DOWODA - Adjoa Ankra carries her baby, wrapped in a white blanket, on her back. The 28-year-old woman set off from home at dawn and is now standing with several dozens other women in the courtyard of a health center in Dodowa, a city in Ghana. Rain drops fall on the brightly-clad women and the corrugated iron roof of the facility, but the sound is drowned out by the song the women are singing: "Thank you Lord for protecting our children."
It is hours before it is finally Ankra's turn to step up to the rickety table. Doctors fill out forms before her seven-month-old son Samuel can get the jab in his upper thigh that could save his life. With the support of the Global Alliance for Vaccines and Immunization (GAVI) two vaccines are being introduced in Ghana, one against pneumococci and the other against rotavirus. They are the main cause of pneumonia and diarrheal illness that kill 2.7 million people around the world every year.
Ankra sells melons at the market; on good days she earns the equivalent of two euros. Her husband, who works on a farm, doesn't earn much more than that. Feeding a large family with so little money isn't easy.
Ankra also had her other four children vaccinated at the health center. Her first child was born when she was 18. "We always wanted a big family," she says. "Children are a gift of God." One of her children died of malaria, but the remaining four are in good health. Every night, Ankra prays for their continued good health – and more children.
Can one tell a mother that her desire for children is possibly one of the reasons she's poor, and could also be dangerous for her? According to the aid organization Save the Children, in the 15-to-19-year-old age group pregnancy is the main cause of death, killing 50,000 young women each year.
Over 200 million women worldwide would gladly practice birth control if they had that option. Nearly every one out of four married woman in developing countries uses no form of contraception even though she wishes to avoid pregnancy. The husband is often the one who takes the family planning decisions.
Having many children is a sign of wealth
But there are also many women who, like Ankra, wish for large families. Nowhere is the pressure on childless women greater than it is in Africa, where – particularly in rural areas – many perceive having many children as a sign of wealth. And in the absence of real pension systems, children are considered as a kind of old-age insurance.
The extent to which the subject of family planning is still taboo came across loud and clear over recent weeks at the London Summit of Family Planning. The summit was organized by the British government together with the Bill and Melinda Gates Foundation and the UN Population Fund.
The summit's ambitious plan is for 120 million women to have access to contraception by 2020 in addition to the 260 million women in the world's poorest countries who are already practicing birth control. The plan will cost an estimated three billion euros, 1.87 billion of which was pledged at the summit.
One of the speakers at the event was Ugandan President Yoweri Museveni. His government spent $5 million (4.1 million euros) on family planning – news that had insignificant success. Despite Uganda's comparatively low economic clout, the amount is still paltry.
"That may seem like a small amount. But we're spending billions trying to get electricity," said the father of four as a justification. "Without electricity, there is no development." Once that is achieved, said the President, the birth rate should automatically fall, while the middle class is growing.
This is the same argument that put the brakes on the first UN World Population Conference in 1974. "Development is the best birth control," is what everybody was saying back then.
In countries like Uganda, where religion exercises considerable influence on politics, the limited availability of contraceptives is directly linked to resistance by church and cultural leaders.
The impact of religion on foreign aid and family planning
Religious influences also impact development aid in Africa: by comparison with 1995, and adjusted for inflation, the U.S. reduced its funding for family planning in developing countries by 40%. This, according to The Atlantic magazine, is because American politicians often equate prevention with abortion and vote against funding family planning initiatives – and this despite the fact that, according to polls, well over 80% of American Catholics have found a way to reconcile birth control with their beliefs.
But outside the U.S., awareness is growing – also in many countries in sub-Saharan Africa, where every woman has 4.8 children on average. The world's population has grown from five to seven billion since 1987, which means the daily growth rate is 216,000 or the equivalent of the population of a small city.
The growth is particularly strong in Africa. In fact, if the birth rate is not checked, the population on the continent would grow from its present billion people to three billion by 2050. Scientists and other experts are assuming that the rate is going to slow down, but even if that is so in view of the threat of more food shortages, increasingly extreme climate conditions and paucity of agricultural land, African leaders cannot afford to ignore the situation.
A large population increases the need for teachers, doctors, and other service providers and the necessary investment in these sectors means that there is less money to invest in creating competitive economic structures. This – along with ineffective structures and corruption – is a main problem in many African nations.
No African president has spoken out so clearly on the subject of overpopulation as Nigeria's President Goodluck Jonathan in the run-up to the London Summit. By the end of the century, the population of his country could grow from its present 160 million to 730 million according to UN estimates. Despite a landmass considerably smaller than either China or India, that would make Nigeria the third largest country in terms of population.
Birth control legislation
So Nigerians should only have "as many children as they can afford," Jonathan said, adding that it may well be time to introduce birth control legislation. The president mentioned China where controversial one child policy has successfully stemmed population growth since the 1960s. In Chinese cities, parents who have a second child are subject to heavy fines– or worse.
The measures Jonathan is looking at are far less draconian, and include developing a social security system for parents with few children. The plans have caused a considerable outcry in Nigeria where in a rare show of unity both the Muslim and Christian churches criticized the idea alongside politicians and community leaders. The problem, they say, is not overpopulation but the inability of the state to distribute oil wealth fairly.
Debates like that, however, are far removed from Adjoa Ankra's reality. At the Dodowa health center, she wraps baby Samuel back in his blanket. He's been vaccinated. Ankra laughs and wipes away his tears. The question of whether or not people of Samuel's generation will decide to have fewer children lies outside her frame of reference.
And yet the example of countries with family planning policies offers a possible way forward. In some Asian countries as well as in the European industrial nations there are ever fewer young people. In Hong Kong, only about 12% of the population is younger than 15 years old – a world record. In Singapore, where the birth rate of 1.27 children per woman is even lower than Germany's, the government is actually encouraging people to have more children. Its slogan is: "Have three children or more" followed by the words: "If you can afford it."
Read the article in German.
Photo - Elsa Finocchiaro