According to him, without the full functioning of the NPC, it will be difficult for the various institutions and commissions set up by the government to achieve any impactful results.
Chief Alhaji Imoro Baaba made the remarks when he paid a courtesy call on the Executive Director of the NPC, Dr Leticia Adelaide Appiah last Wednesday, February 6, 2019 in Accra.
He was accompanied by accompanied by Alhaji Issifu Fuseini and Hajia Adiza Baaba Issa, Deputy Director of the Muslim Family Council Services.
Chief Alhaji Imoro Baaba said a lot of people do not understand the work of the council hence the very little prominence it receives, urging government to provide increased support to the NPC if it desires to see meaningful development.
He also called on the United Nations Population Fund, formerly the United Nations Fund for Population Activities (UNFPA), Planned Parenthood Association of Ghana (PPAG) and other international donors to continue to beef-up support for the population council to do their advocacy work to affect lives positively.
“The establishment of the National population Council dates as far back to the Busia regime which saw population, family planning as the way to go if visible developments is something to go by,” he opined.
Chief Alhaji Imoro Baaba also blamed teenage pregnancy and all the increasing social ills in society to the country’s inability to address population, family planning and related issues.
He has, therefore, requested the NPC to adopt strategic lobbying skills to get the desired prominence it requires to help achieve its mandate in making government efforts in developing Ghana visible.
He was of the view that there is the need for partnership to better position family planning strategically for national development, educate its people and provide requisite information for their follower and provide better understanding regarding the integral nature of NPC’s work in national Development.
The Executive Director of the National Population Council, Dr Leticia Adelaide Appiah who was happy to receive the group commended their efforts and supports.
“Family planning is the way to go,” she said, adding that it is like a missionary work, hence all must join hands in achieving a mandate of providing an improved and sustained quality of life for all Ghanaians.
“We are ready to join you and won’t also mind if you join us to do the needful for the country we all love and want to see develop,” she noted.
In our series of letters from African journalists, Elizabeth Ohene considers the controversial proposal to limit women to having three babies in Ghana.
Among the Ga, the people who are indigenous to Ghana’s capital, Accra, a woman is entitled to a live sheep on the delivery of her 10th child. The word for it is “nyongmato”.
I am not making this up even though it does sound like the kind of apocryphal story that is regularly made up.
Lots of very important people among the Gas can testify to this. Unfortunately, I have not met any woman who has actually got a live sheep for having given birth to 10 children.
Indeed, I have never met any woman who has had 10 children.
I don’t know if I have been moving in the wrong circles, because I don’t even know any woman who has had five children. OK, as soon as I wrote that, I realized I was wrong.
Two months ago, I went to the funeral of a female relation of mine who was my classmate in primary school.
At her death, this relation of mine had 46 direct descendants; made up of eight children, 26 grandchildren and counting, and 10 great-grandchildren and counting.
I was scandalized and I spent the entire funeral going over these figures and moaning to myself how easy it was to find the reasons for the poverty in Ghana.
I have been waging a lonely unpopular battle about the rate of population growth in our country and against women having so many babies, but to no avail.
I roll out what I consider to be a sound argument that I thought would win over all doubters.
I cite Norway, which had a population of 3.5 million to Ghana’s five million at the time of our independence in 1957.
Today, there are 5.3 million people living in Norway while Ghana has a population of nearly 30 million.
‘We don’t count children’
I make the argument that even if none of our rulers ever stole any public funds, we would still have economic difficulties at this rate of population growth.
The last time I visited Lillehammer in Norway, I wrote in my column about the difference in our two situations. I pointed out it is no wonder everything is bursting at the seams and we are forever worrying about the lack of classrooms.
Somehow, these arguments don’t cut any ice with people here because it is considered in extremely bad taste to complain about the number of children somebody has.
As someone once claimed to me: “In our tradition we don’t count children.”
The good news is that now I don’t feel alone in this battle.
Into the fray has jumped the Executive Director of the National Population Council, Dr Leticia Adelaide Appiah, and believe me, she is an exceptionally brave woman.
She is not speaking in parables, she is straight to the point. She has proposed that women should be restricted to having three children.
And she says this should be obligatory.
If a woman goes beyond this sacred number of three, she would be punished by being denied access to free government services.
‘Outrage from men’
We have to talk about the quality of life, Dr Appiah has been arguing.
