wealth," he said.
One mother of four worried that she would not be able to feed her family properly, but her husband was against birth control and wanted as many children as possible. If she didn't he might marry another wife. If she went to the clinic she had to come with her husband, so she could not get birth control.
Senegalese writer-director Ousmane Sembene makes an impassioned plea against the practice of salinde, or female circumcision, in this moving portrait of a society in transition. In a West African village run by uncompromising Muslim males, fiery Colle (Fatoumata Coulibaly) provides safe harbor for young girls fleeing their "cleansing" rituals. But what one man terms "a minor domestic issue" soon puts the whole town on the verge of bloodshed. This movie is available on Netflix DVD.
Keeping Girls in School: Addressing Early Marriage and Breaking Barriers to Reproductive Health CareSeptember 18, 2011, RH Reality Check
This is the story of 20 year-old Haregnesh who was given away in a marriage when she was three. By the time she was 8 she was divorced. Her family wanted her to remarry, but she wanted to attend school.
"I saw educated people and the difference in their lives. I also had friends who were in early marriages, who began having children very young. I watched as they had no food to eat or feed their children and they just kept getting pregnant and having babies. Some of them experienced prolonged labor and fistula. I could see that they were suffering and I wanted my future to be different," she said.
Now Haregnesh has worked at Pathfinder for the last five years. She has seen that when girls have educational opportunities, they are empowered to improve their reproductive health and their lives. Conversely, when they are denied education, they are at a higher risk of poverty, HIV and AIDS, gender-based violence, and other harmful traditional practices. Getting and keeping girls in school is one of the best ways to foster later and chosen marriage, thus reducing the risk of maternal death from early child birth.
Pathfinder International provides educational support intervention (scholarships) to girls like Haregnesh as an integral part of women and girls' empowerment efforts.
Haregnesh has been able to buy sheep for her family, and rent land for her family to farm. She plans to go to college and become a nurse or a midwife.
Last week, The Elders - an independent group of global leaders who work together for peace and human rights, brought together in 2007 by Nelson Mandela - announced a global initiative to end child marriage with organizations focused on these issues, including Pathfinder International, joining the Girls Not Brides initiative.
About 10 million girls worldwide are forced to marry before their 18th birthdays -- more than 25,000 girls a day. Early marriage is a human rights issue and a barrier to health care, education, and prosperity. By keeping girls in school and changing this social norm, girls have an opportunity to change their future and that of their family and their community.
Kanyere, 35, has had 10 children, eight of whom have survived. She bleed a lot after the last birth and said "If I give birth again, I could die," as she learned from her doctor, who gaver her a tubal ligation (sterilization).
In this part of Congo, the complications of childbirth are as dangerous as the militias in the countryside. Each birth raises the odds of a hemorrhage, infection or rupture. Those odds increase dramatically when births come early in life, or late in life, or in rapid succession. In Congo, almost one in five deaths of women during childbearing years is due to maternal causes.
In a program organized by Heal Africa, about 6,000 women of Bweremana contribute the equivalent of 20 cents each Sunday to a common fund. When it is their time to give birth, the fund becomes a loan to pay transportation and hospital fees. The women tend a common vegetable garden to help with income and nutrition. And the group encourages family planning.
While in the U.S. the words "family planning" wave a red flag, in places such as Bweremana, family planning is undeniably pro-life. When births are spaced more than 24 months apart, both mothers and children are dramatically more likely to survive. Family planning results not only in fewer births, but in fewer at-risk births, including those early and late in a woman's fertility. When contraceptive prevalence is low, about 70% of all births involve serious risk. When prevalence is high, the figure is 35%.
According to a 2009 Gallup poll, more than 90% of American evangelicals believe that hormonal and barrier methods of contraception are morally acceptable for adults. Children are gifts from God, but this does not require the collection of as many gifts as biologically possible.
In Congo, while both the pill and condoms are generally available in larger cities such as Goma, access is limited in rural districts. Determining the pace of reproduction is often a male prerogative instead of a shared decision.
