PRB

(January 2008) Ethiopia and Nigeria are sub-Saharan Africa’s largest countries by far, with populations of 83 million and 144 million, respectively. They account for more than one-quarter of the continent’s 788 million people, and are integral to its demographic future. Both are growing rapidly, and both grapple with widespread child malnutrition.

During a PRB Discuss Online, Charles Teller, Bixby Visiting Scholar at PRB; Dr. Kolawole Oyediran, a sociologist from Nigeria; and Dr. Assefa Hailemariam, a demographer-statistician from Ethiopia, answered participant’s questions about the challenges facing Ethiopia and Nigeria.

Thank you for participating in this stimulating Discuss Online session on population issues in Ethiopia and Nigeria, sub-Saharan Africa’s demographic giants. Spotty internet connections limited the direct participation of Drs. Oyidiran and Hailemariam, so Dr. Teller relayed their responses.

January 30, 2008 11 AM EST

Transcript of Questions and Answers

Melaku Woube: The nexus of population and development in Ethiopia puzzles me? What do the scholars say about it?What do you think about the role of good governance and political stability to implement population and development related programs and policies?
Charles Teller: thanks, Melaku, for your honesty in doubting whether countries, such as Nigeria and Ethiopia, which do not rank well on good governance scales (such as the Millenium Challenge Account indicators) can implement effective population and development policies which are equitable to the most needy. The implementation of the comprehensive 1993 National Population Policy of Ethiopia has been analyzed by both national and international policy experts as being still relevant today, but not well implemented, and focused more on advocacy than on efficient strategies and management. The hope is that under the 2006 3rd Poverty Reduction Strategy (PASDEP) where the government has acknowledged population issues as a main constraint to poverty reduction, there will be more political will for implementation.

Agunbiade Ojo: It appears there is a level of apathy for some family planning methods in Nigeria.What factors do you think are responsible for this development and how can family planning be better packaged and delivered across the different social categories(Young and Old)? Thanks.
Charles Teller: Kola writes: With a growth rate of 3.1 percent the level of contraceptive use in Nigeria is still low relative to other sub-Sahara African Countries such a Kenya, Ghana, and South Africa. About 15 percent of Nigerian women are currently using modern family planning methods. Studies have shown that the use of several contraceptive methods are even declining as health workers focus on the more paying and better rewarding HIV and AIDS epidemics. Today, there is near apathy to the use of condom, IUCD, oral contraceptives, and surgical methods for family planning. Although with HIV and AIDS epidemic there are significantly increase in the percentage of women and men (young and old) using condom in Nigeria, majority still do not want to use the method as contraceptive. Actually, this epidemic has further decrease the use of condoms as contraceptive as many believe that identifying with condoms will lead to the erroneous believe that one is either infected or unfaithful to one’s sexual partner. Moreover, several men do not want to use condom because of the believe that it reduces “sexual pleasure”. It is also a known fact that women in the northern-part of Nigeria prefer to use family planning methods that would not be know to their spouses. Therefore, there is low uptake of IUCD in the northern region among women. Africans avoid the permanent methods (TBL and Vasectomy) because of their irreversibility. Also religious issues mitigate against the uptake of contraceptives. For instance, the Catholic Church believes only in natural family planning methods. This is worsened by the fact that since the advent of HIV/AIDS programs, less emphasis are being placed on activities that could improve Family Planning service delivery. On repackaging family planning program and delivering to the various strata, these issues should be put into consideration in initiation, planning and implementation of any specification, design and development of the new strategy in refocusing on family planning program. This response is also relevant to Olalla’s, Elaine’s and Irene’s questions.