I don’t recall that anyone in an official position has been this categorical in Ghana about family planning ever before.
We have had a family planning policy since 1970 but usually people only talk about the spacing of births and then hope that the spacing will lead to the birth of fewer children.
This time around Dr. Appiah is urging a cap on the number of children a woman should have.
It is interesting to note that that the people who claim to be outraged by the proposal to limit the number of children have been largely men. I’m sorry none of their arguments stick in my mind long enough to repeat here.
I have not yet heard any woman complain that they don’t want the number of children they can have to be restricted.
Ghana’s fertility rate, that is the average number of children per woman, currently stands at four, though that figure has fallen steadily over the last 30 years.
Another interesting statistic worth noting is that there has not been a single death from measles in Ghana since 2002. Measles used to be one of the main infant killers, and the main justification for having many births.
This past week, I have been doing a very unscientific survey.
Every pregnant woman I have seen, I have asked which number it was and I have not yet met a woman in her third pregnancy. But I am probably looking in the wrong place by asking working women in banks, in offices and shops; the high birth rates can be found mostly in the rural areas.
There might yet be some women who are aspiring to get that live sheep.
We would probably have to find an equally attractive present for every woman who decides to stop at three or below. The problem is I can’t think what can possibly challenge the “10-baby sheep”, nyongmato.
Dr. Thompson wrote that the NPC is “prosecuting an alarmist campaign’ which according to him ‘seems to be driven more by disregard for facts and history than desire to enlighten the public’.
He described the three child per woman policy target of the NPC as ‘arbitrary and whimsical, even dangerous’ and said there is no research ‘anywhere that identifies three children per woman as the optimal threshold’.
Clearly, his understanding of population and development does not include health of the population; that is why he is talking about absence of an ‘optimal population structure for development’ thereby re-echoing the usual Julian Simon School.
There is too much of it out there describing the effect of higher birth order (and short birth intervals) on reproductive health outcomes (Stover and Ross, 2010; Susuman et al. 2016; Mishra et al. 2017; GSS et al. 2015, 2018).
Births of order 4 and above are shown to increase the risk of infant and maternal mortality. This is one of the reasons why the 1994 revised Population Policy set a total fertility rate (TFR) target of 3 children by 2020. This is important because nations are developed by healthy people reproducing healthily and working to take care of them in a sustainable manner. Just as we have optimal blood pressure level.
A reference to the population policy or engagement with the NPC would inform anyone that the figure is not ‘whimsical or arbitrary’.
This policy target of three children was set as far back as1994 and is therefore not an agenda been pushed by the Executive Director of the NPC. As far back as 1969 when the first population policy was developed there were recommendations for exemptions including limiting maternal leave to three children. Just as limiting pension age in the public service to 60 years does not mean after 60 one cannot work in other organizations.
As we wish to reiterate, his understanding of development is that of a classical economist and does not include health, otherwise he would have known that there is an optimal number of births for the health of women, children and communities.
For the information of the economist, age, birth interval and birth order (4+) are the demographic variables used in defining a high-risk pregnancy and are termed demographic risks.
He writes that ‘contrary to the campaign‘s repeated claims, Ghana does NOT face any imminent crises of population growth’.
He concludes the paragraph that Ghana has succeeded and ‘just needs to manage its success better’. Dr Thompson being the astute journalist, artist and economist should explain why though poverty declined by 0.8% between 2013 and 2017, the absolute figures increased from 6.4 million to 6.8 million with widening inequalities according to the GLSS7 of 2017.
Is this what he terms success that we should just manage? Of course, there is no imminent crises but as clearly stated by Lee Kuan Yew in 1969, we will regret the time lost if we do not take the decisive steps towards correcting a trend which can leave a society with many physically, intellectually and culturally anemic people.
Population growth rate does affect health, education, employment, security among others. The size and population growth rate which are a function of birth rate, death rate and migration do matter because it acts as the supply of labor force for a country and the economic situation the demand factor. An imbalance between the supply of labour and demand gives rise to unemployment and underemployment.
A vicious cycle generated by a high dependency burden associated with a young age structure leads to low savings and investment per capita which in turn leads to low economic growth and a low standard of living.
They produced high fertility rates in turn thus heightens the dependency burden perpetuating the cycle. This vicious cycle could be broken at only two points. First at the high fertility stage primarily by introducing an effective family planning program and at the stage of low economic growth by adopting policies to accelerate economic growth.
