By Susan Anyangu
KAMPALA, Nov 19 2009 (IPS)

Family planning: key to reducing child mortality and improving maternal health; a way to put less strain on the environment; and a smaller population makes the challenge of providing adequate education and health services that little bit easier.

The Millennium Development Goals are closely linked, and according to the United Nations Population Fund (UNFPA), achieving them by 2015 will require recognition of the benefits of slowing population growth.

IPS spoke to Stan Bernstein, a UNFPA senior policy advisor at the International Conference on Family Planning in Kampala, Uganda, who said failing to provide everyone with access to affordable and effective family planning threatens the attainment of all the MDGs.

IPS: How is the provision of effective and affordable family planning related to the attainment of MDGs? STAN BERNSTEIN: At the household level, having many, closely-spaced children affects the health of women, their children, and families, increasing the risk of maternal, child and infant mortality.

For development efforts to be achieved, (governments) must recognise the benefits of slowing population growth. And one way of doing that is to satisfy the current unmet need for family planning.

Many married women report having mistimed or unintended pregnancies or a desire to space or limit future pregnancies, but are not using modern contraceptive methods.

Family planning helps countries reduce child mortality and improve maternal health. It also plays a major role in MDG 2 because a smaller population means fewer people in need of education and health services. Further, it means less strain on the environment and natural resources.

Full achievement of the MDG targets costs less and is more manageable logistically when countries focus on provision of family planning services to reduce population growth.

IPS: What is UNFPA’s recommendation at this point? Is it too late for a turnaround to be achieved? SB: Governments should increase budgetary allocations towards family planning as a matter of urgency if they are to meet their MDGs. At the moment the current pace of increasing family planning uptake is still low, contributing to an increase in unwanted pregnancies and maternal deaths as a result of unsafe abortions and child deaths.

The maternal mortality rate remains high, yet it was (supposed to) be cut by three quarters by 2015. This would have required a reduction of five percent per year from the 1990s to 2015. However, the reality in Africa has been a reduced maternal mortality rate of 0.5 percent per year since the 1990s to date. This is simply not good enough and at this pace MDG 5 will never be achieved.

However, all is not lost if governments renew their commitment to increase the prevalence of family planning and reduce unmet need. This should be scaled-up because in half of the countries in Africa the levels remain alarmingly low and more prevalence rate is needed.

IPS: With the ongoing worldwide economic crisis governments have little money to spare, let alone divert into provision of family planning services. What is the incentive for them? SB: Evidence indicates that improved government commitment through increased budgetary allocations to family planning has had tremendous results.

Rwanda is an example of a country where political commitment has had a significant impact. In 1994, (Rwanda’s) Demographic Health Survey showed a contraceptive prevalence rate of 10 percent. The 2008/2009 survey shows a prevalence rate (the proportion of people using contraceptives) of 26 percent – a marked increase.

This has significantly reduced deaths of children under the age of five, with an increased coverage of immunisation among children.

Despite Rwanda’s unmet need for contraceptives being over 20 percent, it remains a good example. It shows that once the government renewed its efforts in provision of family planning, demand went up because now more people are aware of it and want the services.

While it is the reality that increased commitment means governments must give more money, it has been proven even very small investments in family planning sector will pay off in terms of improved lifestyles among the reduced population.

The impact of not putting in any money is four times more costly than providing funds for family planning.

African governments should also strengthen the health care sector to avert the mass exodus of health works to the West in search of better opportunities. This is unfortunate since it is happening at a time when demand for family planning in Sub-Saharan Africa is increasing.

Governments are thus being urged to review the training of health workers at all cadres to ensure that all can deliver family planning services to the community. And here training of community health workers is being advocated to ensure they are competent enough to supply family planning services.

In Malawi, the Ministry of Health decided to allow health surveillance assistants to administer injectable contraceptives at the community level, a move that has served to increase contraceptive prevalence in that country.