Ronald Pust: What are the relative fertility rates [and total fertilities] of Nigerians who are: 1. Christian 2. Muslim 3. Neither ?
Charles Teller: Kola writes: Total fertility rate based on 2003 NDHS was 5.7 per woman with rural women having 6.1 TFR compared with 4.9 for the urban women. The TFR also varied by region with highest in the North-east (7.0) and lowest in South-east and South-west (4.1). Analysis of fertility by religion sub-group has not been a priority due to the sensitivity of religion. For instance, religion was dropped as part of 2006 National Population Census. However, regional patterns suggest that Muslims are more likely to have higher total fertility than their Christian counterparts. For instance, North-east and North-west are dominated by the Muslim faithful while the South-east and South-south are Christian dominated. Other factors that could explain regional variation in fertility may be attributed education and relative higher economic status. The development indicators in Nigeria revealed that Southern people are more educated and poverty index is smaller compared with Northern resident. Charles adds: The research that Kola and I did in a mixed Muslim and Christian State in Central Nigeria in 2002-03 showed that Muslim women with high school education has similar low fertility rates as the Christian high school educated women. On the other hand, data from some of the COMPASS RH/FP project surveys’ mainly Muslim states in Northern Nigeria where there is low educational attainment, showed modern contraceptive prevalence below 2%.

Irene Maweu: Why is there low usage of contraception in these two countries?
Charles Teller: Irene, see other responses on low CPR. It must be recognized, though, that modern CPR has tripled in rural areas of Ethiopia between 2000 and 2005, admittedly from low levels, and that it is also rising in Southern Nigeria.

Elaine: What are the main barriers (pardon the pun) to increased contraceptive use? Is it simply a supply and distribution issue, or are there strong cultural, religious, and health concerns as well? What are these factors and what is being done to address them?
Charles Teller: Elaine, very thoughtful and comprehensive question. WE have addressed most of your question in other responses, but not much on the health concerns, other than the side effects of contraceptives. I know that in Ethiopia, the community-based reproductive health agents are addressing these broad cultural, religious and health concerns, with success, and now much of that culturally-appropriate approach is being scaled up by the government through the Health Extension Package community-based programs.Can others add to what is currently being done to address them?

Josephat Byaruhanga: Josephat Byaruhanga: Is family planning the best entry point for population control in Nigeria and other developing countries? To what extent does family planning contribute to population control? Do these methods violate the right to human life? What is the view of human rights activists on this issue?
Charles Teller: Please see what Kola responded to a similar question above. I don’t think countries like Nigeria and Ethiopia think in terms of population control, but in terms of the woman’s right to good health, and harmonzing the balance between population size/growth and equitable use of natural and environmental resources.Any one else like to comment on this human rights issue?

Daniel: Hi, What do you think of the trend in the TFRs for the two countries so far? What is the expectation regarding the levels (for urban & rural areas) in the coming 5-10 years? Any possible explanations? Thank you.
Charles Teller: Daniel, the trend in TFR in both countries is still in an early transition stage, as demographers like to call it, but the urban and educated couples has already quite low fertility. The expectation for Ethiopia is for the rapid increase in rural areas is to increase with the expansion of community-based RH programs, while in Nigeria, the trends in most Northern states in not encouraging.What do others think about the trends in Northern Nigeria and rural Ethiopia?

Gauthier MUSENGE MWANZA: – L’Afrique, est-elle peuplée ou sous peuplée? – Que conseillez-vous aux africains, l’augmetantion de taux de natalité ou la diminution?
Charles Teller: If I understand your question about Africa’s being over-populated or underpopulated, that is a complex moral and judgement call. Most of the governments report to the UN mixed feelings about their satisfaction with their population situation; as to the two governments being discuss here, there are well-designed population policies with expectation to lower fertility, mortality and reduce population growth to be more in harmony with the economic and resource situation. Is there any recent research on the governments’ opinions on this subject?

waldhanso Golocha: The population and development nexus is an important issue,and should be given due attention. But, it seems that committment is very low among the decision makers to deal with this issue as seen in the implementation of the population policy of Ethiopia? what should be done to enhance commitment among leaders?
Charles Teller: Walhanso- Melaku and others have commented on this too. It has been observed that one of the big regions, SNNPR (Southern Region), is committed, according to W/z (Ms) Genet of the National Population Dept. of MoFED, and they told me (Dr. Teller) there last month that the Regional Government has instructed the Regional Population Office to move ahead rapidly with the implementation of their revised policy. So one might work on a more decentralized level with greater participation on civil society, religious groups and local organizations. The rapid spread of regional universities and colleages can help with gathering the objective evidence and opinions of the rural communities as to their perception of population issues, including migration, urbanization, population pressure on the land, etc. The international community has helped to strengthen the decision-makers’ commitment to population constraints to development in the new PASDEP (Poverty Reduction Policy). What do other Ethiopians feel about the likelihood of strong implemention of the PASDEP population objectives?

