| SAPLER Population Trust | |
| Splendidly Alive People Within Limited Environmental Resources | |
How to solve the Population problem
The SAPLER Oceanic Rescue Plan President Mandela has now endorsed a Statement on Population Stabilisation Prepared by the Global Committee of Parliamentarians on Population and Development.
Unfortunately such statements are always followed by the vaguest of generalities about education, housing and women's rights. This means that there will be at least 5 million more South Africans in five year's time, whereas a well-directed plan can dramatically change this scenario right now and make the solving of overall poverty and degradation more of a reality.
I have called our plan "Oceanic" for three reasons:
1. We are approaching the first anniversary of the New South Africa. That was a time when nearly all South Africans, rich, middling and poor, felt the oceanic feeling. Archbishop Tutu, a founder-supporter of SAPLER, said it was 'like failing in love'. Exactly!
The essence of this feeling is transcendence - it goes beyond the immediate, the materialistic and the personal.
SAPLER's overall goal is not "population stability" - it is human betterment, a sense of pride in living in a good society, community joy and fulfillment; a South Africa, which works - and a world which works.
A necessary condition of all this is population stability, but while achieving this goal we can work many wonders.
2. William McFee said, "The world belongs to the enthusiast who keeps cool."
The rescuers of the Oceanic kept their cool. They focused on what had to be done and did ft.
One woman, when pestered by some journalist afterwards, said, "Oh, get real!"
Ideals have to be translated into workable objectives. We all do have to "get real", or we not only lose the planet, but we also lose our self-esteem.
The slogans of the politicians and the platitudes of the academics have to be replaced by workable plans being carried out in the real world.
3. The ocean is made of many drops. If the efforts of some South Africans in some parts of the country can each be multiplied by a thousand we will not have a population problem.
This is the most import concept to emerge in international a population thinking. It is summed up by Bhiwandi, Campbell and Potts in People and the Planet (Vol. 3, No 3 1994):
"Wherever realistic contraceptive choices, including voluntary sterilisation, have been offered, fertility has plummeted, regardless of development "
The SANF/SAPLER survey is now complete. What we have found confirms this international observation: between the people and the services there is a great missing link. Millions of South African women need little or no persuasion to use family planning. What they need next is help in starting, help in following through even when there are difficulties, help with transport where necessary - and of course excellent and friendly services.
Swaziland is now aware of their population problem. Our newsclip service sent us many cuttings last year in which desperate leaders shouted for suggestions.
One woman suggested that no one have a child before age 30. If that became South Africa's policy we would have no population problem. We would not even have to mention the dreaded 'Two-child" idea. Since most women in South Africa are under 30 there would be an immediate vast drop in population growth size.
Swaziland is aware. Awareness is the beginning. It should not be the end. Kenya was aware way back in 1962. Soon mother and child programmes and family planning were available all over the rural areas. But the fertility rate went up from 6,8 in 1962 to 7,9 in 1978. Most children lived. It was a period of economic growth.
Many areas in Kenya are now drowning.
During the same period Mauritius gave its people the message and the means for population stabilisation. There was no coercion. They have had Zero Population Growth for over ten years.
Mauritius is now thriving.
The reduction in fertility in Mauritius started before there was any economic growth – in fact during a stagnant economy and a declining per capita income. During the 1960s about half of their population decline was due to a reduction in marital fertility; the other half resulted from increasing age at marriage.
What Dr Karan Singh said then and says now
In 1974 Dr Singh coined the phrase, "Development is the best contraceptive". He now regrets this and urges governments, NG0s and pharmaceutical companies to meet the challenges of the unmet need for family planning.
We will help individuals with their ill help families with s; we will help communities to be sustainable - and we will help nations to survive.
Everything we do is in the spirit of the New South Africa and within human rights.
Our goat is to see that all South Africans are reached with family planning motivation, support and services in the shortest possible time. We will never overlap with others who are effectively doing the same thing, since our aim is universality.
We are non-coercive and non-prescriptive. We believe in maximum grassroots participation and discussion. We believe in self-help.
We believe in "freedom from ignorance".
Caroline Argent, who did our Natal survey, went to inaccessible places she could not get to by car. She came to villages and talked to chiefs. She found villages where the average number of children was thought to be eight.
She asked the women how many children they wanted. They said four.
