Talking more about condoms is good for Africa’s economy

02 November 2022 - 11:44 By Neil Munshi
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Injectable contraceptives and oral birth control pills are often out of stock in SA.
Injectable contraceptives and oral birth control pills are often out of stock in SA.
Image: 123RF/phattana/ File photo

A dozen women in motley-coloured hijabs sat in the small courtyard of Rakiya Maitama’s home, peppering the midwife with questions. It was late last year in Inusawa, a village in northern Nigeria on the arid outskirts of the region’s biggest city.

Over the course of a couple of hours, the women — who ranged in age from their early 20s to their early 40s and each had from two to eight children — talked about their ideal household size and why they’d sought family planning help. But first, they had practical questions.

“Will it change my menstrual cycle?” asked one. “Why is there always air in the tip of the condom?” another said.

Maitama, who acts as the local representative for a London-based non-profit, holds the sessions regularly for small groups of women in villages around the city of Kano. She encourages frank discussion, the kind rarely held in this conservative part of the world.

Countries in Sub-Saharan Africa have the highest fertility rates in the world. Niger, to Nigeria’s north, is at the top of the list with 6.7 births per mother, while nearby Mali and Chad are among those close behind.

With 5.2 children per woman, more than twice the global average of 2.4, Nigeria is firmly in the world’s top 10. The United Nations projects that the number of Nigerians will more than double by 2050, to 450 million, making it the world’s third-most populous country.

Lowering birthrates is key to cutting poverty in the world’s most fertile population.
Lowering birthrates is key to cutting poverty in the world’s most fertile population.
Image: Bloomberg

This part of West Africa is now the engine of global population growth, a title that previously fell on China, India or Southeast Asia — each of which became economic powerhouses. The ascent of those regions was driven in part by what’s known as the fertility transition.

That’s when fertility rates fall towards the replacement rate of about 2.1 births per woman, which stabilises the population and is closely connected to development, growth and poverty reduction. Lower fertility rates mean a higher median age, which means a bigger working population earning and saving money.

A larger savings base tends to bring lower interest rates, which help countries to build infrastructure such as power grids and roads.

Many countries across Africa have already made strides in bringing fertility rates down. But Nigeria — home to about 1 in 7 Africans and the continent’s largest national economy — is nowhere near tipping its population balance.

The nation spent $18.2 million on family planning in 2019, according to data from FP2030, a UN-backed global partnership. That’s about a seventh of Pakistan, a country with a similar population but a fertility rate of 3.4.

Still, such spending is up from just $1.7 million in 2017, and policymakers have recently begun acknowledging the challenges ahead.

This year, President Muhammadu Buhari established the National Council on Population Management, emphasising “the urgency to address Nigeria’s sustained high fertility rate, through expanding access to modern family planning.”

More people means a need for more schools, teachers, hospitals and other vital infrastructure. Without those “critical ingredients,” economic advancement is likely to suffer, says Alex Ezeh, a professor of global health at Drexel University in Philadelphia: “The rate of growth we have in West African countries is too high to allow for them to make the necessary investments in human capital development to improve economic outcomes and growth.”

In places like Mali and Chad, where the population is growing at an annual rate of about 3%, the number of people doubles every quarter-century. In Nigeria, population growth is about 2.5%, and the strains can be seen across the country. There isn’t enough power or water, and there’s a shortfall in funding for healthcare, education and infrastructure.

About four-tenths of Nigeria’s population of more than 200 million were living in extreme poverty — defined as subsisting on $2.15 a day or less — while 3 in 10 were vulnerable to falling to that level, according to World Bank estimates from 2018-19. That’s more people below the poverty line, in absolute terms, than in any other country on Earth, including India, which has a population seven times the size.

Nigeria is home to one-fifth of the world’s out-of-school children. Half of adults are under- or unemployed, a figure that jumps to two-thirds for those younger than 34, the majority of the population. Youth joblessness is fuelling a thriving kidnapping-for-ransom industry, with armed gangs of young men abducting busloads of people from highways or entire schools with hundreds of children.

