| SAPLER Population Trust | |
| Splendidly Alive People Within Limited Environmental Resources | |
Appendix i: Our Time Bomb (by Jordaan Foreword)
On reading Paul Ehrlich's The Population Bomb (1968) in the 1960s, I became aware that rapid population growth was a time bomb with a fuse that was fast burning out, not only in the rest of the world but also in South Africa.
The first results of this time bomb are already evident in the rapidly increasing unemployment, poverty and crime, shortages of medical services and rocketing costs, and the squatter camps that are mushrooming around our cities.
The reactions to my numerous letters on this subject to the Press since, and the lack of reaction from political and business leaders made me realize that the few people who were informed on the realities of the problem and were prepared to air their views publicly and constructively were simply "voices in the wilderness".
Approximately, 15 million people - or nearly 40 percent of our population (including the TBVC states and self-governing territories) - are already living in total poverty; these figures are rapidly increasing. This was one of the alarming conclusions reached during the recent Carnegie inquiry into poverty in South Africa.
Unemployment continues to rise. The number of unemployment is estimated to exceed 2 million and it is predicted that this will increase to more than 9 million within a decade. The backlog in schools, medical services and housing is also growing.
Although the unequal distribution of wealth and the political dispensation thus far in South Africa are held up to be important contributory causes of this alarming problem, this publication concentrates on rapid population growth as the most significant underlying cause.
The South African economy simply cannot grow rapidly enough to provide for the rapidly increasing population. Nor have the important contributions of the population development and family planning programmes of the Department of National Health and Population Development during the 1960s and 1970s, but particularly since 1984, been able to stem the rapidly increasing tide of population growth.
At present the bulk of South Africa's limited funds and skilled manpower is used to treat the symptoms of the overpopulation problem instead of the causes.
It is clear that current population growth control measures will in no way decrease the abovementioned backlogs or successfully address the related problems.
It is analogous to the story of the man who turned on the bath tap on the top floor of his double-storey house when the telephone rang on the ground floor.
While deep in conversation with an old friend he suddenly noticed water starting to stream down the stairs. His first reaction - and that of his wife and children - was to try and dry up the water on the steps with cloths. No one thought of closing the tap in the bathroom.
Unlikely? Still, this is how the population explosion in South Africa is generally approached at present. The steps represent the various government departments affected by the consequences of the population explosion.
Just think of the departments of finance, education, justice and police, health, welfare and pensions, to name but a few, trying to serve the great numbers of people. Action taken by the Department of National Health and Population Development to combat the problem is far too little and too late to hold back the momentum.
This book is an honest attempt to make leaders of all cultural groups at all levels of society (government, church, education, business, agriculture and the media) aware of the extent and causes of South Africa's overpopulation problem so that they are roused to take the necessary action.
The politicisation of the problem is a complicating factor. Many Black people have regarded greater and increasing numbers as the key to power, while some White leaders have openly encouraged White parents to have bigger families. This in turn has strengthened suspicion among the Black community about the government's family planning actions.
The new spirit that has prevailed in South Africa since President F.W. de Klerk's opening address in Parliament on 2 February 1990, however, has created the opportunity for leaders of all cultural groups to approach the issue without party political motives and focus directly on the single most important cause of the poverty problem: a birth rate that is too high.
In Chapters 1 and 2 some background is provided on the causes, extent and consequences of the problem within South African society. In Chapter 3 actions taken in some other countries are discussed and evaluated with a view to the lessons South Africa can learn from them.
Chapter 4 briefly refers to the problem of AIDS and possible demographic implications. In Chapter 5, written by Dr Mandla Tshabalala, senior lecturer in Social Work at the University of CapeTown, relevant perceptions held by the Blacks are highlighted. Chapter 6, written by Ms Zanele Mfono, social worker specializing in population growth problems, emphasises the role of women in solving the problem.
Chapter 7 contains guidelines for possible solutions; in the light of the already huge dimensions of this problem, the solutions will have to be relatively drastic.
Chapter 8 broadly indicates how every South African can contribute to dealing with the population problem and ultimately to a higher quality of life for all. It should be mentioned that the principal author and his co-authors (in Chapters 5 and 6) do not necessarily share and support one another's points of view in this book.
The author and co-authors would like to hear from you - do use the tear sheet at the back of the book and send us your comments. It is hoped that this book will inspire each and every reader with a powerful incentive to make his or her contribution towards putting the necessary solutions into practice in time to ensure the survival of us all.
J.H.Jordaan
.September 1991
Appendix ii
SUBMISSION TO THE HEALTH COMMITTEE by SAPLER
To: Olive Shisana and Dr Johnny Broomberg
Health Dept, P/B X 828, Pretoria 0001.
Fax to: (012) 325-2915
27 February 1995
Findings
1. The SAPLER Population Trust has now completed its year-long survey for the SA Nature Foundation on "The Unmet Need for Family Planning in South Africa".
2. Our main conclusion is that population growth in Southern Africa can be halted if family planning motivation, support, services and follow-through reach all Southern Africans.