At 24 million, Ghana certainly cannot be said to be over-populated. Our landmass, at 91,000 or so square miles, is almost the size of Great Britain. Britain has a population far in excess of 60 million.
The problem of Ghana, is our inability to harness the enormous resources at our disposal to make the population comfortable. We do not accept the suggestion by Mr. Javed Talat, of the World Bank, who has asked the government to fashion out a mechanism to help check the growing population of this country.
We do not believe facilities to slow down our population growth are the priority of this nation. Instead, we would welcome a World Bank initiative that would make it possible for this country to trade with the advanced countries and improve revenue.
The problem confronting Ghana is our inability to balance our imports with exports. We buy more than we can sell, and that is why we are always in debt.
Ghanaians were shocked when they heard that more than 95% of the budget of the Minister of Water Resources, Works and Housing comes from donor support. Our country is unable to afford the cost of providing the water we drink. We are in no position to pay for a proper housing scheme that would provide roofs over our heads.
Even if we halve our population growth without acquiring the resources to take care of the population, we are still going to wallow in the quagmire of abject poverty. Our priority is to improve the national economy.
We need to intensify agriculture to become self-sufficient in food production, and to export the surplus. It is not the best of sights that every now and then famine strikes to the extent that people in some parts of Africa move from their natural habitats to feeding centres, where crumbs from the Western world are served.
Nature has endowed this nation, especially, with fertile land. From the savannah belt in northern Ghana, through the rain-forest to the scrubland in the Accra Plains, fertile land is all over the place. We need to mechanise a little bit to make food production an all-year-long activity.
We can produce enough to feed ourselves and have quite a lot for export. We need not be fooled by so-called Western experts to divert attention from improving the economy and concentrate on population reduction.
African women contribute 70% of the effort towards food production, yet they are still under-represented in areas of research and policymaking, as well as influential leadership positions in agriculture.
The African Women in Agricultural Research and Development (AWARD), a programme funded by the Gates Foundation and the United States Agency for International Development (USAID) is seeking to strengthen research and leadership skills of female agriculture scientists to enable them contribute to food security in sub-Sahara Africa.
This should enable Africa to revolutionize farming practices and rescue millions of citizens from recurrent hunger crises.
The poorer a family is in these parts of the world, the likelier it is to be huge. 55% of women in Kenya do not use contraceptives, and the poor of the poor are the most affected.
Lack of family planning, coupled with low education levels, have led to a population boom in Kenya that will soon hit the 40 million mark, says UNFPA. That is bad news for a country grappling with a staggering economy and overwhelming levels of poverty. Kenya's population in 2009 was 38 million. At its current rate, Kenya's population will reach over 80 million in 2050.
Population is growing by 3% a year, while its economy is growing at only 5.6%. "For the poverty levels, which stand at 46%, to decrease and for Kenya to stabilise, there is need for the economy to grow at thrice the population growth rate. If the population increase is rapid then something needs to be done to slow it down," says Kenya National Bureau of Statistics (KNBS) director general in charge of population, Anthony Kilele.
UNFPA statistics indicate that, currently, a Kenyan woman gives birth to at least four or five children. Plus life expectancy has increased due to the advances made in reducing the spread of HIV/Aids.
Planning minister Wycliffe Oparanya says there is a need to press for reproductive health rights that include the right to freely and responsibly determine the number, spacing and timing of children without coercion, discrimination and violence.
"One in four married women in Kenya has an unmet need for family planning, a figure that has not reduced in more than a decade," the minister says. And about 7,900 women die in Kenya every year while giving birth.
These deaths, according to the Planning ministry, can be prevented if couples are provided with adequate reproductive health information and services, including family planning, and ensuring that every child is wanted and every birth is safe.
The ministry calls for the advancing of rights for girls and women, and safeguarding of the natural resources on which survival depends. The plan hopefully be implemented by the end of this year.
