Why family planning is necessary for attainment of sustainable urban development

By Eliphas Gitonga Makunyi, PhD

Reproductive health has been given worthy attention in the last 30 years or more by the World Health Organisation, among other international organisations. One of the critical components of reproductive health is family planning. Inequalities and iniquities exist in the provision and utilisation of reproductive health services among vulnerable populations like refugees and internally displaced persons.

Nairobi hosts the highest number of urban refugees, most of them originating from Somalia, Ethiopia, South Sudan, and Congo. The city is credited with hosting many international reproductive health conferences and summits, including the International Conference on Population and Development (ICPD 25) in 2019. This is in addition to being one of the first cities to accept family planning in Africa.

The reproductive health of refugees is vulnerable due to poor living conditions and prohibitive health policies. It is worsened by sexual violence and restricted access to family planning services. The consequence is high-risk pregnancies, HIV/Aids, sexually transmitted infections, and unsafe abortions.

The benefits of family planning investment spans beyond a nuclear family to the community and the nation. Evidence demonstrates better economies in nations that effectively use family planning to limit births. In fact, every Ksh1 spent on family planning saves Ksh3 that would have been spent on complications related to pregnancy and child birth.

One in five refugees in Nairobi use modern family planning

A study conducted in 2021 established that in a group of five refugee women living in Nairobi city, only one uses family planning to either space or limit their pregnancies. Among 100 refugee women using family planning, the most preferred methods are implants (31 percent) and male condoms (27 percent).

Apparently, the refugees living in slums use family planning more than those living in formal settlements, due to a community perception that child spacing and limiting is meant for the poor in society.  Utilisation is also reduced by lack of approval by spouses, religious leaders, peers, and the community. The refugees who have lived longer in Nairobi, have tertiary education, in addition to an increase in age, are more likely to use family planning.

Population and development are rising in cities

The Nairobi Expressway, bypass roads surrounding the city, the recent expansion of airports, and increase in skyscrapers are major declarations of the Kenyan capital’s development.

Urbanisation is on the rise across the globe. It is estimated that by 2050, three out of five people will be living in urban areas. The major contributors to this urbanisation will be cities and towns in low and middle-income counties.

The intermediary cities like Kisumu, Mombasa, and Nakuru, will play a critical role in Kenya. This is in addition to the effect of devolution, where towns that were deemed silent, like Wote in Makueni County, have come to life, secondary to being established as county headquarters.

Rural areas are also gradually urbanising. Urban development refers to the economic, physical, social, and cultural development of cities as well as the underlying processes. Therefore, the whole concept of urban development looks at infrastructural issues, including health, markets, education, solid waste management, street pavements, and cultural heritage protection. Ideally, it is characterised by population dynamics (size and density), heterogeneity of the people, mobility, and formality of relations. Housing development, capital formation (investment in roads, electricity, technology, and health facilities) and the physical quality of life index are critical indicators of urban development.

What is driving the population increase in urban areas?

Evidence indicates that the increase in the population in urban areas is mainly a result of natural growth and not due to rural-urban migration as previously thought. Natural increase occurs when the number of births is greater than deaths. Fertility rate (the average number of children a woman can get in her lifetime) has also stalled/stagnated in most major urban areas in Sub-Saharan Africa. This means the number of children one is expected to bear in a lifetime is not decreasing.

For example, cities whose average number of children per woman was five, are still five over several years. The majority of the city’s population live in slums where the social amenities are extremely limited. Urban areas also host large youthful populations that have high fertility, and are in need of family planning for either birth spacing or child limiting.

Bridging the gap between urban development and family planning

Urban development is critical to access to family planning services through road infrastructure and health facility development. Information, communication and the various technologies that characterise urban development increase demand for family planning through knowledge sharing. Due to cultural blending within urban areas, cultures against family planning are also debunked.

Family planning creates sustainable cities by limiting the number of children in urban areas, thereby sparing the social services that are mainly funded by the government, in addition to saving the cost of taking care of children at family level. Effective family planning avails women and families time to actively participate in urban development. Every birth is accompanied by health risks that may lead to the illness of the mother or even death. Family planning is an intervention that reduces birth-related risks and thereby saves the economic burden that accompanies the emergencies that are common during birth.

Stakeholder outreach within Nairobi City County among reproductive health and urban development experts indicated that the synergy between the two critical sectors is very weak. There are no common policy-making meetings, and very few documents contain both aspects. The existing policy documents that speak to both are the integrated country development plans and the national budget statement.

To achieve sustainable cities in Africa, there is an urgent need to bring Sustainable Development Goal three on health, which includes family planning, and Goal 11 that hosts sustainable cities, into working synergy through policy. This could be done through joint policy making meetings, sharing draft policies/briefs with both sectors, more engagement with media as a stakeholder, advocacy for synergy, sensitisation of policy makers in urban space, and deliberate programmes involving the two sectors.

Let us make deliberate and actionable efforts to break the glass wall between urban development and family planning in order to have sustainable populations within African cities.

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Dr Eliphas Gitonga is a lecturer in population and reproductive health at Kenyatta University. He is also a post-doctoral fellow in urban family planning under the International Union of Scientific Study of Populations (IUSSP) Panel on Fertility, Family Planning and Urban Development, with funding from Bill & Melinda Gates Foundation (OPP1179495).

Email: [email protected],

Research gate: https://www.researchgate.net/profile/Eliphas-Gitonga