To be successful, both actions must be pursued simultaneously. With this as a clue, I hope Dr Thompson understands why there is an ever-increasing cohort of school children and we keep building to accommodate them instead of improving quality. Other economists have stated that at 1% population growth rate, nations need between 6.5% and 7% of GDP to maintain the same quality of life. This is termed running to stand still. What does he say about this? Is this consumption or investment?
He states that we are growing at 2.2% which is fine, and therefore we need to sustain the growth. It is however important to note that, our 1969 population policy had a target of 1.7% by the year 2000. Nonetheless, at 2.2 per annum, how much of our GDP do we need annually to just maintain our quality of life giving the life span of our durable assets such as schools, hospitals, roads, bridges currently perked averagely at 50 years not considering the human capital?
When Dr Thompson blames the overthrow of Gaddafi on European failed to connect the dots properly. Why should the overthrow of Gaddafi lead to the influx of African migrants to Europe if economists had good ideas as MechaiViravaidya of Thailand who within 15 years from 1971 halved Thailand’s growth rate from 3.2% to 1.6% and increased use of contraceptives among married couples from 15% to 70% within the same period. Because of the fertility decline and improved quality of life the people of Thailand did not migrate to Europe with or without the overthrow of Gaddafi.
The population of Thailand in 1970 was about 37 million, in2016 it was about 68 million with a GDP per capita increased from $570 in 1960 to $ 5901 in 2016. How does this compare to our situation in Ghana?
The claim by the economist that if indeed high population growth in Africa is the cause of migration, Africans should have been leaving long time ago is mistaken. A profile of the migrants will show that these are young people who have reached their prime ages and cannot find jobs. This is the result of high population growth and slow economic growth.
The high population growth rates he is referring to applied to smaller bases, 3.6% of 6 million therefore any little loan or grant we had was sufficient for our needs, but that will not be sufficient if our growth rate is 2.5 or 2.2 percent of 30 million. A fertility rate of 6 among 1 million women of reproductive age will result in far fewer absolute births than a fertility rate of 4 among 5 million women.
About 40% of Ghana’s population was less than 15 years in 2010 and by 2035 all those surviving from this large cohort and still living in Ghana will enter the economically active population. That high population growth increases the need for employment. This is very well demonstrated by Linden in New York Times of June 8th2018. He described it by illustrating that USA with its population structure generated 129,000 new jobs monthly, however, an America size Tanzania population structure would have had to produce 636,000 new jobs monthly without ceasing. We all have a stake and we will co-create the Ghana we want.
Dr Thompson talks about European women having up to 8 children some 100 years ago and European countries have undergone demographic transition. It is right that some European women had up to 8 children at some point in history and a corresponding life expectancy of 30 years. In economics, the fact that one cannot talk about interest rate without inflation also applies to fertility rate and quality of life in population management.
European countries run the full course of the demographic transition from high stationary to low stationary. Everything developed gradually, they did not face the explosive expansion like developing countries who benefited from medical technology and advancement in public health which lead to rapid decline in mortality.
Unfortunately, some economists did not and still do not support family planning as a critical intervention to reduce fertility to match mortality decline contributing to our current state.
Dr. Nii MoiThompson explains that ‘the slowdown in Ghana’s fertility and population growth rates over the years was largely due to the brisk pace of urbanization, from 23.25% in 1960 to 55.32% in 2017’.
Yes, one huge change in Africa according to Robert Engelman is the mushrooming of gigantic cities. Ghana is urbanizing rapidly with most people arriving from failed farmland and settling into slums.
While it is true that fertility differ according to urban-rural residence, increase in urbanization will never directly lead to fertility decline. The reduced fertility is as a result of easy access to contraceptives and abortion services. The long-standing family planning efforts have accounted for fertility decline and not necessarily urbanization.
In fact, recommending urbanization as a measure for further fertility decline is difficult to comprehend because Ghana’s greatest fertility decline was in the 1980’s when 70% of the country was rural and less literate.
According to Dr. Nii MoiThompson, the NPC ‘typically compares Ghana’s population figures to world averages or individual European countries and conclude that Ghana is doing badly’. We will continue to do so because the sustainable development goals are global targets just as the MDGs were. Human rights and human dignity are universal, and we will continue to do so. He goes further to explain how world population averages distort data from the developing world.