The National Coordination Agency for Population and Development (NCAPD) has long-term plans that include educating women on how to access sufficient education for them to plan their families properly.
Statistics from the Population Reference Bureau (PRB) show that some girls get married when they are as young as 15. Their young age and minimal education are a hindrance when making decisions on family planning and reproductive health.
Another contributing factor to the growing population is that only 30% of Kenya's health care facilities provide maternity services and information on family planning.
"We need to slow down the population, have massive campaigns on family planning and ensure that there is a door-to-door campaign on the same." says Dr K'Oyugi.
"We have parents who cannot afford to raise many children giving birth at a fast pace because they are scared that some will die. This is a very bad mentality that we need to deal with," the NCAPD boss says.
There are people who take access to better public services as a green light to increase the size of their families. "We might be forced to halt the free primary education programme because some parents are exploiting it by getting many children, knowing that the government will cater for their education and maybe food," says Planning Permanent Secretary Edward Sambili.
Prof Sambili argues that family planning is the missing link in the achievement of Millennium Development Goals (MDGs), and that a multi-sectoral approach is needed to remedy the situation at the community level.
by Nyiko Tricia Maluleke, Africa Institute of South Africa
The rate at which the world population is growing creates a great concern to the international community. It is this reason that the United Nations held a number of conferences to discuss the means to control world population growth. The most influential conference was the 1994 International Conference on Population and Development (ICPD) held in Cairo; the conference reached an agreement on the urgent need to control global population growth. Among others, the 20 year ICPD Program of Action declared family planning use as one of the critical approaches to be initiated by United Nations member states as a way of regulating world population.
Different member states were urged to promote and make access to family planning a priority for the purpose of regulating world population growth. As such, the paper seeks to appraise the use of family planning in Africa; the paper is driven by the motive to examine the impact of family planning use on fertility patterns and population growth in the continent. It is strongly argued in the paper that, in order for Africa to successfully achieve the ICPD goal of slowed population growth, access to family planning needs to be critically looked at, as it remains the intermediate factor in the possibility of slowed population growth in the continent and the world at large.
Click here for the entire article.
Nigeria, with about 155 million people, is the most populous nation in Africa and the fertility rate has changed little, still at about five kids on average.
Although various types of contraceptive methods are available, about 20% of Nigerian women say they're not able to access them. Often their husbands stand in the way.
For six years the Society for Family Health, or SFH, an affiliate of the international non-profit PSI, has been trying to promote long-term birth control, such as intrauterine devices or contraceptive implants. Women who came and expressed interest in birth control went home to tell their husbands, but never came back.
So on family planning posters around the community, they started portraying men as caring and supportive. Men started accompanying their wives to the clinic. "Men felt ownership. The men felt that, 'this was about me and my family,' " said Dr. Anthony Nwala, with SFH.
SFH also identified men who were pro-family planning and trained them to educate other men.
Today families are moving away from the farms and moving to an urban area where providing for a large family in is more of an economic burden.
Daniel Smith, associate professor at Brown University, disagrees, saying "Women are more educated and liberated today, and yet they still want to have five or six children." He thinks Nigerians favor large extended families as a way to stay socially connected.
Family planning among the Rwandan people currently stands around 42% for both rural and urban area officials at the Ministry of Finance and Economic Planning said.
The average number of children per Rwandan woman has declined from 6 down to 4 and is likely to reach 3 in the coming years.
In 2005 only 10% of the population used family planning methods in 2005 and by 2010 up to 45% of married couples were using contraception.
The country's long-term development agenda would come under enormous pressure, if a potential population explosion is not averted. It would be extremely difficult for any country to realise its dreams without checking its population growth rate.
A separate, but related article is at http://allafrica.com/stories/201107190460.html --
As Rubavu District celebrated the World Population Day yesterday, women in the area urged government to step up the family planning campaign.
Rwanda's population is estimated at 11 million people.
"This is an important day for us to reflect on the challenges we face in our homes due to the large family sizes," said Francoise, an area resident. Families still lack information on family planning and end up producing children they cannot provide for, she said.