Irene Maweu: It is great to hear that these two countries have low mortality rate. How have they managed to do this?
Charles Teller: Irene, if we knew the right answer to that, we would advocate it more strongly. At the recent AFrican Pop. Conference in Arusha, Tanzania, several factors were documents:
1- Demographic: rising age at marriage and increase contraceptive use by the higher risk age mothers (<18 and above 35)
2-Urbanization and access to health and medical facilities, pharmacies, etc.
3- Addressing the major killers, such as malaria, diarrhea, pneumonia, and expansion of rural health care systems to poorer community
4- Increased education and health education, mass media, etc.
However, the young child malnutrition situation has NOT improved, and access to enough safe water has also not improved enough. Other opinions, on the recent well-documented declines in young child mortality in countries like Ethiopia and Tanzania?

waldhanso Golocha: Though the nexus b/n population & development is a critical issue, it seems to me that there is a low committment among the elites to deal with the problem. This is reflected in the implementation gap faced in the Ethiopian population policy. What should be done to enhance the committment of political leaders in this regard?
Charles Teller: Waldhanso, a followup to our response on this issue of commitment and poor implementation, which Dr. Assefa has documented in his paper on the 10th anniversary of the 1993 ETH pop. policy. I just spoke to Kola about Nigeria too, and he said that the same is true in Nigeria, that the level of awareness among the general population of the pop policy is low. He also says he has NOT seen the implementation framework for the current Nigeria pop. policy.

TTS: What do you see as the most pressing environmental consequences in these countries to the population issues there?
Charles Teller: TTS- thanks for this focus on the environment. Having just participated in a PRB/Packard/USAID supported East African meeting on pop/health and environment, and having heard a series of papers presented at the Dec. 2007 African Pop. Conference on pop-environ, I must say they are wide-ranging:
1- Population pressure on the land, natural resource and envornmentally fragile “hot spots”
2- Environmentally induced migration for livelihood support and negative health consequences (HIV, malaria, cholera/dysentery)
3- Crowded, fetid urban slums, such in Nairobi, which can explode in violence and insecurity
4- Climate change and droughts/floods which affect normal movement of people.
There are many more, and others can chime in here.

Dr. John. G. Laah: Condom is urgently needed to control the rapid spread of HI/AIDS. I want to know how the two countries are overcoming social and personal obstacles to the use of condom
Charles Teller: See Kola’s detailed response to Olalla’s question on low contraceptive use. His research and program evidence shows that the HIV/AIDS epidemic has further decreased the use of condoms as a contraceptive becuase of the identification of the condom with already infection or unfaithful sexual partners. What do others who have studied and tried to overcome the many real obstacles to condom use, among both unmarried and the married? Dr Assefa responds that for Ethiopia, there are thousand of free and los cost condoms distributed, but less than 5% admit to their use, which might be underestimated. There are mass media campaigns and culturally appropriate dramas that encourage condom use.

Zeinab EM Afifi: Family planning programs do not seem to be effective? what are the efforts being made, are they being regularly evaluated, and what are the obstacles met?
Charles Teller: Zeinab, please see the response to similar questions on ineffective family planning programs. Kola, Assefa and I have been very much involved together in their evaluation, and I’m sorry to say that there are still not enough REGULAR and rigorous evaluations of the effectiveness in these two countries. When a strong monitoring and evaluation system is designed at the beginning of a program and used as a management tool and learning experience, we do find many of the obstacles mentioned in the response to Olalla’s questions. But I must say the obstacles can vary greatly, as to whether you are a young, educated Muslim man in Addis Ababa or a illiterate Orthodox Christian middle-aged woman in rural North Gondor Zone. Dr. Assefa says that the government doesn’t have the resources to evaluate it’s FP programs, and there are concerns with stockouts and low quality of services, but many NGOS are doing evaluations. Can others write us NOW and contribute results of rigorous evaluations of the effectiveness of family planning programs (in terms of TFR and CPR) in rural Ethiopia or rural, Northern Nigeria?