Nigeria is in many ways a story of two countries. A 2019 study of 23,000 Nigerian women found that the total fertility rate of the Hausa-Fulani ethnic group that dominates the predominantly Muslim north was 8.02, compared with 4.91 and 4.43, respectively, for the Igbo and Yoruba who are concentrated in the south. Northern states have the highest rates of poverty, out-of-school children and maternal mortality in Nigeria, along with the lowest literacy levels and the most severe insecurity.

A 2014 analysis by the Copenhagen Consensus Centre, a US-based think-tank, estimates that every dollar spent on universal access to sexual and reproductive health services returns $120 in annual economic benefits. But there’s a debate about whether investments in education or family planning would better spur economic development.

Charles Robertson, chief economist at investment bank Renaissance Capital, makes the connection between fertility and economic growth in his 2022 book, The Time-Travelling Economist: Why Education, Electricity and Fertility Are Key to Escaping Poverty. Countries grow fastest when lower fertility rates raise the median age to between the mid-20s and early 30s, when people are working and saving more. “But you’ve got to have the education first because no illiterate country has ever gotten rich,” he wrote. “And you’ve got to educate particularly the women.”

When it comes to education, “just having school buildings won’t do,” says Partha Dasgupta, a professor emeritus at the University of Cambridge who focuses on the economics of poverty. “You have to train the teachers, you need them to show up at school.”

That’s not happening in Nigeria, which spends about 5% of its GDP on education, about a third of the Unesco benchmark. Teachers routinely strike for months at a time over unpaid bills, and schools across the region are woefully underfunded.

Family planning is a sensitive subject, for cultural and religious reasons and for pernicious, historical ones. The non-profit that Maitama works for, MSI Reproductive Choices, was until 2020 called Marie Stopes International, named after the early 20th century British birth-control pioneer whose eugenicist views have come under increased scrutiny in recent years.

Population is also a political issue in Nigeria — the more people, the more parliamentary seats and money a state gets from the central government. The last time the country had a census was 2006, and that was marked by sudden, suspicious surges in various states.

Politicians support rapid population growth, because “it helps them draw in more resources,” says Ezeh, the Drexel professor, who was born in Nigeria. “It doesn’t matter if they are hungry or poor or illiterate, it doesn’t matter to them.”

“Political elites will tell you it is our religion, and I tell them we are not more Catholic than Spain or Italy, we’re not more Islamic than Indonesia,” he says. He mentions Bangladesh — a Muslim society that’s widely cited as a model for African countries — which swiftly brought its fertility rate down to 2 today, from almost 7 in the 1970s. “It’s not a question of religion or culture.”

What’s clear is that the growth is primarily driven by the north, where traditions including adolescent marriage and polygamy have long made large families the norm.

That’s where MSI and the Women’s Integrated Sexual Health program run by the International Planned Parenthood Federation focus the vast majority of their services, which include birth-control pills and implants as well as intrauterine devices.

The groups avoid words like “sexual” or “family planning,” preferring “childbirth spacing.” Buy-in from husbands and male authority figures, both religious and cultural, is crucial, says Effiom Effiom, head of MSI in Nigeria.

His teams engage men first, to disabuse them of “myths and misconceptions around what Islam says about family planning.” Rapid urbanisation is also shrinking the need for large families, which have long been helpful on the farm. That could help reshape attitudes.

Back in Inusawa, Shafaatu, 24, said she didn’t want to have more than the two children she has, and her husband agreed. Shamisiyya, a 30-year-old with six children, echoed the sentiments of the other women when she said that family planning was also about giving a break to women in a long cycle of delivering and raising children. “I want to plan out my family, to have a better understanding with my husband so we don’t have any issues or quarrel about money,” she says. “But I also want some rest.”

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