Thursday, October 04, 2012

A Drop in Fertility? Some observations

from TPMBarnett's website:

this is not a map of actual fertility, but of the drop in fertility rates since 1970.

Zimbabwe's drop is huge: under the white gov't they had an active family planning program, but it was run by an outside funding that used "pill ladies" in every village: usually they were the wives of local school teachers who could talk "woman to woman". Because if the gov't had run it, it would have allowed the Marxist insurgents to claim that family planning was a form of genocide.

I worked at a Catholic hospital, so we were not allowed to give out birth control.
But we did have an active nutrition program that stressed food/eggs/veggies and that moms should breast feed for two years.

Breast feeding is nature's way of spacing children, and in past days, wives who got pregnant too quickly would often lose their newly weaned child from kwashiorkor, since there was not enough protein in the child's diet.

In the past, continence, R rated methods and polygamy would help the woman space their children, but as all the men started working in the mines and cities, they expected sex when they came home on their leave, especially the men who came home to plow the fields and stayed for a few weeks. (Men plowed with oxen, a dangerous animal, for the main crop; women had smaller fields and used hoes to cultivate their own garden, which they controlled).

So we gave out Depo Provera in baby clinic: Depo Provera has a lot of problems in ordinary women (i.e. non nursing women) such as constant bleeding or no period at all. But when given after a delivery, it would prolong the infertility/non ovulation phase that is normal after a pregnancy (i.e. no periods). It also made one put on weight, and did not decrease the amount of breast milk for the baby: indeed, it probably increased it a bit.

So we only to nursing mothers, to increase their breast milk, and prolong post partum amenorrhea (no periods after you give birth). In other words, we gave it out to keep the children fed, and if it stopped pregnancy as a side effect, well, the bishop and nuns looked the other way.

If you didn't have a baby on the bosom, well, there were pill ladies in every village if all you wanted was to stop from getting pregnant.

But anyway,the birth control was not pushed by the government clinics, because no one trusted the government.

The pill ladies were women, usually schoolteacher's wives or shopkeepers who were respected by the ladies. Since most Educated Zimbabweans were also known to be against the Smith government, they were trusted to give you facts to help you, not the hated white run government.

They would talk to you and instruct you how to take the pill. No pap smear or exam: if you had a history of problems, they would send you to us for a checkup, or to the local gov't hospital for a tubal ligation or IUD, and answer your questions about side effects etc.

We didn't have HIV back, and no one had pap smears, so no problem.

African woman, even village women, are fairly independent in these things, so it was ideal. And the husbands? Well, traditional husbands living at home could be reminded of the alternative: No hanky panky until the child was weaned. And those visiting three times a year from their work in cities? Well what they don't know won't hurt them...

There was not a big taboo against birth control in Africa, but there was a desire to have children. Pointing out that spacing children meant healthier, better educated children than losing kids because they came too quickly was the way to encourage smaller families.

There is a course on Population at Yale that discusses how thie "pill lady" approach worked in what the experts thought was the hardest population to reach: pious illiterate Muslim ladies in the villages of Bangladesh. These ladies were subservient to their husband and family, and could not even see the doctor without the husband's permission.

But what mother in law would say "no" to a visit from an esteemed lady teacher or businesswoman?

The pill lady would talk to the woman (with her bossy mother in law sitting in on the session). But the mother in law's presence actually turned out to be a help because (woman to woman, and when the men aren't around), even the most pious women will admits having 12 kids is just too much... so often the result will be that the mother in law would become a partner with the woman and support her choice to limit children even  if her husband objected.

Similarly, when the Mullahs took over Iran, they faced a population boom, and decided to slow it down until the wealth was spread around a bit better. So they encouraged the idea to space children to protect the mother's health and have fewer babies so they could be cared for and educated, as the way a responsible Muslim should act. They even cited the holy writings that insisted a man should care for the health of his wife and family as saying family planning is not just allowed but encouraged in Islam.

Do the mosques with Sunni preachers from Saudi agree with this? I don't know (haven't worked with many Muslims recently).

