Kenya's plans for its children.
Fifteen children is a big family even in Kenya, a country that as recently as a decade ago was thought to have the highest population growth rate in the world: 4 percent. Since 1948, when Kenya's first census was taken, the population has grown from 5 million to 26 million--a staggering fivefold increase. In the early 1980s, experts both inside and outside the country were predicting growth of the same magnitude for several more decades.
That's why the 1989 Demographic and Health Survey came as a shock. The DHS, produced by the U.S.-based consulting firm Macro International and Kenya's National Council for Population and Development, showed that the country's total fertility rate--the average number of children a woman will bear in her lifetime--had declined from 8.1 to 6.7. The 1993 DHS showed a further decline to 5.4. A 33 percent drop in the rate over the course of only 15 years is one of the most precipitous declines ever measured. Kenya's population growth rate had started to fall: it now stands at about 3 percent. What lay behind the changing numbers?
Kenyans had always had large families. Only a few decades ago, a high child mortality rate meant that parents had to have many babies, to insure the survival of some. But it wasn't just a matter of survival: marriages were polygamous, and family size reflected the affluence of the father. A large family was the mark of a wealthy man--one who could pay the substantial dowry required for each wife, and support all their offspring.
Two of my great grandfathers were apparently rather affluent: one had eight wives, while the other had 12. In the traditional economy, children were regarded as an unqualified blessing--as a source of free labor that would allow a family to cultivate more land or raise a bigger herd. Large families were a kind of pension as well, a way of guaranteeing the parents comfortable care in their old age.
But traditional society has been reshaped by western influences. Western medicine, for instance, has radically reduced child mortality rates. In 1963, the year Kenya won independence from Great Britain, more than 120 of every 1,000 babies failed to see their first birthday; 200 did not live to be five. Today those numbers have fallen to 62 and 95 respectively. In most countries, a drop in child mortality before age five is accompanied by a drop in the number of children per family, presumably because parents are more confident their children will survive to adulthood. But that didn't happen in Kenya. Part of the reason may be that the spread of monogamy--another western trend--had diluted a tradition that once protected mothers from becoming pregnant too often. In the polygamous unions, mothers were expected to abstain from sex for at least a year after childbirth, and sometimes until the infant was weaned--which could occur as late as the third birthday. The long intervals between births gave the mother time to recover from pregnancy and guaranteed the new-born plenty of attention. The loss of this long post-partum abstinence period, combined with a low rate of contraceptive use, tended to keep the birth rate high.
But as the population continued to grow, other factors came into play. As the amount of arable land per capita shrank, children were no longer needed in the fields, which in any case could feed fewer of them. The expenses of formal education and western medicine--both increasingly perceived as necessities--greatly increased the cost of raising a family. And in the late 1980s, those burdens were made heavier by a foundering economy. It was sometime in that decade that the shift began.
From an early date, Kenya's governments had tried to guide the demographic transition. Alarmed by the 1948 census, which showed a rapidly growing population, the colonial government encouraged medical practitioners to provide family planning services. After independence, Kenya became one of the first sub-Saharan countries to adopt a population policy. But as recently as 1984, the government still hadn't made a dent in the growth rate, as Vice President Mwai Kibaki conceded at the second World Population Conference held that year in Mexico City. Progress didn't come until the government and the nongovernmental organizations involved in family planning began to decentralize their programs--and to work out more effective ways of distributing contraceptives, particularly in rural areas.
In 1977, only 7 percent of married women used contraceptives. Today, that figure is 34 percent. Ninety percent of married people approve of contraception in principle, know of at least one method, and know where contraceptives can be obtained. There has also been a radical shift to modern methods, which now account for nearly 95 percent of contraceptive use. The most popular methods are the pill and a regime of periodic injections administered to women. These are chosen by 9.5 and 7.2 percent of married women respectively.