3. Fortunately there is no conflict between our aim of stabilising population growth and many other good and wished-for results.
e.g. a drop in infant mortality a drop in maternal mortality an improvement in the health of the mother an improvement in the health of the children more attention given by the mother to her child in the crucial developmental years an improvement in the family's economic position a freeing up of the mother for other activities
4. We must not make the Kenya mistake of thinking that just because mother-and-child services and family planning provision are in place the fertility rate will drop.
After Independence, Kenya did well economically and they became the first country in sub-Saharan Africa to articulate a population policy. "The goal of the policy was to provide family planning through an integrated maternal and child health programme, with responsibility under the Ministry of Health whose priority at the time was rural health programme-." (Dr Ayo Ajayi)
The result of this programme was that the fertility rate went up from 6,8 children per mother in 1962 to 7,9 in 1978.
The programme was acknowledged to have failed completely.
Improved access to contraceptives by women and couples in the rural areas, good training schemes and communication programmes brought the fertility rate down to 6,7 by 1989.
5. The areas in South Africa which we investigated were Paarl in the Cape, the former TPA and NPA, and the former homelands of Kangwane, Gazankulu and Lebowa.
Everywhere the family planning services are in place in hospitals and clinics. But only Paarl and the former TPA and isolated nompilo schemes bring people from the community to the services.
A Kangwane family planning nurse told us: "We do a hit-and-run operation. We go into a village, throw information at them and leave them confused."
6. Examples of missing links are:
a) Shirley Ngwenya of the Wits HSDU (Human Sciences Devp Unit) in Gazankulu, talks to everyone about contraceptive issues teachers, drought workers, traditional healers, ministers.
At a meeting with ministers of religion - Lutherans, Baptists, Anglicans etc. - all except the Catholics and the ZCC she found them in favour of family planning and they all had horrendous stories to tell about ignorance and superstition and misconceptions.
Yet there has been no increase in the number of women who actually use family planning at the Tintswalo Hospital. (HSDU operates from a mobile at the back of this hospital.)
b) Beryl Botha of the Population Development Programme (PDP) in South Natal talks to the chiefs in that area. At first this was difficult, but now she has won many of them over. They say that there are more teenagers than anyone else and the teenagers are stealing the pensions of the old people.
Yet when I asked Beryl how many women now use family planning as a result of her outreach she had no idea.
C) Sister Nancy of Elim Hospital in the Northern Transvaal likes to try and motivate the women who come to the hospital for ante-natal care. She has no videos but she draws pictures and answers questions on family planning.
"But then I lose them. They go into the baby ward to have their babies and then all they want to do is to get home."
"Couldn't someone liaise between your department and the baby ward?"
"Oh, I am much too short-staffed for that sort of thing."
d) The TPA, which managed to keep its family planning advisers in spite of the ruling that they should be put into general primary health work, now has a problem in that they are able to motivate people to have sterilisations and then the govt. steri depts. are not able to deliver an efficient service.
7. In contrast to the above Dr Pohl de Villiers of the Paarl Hospital does all 4 stages which are necessary:
One result of this has been that been that whereas in 1970 20% of mothers still had 10 or more children, no such mothers existed after 1989. The social services in Paarl now run very much more effectively. There are no longer double sessions in the schools.
8. The Population Development Programme (PDP) has existed for the last 11 years. The people who work in this dept fully understand the urgency of the population issue.
Yet they not only have not ensured that all aspects of family planning are in place - they have had such a feud with the family planning department that the two do not even talk to each other.
The feud is about whether to say, "The two-child family is best", or to say, "We only want you to space your children for the sake of your health".
In five years' time this feud will seem as incomprehensible as the one the medieval monks had about how many angels can dance on the point of a needle.
9. The concept of "unmet need" is now internationally accepted. It goes beyond the simple existence of family planning services and includes the issues we have been writing about.
Fifty per cent of women in the developing world who would use family planning if it were well explained and delivered are not getting it.
At the Ecolink centre in the Eastern Transvaal all aspects of living in a sustainable way are emphasised. Two excellent booklets have been brought out which are based on conversations the women have in their sewing group on family planning and population growth. The women express their doubts and anxieties and these are addressed by Theresa, a care worker.
I spoke to the family planning dept in Nelspruit about these women. Would it not be a perfect occasion to reach these women with actual family planning services?
"Oh we would never do that!" exclaimed the spokesperson. "We wait for them to come to us. We would never force our services on them."
10. Teenagers face special problems in that there has been a breakdown between parents holding traditional tribal or Christian values and teenagers in touch with the Western permissive culture. Many of them have also been dislocated by different methods of parenting or by no parenting at all.
Medunsa (The Medical University of SA) in Pretoria has a youth clinic on Saturday mornings. This is very popular and the teenagers attend regularly. 50 to 60 teenagers, aged 16 to 19, attend this clinic every Saturday. They are only given Nuristerate injections. This is because it is the most acceptable contraceptive to the teenagers themselves. (No long wait to fall pregnant when you stop.)