IPS: Is it only up to governments? What is the role of activists working in the family planning sector as well as donors? SB: While the onus is on governments to re-commit to the family planning sector, advocates in the area are being challenged to devise new strategies to mobilise commitment and resources for family planning programmes through using evidence-based strategies that will get through to the governments, donors and policy makers.

Donors who since the 1990s refocused on HIV also need to appreciate the need for funding in the family planning sector. And if governments show commitment it may be worthwhile to reward countries through donor investment in this area.

Excerpt:

Resistance to a government scheme to upgrade housing in Nairobi’s Kibera slum is enmeshed in economics, history and identity.

Apart from being university-educated, a rarity amongst his Nubi ethnic group, Adam Hussein says his story could be the story of most Nubians.

“It is a story characterised by the need to survive through challenges that are never explained to you. It is a story characterised by limited interactions with state officials who always remind you it is your privilege to be served by them. It is a story characterised by assuming false identities in order to belong,”

Hussein is a programme officer in charge of the citizenship and stateless project at the Open Society Institute in Nairobi. He says he had long accused most of his Nubian peers of being lazy. However, after leaving university and struggling to find formal employment for ten fruitless years, he nearly joined the many Nubians in Kenya who have given up hope of productive careers because they are denied national identity cards.

He has come to understand that Kenyan Nubians simply do not belong, he says.

At 18, every Kenyan is expected to apply for a national identity card which they are expected to carry on them at all times; ID cards are a basic necessity in Kenya, required for such things as opening a bank account, applying for work, signing a contract or obtaining a passport.

Acquiring a card should be straightforward – present a birth certificate and copies of your parents ID cards. But members of the Nubian community are routinely subjected to additional vetting of their applications, treated with suspicion of having come into Kenya from Uganda and Sudan. Nubians are often asked to bring in their grandparents’ documentation as well as a statement from their local council of elders to prove they are Kenyans.

Many never get ID cards at all, despite presenting these documents. And without an ID card, a passport is out of the question. Adam Hussein, of the citizenship and stateless project at the Open Society Institute in Nairobi, had to forgo excellent job opportunities over seas for this reason.

Kenyan Somalis face similar problems obtaining Kenyan ID cards. But Nubians point out that they are not a border community, and while government agrees there is no rationale for such vetting, the reality facing young people applying for the cards remains difficult.

Sheikh Ahmed Ramadhan is another young Nubi with a similar story. The imposing 30-year-old is coordinator of the Nubian Rights Forum, a human rights organisation working to promote the rights of the Nubian community in Kenya. Ramadhan contends the lack of recognition of Kenyan Nubians has persisted for too long and it is time they speak up and demand their rights.

“Our youth are put through rigorous vetting procedures when seeking identification documents despite the fact that they are Kenyans. And while we struggle to be acknowledged as citizens, the land that our fore-fathers were given in the early 1900s is slowly being snatched away from us. And with that aggression, our rich history and culture is being wiped out bit by bit,” he says.

When the six-foot Ramadhan says his community will stand up for their rights and demand what is theirs, you believe him.

“Kibera was one of the lands allocated to our fore-fathers to settle and here five to six generations of Nubians reside in tight-knit family setups, in accordance with our culture. When there is war in Kibera and people die, the others are transported elsewhere while Nubians are buried in Kibera. We have our cemetery here. Our history in this country is deeply rooted here. This is our ancestral land,” Ramadhan says, his voice shaking.

What is stirring up passions is a slum upgrading project in Kibera. For some residents, the project is a source of hope on par with the great exodus of the Israelites to the land of Canaan. For the Nubian community, the project has awakened feelings of statelessness and discrimination.

A collaboration between the Kenyan government and UN-HABITAT, the slum upgrading project in Kibera – Kenya’s largest slum and Africa’s second largest informal settlement – is aimed at resettling the estimated one million people living in mud-walled shacks in modern high-rise apartments.