Refugees fleeing the drought in Somalia take on average nine days in 50-degree Celsius (122 degrees Fahrenheit) heat to travel the 80 kilometres of sandy desert Dadaab in Northern Kenya. They travel through territories of lawlessness where armed bandits and even police harass the refugees.
When they reach Dadaab, they reach a country where an estimated five million people are facing starvation because of drought, according to Abbas Gullet, the secretary general of the Kenyan Red Cross. In the northern part of Kenya, the local Turkana community is facing starvation, just like the refugees at Dadaab.
Of about 850,000 people in Turkana, more than 385,000 children and 90,000 pregnant and breastfeeding women are suffering from acute malnutrition, says UNICEF. This has increased the number of new admissions of children suffering from malnutrition to 78%.
Across the entire Horn of Africa) more than 10 million people are affected and two million children are affected, with half a million of the children suffering from severe acute malnutrition and (many are) on the brink of death," according to UNICEF.
Every year on July 11 is World Population Day, but this year, July 11 2011 was particularly important because this year somewhere around October 31, the world's population will reach 7 billion. In response to this, the United Nations launched a campaign entitled 7 Billion Actions to educate, raise awareness and encourage action around the growth of the world's population. As Ashley Judd puts it "the campaign is a wake-up call to the health, environmental, and social challenges associated with rapid population growth. It is also a wake-up call to the importance of voluntary family planning." Judd claims that, "in 2011, more than 200 million women worldwide are still denied access to desired family planning services due to unavailable resources or lack of support from their husbands and communities." It is her sense that it is time to make universal access to family planning a global priority, and that it is essential to welcome men into the conversation.
Judd's service as Global Ambassador to Population Services International(PSI) has given her the opportunity to witness first hand the unnecessary dangers that women face in developing countries due to childbirth and pregnancy. Judd cites World Health Organization statistics stating that world wide 1000 women die every day from complications of childbirth and pregnancy, and that over 99% of these maternal deaths occur in the developing world, in countries where a mother's death can leave children -- and entire families -- in a perilous scenario. Many of these women would choose to have smaller families but do not know how to prevent pregnancies. Some choose to use toxic, poisonous herbs and risk their lives to attempt to prevent or terminate pregnancies while husbands and partners are relegated to worriedly and helplessly watching their wives struggle with these poisons. Judd's point is that family planning education and methods must be more accessible to these families, and must include the men.
It turns out that men in these countries are worth including in the family planning decision making process, because research suggests that when they are included they are more likely to support their partner's family planning choices. Unfortunately though, few of the family planning programs used in developing countries include men in their educational models. But a program in the Democratic Republic of the Congo (DRC) is working to change this model. To do this, it is incorporating the use of cell phones to increase communication to both men and women of the DRC.
Because in 2011, 70 percent of world-wide cellular phone users live in developing countries, the World Bank has recommended contacting cell phones to deliver health services, particularly in remote areas like the Democratic Republic of the Congo .
Recognizing these statistics as well as the fact that 24% of the women of reproductive age in the DRC have unmet family planning needs, the Population Services International (PSI) and its local partner, Association de Sante Familiale, have moved to use cell phone technology to launch a "family planning hot line in the DRC called La Ligne Verte" (Judd)
Ligne Verte is open 5 days a week for 8.5 hours and offers no-cost, accurate information on family planning. Moreover it refers callers to family planning clinics across a wide geographic area.
But probably the most significant offering of the Ligne Verte is that it supplies a "safe, confidential zone for Congolese men and women to ask sensitive questions about family planning, as well as other sexual health concerns such as HIV."
Apparently to date, 84% of Ligne Verte callers have been men. Similar PSI hotlines in other countries reflect corresponding statistics. More that three quarters of the callers to national PSI family planning hotlines in Benin and Pakistan were men.
