Rose N. Oronje

NAIROBI, Jul 31 2008 (IPS) – This year the world reaches an invisible but momentous milestone: for the first time in history, more than half its population will be living in urban areas. In Kenya, rapid urbanisation is creating deepening poverty among urban residents.

Researchers are asking how education affects women s family planning choices Credit: Rose Oronje/IPS

According to the United Nations Population Fund (UNFPA) report State of the World Population published last year, poor people will make up a large part of future urban growth. Most urban growth in developing countries now stems from natural increase (more births than deaths) rather than migration from rural areas.

But wherever it comes from, the growth of urban areas includes huge numbers of poor people. Ignoring this basic reality will make it impossible either to plan for inevitable and massive city growth or to use urban dynamics to help relieve poverty, states the report.

The UN Human Settlements Programme (UN Habitat) estimates that more than half of the residents the Kenyan capital, Nairobi, are living in slums, where unemployment is high, livelihoods are unreliable, housing is poor, and basic amenities such as running water and proper sanitation are lacking.

According to Dr Alex Ezeh, executive director of the African Population and Health Research Centre in Nairobi, poor people in urban areas cannot afford formal housing, so they gravitate to slum settlements, where unsanitary conditions mean they have poorer health outcomes than people living elsewhere.

If you look at infant mortality rates, out of every 1,000 live births in the slum areas, 91 will die before their first birthday, compared to 67 in Nairobi as a whole, and 79 in rural areas. For under-five mortality, at least 151 infants die before their fifth birthday in the slums compared to the national average of 115, 117 in rural areas, and 95 in Nairobi as a whole.
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The UNFPA report, however, states that the potential benefits of urbanisation far outweigh the disadvantages: the challenge is in learning how to exploit its possibilities. It recommends that approaches should aim to reduce the major component driving urban population growth, which is natural increase. Such approaches, the report says, should aim to reduce poverty levels, promote women s rights, and better reproductive health services.

Once policymakers and civil society understand and accept the demographic and social composition of urban growth, some basic approaches and initiatives suggest themselves.

Advances in social development, such as promoting gender equity and equality, making education universally available and meeting reproductive health needs, are important for their own sake. But they will also enable women to avoid unwanted fertility and reduce the main factor in the growth of urban populations-natural increase, states the report.

To Ezeh the initiative that suggests itself is family planning programmes targeted at urban poor communities: Large proportions of poor urban women who either do not want any more children or want to delay their next birth for at least two years, are at risk of getting pregnant because they are not using any method of family planning.

Ezeh says that across sub-Saharan Africa, the urban poor are far less likely than other city dwellers to access family planning services. The factors underlying a woman s decision to use contraception are complex, and a five year study, entitled , is currently under way to unravel these factors. The study, which is being conducted in Kenya, Ghana, India and Pakistan, is coordinated by the University of Cambridge with funding from the UK government s Department for International Development.

It examines the link between schooling and reproductive decisions in poor households. It focusses on questions relating to women s agency and decision making power in poor communities. Other questions it seeks to answer are whether schooling works by influencing the individual or the community, and how many years of schooling are required to enable women to take more independent decisions and to access a wider range of external resources.

Fatma*, a 32-year-old resident of the Korogocho slum in Nairobi has eight children. Apart from attending a madrassa (an Islamic religious school) when she was a young girl, she has had no other form of schooling. Fatma believes that children are a gift from God and so any attempt to stop conception is a sin. This is deeply rooted in her religious beliefs.

She got married at the age of 14 and has since been bearing children after every one and a half to two years. Apart from avoiding sex on her unsafe days , something she was taught in madrassa, she has never used any form of modern contraception and she says she does not need it.

Using contraceptives is killing something but children are gifts from God, she says. Many young girls who use contraceptives are unable to conceive when they get married, because they are now barren as they have already killed all their children.

This is in contrast to the attitude of Jane*, a 37-year old mother of seven also from Korogocho. Jane is unemployed and she lives with her husband, a casual worker. They only wanted to have four or five children, she says.

After delivering her fourth child, she decided to get the three-month contraceptive injection, which she had to pay for, at a nearby clinic. This method caused excessive bleeding, so she stopped it, and she got pregnant.

After their fifth child, she opted for the pill, which she bought from a local chemist. But this method too gave her severe side effects. Whenever I took the pill, I would feel nausea, weak and would sometimes get fever, she said. She abandoned this method too.

Following this, she gave birth to their sixth and then their seventh children. Now, her last born child is six months old and Jane is yet to start using a modern contraceptive method.

Jane says she would like these services to be made more easily accessible and free of charge, especially for poor women. She would also like women to be given proper education on all the methods available and their side effects.

With additional reporting from Kathryn Strachan in Johannesburg

*Names have been changed to protect privacy