World Population Awareness

The Word on Women - Niger Starts to Tackle Soaring Population - with Help of Imams

Until recently the subject of family planning in Niger was taboo, but commissioner Kristalina Georgieva, the European Union's top humanitarian-aid official, was pleasantly surprised this time to see a project teaching women about contraception and the importance of spacing births.

The local Imam where she visited "was quoting the Koran saying there's a verse that says there has to be time between the birth of children so the children and mother can recover and be strong."

The support of the local religious leaders at the health centre she visited in Bambey, in western Niger, was crucial for bringing down the high rate of population growth, she said. The growth was putting a strain on a country that is among the poorest in the world, that struggles with a harsh climate and is vulnerable to the effects of climate change.

Since independence in 1960, Niger's population has risen from less than 2 million to 15 million plus.

Now there is "remarkable openness to address family planning". "At the level of the president, prime minister, ministers and cabinet there's an openness to discussing family planning. There's an openness that 3.3-percent population growth is not sustainable," she added.

"There are already activities on the ground (for) family planning in a very community-based and respectful manner … The topic is not taboo anymore."

Mothers need to space their children to avoid back-to-back pregnancies which contribute to malnutrition and keep mothers weak. "That's where there is potential to work hand in hand with community leaders and religious leaders. It has to be culturally acceptable to work."

The annual hungry season in Africa's Sahel countries is expected to begin in late February or early March - several months earlier than usual. Aid agencies say between five and nine million people are at risk.

Talking about population growth in relation to food shortages is a sensitive issue, partly because large families are considered important in many cultures, particularly where people rely on their children to help on the land and to support them in old age.

Many argue that the real causes of food shortages are political and economic. Georgieva says a food crisis is looming in the Sahel due to poor rains, bad harvests, food-price hikes and the return of migrants from Libya, among other factors.

But she also argues more generally that it is time for the world to pay more attention to managing population growth in fragile environments. When she visited Kenya last year she realised that in 1963 it had more or less the same population as her own country Bulgaria - well below 10 million. Today Bulgaria is at 7.5 million whereas Kenya's has soared to 40 million.

The populations of other affected countries had also grown five times and this meant that when there were droughts the impact was all the more severe.

For a very readable look at some of the arguments on why population growth is not the cause of famine, take a look at this article published by Al Jazeera: Famine in the Horn of Africa: Malthus beware. http://www.aljazeera.com/indepth/opinion/2011/08/20118178844125460.html

Drought in West Africa Threatens Millions

In the Sahel region, Niger, Senegal, Mali, Mauritania, Chad, Cameroon, Burkina Faso and Nigeria are suffering failed harvests and lack of rain, affecting millions of people, with up to 500,000 on the brink of starvation.

The crisis is made worse by rising food prices and the return of 200,000 migrant workers to West Africa because of the civil wars in Libya and Ivory Coast. These workers are no longer able to send money home from their foreign jobs.

Now the question is whether the world's wealthy nations will respond in time - or whether they will repeat the disaster of the Somalia famine last year, when early warnings were ignored for nearly a year and thousands died needlessly before massive aid was finally sent.

The Sahel is a vast, sprawling, arid region, with villages often in remote and inaccessible places, making it difficult to distribute food to them.

Unlike Somalia, the Sahel is not in the grip of war, and it is not controlled by a militant group blocking aid from reaching much of Somalia.

UNICEF says it needs $100-million this year to save the lives of 500,000 children in the Sahel. It wants to provide food to a million people in the region, and so far it only has the resources to feed half of them.

David Gressly, the regional director of UNICEF in West Africa said: "Everyone has learned a lesson from the Horn of Africa famine. We're acting much more quickly this time. We're going to react in time and save a large number of lives."

The latest UNICEF surveys have forecast that more than a million children will suffer acute malnutrition in the Sahel crisis. As many as 60% of malnourished children can die in a food crisis, but the death rate in the Sahel could be higher than usual because the region has still not recovered from a serious drought in 2010.

Climate change is believed to be one of the reasons for the rising number of food crises in the Sahel, but high fertility rates and rising populations are contributing to the problem by putting huge pressure on the Sahel's arid farmland, which can't support many people.

Niger, for example, endured devastating droughts in 2005, 2010, and again this year. "The death rates could be higher this time because households are still under stress. It takes households that are on the edge and it pushes them over the edge. We've seen families starting to withdraw their children from school as a coping mechanism," Gressly said.

Emergency aid for the Sahel should be followed by long-term programs to strengthen the communities and help them prevent such crises in the future. It costs $80 a day to treat a malnourished child, yet it would have cost only $1 a day to prevent the child's malnutrition if the money had been invested in development programs in advance.

World Must Wake Up to the Coming Crisis in the Sahel

There is a zone of human pain in the failed, and failing states along the Sahel on the edge of the Sahara desert, and across to Somalia, Yemen and Afghanistan, says Professor Malcolm Potts.

Rapid population growth, global warming, poor governance and a hideous mistreatment of women are combining in a perfect storm which could lead to unprecedented levels of environmental stress, starvation, escalating conflict and massive waves of migration. The scale of these problems goes beyond the usual response to a potential humanitarian disaster. Unless strong action is taken, the catastrophe now unfolding in the Sahel has the potential to kill as many tens of millions of people.

This is a global problem and it needs a global understanding and a global response. New international strategies need to be built about food security, family planning, gender equity and governance that have major geopolitical implications for the rest of the twenty-first century. A proper response will require billions of dollars , which would likely come primarily from the World Bank, regional development banks and other traditional donors.

Today's extremes of drought, caused by climate change, could become averages by 2050. Overgrazing, poor agricultural practices, lack of infrastructure and uneven governance could result in inefficient use of natural resources including soil, water and ecosystem-based services. Soil erosion and destruction of trees for firewood are about to collide with climate change turning serious problems into a catastrophe.

From October to May there is no rain and temperatures can exceed 120° Fahrenheit (49° C). Tremendous dust storms cover huge areas of the Sahel and Northern Nigeria. Climate change will make a bad situation worse. Droughts that used to occur every 10 years are already happening every five and they will be interspersed with torrential downpours leading to flash floods that wash away homes and crops.

Already agricultural output cannot keep pace with population growth. The UN Environment Programme sees the Sahel as "heading towards an environmental disaster" and feeding tens of millions of people as "mission impossible."

44% of children in Niger are stunted and face a life-long penalty in stunted growth and inhibited brain development if they survive.

The third largest city in Kenya, after Nairobi and Mombasa is now a refugee camp of drought victims in the north. It was built for 400,000 refugees, but every day an additional 1,500 women and children, fleeing from drought in Somalia and Ethiopia, arrive.

The worst drought in 60 years is hitting the Horn of Africa; 13 million people are already hungry. "750,000 could die in the next six months unless aid efforts were scaled up" says the New York Times. But this is just a sign of things to come. We must recognize the nature and the scale of the problem and focus on outcomes not process.

50 million people live in the Sahel. In Niger population is projected by the UN to rise from 16 million today to almost 60 million or possibly even higher in 2050 and an implausible 139 million by 2100 million, implausible since death rates may rise due to starvation or disease.

Burkina Faso is projected to go from 16 to almost 50 million people by 2050, Chad from 11 to almost 30 million. Mali is projected to more than double from 15 to 35 million and Somalia from under 10 to over 20 million.

Until recently, the UN's World Population estimates assumed that most countries would reach 2.05 children per women by 2050, and that least developed countries would fall to 2.41, but demographers have recently accepted that birth rates in the high fertility countries will not reach replacement level fertility any time soon. The highest world projection for the end of the century is now 15.8 billion ( the lowest 6.2 million) at the century's end. These few high fertility countries (averaging from 4 to over 7 children per woman) with a total population of 1.2 billion today, are projected to be the largest population block in the world by 2100.

Delay in raising the age of marriage and in instituting family planning will be as lethal in a country like Niger, as was the delay in instituting HIV prevention in Africa in the 1980s. Today in Niger, only one in 1000 women completes secondary education. In the Sahlel, few people are educated, making non-agricultural employment virtually impossible. Few girls enter secondary school and virtually none complete it.

Unless investments are made today in education, especially for girls, and in family planning in these high fertility regions then the world will become even more divided than it is today between rich and poor and between stable democratic nations and failed states. The Sahel presents the most immediate, and also the most easy to document, set of problems.

We must make family planning easy to obtain. In the case of family planning we have half a century of robust evidence of what works. We must meet the unmet need for family planning. Even failed states have markets than can be tapped into. We must knock down uninformed medical barriers to family planning. We must recognize how common misinformation is leading women to believe family planning is dangerous.

In Cambodia after the fall of Pol Pot, in refugee camps along the Thai border, neither UNICEF nor Doctors Without Borders were supplying contraception in the camps. But when this was done by another NGO, use of contraceptives jumped from zero to 52% of married women in one month.

Sahlel countries see a very high rate of child marriage. Increasing the age of marriage by five years reduces population growth by 15 to 20%, according to demographers. High fertility countries will not slow population growth rate until the average age of the first birth is raised. In Niger, the average age of marriage is under 16.

Under-age girls are married off to older men every day. Most child brides either never go to school, or drop out when they marry. Compared with mature women, these girls are twice as likely to be beaten by their husbands and five times as likely to die in childbirth.

Poor soils and unpredictable weather are outside human control. We don't know how to ameliorate corruption in contemporary governments. Subsidies to American farmers depress African markets unfairly, but they are unlikely to change soon. But addressing population through access to family planning, eliminating forced marriage for young girls and raising the age of the first birth have more promising solutions.

In a project involving a polygamous society on the border with Niger, where the average aged of marriage is 14.5, we found that a small educational grant of $196, spread over six years, had resulted in between 82% and 92% of girls remaining in school.

We need to apply funds to pilot projects, such as the success keeping girls in school, on a nation-wide scale. We may need careful, random control trials to show that cash transfers work.

Africa: Miracle Or Malthus?

African is the only continent that is estimated to double in size, reaching 2 billion people by 2045 at current rates. Liberia and Niger are expected to double in size in less than 20 years—a stunning increase that is causing forecasts of Malthusian disaster for countries that cannot feed themselves.

Yet in north Africa families of two are the norm. In southern Africa, families of three prevail. Big cities, such as Zambia's Lusaka and Congo's Kinshasa, have fertility rates below four; the rate in Ethiopia's Addis Ababa is probably just two. Evidence of lower fertility is raising hopes that Africa can reap a "demographic dividend", the economic benefit countries get when the share of the working-age population rises relative to children and old people.

When fertility started to fall in Asia after 1960 and Latin America after 1970, the number of children a woman could expect in her lifetime fell from six to two in a generation. And contraceptive use spread rapidly. Family planners were amazed to discover that only a year or two after contraceptives had appeared in cities, illiterate women were using them in remote villages.

But in Niger and Uganda, the fall in fertility has barely begun. Where it has started, the decline is usually slower than it was in Asia. East Asian fertility fell by more than half in the 20 years to 1985. In Cameroon fertility has fallen only one point (from 5.7 to 4.7) in the past 20 years. And in eight African countries, including Ghana and Kenya, the decline has stalled—that is, after falling for a while, the rate got stuck at about five.

But fertility stalls happen: Argentina's fertility remained at three for decades; South Korea and Costa Rica also experienced hiccups. But Africa has experience more stalls than other countries, and so early in the process of decline.

In the 1970s the extended family played a big role in African life; children are often brought up by cousins or aunts. This reduces the burden of child-rearing on the parents and cuts the implicit cost of children.

Family planning is much less readily available in Africa than it was in Asia. By some estimates, a quarter of married women want contraceptives but cannot get them. That reflects reduced aid for family planning in the past 15 years and political ambivalence about cutting fertility in Africa itself.

Uganda's president once told a student gathering "your job is to produce children"; a Ugandan village chief says “to avoid having intruders grab our land we must keep producing many children."

Malawi increased modern contraceptive use from 17% of women in 1998 to 42% in 2010 but fertility fell only a bit,. Many Africans have traditionally used birth control to space their children, while still planning large families. The average lapse between first and second births in South Africa is almost four years. This method of control does cut fertility, but not as much as the other.

Infant mortality in Africa remains stubbornly high: 85 babies die for every 1,000 live births. True, that is half the level of the 1950s, but more than four times East Asia's current rate. By increasing mortality, the spread of HIV/AIDS probably kept fertility higher than it would have been. Last, female education in Africa, like contraceptive use, has lagged behind the rest of the world, and there is a close connection between educating girls and having fewer children.

The decline could accelerate if Africa were to get the conditions right. Africa's demographic transition may end up different it will be patchier (with occasional fertility stalls) and led by cities and a few countries (South Africa, Rwanda). Until Africa reduces rural fertility, it will not reach replacement levels.

Food for 9 Billion: Food Fuels Egypt's Revolution

As a result of Arab Spring, Egypt is seeing its first democratic elections in decades. At stake is the price of food, among other things. High prices -- for bread, in particular -- helped fuel the protests in Tahrir Square back in January. Experts say that if Egypt's going to have any chance at feeding its 85 million people, it needs a food policy do-over. The PBS series, Food for 9 Billion, is about the global challenge of feeding a growing world.

Market Place's Sandy Tolan says: Egyptians are proud to say that their revolution, swelling up from here in Tahrir Square, was about dignity, and shaking off a dictator. The groundwork for the revolution goes back to the international food crisis of 2008. As global commodity and petroleum prices rose, cooking oil, tomatoes, lentils, rice and wheat soared out of reach for many families. Riots and protests broke out around the world. In Egypt, fights erupted in bread lines and some Egyptians died.

Qotb's family comes from more than a hundred generations who grew Egypt's food in the fertile Nile silt. Now Qotb is one of more than a million Egyptians who've quit the land. Some estimate the number is closer to four million. No longer growing food, his family spends more than half its income on it.

Today Egypt imports more than half its wheat. Entrepreneurs are using up Egypt's underground water to grow grapes and strawberries for Europe. This came out of what the U.S. Agency for International Development promoted: Grow what you can for domestic consumption, and import the rest using cash from these high-value export crops. But this was no free market: The model under Mubarak was distorted, built on favors, under Mubarak's crony capitalism ruled. And cash never really trickled down to the farmers. They've been capitalizing on connections that the average farmer cannot have in terms of marketing, economy of scale, access to water, access to technology, access to subsidized fuel, access to subsidized fertilizers.

Millions of farmers were off the land for various reasons: Families grew too big for a single plot; fertilizer got too expensive; and under Mubarak-era laws, land rents got so high that farmers couldn't afford them anymore, and Mubarak's police state took it away that had been given to to farmers and gave it back to the original landlords.

Part of the Arab Spring revolution was farmers demanding help to stay on the land and grow food for Egyptians. That is the only way you can save the future agriculture of Egypt. Then you can cultivate the crops you need to minimize the gap between what we need and what we produce.

Also the country will need to modernize: More efficient irrigation, larger land plots through farmer cooperatives, criminalizing land grabs around the fertile delta. Otherwise the country will be vulnerable to price spikes in the global food supply, and to the political agendas of wheat- exporting countries like Russia and the United States.

Unfortunately food is not exactly the top item on Egypt's political agenda -- not when a new parliament will be fighting simply to implement democracy amidst military control. But citizens groups and some national leaders around the world link food self-suffiency with national security. They say the international markets have failed. It's time to grow more of our own at home.

Burkina Faso: Burkinabe Women Experience High Rates of Unintended Pregnancy. Some 64% of Women Who Want to Avoid Pregnancy Do Not Use Modern Contraceptives

A new report from the Guttmacher Institute and the Institut de Recherches en Sciences de la Santé, "Benefits of Meeting the Contraceptive Needs in Burkina Faso," notes that 64% of Burkinabe women who want to avoid pregnancy have an unmet need for modern contraception. Approximately 70% of these women want to postpone a birth for at least two years, while 29% want no more children.

