1. The population debate has been with us for a very long time dating as far back as classical Greece and Rome. It has evolved overtime and now includes population explosion and implosion as well as women’s reproductive health and rights.
2. At the global level population dynamics is a function of changes in births and deaths. However, at the national level (e.g. Uganda) total population is a function of births – deaths + in-migrants – out-migrants.
3. The world population change has gone through three phases: the first phase occurred in the Neolithic Revolution caused by shifts from nomadic hunter/gatherer communities to crop production and animal domestication making more food available to feed more mouths in settled communities and reduced deaths; the second phase from the Industrial Revolution that started around 1750. Improved transport systems and cold storage facilities connected food surplus to deficit regions and public health including general hygiene, safe drinking water and sanitation that lowered mortality; the third phase began in the late 1950s and is characterized by medical and technological advances that too lowered death rate. Thus, all these phases from the first through the third have one thing in common: they saved lives and increased life expectancy. Thus, during these three phases the increase in population was not because couples were having more babies. It is because people were living longer due to a reduction in mortality.
4. Demographers (scientists who study population) have used the term “demographic transition” to refer to three periods of demographic change. The first period is marked by high birth rate and high death rate and a stable population in agricultural societies; the second period is marked by continuing high birth rate and falling death rate and rapid population growth that began around 1750 during industrial take off; and the third period is marked by low birth rate and low death rate with a stable population in basically prosperous societies with developed welfare systems.
5. Malthus published his essay on the Principle of Population in 1798 at a time when England and the rest of Europe was going through a difficult time marked by rapid population growth, food shortages due to bad weather and war. He wrote pessimistically that the power of population was greater than the power of the earth to produce subsistence for all. To Malthus population was growing geometrically (1, 2, 4, 8, 16 etc) whereas food was growing arithmetically (1, 2, 3, 4, 5 etc). Human betterment would be impossible, he thought, because unemployment, poverty and misery were inevitable. To keep population growth in check Malthus suggested that workers should not get married until they had enough money to support a family. The subsidy component of England’s ‘poor relief’ laws that was paid according to the price of bread and size of the family should be cut back because it encouraged high birth rates. He added that only the ‘class of proprietors’ could be trusted with fecundity (to have many children). Thus, the ‘unworthy’ poor would be targeted for birth control. Malthus theory of population helped Darwin in his work on the Origin of Species, concluding that natural selection was the inevitable outcome of rapid increase of all organic beings.
6. Eugenicists (those concerned about human quality) believed that because the poor were out-reproducing the rich, the overall quality of the human race would be diluted. To prevent that from happening they advocated selective human breeding, implying that the poor would be prevented from reproduction.
7. After WWII, population studies showed that population in developing countries was growing faster than in the developed regions of the world. The Malthusian scare that population growth would exceed the earth’s capacity returned. In 1961 it was suggested that population issues be an integral part of the United Nations agenda. Population growth would be controlled by family planning through voluntary contraception (methods that prevent conception). Thus, reduced population growth in developing countries would reduce sharing of resources between the poor and the rich.
8. The rationale for family planning has evolved over time as well. From the 1960s to mid-1970s, family planning was concerned with controlling population growth in developing countries. Through provision of information, supplies and services couples would control their fertility and have the ‘right’ number of children. Non-coercive methods of persuasion (e. g. a free radio or money) would be used to generate motivation. If they did not work then coercive methods would be employed (e. g. withdrawing tax and/or housing benefits). Critics argued that cultures in developing countries had evolved in the context of high mortality and short life span. Consequently couples developed norms that support high fertility to survive. Therefore cultural change was a prerequisite for sustained and substantial reduction in fertility. Thus, the supply of contraception was not the answer: changing social conditions that generate high fertility demands was. Critics also believed that decline in fertility in countries with family planning programs (FPPs) would have occurred without FPPs. Yet other critics felt that FPPs had a ‘genocide’ motive targeting lower quality people in developing countries who are predominantly black, yellow and brown. And within these developing countries FPPs targeted the poor.
9. From the mid-1970s – based on accumulated knowledge of negative side effects of FPPs – attention shifted to maternal and child health concerns. It was also recognized that FPPs alone would not reduce rapid population growth. Since the poor who produce many children live in the countryside, rural development through increased productivity for food and cash was essential to produce prerequisites for family planning. Since the mid-1980s the emphasis has moved to women’s reproductive rights and health, empowerment, status and education. However, critics argue on the one hand that current programs still have a principal goal of imposing Western values on other cultures and; that focus should be on development rather than on contraception. On the other hand, those who believe in FPPs argue that over-emphasis on reproductive rights agenda may undermine efforts to complete the demographic transition from high birth rate and high death rate to low birth rate and low death rate. Thus, those who emphasize women’s rights and empowerment denounce contraception as cultural intrusion or genocide while supporters of contraception argue that the new agenda is an attempt to highjack successful programs.
10. After many years of research and debate, consensus has emerged that a combination of education, empowerment and participation of women in the labor market; adoption of a new lifestyle including better clothing, increased travel and leisure; and shared economic prosperity works better to lower fertility and improve maternal and child health than birth control measures by themselves.
Where does Uganda fit?
Uganda is predominantly an agricultural country with some 90 percent of the population depending on land for food and cash. Since 1971 the country has suffered political instability in whole or in part, authoritarian rule, civil wars, endemic diseases and AIDS pandemic. Economic hardship, endemic shortages of medicines and elimination of health subsidies have kept mortality rate at an unacceptably high level leading to low life expectancy. In fact between 1980 and 1995 life expectancy decreased as reported by the United Nations (E/1997/15 ST/ESA/252). Between 1980 and 1995 Uganda’s life expectancy declined from 47.0 (1980-1985) to 43.7 (1985-1990) and to 41.0 (1990-1995). An environment like this strengthens cultural values in favor of large families explaining in large part why Uganda’s total fertility rate has declined slowly from 7.1 to 6.5. The high school dropout and consequent early marriage and child bearing have also contributed to high fertility.
The 2010 Uganda’s population report has found that high fertility is a function of cultural and religious beliefs, low levels of education, early marriage and child bearing. These conditions favor large families. It is no wonder that the contraceptive prevalence rate (and serious side effects) is low at only 23 percent.
In these circumstances, family planning program by itself even with strong state and non-state support will do very little to reduce Uganda’s population growth and improve maternal and child health. A conscious integrated and multi-sector approach in the short, medium and long term that takes migration into serious consideration will be unavoidable supplemented by contraception on a voluntary basis.