The popular Kenyan band Sauti Sol sang in their song Nerea, “Mungu akileta mtoto, analeta sahani yake” a common Swahili proverb, which translates to When God gives you a child, he brings him with his plate or he provides for him. As much as the song tunes well to our ears, the reality is that it is upon the parents, the community, and the government to prepare a plate for the coming child.
This is the reality that the 20th Tanzania Economic Update Report by the World Bank titled Overcoming Demographic Challenges tries to remind all of us. The report shows with a 3 percent annual population growth rate, the population of Tanzania is estimated to double every 23 years.
One significant aspect highlighted in the report is the interconnectedness of healthcare with other sectors, particularly the economy and government planning.
Population growth and healthcare
The high population affects social services delivery, for example, the report shows by 2061 the cost of vaccinating children and adolescent girls against HPV will be US$718 million in the case of a low fertility scenario, and US$1.3 billion in the case of a high fertility scenario.
READ MORE: The Little Feet That Never Felt the Earth
Most of the time, healthcare is looked upon as something that exists alone without considering how many other sectors affect its accessibility, affordability, and availability.
Better health outcomes have been associated with improving economic growth but only when there are policies and strategies in place to facilitate the growing population to make use of the opportunities that come with population growth.
It is worth noting that there has been a major shift in healthcare services in Tanzania over the past 10 years, including the expansion of health facilities and availability of medical equipment. This not only facilitates better health but also reduces morbidity and mortality hence the increase in population.
While maternal, infant, and child mortality have reduced steeply since 1990, and life expectancy has increased by 15 years; fertility transition has remained slow in Tanzania. As a result, Tanzania is one among the 8 countries that are expected to be responsible for more than 50 percent of the global population increase in the next 30 years.
This is why as a health practitioner; I see one of the most important key takeaways from the report was the importance of reproductive health and education in creating a sustainable economy.
READ MORE: Saving Lives Of Little Ones: A Slow-Paced Journey
This is not about stopping having babies; it is about creating an environment that will accommodate the population and a population that will not become an economic burden to the country. To understand this let’s reflect on the key statistics on fertility.
Facing our reality
According to the Tanzania Demographic Health Survey report of 2022, on average a woman in Tanzania has 4.8 children which is double the rate in lower-middle-income countries (2.6). The two major determinants of this are the early age of marriage and childbearing and low levels of contraceptive use.
Tanzania remains one of the countries with high levels of child marriage and laws that legalize it. And for a couple of years even after the court ruling which declared the practice unconstitutional, it is yet to be changed.
This leaves a loophole for child pregnancy that always has poor outcomes as the young mothers do not have reproductive autonomy and hence have the lowest uptake of contraceptives as the decision is usually made by their adult husband or in-laws.
As a result, the fertility rate is high in this group and they are less likely to complete secondary school education which has been proven to be a key to fertility transition, reproductive autonomy, and better child health outcomes.
READ MORE: Child Marriage: The Bogeyman Terrorizing Tanzanian Girls
Tanzania needs to take a page from Malawi where child marriage was ruled unconstitutional in 2017 more than 800 child marriages were annulled and the girls were sent back to school.
Also, there is a need to adopt and scale up some of the best practices such as the use of religious leaders and male involvement to scale up family planning.
This is one of the best practices that was shared during the launch of the report by Dr. Salim Slim, the Director of Preventive Services, Ministry of Health Zanzibar. This practice is attributed to the uptake of family planning services in Zanzibar from 14 percent to 17 percent.
Also, the expansion of primary healthcare services through the use of Community Health Workers to provide contraceptive education proved fruitful.
As I mentioned in the beginning, to counter some of these demographic challenges we need collaboration between government and the community.
The government needs to put in place strategies and programs to facilitate child spacing, the community needs to accept and implement the programs, and the parents need to make use of and adhere to family planning methods for a better future.
Kuduishe Kisowile is a medical doctor and public health commentator based in Dar es Salaam, Tanzania. She is available through kuduzekudu@gmail.com or on X as @Kudu_ze_Kudu. These are the writer’s own opinions and do not necessarily reflect the viewpoint of The Chanzo. Want to publish in this space? Contact our editors at editor@thechanzo.com for further inquiries.