This was without any motivation and education. Women who have entered the cash economy, women living in drought-stricken areas, women who can't feed their children properly, WANT to stop having more children. The 'two-child family" may sound alarming to them.
But d they want to stop at four well let's help them do it.
If we have all these millions for our army and for our Olympic bid, then we also have millions to ensure that South Africa and her neighbours are not growing.
It is the poorest section of Southern Africa who are growing fastest. The simplistic answer is to say, "Make them rich" and "Educate them".
Jamaica tried that - but the caster they built the schools the larger the slums grew. Then they woke up and limited their population.
Every year we put off tackling this problem is a year lost to the RDP. So let's put some of the RDP millions into giving people what they already want and at the same time ensuring that the eventual number we want to help in all ways possible is not growing ever larger.
The National Family Planning Programme (NFFP)
Unknown to most of us SOUTH AFRICA HAS HAD A NATIONAL FAMILY PLANNING PROGRAMME.
Started in 1975, it was well organized and effective. During its first ten years there was a dramatic drop in the fertility rate of the old RSA.
Then in 1984, SA started its "POPULATION DEVELOPMENT PROGRAMME" (PDP), which was given strict instructions to have nothing whatsoever to do with family planning.
Soon the PDP rose to be a "Chief Directorate" and the NFFP sank to become a "sub-directorate".
Then the NFFP was handed over to the provinces. This programme, so vital to the nation's welfare, was no longer "national'. Morale deteriorated.
Now family planning has been dumped into "Primary Health Care". This has been done for no good reason. There is no "get real" motive behind it. Family planning will suffer because "Primary Health Care" is orientated towards curative medicine.
Advisers trained in family planning now fill in forms and help with bandaging.
At Jane Furze Hospital we found that an excellent and enthusiastic family planning nurse was working in Outpatients. She not only loved family planning work - she also preferred working in outlying clinics, unlike most other nurses.
Why had this happened? "Because nurses must be rotated."
During the period from 1984 to 1994 the fertility rate dropped more slowly than between 1974 and 1984.
What of the ten ex-homelands? The NFFP did not operate there, but was prepared to train homelands nurses.
The 1991 census showed close on 20 million people living in the ten ex-homelands - and 20 million others living in the old RSA. Since then the old RSA has gained numbers through urbanisation and the old homelands have gained numbers through births. So let's say now R is 21:21. (The post-election estimate for SA is 42 million.)
South Africa’s suffering from a vast self-deception that we can get " equal services" to everyone. Equal health, equal education, equal housing.
When we put together the budgets of the old homelands and the budgets of the old RSA we find that the per capita amount spent in the old homelands was far lower than that spent in the RSA. RSA black people did far better than homeland black people.
Because of poor statistics there is no way of even estimating how many homeland people are protected by family planning methods - but it can't be much more than about 10%.
There is very little outreach. A Kangwane nurse said to us: "We do a hit-and-run operation. We go into a village, throw information at them and leave them confused."
Even in the old RSA only just over 50% of fertile women were said to be using contraception.
We went to a farm in Walkerville, halfway between Johannesburg and Vereeniging. This farm is 1Okm from a clinic, and the clinic only comes on Monday mornings. To get to it you have to walk over a hill. We spoke to 28 women of childbearing age. They had all heard of family planning. Some had tried "the injection" but had not liked the symptoms.
Five of these women wanted sterilisations. One month later these five were still absolutely certain that they wanted to be sterilized. We took them to Sebokeng Hospital on the right day for sterilisation and then brought them home again.
Not difficult. Multiply that by 1 000 and you get 5 000 women protected from unwanted pregnancies for the rest of their lives.
Winterveldt is a huge "resettlement area" - which is a polite way of saying "dumping-place" - north of Pretoria. Some say half a million people live there, others say two million, depending on whom they want to impress.
We found that the Anglican Tumelong Mission already had a nutrition scheme there. This involves feeding people, growing vegetables, and learning about good nutrition and breast-feeding.
So we have latched on to their experience to start our pilot SAPLER-nompilo scheme.
SAPLER-nompilos are mini-experts in STDs and family planning.
Last October Caroline went there and started talking to the people. They were very keen on the idea. Every Sunday morning until mid-December meetings were held before church to discuss our proposals and to suggest their own. Then nine nompilos - six women and three men - were elected in different regions. Every Monday they get together to discuss their experiences.
