By popular demand we shall continue the discussion on birth control in Uganda that we began last Sunday, January 27. Let me begin by restating that having children: how many, when and how to space them is a human right which must be exercised voluntarily. Anything done otherwise is a violation of that right.
Throughout human history, couples have controlled their reproduction behavior for various reasons on a voluntary basis or through coercion. For example, ancient Greeks kept their families small through abortion or women taking drinks that brought on violent vomiting and subsequent miscarriages. Others exercised vigorously through repeated jumping that terminated unplanned or unwanted pregnancies.
On the other hand, ancient Romans preferred large families. Even so they exercised birth control as well especially by women who married early. The first recorded use of contraceptives occurred in ancient Egypt (Reader’s Digest. How Was It Done? 1995).
Even in Uganda some couples decided and still do on their own about how many children they wish to have, when and how to space them. For example, longer periods of breast feeding coupled with prohibition of sexual relations during this period delayed pregnancy.
In today’s discussion we shall focus on involuntary birth control through legislation or other coercive methods. Forced birth control is essentially about two things:
1. Maintaining a high quality of life
2. Reducing competition over resources.
In England the number of the poor had increased so much that in 1883 Francis Galton cousin of Charles Darwin (author of Origin of Species) expressed concern about the impact of the poor on the genetic quality of the English people. He argued that intelligence is an inherited trait which was being undermined by the poor or the ‘least fit’ in society that were growing faster than the rich. He developed the science of Eugenics to produce and maintain a better class of persons through selective breeding. A Eugenics movement was founded and enthusiastically supported by members of the upper strata or rich in society. They advocated forced abortion, sterilization and prohibition of marriage of men and women considered least fit in society by class or race. Accordingly, governments were prevailed upon to pass laws to limit reproduction of the least fit. In South Africa both blacks and poor whites were targeted in birth control programs.
By and large, it was believed that blacks lagged behind white on the evolutionary scale. And in the 1960s, Henry Garret maintained that people of African lineage were very many years behind those of fairer complexion. Thus birth control programs began to target citizens of less developed countries that happen to be predominantly black, yellow and brown.
After the Second World War, the population in developing countries “exploded”. In Africa for example, population tripled between 1950 and 1990. Overall the population in developing countries was ‘over-breeding’ the developed countries.
It is interesting to note that organizations that had existed before such as Margaret Sanger League encouraged birth control primarily for women health, not to control population growth as such.
However programs that followed were specifically designed to limit population growth of least fit in developed countries and population in general in developing or Third World countries.
In 1952, the Population Council was established to serve as a forum and lobby for birth control.
The United Nations joined the bandwagon in search of a solution to exploding population in developing countries and issued a report in 1950 recommending “reduced growth of population”(Adam Roberts 1989).
At its twenty-first session in 1966 the United Nations General Assembly was presented with a report which showed that in the 1950s population in developing countries had increased by 22 percent whereas the population in developed countries had increased by 14 percent, with all the implications. The Secretary General also reported to the General Assembly that an expert committee had recommended a multidisciplinary approach pertinent to fertility and family planning to reduce population growth.
You need to know at this juncture that the term birth control became unpopular. It was replaced by family planning which also raised concerns about reducing population. Now the term reproductive health is more common. Even the United Nations changed the terminology from assistance to family planning to population assistance.
Whatever terminology is used, ultimately population growth will be reduced.
To scare people and force developing country people into birth control, such terms like Population Bomb and Population Explosion became common. And Robert McNamara, then World Bank president warned that “To put it simply: the greatest single obstacle to the economic and social advancement of the majority of people in the underdeveloped world is rampant population growth… The threat of unmanageable population pressure is very much like the threat of nuclear war”(McNamara was minister of defense before joining the World Bank). That was in 1968. In 1994, he repeated the same threat that population growth was the greatest barrier to economic growth and social well being. Others saw population growth as a security and ecological threat because if demand for goods and services exceeded their supply, there would be political, economic and social instability and efforts to increase supply of goods would undermine the environment through de-vegetation and supply of resources from developing countries to meet the demand of population in developed nations would also decline.
And since voluntary means of reducing population growth were inadequate, other means of birth control had to be introduced in the Third World hence modern contraception.
Some politicians and experts argued that development and ending of neo-colonialism were the best methods of reducing fertility. The minister of India argued that “The best contraception is development”. Chairman Mao held the same view.
Be that as it may, pressure built up for birth control. In 1968 United Nations Population Fund (UNFPA) began funding birth control activities. And in 1970, the World Bank approved its first project on population assistance. From then on adopting family planning became a condition for providing funding to developing countries.
In some countries as in India and China, coercive measures have been used with serious political and demographic and other consequences. In India, Indira Gandhi lost re-election for prime minister. China’s one child policy has had daunting demographic and social problems.
Before considering effects of birth control in general, let us outline the history of birth control in Uganda. In 1957, the Family Planning Association was founded to cater for the needs of Indian and European populations. Ugandans did not join the Association because they associated family planning with birth control and saw it as a western plot to limit the size of African population. In spite of this position, the association’s activities were extended into the countryside in the 1960s and conducted in the clinics. And the president’s wife became the Association’s patron. In 1970 the association was officially designated by the government to be the main organ of implementing family planning policy.
In drawing up the 1971-76 Development Plan the government expressed concern over rapid population growth and possible adverse impact on economic and social development. A program of advice to women on family planning and child spacing was incorporated into the Plan. The Plan was never implemented because Amin came to power in 1971 and directed termination of family planning activities in Uganda.
