TO
KAYORO
Bringing Reproductive Health to a Village in Ghana
MARGARET CATLEY-CARLSON
POPULATION COUNCIL
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FROM TO KAYORO Bringing Reproductive Health to a Village in Ghana
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| Moving Kayoro through
the fertility transition. Slowly, but surely, the people of Kayoro are beginning the fertility transition to low birth rates that has already occurred in most areas around the world. Once rare, contraceptive use is now practiced by one in five women; total fertility was 5.5 before the Navrongo experiment began and declined to below five births per woman in the year following my visit. In the spirit of Cairo, the Navrongo Health Research Centre is offering family planning within a broader range of reproductive health services.
How quickly the fertility transition progresses depends on three key factors. The first is a reduction in unmet need for contraception. Failure to use family planning results not only from lack of access to high-quality contraceptive supplies and services, but from lack of knowledge, fear of side effects, and disapproval by family and society in general. These reasons explain why more than 100 million women in less developed countries are not using contraceptives in spite of the fact that they would prefer to space the next birth or have no more children. In the developing world as a whole, one in five women have an unmet need for contraception, and in some countries the number is much higher, for example in Pakistan, where close to one-third of women have an unmet need for contraception. In Kayoro, the power relationship between women and their husbands is so disparate that women do not even raise the subject because they fear spousal disapproval. Desired family size is another determinant of the pace of the fertility transition. In most traditional societies of Africa, women typically want at least five or six children, but as development proceeds desired family size is expected to decline. Using Asia as an example again, there have been remarkable changes in desired family size in the region. In 11 Indian states very low levels of ideal family size are reported—from 2.1 to 2.6 children per family. Similarly, there has been close to a 40 percent drop in desired family size in Bangladesh over the last two decades. In Kayoro village, a substantial number of men and women believe that the number of children they have is God’s gift, and almost none want a smaller number. But the chiefs are beginning to change their minds and the elders are reserving their opinions. This acceptance of the desirability of small families will be fostered by improvements in the health and education systems and by the introduction of some measure of social security. It means making steady gains on issues regarding the status of women; in Kayoro village, this is not going to happen tomorrow but it will happen some day. Even if fertility were to decline quickly in Kayoro, population growth would continue for several more decades because of population momentum. The third factor determining the pace of the fertility transition, momentum is caused by the large numbers of young people entering their reproductive years. In the developing world as a whole there are almost one billion 10-to-20-year-olds, the largest such cohort of adolescents in history. If every woman in the developing world had access to and used contraception and each family had only 2.1 children (the number required to replace them), the developing world’s population would still increase to 7 billion by the year 2100 from the current level of almost 4.8 billion. This example shows how powerful a demographic force population momentum represents.
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