In January they did a two-week course in STDs and family planning at the Boskop training centre at Marble Hall.
Now they bring never-before women to the clinics, and they give talks at the schools - and it is all going wonderfully well.
But the clinics are over-worked, and our nompilos are longing to be taught to do injections themselves.
The IDT (Independent Development Trust) is funding Winterveldt. ITHUBA has given us money for Londolozi.
Sister Siphiwe has long been a member of SAPLER. She works from the award-winning sustainable village at Londolozi game park. From there she drives to the very poor villages alongside the game reserve.
She writes: "I am quite impressed about what Caroline is doing and I therefore think ft will be of utmost importance for her to be with me. There's a great need for nompilos this side - the service that I am presently giving to the community is like a teaspoon of salt in a sea - there's a need for more workers in schools and for us to reach out to refugees' villages..."
So as soon as Caroline is satisfied that the Winterveldt project is running itself she will go to Londolozi.
At Medunsa (The Medical University of South Africa) a teenage clinic is held every Saturday. This is very popular and the teenagers who use it are said to be consistent and regular clients. They age from 16 to 19, and 50 to 60 come every Saturday.
These teenagers are all given the Nuristerate injection. This is by their own request, as Depo Provera sometimes delays pregnancy after you stop using it.
They are not examined for STDs, but while they wait they attend talks on the subject. If worried they can then go for tests.
Zanele Mfono says she approves of the simplicity of this outreach because it enables more teenagers to be seen. She is the youth director at the PDP and has been talking to the youth for many years.
She is extremely worried about the lack of provision in many areas. She believes more could be done to reach the youth who attend youth clubs, many of whom are not at school. She feels these clubs need scientifically trained young people who can put across the facts.
While we have been working on our survey, Transvaal youth clinics have had to close down through lack of funds. The Pietersburg youth clinic no longer works on Saturday mornings - for security reasons.
Kenya and Zimbabwe now have male outreaches. They say that men are responding to economic and environmental issues. During our survey we spoke to many men on drought forums etc. and found them more than willing to listen, whether they have Standard 6 education or no education at all.
Lindsay Milne, a SAPLER member and a worker for the Anglican Crisis Committee in the drought and fire ravaged Tzaneen area, spoke to a priest recently who had never heard of the population problem, but once they started talking about it he was fascinated. Not only can less be grown in that area than before, but trained mechanics are being laid off because of burnt plantations.
Mankuba Ramalepe of Ithuseng, just south of Tzaneen, says the men are starting to come to her community centre and ask questions. She says an outreach to the men now would take off.
Shirley Ngwenya talks to the men in Gazankulu. At a meeting with ministers from all religions Lutherans, Baptists, Anglicans etc. 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.
My bleakest thoughts always arise when I think of migrant workers. I walk round the block to the bottle store and the manager tells me how the men hang about and boast to each other about how many children they have fathered around the country.
Then I think of AIDS and Mitchell Warren.
Mitchell Warren is an American who heads an organization now called Society for Family Health, which is the local branch of Population Services International.
Mitchell Warren is reaching the very men whom nobody else is reaching - at spazas and mines and petrol stations and shebeens and takeaways.
During 1994, SFH distributed its two millionth LOVERS PLUS condom.
SFH uses social marketing - a proven and cost effective public health intervention - to promote safer sexual behaviour and to distribute a condom designed to appeal most to those who are poor and to individuals who practise high risk behaviours.
The condoms come in packs of three, with an attractive scene with shadowy no-race lovers on the cover. The pack is sold at a subsidised price of Rl. This price is low enough to be affordable but allows for the individual to make a personal investment which is more likely to lead to actual use.
Mitchell believes this is working. The majority of outlets are selling LOVERS PLUS on an on-going basis, implying that people within the given communities are, in fact, using condoms.
This does not mean that the men use condoms for their home wives. In fact we have been told that they don't, since they still want large families. But at least when presented with a condom by their 10-child wives, who are encouraged by Frans Themba to do this in Sekhukhuneland, it will no longer seem such an unthinkable idea.
That family planning solves many problems other than pop-lim should be seen as a delight, not a battleground. Being concerned about population growth is an honourable and ethical thing to be. Wanting to help individual women with their health or families with their finances is likewise honourable and ethical.