One-third of all pregnancies in Burkina Faso are unintended, contributing to the country's high rates of maternal mortality and ill-health: 25% of the approximately 3,600 women who die every year from maternal causes had not intended to be pregnant. Furthermore, 87,000 Burkinabe women who experience unintended pregnancies have abortions every year, and approximately 43% of them suffer complications serious enough to require facility-based care.

If the need for modern contraceptive methods were fully met, there would be nearly 232,000 fewer unintended pregnancies than currently occur, which would reduce unplanned births and unsafe abortions by 85-87%.

Meeting women's need for modern contraceptives and reducing unintended pregnancies also saves money, most immediately by reducing spending on maternal and newborn health costs. Meeting half of the need for modern contraceptives would result in net savings of US$18 million (FCFA 8.6 billion), while fulfilling all unmet need would generate a net savings of $32 million (FCFA 15 billion).

"Ensuring that Burkinabe women have full access to family planning services allows them to make the best decisions for themselves and their families. It improves their health, their productivity and their ability to care for their families," said Dr. Danielle Yugbaré/Belemsaga of the IRRS and coauthor of the report. "It also makes perfect economic sense, in that the money saved by averting unintended pregnancies can be reallocated to other critical areas and ultimately accelerates Burkina Faso's ability to meet the Millennium Development Goals."

Contraceptive Use in Ethiopia Doubles Twice in Ten Years

Ethiopia's low use of family planning had led to high fertility rates and one of the highest rates of maternal mortality in the world. However, the contraceptive prevalence rate has increased from 8% in 2000 to 15% in 2005 and then on to 29% last year, Pathfinder's Deputy Country Representative in Ethiopia Dr. Mengistu Asnake said. "It's a significant accomplishment for Ethiopia and shows that investments in family planning pay off. Unmet need for family planning has declined, as have maternal mortality and total fertility rates."

Six years ago, the Ethiopian government began a bold initiative to improve health services by training and deploying more than 34,000 rural health extension workers. This community outreach model, combined with the Ethiopian Federal Ministry of Health's skillful mobilization of community, government, and donor resources to construct 15,000 health posts in rural villages, has increased access to preventative education and health services, including family planning.

With generous financial support from USAID and other donors, including CDC, the David and Lucile Packard Foundation, the Swedish International Development Agency and others, Pathfinder International managed - in partnership with John Snow, Inc., and a local NGO, the Consortium of Reproductive Health Associations, - the Integrated Family Health Program. Through this program, access to Implanon, a popular one-rod implant that provides three years of contraception has been expanded, particularly in rural, hard-to-reach areas where health clinics are scarce or hard to reach. Nearly 400,000 rods were implanted. Prior to the start of the Implanon program in 2009, both the Integrated Family Health Program and the Pathfinder-led Reproductive Health and Family Planning Project had implemented practical training and support to the health extension workers, enabling them to provide family planning counseling and services, including injectable contraceptives. The health extension workers also distributed contraceptive pills and condoms for dual protection.

"While further studies are underway, we are seeing that Ethiopian women are increasingly having more say in decisions about whether and when to have children, and how to plan their fertility," noted Tilahun Giday, Pathfinder's Country Representative in Ethiopia. "We applaud the government's bold measures to address women's health. These changes are already having an impact on women's lives today. Our hope is that this will provide a continuing, positive trend for the women we serve, their families, and their communities."

Pathfinder Saves Lives

Pathfinder tells the story of Georgette, a mother in the Democratic Republic of Congo had been pregnant 20 times and lost 7 of her babies to starvation. Then she met a Pathfinder-trained community health worker. Empowered with information about family planning, Georgette was finally able to make decisions about her body and her future. She told one of Pathfinder's staff, "family planning saved my life."

In the first six months of 2011, Pathfinder was able to provide much-needed services through more than 9.4 million visits and contacts with Pathfinder-supported health providers.

Pathfinder says: your generous support and continued involvement - whether by signing a petition, sharing a video, attending an event, or following us on Facebook - means a lot.

Ethiopia: Teje's Story: Child Marriage and Education

Teje, a young Ethiopian girl, struggled to avoid early marriage and stay in school. With Pathfinder's help, she is now well on her way to making a better life for herself and her family.

Africa's Birth Rate: Why Women Must Be Free to Choose

By Tewodros Melesse, IPPF Director-General and an Ethiopian national

Nearly all of the growth in the world - 97% - is occurring in less developed countries. Africa's rapid population growth -- 2.3% a year, double the rate of Asia's -- puts pressure on its economies as governments struggle to provide education and health services.

In sub-Saharan Africa the population issue is due to too many women lacking the freedom to exercise choice when it comes to childbearing. In remote locations women are forced to walk many kilometers to obtain contraceptives, and in some areas they are simply not available.

Globally two in five pregnancies are unplanned. Clearly 'unmet need' for contraception is a wasted opportunity to boost development and stabilize population growth through something women want and need: the ability to decide when to become pregnant.

Women are often required to have large families to improve their social standing and ensure their economic survival. In many countries girls marry at a very young age, become pregnant too early and cut short their education to take care of their young family. Poorly educated and unable to work they have no income, adding to the cycle of poverty. In addition, young mothers face terrible threats to their health such as fistula - a hole in the birth canal caused by prolonged labor without prompt medical intervention, leading to chronic incontinence and ostracization.

Women must be empowered to be able to make their own decisions free from fear of coercion or pressure from partners, family, and society. Their sense of self-worth should not depend on the number of children they have. They must have easy access to a range of safe, effective, and affordable contraceptives and the information and counseling needed to use them.

Contraceptive access needs to be backed by better health infrastructure - we have abundant evidence that when parents are confident that their children will survive, they will have fewer and invest more in each of them.

Experience has shown us that education for girls, legal reform and access to family planning have made a difference in many countries. While it's true that economic and social development leads to women having smaller families, the converse is also true -- that the gains that contraception has made possible in women's health make family planning one of the most successful international development stories.

South Africa: Can a Faster Condom Help Prevent HIV? Unwrap This Timesaver Before You Get Busy

Pronto is a condom that claims to go from package to shaft within three seconds. The inventor of South African Willem van Renburg, who sought to develop a barrier method that didn't "kill the mood" with all that awkward fumbling. South Africa has the world's highest population of HIV-positive people.

Men refusing to wear condoms is a major factor in the global spread of HIV. Traditional rubbers present problems of smell, fit, feel, the length of time and difficulty in putting them on. Reducing that process to a second could go a long way in convincing some couples to stay safe.

Pronto's packaging doubles as an applicator. Users just need to crack the package in half, slip it on, and discard the applicator in one quick motion.

Talking Their Way Out of a Population Crisis: by Emboldening Women, Evangelical Churches in Africa Help Them Overcome Traditional Resistance to Family Planning.

The world is soon to reach 7 billion people and cound see 10 billion by the end of the century, according to the U.N. Most of these additional people will be born in Africa, where women in some countries bear seven children each on average, and only 1 in 10 uses contraception. With mortality rates from disease falling, the population of some countries could increase eightfold in the next century.

In many parts of Africa, people already scramble to obtain food, land and water, and discontent provides fertile ground for extremism. So it is important to think carefully about the response to Africa's exploding population.

Researchers have found that relaxed, trusting and frank conversations between men and women may be the most effective contraceptive of all.

We learned this lesson from Western history. In Europe and the United States, birthrates plummeted between the late 18th and early 20th centuries. This had nothing to do with modern contraceptives, which had not yet been invented, or with government policies, a research team led by Ansley J. Coale of Princeton University found in the 1980s. Australian demographer John Caldwell speculated that is was due to the idea that childbearing was something couples could discuss openly and decide for themselves.

Many researchers have more recently found that spousal communication is a powerful predictor of both contraceptive use and smaller family size. On the other hand, wherever such discussions are silenced by churches, governments, patriarchy or puritanism, birthrates remain high.

Such a "cure" might work in Africa, as seen in what is happening in Africa's evangelical churches, long seen as the bane of family planning programs everywhere.

10 years ago a Columbia University demographer, James F. Phillips, discovered this when he and a group of Ghanaian colleagues had spent a decade trying to encourage contraceptive use in the Kassena-Nankana district of northern Ghana, with little success. When they started on the project, the people were among the poorest in the world and losing one child in four to disease and malnutrition. Large families were considered an asset.

Women who refused to have sex with their husbands, or who tried to use contraception secretly, were beaten. When asked about family planning, another woman said, "If you talk about such issues, you are a fool."

A program where nurses went from hut to hut on motorized scooters treating sick children and pregnant women and offering contraceptive pills and injections resulted in a decrease in child mortality by 70%, but most women were still afraid to even discuss family planning.

They organized all-male political gatherings presided over by the village chief to help explain to men that family planning would make their women and children healthier and stronger. These efforts weren't very successful.

But suddenly data showed that large numbers of women were having fewer children, whether or not they lived near the experimental family planning programs. And at the same time large numbers of evangelical preachers were establishing churches in the Ghanaian hinterlands to which, every Sunday, Kassena-Nankana women dressed in Western-style finery headed in droves.

Dr. Phillips and his team found that female Christian converts were three times as likely to use family planning as women who retained their traditional African faith, and had significantly smaller families, even though the churches didn't promote family planning. It turned out that many churches were giving women a voice denied them by their own culture.

The born-again women were forming committees, making speeches and organizing outings, fund-raisers and other activities. Traditional religion forbids women to communicate with ancestors and other spiritual beings, but the Christian women were speaking directly to Jesus about their problems. He was, many of them may have felt, the first man ever to listen. This may have given them a language for speaking to mortal men as well, even about such sensitive matters as contraception.

Then Dr. Phillips and his colleagues urged elders there to admit women to the traditionally male-only health and family planning meetings.

At one of the first events, a woman spoke of the burden placed on women by men who demanded that they produce so many children. The local women in the crowd went wild with enthusiasm.

Men who beat their wives were urged to stop. Since the start of the program wife beating has declined and the fertility rate has fallen to 3.5 children per woman, a drop of more than one birth.

Being able to express oneself and exchange ideas without fear of reprisal may be the very essence of empowerment, and potentially more important to lowering birthrates than money or access to health services, or even education. This ability for self-expression may be a path to Africa's broader political and economic development as well.

Africa Rapidly Changing as World Population Nears 7 Billion

Cairo is Africa's largest city, but Lagos, Nigeria, where problems with traffic congestion, sanitation, electrical power and water supplies are staggering and two-thirds of the residents live in poverty, is expected to overtake Cairo.

Nigeria itself is growing at somewhere between 2% to 3.2%. Already it is Africa's most populous country with more than 160 million people. Ndyanabangi Bannet, the U.N. Population Fund's deputy representative in Nigeria, notes that 60% of the population is under 30 and needs to be accommodated with education, training and health care. If this youth budge is not taken advantage of, if it is not harnessed, "it can be a challenge, because imagine what hordes of unemployed young people can do," he said.

Uganda's President Yoweri Museveni, used to be disdainful of population control and urged Ugandans, especially in rural areas, to continue having large families. But the government has recently conceded that its 3.2% population growth rate must be curbed because the economy can't keep pace, and is convinced that unless it invests in reproductive health, Uganda is destined to a crisis.

Earlier this year, anti-government protests by unemployed youths and other aggrieved Ugandans flared in several communities, and nine marchers were killed in confrontations with police.

One father of nine said: "I never intended to have such a big number." ... "I with my wife had no knowledge of family planning and ended up producing one child after another. Now I cannot properly feed them." ... “The environment is being destroyed by the growing population. Trees are being cut down in big numbers and even now we can't get enough firewood to cook food," he said. “In the near future, we will starve."

Burundi, with 8.6 million people, is another fast-growing country. It's the second most densely populated African country after Rwanda.

High growth coincides with dwindling natural resources, according to Omer Ndayishimiye, head of Burundi's Population Department. Land suitable for farming will decline, and poverty will be rampant. 90% of the population live in rural areas and rely on farming to survive. The government has been trying to raise awareness among the clergy, civic leaders and the general public, suggesting to couples to go to health clinics to get taught different birth control methods, but "many Burundians still see children as source of wealth," he said.

One mother of four worried that she would not be able to feed her family properly, but her husband was against birth control and wanted as many children as possible. If she didn't he might marry another wife. If she went to the clinic she had to come with her husband, so she could not get birth control.

Senegal: Moolaadé - Movie Review

Senegalese writer-director Ousmane Sembene makes an impassioned plea against the practice of salinde, or female circumcision, in this moving portrait of a society in transition. In a West African village run by uncompromising Muslim males, fiery Colle (Fatoumata Coulibaly) provides safe harbor for young girls fleeing their "cleansing" rituals. But what one man terms "a minor domestic issue" soon puts the whole town on the verge of bloodshed. This movie is available on Netflix DVD.

Keeping Girls in School: Addressing Early Marriage and Breaking Barriers to Reproductive Health Care

This is the story of 20 year-old Haregnesh who was given away in a marriage when she was three. By the time she was 8 she was divorced. Her family wanted her to remarry, but she wanted to attend school.

"I saw educated people and the difference in their lives. I also had friends who were in early marriages, who began having children very young. I watched as they had no food to eat or feed their children and they just kept getting pregnant and having babies. Some of them experienced prolonged labor and fistula. I could see that they were suffering and I wanted my future to be different," she said.

Now Haregnesh has worked at Pathfinder for the last five years. She has seen that when girls have educational opportunities, they are empowered to improve their reproductive health and their lives. Conversely, when they are denied education, they are at a higher risk of poverty, HIV and AIDS, gender-based violence, and other harmful traditional practices. Getting and keeping girls in school is one of the best ways to foster later and chosen marriage, thus reducing the risk of maternal death from early child birth.

Pathfinder International provides educational support intervention (scholarships) to girls like Haregnesh as an integral part of women and girls' empowerment efforts.

Haregnesh has been able to buy sheep for her family, and rent land for her family to farm. She plans to go to college and become a nurse or a midwife.

Last week, The Elders - an independent group of global leaders who work together for peace and human rights, brought together in 2007 by Nelson Mandela - announced a global initiative to end child marriage with organizations focused on these issues, including Pathfinder International, joining the Girls Not Brides initiative.

About 10 million girls worldwide are forced to marry before their 18th birthdays -- more than 25,000 girls a day. Early marriage is a human rights issue and a barrier to health care, education, and prosperity. By keeping girls in school and changing this social norm, girls have an opportunity to change their future and that of their family and their community.

See www.pathfinder.org/BreakingBarriers.

Family Planning as a Pro-life Cause

Kanyere, 35, has had 10 children, eight of whom have survived. She bleed a lot after the last birth and said "If I give birth again, I could die," as she learned from her doctor, who gaver her a tubal ligation (sterilization).

In this part of Congo, the complications of childbirth are as dangerous as the militias in the countryside. Each birth raises the odds of a hemorrhage, infection or rupture. Those odds increase dramatically when births come early in life, or late in life, or in rapid succession. In Congo, almost one in five deaths of women during childbearing years is due to maternal causes.

In a program organized by Heal Africa, about 6,000 women of Bweremana contribute the equivalent of 20 cents each Sunday to a common fund. When it is their time to give birth, the fund becomes a loan to pay transportation and hospital fees. The women tend a common vegetable garden to help with income and nutrition. And the group encourages family planning.

