Progress in Population

I am posting this report mostly because it IS a report, as opposed to someone’s skewed propaganda, and I have then annotated it.  I hope, if wordpress will cooperate, with my comments in red.


Ms. Beatrice Mwago introducing Bill Ryerson at the University of Nairobi

Access to family planning alone won’t stop the population boom

Beatrice Khalayi Shibunga is a community health worker and family planning champion, working in the slums of Korogocho in Nairobi. She goes door-to-door to offer women in her community family planning information. In her work experience, she has met women who use contraceptives but without the knowledge or consent of their husbands.

“Because some men are unco-operative, some women are forced to use contraceptives without the knowledge of their husbands,” she says.

Elizabeth Lule, director of family planning, Bill & Melinda Gates Foundation, confirms this: “Injectables (contraceptives) are popular because it can be used covertly because men may not give consent to their wives to use contraceptives.”

(Availability of contraception is an absolute first-step requirement.  Using excuses to not make them availab le is unacceptable.  Dealing with the reasons is a necessary second or concurrent step)

During a forum organised recently to assess the progress that Kenya has made towards expanding contraceptive access and options to its citizens, experts spoke of the need to expand access to family planning options so as to improve the lives of women and infants.

That is an excellent idea. However, from Shibunga’s revelation, it seems that the population problem is more complex than simply providing more contraceptive options.

In a speech last year at the University of Nairobi, Bill Ryerson, president of Population Media Centre in the US, said changing the current situation where married couples are still not using family planning as a means of controlling their families will take more than provision of more family planning methods.

Abraham Rugo from the Institute of Economic Affairs says up to now, many Kenyans don’t realise the connection between family size and development. He says this is so because it does not make a difference if you are poor. However, he says the government should come up with programmes that motivate people to have small families.

“I think the government can create incentives such as subsidising provisions for the first two or so children. Also, where cost of living is lowered and opportunities for development assured, then people would not need to have large families for social security,” he says.

(It is not possible long term to fight population growth by using economic growth.  Mathematically and physically impossible on a depleted earth,  LL)

During the just concluded International Conference on Family Planning in Addis Ababa, Kenyan researchers said myths and misconceptions on the side effects of using contraceptives are among the reasons why women do not use the services.

The Addis Ababa meeting was a follow up of a meeting that took place last year in London, at which global leaders committed themselves to provide an additional 120 million women and girls in the world’s poorest countries with access to modern contraceptive information, services and supplies by 2020.

In the 2012/16 National Family Planning Costed Implementation Plan released last year, the government has identified low male involvement as one of the traditional barriers to family planning uptake, and says that it plans to develop a comprehensive strategy for male involvement in family planning issues.

(Training women to think like men – as was done to “help” me –will not repair our corposystem culture of male dominance.  We might try is training men AND WOMEN to think like women if we want to approach a viable balance in our cultures.)

Prof Fred Segor, Principal Secretary for Health, told the forum that the government was on course to achieve its goal of reaching a 56 per cent modern contraceptive prevalence rate by 2015. He said that in the 2013/14 financial year, the government had committed $9 million (Sh765 million) to family planning programmes. This is a marked improvement compared to previous years.

The PS says this will help increase the contraceptive prevalence rate from the current 45.5 per cent to 56 per cent by 2015, as part of interventions to accelerate achievement of Millenium Development Goal 5 and Vision 2030. Prof Segor said the poorest women and those with the lowest level of education report the highest ‘unmet need’.

“Family planning is one of the most cost-effective methods to improve the health of women and provides them with the tools to plan their families and their lives,” he said.

‘Unmet need’ refers to women who want to delay their next pregnancy by at least two years but were not using a modern method of contraception. The reasoning of policy makers has been that if there was a gap between what people want and what they are doing, improving access to contraceptives would close that gap.

According to Charles Westoff of Princeton University’s Office of Population Research, a review of numerous demographic and health surveys determined that about half the women categorised as having an ‘unmet need’ have no intention of using contraceptives even if they were made freely available.

This sounds pretty great to me.  When the cultural pressures reach the point where those with smaller families are visibly better off (which is more likely to happen as communities learn better methods of land usage) then there will probably be a rapid switch of many families.  Of course, with another population doubling in a decade or two, this goal may be impossible, but the other option seems to be not to try, so providing negative data might not be helpful.

Ryerson says the confusion between the term ‘unmet need’ and ‘unmet demand’ has misled policy makers to assume that such ‘unmet demand’ could be overcome by improving family planning services and contraceptive distribution. He says the discrepancy between attitudes and behavior has less to do with availability.