These are significant statistics. Men, as well as women, are asking questions about family planning and seek answers about how to keep their families physically and economically healthy. To continue listening to questions and to continue finding ways to answer questions helpfully, The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal will co-host with over thirty other co- sponsors, the second International Conference on Family Planning: Research and Best Practices November 29-December 2, 2011 in Dakar, Senegal.
Only improved funding of family planning by the west can prevent further crises.
Ten years after the last drought, Ethiopia is facing another crisis of insufficient food. Ten million people live in the affected areas. The immediate cause is erratic rainfall. Climate change may be behind this and is, in any case, expected to result in increasingly unpredictable weather patterns in the future.
However, the underlying cause is population growth. The population of Ethiopia has grown almost four fold in the fifty years since 1960, from 23 million to 83 million. Over the same period, the populations of neighbouring countries have also grown rapidly: Somalia three fold from 3 million to 9 million; Kenya five fold from 8 million to 41 million; while Djibouti has grown ten fold from 85,000 to 889,000. This growth in population counteracts improvements in agriculture or infrastructure and leaves people vulnerable when food production is disrupted by adverse natural or human events.
The UN estimates that the current Total Fertility Rate for these countries is almost five children per woman. Between one quarter and one third of married women of child-bearing age in the region would like to delay or avoid further pregnancies but do not have access to modern contraception. While universal access to reproductive health was one of the UN Millennium Development Goals, funding has stalled in recent years.
Simon Ross, chief executive of Population Matters commented, "It is right that we should provide disaster relief in response to humanitarian crises. However, we must also consider how best to prevent future disasters. Unless we address population growth, the scale of relief required in the future can only increase. Longer term investment in agriculture and infrastructure will not be effective unless we also fund the family planning programmes necessary to relieve the pressures of ever growing populations."
Facing severe budget shortfalls at home, many donor countries are cutting back their foreign aid programs, including support for crucial international family planning programs. The United States, the global leader in supporting contraceptive services in the world?s poorest countries, recently reduced its 2011 international family planning and reproductive health assistance by $33 million.
Uganda must step up its own funding for family planning. The time to act is now. The country has experienced strong economic growth in recent years, but we should remember that social and economic progress is linked to improved access to quality family planning services. Such services save women's lives, save the country money, and create a healthier, more productive society. Failure to support these services now will only end up costing more down the line.
Low levels of contraceptive use are already taking a toll. 70% women who want to avoid pregnancy are not using an effective contraceptive method. More than half of all pregnancies are unintended.
In rural areas, where 85% of the population lives and where family planning services are scarce, the poorest women now have two more children, on average, than they want, increasing economic hardship among the most vulnerable families, leaving them with fewer resources to invest in education, health care and other basic needs.
Unintended pregnancy is also a serious threat to the health and survival of women and newborns, often resulting in high-risk births occurring too soon after a previous delivery or when a woman is too young. This reality is starkly reflected in Uganda's high rates of maternal and newborn deaths.
Delivery with the aid of a traditional birth attendant is the best a pregnant rural Turkana woman can hope for in a region with a shortage of health facilities and where only 8.2% of all the babies born are delivered in hospital.
The average pregnant mother in rural Turkana has to walk at least 50 kilometers to the nearest health center. There are only 34 dispensaries within a sixteen thousand square kilometer region. The biggest danger with walking is that a woman can bleed to death on the way.
Turkana men are often away from the homestead for months on end grazing their cattle, pregnant women in the region are often reluctant to leave their homes unattended even as their time for delivery nears, no one to take care of the children and animals, so they choose to deliver at home.
In Mozambique, a woman has a 1 in 37 lifetime risk of maternal death. Most of those deaths will be from postpartum hemorrhage, with one woman dying from postpartum hemorrhage every seven minutes. In the U.S.,only 1 in 2,100 die of of maternal causes, according to the World Health Organization.
Health experts say the drug misoprostol is saving women's lives around the world. It's also controversial because it can also be used to induce abortion.
Mozambican OB-GYN doctor Cassimo Bique lead a year-long trial of the drug misoprostol designed and carried out by an American women's health nonprofit called Venture Strategies Innovations. Bique said a woman can die as early as two hours after childbirth.