While in the U.S. the words "family planning" wave a red flag, in places such as Bweremana, family planning is undeniably pro-life. When births are spaced more than 24 months apart, both mothers and children are dramatically more likely to survive. Family planning results not only in fewer births, but in fewer at-risk births, including those early and late in a woman's fertility. When contraceptive prevalence is low, about 70% of all births involve serious risk. When prevalence is high, the figure is 35%.

According to a 2009 Gallup poll, more than 90% of American evangelicals believe that hormonal and barrier methods of contraception are morally acceptable for adults. Children are gifts from God, but this does not require the collection of as many gifts as biologically possible.

In Congo, while both the pill and condoms are generally available in larger cities such as Goma, access is limited in rural districts. Determining the pace of reproduction is often a male prerogative instead of a shared decision.

Ghana: Population Reduction is Not Our Priority

At 24 million, Ghana certainly cannot be said to be over-populated. Our landmass, at 91,000 or so square miles, is almost the size of Great Britain. Britain has a population far in excess of 60 million.

The problem of Ghana, is our inability to harness the enormous resources at our disposal to make the population comfortable. We do not accept the suggestion by Mr. Javed Talat, of the World Bank, who has asked the government to fashion out a mechanism to help check the growing population of this country.

We do not believe facilities to slow down our population growth are the priority of this nation. Instead, we would welcome a World Bank initiative that would make it possible for this country to trade with the advanced countries and improve revenue.

The problem confronting Ghana is our inability to balance our imports with exports. We buy more than we can sell, and that is why we are always in debt.

Ghanaians were shocked when they heard that more than 95% of the budget of the Minister of Water Resources, Works and Housing comes from donor support. Our country is unable to afford the cost of providing the water we drink. We are in no position to pay for a proper housing scheme that would provide roofs over our heads.

Even if we halve our population growth without acquiring the resources to take care of the population, we are still going to wallow in the quagmire of abject poverty. Our priority is to improve the national economy.

We need to intensify agriculture to become self-sufficient in food production, and to export the surplus. It is not the best of sights that every now and then famine strikes to the extent that people in some parts of Africa move from their natural habitats to feeding centres, where crumbs from the Western world are served.

Nature has endowed this nation, especially, with fertile land. From the savannah belt in northern Ghana, through the rain-forest to the scrubland in the Accra Plains, fertile land is all over the place. We need to mechanise a little bit to make food production an all-year-long activity.

We can produce enough to feed ourselves and have quite a lot for export. We need not be fooled by so-called Western experts to divert attention from improving the economy and concentrate on population reduction.

Kenya: How Women Can Boost Food Security

African women contribute 70% of the effort towards food production, yet they are still under-represented in areas of research and policymaking, as well as influential leadership positions in agriculture.

The African Women in Agricultural Research and Development (AWARD), a programme funded by the Gates Foundation and the United States Agency for International Development (USAID) is seeking to strengthen research and leadership skills of female agriculture scientists to enable them contribute to food security in sub-Sahara Africa.

This should enable Africa to revolutionize farming practices and rescue millions of citizens from recurrent hunger crises.

So far, the program has benefited 250 women across eleven countries in sub-Saharan Africa.

Kenya: Plan Your Family Or We Will Halt Free Primary Education Project

The poorer a family is in these parts of the world, the likelier it is to be huge. 55% of women in Kenya do not use contraceptives, and the poor of the poor are the most affected.

Lack of family planning, coupled with low education levels, have led to a population boom in Kenya that will soon hit the 40 million mark, says UNFPA. That is bad news for a country grappling with a staggering economy and overwhelming levels of poverty. Kenya's population in 2009 was 38 million. At its current rate, Kenya's population will reach over 80 million in 2050.

Population is growing by 3% a year, while its economy is growing at only 5.6%. "For the poverty levels, which stand at 46%, 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.

UNFPA statistics indicate that, currently, a Kenyan woman gives birth to at least four or five children. Plus life expectancy has increased due to the advances made in reducing the spread of HIV/Aids.

Planning minister Wycliffe 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.

"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. And 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 calls for the advancing of rights for girls and women, and safeguarding of the natural resources on which survival depends. The plan hopefully be implemented by the end of this year.

The National Coordination Agency for Population and Development (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% of Kenya's health care facilities provide maternity services and information on family planning.

"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." says Dr K'Oyugi.

"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.

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.

Manuscript: Assessing Family Planning Use and Its Impact in Controlling Population Growth in Africa

by Nyiko Tricia Maluleke, Africa Institute of South Africa

Abstract:

The rate at which the world population is growing creates a great concern to the international community. It is this reason that the United Nations held a number of conferences to discuss the means to control world population growth. The most influential conference was the 1994 International Conference on Population and Development (ICPD) held in Cairo; the conference reached an agreement on the urgent need to control global population growth. Among others, the 20 year ICPD Program of Action declared family planning use as one of the critical approaches to be initiated by United Nations member states as a way of regulating world population.

Different member states were urged to promote and make access to family planning a priority for the purpose of regulating world population growth. As such, the paper seeks to appraise the use of family planning in Africa; the paper is driven by the motive to examine the impact of family planning use on fertility patterns and population growth in the continent. It is strongly argued in the paper that, in order for Africa to successfully achieve the ICPD goal of slowed population growth, access to family planning needs to be critically looked at, as it remains the intermediate factor in the possibility of slowed population growth in the continent and the world at large.

Click here for the entire article.

In Nigeria, Selling Men on Birth Control is An Uphill Battle

Nigeria, with about 155 million people, is the most populous nation in Africa and the fertility rate has changed little, still at about five kids on average.

Although various types of contraceptive methods are available, about 20% of Nigerian women say they're not able to access them. Often their husbands stand in the way.

For six years the Society for Family Health, or SFH, an affiliate of the international non-profit PSI, has been trying to promote long-term birth control, such as intrauterine devices or contraceptive implants. Women who came and expressed interest in birth control went home to tell their husbands, but never came back.

So on family planning posters around the community, they started portraying men as caring and supportive. Men started accompanying their wives to the clinic. "Men felt ownership. The men felt that, 'this was about me and my family,' " said Dr. Anthony Nwala, with SFH.

SFH also identified men who were pro-family planning and trained them to educate other men.

Today families are moving away from the farms and moving to an urban area where providing for a large family in is more of an economic burden.

Daniel Smith, associate professor at Brown University, disagrees, saying "Women are more educated and liberated today, and yet they still want to have five or six children." He thinks Nigerians favor large extended families as a way to stay socially connected.

But Nwala still believes women - and men - are slowly learning that having fewer children will help them economically.

Rwanda: Progress On Family Planning Encouraging

Family planning among the Rwandan people currently stands around 42% for both rural and urban area officials at the Ministry of Finance and Economic Planning said.

The average number of children per Rwandan woman has declined from 6 down to 4 and is likely to reach 3 in the coming years.

In 2005 only 10% of the population used family planning methods in 2005 and by 2010 up to 45% of married couples were using contraception.

The country's long-term development agenda would come under enormous pressure, if a potential population explosion is not averted. It would be extremely difficult for any country to realise its dreams without checking its population growth rate.

A separate, but related article is at http://allafrica.com/stories/201107190460.html --

As Rubavu District celebrated the World Population Day yesterday, women in the area urged government to step up the family planning campaign.

Rwanda's population is estimated at 11 million people.

"This is an important day for us to reflect on the challenges we face in our homes due to the large family sizes," said Francoise, an area resident. Families still lack information on family planning and end up producing children they cannot provide for, she said.

Millions Stare Death in the Face Amidst Ravaging Drought in the Horn of Africa

Refugees fleeing the drought in Somalia take on average nine days in 50-degree Celsius (122 degrees Fahrenheit) heat to travel the 80 kilometres of sandy desert Dadaab in Northern Kenya. They travel through territories of lawlessness where armed bandits and even police harass the refugees.

When they reach Dadaab, they reach a country where an estimated five million people are facing starvation because of drought, according to Abbas Gullet, the secretary general of the Kenyan Red Cross. In the northern part of Kenya, the local Turkana community is facing starvation, just like the refugees at Dadaab.

Of about 850,000 people in Turkana, more than 385,000 children and 90,000 pregnant and breastfeeding women are suffering from acute malnutrition, says UNICEF. This has increased the number of new admissions of children suffering from malnutrition to 78%.

Across the entire Horn of Africa) more than 10 million people are affected and two million children are affected, with half a million of the children suffering from severe acute malnutrition and (many are) on the brink of death," according to UNICEF.

Family Planning: It's Time to Welcome Men Into the Discussion

Every year on July 11 is World Population Day, but this year, July 11 2011 was particularly important because this year somewhere around October 31, the world's population will reach 7 billion. In response to this, the United Nations launched a campaign entitled 7 Billion Actions to educate, raise awareness and encourage action around the growth of the world's population. As Ashley Judd puts it "the campaign is a wake-up call to the health, environmental, and social challenges associated with rapid population growth. It is also a wake-up call to the importance of voluntary family planning." Judd claims that, "in 2011, more than 200 million women worldwide are still denied access to desired family planning services due to unavailable resources or lack of support from their husbands and communities." It is her sense that it is time to make universal access to family planning a global priority, and that it is essential to welcome men into the conversation.

Judd's service as Global Ambassador to Population Services International(PSI) has given her the opportunity to witness first hand the unnecessary dangers that women face in developing countries due to childbirth and pregnancy. Judd cites World Health Organization statistics stating that world wide 1000 women die every day from complications of childbirth and pregnancy, and that over 99% of these maternal deaths occur in the developing world, in countries where a mother's death can leave children -- and entire families -- in a perilous scenario. Many of these women would choose to have smaller families but do not know how to prevent pregnancies. Some choose to use toxic, poisonous herbs and risk their lives to attempt to prevent or terminate pregnancies while husbands and partners are relegated to worriedly and helplessly watching their wives struggle with these poisons. Judd's point is that family planning education and methods must be more accessible to these families, and must include the men.

It turns out that men in these countries are worth including in the family planning decision making process, because research suggests that when they are included they are more likely to support their partner's family planning choices. Unfortunately though, few of the family planning programs used in developing countries include men in their educational models. But a program in the Democratic Republic of the Congo (DRC) is working to change this model. To do this, it is incorporating the use of cell phones to increase communication to both men and women of the DRC.

Because in 2011, 70 percent of world-wide cellular phone users live in developing countries, the World Bank has recommended contacting cell phones to deliver health services, particularly in remote areas like the Democratic Republic of the Congo .

Recognizing these statistics as well as the fact that 24% of the women of reproductive age in the DRC have unmet family planning needs, the Population Services International (PSI) and its local partner, Association de Sante Familiale, have moved to use cell phone technology to launch a "family planning hot line in the DRC called La Ligne Verte" (Judd)

Ligne Verte is open 5 days a week for 8.5 hours and offers no-cost, accurate information on family planning. Moreover it refers callers to family planning clinics across a wide geographic area.

But probably the most significant offering of the Ligne Verte is that it supplies a "safe, confidential zone for Congolese men and women to ask sensitive questions about family planning, as well as other sexual health concerns such as HIV."

Apparently to date, 84% of Ligne Verte callers have been men. Similar PSI hotlines in other countries reflect corresponding statistics. More that three quarters of the callers to national PSI family planning hotlines in Benin and Pakistan were men.

These are significant statistics. Men, as well as women, are asking questions about family planning and seek answers about how to keep their families physically and economically healthy. To continue listening to questions and to continue finding ways to answer questions helpfully, The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal will co-host with over thirty other co- sponsors, the second International Conference on Family Planning: Research and Best Practices November 29-December 2, 2011 in Dakar, Senegal. lvp

Feeding Ethiopia with Family Planning

Only improved funding of family planning by the west can prevent further crises.

Ten years after the last drought, Ethiopia is facing another crisis of insufficient food. Ten million people live in the affected areas. The immediate cause is erratic rainfall. Climate change may be behind this and is, in any case, expected to result in increasingly unpredictable weather patterns in the future.

However, the underlying cause is population growth. The population of Ethiopia has grown almost four fold in the fifty years since 1960, from 23 million to 83 million. Over the same period, the populations of neighbouring countries have also grown rapidly: Somalia three fold from 3 million to 9 million; Kenya five fold from 8 million to 41 million; while Djibouti has grown ten fold from 85,000 to 889,000. This growth in population counteracts improvements in agriculture or infrastructure and leaves people vulnerable when food production is disrupted by adverse natural or human events.

The UN estimates that the current Total Fertility Rate for these countries is almost five children per woman. Between one quarter and one third of married women of child-bearing age in the region would like to delay or avoid further pregnancies but do not have access to modern contraception. While universal access to reproductive health was one of the UN Millennium Development Goals, funding has stalled in recent years.

Simon Ross, chief executive of Population Matters commented, "It is right that we should provide disaster relief in response to humanitarian crises. However, we must also consider how best to prevent future disasters. Unless we address population growth, the scale of relief required in the future can only increase. Longer term investment in agriculture and infrastructure will not be effective unless we also fund the family planning programmes necessary to relieve the pressures of ever growing populations."

Time for Uganda to Prioritize Family Planning Investments

Facing severe budget shortfalls at home, many donor countries are cutting back their foreign aid programs, including support for crucial international family planning programs. The United States, the global leader in supporting contraceptive services in the world?s poorest countries, recently reduced its 2011 international family planning and reproductive health assistance by $33 million.

Uganda must step up its own funding for family planning. The time to act is now. The country has experienced strong economic growth in recent years, but we should remember that social and economic progress is linked to improved access to quality family planning services. Such services save women's lives, save the country money, and create a healthier, more productive society. Failure to support these services now will only end up costing more down the line.

Low levels of contraceptive use are already taking a toll. 70% women who want to avoid pregnancy are not using an effective contraceptive method. More than half of all pregnancies are unintended.

In rural areas, where 85% of the population lives and where family planning services are scarce, the poorest women now have two more children, on average, than they want, increasing economic hardship among the most vulnerable families, leaving them with fewer resources to invest in education, health care and other basic needs.

Unintended pregnancy is also a serious threat to the health and survival of women and newborns, often resulting in high-risk births occurring too soon after a previous delivery or when a woman is too young. This reality is starkly reflected in Uganda's high rates of maternal and newborn deaths.

Kenya: Maternal and Child Health Vulnerabilities Among Pastoralist Communities in Turkana

Delivery with the aid of a traditional birth attendant is the best a pregnant rural Turkana woman can hope for in a region with a shortage of health facilities and where only 8.2% of all the babies born are delivered in hospital.

The average pregnant mother in rural Turkana has to walk at least 50 kilometers to the nearest health center. There are only 34 dispensaries within a sixteen thousand square kilometer region. The biggest danger with walking is that a woman can bleed to death on the way.

Turkana men are often away from the homestead for months on end grazing their cattle, pregnant women in the region are often reluctant to leave their homes unattended even as their time for delivery nears, no one to take care of the children and animals, so they choose to deliver at home.

Mozambique: Drug Given to Moms After Childbirth Sparks Controversy

In Mozambique, a woman has a 1 in 37 lifetime risk of maternal death. Most of those deaths will be from postpartum hemorrhage, with one woman dying from postpartum hemorrhage every seven minutes. In the U.S.,only 1 in 2,100 die of of maternal causes, according to the World Health Organization.

Health experts say the drug misoprostol is saving women's lives around the world. It's also controversial because it can also be used to induce abortion.

Mozambican OB-GYN doctor Cassimo Bique lead a year-long trial of the drug misoprostol designed and carried out by an American women's health nonprofit called Venture Strategies Innovations. Bique said a woman can die as early as two hours after childbirth.

The traditional birth attendants use a brightly colored cloth called the capulana, typically worn as a skirt, shawl, or baby sling, to soak up blood loss from the mother. Before misoprostol, they would need three or four capulanas to soak up typical blood loss from the mother. After miso, they needed just one.