Well indeed if all the unmet demand has already been met, then it is time to put more stress on environmental issues, but that should not be used as an excuse to back off on the provision of services.  This is not an either/or problem.

Major global health players have come in to help meet this ‘unmet need’. Bayer HealthCare recently reduced the price of its long-acting and reversible contraceptive implant, Jadelle, by more than 50 per cent over the next six years. Merck Sharp & Dohme has also halved the price of its long-acting, reversible contraceptive implants, Implanon and Implanon NXT.

However, Ryerson points out other factors that hinder the use of contraceptives. According to the 2008-09 Kenya Demographic and Health Survey, 96 per cent of currently married women and 98 per cent of husbands know about modern contraceptives. Of the married women who are non-users, 40 per cent do not intend to ever use contraception.

So what?  That is not a reason to withdraw services from the 60 percent who do (which I know some will attempt).

Among the reasons given for not using contraception by women who are not pregnant and do not want to become pregnant, only 0.8 per cent cited lack of availability of contraceptives. The top four reasons among those who are still capable of bearing children were concern with the medical side effects of contraceptives (31 per cent); religious prohibition (nine per cent); personal opposition (eight per cent); and opposition from husbands (six per cent).

Ryerson says these issues are best addressed by information and motivational communications, rather than focusing only on increasing the prevalence of contraceptives as government and health partners are currently doing.

I believe the remaining people will have to see some evidence of the benefit of smaller families by actually making it beneficial, and that will take time.  I also believe the only long-term useful way to do this is to work as Gates and also Jane Gooddall do to improve the conditions of the community.  We MUST STOP thinking within the corposystem box that forces us into either/or confrontations.,  This biological problem CANNOT be solved by dichotomous corposystem thinking.  Biology doesn’t function that way.  On the other hand, if we can pull together a new cultural vision, we might make it.

Changing the situation requires helping people to understand the personal benefits in health and wealth for them and their children of limiting and spacing births. It also involves role modeling family planning use, and overcoming fear that contraceptives are dangerous. It requires getting husbands and wives to talk to each other about use of family planning, Ryerson says.

“Access to family planning methods is not sufficient if men prevent their partners from using them, if women don’t understand the relative safety of contraception, compared with early and repeated childbearing throughout the reproductive years,” says Ryerson.

Many population planners measure progress in reproductive health on the basis of contraceptive prevalence rates. Ryerson agrees that this is critical, but he says that it will not result in population stabilisation if desired family size is five or more children.

A survey done by Health Rights Advocacy Forum, a health rights advocacy group, concluded that the budget for contraceptives by government is inadequate since the budgeting process is guided by bureaucratic considerations, rather than by priorities identified by the department of reproductive health.

Further, the Heraf report says 90 per cent of all funds allocated for reproductive health goes to procuring contraceptives while the remaining 10 per cent goes to distribution of the same. This shows that there is little that goes to advocacy and communication.

“The government needs to provide full choice and full access to those currently demanding contraceptives, as it improves its efforts to increase demand in the regions with poor contraceptive prevalence rate,” says Josphine Kinyanjui, a programme officer with Heraf.

Rugo says that little is being done to change the attitude of Kenyans about family planning. He adds that most of these efforts (reproductive health) are donor-funded and contraceptives come from the same countries, and thus the reason for the skewed focus.

“Moving forward, there is need to spend more money on focal areas of attitude change but that would mean that the Kenyan government will have to spend its own money,” he says.

Part of the wider strategy could include non-medical interventions like raising women’s status by providing mandatory and free education for children, especially girls. If we have more young women staying in school, they will most likely join the workforce and provide a better future for their families.

Again, teaching women to think like men will only reinforce the existing cultural imbalances.

Available information shows that no country has gone from developing status to developed status without first reducing birth rates and population growth rates. Reduced family size enables couples and nations to save more and invest in education, infrastructure, health and industry.

Providing family planning services has helped reduce fertility rates, particularly in Asia and Latin America. But meeting unmet demand for contraceptives is only part of the solution. Such countries have emphasized changing attitudes of the people regarding the role of women, ideal family size, age of first pregnancy, and the benefits of using modern contraceptives.

“We can solve the population problem voluntarily and relatively quickly, if we apply what we know, and mobilise the relatively small amount of funds needed, to provide all people with family planning information and services,” says Ryerson.