Mobilization for family planning and HIV/AIDS testing.

My last two Reports from Kenya (here and here) have been about the fact that the 2019 Kenyan population was 5 million or 10.4% less than the medium estimate made by the United Nations Population Division. For me that was not surprising since I had noticed (here) in 2014 that younger women were not having near the number of children that their mothers and grandmothers had. This Report from Kenya analyses the situation in Burundi, which at a fertility rate (2018) of 5.93 children per child-bearing age, is the 3rd highest in the world.

While I did my own observations on the ground in Kenya, I do not live in Burundi. Consequently I asked Parfaite Ntahuba, the National Coordinator for the Friends Women’s Association in Burundi, for her observations. Note that unlike the unbiased observer I was in Kenya, one of the main programs that Parfaite’s Ntaseka Clinic runs is public presentations to encourage people to use modern family planning methods and become tested for HIV/AIDS. The clinic provides all the methods of contraception available. In Parfaite’s monthly reports the Ntaseka Clinic gives the total number of women coming in for family planning and monthly the numbers of women obtaining contraceptives continues to increase. For example, in October this small clinic had 368 women coming in for family planning of which 254 were old cases and 114 were new cases.

When I asked Parfaite about the fertility rate, she responded, “The average of children per woman is going down slowly here in Burundi. Indeed, in 2016 the average was 6.2 kids per woman, and now it is 5.7 per woman.” This implies that the fertility rate is going down at the rate of 0.125 children per year per woman. If this rate would stay steady, in 29 years Burundi’s fertility rate would reach the replacement rate of 2.1 children per woman. Note that the United Nation Population Division estimates that the replacement fertility rate in Burundi will not be reached until 2090 or 71 years from now. Yet why should we assume that the fertility rate will not go down even faster in the coming years as stigma decreases and an increasing number of women begin using family planning methods? Perhaps it will take Burundi only 15 years to reach the fertility replacement rate.

One interesting comment Parfaite made is, “As a Pastor [of the Friend Church], during the premarital counseling, most young women tell me that they want three or four children.” This is a considerable decline from the current number of children.

Burundi is mostly a Catholic country so those hospitals and clinics run by the Catholic Church do not provide modern methods of family planning. There is still much sigma and misunderstanding about family planning which is why the Ntaseka Clinic holds public information sessions. Parfaite comments, “Some women have now understood the importance of spacing babies. Others still do not because of their religious beliefs. And this causes a lot of conflicts between the husband and the wife.” As a result, since they don’t need to inform their partners, 82 percent of the women who came to the clinic for family planning in October chose contraceptive injection as their preferred method. As Parfaite commented, “At Ntaseka clinic, we have women who hide themselves when they are coming for family planning methods because their husbands don’t trust the family planning methods.”  

The Burundian Government has signed on to the FP2020 (Family Planning 2020 campaign launched in 2014) to increase family planning services. The statistics indicate that about 29% of women now use family planning. This compares with 60% in Kenya.

There is another interesting aspect to the population increase. Similar to over-estimating the Kenya population, the United Nations Population Division had over-estimated the population in Burundi. Burundi conducted a census in 2016. In 2015 the UN Population Division had an estimate of 11,179,000. If you add the usual 3% increase at that time, their total for 2016 would have been 11,514,370. The census in 2016 counted only 10,524,117 people for a decrease of 990,254 people or 8.5%. As a result it took three years (2018) for the Burundian population to reach the estimated 2015 total. Again the UN Population Division is significantly over-estimating population increase.

In conclusion when we look at an African country with a low and fast declining (Kenya) birth rate and one with a high and slowly declining birth rate (Burundi) we can see that the demographic transition to the replacement rate is happening much faster than projected. This has huge implications for infant and child mortality, maternal death rate, life expectancy, living standards, quality education, health improvements, and so on. The expectation that it will take to near the end of the century for Africa to finish the demographic transition is out-of-date as shown by the rapid progress on the ground in Kenya and Burundi. Exceedingly good news for Africa.


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David Zarembka

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