When the traditional birth attendants are asked if they have watched women die because they were bleeding after giving birth, before miso was available, they nod and say yes.

Uganda: When Women Go Without Needed Contraceptives

When Bernadette could not get her monthly contraceptive injection that was out of stock in the government health centres in western Uganda, she fell pregnant with her fifth child.

By the time she decided to pay for the contraceptive and went to Reproductive Health Uganda, a family planning association, she was already four weeks pregnant.

Many mothers in western Uganda have had unintended pregnancies due to shortages of commonly used contraceptives at government health facilities. Depo-Provera Contraceptive Injection is one of the most commonly used.

The one-month contraceptive injection is popular because rural women find it easier to use compared to pills and/or they could take the contraceptive without the knowledge of their husbands.

Muhereza of Reproductive Health Uganda said that women were subjected to violence by their husbands when they unintentionally fell pregnant. "In the long run when a mother is not counseled well, then they resort to backyard abortions." Non-professionals perform most abortions. An estimated 297,000 abortions are performed in Uganda because most of the pregnancies are unintended according to a study conducted in 2005 by the Guttmaacher Institute between 2003 and 2005.

A health at another health center said, "We instead give them condoms advising them to convince their husbands to use protection until we have restocked. But some women are not be able to convince their husbands (to use condoms) so they fall pregnant."

Not all forms of contraceptives are suitable for everyone. For example, pills are not suitable for rural women because they are required to be taken daily. Most rural women prefer to take a monthly contraceptive injection.

Wagama Theresa, a senior nursing officer in a neighboring district said: "Some men have begun supporting their wives in family planning. But when they come and don't find their selected contraceptive (available), they get frustrated and you will never see the husbands back here," said Wagama.

Eliab Tayebwa, the head of Reproductive Health and HIV/AIDS in Bushenyi district explained that the district experienced contraceptives shortages when there was a delay in delivery from National Medical stores.

Access to and use of family planning in Uganda has been identified as one of the factors in achieving 2015 United Nations Millennium Development Goals (MDGs), but progress in both these areas has been slow.

The 2006 Uganda Demographic Health Survey showed that 41% of women in Uganda needed contraception, but could not get it.

Mobile Health Offers Hope to Patients in Africa

83% out of 122 countries surveyed use mobile phone technology for services that include free emergency calls, text messaging with pill reminders and health information and transmission of tests and lab results, according to the World Health Organisation (WHO).

Up to 40 African countries are using mobile health services. Large countries such as Ethiopia, Nigeria, South Africa and Kenya are leading the way. "The momentum is huge." ... "Millions of people in Africa still do not have access to any healthcare. With mobile technology they can at least have some," said the manager of WHO's special unit Global Observatory for eHealth.

In Africa, mobile penetration exceeds infrastructure development, including paved roads, and access to electricity and the internet.

In the Democratic Republic of the Congo, Population Services International (PSI) supports a free hotline to complement its family planning campaigns. In Ghana, funding from a US university provides free mobile-to-mobile voice and text services between the 2,000 doctors who serve the country's 24 million population.

Migration to Urban Areas Holds Key to Kenya's Middle Income Status

Kenya is on the verge of a major demographic transition and rapid urbanisation.

The World Bank, in its report Turning the Tide in Turbulent Times, says this must be well managed for the country to attain middle income status within this decade. 30% of Kenyans live in cities; by 2030 this proportion may reach 48%.

"Economic activities in urban areas have a much higher yield than those in rural areas. No country has transitioned into middle income status by remaining predominantly rural," said the World Bank country director. In Kenya, for example, Nairobi and Mombasa have only 10% of the country's population, but 40% of wage earnings.

The working age population - age 15 to 64 - is bigger than the rest of the population, which depends on them. 55% of Kenya's population is of working age and is expected to reach 63% by 2030. As families become smaller, and life expectancy grows, this economically vital group drives the economy by working, saving and investing.

However massive investment is needed to support the pressure of an increasing population - in housing and infrastructure, job creation, and crime prevention - to reap the benefits of this urban transition.

The building of new homes is not keeping up with the demand, with only one-fifth to one-third of the necessary houses being built - even as the population grows by one million a year. Only 25% of those born today will have access to quality housing in the next two decades as they reach adulthood and start family life.

Electric power is the biggest infrastructure constraint on Kenyan firms, with transport coming a close second.

The World Bank report suggests that if Kenya's infrastructure could be improved to the level of continent-leader Mauritius, annual per capita growth rates would be 3.3% higher than they are currently.

Addressing Kenya's infrastructure deficit will require spending 21% of GDP.

The World Bank is optimistic that, with the right kind of focused investment and urban policy, Kenya can still achieve middle income status of $1,000 per capita by 2019. In 2010, growth was higher than expected at 5.6%.

Ghana: Country May Miss MDG If Less Than 80 Women Win

Twenty-three out of the 64 women who contested the New Patriotic Party (NPP) primaries were elected as parliamentary candidates and would contest on the ticket of the NPP in the 2012 general elections.

Women's rights advocates who called for reduced filing fees for all female hopefuls, and are happy that they have been successful.

Nevertheless, if the other parties, particularly the CPP and NDC do not field more women then Ghana will not be able to achieve the Millennium Development Goal 3: Promote Gender Equality and Empower Women.

Revised World Population Forecast: U.N. Forecasts 10.1 Billion People by Century's End

Many people expected the population of the world to stabilize around 9.3 billion in the middle of the century, but newly released projection from the U.N. reports that it will hit 10.1 billion by the year 2100.

Africa, already struggling to provide food and water for its people, could more than triple its population in this century, from one billion today to 3.6 billion.

The world population is expected to reach 7 billion in late October, only 12 years after it reached 6 billion.

John Bongaarts, a demographer at the Population Council said "Every billion more people makes life more difficult for everybody." ... "Is it the end of the world? No. Can we feed 10 billion people? Probably. But we obviously would be better off with a smaller population."

Fertility is not declining as rapidly as expected in some poor countries, and has shown a slight increase in many wealthier countries, including the United States, Britain and Denmark.

The world's fastest-growing countries, and the wealthy Western nations that help finance their development need to decide whether to renew their emphasis on programs that encourage family planning, said the director of the United Nations population division, Hania Zlotnik.

Family planning programs have stagnated in many countries, caught up in ideological battles over abortion, sex education and the role of women in society. Conservatives have attacked such programs as government meddling in private decisions, and in some countries, Catholic groups fought widespread availability of birth control.

Foreign aid to pay for contraceptives - $238 million in 2009 - has remained almost stagnant. Although the U.S. was the biggest donor, the budget compromise in Congress last month cut international family planning programs by 5%.

Yemen's population quintupled since 1950, to 25 million, and could quadruple again, to 100 million, by century's end, at the current rate. Yemen already depends on food imports and faces critical water shortages.

Nigeria's population is expected to rise from today's 162 million to 730 million by 2100. Malawi could grow from 15 million to 129 million by 2100.

All predictions assume that food and water will be available for the billions yet unborn, and that potential catastrophes including climate change, wars or epidemics will not serve as a brake on population growth. For some countries these numbers are not sustainable.

Provided with information and voluntary access to birth-control methods, women have chosen to have fewer children in societies as diverse as Bangladesh, Iran, Mexico, Sri Lanka and Thailand.

Women's lack of power in their relationships with men, traditions like early marriage and polygamy, and a dearth of political leadership have slowed progress in Africa. 25% of married women in East Africa, 10% in West Africa, and 7% in Central Africa use a modern contraceptive, compared to 75% of married American women.

A study found that only when women had greater autonomy in deciding whether to use contraceptives did they have significantly fewer children. Other studies found that general education for girls plays a critical role, in that literate young women are more likely to understand that family size is a choice.

China is expected to see a declining population, peaking at 1.4 billion in the next couple of decades, and falling to 941 million by 2100.

The United States is growing faster than many rich countries, largely because of high immigration and higher fertility among Hispanic immigrants. The new report projects that the United States population will rise from today's 311 million to 478 million by 2100.

Zambia: Community Radio Effective in Fostering Behavioural Change

Community radio is effective in fostering behavioural change in combating HIV/AIDS in parts of Southern Africa that are hardest hit by the pandemic.

Television, newspapers and others may not be able to penetrate poor and vulnerable communities like radio can. Radios are listened to at community centres in villages where people gather.

In Zambia, Afya Mzuri community radio programs are used by a local NGO called Corridors of Hope (CoH) III to empower communities to change their attitudes towards risky behaviours and practices.

A 2009 Zambia sexual behaviour survey shows that 99% of Zambians have heard about HIV and AIDS and 95% are aware that HIV can be avoided. Unfortunately only "23% of those interviewed have voluntarily requested for an HIV test, received the test and received the results," CoH programme director for Zambia Leslie Long said.

Multiple concurrent sexual partnerships is one of the leading drivers of the transmission of the virus. But with these partnerships, there are different understandings among different communities on what is meant by 'being faithful,' according to a 2010 report from the FHI, National Aids Council (NAC), USAID, and the International Organisation for Migration (IOM).

CoH is a five-year comprehensive HIV/AIDS prevention project funded by the United States government President's Emergency Plan for AIDS Relief (Pepfar) through USAID.

Sexual cleansing, one of the key drivers of HIV, was halted after radio programs about the risks involved in such practices were intensified.

Other negative practices which have since recorded a decline include gender- based violence, alcohol abuse and child abuse. Now radio programmes educate the community on the dangers of alcohol abuse, in relation to increased HIV infections and low condom use.

Some of the radio programs focused on the negative effects of early marriages, and a lot of young girls who had initially dropped out of school in preference for marriages have realized the importance of education and most of them have made efforts to return to school.

Even parents and guardians are aware of the dangers of marrying off their young girls, and are now instead encouraging them to continue with their education.

Kenya: Microfinance: Women Pull Together Against Poverty

39 women in the Kiambu District of Central Kenya joined together to form the Consolata Self Help Group, which was linked with a microfinance institution known as the Pamoja Women Development Program (PAWDEP).

Each member of the Consolata group was to put the equivalent of $2.50 into a common kitty each month. Members presenting a workable business idea can then borrow money from the combined savings at an interest rate of 5%; the loan is repayable at the end of three months.

Members' loans are limited to two and a half times the capital they have accumulated in savings with the group; for example, a member who has accumulated $100 in savings can take out a loan of $250. In this way 40% of the loan is guaranteed against money the borrower herself has put into the scheme if she defaults.

Esther, a participant in the program, is the proprietor of a dairy project with 15 cows, delivering 100 litres of milk daily to the nearby milk collection centre in her home village.

After starting with one cow, she repaid the first loan from the proceeds of selling milk and then borrowed 625 dollars to buy a second cow. Milk sales again covered repayment, and a series of larger loans from the Consolata group steadily built her operations.

The other members of the Consolata group have experienced similar rapid growth, establishing small businesses or farming.

PAWDEP currently works with savings schemes whose combined membership totals 48,000 women in the Central, Eastern, Rift Valley and Nairobi provinces of Kenya. There are several similar institutions in Kenya, helping women and youth with enhanced access to credit.

A 2010 report published by international development charity ActionAid - "Fertile Ground: How Governments and Donors Can Halve Hunger" - based on data gathered in Kenya, Uganda and Malawi - suggests that this kind of support for women small-scale farmers could halve hunger on the African continent by 2015.

While many African women would find the benefits of enhanced access to credit limited by legal and traditional patterns of land tenure, domestic power relations; rural men and women alike also struggle to overcome weak infrastructure that denies them water, access to markets, or even sound advice and agricultural technologies -- microfinance still contributes powerfully to making the most of resources available to rural people.

The Economics of Sex Work

In a port town on Lake Tanganyika in Zambia, the official HIV infection rate is about 10.8%, lower than the national infection rate of 14%. Unofficial estimates put prevalence in Mpulungu much higher. A high volume of traffic and a low cost of living has made the place an attractive destination for sex workers. Its broken streets are lined with bars that never seem to close.

Free condoms are distributed at health clinics, guest houses and bars, but the subsidized condoms in attractive packaging, against the bland presentation of free condoms, are much more popular, even though they cost about 500 kwacha ($0.10) each.

Solomon Kaluba, an AIDS advisor, said the socially marketed condoms were preferred, as "sex is prestigious," and the packaging and presentation added to the currency of such condoms.

Uganda: Majority Use Condoms Against Pregnancy, Not HIV/Aids

The Dean of Makerere University School of Women and Gender Studies said a study shows majority of people use condoms for fear of pregnancy than acquiring HIV/Aids. Cultural norms and values which put precedence of male over female and female's vulnerable economic status make it difficult for females to enforce condom use with their sexual partners.

Of those surveyed, 24.% condom adopters were males while 17.5% were female.

Although there has been a decline in HIV infection rates, women are still vulnerable to the infection. Funds allocated to the health sector, especially for the pandemic, had been diverted.

35.7% of female respondents negotiate for safer sex with their partner as compared to 57% of their male counterparts.

Sierra Leone: Facing Facts of Teenage Pregnancy

Teenage pregnancies account for 40% of maternal deaths in Sierra Leone, where early marriage is supported by traditional practice. 70% of teenage girls in Sierra Leone are married, according to a 2008 survey by the World Health Organization.

A United Nations Children's Fund's (UNICEF) report, "A Glimpse Into the World of Teenage Pregnancy in Sierra Leone", states that "such importance is given to girls marrying as virgins that the age of marriage often coincides with the first occurrence of female menstruation".

The typical consequences of teen pregnancy are social stigma, unstable marriages, poverty, end of a girl's education, extreme poverty, and prostitution.

Sierra Leone's mortality rate is extremely high, calculated as 970 deaths per 100,000 live births, with the risks of childbirth by young women an important contributing factor.

Babies born to teenage mothers have 50% more neonatal deaths and frequent low birth weights.

Few teens have ante-natal checkups, instead trying to hide their pregnancy or try to abort. This makes early detection of potential problems in a high-risk group very difficult.

Dr Helenlouise Taylor, in a World Health Organization draft report, says measures to reduce coerced sex and unsafe abortion and increase access to contraception for adolescents are all important, and urges a review of life skills and biology in the school curriculum, as well as tighter links between schools and antenatal clinics - possibly even offering antenatal care at schools. She also calls for appropriate training for health personnel and teachers to help both groups communicate accurate and effective information on sex and birth control to teens.

Kenya: 73 Million Condoms on the Way to End Shortage

73 million condoms will be delivered to Kenya in April and May to end the acute shortage of the contraceptive in various parts of the country.

The condoms are needed in the government's war against AIDS, particularly in marginalised areas of northern Kenya, where most people depend on the free condoms supplied by the government.

Kenya's population is "growing at three per cent per year and there is also growing demand due to enough (AIDS) education," said deputy director Alexander Ilyin.

Africa's Urbanization Outpaces Capacity to Provide Water, Sanitation - UN Report

Africa is the fastest urbanizing continent on the planet, and 40% of its one billion people live in urban areas, 60% of them in slums where water supply and sanitation are severely inadequate.

The UN Environment Programme (UNEP) and the UN Human Settlements Programme (UN-HABITAT) report that Africa's urban population without access to safe drinking water rose from close to 30 million in 1990 to more that 55 million in 2008, and the same period, the number of people without reasonable sanitation services doubled to around 175 million.

Achim Steiner, UNEP Executive Director spoke of the upcoming 2012 UN Conference on Sustainable Development, where one the themes will be "green economy" in the context of sustainable development and poverty eradication.