As much as possible we try to present a balanced picture, but we see no problem comparing with world averages. That is exactly what an average is: it combines the best performing and the worst performing. Just as some countries in the world have TFRs less than 2, others have up to 6 so there is nothing wrong with world figures and the distortions he is talking about are only imaginary.
However, we shall limit our comparisons here to only developing countries as suggested or recommended by the economist.
According to the world population prospects estimate by UN 2010-2015, the growth rate of all less developed countries is 1.37% (against 2.39 for Ghana); a growth rate of 1.70% for less developed countries excluding china (against 2.39% for Ghana); a growth rate of 1.48% for lower middle-income countries (against 2.39 for Ghana).
The last is 2.39% for least developed countries (against 2.39% for Ghana); The NPC will continue to present a balanced comparison of Ghana’s population indicators including global ones because there is a global agenda with common benchmarks for all countries.
About the wild allegation of the ‘NPC campaign [being] an unwitting extension of its European counterpart, which operates through “foreign aid”, we wish to ask what is driving his agenda. Is it driven by ‘aid’?
The vision of the NPC is quality life for the people of Ghana (children, teachers, nurses, mothers, fathers, doctors etc.) not just number of births. Numbers with purpose.
According to the council, issues bothering on population cannot be taken out of the equation of development.
The Chairman of the Council, Nana Otuo Siriboe II, said there is an urgent need to prioritise population management in the development planning of the country as it has a direct bearing on the country’s resource use and distribution.
Nana Otuo Siriboe made the remarks when the Executive Director of the NPC, Dr Leticia Adelaide Appiah gave a presentation on Ghana’s population structure at the State House in Accra.
“I’m scared looking at the population structure of Ghana…that in fact, we are sitting on a time bomb,” the Council of State Chairman said, adding that “We haven’t taken care of these things and our population is ballooning.”
He said no matter the amount of effort government put in place to develop the country, once the population is not factored in, such efforts would not yield any result.
“In our time, the secondary schools with high population was not up to 700 people but today, Opoku Ware Senior High School has more than 2000 students,” he said.
Speaking on the topic: “Population dynamics in socio-economic development”, Dr Appiah, said “It is very difficult to develop if you ignore population” pointing out that although “reproduction is an individual choice, it has communal implications.”
She described Ghana’s population as a youthful one, noting that such a population structure has implications on the country’s expenditure.
According to Dr Appiah, youthful population is characterized by high poverty rate, high dependency ratio, high expenditure on government to contain diseases and not to improve healthcare, fewer people paying taxes, and poor quality of education and lack of employment opportunities.
She explained that population and development are inter-related, explaining that in order to improve the quality of development planning, it is important to promote awareness among planners and policy makers on the need to adapt population policies consistent with development objectives.
According to her, it is important that stakeholders realise that high risk births, unwanted childbearing and rapid population growth as a demographic path is a major obstacle to our development.
Dr Appiah has therefore called for family planning services as part of measures to manage the country’s population, saying “family planning programmes have proven to bring about health and socio-economic benefits by encouraging smaller, healthier, more educated and skilled families.”
“We therefore need to invest in family planning to reduce high risk pregnancies which translate into reduction in medical, economic and social expenses,” she noted.
She explained that reducing high risk pregnancies sets the stage for adequate investment in nutrition, health, education and skill needed for human capital accumulation.
Dr Appiah further explained that investing in family planning “reduces the high youth dependency ratio and increases investment per child and ultimately improves the economic prospects of households and the nation.”
She was of the opinion that one way of making family planning easily accessible to people of reproductive age was to make contraceptives “easily accessible to people.”
According to her, making contraceptive accessible and easily available can be achieved through well-funded and active countryside media campaign supported by political leadership that provides information about the benefits of contraception, smaller families and the advantages of reducing risky pregnancies to the family, community and nation.
The programme, which will be piloted in the 2019/2020 academic year, according to the Rector of the school, Professor Kwamena Kwansah-Aidoo, is aimed at equipping students to better understand population dynamics and how it affects development.
He gave the hint when he paid a courtesy call on the Executive Director of the National Population Council, Dr Leticia Adelaide Appiah at her office in Accra on Thursday, January 31, 2019.
Prof. Kwansah-Aidoo was accompanied by the Head of Research and Acting Head of the Department of Communication at the school, Dr Lawrencia Agyepong.
