Suddenly Uganda is witnessing a flurry of birth control activities. Where the urgency has come from is still baffling. Uganda is a country that has lost – and still losing – so many people since the 1970s due to the Amin murderous regime, the guerrilla wars in the Luwero Triangle and in northern and eastern Uganda, AIDS pandemic, malaria particularly in Kabale due to climate change that facilitated mosquito invasion of the district with devastating outcomes and increasing diseases of poverty. According to Shifa Mwesigye (Observer {Uganda} August 2010) there is a conflict between on the one hand Uganda leaders and politicians who want more children and on the other hand donors and experts who want fewer children. That is already a major stumbling block that needs to be resolved first.
Birth control programs in Kenya that started in the late 1960s experienced implementation difficulties because they were imposed on an unwilling national leadership soon after independence that was won after a devastating Mau Mau liberation war. But since birth control was a prerequisite for foreign aid, the Kenya government went along but was not keen on birth control implementation. This lesson should not be lost on those eager to implement birth control in Uganda where resistance is still very strong.
Those who are advocating birth control should state clearly how they want it to be implemented. So far the focus has been on the unsatisfactory description of the dangers of rapid population growth. Rapid population growth in Kampala which has been described as a case of imminent population ‘explosion’ is mainly due to rural-urban migration because agriculture and rural development has been neglected by the government which has focused on services in the capital city of Kampala which contributes 70 percent of GDP. Kampala has also become a magnet to immigrants from many parts of Africa because of Uganda’s liberal immigration policy. Reducing birth control alone may not lessen Kampala’s population ‘explosion’.
It is difficult to accept that Ugandans are going to bed hungry as some commentators have stressed because the domestic demand has exceeded supply of foodstuffs. The problem is that the NRM government since the 1990s has chosen to feed the rest of the world at the expense of its people. Uganda government is more interested in earning foreign exchange with which to import luxury products for the few rich families.
It is also going to be difficult for enlightened Ugandans to accept donors’ or foreign experts’ advice about birth control measures in Uganda when higher fertility is being encouraged in their countries. They should not push Ugandans into a situation they have found themselves in: rapid population aging. If anything they should help Uganda to design a policy that optimizes population in the short, medium and long-term. This will require a focus on persons and not numbers. This will require meeting the demands of clients, not pushing for total population reduction in a short time. Setting targets at couple or national level should be avoided because in a free society or even in a repressive one targets do not work.
It is going to be difficult for Ugandans to accept that Uganda does not have enough resources to get people out of poverty when they see so much corrupt practices, mismanagement of national funds and luxury expenditures on the well connected few many of them with large families.
Ugandans should be facilitated, not coerced, to manage their reproduction responsibly. Using force will not work. It will only raise suspicions about the motives especially when Uganda is attracting so many immigrants into the country who are taking away land from the natives. The politics of and access to economic opportunities in Uganda are increasingly dependent on how large your tribe is. It is therefore difficult to advise one tribe to reduce its population size when its neighbor is busy increasing its own. When communities grow poor as is happening in Uganda, the rational behavior is to have more children to make ends meet. Lack of rural energy and social amenities contribute to rapid population growth. Those who remember what happened to the New York City population nine months later when electricity failed for one night will understand the importance of rural energy.
In a religious sensitive place like Uganda it will be surprising that religious leaders will tell their flock to be the first to embark on a birth control exercise. Muslims are trying to catch up, Catholics do not want to lose their slim demographic edge and Protestants are worried they are not growing fast enough. Scary population projections are not going to change this religious reality. The author has had conversations with members from each faith. The situation is not as easy as we would like it to be.
Despite these few illustrations of stumbling blocks, the author is convinced that birth control will happen in Uganda provided a realistic, gradual and sequenced approach is taken – no shock therapy! Family planning facilities should be established for voluntary use. Rural poverty must be addressed and girls’ education and women economic empowerment enhanced. Men must be involved in reproduction matters. So far women have been the target which has been a big mistake. The government must accept responsibility for family planning and draft appropriate policy and strategies to meet different demands. One-size-fits-all approach should be avoided. Communities should be involved. Donors and foreign experts should not be seen to be imposing their own agendas on the government and people of Uganda. Similarly, Ugandans should not be seen to be implementing donors’ family planning agendas in Uganda. There should be genuine debates from all sides. So far activities have been one-sided and dominated by those who want quick birth control outcomes including by using coercion(aggressive promotion) if necessary. Using coercion would be a wrong approach to start a long journey on a slippery and winding birth control path.