"There is growing evidence from work on the Green Economy that a different path in terms of water and sanitation can begin to be realized. Indeed, public policies that re-direct over a tenth of a per cent of global GDP per year can assist in not only addressing the sanitation challenge but conserve freshwater by reducing water demand by a fifth over the coming decades compared to projected trends," he said.

Cities in the continent where high urbanization rates are not matched with adequate water and sanitation infrastructure are Addis Ababa, the Ethiopian capital, Grahamstown in South Africa, and the Kenyan capital, Nairobi.

Madagascar: A Poor Country Gets Poorer

Madagascar, one of the world's poorest countries, has lost about US$400 million in donor support since the March 2009 coup in which Andry Rajoelina deposed President Marc Ravalomanana.

Donor money traditionally contributed about half the government's budget, and around 70% of public spending, making it "by far, the main source of funding in social sectors", according to the a World Bank report.

The political crisis, now in its third year, remains unresolved, preventing donors from reviewing their decision to freeze all aid apart from emergency funding. The African Union and the Southern African Development Community, the regional body, also cannot reinstate trade benefits and lift sanctions.

There has been, however, increased humanitarian assistance for education, health and social protection, rising to $260 million in 2010 from a pre-crisis amount of $180 million. Infrastructure, productive activities and institutional support had experienced the steepest decline in funding.

According to UNICEF, government funding for health dropped to $2 a head in 2010, its lowest level, compared to $5 in 2009 and $8 in 2008.

Another survey from WHO, UNICEF, and UNFPA found assisted births fell from 51% in 2006 to 44% in 2009, and more than half the people living in the drought-prone south reported that financial difficulties prevented them from visiting clinics.

Using a $230 individual annual income benchmark as the poverty line, Madagascar's National Institute of Statistics INSTAT reported that nationwide poverty increased from 69% in 2005 to 76% in 2010, while rural poverty rose from 73% to 82%. A rising income disparity between urban and rural populations was highlighted. 80% of the 20 million population live in rural areas.

"When you think that the years before the crisis were growth years, this shows poverty has increased by nine percent in just two years, which is directly attributable to the domestic political crisis and compounded by the global economic crisis," said the head of a leading international institution in Madagascar, who declined to be named.

The government has attempted to fix the price of rice, and petrol, but "The government can't keep prices down by decree forever, it doesn't have deep enough pockets to absorb very fast commodity price rises on the international market," said, Madagascar analyst at The Economist Intelligence Unit.

In addition, northeastern Madagascar was hit by a cyclone in February , causing extensive damage to crops, which is likely to deepen food insecurity and hit cash-crop production.

UNICEF said each year more than 70,000 Malagasy children died before the age of five from preventable diseases, including diarrhoea, acute respiratory infections and malaria.

'Mobile Midwife' Helping Ghana's Poor

A system called Mobile Midwife that uses cell phones to improve the delivery of health care to pregnant women and newborns has been established in a poor agricultural region of Ghana. Parts of it may soon be replicated in India and other poor areas of the world.

With the sysstem, nurses in northeast Ghana keep electronic medical records, fill out forms and retrieve patient information using cell phones. And pregnant women and new mothers get regular cell phone messages telling them about the importance of good nutrition or reminding them when they are due to get a pre-natal exam or to have their children immunized.

Inexpensive cell phones -- and the towers to serve them -- have become common in remote, rural regions. In northeast Ghana, a poor, agricultural region where families live in rustic compounds, about 60% of households now have access to a cellular phone. Ghanaians even use them to do electronic banking and to check prices at the market.

The Bill and Melinda Gates Foundation saw the potential for improving health more than two years ago, when it financed a project called the Mobile Technology for Community Health. Other partners included the Grameen Foundation, an anti-poverty organization, and the Ghana Health Service.

Empower Women to Realize the African Dream

The World Bank Vice President for the Africa region, Obiageli Ezekwesili, says:

In Africa, poverty has been feminized. One in 20 girls born today in Angola, Mozambique, Liberia and Sierra Leone will die in childbirth. An African woman is 25 times more likely to die during labour than a European woman. Girls still face genital mutilation in 28 African countries. More than 800,000 Africans, most of them female, are victims of human trafficking. Three young women are infected with HIV/AIDS for every young man in Africa.

On the other hand, the rate of female entrepreneurship is higher in Africa than in any other region of the world. An African country Rwanda boosts the highest female representation in parliament. The primary school enrollment rate has climbed from 84 girls for every 100 boys in 1991 to 91 in 2009.

But there are only 68 young women for every 100 males in tertiary education and female representation in parliament across Sub-Saharan Africa is only about 18%.

To achieve the Millennium Development Goals in Africa we must quickly release the productive power of women by advancing women's education and access to information, protecting women's rights, improving women's access to agricultural inputs and security over their land, promoting female entrepreneurship, and increasing the participation of women in government and public life.

We must support girls at the secondary and post-secondary levels, where the crucial school-to-work transition is made, and in acquiring skills that allow for innovation and entrepreneurship when faced with limitations.

Family laws on inheritance, marriage, labour markets and land rights must be changed to give women economic decision-making and empowerment. Legal restrictions on mobility, work outside of the home and control of personal assets are in dire need of reform in many African countries.

If women and men had the same access to agricultural inputs, productivity on women's farms could increase by 10% to 30%. Innovative programs are needed to provide women with these inputs and concerted action is needed to protect their rights to land.

African women currently in businesses in the informal sector need technical support and access to not just microfinance but to higher credit amounts at low interest rates with longer maturity terms.

Progress is possible and can come swiftly, as primary school enrollment has shown.

At the World Bank, we are bringing our contribution to help build a foundation for progress. Our Gender Action Plan fosters women's access to land, agricultural inputs, infrastructure, labour markets and financial services, while our Adolescent Girls Initiative trains mentors and empowers young African women to transition to work.

Our private sector arm, the International Finance Corporation has invested a combined U.S. $170 million under a Gender Entrepreneurship Markets initiative which has benefited thousands of women in 23 sub-Saharan African countries.

So far, gender has been an obstacle, yet every obstacle is an opportunity in disguise. The expansion of economic and social empowerment of the African woman is the key to the realization of the African promise.

Kenya: Melinda Gates: Discussing Family Planning with the Mothers of Korogocho

Melinda Gates, philanthropist, talked with new mothers in Korogocho, a large slum in Nairobi, Kenya. She asked them "Why do you want to plan the number and spacing of your children?"

One woman said she wanted to be able to feed all her children.

Another woman added, "Where am I going to keep them? Under the bed?" It was funny until she explained she had only a single room in which to raise her children. "Our houses are toilets," she said. "Why bring so many kids into a toilet?" It was impossible for her to raise her children in a safe and healthy environment.

One woman said if she had too many children, her husband would leave her.

Finally a woman summed the whole conversation up in one sentence. "I want to bring every good thing to one before I have another," she said.

"As different as many of their experiences are from mine -- fighting their husbands for the right to plan, struggling to put food on the table -- there is something universal in motherhood that unites us. We all want to bring every good thing to our children," Gates said.

Africa: Educate the Girl, Empower the Woman

A typical working day for many rural women in today's developing world is bending over with a Medieval-style hoe in hand, tilling the soil under a beating hot sun - only to retire home to care for her family without electricity or running water.

Lack of access to education and technology has forced many to resort to traditional and often painful methods of livelihood.

Women in Law and Development in Africa (WILDAF) is a pan- African network bringing together individuals and organisations from 23 countries, to tackle this issue head on.

WILDAF believes lack of knowledge about education rights, specifically among young girls, is one of the main reasons forcing rural people to endure lives of agricultural hardship.

Adaeze Agu, a New York-based Nigerian, is using education to empower young people in Ghana and Nigeria, as a volunteer with HIV advocacy group World Mission.

Deconstructing The Dangerous Dogma Of Denial: The Feminist-Environmental Justice Movement And Their Flight From Overpopulation

Editor's note: The entire article infuriated me so much that I only summarized enough to give you the gist. My comments are below

by Madeline Weld President, Population Institute of Canada

To be politically correct we must only criticize people of our own ideology or share a biological characteristic of the people being criticized. Otherwise we are seen as racist. Good arguments are routinely dismissed when waged by someone thought to be racially or sexually disqualified to comment on the issue. But Madeline Weld is a woman, and she reproaches the fem-left for its collusion in the crippling of the Program of Action as set out by the International Conference on Population and Development in Cairo 16 years ago. She asserts that the feminist wing of the so-called "Environmental Justice" movement helped scuttlie effective population stabilization programs in developing countries.

Dr. Weld concludes,"It is time to drive the ideologues off the territory they are illegally occupying with a "fact-based revolution" —by simply presenting the facts, fearlessly and persistently."

Media reports on the wave of unrest sweeping the Arab world for the most part ignore a crucial underlying factor: rapid, unsustainable population growth. Seventeen years ago, Egypt, one of the countries at the center of the current unrest, hosted the International Conference on Population and Development (ICPD).

Under the influence of feminist and social justice NGOs, population reduction as an end in itself was off the agenda as antithetical to women's rights. A focus on development alone was expected to bring about a reduction in population growth. In the absence of national or international (UN) population strategies, financial support for family planning has fallen sharply and population growth has remained rapid. Consequently, development has lagged and a deteriorating environment and resource scarcity have led to conflict in many regions.

Population growth, development, and stability: Egypt as an example

In 1994, Egypt had 60 million people, in 2010 it had 85 million—a 42% increase in 16 years. The UNFPA projects 130 million by 2050 (UNFPA, 2010). Rapid growth is fuelled by the youth of the population: one-third under 14 years of age, 20% between 15 and 29 years old. (And much more undeniable facts about Egypt - please read the entire article at http://candobetter.net/node/2373 for this infomation.)

Egypt's population growth is destroying its ability to feed itself. In 1960, Egypt had 26 million people and was self-sufficient in almost all basic food commodities. In recent decades, it has depended on revenues from oil exports to import about half of the staple foods it needs. Now, with its oil reserves running dry and its growing population needing more oil for its own uses, Egypt is about to become an oil importer.

The Programme of Action, the document that arose from the Cairo conference, was clear on the potential for trouble ahead (UNFPA, 1995a). It specifically recognized that the large proportion of young people in many developing countries would result in extremely rapid growth at current fertility rates, and that this growth would cause enormous social and environmental problems that their governments were very poorly equipped to handle. The impact of the population factor is not negated by the existence of corrupt and despotic governments, bad governance, unfavourable trade conditions, or anything else. The International Conference on Population and Development: stymied by ideology

The Cairo conference fled from numbers. It focused on the rights of women, the poor, and the disempowered. The Programme of Action offered no guidelines for governments or international organizations such as the World Health Organization to implement ethical, practical programs for slowing population growth and bringing population levels in line with the resource base available to support them. Instead, it stated that "All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so."

If the Programme of Action recognized that rapid population growth was taking many countries down a dangerous road at great speed, why did it refuse to actively promote the use of brakes?

South Africa: Pregnancy Tsunami

Almost 5000 schoolgirls in the Gauteng province became pregnant in only one year. Even more shocking is that more than 113 primary school girls became pregnant in the same period.

Health Minister Aaron Motsoaledi said teenage pregnancy statistics were of greater concern than those for HIV. "What this proves is that our children are having unprotected sex, which makes them more vulnerable." ... "Young girls are having sex with older men ... old men are targeting young women, whom we must protect."

Health MEC Ntombi Mekgwe said "Future generations will curse us and spit on our graves if we do not address this problem head-on." She was said "Bodies of young girls are not only unprepared for pregnancy and child birth, they are also not prepared for sexual intercourse.

A Sowetan teenager who has seen many of her friends become young mothers said: "It's fashionable to have a baby. You are like an idiot if you don't have sex".

Peer pressure, dysfunctional family units, and alcohol and drug abuse were some of the main contributing factors to the unprecedented increase in teen pregnancies, said Mekgwe.

Somalia Faces Malnutrition Crisis

One in three children in Somalia have been left acutely malnourished due to severe drought which has caused a sharp rise in prices. About a third of Somalia's approximately population require humanitarian aid, according to the UN. This figure is up .4 million from six months ago.

Even though fighting continues in many areas of the country, drought has overtaken insecurity as the main reason for people being displaced.

The exodus from conflict-racked Mogadishu has reversed, with thousands of people leaving the countryside for the capital in search of food and water over the past two months. Widespread livestock deaths are reported, cereal crops are failing, and some families are planning to travel to refugee camps in Kenya and Ethiopia.

Many do not have access to aid. The al-Shabaab Islamist group, which controls much of south and central Somalia, has an ideology of self-sufficiency and rejects outside aid. The World Food Programme does not distribute to these areas, including the central Hiraan region, where 70% of the population are "in crisis", according the UN.

In the Juba region maize prices increased by about 80% in November and December, according to the UN's Food Security and Nutrition Analysis Unit (FSNAU).

Until 2010, there had been seven consecutive seasons of rain failure in Somalia. But last year the rains were good, resulting in the best harvest for 15 years.

The fact that the country has slipped so quickly back into a food crisis shows how vulnerable its people are a result of two decades without an effective government. It has also raised questions about how the grain gathered last year has disappeared quickly, with suspicion falling on farmers and traders who may be seeking to profit from the food shortages.

The UK plans to provide 10.5m of emergency assistance to Somalia through the UN.

Nigeria Reports Water Scarcity Across Numerous States

Nigeria, the world's eighth most populous country, has suffered water scarcity across a number of its states, which poses questions about infrastructure, long-term sustainability and population density.

Oil-rich Nigeria has a population of over 152 million people, with less than 30% having access to adequate drinking water, according to a 2002 Daily Trust report.

Earlier this year the government tried to ban latrines and select fuel stations in an attempt to prevent runoff. HReverend Babatunde Olusegun of the Christian Council of Nigeria said, "As the world is taking concrete efforts at meeting the United Nations goals of safe water and sanitation by the year 2015, Nigeria is yet to commence any action towards realizing these goals."

The US Energy Information Administration says that Nigeria has an estimated 37.2 billion barrels of oil reserves, yet 70% of Nigerians try to get by with inadequate freshwater supplies.

There is a glimmer of hope: the CIA World Factbook says that Nigeria's population is estimated to grow by 1.97% in 2010 - down from a growth rate of 2% in 2009 and 2.03% in 2008.

Toxic Water Rising Below Johannesburg

The water from the spring about 20 miles northwest of Johannesburg flows blood red. It is toxic, highly acidic and full of heavy metals, so nasty that newly weaned impala and other animals in the Krugersdorp Game Reserve downstream can't or refuse to drink the water - and some of them die of thirst. Not one living organism survives in the poisoned water.

Millions of gallons of the same kind of toxic water lie underneath Johannesburg, a city of nearly 4 million people. The water is rising 50 feet a month. If nothing is done, subterranean parking garages will fill with the toxic red water in about two years' time. Tunnels for electrical cables and underground railway stations will flood. And unnatural crimson streams will spring from the ground across the suburbs to the east of Johannesburg as the rising water escapes.

The city of Johannesburg exploded in a gold rush after the metal was discovered in 1886. Gold mines operated along a 25-mile strip from Roodepoort to the west of Johannesburg to Boksburg to the east, as hundreds of mining companies gouged out a gigantic hole under the city and its suburbs.

When rain falls, water runs off the hills and much of it is absorbed by the earth. The water turns toxic when it reacts with heavy metals underground.

When the mines were functioning, pumps siphoned the water away. But one by one the gold mines under Johannesburg were shut down as the gold ran out. The last one - which was pumping all the water from "the void" - was East Rand Proprietary Mines, which stopped pumping in 2008.

"The government has had acid mine drainage on its urgent agenda since 2009 but has yet to act," said University of the Witwatersrand geology professor Terry McCarthy, who released a study on the problem Thursday in Johannesburg.