He said the visit was to enable him to familiarise himself with sister state institutions and to find out how best they (institutions) can collaborate to contribute to the development of the country.
He said NPC was doing something great which the GIJ finds worthy to collaborate with, saying “We are interested in what you do and we want you to be interested in what we do.”
According to Prof. Kwansah-Aidoo, the familiarization tour also forms part of activities to create public awareness about the school’s upcoming 60th anniversary.
The school was established in 1959 by the Kwame Nkrumah government to provide training in journalism toward the development of a patriotic cadre of journalists to play an active role in the emancipation of the African continent.
For her part, Dr Agyepong, said “We want to link what we do to development of the country”, pointing out that GIJ as an institution does not only train communicators, but contributes to national development.
She commended NPC for instituting media award scheme to whip-up the interest of journalists in population reporting.
According to her, the award scheme will help promote understanding of population issues among the populace.
Touching on the course, Dr Agyepong said the course will be piloted in 2019/2020 academic year either at level 300 or 400, saying “we cannot leave population to chance.”
The Executive Director of the NPC, Dr Leticia Adelaide Appiah, expressed optimism that the collaboration between the two institutions would greatly contribute to the development of the country.
“It is important that we work together for the content our media people put out so that policy makers and stakeholders would well appreciate the impacts of population on national development,” she stated.
She expressed her happiness about the decision of the school to introduce a course on population reporting, noting that “I am excited that you have come on board. If we do not sow in season, we cannot reap the expected outcome.”
According to Dr Appiah, issues of population are long term things and that long term things don’t attract people’s attention, hence many people particularly in Ghana do not see the effects of the country’s growing population.
“Population is everything,” she said, adding that the decision by GIJ to introduce a course will help journalists and media practitioner to have better understanding of population issues and how to report on such issues with clarity.
Dr Appiah said any developed country takes population issues seriously, stressing that “people are not seeing the importance of population.”
She also expressed worry about lack of synchronization among state institutions, pointing out that such a practice leaves a lot to be desired.
According to her, it would be better if state institutions and agencies work together in the discharge of their duties, saying “We need to work together. We cannot sit in our silos.”
This, according to the Executive Director of the National Population Council (NPC), Dr Leticia Adelaide Appiah, would help to prevent unintended pregnancies and improve maternal and child health in the country.
“We can either invest in reproductive health information and services and reap the dividends or ignore it and continue to bear the expenditure of unintended pregnancies, both in the short and long terms,” she said.
According to her, the full value of investing in sexual and reproductive health services had really been underestimated in the country, saying “We need to intentionally prioritise funding for SRHR because we cannot be neutral; we are either part of the solution or part of the problem.”
Speaking at the launch of the maiden population and development media awards, Dr Appiah said 90 per cent of all adolescent pregnancies in 2017 ended up in unsafe abortions.
According to her, such pregnancies and abortions could have been prevented if the victims had access to information on SRHR.
She explained, for instance, that “Adolescent childbearing has remained at almost 14 per cent since 2003 with 50 per cent of married adolescents, not using any form of modern contraception.”
“Factors accounting for these outcomes are multiple, and include inadequate access to information on SRHR, social stigmatization against persons who access SRHR services such as family planning particularly among adolescents,” Dr Appiah stated.
Touching on the awards scheme, Dr Appiah said it was intended to increase media reportage on population, family planning and its related issues, saying “by this, the NPC and its partners will be engaging the media on a regular basis to help in the dissemination of information on population and development from an informed position.”
From left: Minister for Information, Mr Kojo Oppong Nkrumah; Executive Director of the National Population Council (NPC), Dr Leticia Adelaide Appiah, and Executive Director of the Planned Parenthood Association of Ghana (PPAG), Mrs. Abena Acheampong.
According to her, the ultimate aim of the awards was to celebrate and recognize the best of population and development reporting across the country “which convey relevant information on population and development to the people of Ghana.”
Dr Appiah said the submissions would be opened from December 1, this year, to June 30, 2019, and that the awards would be held in July, 2019 to climax the World Population Day.
She, therefore, encouraged journalists and media practitioners to report more on population and SRHR issues to enable them to win any of the categories in the contest.
The Executive Director of the Planned Parenthood Association of Ghana (PPAG), Mrs. Abena Acheampong, said the awards would serve as a motivation to journalists to report on population and SRHR issues in the country.