seblewongel deneke: I am working on gender equality issues and I wonder how much of this challenge is related to culture and the position of women in the respective societies? ANy thing you can say on that? Secondly, what are the policies within these two countries regarding population issues? my other question is regarding the statistics, it is said here 83 million for Ethiopia while I refer to 75 million so can you please clarify? thank you.
Charles Teller: Kola responds: The structure of power relations in a society – who decides what, who can do what, who controls whom – creates opportunities for and imposes constraints on access to welfare and capacity for development of both individuals and communities. It can therefore affect poverty either positively or negatively. The structure of power in power relations is rooted in social organization and to some extent on how democracy and governance activities are carried out in a society. Since men control power at macro and micro-levels, ownership and use of productive assets such as land and capital are skewed in favor of men in Nigeria, thus making women subordinate to their male counterparts. Closely related to the above is the resultant very low level of participation of women in political processes in Nigeria. For instance, 11 women out of 109 Senate members were elected during the 2006 general election which is low compared to the 30 percent representation as highlighted in the Affirmative Action Plan. The situation was even worse at lower levels of governance (State and LGA) where no women were elected. In Nigerian culture, women are generally assumed to be weaker vessels both physically and psychologically. The traditional theory that a woman’s place is in the home to handle all the house chores and to satisfy the man, is highly entrenched in Nigerian culture. One result of this is that women are less empowered to make autonomous and informed decisions to address their own health issues and family planning. To address the second question, the population policies in Nigeria were recently reviewed; the expected number of children (four per woman) was changed to reflect the number of children that a family could successfully cater for with respect to education, health and other needs. Can others chime in on the last issue of Nigerian population policies? Dr. Assefa agrees with you, that the population size of Ethiopia is probably in the 75-77 range, but this is a CSA projection based on the old 1994 Census. We are awaiting the results of the 2007 census eagerly. Also he says that the 2.7% a year pop growth rate may decline a bit from higher CPR, but then mortality is also lowering, so we’ll have to wait and see.

J Kishore: Population explosion is not a national issue but international also and must be handle international. We have understanding of the problem, advance technology and techniques to handle population. What we should decide is to involve people of these two countries at various forums and provide them a helping hand. We already know it is the illiteracy, poverty, female and child health and insurance etc. are directly responsible for large population. Nothing is in the hands of individials. So we all have to act.
Charles Teller: Quite an eloquent statement. Yes, this is a global community, but that means helping each other. Global problems, though, often require local solutions, and research and reliable data show how different the population dynamics are from region to region, social class and ethnicity. Dr. Assefa adds that efforts at poverty alleviation, improved health serves in rural area, school expansion and community-based services are those that the international community can help in, beside the obvious of supportive contraceptive security.
What do others feel about how we as the global population and human development community should act together to facilitate local solutions?

tamara fetters: Can you summarize your thoughts about the fertility disparity between Addis and rural Ethiopia? DO you think this trend will continue to grow? DO you agree with the hypothesized causes of delayed sexual debut and marriage? DO you think that abortion plays a role?
Charles Teller: Tamara, the research on this shows that education and late sexual debut and much older age at first marriage, contraceptive use, abortion and lack of housing and improved economic opportunity has brought the Addis fertility even below replacement level, as around 1.6 (as opposed to around 6.0 for rural areas and around 3.5 for other urban areas. So there is agreement on the causes, but whether they are positive or negative ones, there is disagreement. I don’t think that this great gap will continue, as rural areas are also increasing their use of contraceptives, and the cost of child-rearing is also increasing, with shrinking land. Dr. Assefa says that he expects the disparity will decrease, as living and employment conditions improve in Addis, and as rural areas get more health and education services and demand the injectable contraceptive. Other research findings from others in Ethiopia are welcome!!