As economic, social and environmental challenges mounted, Amin had to find a scapegoat in rapid population growth and directed that the “Act of God” in reproduction had to be tamed. Beginning in 1975, birth control program was incorporated into government planning process. The Family Planning Association began supplying contraceptives in the country and training staff.
The UPC II government announced birth control measures to:
1. Lower the population growth rate from projected 3 percent per annum to 2.6;
2. Improve the quality of Ugandans through education, social and cultural development.
However, other preoccupations including population instability and shortage of funds prevented implementation of the program.
From the beginning of its regime in 1986, NRM government especially the president encouraged high fertility reasoning that Uganda had plenty of unutilized arable land. NRM even adopted a liberal immigration policy, causing more people to move to Uganda, some of them staying permanently and contributing to population growth. He urged Ugandans to produce more children that he volunteered to educate.
However, from the mid 1990s, NRM position changed and in 1995, a National Population Policy for sustainable development through reducing maternal mortality and fertility was adopted. NRM also limited the number of children per family to benefit from free primary education to four, indirectly imposing birth control as educating an extra child would be the sole responsibility of parents. Guidelines for a multi-sector approach were drawn up that included sexual and reproductive health, universal education, gender issues, poverty eradication and modernization of agriculture. The policy was amplified in the 2008 population policy that we summarized in our program last Sunday.
However, while NRM government is good at preparing good development programs it has proved to be very weak at implementation so that good programs gather dust in offices. In the 2010 State of Uganda Population Report, it is shown that population had continued to increase at an increasing rate of 3.2 per annum. The latest growth rate of 3.5 percent has been reported. The 1980 population census reported that population had grown at 2.8 percent. Thus, population is growing faster than before. But this is difficult to explain in natural growth terms (births over deaths) only because since 1971 Uganda has suffered tremendous human losses including the Luwero Triangle, Northern and Eastern wars and AIDS pandemic. The collapse of health services and re-emergence of diseases that had disappeared means that mortality has increased. Therefore natural population growth alone is not a sufficient explanation of the population explosion.
Except for the world as a whole where population growth is the result of births over deaths, at lower levels namely continents and countries, population growth is influenced by births over deaths but also by more in-migrants than out-migrants. As we know, Uganda has been a magnet attracting legal and illegal migrants and refugees especially from our politically, demographically and economically troubled neighbors of Rwanda, Eastern DRC and Burundi. We have also attracted refugees from Kenya (caused by tribal fighting in the Rift Valley in December 2007) and Sudan. The 2010 state of Uganda population records that information on migration trends “is scarce” which is hard to believe. The ministry of internal affairs, labor and preparedness compile statistics on migration and refugees. Therefore the information is there. Why it was not used is a question that the government only can answer. The second source of information about migration and refugees could be extracted from vital registration files but it was reported recently that the files had been stolen. It is our humble view that until information on migration and refugees is obtained and analyzed to determine its contribution to Uganda’s population growth, no birth control policy should be adopted.
Before examining whether or not birth control program will work in Uganda, let us summarize side effects of birth control generally.
Many adverse side effects have been reported. They include:
1. Interruption in the menstrual cycle which is disconcerting, unnatural and intolerable. A woman in Namibia reported that after receiving a Depo-provera injection she bled all the time for a whole year.
2. Contraception leads to loss of sexual interest contributing to domestic violence and even divorce.
3. Some women who use contraception experience difficulties in becoming pregnant.
4. Contraception users experience nausea, severe stomach pain, headache and high blood pressure.
Some women withdraw from modern contraception altogether and begin having children or resort to traditional methods that don’t work well.
Finally, if birth control is introduced by law will it work? It is unlikely to succeed if confined to contraception alone. Here are some reasons.
1. Because birth control law which is primarily to target poor people who produce more children than they can afford will be opposed by those who will believe that the solution is in eradicating poverty than contraception per se. Poor people in semi-subsistence economies where death rate is still high and they need more hands to make ends meet and more children in old age as security will resist birth control.
2. At the regional level, the region with the highest population size and benefits politically and economically will resist reducing its demographic advantage to others. Those regions that wish to gain political benefits such as constituencies will want to increase their population size.
3. Ethnically, no group will accept to reduce its population and be dominated by another. Each will plead that someone else should do it. I witnessed it in Zambia which is ethnically and regionally sensitive. All Zambians agree that there is need for birth control but none is willing to take the first step.
4. Religiously, no leader will volunteer to have his/her flock begin birth control. I have conducted research on this subject in Uganda. What you hear is that Muslims are few and don’t need birth control. Catholics won’t yield their numerical advantage to Protestants who in their turn would not accept birth control because they will fall farther behind Catholics.
5. Poor health services and negative side effects will discourage birth control.
6. Those who oppose birth control will insist Uganda needs to control migrants, reduce poverty, increase education of girls and provide lunch to keep then in school to escape teenage pregnancies and empower women to manage their reproductive behavior without being harassed by their spouses. This combination of measures will reduce population growth without legislation and other punitive methods. In Uganda there is a leadership, not population problem.
Let me end by clarifying that I am not against smaller family size as some have accused me of. I am only opposed to contraception as the only means of achieving that goal through coercion. I am also concerned that in this exercise we should pay particular attention to short, medium and long term effects drawing lessons from European and some Asian population implosion.
As a trained and experienced demographer in birth control and population census affairs I have volunteered to help as presidential or government adviser on birth control matters and the next population census. I had earlier signaled interest to serve Uganda in advisory capacity but the appointing authority didn’t respond.