McCarthy warned that current mining operations in other parts of South Africa were doing even more damage, and would eventually pollute some of Johannesburg's main drinking water sources, the Vaal dam and Vaal River, posing greater costs for future generations.

Some of the toxic water from the mines is polluted with uranium. Stephan du Toit, an environmental specialist with the Mogale municipality near the Krugersdorp Game Reserve, said that the water flowing through the reserve had extremely high sulfate concentrates. rw

On the Ground in Ethiopia; the Population Challenge Up Close and Personal

Ethiopia is the second most populous country in Africa, with almost 90 million citizens, and it has one of the highest fertility rates in the world -- 5.4 births per woman. But the country also has a new program that's lowering its birthrate even as it works to improve the health of all of the country's citizens.

30,000 young women serve as rural community health workers all around the country. They get a year of training in basic preventive health care and then head back to their home communities to teach hygiene and nutrition, administer childhood immunizations, help people put up bed nets to keep out malaria-carrying mosquitoes, offer basic prenatal care, and attend to births if mothers can't get to hospitals. They operate in pairs and serve about 5,000 people, spending much of their time going door to door, aided by a handful of volunteers.

They talk to couples about their family planning options with wall charts and an illustrated book and offer free contraceptives -- distributing condoms and the Pill, giving Depo-Provera shots (which work for three months), and inserting Implanon implants (which work for three years).

One woman's first seven children were spaced close together, a consequence of having no access to birth control. When health workers brought contraception to her community, she started using Depo-Provera and was then able to wait six years before having her eighth child. Amina wants a large family, but that's not what she wants for her daughter. "My wish for my daughter is to see her complete her education, get a good job, earn a salary, be independent, and live on her own," Amina said.

In another area, a married couple serve as community health volunteers, spreading information to their neighbors and modeling good health practices for the community. With family planning the couple has been able to space out their children -- they have a son who's 7 and a daughter who's 1. The wife now has an Implanon implant. They haven't decided whether to have more kids; they say it will depend on future earnings from their farm.

Ethiopia launched its health extension program in 2004. The program has established 16,000 health posts (small buildings, usually without electricity) in rural communities around the country, where health workers with local roots provide basic preventive services. 84% of Ethiopian people live in rural areas (separated from hospitals by long distances, bad roads, and a lack of cars), and where doctors are in serious short supply (many Ethiopian physicians, when their training is complete, leave the country for more lucrative opportunities). Over the first five years of the program, the ratio of health workers to citizens went from 1-to-30,000 to 1-to-2,500.

The program also appears to be creating a new generation of feminists -- young women pursuing careers outside the home, empowered to provide vital services to their communities, earning the respect of their neighbors, and serving as role models for young girls.

However, contraceptive supplies are short. Implanon implants have only been available for a few months in some areas, but they're already in high demand from women eager for a method that works for three years. While health extension workers can insert the implants when they have all the necessary supplies, they don't have the skills and training to take them out, so if women have unpleasant side effects or want the implants removed for other reasons, they have to find their way to a higher-level medical professional.

At the current rate, Ethiopia is projected to just about double its population by 2050 to 174 million, making it all the more difficult for its people to climb out of poverty. The government's official goal is to get the fertility rate down from 5.4 births per woman to 2.1 within five years The effort to spread family planning far and wide will improve the lives of millions of Ethiopian women and their families. rw

Uganda: Half of Population Unproductive

With Uganda's population swelling by 1.2 million people every year, the competition for resources is set to get tighter. At an annual growth rate of 3.2% each year, Uganda's population is projected to double in the next 22 years from about 32 million to 64 million people, spelling more doom for a country whose population structure is largely youthful and unproductive.

Over 56% (17.8 million people) of the population is under 18 years while about half (15.9 million people) of the population is under the age of 15 years. This population is predicted to remain unproductive for the next 15 years.

The rising population is due to a very high fertility rate (6.7) and a high teenage pregnancy rate (25%), notes Charles Zirarema, the acting director of the Population Secretariat. t Philda, a typical example of a teenage mother,conceived at 14 years and quit school. At age 27, she has five children and finds it hard to fend for them. Reproductive Health Uganda recently talked to her about contraceptives.

Hundreds of women like her in Uganda are ignorant or cannot access family planning. The unmet need (the number of women who would have wanted to access family planning but cannot) in Uganda is 41%. The contraceptive prevalence rate is 23%, and child spacing is less than 24 months, on average, and the poverty level is 31%. These are key reasons for the rapidly rising population in Uganda.

At a recent conference in Uganda, a report on the state of Uganda's population titled: "Population and Sustainable Development: Emerging Challenges, Opportunities and Prospects" as well as the State of the World Population report titled: "From Conflict and Crisis to Renewal: Generations of Change," was disclosed.

Resources are not increasing to match population growth, presenting Uganda with a challenge of planning to ensure quality and productive nationals. Uganda is sitting on a time bomb.

"The floods, drought, landslides and famine we see are as a result of pressure on land. The land gets overburdened and it gives way a result of population pressure."

The 2009 UN Habitat Report indicates that 80% of Ugandans rely on resources like and and lakes for livelihood, while 99% use firewood and charcoal for cooking, putting a strain on the natural resources.

Hopefully the Bill on Establishment of a National Population Council, which Cabinet approved recently will help in planning for the high unproductive population.

Men were urged to get involved in determining the number of children for their families. This, will reduce maternal and child mortality. "The more children a mother has, the higher the risk of maternal and child mortality."

A United Nations Fund for Population Activities urged the Government to plan services for an increased population, increase funding and investment, especially in activities involving the youth, if the country is to develop its human capital. It also recommends policies targeting for employment for the youth.

Despite the large and fast-growing youthful labour force and the Government's introduction of universal primary and secondary education, Uganda still has a shortage of skilled human power. The report blames this on poor quality of the education system which does not respond to the skills requirements of the job market.

According to the Uganda Bureau of Statistics (UBOS), for out of every 10 jobs advertised, over 1,500 graduates apply. At least 400,000 graduates come into the labour market annually, but only about 80,000 are able to find formal employment.

Agriculture Agriculture accounts for over 75% of Uganda's labour force. However, there is low agricultural productivity, land degradation and soil fertility depletion, which is affecting crop yields.

Uganda's labour productivity is very low compared to neighbouring Kenya and Tanzania. The report says six Ugandans are employed to do a job that can be done by one Kenyan. Tanzania's labour productivity is 28% higher than that of Uganda.

The country's size and per capita income are still very low, compared to those of other economies in Africa and Asia, the report adds.

"While Uganda's economic performance was at par with countries such as Kenya, Ghana, South Korea and Malaysia in the early 1970s, these economies have since improved significantly over Uganda's economy," the report says.

The report cites unemployment, underemployment, lack of skills, a poor culture towards work, gender relations, inadequate and poor state of the infrastructure as some of the factors which contribute to the low productivity level in Uganda.

The report notes that women are excluded from contributing to profitable production and development. Women earn less than men, with over 50% employed in the lowest paying sectors which do not require highly-skilled labour.

It adds that women dominate food production, providing nearly 70% of labour in agriculture. "Women account for 80% of food production, yet most of them do not own land. They also rely on labour-intensive tools such as hoes."

Youth, especially females, are the most unproductive group, with about 70% engaged in unpaid family work. The highest unemployed population is in urban areas, and a greater proportion of the unproductive population is located in northern Uganda.

State of world population report According to the UNFPA report, the high annual population growth rate of 3.2% is far above the global average population growth rate of 1.1%, which makes Uganda one of the countries with the fastest growing populations in the world.

The world report focuses on the effect of conflicts on women and their involvement in rebuilding the community after conflicts have ended. rw

Counselling Key to Success of Male Cut

When Kenya launched its national voluntary male circumcision campaign in 2008, critics worried that it could lead to greater sexual risk-taking - but men in the western Nyanza Province seem to be disproving this theory.

For example, a 23-year-old said: "When I heard people say male circumcision helps in reducing HIV infection, I went there with the sole purpose that it would lessen the burden of having to use a condom. But after that, I have known a lot through the counselling I received; I use a condom every time with anybody ... I am not married so I am not going to trust anybody."

Kenya's programme aims to circumcise more than one million men by 2013, while doing HIV testing and compulsory counselling on HIV prevention, including messages about the importance of continued condom use, since circumcision does not offer full protection from the virus.

A small 2010 study by the University of Illinois in Kisumu found that most respondents - whether circumcised traditionally or in health facilities - reported either no behaviour change or improved protective behaviour, such as increased condom use and fewer sexual partners. Respondents understood that that male circumcision only provided partial protection against HIV.

Another study found that circumcised men did not engage in more risky sexual behaviours than uncircumcised men in the first year after the operation.

Most men in Kenya are circumcised as teenagers during rites of passage into adulthood that do not generally feature HIV education. One young man told the story about how, after he was circumcised during the traditional ceremony of western Kenya's Bukusu community, he was told that he was man enough to have sex with as many girls as he chose. But he heard it being talked about on the radio and everywhere that "circumcision cannot prevent you from HIV unless you use a condom or are faithful." Studies show that not all traditionally circumcised men heed the message about the HIV risk with unprotected sex. rw

Niger Averts Food Crisis but Faces Population Boom

Foreign aid covered 80% of Niger's needs during this year's food crisis, but the United Nations has warned that the country must rein in its population growth to prevent further crises.

A senior U.N. official said that population in the West African state, one of the world's poorest, could swell from 15 million today to 50 million by 2050 if current growth was not reduced, which would ease pressure on the food supply chain.

After previous governments played down earlier crises, Niger's military junta swiftly called for hundreds of millions of dollars in food aid for half of Niger's population after rains failed to come, decimating crops and cattle.

A broader food crisis in Africa's Sahel region is also easing as crops start coming in. But experts say more must be done to end the cyclical shortages, especially as climate change disrupts weather patterns.

Valerie Amos, the United Nations' top aid official who visited Niger last week, said "There are recurrent food crises, but there is also a very high growth in population, which could go from 15 million today to about 50 million in 2050," Amos said at the weekend.

"I don't think Niger's agricultural production, which is already vulnerable to climate change, can sustain this and so we need, amongst other things, better family planning policies."

Experts say the Sahara Desert is advancing south by about 10 km per year, eliminating potential growing areas.

Across Africa, high population growth rates are undermining efforts to improve living standards and cut poverty rates. But birth control programmes are particularly controversial in mostly rural, Muslim states like Niger.

Colonel Abdoul Karim Goukoye, spokesman for the junta that seized power in a February coup, said the newly-created Nigerien food security agency, known as HASA, would develop short-, medium- and long-term policies to improve the situation, like promoting high-value crops and irrigation.

Niger has vast uranium reserves, but has struggled to implement existing plans to alleviate poverty and hunger. rw

Africa: Preventing HIV Infection: Turning the Tide for Young Women

In sub-Saharan Africa women represent about 60% of all people living with HIV infection in the region. In young women aged 15-24 years, in some areas the prevalence of infection is nearly three times that of young men. This heightened vulnerability is driven by social, economic, and cultural factors that include transactional partnerships with older men, who are more likely to be infected. In gender-inequitable and transactional sexual relationships, decisions about behavioural change and condom use are mainly controlled by men and thus, prevention approaches have not greatly reduced the risk of HIV infection for young women in sub-Saharan Africa.

It was very disappointing that, in a large randomised trial of PRO2000 vaginal gel for the prevention of HIV-1 infection in women, 0·5% and 2% PRO2000 gels provided no protection against HIV infection. Results will certainly indicate the end of the road for PRO2000 as a potential HIV-prevention tool for women.

However, the results of the CAPRISA 004 trial, were released in July at the XVIII International AIDS Conference. These results showed that a microbicide containing 1% tenofovir reduced a woman's risk of HIV infection by 39% and the protective effect of the gel increased with consistency of use; women who used the gel in more than 80% of sex acts had a 54% reduction in HIV infections. The CAPRISA results are a substantial breakthrough for HIV prevention.

Promising, preliminary results from another potential prevention method controlled by women: conditional cash transfers. After 18 months' follow-up of a study in Malawi, girls in the cash group who were in school at the start of the study had a 60% lower HIV prevalence compared with schoolgirls who received no payments (1·2% vs 3·0%, p<0·05). This result was probably due to a reduction in transactional sex with older men.

Importantly, the results held even for a group of girls who received cash with no school attendance requirements (unconditional cash). The effect increased with payment size, which suggested that extreme poverty had a central influence on girls' sexual choices.

Although neither tenofovir microbicide gel nor conditional cash transfers will be an immediate prevention panacea, these promising approaches have the potential to greatly expand prevention options for women in sub-Saharan Africa. rw

Abused Village Women Speak Out for Justice in 'The Rape Capital of the World'

In the Democratic Republic of Congo, a UN visit has raised hopes of legal action over sexual violence.

The women of Kampala village, where 35 were raped, still sleep in the forest at night, for fear the rapists will return. They gathered to tell their stories to a special U.N. representative on sexual crime in conflict.

The mass rape of more than 300 women, several men and children in villages deep in the forest of the eastern Democratic Republic of Congo at the beginning of August has renewed momentum to tackle the sexual violence.

The prosecutor of the international criminal court in The Hague is sending a team to investigate the mass rapes.

Callixte Mbarushimana, executive secretary of the FDLR, one of the rebel groups implicated, was recently arrested under an ICC warrant in Paris. The core of the FDLR are Hutus who fled Rwanda after participating in the genocide of Tutsis in 1994, and are accused of war crimes in the DRC.

The arrest was a "crucial step in efforts to prosecute the massive sexual crimes committed in the DRC".

Although a peace treaty in 2003 formally brought to an end the decade-long war, atrocities - primarily against women - have not subsided. Rape is a way of humiliating and cowing local populations who may be used as slave labour.

The 80 Indian soldiers assigned as UN peacekeepers are often as brutal and ill-disciplined as the militia and rebels they are fighting.

After the rapes the government of President Joseph Kabila announced a temporary ban on mining, which may be lifted later this week. The idea is that government agents should tax the miners rather than leave them to run a gamut of illegal roadblocks manned by rebels, militia and rogue soldiers. But this seems unlikely to stop the brutality. UN sources say battalions of government troops that have fanned out across the jungle. They are now preying on the population, looting and raping.

The US Congress has approved a financial reform law that requires US-listed companies to disclose whether their products contain "conflict minerals" from the DRC.

In Nyasi village the women say they will only feel safe if UN peacekeepers patrol more often and stay close. "We had the courage to speak out because we've had enough. We're like dying people, who are no longer afraid because they know they're at the end of their journey." rw

Ending Hunger in Africa

As hunger and drought spread across Africa, there's a focus on increasing yields of staple crops, such as maize, wheat, cassava, and rice. Although these crops are important for improving food security, they cannot cure malnutrition alone.

There is no one-size fits all or single crop solution to solving global hunger, alleviating poverty, or protecting the environment and mitigating climate change. But the good news is that there is a multi-crop solution and it's already being spear-headed by farmers on the ground: vegetables.

Some 1 billion people worldwide are affected by "hidden hunger," or micronutrient deficiencies - lack of Vitamin A, iron, and iodine, none of which are found in staple crops, but rather, in vegetables. Vegetable production is the most sustainable and affordable way of alleviating micronutrient deficiencies among the poor.

It's also the most sustainable and affordable way of improving biodiversity, preserving traditions and cultures, and improving livelihoods. Because vegetables typically have a shorter growing period than staple crops, they are less risk-prone to drought, maximizing scarce water supplies and soil nutrients better than crops such as maize.