Dick Fredland: So, all that is said on this subject, what will lower borth rates?
Charles Teller: Research shows that several factors lower birth rates in Africa:
1- Government commitment to implementation of population policies
2- Woman’s education and gender equity
3- Urbanizaton and non-agricultural living
4- Rising expectations and hopefulness of a better life
5- Improved family planning programs
6- Strengthen community-based health care programs to reach to poorest and most inacessible
7-Social change and globalization of ideational factors that tell couples that it’s OK not to have as many children as their parents did.

tamara fetters: I am interested in your comments about national priorities shifting from FP to HIV/AIDS programs. Do you think this is a shift that is donor driven? How might we create a policy environment that allows these priorities to better coexist? Is that something that is necessary?
Charles Teller: Hi, I just called Kola, who is in the “bush,” on this. He says that the shift is definitely DONOR-DRIVEN, with lots of money and taking good people away from family planning. Moreover, there there is no need to separate the two, as the same people can work in both. So the donors can do a lot to promote better coexistence, and the country also should insist on this.Dr. Assefa just called to say that there used to be much more separation of the two programs, but now there is much more integration (eg., PMTCT) and more emphasis on prevention.

Hazel Denton: I want to go back to one of the earliest questions, namely “Is the shift away from FP toward HIV and AIDS donor-driven?”. The answer, and follow-up discussion, all indicate that it is. The fact that the two issues could readily be handled together has also been noted. What can be/is being done to encourage donors to re-direct their efforts?
Charles Teller: Hazel, thanks for the followup, and I just finished talking to both Kola and Assefa about this crucial issue. The concensus is that is it donor driven. What Kola says is that the same groups of workers can and should work on both problems at the same time. Assefa says that in Ethiopia, there more integration now that before, particularluy by the NGOs, and the key to this is the focus on prevention. Family Planning is one of the most effective means of dual prevention and protection. What still disturbs me (Teller) is that there really is not much close evaluation of the effectiveness of HIV/AIDS prevention programs and strategies,in the reduction of NEW HIV/AIDS cases. If it can be demostrated that family planning and others BCC progerams prevent, then policy makers will be more likely to follow the evidence. I’ve also been told by colleagues in Kenya and read their research results, that fertility has leveled off at 4.9 since 1998 and contraceptive prevalence has even declined. Some attribute this to this shift of resources to HIV/AIDS, and that many of the community-based family programs have become clinic-based.

Belay Endeshaw: Hello! I’am a graduate[demography] student in Addis Ababa university.Recently, the result of the WHO [2007]muliticountry study placed Ethiopia in the forefront regarding sexual[domestic] violence. What do you think the root causes of this crime? Is there something related to the law of the land[penal code,1957]? Thank you.
Charles Teller: thanks, Belay, for bringing this 2005 “Multi-country Study on Women’s Health and Domestic (physical and sexual) violence Against Women” to all our attention (see the WHO website). Yes, the rural study areas in Peru and Ethiopia had the most prevalent vioIence “ever-experienced”, and 49% and 36%, respectively, with severe physical violence (eg., hitting with fist, beaten up, choked, burnt, etc.). It’s only fair to clarify that the Ethiopian study was done in only one (Meskan-Mareko) district out of over 500 districts in the country, and a predominantly Muslim district at that, thus probably not representative of the country, although it is still high. (Teller and Assefa agree on this point.) There were wide variations in violence within countries where more than one district was studied. The study identified personal, social and family factors that put her at greater risk but that can also protect her. Interestingly, it also showed that these rural Ethiopian women had the highest percentage agreeing with certain reasons that justify wife beating. On the other hand, qualitative research consistently finds that women frequently consider emotional abusive acts (eg., insulting, humilation) to be more devastating than physical violence. It might also be important to find out how much emotional abuse there is from wife to husband also, and does this vary by social class (my personal opinion, Dr. Teller). Kola added: One of the key issues addressed at the 1995 Fourth World Conference on Women in Beijing was the elimination of violence against women. Violence affects the lives of millions of women worldwide, irrespective of socio-economic status. It cuts across ethnic, cultural and religious barriers, impeding the rights of women to participate fully in society. Analysis of 2003 Nigeria Demographic and Health Survey (NDHS) revealed that domestic violence is deep-rooted in culture; for instance wife beating is considered a prerogative of men, and a purely domestic matter by the legal system in Nigeria. Domestic violence is one of the greatest barriers to ending the subordination of women. Women, in fear of violence, are unable to refuse sex or negotiate for safer sexual practices, thus, increasing their vulnerability to HIV if their husbands are unfaithful. Dr. Assefa says that the old 1957 penal code and the new Family Code are in place, but that does not necessarily mean that people will abide by it. He also notes that other research in Ethiopia has documented the high level of domestic violence in rural areas (although less in Addis Ababa), often based on traditional norms and values of both men and women. I (Teller)also took note of the fact that most (63-80%) study women still agree with the justification for wife-beating (if wife does not cople houserok, disobeys humband, is unfaithful). So cultural change is needed.

