Since Museveni and his National Resistance Movement (NRM) government came to power in 1986, Ugandans have developed a habit of dragging the country into fads without proper analysis of pros and cons or even when they know these fads won’t work. Because Museveni likes to be in the news or popular with the west he has plunged Uganda into experiments in economics, agriculture, health, etc that have overall produced adverse outcomes. Uganda adopted shock therapy version of structural adjustment in 1987 fully aware that it had been rejected in Ghana because of negative consequences. Uganda adopted abstinence in the fight against HIV knowing fairly well that it would not work. Uganda also developed a confrontational regional policy in an atmosphere of geopolitics that has created poor relations with neighbors witness the plunder of Congo resources, meddling in Kenya’s 2007 elections and the latest allegation that Uganda troops were involved in Hutu genocide in DRC. Also Uganda elite have become obsessed with making money or keeping their jobs that many will fully support donor-driven projects or government programs even when they know they will hurt their fellow citizens.
If Ugandans in senior position of responsibility had listened to views of those who wanted a gradual and sequenced approach to structural adjustment program (SAP) probably SAP would not have ended up in failure and embarrassment to a proud nation.
The launching of birth control (officials prefer the better nuanced family planning term) seems not to have drawn on SAP lessons. It has become another fad. With donor funding, seminars, workshops and articles have adopted a Malthusian school of thought that Uganda’s problems are caused by high fertility and birth control through contraception (any practice or behavior that prevents conception) is the solution. Other considerations have been sidelined. Thus in the absence of a balanced approach Uganda society will remain uninformed about population and development relations and appropriate policies for reducing family size. Let us review a few areas where gaps need to be filled.
First, proponents of family planning are arguing that Uganda’s population has ‘exploded’ without a convincing explanation. Population growth in any country is the result of the difference between births and deaths (natural growth) and in-migrants and out-migrants (net migration). In Uganda where vital registration of births and deaths is virtually non-existent there is no way of determining with accuracy the natural growth rate. Given Uganda’s political instability, civil and regional wars that have decimated men, placement into camps of internally displaced persons that do not favor sexual relations, AIDS pandemic and the rising diseases of poverty, one can safely conclude that mortality has increased faster than fertility.
Although there are reliable sources of information about migration in ministries of labor and internal affairs and in the office of the UN High Commissioner for Refugees (UNHCR), it is very surprising that there is no analysis of migration and its impact on Uganda’s population dynamics because of a scarcity of data. This is unacceptable. Either there is something being hidden about migrants or the writers of the 2010 population report did not have funds to collect and compute the data on migration. This omission has undermined the value of the report as a tool for population policy formulation. In the absence of accurate information on births and deaths and on migration, the so-called population ‘explosion’ is pure guess work. Projections are not a reliable source of information in time and space. Uganda therefore needs to have detailed, accurate and disaggregated data on natural population growth and net migration before designing a meaningful population policy and strategy. Uganda family planners are therefore groping in the dark with birth control experiments on unfortunate and vulnerable women.
Second, to sell the idea of birth control, proponents have presented Uganda as if it is the country in the world with the fastest growing population and unchanging fertility at 7 children per woman. However, the latest United Nations Secretary-General’s report on Least Developed Countries (LDCs) dated May 17, 2010 (A/65/80-E/2010/77) clearly shows that there are countries in Africa and other parts of the world with a population growth rate faster than Uganda’s. Furthermore between 1969 and 1980 Uganda’s population growth rate declined from 2.8 to 2.5 percent. Since the period from 1980 to 2009 has been dominated by destructive civil wars, AIDS and rising diseases of poverty, natural population growth (births over deaths) does not seem to have been so high as to constitute an explosion. If the explosion has indeed occurred at all, the answer must be sought in migration. As will be elaborated later net migration has not been considered because of lack of data which is baffling because there are reliable sources on illegal and legal immigrants and refugees.
Third, contrary to popular belief, Uganda’s fertility (number of births per woman during her reproductive period) has been declining from 7.1 to 6.5. Although the figure is still relatively high, there is progress which should be acknowledged and appreciated instead of demeaning women.