Unfortunately, no country in Africa has a big focus on vegetable production. But that's where AVRDC - The World Vegetable Center steps in, working with farmers to build a sustainable seed system in Africa. The Center does this by breeding a variety of vegetables with different traits—including resistance to disease and longer shelf life—and by bringing the farmers to the Regional Center in Arusha and to other offices across Africa to find out what exactly those farmers need in the field and at market.

Babel Isack, a tomato farmer from Tanzania, is just one of many farmers who visit the Center, advising staff about which vegetable varieties would be best suited for his particular needs—including varieties that depend on fewer chemical sprays and have a longer shelf life.

Mel Oluoch, a Liaison Officer with the Center's Vegetable Breeding and Seed System Program (vBSS) trains both urban and rural farmers in seed production. "The sustainability of seed," says Oluoch, "is not yet there in Africa." In other words, farmers don't have access to a reliable source of seed for indigenous vegetables, such as amaranth, spider plant, cowpea, okra, moringa, and other crops. But Oluoch and others at the Center are working closely with farmers to change that.

The hardiness and drought-tolerance of traditional vegetables become increasingly important as climate change becomes more evident. Many indigenous vegetables use less water than hybrid varieties and some are resistant to pests and disease without the use of chemical inputs, which are expensive both financially and environmentally.

Of course, it's not only crucial for farmers to grow indigenous species; people also need to want to eat them. In many parts of sub-Saharan Africa, local foods are looked down upon by rich and poor shoppers alike. In Senegal, for example, many consumers and cooks consider local rice to be inferior and instead buy imported European brands that can cost four times as much.

At the heart of these issues is a loss of knowledge about agricultural practices and indigenous varieties that create local agricultural, as well as cultural, biodiversity. While what we eat is important, what may be even more essential over the long term is preserving knowledge about how to plant, grow, and cook what we eat.

In Uganda's Mukono District, Edward Mukiibi, 23, and Roger Serunjogi, 22, founded the Developing Innovations in School Cultivation Project, or DISC, with this premise in mind. The project began in 2006 as a way to improve nutrition, generate environmental awareness, and preserve food traditions and culture for local students by establishing school gardens at 15 preschool, day and boarding schools.

By focusing on school gardens, Mukiibi and Serunjogi are helping not only to feed children, but are also revitalizing an interest in - and cultivation of - African indigenous vegetables, cultivating the next generation of farmers and eaters who can preserve Uganda's culinary traditions and increase food security.

Says one 19 year-old student, Mary Naku, who is learning farming skills from DISC, "as youth we have learned to grow fruits and vegetables to support our lives."

Organizations like the AVRDC and DISC, by inspiring our future farmers, working with current farmers and reigniting an interest and appetite for indigenous crop varieties, are helping to improve diets, livelihoods and local ecosystems around the world.

Staple crops can't do it alone. Luckily for us, creating a sustainable agriculture system and fighting hunger takes all kinds of crops, for a more delicious and sustainable, well-nourished future. rw

Rwanda Working to Curb Population Explosion

In Rwanda people getting married are wished "God (happiness), milk (material well-being) and children." In the years that followed the 1994 genocide, birth control was a taboo subject in Rwanda. Only four years ago did the government make a serious attempt to tackle galloping population growth.

With child mortality on the decline, most Rwandans accept that their children will be healthier and better educated if they have fewer of them, health workers say.

The government's goal is reduce families to an average of three children, and has tripled the country's family planning rate in the last four years. The country used to have a fertility rate of 5.3.

Rwanda is already the most densely populated country in mainland sub-Saharan Africa. The population has risen fourfold since 1960 to more than 10 million today. "When we build schools or health centres or hospitals, capacity is very quickly outstripped," said Francois Byabarumwanzi, deputy vice president of the Liberal Party (PL), a partner in the ruling coalition.

44% of the population is currently 14 or under -- means that the latest reforms will not impact on statistics in the immediate future. "Any change from new behaviour trends -- if these are amplified ... will only be felt in the medium term," said a professor.

"If the current annual population growth rate of 2.6% persists, the country's population is projected to reach 14.6 million by 2025," according to the Population Reference Bureau (PRB), a Washington, DC-based non-profit group.

The most popular birth control methods are implants and injections, which are invisible to husbands who might be reticent about contraception.

A bank worker says: "I only want two children," she said. "My colleagues feel the same way. They are educated and they know that educating a child is expensive, so we prefer to have fewer children and educate them properly." rw

Kenya: What Should Be Done About the World's Population Explosion?

Half of Kenya's population is aged 25 years and below and it is experiencing population explosion. What should be done?

Demographic growth is interlinked with poverty and environment that gets ignored whenever leaders meet.

Campaigners on population issues acknowledge that poverty and environmental damage can have complex causes. A surge in population in some well-documented cases has helped catapult a country to prosperity.

But, relentless population pressure is common to many of the problems besetting the Millennium Development Goals (MDGs), up for review in New York. In poor countries, unbraked demographic growth adds to strain on infrastructure, health and educational resources, amplifies the risk of environmental damage and boosts exposure to climate change.

Even if countries reduce the proportion of people living in poverty, the number grows simply because of massive population growth.

If you have a population growing at 3% a year, it is doubling every 23, 24 years or so.

One example is Kenya, where the population in 2009 stood at 38.6 million, an increase of around 10 million since 1999. Less than a third of Kenyans have piped water and three-quarters have no means of sanitation.

Since the MDGs were drawn up in 2000, the world's population has expanded from 6.0 to 6.8 billion, 95% in poorer countries. By 2050, the total is likely to be more than nine billion, according to UN estimates.

Providing these extra souls with housing, water, electricity, sewerage, hospitals and schooling is going to be a mighty challenge, 227 million people had escaped slums in the past decade -- but the overall people living in slums had increased, from 776.7 million to 827.6 million. Half of the rise was due to population increase in existing slums, and a quarter to rural exodus. rw

Niger: Small Steps Towards a Sustainable Future

The population of Niger is growing at an unsustainable rate. If current growth rates of 3.3% per year remain unchanged, by 2050 Niger's 15.2 million will have reached 50 million. Even today there is widespread malnourishment.

25 years ago Niger identified population control as a priority in its fight against poverty. But convincing people to have fewer children by marrying later and using contraception is not an easy task.

The government is unable to feed and educate its population.

Nearly 60% of the population survives on less than a dollar a day. A woman dies every two hours while giving birth. Nearly one child in five dies before the age of five. Almost one in three does not attend primary school. There is no land for farming.

The economy would have to grow at a rate of 7% a year to meet people's basic needs, but average annual growth in the last decade has been just 3.1%.

By 2015, at the current rate of population growth, thousands more classrooms, teachers, and health personnel will be required. On average, each active member of society will have to look after at least two inactive ones. And the already deficient food production will be even less adequate.

The average number of births per woman is 7. Women are learning that it is good to put some time between children.

The average age at birth is 15-16. By 2015, the country aims to reduce the proportion of early marriages from 60% to 40% and the number of children per women to five. Some 18% of its sexually active population should be using contraception by then.

The contraception message seems to have had more resonance in the cities.

When a man has several wives, wives will often compete to have the most children, because this will reflect on their status in the family and on their inheritance share.

Without the sanction of men and religion, change is unlikely. A representative of the UNFPA says: "It is men who decide when it comes to contraception, or delivering at the health centre. This is related to the problem of women's status in the society."

Now the UNFPA has started started engaging men in family planning. Married men were invited to meet twice a month to discuss reproductive health, which helped them to become more involved with health and family matters.

The father of 12 children under 21 describes it as a heavy burden but also explains: "We think that if you have five children who can fetch wood, well, that will help the family." But the UNFPA is trying to fight against that idea by stressing that children are expensive to raise.

It is no longer necessary to have five children to ensure two survive, with many more children surviving now that there is better access to health care and vaccination.

Islam is not against family planning. Muslim countries such as Indonesia, Saudi Arabia and Iran have successful family planning programs.

The size of the family needs to be on a par with resources. The Koran never said you should make children regardless of your ability to look after them.

The use of contraception has increasedfrom 5% in 2006 to over 13%. Contraception was a taboo subject in 1990. "This is no longer the case. Condoms are being shown on TV and people are not shocked." rw

Burkina Faso: Women's Economic Empowerment Key to Girls' Education

A new government program to keep girls in school by supporting income-generating activities for their mothers is showing success in Burkina Faso, where poverty and cultural values still deprive many girls of an education.

Often, even having to buy notebooks and pens is enough to stop a child from going to school and enough to get a girl married off to a husband.

The 300 chapter Association of Mothers Who Teach (AME) was created to consolidate the success of a 2007 campaign to raise awareness of the importance of girls' education.

Mothers are encouraged to support schools because they are the ones who keep the girls at home to help with economic and domestic activities.

The school completion rate in Burkina Faso is among the lowest on the continent, especially for girls. Only 42% of students who enter grade one complete their primary education; for girls, it is 37.

In the country's northern Sahel region, where the ministry focuses its outreach activities, just 18% of girls complete their education.

"Getting girls to stay in school is the challenge, especially in the context of arranged marriages. We know that if the wife can read, it's a first battle won for girls' education," said one expert.

The United Nations Childrens Fund (UNICEF) backs income-generating activities such as the sale of milk, and raising goats and sheep, of which a portion is reinvested in the children's education. For example, one AME bought lamps and oil, thus enabling poorer students to study at night.

In one AME area, the enrollment rate for girls ispresently 66%, compared to just 15% in 2003.

If the AME members suspect a plan for an arranged marriage, they will report the matter to the school principal very quietly and they take many discreet actions to prevent early or forced marriages.

Men who challenge the women in the AME, are told: "It not only helps girls themselves if they attend school, but it can help their future husbands one day; this is so fathers won't give their daughters away in early marriage when they have money problems."

Swaziland: A Culture That Encourages HIV/Aids

Cultural beliefs among Swazis actively encourage the spread of HIV/AIDS. The study by UNFPA and Swaziland's Ministry of Health and Social Welfare echoes warnings by local NGOs that "AIDS cannot be stopped unless there is a change in people's sexual behaviour."

"Swazis are traditional people, and their sexual behaviour is inbred and totally against safe sexual practices, like condom use and monogamous relationships. The report,found that maintaining a centuries-old cultural belief in procreation to increase the population size, was having devastating consequences in the age of AIDS.

The study shows that Swazis believe it is ideal if a Swazi woman has a minimum of five children. "Nothing must stand in the way of procreation. This belief had come about when the population was a tenth of its present size. Swazis still believe that a woman's role is to bear children continuously, and that a man's role is to impregnate multiple partners, which is why polygamy is so strong here. In the minds of young men, who may not ever get married they can still have many children from multiple girlfriends.

A survey of nearly 2,000 women found that 42% tested HIV positive in 2008, up 3% from 2006.

In 2000 life expectancy was 61 years; now it is 32 years.Women report that they have been subjected to continuous childbirth by their husbands or in-laws, against their will.

In Swazi culture, decision-making has traditionally been a male prerogative and Swazi men strongly defended the practice of "kungena", or wife inheritance, whereby a widow becomes the wife of the deceased man's brother, a practice found to spread HIV.

Another cultural factor was gender preference - often insisted upon by in-laws that a woman bear a boy. In traditional law only a boy can lead a family into its next generation.

Swaziland is mainly rural, but in the northern Hhohho Region, where the capital, Mbabane, is located, the fertility rate is 3.6 children per female, compared to 4.3 children in the underdeveloped southern Shiselweni Region. The fertility rate among women whose education finished at primary school was 5.1, but only 2.4 - less than half the number of children - among students who advanced to tertiary education. The poorest Swazi women have a fertility rate of 5.5, while the figure among the richest is only 2.6 children.

"The rich/poor fertility divide is testament to the lack of a government social safety net - like a good pension scheme for the elderly - so, for those without assets, their only security comes from lots of children, who together can support their parents when they are older," said Tanya Kunene, a social welfare officer in Manzini Region.

The study found that, like many traditional societies, Swazis lived in isolation and were generally suspicious of other cultures - practices like monogamy.That may be changing. According to the study, some survey participants "called for the recognition of multiculturalism in Swaziland, which would create tolerance for other cultures co-existing with our own", and thus make "foreign" practices found to be effective in curbing HIV/AIDS more acceptable. rw

Tackling the Perils of Pregnancy in Ethiopia

Childbirth will prove fatal for one in 27 women in Ethiopia and much of the rest of the continent, versus a rate of one in 8,000 in industrialized countries.

Giving birth at home is like a tradition; for example, if a woman goes into labour at 4pm and by 8pm she has not given birth, she will go to a clinic 40km away. Low education levels and poor health infrastructure limit the number of women giving birth in a medical facility to about 5.3%, as well as reducing contraceptive use, another factor in maternal mortality.

Just 6% of births in Ethiopia take place in the presence of a skilled health professional. For every 100,000 live births, 673 women die. Women tend to deliver at home, where there are delays in diagnosing problems. Delays in identifying obstetric emergencies, in getting the woman to the health facility and in getting the services at the health facility all combine to result in maternal death.

Women don't come in early for pregnancy check-ups; they also do not really talk about being pregnant. Distance is also a big issue, if you are busy; you have to take the day off to go to the clinic. But before creating demand for clinical childbirth facilities through public information campaigns, it is essential to put such facilities in place.

Every village in Ethiopia now has two extension health workers. They "are trained in clean delivery but not considered skilled attendants. They are also not the traditional midwives, so there are credibility issues. The pay is also not that great, they may make more money farming but they like the skill, the status.

More than seven in 10 women who want to avoid pregnancy either do not practise contraception or use a relatively ineffective traditional method. Expanding contraceptive use is crucial to limiting women's exposure to the general risks inherent in pregnancy and childbearing and to enabling women to avoid high-risk births in particular.

Having only a few children or controlling birth is not something we like. We don't want to stop giving birth because then the husband can go and get a new and young wife," said Fadumo Dayib, a Jijiga resident. Children also assist with farming and taking care of the animals. When one gets more children one gets more resources. rw

Population Media Center Announces Results in Nigeria

In Nigeria, which has one of the highest birth rates in the world, 92% of married women do not use contraceptives and 55% say they never intend to. The fertility rate is 5.7 children per woman, and the women think 7 children is the ideal number. The men think 9 children is the ideal number. Only 0.2% of Nigerians say they don't use contraceptives because services are not available, and only 0.2% cite cost as a barrier.

Of all births in Nigeria:

87% were wanted at the time and another. 7% were wanted, but not until later. 4% were unwanted.

Population Media Center's program in northern Nigeria is designed to help people understand the benefits for them and their children of limiting and spacing births. The program has had significant effects in changing desired family size among women who were listening. The 208-episode drama program was broadcast in Kano, Kaduna, Katsina, and Sokoto states from July 2007 to June 2009. The program storylines promoted and modeled birth spacing and smaller family size. The main characters in the drama featured couples who often discussed family planning issues and both positive and negative views related to making a decision to use contraceptives to space children and achieve smaller family size.

Results show that 70% of respondents in the four states listened to the broadcast one or more times per week. These percentages confirm similar listenership levels found in clinic monitoring reports during broadcast.

At the time of the baseline survey in the four states where we were planning to broadcast, the mean desired number of children for all respondents was 7.43 and this decreased to 5.93 by the endline survey, most notably among females.

* The likelihood of respondents saying they did not want to have another child was 5.7 times greater at endline compared to baseline.

* The likelihood of respondents saying they "currently use something to delay or avoid pregnancy" was 5.6* times greater at endline compared to baseline. Listeners were 2.4 times as likely as nonlisteners to say they "currently use something to delay or avoid pregnancy.