Adamu M. Garun Gabas: (1) Based on the last census figures in Nigeria, what is the total size of the population aged 6-11 years (school going age) and if the population of a particular state is “x” what proportion of it could consertively be taken to represent the size of those aged 6-11? (2) What are the current issues or thinking about urbanization in Nigeria? (3) What is the most striking contrasting feature of the population situation in Nigeria and Ethiopia
Charles Teller: Hi Adamu, I’m going to let Nigerian demographer Dr. Kola answer your first two questions, but I (Dr. Teller) am so pleased you asked the third question. Having worked in both countries, but more extensively in Ethiopia, I am struck so many similarities demographically in many ways, in fertility, mortality and population growth. But there are two main differences: Nigeria is much more urbanized (44% to only 16% for Ethiopia); and Nigeria is much more densely populated, with 156 person per square kilometer compared to 70 for Ethiopia. Of course, Nigeria has almost 150 million people to about 80 million for Ethiopia. As for use of contraceptives, Ethiopian rural population has seen as much sharper recent increase in the use of modern methods in recent years (particularly the injection), tripling its rate from a low level of 4% in 2000 to over 11% in 2005. Kola’s computer is not working out in the bush now, so didn’t answer the first two questions. Urbanization is much higher in Nigeria than Ethiopia, and the thinking in Ethiopia is that it is TOO LOW. On the education figures, you might check with the new DHS from Nigeria on educational attainment.

Finote M.A.: Dear Assefa Hailemariam, Charles Teller, And Kolawole Oyediran….Hear is my question. Currently The stated two countries are the leading most populous countries in Africa and found in many problems such as environmental degradation, povery, food insecurity, political instability, high rates of unemploymnent, etc.Most scholars correlate their population size with the prevailing environmental, social, cultural, economic, even political problems. I do not mean and want to argue that it has not a contribution at all. However, I deem that it is not the burden because of the population which causes these problems but the problems are resulted mostly because of the mismanagement of resources, maladministration,weak policies and strategies, in efficient capacity to even implement the policies and strategies designed as well as the absence of good governance that couses the aforementioned problems in Ethiopia and Nigeria.what is your observations in this regard? thank you all!
Charles Teller: Finote, you are to be commended for having addressed a rather controversial issue in a broad-mined and multi-sectoral manner. I (Dr. Teller) am interested to see how my colleagues answer this one, although I know they also view it in this broader perspective. It is certainly not unique to these two GIANTS (not to mention the third giant- DRCongo) that governance, policy implementation and program resource management are constraints to social and economic change, but being so large may be an even greater challenge to these very diverse socio-cultural and ethno-religious countries. Oil as the main resource that has been thought to be mismanaged in Nigeria, contrasts with coffee and hides/skins for Ethiopia. I think my colleagues agree, but it appears that Ethiopia is beginning to be more proactive in implementation than Nigeria.

Olalla Bohigas: Hello, I’m a Geography student from Spain. I would like to ask about the reasons of the low contraceptive use in these countries.