Health Planning and Population Policy in Africa

Abstract

Despite common interests, health planners and population planners have apparently different objectives: respectively to improve health and reduce mortality, and to reduce rapid rates of population growth. To the extent that reductions in mortality increase population growth, the objectives appear contradictory. seeming contradiction has been heightened by demographic evidence that post-war rapid population growth in developing countries was largely the result of public health measures which suddenly lowered mortality rates. Population and health planners have agreed on family planning as a common program where their objectives converge, since family planning both reduces births and improves the mother's and already-born children's health. However, one school of thought in the population field maintains that the solution to the population problem lies not soley in family where the health and welfare of the family are the motivating force, but in measures beyond family planning, where concern with economic development and societal welfare are paramount. beyond-family-planning school maintains that individuals want more children than the larger society can afford, that family planning permits the planning of families which are too large. They assert that, in addition to family changes are required in tax structure, housing policy, and female employment strategies if childbearing is to be discouraged (Davis, 1967; Berelson, 1969). premise of this essay is that, despite the apparent contradiction, those in the population field should give priority to improving health standards and reducing mortality in Africa. In Africa, cultural, social, and political constraints militate against a strong public commitment to population limitation. Studies of the public's attitude toward family size (Knowledge, Attitude, and Practice of Family Planning, commonly called KAP studies) have repeatedly demonstrated that African parents do not have more children than they want (Caldwell, 1968 and 1974).1 In fact, recent evidence suggests the possibility that some African parents have fewer children than they desire, because of subfecundity caused by nutritional and general health problems (McCabe, 1975). African governments at the 1974 World Population Conference in Bucharest generally took the position that population should not be treated as an issue per se, that The Best Pill is Development (Pradervand, 1973b).2 At present, only Ghana and Kenya have policies favoring less rapid growth of population; Nigeria, Tanzania, and others promote family planning on the grounds of health; some countries, such as Cameroon, Gabon, and the Ivory Coast, actively favor more rapid growth (Gwatkin, 1972).