Why Birth Control Interventions In Africa Have Failed.

Why Birth Control Interventions In Africa Have Failed.

Why Birth Control Interventions In Africa Have Failed.

2560 1707 Oliver Kagwe

I am inclined think that the various attempts to normalise birth control in Africa have failed. I say this because over the last 30 years, huge investments have been made in Latin America, Africa and Asia to help them get a hold of their growing populations. While Latin America and Asia are seeing significant improvements, Africa is still lagging behind. The question that I then ask myself is, why? Why is the use of birth control underwhelming in this beautiful continent of ours?

Of course this question is broad, and may not be satisfactorily answered in a single blog post. However, it is worth exploring. Women in Africa continue to bear an average 5 children during their child-bearing years, compared to the global average of 2.5. Cases of teenage pregnancies and unintended pregnancies are still very high – 1 in every 9 girls has a child. The situation was made worse by the misfortune that is COVID-19. Late last year, Thellesi Co ran an awareness campaign on social media to call attention to the rise in sexual activity amongst the youth (15-29yrs), who cited such reasons as boredom during quarantine, stress, anxiety, alcoholism and drug abuse. That being said, a study shows that maternal conditions such as complications during birth and unsafe abortions are the leading causes of death amongst our adolescent girls.

What non-profits and governments have been doing, among other things, is bringing the contraceptives to us, making them free, training our health workers to encourage us to take up a method and to administer the method, training community health volunteers to come sell the idea to us, speaking on tv and radio about all the wonderful benefits, running social media campaigns and ads and influencing laws. While they have managed to make some leaps, this has costed them billions of shillings, and the stats can be described in many ways other than exciting. I feel an overwhelming need to say that if this is the trend, then it looks like it might take them a really long time to hit the milestones they set.

Also read this. 

In an attempt to be useful, I have tried to educate myself on this matter and I have arrived at some speculations, which I share below:

I have been growing up in a community where family is the most important social unit. My community is also patriarchal, just like majority of Africa. For a long time, the way men have been considered wealthy is by the size of their families and material possessions such as cows and goats. The number of children a man has is highly dependent on the number of wives he marries. Also, it has been important that a man has a son, because it is this son who will carry on the family’s name. If say, a man marries his 1st wife and she bears him 4 children who all happen to be girls, the man is more likely to keep trying or marry more women until he gets a boy.

If I remember my social studies accurately, one of the reasons why families had many children was because children are seen as investments by their parents. They believe that the more children one gets, the more likely it is that when the children grow up and make it, they will come back and take care of their parents. Others like the prospect of how much bride price they will get when their girls are swept away by charming Princes.

In Traditional African Societies, a man was regarded and respected as a man because of his family. That being said, it would be redundant for me to go on about the experiences of impotent men, and the lengths they went into to reverse their nature. So children were, and still are, important. In modern day Africa, such cultural mindsets are still alive in rural areas (where majority of Africans live), but are well at the back of the minds of urbanites.

I would consider this post shallow if I don’t mention bride price. In Kikuyu we say, “Kùgùrana“, which translates to “buying a bride” in the context of marriage. I do not have much evidence, but I am inclined to think that the act of exchanging a wife for some money, goats, cows or whatever it is, gives men a sense of ownership of the women they pay bride price for. That being the case, it is easy for men to make demands, including [more] children.

Moreover, cultures such a FGM aggravate the situation. Once a girl has undergone the cut, she is now considered a woman, at which point she is handed over to a man who becomes her husband. The earlier a girl is married off, the earlier she is likely begin having children and the longer her child-bearing years. If she happens to escape all this and live a relatively normal life, she most certainly will go to church and read the passage that says “…Multiply and fill the earth.” As if that isn’t enough, she will not feel like washing the dishes that Sunday afternoon and her mother will say, “You and your ‘relaxing’, who will want to marry such a lazy girl?” When she approaches her 30’s, family gatherings will be awkward because there is going to be an elephant in the room, and one day an auntie will decide to address it by asking, “And by the way Anne, when are you bringing us ‘visitors’? Anne will eventually bring visitors, and that damn auntie will still ask, “So when are we expecting our first born?”


Now bring in the more modern factors, such as lack of information about various methods of contraception, fear of side effects, myths and misconceptions surrounding birth control, its association with cheating, shame etc.

At the usual risk of overwriting, this is my point: we do the things we do because of how we have been socialised. The mental models you acquired from when you were a baby to who you are now are have guided the choices you make. Living in patriarchal communities has caused us to base our actions and perceptions within its confines, because for a long time, it is all we have known. It is the familiar, stored in our system one and system two brains. So if you wanted to change any sort of behaviour, the best approach to take – in my wisdom – is to bring in the unfamiliar using the familiar.

To get youth in Africa to consider using contraception, you have to meet them where they are. You have to immerse yourself in their cultures and understand their mental models. How are their communities structured? What existing perceptions do they have? What are their pregnancy intentions? Etc

If you ask me, I think men should lead the conversation on birth control. They are currently, the holders of authority (please calm down feminists, just hear me out), and they have been for a long time. Men make the rules and the policies. Not just at home and in the village, but also in high offices such as in government. As radical as it may sound, men make the choices for women as far as contraception and number of children is concerned – even though the reverse seems more likely. Once men are on board, we are more than halfway there! Lastly, in keeping with the theme of using the familiar to introduce the unfamiliar, I think there is a huge opportunity for relevant parties in using the patriarchy to drive some of these agendas, simply because of the prevailing perceptions and pursuit of results.

As I end here, the question has morphed into: how do we get men to be the ones encouraging their wives and girls and side-chics to be on birth control?

  • I don’t think it’s a question of men encouraging women to be on birth control. Women don’t need encouragement, but better birth control options with less drastic, and even life threatening side effects.

    The question is why can’t men get on birth control? Surely. They exist.

    • Modern birth control options exist in Kenya. I don’t dispute that there are challenges with supply. But that is a small component of the whole issue. Assuming they were abundant, but they have not been accepted by all parties involved, you still have a problem on your hands. Men need to play their part in encouraging women to consider birth control.

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