Family planners who still believe in the slogan ‘development is the best contraceptive’ are nuts, argues Ann Cluver Weinberg
‘BECAUSE it feels right” is no way to run a country. In the United States presidential campaign of Senator Barry Goldwater in the early 1960s, the slogan was coined: “In your heart you know he’s right.” This was merrily doing the rounds in the US until an elderly pensioner rephrased it: “In your heart you know he’s right, in your guts you know he’s nuts.”
Practical family planners know that the heart- warming slogan behind the Cairo document and the South African population Green Paper — “Development is the best contraceptive” — is nuts. Dr Karan Singh, who coined the phrase for the 1974 population conference in Budapest, now very much regrets having said it, and recommends that the worldwide need for family planning be met with utmost speed.
If I go into a village where family planning is not well understood, and I explain it in a friendly way and I help with transport, then it is I who have “limited the population”, not “development”. All over South Africa developmental schemes have been started with no accompanying emphasis on family planning, schemes such as food gardens, irrigation schemes, brick-making, literacy, etc. There is no automatic drop in the population because of these schemes.
If they mean “development” in the urban/industrial sense, then how are we going to do it? Wave a magic wand over Gazankulu and turn it into Switzerland?
Treating this slogan as a scientific truth is hastening what Richard Leakey, Kenyan palaeontologist and conservationist, calls “The Sixth Extinction”. In the history of the planet there have been five major extinctions, of which the famous dinosaur is only one example. The first five were natural disasters. The sixth will be caused by us.
It will be caused as much by what we are doing on the planet as by our growth in numbers, but blaming the rich for pollution as an alternative to reaching the poor with family- planning services is a cop-out. It is the poorest of the poor who will suffer first and worst if we don’t get this right.
Another wacky phrase is: “At the Cairo conference we made a paradigm shift towards the individual.” Really? There are more people alive today than have ever died. Millions of these are environmental refugees in Africa. Think of them as “individuals”, if you can.
We want the development of individuals, but we will not get it if we neglect the most obvious remedy: family-planning understanding and support absolutely everywhere in Southern Africa.
While we mumble about “development” and leave the Health Department to take care of family planning, we are leaving out all sorts of things which could be done.
The Sapler Population Trust did a survey for the World Wide Fund for Nature on the unmet need for family planning in South Africa. Everywhere we found gaps.
“We go into the villages and throw information at them and leave them totally muddled,” said a harassed family-planning nurse in Kangwane. A few hospitals offer good family-planning education and follow-up to their antenatal patients. Most do not. An overworked sister at Elim Hospital said: “I try, but I lose them when they go for their babies.”
In Walkerville, half-way between Johannesburg and Vereeniging, surely a “peri-urban” area, we found that the women who lived a 20-minute walk on level ground away from the mobile clinic which came on Mondays used family planning. Over the mountain we spoke to 60 women who lived a rough hour’s walk (or two taxi rides) away from the clinic, who vaguely knew about family planning, but who didn’t understand the side effects and had easily given up on the whole thing. Five women wanted sterilisations, but had no idea how to go about it. We were able to take them to Sebokeng Hospital for their sterilisations.
On the other hand, there are successful schemes which could be multiplied and which could reach every Southern African. At the Ithuseng clinic, founded by Dr Mamphela Ramphele, Mankuba Ramalepe told us that she had long ago taught lay women in distant villages to hand out contraceptive pills. This was illegal. Mankuba’s penalty? The Mandela Health prize.
Health Minister Nkosazana Zuma plans to take primary health care to everyone. The intention is to provide family planning at all clinics. But we found over and over again that when curative needs escalate, good family planning is left out. Family-planning nurses get roped into crisis medicine. Even if this were not to happen, the outreach element would be missing.
Worldwide, the “hard-to-reach” syndrome is well understood. Those women who are uncertain about starting contraception, who are afraid of the men’s disapproval, or who live far from the clinic are left out.
In Winterveld, where Sapler runs a grassroots family-planning education scheme, the nurses at the clinics, at first suspicious of us, now say: “Please can’t you come and explain to the people in the queues. We don’t have time.” There is already an epidemic of sexually transmitted diseases (STDs) in the area. What will happen in the country as a whole when more than one million HIV-positive people start to have Aids symptoms?
The best is for every community to have its own “family planner” — a person who would also be well informed about STDs. These lay planners should be allowed to do any family planning themselves that they possibly can do. This would be seen as an essential thread of “development” throughout Southern Africa.
There is nothing as cost-effective, as life- saving and as encouraging as getting this right. There is nothing as nutty as getting it wrong. It is an avoidance game of mammoth consequences.
What about the men? In Zimbabwe in the 1970s, where the lay planner idea was tried, it was found that most men soon got used to having these planners around. In Zimbabwe today they are finding that rural men are very responsive to an approach based on environmental and economic issues.
There is nothing unethical or against the spirit of the new South Africa in all this. Luckily, if you empower a woman, you are also empowering the nation. Suit one, suit all. Let’s make it a priority, both for ourselves and in co-operation with our neighbours.
Ann Cluver Weinberg is the founder of the Sapler Population Trust. Sapler stands for “Splendidly alive people within limited environmental resources”