The plan involves moving residents into other accommodation, and razing the vacated shacks to build new apartments in their place. Once completed, those who were forced to move during the clearance will be allocated space in the new two-bedroomed apartments, for which they’ll pay rent to the government. Each apartment is expected to house two families.

For the Nubian community, this project seems to have brought back memories of similar ventures which went awry in the past. Instead of being among the beneficiaries, they were pushed to the sidelines while others took advantage.

“This is not the first slum-upgrading project in this country. Others have been tried in the past through the National Housing Corporation and the reality then was that the families that were supposed to benefit never got a chance to move into the modern houses,” says a sceptical Yusuf Diab, secretary general of the Nubian Council of Elders.

“The only successful project was that of Karanja Estate in 1962, where, upon completion, 80 percent of those who got the houses were of the Nubian community. However, subsequent projects have ended up in the hands of foreigners and not residents of Kibera.”

The Nubian community has resisted moving into the new apartments and instead vowed to stay put in the informal structures until government gives them adequate compensation; the community is the most well-established in Kibera, with many families renting accommodation to other residents.

The Nubian community says they have never been consulted about the upgrade. Diab argues that the government and donors came into their community with a “know-it-all” approach and assumed all residents of Kibera live on less than a dollar a day and will eternally depend on handouts.

“We may live in this informal structures but that does not mean we do not have finances. We as a community stick to our culture of generations living together in one house. But this does not mean we are poor. If you come into our homes we have all the facilities that affluent people have and despite being informal we have enough room to accommodate our large families,” he says.

He wonders how a household of up to five generations is expected to reside in one room sharing the toilet, bathroom and kitchen area with another family.

“This plan would turn us into government tenants for the rest of our lives. Here in Kibera we are landlords and apart from our houses we own rooms that we rent out. How do you then expect us to sit back and allow someone to take away our source of livelihood and turn us from home-owners into tenants?” he pauses.

According to Diab, the Nubian community would have preferred a plan that would ensure they end up as home-owners. Even better, he says, would be to allocate land to the community and leaving them to develop it themselves would be ideal.

“Instead of the government building apartments for us, all we asked for was about 400 acres of Kibera land be allocated to the Nubian community. Then we would develop it at our own cost,” he says.

Hussein argues the fact that Kenyan Nubians remain effectively stateless is the reason they cannot own land and thus remain huddled in informal settlements such as Kibera as squatters on government land.

“The issue here is, Nubians are considered foreigners and indeed, when proposals are forwarded about allocating several acres to the community, politicians have clearly stated that no one will be allowed to own land in Kibera, and especially not a foreigner,” Hussein says.

Located only five kilometres from Nairobi’s central business district, Kibera is prime property. Diab argues most of the proposals and counter-proposals surrounding questions of in Kibera have arisen out of greed, with many eyeing an opportunity to pounce and grab land in that area.

The entire project is expected to re-house all two million slum residents in the city over the course of nine years at a cost of 1.2 billion dollars. While it enjoys the backing of the United Nations and Prime Minister Raila Odinga – the member of parliament who represents Kibera – whether it will be carried out successfully remains in question.

The project has come under fire from urban planners who say that it risks repeating the mistakes of previous schemes – where some of the low-income beneficiaries sublet their allocated flats to wealthier families and move back to slums themselves, or families share the two-roomed apartments with one or even two other families in order to be able to afford the rent.

The first batch of 1,500 people to leave the slum were moved to 300 new apartments in September. They will pay approximately $10 a month in rent. Most residents of Kibera earn less than $2 per day and pundits argue they may not be able to pay rent as well as new charges for electricity and water.

The slow pace of the project has also been questioned: if it continues as it has begun, it and it is feared at the current pace it will take 1,178 years to complete.

The potential for further delay is high. The Nubian community is vowing not to back down, and Kibera landlords drawn from various other ethnic backgrounds have joined a legal challenge to the upgrade process through a suit filed at the Kenyan High Court.