According to her, issues on population and SRHR had been underreported in the country probably due to the lack of information and understanding on it by journalists and media practitioners.
She said issues on population and SRHR affected every aspect of the country’s development, hence the need to educate the public on them.
Mrs. Acheampong noted that PPAG would continue to partner NPC and other relevant stakeholders to disseminate information and educate the Ghanaian public on issues on population and SRHR.
The Minister for Information, Mr. Kojo Oppong Nkrumah, who officially launched the awards scheme, said population issues were of great importance to the government, as government programmes and policies were all tied to the population of the country.
He, therefore, urged the media to continue to serve as agents of development by highlighting issues that affected the very existence of the citizenry.
“The best journalist is the one who looks out for stories that the society must hear,” he said, pledging the support of the government towards the organisation of the awards.
Mr. Oppong Nkrumah also called on corporate bodies, both public and private to support the organization of the award since population affected every business, saying “consider it (this media contest) as your Corporate Social Responsibility.”
Dr. Leticia Adelaide Appiah, the Executive Director, National Population Council, Ghana stated this in a recent interview, with a reporter, on the far-reaching consequences of escalating population in many African countries including Nigeria and Ghana. Excerpts:
Dr please what is your academic and professional background?
I completed medical training in June 1993 from Donetsk Medical School in Ukraine and came home immediately fired up to contribute my quota to national development. During my training in Donetsk, the maternity ward was the happiest of all the wards because; there was joy, flowers and smiles when babies were born. I therefore decided that I needed to specialise as an obstetrician gynaecologist because I wanted to be there to always welcome new precious citizens into our world. However, when I started practicing medicine in Ghana, I realised to my dismay and sadness that not all babies in Ghana are received in the world with joy, laughter and smiles. Some parents are ill prepared to receive them whiles some are just not wanted and end up abandoned, malnourished or simply maltreated. I therefore decided to pursue a Master’s in Public Health to enable me get closer to the community since health or diseases are manufactured in homes which is the best place for health interventions for maximum effect. In 2003 I completed my Master’s in Public Health and completing my PhD in public health this year.
I was appointed as the Director of Health Services in 2008 at the Ledzokuku-Krowor Health Directorate in the greater Accra Region when the Municipality was newly established, a position I held until November 2016 when I was appointed the Executive Director of the National Population Council, the highest advisory body to the government of Ghana on population and related issues.
What is over population?
Over population is an undesirable condition where numbers of existing human population exceed the carrying capacity of the earth. This is because of reduced mortality rate, better medical facilities, industrialization and improved public health and high fertility levels. Currently, Africa’s problem is the extremely rapid population growth rate that makes it extremely difficult for governments to supply the needed social and economic programs to improve quality of life. For example, the total population in Nigeria was estimated at 191 million people in 2017 and a net increase of about 14, 000 people (21,000 births and 7,000 deaths) daily or about 5 million annually. In 1960, Nigeria had 45.1 million people. The United Kingdom on the other hand had a population of 52.2 million people in 1960 and was estimated at 66.2 million people in 2017, according to the latest census figures. Though UK had more people than Nigeria in 1960, Nigeria has about three times more people compared to UK in 2017.
Such high population growth rates lead to widespread food shortages, malnutrition, crowded and sub-standard schools, crowded hospitals, teeming slums, inadequate water supply, inadequate electricity supply, failing banks and security threats among others. After all, nation building is by the people and for the people. There is therefore the need to balance the reproduction and production capacities of the citizenry through effective policies and programs with the welfare of the people as the paramount goal. Healthy people are more productive while unhealthy, malnourished, stunted, poorly skilled people consume more than they produce.
What are the major causes and consequences of this challenge?
The population growth rate which is a function of birth rate, death rate and migration, acts as the supply of labour force for a country and the economic situation -the demand factor. An imbalance between the supply of labour and demand gives rise to unemployment, underemployment and poverty. A vicious cycle generated by a high dependency burden associated with a young age structure leads to low savings and investment per capita by families and nations which in turn leads to low economic growth and a low standard of living. The produce of high fertility rates in turn heightens the dependency burden perpetuating the cycle putting pressure on governments to spend more just to maintain quality of life. Some economists have stated that at 1 percent population growth rate, nations need between 6.5 percent and 7 percent of GDP to maintain the same quality of life. This is termed running to stand still. With Nigeria growing at over 2 percent growth rate, how much of GDP is needed just to maintain quality of life?