The traditional birth attendants use a brightly colored cloth called the capulana, typically worn as a skirt, shawl, or baby sling, to soak up blood loss from the mother. Before misoprostol, they would need three or four capulanas to soak up typical blood loss from the mother. After miso, they needed just one.
When Bernadette could not get her monthly contraceptive injection that was out of stock in the government health centres in western Uganda, she fell pregnant with her fifth child.
By the time she decided to pay for the contraceptive and went to Reproductive Health Uganda, a family planning association, she was already four weeks pregnant.
Many mothers in western Uganda have had unintended pregnancies due to shortages of commonly used contraceptives at government health facilities. Depo-Provera Contraceptive Injection is one of the most commonly used.
The one-month contraceptive injection is popular because rural women find it easier to use compared to pills and/or they could take the contraceptive without the knowledge of their husbands.
Muhereza of Reproductive Health Uganda said that women were subjected to violence by their husbands when they unintentionally fell pregnant. "In the long run when a mother is not counseled well, then they resort to backyard abortions." Non-professionals perform most abortions. An estimated 297,000 abortions are performed in Uganda because most of the pregnancies are unintended according to a study conducted in 2005 by the Guttmaacher Institute between 2003 and 2005.
A health at another health center said, "We instead give them condoms advising them to convince their husbands to use protection until we have restocked. But some women are not be able to convince their husbands (to use condoms) so they fall pregnant."
Not all forms of contraceptives are suitable for everyone. For example, pills are not suitable for rural women because they are required to be taken daily. Most rural women prefer to take a monthly contraceptive injection.
Wagama Theresa, a senior nursing officer in a neighboring district said: "Some men have begun supporting their wives in family planning. But when they come and don't find their selected contraceptive (available), they get frustrated and you will never see the husbands back here," said Wagama.
Eliab Tayebwa, the head of Reproductive Health and HIV/AIDS in Bushenyi district explained that the district experienced contraceptives shortages when there was a delay in delivery from National Medical stores.
Access to and use of family planning in Uganda has been identified as one of the factors in achieving 2015 United Nations Millennium Development Goals (MDGs), but progress in both these areas has been slow.
83% out of 122 countries surveyed use mobile phone technology for services that include free emergency calls, text messaging with pill reminders and health information and transmission of tests and lab results, according to the World Health Organisation (WHO).
Up to 40 African countries are using mobile health services. Large countries such as Ethiopia, Nigeria, South Africa and Kenya are leading the way. "The momentum is huge." ... "Millions of people in Africa still do not have access to any healthcare. With mobile technology they can at least have some," said the manager of WHO's special unit Global Observatory for eHealth.
In Africa, mobile penetration exceeds infrastructure development, including paved roads, and access to electricity and the internet.
In the Democratic Republic of the Congo, Population Services International (PSI) supports a free hotline to complement its family planning campaigns. In Ghana, funding from a US university provides free mobile-to-mobile voice and text services between the 2,000 doctors who serve the country's 24 million population.
Kenya is on the verge of a major demographic transition and rapid urbanisation.
The World Bank, in its report Turning the Tide in Turbulent Times, says this must be well managed for the country to attain middle income status within this decade. 30% of Kenyans live in cities; by 2030 this proportion may reach 48%.
"Economic activities in urban areas have a much higher yield than those in rural areas. No country has transitioned into middle income status by remaining predominantly rural," said the World Bank country director. In Kenya, for example, Nairobi and Mombasa have only 10% of the country's population, but 40% of wage earnings.
The working age population - age 15 to 64 - is bigger than the rest of the population, which depends on them. 55% of Kenya's population is of working age and is expected to reach 63% by 2030. As families become smaller, and life expectancy grows, this economically vital group drives the economy by working, saving and investing.
However massive investment is needed to support the pressure of an increasing population - in housing and infrastructure, job creation, and crime prevention - to reap the benefits of this urban transition.