Maybe those Muslim countries who are having problems convincing the local governments to allow family planning need to import family planning experts from countries that have had successful programs.

However, I do agree with Barnett that in Subsahara Africa and Islamic countries, the appoach to fertility will change as urbanization occurs and globalization changes culture.

I have to laugh at StrategyPage pointing out how the simple cellphone is changing culture in Afghanistan:
the Taliban is hostile to education and cell phones (especially the ones that can access the Internet, and most can). Any Afghan who becomes literate and gets a cell phone soon discovers there is a huge world out there and it is different
or as Spengler of the Asian Times quipped: As soon as Muslim women become literate, they learn to read the instrutions on the birth control pills.

Indeed, if you look at the map, the countries in sub Saharan Africa without drops in fertility tend to be those who have few people per square mile (Namibia), little development (Mali), or chronic problems with civil wars and.or the post civil war lack of civil society (Nigeria, Mozambique, DRC).

But again, the family planning folks will have to work with the culture.

Ann Coulter once quipped the way to get rid of Islamic terrorism was kill the terrorists and convert them all to Christiantiy. Uh, she went a bit far, but her point, that changing culture is needed, is actually the idea behind Bush's war in Iraq and Obama's support of the Arab Spring: to encourage a moderate secular Muslim government, where the "secular" governments tended to be plutocracies or worse.

Now, globalization will change people at the village level in many ways, not just cellphones, TV and the internet. (even Sister Eurphrasia now has a cellphone and Email in her small town in Zimbabwe).

But a lot of the real problem of globalization is culture change, and culture shock: and this often happens when folks leave the clan and villages to go to the city, where they are lost.

Europe went through this a century ago, and see all the wars/revolutions and terrorism it spawned. Yet some Americans, with their limited attention span, think the Middle East/Africa/Asia can do it is a generation, not a century, and not have problems.

This is where religion can help: the problem is which religion? The religion of communism? The religion of Fascism? the religion of Islamic fundamentalism?

Yes, but the dirty little secret is that most Americans don't see that there are other answers.

Why not a religion that fits the culture, strengthens what is lacking, and helps people to live productive lives?
The Sufi version of Islam, with it's emphasis on personal holiness, not rules and dogma, is one answer. The bad news is that no one is spending millions of petrodollars building mosques and madrasses that promote a modern Islam. 

Here is where Christian countries have an advantage.

I used to get mad at all the American protestants "converting" poorly educated Pinoys to become Protestant, until I realized the alternatives was communism...or maybe drugs.

In the "Catholic" Philippines and South America, many city folks tend to be attracted to "born again" churches, which become the replacement for the extended family of the villages, which support people in need with material but also emotional support. Before, if you needed a job or a handout in an emergency, you went to a relative, now you go to a fellow church member...and the preacher also promotes the values of honesty thrift, and hard work along with their theology.
the Philippines,  learning from your protestant neighbor that you don't have to have a lot of babies, and indeed God expects you to only have the children you afford, may be a new idea, but it is one that individual women will welcome. The result will be a lower population in the Philippines no matter how many "RH bills" pass or don't pass the Senate.
Indeed, fertility has dropped from the average of 6 to less than three kids per woman in the Philippines. And one doubts the days of 6 kids per family will come back, even among pious Filipinas,  no matter how often Father preaches about the wonderfulness of children and the evilness of the pill on Sunday.

One small problem that could cause a setback: I fear that Hillary and her PC friends from America will muck up the RH bill passage by linking it with abortion on demand, which is abhored by all and sundry. Nor does the idea of teaching promiscuity in high schools under the guise of HIV prevention, and promoting gay rights, when gays here are accepted if they are quiet about what they do. In other words, if you promote family planning, not as a population measure or as part of a larger American agenda of destroying the countries morals, there would be a better chance of passing the RH bill...

But what about Muslims in  the Middle East ad Sub Sahara Africa?

 Again, I don't know the culture of these various lands, but I suggest instead of importing American or British style "population control", that instead they Iran to send good Muslim Family planning workers to instruct them in the Muslim tradition of limiting fertility for health reasons.

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