Only people who are literally starving are not concerned about the future. In everyone else we can trigger the oceanic feeling: everyone wants South Africa to work; everyone wants the future to work. What we need is a joint pop-lim/ fp dept under a Minister of Sustainability.
A lot of confusion surrounds the term, "Primary Health Care". Like "Development" it gives people good feelings. But to some it means "preventive medicine" and to others it means, "The first person you see when you are sick".
Dr Liz Standing, founder and director of the Bekimpilo Trust would abolish the term altogether. Bekimpilo works in the informal settlements around Durban.
They only do preventive work. In this way they prevent 90% of the complaints which used to go to the clinics from ever happening. This both prevents suffering and is highly cost-effective.
Immediately you put preventive work together with curative work, the prevention deteriorates. We are all geared to tackle emergencies. A family planning liaison officer went to check up on how family planning was getting on at the Jo'burg Gen. She found a room full of clients - and no family planning nurses at all! They had all been called away to help with emergencies in other parts of the hospital.
Bekimpilo pays its nurses less than they would get in Durban. Yet it has never had to advertise for nurses and has files full of nurses who want to work for it. "This is because the organisation is calm and well-structured. Everyone knows what they are doing.
Bekimpilo started in 1990. Family planning attendances went from 5 676 in the first year, to 10 551 in the second year and to 16 034 in the 1993/4 year.
A war , or a business, or an Oceanic Rescue Plan has to be extremely well run - or you lose. SAPLER's next task is to find and fundraise an executive director someone who sees no obstacles, who is prepared to work below their market value (since this is priceless), who is extremely organized and of high integrity.
The overall goal of this director is to see that there is enough money, organisation and personnel to reach everyone with excellent, cost-effective family planning motivation and services.
This person to build up a small tight team of people who become experts in the various areas:
1. The youth: Build up a service corps of peak responsible young people who will not only teach each other but will be themselves trained in fp methods and STD diagnosis.
We have found that the youth love it when debates around the issue of when to start sex and when to start babies take on a larger meaning. We can rejoice that most people in this country are young.
2. Supplies and training: Everywhere we found gaps, e.g. you can't get a state sterilisation in Jhb or Alex. Supplies sent to deep rural areas - or even to informal settlements around cities - are too few or the wrong kind. This whole operation needs proper monitoring.
3. Education and motivation: The best people in the PDP to be used in the most necessary places.
Someone to be delegated to every hospital which offers both ante-natal care and family planning. Sister Nancy of Elim Hospital said to me, "I talk to the pregnant women. 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."
In Paarl no expectant mother has her baby without having made a proper plan for the future.
One of our Winterveldt nompilos said to Caroline: "I never ever realized that family planning was about PLANNING! I thought it just meant preventing babies."
Talking to groups of men and to communities in those areas where there is still resistance.
For everyone else we can simply show the excellent existing PDP and "Race to Save the Planet" videos all over again to those who have not yet seen them.
4. Money for SAPLER-nompilo organizers. There is no point in doing this gradually. We know that the scheme works. It empowers people in many ways at once. There is no woman so empowered as one who has control over her own fertility.
The team as a whole will push for a relaxation of laws which have no validity, such as not allowing lay people to give injections.
At the moment we have two govt. depts. which should be under one minister. Instead they are not even talking to each other!
The family planning dept, now dumped in "Primary Health Care", believes the only message which should be given to people is, "We will help you space your children." The Population Development Programme has nothing whatsoever to do with direct family planning provision and motivation. Their aim is to balance population and resources. Their message is "the two-child family".
Most of their education programme is superfluous. Urban people With television sets NOW KNOW ABOUT THE POPULATION PROBLEM. They are moreover motivated to have small families and services are available to them. The good thing about the people who work in the PDP is that they do understand the nature and urgency of the population problem.
The PDP has now been dumped in "Weldare" and staff sent to all nine provinces. But some provinces are much more in need of population understanding and family planning provision and services than others.
The feud between these two depts. will in time seem as foolish as the medieval monks who argued bitterly about how many angels dance on the tip of a needle.
This newsletter was written by
Ann Weinberg and published by SAPLER.
Special thanks to Caroline Argent and Julian Weinberg, and to the Goldfields Foundation and SANF.