Fourth, the low contraceptive prevalence rate of 23 percent is insufficiently explained as due to high unmet demand for family planning. The impact of adverse side effects of contraception has been conveniently left out because it is known. Severe side effects including loss of sexual interest have forced many women to drop out of the program in part to avoid domestic violence with their spouses on matters of sexual incompatibility. The cumbersome method of taking a pill every day which are also difficult to hide from spouses (who are not involved in family planning or don’t approve of it) is a serious deterrent. That is why women are demanding contraception with long term effect which is expensive – only available in private clinics. So far contraception has been supply rather than demand driven. It is also known that uneducated women (and Uganda has many of them) have a very low propensity in contraceptive use.
Fifth, the timing of sudden scaling-up of family planning is not explained. Why now? It is believed that rising opposition to African immigrants into Europe has reignited the need to control population growth. Further, rising unemployment and poverty in Uganda has necessitated putting the blame on population growth as an “Act of God” beyond government control.
In Uganda, when the economy is doing very well population issues do not feature in development discourse. However, when the economy sours population easily becomes the scapegoat. In the early part of Amin’s regime, the government denounced family planning and banned its activities. When the economy plummeted after Asians had left, Amin blamed population growth and reinstituted birth control.
As is well known Museveni has personally encouraged high fertility until Uganda reaches an optimal population level for sustained economic growth. However rising unemployment and poverty because of poor economic policies has forced Museveni to quietly change course and turn to population growth as an explanation. In his Labor Day speech of 2003 President Museveni announced that the high annual population growth of 3.4 percent resulted in high unemployment and poverty. Ipso facto, scaled up birth control would provide a quick solution. Consequently, the government has refused to provide public works to ease unemployment in the short-term. Further the government has refused to provide school lunches to keep girls in school and delay marriage and having children. Thus blaming high population growth and abruptly embarking on birth control has temporarily saved the government the burden of taking hard choices involving allocation of resources to school lunches and public works.
Sixth, to address Europe’s opposition to African immigration and Uganda’s poverty and unemployment problems, Uganda has embarked on a population reduction exercise that differs fundamentally from the decision of the International Conference on Population and Development at Cairo in 1994 which stressed the importance of the person rather than population numbers. The conference concluded that slowing population growth would have to be addressed within the larger context of human rights for women with family planning an integral component. Birth control implementation has progressed much faster than other components. The fact that Uganda has focused on birth control is attested to by the prominence of medical doctors rather than demographers. As in the case of structural adjustment Uganda seems to have accepted to try family planning even if it knows full well that birth control has not been popular in Africa since the 1960s. As a pilot case of renewed birth control funds have begun to flow into the country and Uganda is again in the news giving Museveni another window of popularity as the darling of the west at the expense of Ugandans once again.
Seventh, individuals or couples have a right to determine the number of children and how to space them. The government of Uganda has indirectly placed a ceiling or fixed a target of four children when it decided that only four children per family would be admitted in universal primary schools. The NRM government cleverly stressed that family planning is a basic human right without at the same time mentioning that determining the number of children and how to space them is also a fundamental human right.
Eighth, NRM government has hidden skewed income distribution that has kept many Ugandans poor and environmental degradation caused by expanding export-oriented agricultural production and timber exports by blaming rapid population growth. In areas like Nyabushozi in Mbarara district and Kabale de-vegetation has happened not because of rapid population growth but because of a few families’ desire to expand livestock herding activities for profit. Birth control whether voluntary or imposed will not regenerate biodiversity in these two areas. Second, with Uganda’s economy growing at an average rate of 6 percent according to government data and population growing at an average rate of 3 percent, spreading and deepening poverty cannot be attributed to population growth.
Ninth, in order to have an effective birth control program, Uganda authorities will need to provide maps indicating areas of high and low fertility rates and to involve men and local communities in family planning matters. These two vital elements are too important to be skipped or glossed over.
Tenth, the 2010 Uganda’s population and the African Peer Review reports have succeeded in identifying obstacles to family planning. These include cultural and religious beliefs and large families which remain strong, low level of education and early pregnancies. These constraints will not be resolved by family planning. A continuation of birth control policy alone to reduce Uganda’s population growth will likely fail like structural adjustment, hurting Ugandans in the process. In the structural adjustment case, sound and more pragmatic advice by experienced Ugandans was rejected in preference for external advice. To avoid a repetition of SAP failure Uganda government needs to listen to all views before a multi-sector approach on population dynamics is finally adopted.
The next government should avoid reliance on foreign advisors and/or family members, in-laws and friends alone especially in multi-sectoral and highly controversial sectors like birth control because Ugandans have seen what type of outcomes they produce and when things go wrong the leader should take full responsibility.