OP-ED: Uganda’s rapid population growth among the poor will prevent it from attaining middle-income status

By Dr Ian Clarke

There has been a photo circulating on social media showing about a hundred newborn babies sleeping together at Kawempe Hospital. This is apparently the daily production of Kawempe Hospital, which according to a statement issued by the Minister of Health delivers at least a hundred babies per day.

The MOH is a bit defensive about the photo, but no one is blaming them, it is seeing this amazing production line of babies that is an eye opener.

We are aware that Uganda has one of the highest rates of population growth in the world, which of course means that we produce a huge number of babies, over one million each year. These million babies grow into children who need educated, and we then complain about poor standards of education and large class sizes.

These school children in turn grow into young people who are mostly unemployed because we cannot create enough jobs. These under-educated or unemployed youth don’t have much to do, so they make more babies. We have a 25 to 35% rate of teenage pregnancy, and so the cycle goes on.

Since we have such a high rate of production of babies, we give a high priority to maternal and child health, but despite this we still have a maternal mortality rate of around 400 per 100,000 births. We recognize that education is essential for our children so the education sector takes one of a high allocation in the budget, but most of our kids are still poorly educated. Because we have so many young people we allocate spending to SACCOs and schemes to help create jobs for the youth, but the majority are still jobless.

The policy makers have slowly begun to recognize that we are not keeping up with the rate of population growth yet there seems to be a reluctance to take measures to address the issue and stem the flow, and some policies are directly contradictory. We have an extremely high teenage pregnancy rate but we have a policy forbidding contraception for teenagers based on the rationale that providing contraception for teenagers will make them more promiscuous. We believe that it is the responsibility of the families to ensure they are well behaved, thus allowing them to use contraception would be an admission of cultural failure. We hold onto our cultural values at the expense of reality.

We are molded by traditional and social norms and we will not go against easily, them even if they are failing us, unless there is very strong leadership. This happened in the early eighties when HIV was devastating Uganda and it was only the strong leadership of the President which could withstand the cultural pressures and highlight the issue. This is why Uganda is now farther ahead in the fight against AIDS than countries such as South Africa, which failed to acknowledge the problem until it was too late.

Traditionally pregnancy among young girls was accepted, because older men married younger brides, but now this high teenage pregnancy rate is part of the problem. The accepted wisdom is that the high birth rate will reduce as we become more prosperous and develop a middle class in which people have fewer children. This is actually happening in Uganda among the middle class, but since they represent such a small fraction of the population it will have negligible impact.

Uganda’s population is not in the shape of a pyramid with the very rich at the top, the middle class in the middle, and the poor at the base. Our population is flask shaped like a gourd, with a small neck containing the rich and middle class, and a large fat base, which is the poor. In Uganda it is the poor who make up the vast majority of the population and continue to have large numbers of children. And it is also the rapid population growth among the poor that will prevent us from reaching middle-income status and thus allowing the emergence of a large middle class to sort out the problem.

If we continue on our present trajectory the base of the flask will simply get fatter as we produce a huge, young, poor and increasingly desperate population. This is one of the most pressing issues that Uganda is facing, but no one is addressing it as we skirt around the problem.