The building of new homes is not keeping up with the demand, with only one-fifth to one-third of the necessary houses being built - even as the population grows by one million a year. Only 25% of those born today will have access to quality housing in the next two decades as they reach adulthood and start family life.
Electric power is the biggest infrastructure constraint on Kenyan firms, with transport coming a close second.
The World Bank report suggests that if Kenya's infrastructure could be improved to the level of continent-leader Mauritius, annual per capita growth rates would be 3.3% higher than they are currently.
Addressing Kenya's infrastructure deficit will require spending 21% of GDP.
The World Bank is optimistic that, with the right kind of focused investment and urban policy, Kenya can still achieve middle income status of $1,000 per capita by 2019. In 2010, growth was higher than expected at 5.6%.
Twenty-three out of the 64 women who contested the New Patriotic Party (NPP) primaries were elected as parliamentary candidates and would contest on the ticket of the NPP in the 2012 general elections.
Women's rights advocates who called for reduced filing fees for all female hopefuls, and are happy that they have been successful.
Nevertheless, if the other parties, particularly the CPP and NDC do not field more women then Ghana will not be able to achieve the Millennium Development Goal 3: Promote Gender Equality and Empower Women.
Many people expected the population of the world to stabilize around 9.3 billion in the middle of the century, but newly released projection from the U.N. reports that it will hit 10.1 billion by the year 2100.
Africa, already struggling to provide food and water for its people, could more than triple its population in this century, from one billion today to 3.6 billion.
The world population is expected to reach 7 billion in late October, only 12 years after it reached 6 billion.
John Bongaarts, a demographer at the Population Council said "Every billion more people makes life more difficult for everybody." ... "Is it the end of the world? No. Can we feed 10 billion people? Probably. But we obviously would be better off with a smaller population."
Fertility is not declining as rapidly as expected in some poor countries, and has shown a slight increase in many wealthier countries, including the United States, Britain and Denmark.
The world's fastest-growing countries, and the wealthy Western nations that help finance their development need to decide whether to renew their emphasis on programs that encourage family planning, said the director of the United Nations population division, Hania Zlotnik.
Family planning programs have stagnated in many countries, caught up in ideological battles over abortion, sex education and the role of women in society. Conservatives have attacked such programs as government meddling in private decisions, and in some countries, Catholic groups fought widespread availability of birth control.
Foreign aid to pay for contraceptives - $238 million in 2009 - has remained almost stagnant. Although the U.S. was the biggest donor, the budget compromise in Congress last month cut international family planning programs by 5%.
Yemen's population quintupled since 1950, to 25 million, and could quadruple again, to 100 million, by century's end, at the current rate. Yemen already depends on food imports and faces critical water shortages.
Nigeria's population is expected to rise from today's 162 million to 730 million by 2100. Malawi could grow from 15 million to 129 million by 2100.
All predictions assume that food and water will be available for the billions yet unborn, and that potential catastrophes including climate change, wars or epidemics will not serve as a brake on population growth. For some countries these numbers are not sustainable.
Provided with information and voluntary access to birth-control methods, women have chosen to have fewer children in societies as diverse as Bangladesh, Iran, Mexico, Sri Lanka and Thailand.
Women's lack of power in their relationships with men, traditions like early marriage and polygamy, and a dearth of political leadership have slowed progress in Africa. 25% of married women in East Africa, 10% in West Africa, and 7% in Central Africa use a modern contraceptive, compared to 75% of married American women.
A study found that only when women had greater autonomy in deciding whether to use contraceptives did they have significantly fewer children. Other studies found that general education for girls plays a critical role, in that literate young women are more likely to understand that family size is a choice.
China is expected to see a declining population, peaking at 1.4 billion in the next couple of decades, and falling to 941 million by 2100.
The United States is growing faster than many rich countries, largely because of high immigration and higher fertility among Hispanic immigrants. The new report projects that the United States population will rise from today's 311 million to 478 million by 2100.