Tanzania started offering contraceptive services in 1959 but was among the last countries in Africa to declare an official population policy in 1992. In 1974 at the World Population Conference in Bucharest where the alliance of “the Soviet Union, the Vatican, John Rockefeller and most of the Third World” criticised “international population programs and family planning interventions”  for their  “ideological underpinnings of racism, imperialism and xenophobia”, Tanzania was outspoken in its refusal of the idea that population was a major problem for development. Yet Lisa Ann Richey makes the rather startling observation in her book Population Politics and Development: from the Policies to the Clinics that Tanzania’s National Population Policy when adopted in 1992 looked “strikingly similar to those of other Third World countries”

Book: Population Politics and Development: From Policies to the Clinics,  Author: Lisa Ann Richey,  Volume: 269 Pages,  Publisher: Fountain Publishers Kampala Reviewer: Allan Mwesiga, Â

1992 was two years before the 1994 International Conference on Population and Development in Cairo where reproductive health, as a term, emerged and the link between population, health, gender and development issues was established. A decade before, (Mexico, 1984) many Third World countries, then in economic crisis, were already making adjustments towards “conformist population policies”. Policies that had one shared idea: population is the problem hindering development. However, by the mid-90, actual demographic evidence demanded a review of this assertion.

Introducing the interlocking narratives on population discourse as discussed by the author; the demographic (overpopulation is the fundamental obstacle to development), development (Socioeconomic status is related to the population challenge) and the feminist (solve the problems of women’s empowerment and gender equality, which are population problems, and development will be achieved). The book chronicles how these narratives affected Tanzania’s Population Policy and its implementation. It also gives a disquieting account of how the feminist objectives get sidelined as resource constraints and competing agendas duel in an environment where policy is influenced by external expertise and foreign aid and how “most of the priorities of local implementation can be understood as responding to the weight of international agendas”. Agendas that change and that are influenced by a broad field of actors: from political parties to religious groups, from donors to consultants to ‘local’ experts, from NGO’s and UN agencies to Bretton Woods Institutions.  It is also an inspiring account of how governments through what the author calls a “polyvalent performance” can effectively subject donor priorities to national needs through a process of “accommodative bargaining”.

Two years of field study into the realities of population policy implementation in three regions of Tanzania are not just presented in discussions of literature, tables and graphs but through four accounts from the author’s experiences. This “Intermezzo” feature gives a human face to an often policy based discussion especially as it includes the views and the perceptions of those targeted by such policy: women. Women who are viewed as children’s mothers not as individuals, who are provided limited family planning options through clinics and Community Based Distributors. Women who are supposed to be reached out to by mostly government clinics, Integrated Projects and locally based NGO’s like UMATI (Uzazi Na Malezi Bora) The Family Planning Association of Tanzania that have had to put up with bouts of political opposition and support from government and donors alike. Women who are victims of the turf wars between NGO’s and who live with conflicts; about the perception of the traditional and the modern; about whether medicines configured for western bodies can be successfully applied to African ones; and how to negotiate shared understandings with family planning agents, their partners and spouses about the options available, the associated risks, their reproductive health and the health of their children.

Tanzania teaches the rest of Sub-Saharan Africa an important lesson about fitting family planning into basic social service delivery. Yet challenges exist for Tanzania and the developing world in the provision of basic health care for children and their mothers and in the commercialization of health care. The author tells of a race against time to save the life of a young boy affected by malaria in rural Tanzania; how he could not be admitted without a “notebook”, the rush to a pharmacy to buy a vial of quinine and medical sundries. How, when the boy was admitted,  a doubly expensive full liter bottle of glucose IV solution, purchased for the boy’s use(Half liter bottles of glucose IV solution were out of stock at the pharmacy) and reluctantly accepted by a nurse, disappeared and a half-liter bottle of solution suddenly materialized. It is clear then, a young boy could get minimal care for a treatable disease, a situation that is hardly uncommon in Uganda.

Perhaps the most important challenge Lisa Ann Richey points out is the impact of HIV/AIDS on fertility and the need to provide counseling for women and couples on family planning and the provision of a broader range of options that go beyond pills and injections. Women should not be asked: What do you want from what is available? Instead they should be asked: What do you want for your children?

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