Dr What should be done to curb these negative trends?
This vicious cycle can be broken at only two points. First, at the high fertility stage primarily by introducing an effective family planning program and at the stage of low economic growth by adopting policies to accelerate economic growth. To be successful, both actions must be pursued simultaneously. Balancing reproduction and productivity is key to national development. Unfortunately, some of our leaders focus only on the productive part of education and job creation with little attention to the reproductive needs of their citizens thereby keeping a lot of women and girls under the bondage of involuntary reproduction and nations bearing the consequences thereof.
Please would you like to mention a few countries that have achieved success in population control especially Ghana?
Thailand within 15 years from 1971 halved it’s growth rate from 3.2 percent to 1.6 percent and increased use of contraceptives among married couples from 15 percent to 70 percent within the same period and number of births per woman reduced from 6 to 2 The population of Thailand in 1970 was about 37 million and increased gradually to about 68 million in 2016 with GDP per capita increasing from $570 in 1960 to $ 5901 in 2016. In effect, Thailand produced fewer, healthier, happier and more educated people for national development.
Rwanda is another country which places emphasis on the harmonization of population growth in its Economic Development and Poverty Reduction vision 2020. The reduction of the main causes of mortality, reducing total fertility rate, decreasing infant and maternal mortality and ultimately reducing population growth as the thrust of the vision. The vision identified high population growth rate as a major challenge and singled out Family Planning (FP) as a key intervention crucial for reducing birth rates and improving quality of life.
The program has so far been successful that the contraceptive prevalence rate among married women increased from 4 percent in 2000 to 10 percent in 2005 to 45 percent in 2010 (RDHS, 2005 & 2010) and the total fertility rate decreased from 6.1 per woman in her lifetime in 2005 to 4.6. In 2010, maternal mortality ratio reduced from 750 per 100,000 live births in 2005 to 487 per 100,000 live births in 2010 underscoring the important role of FP in addressing population growth and improving quality of life.
How many unintended births, miscarriages, abortions and other morbidities with detrimental health and economic consequences to women, children, families and communities were averted in Rwanda by repositioning family planning as key intervention? By how much has it reduced the cost of their social interventions in health, education, water, electricity, road infrastructure, LEAP, prison services, and police services) or improved services?
Dr What is the situation in Ghana and Nigeria in terms of public acceptability and use of contraceptive?
Contraceptive use and unmet need for family planning are key to effective fertility management, improving reproductive health and ultimately health of all citizens worldwide. Contraceptive use helps couples and individuals realize their basic right to decide freely and responsibly if, when and how many children to have and remain a sustainable family. The use of contraceptive methods not only results in improvements in health-related outcomes such as reduced maternal mortality and infant mortality but also educational, employment outcomes and in reaping demographic dividend.
According to the world trends in contraceptive 2015 report, globally, the contraceptive prevalence rate for modern methods is 57 percent. Within Africa, countries with contraceptive prevalence of 50 percent or more are mainly islands (Cabo Verde, Mauritius and Réunion), or located in the north of the continent along the Mediterranean coast including Algeria, Egypt, Morocco and Tunisia as well as in Southern Africa such as Botswana, Lesotho, Namibia, South Africa and Swaziland.
Five countries in Eastern Africa including Kenya, Malawi, Rwanda, Zambia and Zimbabwe also had contraceptive prevalence levels of 50 per cent or more in 2015. In contrast, 17 African countries including Nigeria had contraceptive prevalence levels below 20 per cent with high unmet need for family planning and corresponding high dependency ratio and pregnancy related morbidities and mortalities. Ghana is doing relatively better than Nigeria because the population is far less and the fertility rate is also lower. Nonetheless, the government of Ghana also needs to reposition family planning to reduce fertility and dependency ratio for accelerated socio-economic development.
Advocating for the acceptability of contraceptives in Sub-Saharan Africa should be a socio-economic empowerment agenda spearheaded by our political leadership enlisting the support of all stakeholders including the religious leaders, traditional leaders, health workers, teachers, civil society, private sector, the media, school children and the international community. Reducing fertility through increased contraceptive uptake reduces expenditure in all sectors and set the stage for accelerated economic development of families and ultimately nations. Focusing on family planning education and access in an enabling environment should therefore be an agenda for African leaders. After all, good politics improves human lives, reproductive health rights and responsibilities also improve human lives, therefore improving reproductive health and rights in a responsible way is good politics.
