‘Plan your family or we will halt free primary education project’

Gorety Awinja, 20, cuddles her one-and-a-half-year-old daughter. The wailing child is hungry, but her mother is seven months pregnant and, therefore, unable to find work; so there is no food. Neither Gorety nor her husband has a steady job, neither of them went to secondary school... and none of them believes in family planning.

By the time their first born celebrates her second birthday, her younger sibling will be four months old, and Gorety could be pregnant again. The family will have grown, but its finances are most unlikely to have improved. With little education, the job opportunities available to both father and mother are limited and low-paying.

Gorety and her husband are proving sociologists right: the poorer a family is in these parts of the world, the likelier it is to be huge. Fifty-five per cent of women in Kenya do not use contraceptives, and the poor of the poor are the most affected.

According to the United Nations Population Fund (UNFPA), lack of family planning, coupled with low education levels, have led to a population boom that is set to hit the 40 million mark two months from now.

That is bad news for a country grappling with a staggering economy and overwhelming levels of poverty.

This year, for instance, the economy is projected to grow at 5.6 per cent. Contrast that with the expected three per cent growth in population numbers and you will see why the increasing number of mouths to feed is worrying planners.

“For the poverty levels, which stand at 46 per cent, to decrease and for Kenya to stabilise, there is need for the economy to grow at thrice the population growth rate. If the population increase is rapid then something needs to be done to slow it down,” says Kenya National Bureau of Statistics (KNBS) director general in charge of population, Anthony Kilele.

During celebrations to mark World Population Day on July 11, Planning minister Wycliffe Oparanya said this matter presented a challenge, an opportunity and a call to action for the country and the world.

The 2009 national population census reported that Kenya has about 38 million citizens, and that number is growing at a rate of three per cent annually. That means Kenya gets rough one million new souls every year, growing the population to over 80 million in 2050.

“(The Kenya) Vision 2030 aims to achieve a balance between population and socio-economic growth to improve people’s wellbeing,” Oparanya said.

“Whether we can live together on a healthy planet will depend on the choices that we make now.”

Experts are working on strategies to decrease the number of births per woman as a short-term measure.

UNFPA statistics indicate that, currently, a Kenyan woman gives birth to at least four or five children, leading to a national total of 7,150 new babies daily.

These statistics, combined with those on population growth rate, point to a country with a high fertility rate, poor use of family planning methods and increased life expectancy due to the advances made in reducing the spread of HIV/Aids.

Oparanya says there is a need to press for reproductive health rights that include the right to freely and responsibly determine the number, spacing and timing of children without coercion, discrimination and violence.

“Unfortunately, while the right to sexual and reproductive health has been proclaimed, it is far from being universally respected. There are still an estimated 215 million women in less developed countries who want to avoid or delay pregnancy, but lack access to modern contraception. One in four married women in Kenya has an unmet need for family planning, a figure that has not reduced in more than a decade,” the minister says.

Another terrible statistic born of the impact of the lack of reproductive health is that about 7,900 women die in Kenya every year while giving birth.

These deaths, according to the Planning ministry, can be prevented if couples are provided with adequate reproductive health information and services, including family planning, and ensuring that every child is wanted and every birth is safe.

The ministry has formulated a plan that will reduce inequities, ensure that women have access to family planning and improve current living standards as well as those of the generations to follow.

This, experts say, will require new ways of thinking in the way Kenyans solve individual, communal and national challenges that impede the enjoyment of quality life. It also calls for the advancing of rights for girls and women, and safeguarding of the natural resources on which survival depends.

To enable this, the National Coordination Agency for Population and Development (NCAPD) has developed a national policy that has already been discussed by members of Parliament and will hopefully be implemented by the end of this year, chief executive Boniface K’Oyugi says.

NCAPD has long-term plans that include educating women on how to access sufficient education for them to plan their families properly.

Statistics from the Population Reference Bureau (PRB) show that some girls get married when they are as young as 15. Their young age and minimal education are a hindrance when making decisions on family planning and reproductive health.

Another contributing factor to the growing population is that only 30 per cent of Kenya’s health care facilities provide maternity services and information on family planning.

Continued collaboration and support will be needed to increase this percentage and reduce the risk to women’s lives, according to NCAPD.

“We need to slow down the population, have massive campaigns on family planning and ensure that there is a door-to-door campaign on the same. However, the long-term plan is to ensure that women and girls are more educated because those who get education, especially up to secondary school level, tend to give birth to fewer children,” says Dr K’Oyugi.

Among poor families is also a tendency to get more children to counter high mortality rates.

“We have parents who cannot afford to raise many children giving birth at a fast pace because they are scared that some will die. This is a very bad mentality that we need to deal with,” the NCAPD boss says.

Those living below the poverty line represent more than 50 per cent of the population and are from the poorest provinces — such as North Eastern, Nyanza and Western. They also experience more health risks and much higher rates of infant and child mortality compared to other areas such as Nairobi and Central provinces.

In this context of rising poverty, population growth and unequal health outcomes, the United States Agency for International Aid (USAid) says it is important to understand the government’s resource allocation policies.

Budgetary allocation protocols that ignore the disproportionate need for health resources can reinforce and even worsen the inequality of health conditions across provinces and income groups.

However, there are people who take access to better public services as a green light to increase the size of their families.

“We might be forced to halt the free primary education programme because some parents are exploiting it by getting many children, knowing that the government will cater for their education and maybe food,” says Planning Permanent Secretary Edward Sambili.

Prof Sambili argues that family planning is the missing link in the achievement of Millennium Development Goals (MDGs), and that a multi-sectoral approach is needed to remedy the situation at the community level.

It is, therefore, crucial that Kenya improves service delivery and resource allocation for family planning. Neighbouring countries like Ethiopia and Rwanda are illustrations of how this can work.

Ethiopia has been cited by population and family planning experts as a good example of integrated service delivery at community level. Furthermore, the one-stop-shop service model offered through health centres is popular with clients, especially youth.

In Rwanda, community ownership and government support is credited for improving contraceptive use from 15 per cent in 1994 to 45 per cent in 2011. The country has a target of 70 per cent by 2013. The newly independent Republic of South Sudan recorded a contraceptive prevalence rate of 18.9 per cent in 2010, up from one per cent in 2000.

In a meeting dubbed “Effective Community Approaches to Family Planning”, held in Nairobi last month, delegates from across Africa agreed to learn from one other. Experts plan to continue working together to increase the uptake of family planning and other reproductive health services in their countries.

During the meeting, it was observed that Africa has the potential to accelerate achievement of MDGs if communities are fully involved in designing health programmes, including family planning. Community health workers, for example, deliver services at the household level and if adequately provided with skills and tools, they can play a key role in increasing coverage and improving quality.