In Areas Where Children Die Young, Family Planning Is a Hard Sell

Nairobi, Kenya — There are a variety of reasons why women in traditional or less-developed societies give birth to many children: religious, cultural, economic, status and lack of adequate information. But one reason that seems so obvious once you think about it — but which seldom tops the list — is the fear that the children they do bear might not survive.

“Although I live in a small house — in fact, it’s a toilet — I would still like to have as many children as God wills,” a young mother from Korogocho, a slum in Nairobi, said at a young mother’s club created by Jhpiego, an affiliate of Johns Hopkins University, to bring together mothers to discuss health issues. “I’ve seen many women who only have five children, and two of them die, leaving her with only three. Can you imagine if she had just two?”

In such societies having numerous children is a kind of social insurance, a guarantee that those who do survive will help the parents financially and take care of them in old age. Traditional family planning campaigns have stressed the benefits of spacing births for both the children and the mother. Fewer children means each would receive more attention and resources, and the mother would be able to regain her strength before giving birth again.

But in my work for Jhpiego’s Tupange project, an urban health initiative offering access to…

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