Latest posts by Serufusa Sekidde (see all)
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A new World Bank working paper released in June this year reaffirmed one of the most prominent public health truths: Lower fertility rates facilitate economic growth in low-income countries. In a fit of self-prescribed professional madness and social conscientiousness, I began mailing that paper out to a couple of my fellow Ugandan medical doctors and other indigenous experts in the fields of demography and public health. I have a feeling that my email might have been ignored.
These are tepid and inauspicious days for Uganda and haruspices are having a field day. Nonetheless, my doomsday messages might come off as picayune when juxtaposed against the seemingly more immediate and funereal issues facing our country. With inflation hitting an all-time high of 21%, a potpourri of economic and political bush fires running amok and the daily existence of the common gentry continuously bombarded with a slew of lifestyle shocks, Ugandans have just about had enough of bad news.
Apparently, Ugandans are a fecund lot. We are ranked third in the world as far as growth rates go with a populace that expands at a rate of 3.576% annually. Our total fertility rate is only second to Niger’s and stands at a fruitful 6.69 children per Ugandan woman during her productive years. When I presented these facts to a coterie of Boston-based Ugandans from timorously diverse social backgrounds and who have amongst them varying degrees of educational achievement, their knee-jerk reaction to these data was to quip that Ugandan men have been working ‘overtime’. This, some claimed, is not hard to envisage in view of the government-imposed power rationing measures that have been imposed, intermittently the past 10 years and with increasing regularity and alacrity the last few months. Candle-lit dinners are a way of life in some parts of Uganda.
When the discussion got more serious, with the decibels rising in tandem with the crescendo of emotions, anecdotes began to fly by about how civil society and the political leadership in Uganda have actively stoked the embers of Uganda’s reproductive instincts. In the imperceptive minds of some of the eminent local pols, a large population leads to power, influence and economic growth, in no particular order. The dissonance of their rhetoric and rhubarb and the reality is jarring. A June 2009 report by Population Action International said it all:
Uganda’s president, Yoweri Museveni, maintains a strong pronatalist stance, positing that a large population leads to power and economic growth. Recently, a chairperson of the National Resistance Movement, President Museveni’s ruling party, in a district in northern Uganda spoke out in opposition to family planning, stating that family planning advocates “will not be tolerated,” and urged his constituents to have many children. Meanwhile, the newly appointed state minister for planning has speculated that Uganda’s rate of high population growth can be attributed to limited access to electricity, and suggested that infrastructure improvements would “lower the high population growth rate even without birth control measures.”
In the World Bank working paper mentioned above, Development Research Group members Monica Das Gupta, John Bongaarts and John Cleland conducted a review of the admittedly large but scattered literature on the implications of high fertility and they found out there is concurrence among researchers that lower fertility rates facilitate economic growth in low-income countries.
While the authors admit that family planning programs are by no means the only policy lever to help reduce fertility, they opine that they are an effective but neglected lever with a clear rationale for public funding. There is also the argument that a high fertility rate produces the pitter-patter of feet that increases mankind’s ecological footprint and it would serve us well, as we strive to manage our global common properties, if we actually reduced the number of feet being born.
Oral contraceptives, injectables and implants are on Uganda’s Essential Drugs List. Their provision is an essential component of the minimum health care package, according to each successive Uganda’s National Health Policy, so there exists a Ministry of Health budget line for contraceptives. That is superb. What we now need to do is ramp up the political support and clamp down on misinformation. There is a veritable cornucopia of benefits to be enjoyed. For example, micro-studies have also found that lower fertility is also associated with better child health and schooling, reduced maternal mortality and morbidity, increased women‘s labor force participation, and higher household earnings. This is quite aside from the intrinsic human right of being able to control one‘s own fertility.
In light of this compelling piece of evidence adduced by this team of World Bank researchers, Ugandan and international medical doctors, demographers, public health practitioners and researchers, must make sure not to fall into the trap that befell Greek mythology’s Arachne. We should speak the truth and interpret it wisely, not out of pride or in an effort to smear or engage in subterfuge, but in the spirit of concern and love.