The condom is a special case because it is also a means of preventing the spread of sexually transmitted diseases. Its popularity is uncertain: among men, 12 percent say they use it; among women, only 0.8 percent. But the threat of AIDS is likely to make it more common. Already, 700,000 people are infected with HIV; by the year 2000, that number is expected to be 1.6 million. The most common means of transmission is heterosexual contact, so the infection is split about equally between the sexes. About four of every 10 Kenyans know someone with AIDS; two people I knew in high school recently died from it. Until recently, condoms were never openly sold. Today, you can buy them from vending machines. Uchumi, a national chain of department stores, sells condoms beside its alcohol stalls.
But much remains to be done. According to the 1993 DHS, some 26 percent of women would like to space their childbirths farther apart, while another 52 percent don't want any more children at all. If unwanted births could be eliminated entirely, the total fertility rate would drop another two points, from 5.4 to 3.4. It's clear, then, that many couples who would benefit from contraceptives still aren't using them. There are several reasons for this. Health clinics are often too far away and clinic lines can be discouragingly long. For the more complex contraceptives like the pill, information on side effects can be hard to come by, and women who experience anything unusual often discontinue use.
To alleviate these problems, the government has established a Community-Based Distribution (CBD) program. In keeping with the effort to decentralize family planning, the program works with local leaders to help them meet the needs of their communities. The government invites teachers, traditional birth attendants, and other people in positions of public trust to attend a brief course in family planning techniques. These people are then given contraceptives to distribute, and they can offer advice on how to use them properly. Participation is on a volunteer basis, a cost-cutting measure that greatly contributes to the program's stability.
Through its Information, Education, and Communication program, the CBD is addressing another side effect of social change. Traditionally, a pre-teen boy or girl learned about sex and sexual mores from a closely related adult, usually an aunt. But today, the extended family is disappearing. Parents are often too embarrassed to talk about sex, and teachers don't consider it one of their responsibilities. For fear of being labeled promiscuous, many young people won't venture anywhere near a family planning clinic. Instead, they pick up an incomplete and misleading picture of sex through the media, popular literature, and casual conversation. The IEC program is intended to make sure young people get the family planning message. It publishes pamphlets, conducts workshops, and produces television and radio broadcasts. At present, its TV and radio soap operas, which extol the virtues of small families, reach some 40 percent of the population.
Formal education, too, has played an important--if indirect--part in slowing population growth. In general, demographers find that the more education a woman receives, the fewer children she is likely to bear. Education gives a woman more social and economic options; motherhood becomes only one of many roles that she can play. In Kenya, the 1993 DHS survey found that women with no education or only primary schooling bore six children on average, while those with some secondary schooling averaged four. Contraceptive use follows a parallel trend: from 20 percent of married uneducated women, to 52 percent among those with secondary schooling. Universal primary education is an official government goal, and it has very nearly been achieved: enrollment stood at 98 percent in 1986. Secondary enrollment for that year stood at 20 percent.
Another brake on family size may be the eighth year added to the primary curriculum in 1984. The average age at which young women become sexually active has been rising, perhaps partly because of the extra school year. The "cost sharing" method through which public schools are funded seems to be having an effect as well. Parents pay little or no tuition, but they must pick up the tab for part of the school's maintenance, for uniforms, textbooks, and so forth. The expense seems to be dampening parental desires for more children.
Decades of work have begun to pay off, but a growth rate of 3 percent is still high. Further progress may require some basic changes in Kenya's approach to family planning. The current program assumes that sex begins with marriage, but according to the 1993 DHS, 83 percent of women have had sex by the time they are 20, while only 63 percent are married by that age. The government could reach sexually active youths by including sex education in the school curriculum, perhaps in that final primary year. The program should also be better adapted for male audiences. Men generally know about and approve of contraception, but they still tend to want big families. Recently, a research center was set up in Nakuru, a city northwest of Nairobi, to find ways to increase male participation. Such efforts may eventually broaden the program's reach.
But even in its present form, the Kenyan program has set an important precedent. Kenya has shown that progress in family planning need not await some threshold level of prosperity. Even in the midst of serious economic constraints, growing numbers of couples are having smaller, healthier families.
Nancy Chege is a staff researcher at the Worldwatch Institute.
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|Date:||Jan 1, 1995|
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