India and China recorded huge successes in shrinking their demographics through giving incentives to families with one or two only children.
Do you think that this approach can be adopted in this region?
Yes, China and India implemented population policies that worked for them though some aspects were unethical by forcing people or through coercion. Currently, China has a fertility level that is below replacement of 2.1 per woman and therefore has relaxed its policy to allow women to have at least 2 children. Population policies differ from country to country and at times within countries, like weight management. Just as people who are over weight should reduce their weight to within a normal BMI range, so should countries with high fertility rates have policies that give incentives and encourages fertility reduction as most countries in SSA. Countries with fertility rates below replacement level fertility of 2.1 should have policies serving as incentives and encouraging women to increase their fertility to the replacement level and countries with fertility levels at the replacement level should maintain whatever they are doing.
Governments drive everything through the policies they implement. An example is Iran. In December 1989, the government of Iran introduced a family planning program with 3 major goals. First to encourage women to space their pregnancies between 3-4 years, discourage pregnancy among women younger than 18 years and older than 35 years and limiting pregnancies to three per woman. Iran therefore fashioned its policy around reducing high risk pregnancies through advocacy and free supply of contraceptives. In as much as citizens had the right to have as many children as they wish, the government made them responsible by making citizens bear the full cost of additional births after the third child. The total fertility rate declined from 5.2 births per woman in 1989 to 2.8 in 1996. There was reduction in maternal and infant morbidity and mortality, improvement in health care and educational outcomes among other advantages.
What roles should ECOWAS and AU play in strengthening member countries on adoption of more stringent policies and legislation in this campaign?
ECOWAS and AU member countries should support each other in breaking the poverty cycle by simultaneously implementing an effective family planning program in addition to all the economic activities. Afterall, the World Bank talks about GDP per capita. This means, nations should help their citizens reproduce themselves healthily and work effectively and efficiently to improve the GDP per capita. ECOWAS and AU must focus on reproductive health rights and responsibility as equally as they focus on economic interventions because one cannot afford to forget the per capita part of GDP per capita and meet the SDG goals or the Africa Agenda 2063. Nigeria being the most populous African country with a high population growth rate with massive population momentum, should be targeted for support by ECOWAS to reposition family planning as a critical socio economic intervention to improve human lives in this generation and set the stage for improved life for the next.
What is your advice to executives of population control agencies in Nigeria and other countries?
Nigeria is Africa’s most populous country. It has over 40 percent of its population below 15 years and has a net annual increase of about 5 million people. That is about the population of Norway being added to Nigeria’s population annually. This is certainly not sustainable for sustainable socio-economic development.
Population growth dramatically increases the need for all services including job creation. Linden, writing in the New York Times in 2017, illustrates the burden of exploding population. He said per the population structure of the United States, on average 129,000 new jobs monthly were created in 2016 but an America-size Nigeria would have to produce 319,000 jobs monthly, without cease. How can we sustain this? Let us know that the might of a nation is not necessarily in its size but in the might of its people that is the human capital.
Dr What are your final thoughts on these issues?
I believe that every pregnancy should be wanted, and every child cherished and nurtured to be a productive and proud citizen of nations. That is the only way any nation can develop since quality human capital accumulation is key for manufacturing durable assets for common good. Adequate investment in children from infancy through adolescence till they become productive is expensive and time consuming but that is the only way to transform our human resource to human capital for development. Investing in reproductive health and rights have huge returns not just in terms of preventing high risk and unintended pregnancies, unsafe abortions and complication, but also improves nutrition for women and children, reduces risk of anaemia for women and children, increases survival and better health for mothers and children and fewer orphaned children. Investing in reproductive health in addition to reducing heath bill, frees up money for quality education of the citizens, thereby improving the status of all including women to contribute to economic growth. Investing in reproductive health saves money and helps nations produce healthy productive citizens for sustainable socio-economic development. The Africa we want, where no one is left behind.
As the former President Olusegun Obasanjo said on TV once, “if you don’t see what you should see, and you don’t do what you should do, you will become a victim of what you don’t like”.
I totally agree with him and urge all of us to see the importance of reproductive health rights and responsibilities as a developmental agenda and focus on it to enable us get the results we so desire. Let us see what we should see and do what we should do to get the results we desire.