* The likelihood of respondents saying they had talked with their spouse or partner "once or twice" or "more often" about family planning in the last three months was 4.5 times greater at endline compared to baseline. For males there was a notable relative increase of 48% from baseline to endline; however for females there was a sharp relative increase from baseline to endline of 172%. This result shows that the program strongly benefited both females and males in increasing the amount of discussion of reproductive health with their partner.

* The likelihood of respondents saying they "discussed the practice of family planning with family, friends, or neighbors" in the past three months was 2.7 times greater at endline compared to baseline. Listeners were more than 1.9 times more likely than nonlisteners to say they "discussed the practice of family planning with family, friends, or neighbors" in the past three months.

* The likelihood of respondents thinking that “couples should space children 2.5 to 3 years apart" was 1.5* greater at endline compared to baseline.

* Listeners were 1.9* times more likely than nonlisteners to think that "couples should space children 2.5 to 3 years apart". Listeners were 1.7* times more likely than nonlisteners to say "yes" when asked if "couples should share responsibility for making decisions about family size."

* Listeners were nearly two times as likely as nonlisteners to think that "people should plan how many children they have. The likelihood of respondents saying that using contraceptives is not "against the will of Allah" was 3.6* times greater at endline compared to baseline. Listeners were 1.5* times more likely than nonlisteners to say that using contraceptives is not "against the will of Allah."

* Listeners were 1.7* times more likely than nonlisteners to "know a place to obtain a method of family planning. rw

Kenya: Church Under Attack Over Stand on Abortion

Religious leaders campaigning against the proposed Constitution have been accused of favouring the life of the unborn child over that of the mother.

"I am baffled by the one-sidedness of trying to protect fetal life while turning a blind eye on the thousands of women who die seeking abortions every year," said Buettner in her monthly Sexual and Reproductive Health and Rights situation report, published on Gender Across Borders, a global feminist blog.

A cross section of religious leaders, mainly from the mainstream churches, have ganged up against the draft laws set for a referendum vote on August 4.

The church leaders claim the proposed law allows "abortion on demand".

The bone of contention is Section 26(4) of the proposed law that says: Abortion is not permitted "unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law."

Buettner, a social justice worker and freelance human rights policy researcher, points out that 15,000 women die annually of pregnancy-related complications and more than a third in unsafe abortion.

"Maternal mortality rates in Kenya are among the world's highest. Direct medical causes for maternal death include haemorrhage, infection, obstructed labour and unsafe abortion," she cautions.

Contraceptive prevalence in Kenya hovers around 30% and the fertility rate is between four and five children per woman.

As in all poor countries with high maternal mortality rates, the severity of these problems is driven by social factors.

In Kenya, health systems are lacking and infrastructure issues make it difficult to access resources.

According to the Centre for Reproductive Rights' report "In Harm's Way: The Impact of Kenya's Restrictive Abortion Law," 2,600 women die every year due to unsafe abortion complications.

More than half this figure never sought medical care.

The in-depth report includes stories on women denied the right to choose, including 14-year-old Sarah, who lost her life due to complications from an unsafe abortion; too afraid to go to a doctor as she suffered from a raging infection because she feared being arrested or condemned by the community."

In Kenya, institutionalised social ideas about women's role and worth is said to be the cause of deaths of thousands of women. rw

Uganda: Will Mother Nature Survive Population Pressure?

According to the UN Habitat report 2009, the population density in Kampala is so high, about 12 families occupy a single plot of land, and about 1.5 million people live in slums in Kampala. The wetlands and swamps have now been turned into residential areas because of the increase in population.

This has caused environmental damage. In Kampala, damage to wetlands and swamps has resulted in floods, especially in Kalerwe, Bwaise, Kawempe, Zana, Ndeeba, Bwaise and Kanyanya. In the east and north east of Uganda, mudslides and floods are becoming common.

The 20-year stability and improvement in livelihood and child mortality, coupled with a high fertility rate have contributed to a population growth rate of 3.3% compared to the global average of 1.1%. This makes Uganda one of the countries with the fastest growing populations in the world.

80% of the Ugandan population relies on resources like land and lakes for livelihood. 99% uses firewood and charcoal for cooking, putting a strain on forests, wetlands and causing a shortage of agricultural land. Kampala has swallowed up the greenery that once covered the empty hills and valleys.

More wetlands in Kampala have been cleared for human settlement and industries.

When the floods hit Kampala early this year, the former minister of environment, Dr. Kezimbira Miyingo, issued a directive that all houses in wetlands be demolished. However, owners opposed the directive, claiming they did not know they were building on wetlands.

The problem of flooding is so severe in the Kampala suburbs of Kalerwe, Kisenyi and Bwaise that tenants shift to other areas to escape the floods. Latrines are built above water streams.

During rainy seasons, the area residents often open a hole to release faeces from the latrines. The rain then washes the faeces into streams, from where they fetch water. Many people have no toilets and incidents of people using polythene papers as toilets is common.

In May this year, KCC received money from the World Bank to boost the fight against flooding in Kampala suburbs. The money was for reconstruction and rehabilitation of high risk areas, starting with a 3.6km drainage channel in Bwaise. Part of the channel was constructed, but it has not been helpful in controlling floods.

According to the 2002 population census, 12% of Uganda's population lived in the urban areas. The United Nations indicated that by 2007, 3.7 million Ugandans lived in urban areas.

According to Uganda National Bureau of Statistics, Kampala's population in 2010 is about 1.6 million people.

It is possible for sparsely populated areas to be overpopulated as such areas may have a meagre or non-existent capability to sustain human life. Already this is beginning to show in Uganda. Although access to water has improved, (67% of the population has access to an improved water source), it takes an average Ugandan over 30 minutes to collect water.

Rural households are also increasingly spending more time looking for firewood. Overpopulated places compete for the basic life-sustaining resources, hence a diminished quality of life. Increase in time for collecting water or fuel impacts on women more. Girls cannot complete their education, thus early marriage and childbearing which starts a cycle of poverty.

Despite the increase in population density in world cities, the UN Habitat says in its report that urbanisation may be the best solution to managing the rising global population.

Cities concentrate human activity within specified areas, limiting the extent of environmental damage. But this mitigating influence can only be achieved if urban planning is significantly improved. rw

AIDS Scientists Call for Month of Sex Abstinence

Leading scientists fighting the world's worst HIV and AIDS epidemic have called on African leaders to head a month-long sexual abstinence campaign, saying it would substantially cut new infections by up to 45%, a huge step in countries such as South Africa, Zimbabwe and Swaziland.

There is some evidence that a newly infected person is most likely to transmit HIV in the month after being exposed to it.

Researchers focused on religious groups, such as Muslims who abstain from sex during Ramadan, and Zimbabwe's Marange Apostolic sect, which bans sex during Passover.

Muslim countries have an HIV prevalence rate of 0.2%. The low rate has previously been attributed to the universal practice of male circumcision. But Muslim men are also protected from HIV by the ban on sex during the daylight hours of Ramadan, as well as strict teachings on alcohol use, homosexuality and extra-marital sex.

Predominantly Christian South Africa has 18.1% (5.7 million people) living with Aids. Zimbabwe has a similar proportion but members of the Marange sect have lower rates than the surrounding population. Swaziland, a small kingdom wedged between South Africa and Mozambique, has the highest proportion of infections in the world, at 26.1%.

This kind of initiative could provide countries with a one-off, short-term adaptation that is cost-effective, easy to monitor and does not create additional stigma.

A month-long pledge to use a condom could also be effective. The main thing is to agree on a period in which the entire population would live by the same rule.

In Swaziland, the idea was welcomed by the agency in charge of AIDS prevention. "We see this kind of initiative as a way of breaking the cycle. We think a good month to do it would be during the southern African spring, in October or November." rw

South Africa: Less Sex, More Violence for Teens

Africa: Family Planning Improves the Lives and Health of the Urban Poor and Saves Money

Urbanization is occurring so rapidly that cities are not able to keep up with increased demand for services, not to mention the employment, housing, and transportation needs of a population that may double in less than 25 years. Three-quarters of those living in the cities of the developing world live in slum-like conditions, often without access to sanitation and safe drinking water, associated with increased health problems. Urban slums have much higher rates of illness than nonslum areas of the same cities and health and social problems related to the environment, violence, injury, and noncommunicable diseases are more common.

Family planning is often overlooked as an essential strategy to improve urban health. The poor who live in urban areas have more difficulty, for a variety of financial, social, and cultural reasons, accessing family planning services than do wealthier residents. Improving the access of the poor to family planning services in urban areas should be a high priority, especially since the majority of urban residents in many countries live on less than US$2 per day.

The majority of urban population growth (60%) is because births among urban residents outpace deaths. As infant and child mortality has declined, this rate of "natural increase" has become especially high in urban areas of sub-Saharan Africa, some of which are growing at 4% per year. This has proven difficult for governments and the environment to accommodate.

Urban families want to have fewer children than rural residents. Many urban women report that they have more children than they intended to have. While most wealthier urban women have access to contraception, poor women have less physical and financial access to high-quality reproductive health services and to an affordable range of contraceptives that meets their needs. As the growth of urban areas continues unabated, the value of reducing unwanted and unplanned births by enabling equitable access to contraception should not be underestimated.

Because of past high fertility, rapid urbanization is likely to continue. In sub-Saharan Africa for example, the number of women of reproductive age will grow by 35% in the next 10 years. Unless women are able to limit their family size the number of births over this same period will increase by 33%. This will fuel even more rapid population growth.

Poor women who desire to stop having children but are not using a modern method of contraception have an especially high "unmet need" for family planning. In Senegal and Ethiopia, for example, one in every three women ages 15 to 49 who live in urban areas has an unmet need for contraception.

Nigeria has one of the lowest levels of unmet need in sub-Saharan Africa—13% among urban women and 17% among the poorest women. However, because Nigeria is by far the largest country in Africa, the number of women with unmet need, 4 million, is large and it is growing as the demand for family planning increases. The millions of women with unmet need for contraception contribute directly to rapid population growth as well as to high rates of maternal and infant death.

Women in sub-Saharan Africa have a one in 22 lifetime risk of dying of causes related to pregnancy and delivery. While maternal mortality has declined since 1990, by 26% in Latin America and 20% in Asia, it has only fallen by 2% in sub-Saharan Africa. Women who give birth before age 18 or after age 35, or who have closely spaced pregnancies are at a greater risk of death.

In many countries of sub-Saharan Africa, early marriage and childbearing is common. In Mali, Malawi, Mozambique, and Niger, for example, half of all women have given birth by age 18. Women who give birth before age 20 are twice as likely to die of pregnancy-related causes as are older mothers. Family planning can avert these deaths by enabling young, sexually active women to delay their first pregnancy until they are older and more physically and emotionally mature. However, contraceptive use among sexually active women, whether married or unmarried, is very low in most countries of sub-Saharan Africa. In Nigeria, just 3% of married women and 37% of unmarried women ages 15 to 19 use a modern method of contraception.

In selected sub-Saharan African countries, including Nigeria and Kenya, between 25% and 41% of unwanted pregnancies are aborted, and in sub-Saharan Africa as a whole, 99% of the nearly 5 million abortions that occur each year are conducted by persons lacking the necessary medical skills or under unsafe conditions or both. Sub-Saharan Africa has the world's highest proportion of abortions performed among young women ages 15 to 19. As a consequence, abortion is a leading cause of death among young African women. In East Africa, including Kenya, unsafe abortions account for 17% of maternal deaths. Assuring that young people have the family planning information and services they need could significantly reduce deaths due to abortion as well as deaths from other maternal causes.

Spacing births at least two years apart is one of the most important and successful strategies for improving birth outcomes and the survival of infants. Infants born less than two years after a previous birth are about twice as likely to die in the first year of life as an infant born three years after a previous birth.

Infants and children born to mothers who are under age 20 are also much more likely to die in the first days, months, and years of life. In Senegal, for example, one of every 10 infants born to women under age 20 dies in the first year of life, as opposed to one in 17 among women who give birth between ages 20 and 29. In Senegal alone, family planning could avert 1.3 million unintended pregnancies, 400,000 abortions, and 200,000 deaths to children under 5 over a 10-year period.

The importance of family planning to reducing mother-to-child transmission of HIV has not received sufficient attention. Each year, more than 577,200 unintended pregnancies among HIV-infected women in sub-Saharan Africa are prevented through the use of contraception, which already prevents more HIV infections among infants than antiretroviral therapy. While it is essential that all women in need of ART have access to it, more than half a million additional unintended pregnancies to HIV-positive women could be averted each year if all women in the region who did not wish to become pregnant had access to modern contraception.

Investing in family planning results in large savings to the health, education, and environmental sectors. With fewer children to educate, governments can extend safe water and sanitation services to a greater share of their populations. This will in turn have benefits in terms of reduced water-born illnesses and deaths due to diarrhea. When population growth occurs more slowly, there is also less pressure on scarce land and water resources and less environmental degradation due to deforestation, salinization of soil, and air pollution.

In Kenya, for example, meeting unmet need for family planning at a cost of $71 million can be expected to reduce expenditures on education by $115 million, on immunization by $37 million, on water and sanitation by $36 million, on maternal health by $75 million, and on malaria by $8 million. For every dollar spent on family planning, Kenya would recoup $3.79 in savings in these sectors alone.

There is near universal agreement among governments that every child has a right to be wanted and women and couples have a right to decide freely on the number of children they will have. In most societies, poor women are the least likely to be able to exercise the right to use contraception, in part because they are the least able to pay for family planning services. Until poor women have the same ability to exercise that right as wealthier women, urban areas will grow not only in size but in level of inequality. The percentage of people living in poverty will continue to increase and income inequality between rich and poor will grow larger.

Governments and urban planners should ensure that the poor are the recipients of public funds that subsidize and aim to improve the quality of reproductive health services. Without this assurance, subsidies and incentives are more likely to be utilized by those who do not need them as much. Investments in reproductive health and family planning are among the most cost-effective that governments can make. In Kenya and Nigeria, for example, the cost of protecting an urban couple from an unwanted pregnancy for a year through the provision of clinic-based services is only $4.27.

This small investment is worthwhile for the benefit of individuals and families and for the greater society. rw

Family Planning in Sub-Saharan Africa: Progress Or Stagnation?

Sub-Saharan Africa fertility and future projected population growth are higher in than in any other region of the world. Even the small decline in birth rates in the region has slowed even further over the past decade. Development and health goals are at risk. This study rests on the assumption that fertility will decline only if the population at large adopts effective modern methods of contraception, as the rest of the world has done.

Fertility is not likely to decline at a fast sustained pace unless a large and growing number of couples is "ready, willing and able" to use modern contraception. People are ready to use contraception when there is the need or desire to postpone births or cease childbearing altogether. They are willing to use contraception when they are in favor of contraception and of certain contraceptive methods in particular. In many societies resistance to modern contraception is common at first and takes the form of outright opposition for religious or cultural reasons or because of fear of becoming sterile and other health concerns. In Africa deep-seated resistance to the use of modern contraception has been documented.

People are able to use contraception when they are familiar with contraceptive methods and their supply sources and having reasonable access to them.

The central message of this paper is to reverse stagnation in the use of modern family planning methods in most of western Africa and in some eastern African countries, contraceptive services need to be made more accessible. This calls for large new investments and for vigorous information campaigns to address unfavorable attitudes towards family planning overall and towards certain methods in particular. Important shifts in political priorities and the emergence of strong local leadership will be needed to legitimize the idea of smaller families and contraception. Second, schooling opportunities for girls need to be greatly improved, both for their intrinsic value but also as a means of accelerating reproductive change in the next generation.

This paper is highly technical and you must follow the link in the headline to see it in its entirety.