No attempt is made to examine them for STDs, but while they are waiting they attend lectures on the subject.
Because of family planning budget difficulties - there has been no increase for inflation, and also the whole health budget was cut by 1% last year - several youth clinics have had to close down.
The Saturday morning youth clinic in Pietersburg has had to close because of security problems.
Answers
1. President Nelson Mandela, along with other heads of governments of the Non-aligned Nations, endorsed a Statement on Population Stabilisation prepared by the Global Committee of Parliamentarians on Population and Development.
Mandela probably does not know that neither the Population Development Programme nor the President's Council on Population do anything to bring about that stabilisation.
2. Vague statements about development are now totally discredited as a means of stabilising populations. The developing countries which have achieved zero population growth have done this through making quite sure that absolutely everyone was reached with excellent family planning, support and motivation.
Dr Karan Singh coined the phrase "Development is the best contraceptive" at the Bucharest Population Conference in 1974. He 11 coined the phrase" - it was never a testable hypothesis. He now urges governments, NG0s and pharmaceutical companies to meet the challenges of the unmet need for family planning.
3. We must be very clear about goals and objectives. Caroline Argent, our Winterveldt nompilo organizer, explained the difference to us:
The goal is what you want to achieve.
Objectives are the means you use to attain that goal.
Two years ago Dr Motlana and I judged a heart-warming debate on population growth. For 6 months Trudi, of the Johannesburg PDP, had been organizing this debate among schools in Gauteng. The standard of the debate was exceptional. It was won by Bongani Bingwa, who showed an outstanding grasp of the issues.
The objective of a good airing of the population problem was attained.
This objective in no way contributed to bringing down the birth rate by one single birth. The other young people who attended the debate were the friends of the debaters. They were an elite.
4. Everyone who owns a television or who reads a newspaper knows that there is a population problem. We can now take the entire staff and budget of the PDP and use it for solving the problem of the unmet need for family planning.
5. SAPLER is prepared to fundraise overseas for this purpose - but then the money would have to be used in a direct way to solve the problem.
6. This does not mean that while solving this problem we will not be addressing any other issues which go easily with it. In Winterveldt our nompilos are informed about STDs in addition to family planning. They also know about oral rehydration, since infant diarrhoea is a major cause of infant mortality - and it is particularly easy to cure.
7. Once we begin to address this problem in a direct way, many other possibilities can be considered.
Because doctors cannot be persuaded to do sterilisations, we could train medical auxiliaries to specialize in sexual reproductive health. This would be mainly a practical training since doing steris well is only possible if you are actually doing them often. These people could then also do abortions and STD examinations.
Nompilos can be taught to do injections. There is absolutely no reason why this cannot be legalised. "No one has ever died from Depo."
Handing out pills by trained lay people should be legalised as soon as possible. It is at any rate already done by problem-solvers all over South Africa.
A lay person trained in simple family planning techniques is better than a busy sister who has 20 other ailments to deal with.
8. An example of an unmet need - and of providing the missing link: In the course of our survey we went to a farm in Walkerville. Walkerville is halfway between Jhb and Vereeniging. The nearest clinic for this farm is 10km away and over a hill. The clinic staff only come on a Monday morning.
We spoke to 28 women of child-bearing age. They all knew about family planning. Some had tried "the injection" but had not liked the symptoms so had stopped.
We found five women who wanted sterilisations. A month later these women were still sure that they wanted to be sterilized. We took them to Sebokeng Hospital for their sterilisations and brought them home again.
Anyone could do this. It is an ideal job for young people who have not been able to get Matric. Of course this needs supervision and organization - but this is a perfectly ordinary human activity. Anything humans can do, South Africans can do better.
9. The overall goal: Stabilising population growth.
The attendant immediate benefits: (i) Helping individual mothers.
(ii) Helping families (iii) Helping communities.
10. The steps:
(i) Reach people who have never used contraception or who have had insufficient help in overcoming difficulties with it.
(ii) Make sure those problems with transport and supplies are solved.
(iii) Talk to the resistant men wherever they are.
(iv) Have youth clinics wherever they are needed.
11. The whole programme to be of a high standard - ethically and practically - but cost-effective and manageable.
12. We must reach everyone - and soon.
With thanks,
ANN WEINBERG
Chairperson, SAPLER
SUBMISSION TO THE HEALTH COMMITTEE by DR ELIZABETH STANDING DR ELIZABETH STANDING
Consulting specialist in Community Health, Westville, Natal.
Public Health Services
I would like to see the complete exclusion of the phrase "Primary Health Care" from all future Ministry of Health policy documents which, in the field of "health care", should focus on the following:
All these should be at a level that is both appropriate and affordable.
What people want
Most deprived communities in this country place health services low on their totem pole of expressed needs. Their top priorities almost always, are food, shelter, education and employment. Then come safe water and electricity, transport and roads, child-care facilities, safety and security, with health coming in at somewhere between 7 and 12.
Health gain invariably results from improvement in the fields of a community's higher priorities as they lead to a better quality of life.