Mozambique, one of the countries featured in the 2011 State of World Population, is a place where persistent high fertility goes hand-in-hand with poverty and gender inequality. The following story, compiled from research for the report, looks at some of causes and consequences of population growth in one of the world’s least developed countries.
MAPUTO, Mozambique — “I want three children,” Ana Maria says, pointing to her belly as she waits for prenatal care at the Boane Health Centre about an hour outside the capital, Maputo. “I already have two—a boy and a girl—and I want this to be my last,” she says, explaining that raising children is expensive and that she would rather use the money to build a new house, one that has four rooms.
Meanwhile, at an impromptu market on the outskirts of Maputo, Asucena, a 22-year-old tomato vendor, says she wants only three children. The women working in the adjacent stalls all say they want only two or three children.
And Rosalina Amores, 30, who earns approximately $100 per month as a cleaning lady at a 5-star hotel, had finished middle school when she got married at the age of 26. Pregnant with her third child, she thinks it’s time to stop.
Skipping meals to scrape by
Yet the average Mozambican woman has about six children in her lifetime, and those who live in some rural areas have an average of nearly seven. Many families don’t have enough resources to feed their large families.
Fatima, 38, for example, has six children, but is having a hard time supporting them on the $40 a month she earns cleaning a strip of the beach where she lives in Ilha de Mozambique. She’s been married for 18 years now, but her husband, like many men in the community, doesn’t have a job. “If we have breakfast, we have to skip lunch. If we have lunch, maybe we won’t have dinner,” she says.
One kilo of fish costs less than $3, but they can’t afford it either. Bananas and bread – 7 cents each – are the most common fare. “In the morning, before coming to work, we have sweetened hot water most of the days. The kids have corn flour porridge, when we get it.”
High fertility rates a 'public health issue'
Women in rural Mozambique, especially in the north, typically do all the farming, and if pregnancy or poor health prevents them from producing enough food for the family, the children risk going hungry or becoming malnourished, according to Dr. Leonardo Chavane at Mozambique’s Ministry of Health.
Nationally, 44 per cent of children are chronically malnourished, he says.
In one northern province, Cabo Delgado, where almost one in three girls is married before the age of 15 and where only 3 per cent of the female population uses modern contraception, the figure reaches 59 per cent.
A malnourished child, Dr. Chavane adds, is at risk of becoming cognitively or physically stunted, jeopardizing his or her chances for a long, healthy and productive life and contributing to an intergenerational cycle of poverty.
“High fertility rates are a public health issue,” he explains, particularly for mothers who do not have at least two years between pregnancies and who are therefore weakened and vulnerable to illness. Pregnant mothers, Chavane says, may not have “enough time to watch over their own health or the health of their other children.”
Gender inequality robs women of their power
Why is there a disconnect between the number of children women say they want or that they can support and the number they actually have?
According to a number of population and development experts and aid agencies in Mozambique, the low status of women and other forces that limit women’s economic and social opportunities are partly responsible. The country ranks high in gender inequality (111 out of 169 in UNDP’s 2010 gender inequality index). “Women are not the decision makers,” especially when it comes to choices about how many children to have or when to have them, says Carlos Arnaldo, a demographer.
Pressure from peers and family also leave little room for women to make their own reproductive decisions.
In many areas of Mozambique, if a woman secretly obtains a contraceptive from a family planning clinic and does not become pregnant, her partner or husband—and her own family, friends, even the neighbours—may criticize her for failing to have children, which in most cases are seen as a source of wealth. If a man discovers that his wife is using a contraceptive, it could lead to domestic physical violence. Or the husband may look for another woman who will bear his children. One in four Mozambican women are in polygamous unions, which is culturally accepted in some regions of the country.
Early marriage effects power dynamics and fertility
Early marriage in Mozambique is another force that chips away at a woman’s right to determine her own reproductive destiny and often resulting in early and numerous pregnancies. According to a study by Mozambique’s National Statistics Institute, more than half of women between ages 20 and 49 say there were married before the age of 18, and about one in five say they married before age 15.
“At school, adolescents are taught to wait, but there is a clash with what the family says,” explains Angela de Jesus, Provincial Director for Youth and Sports in Nampula.
“Many of these kids are brought to the rites of initiation when they are 12, 13 and deemed ready for marriage afterwards," she adds. "It’s a powerful thing when someone from your own family, someone you respect and must obey, tells you that and starts to discuss dowry issues. It’s very difficult to challenge these cultural issues.”
A 2003 report from UNFPA and the Population Council describes the “demographic consequence” of child marriage: short spans between generations and population growth. “The bride’s young age, often combined with the older age of her partner, intensifies power differentials in the relationship,” the report states.
“Her young age is indicative of a relatively low level of education. Her lack of knowledge and skills may make her more reliant on high numbers of children for security within the marriage, as well as long-term social security, and often undermines her ability to negotiate sexual relations,” according to the report.
Cultural practices reinforce inequalities
In rural areas of the country, many women become dependent on men, not by choice or longstanding tradition, but by default through the practice of lobolo, where a man offers gifts or money to a woman’s parents in exchange for a bride.
And once the man pays for the bride, he expects her to have children who can work on the farm or help out with household chores, explains Graça Samo, Executive Director of Forum Mulher, a women’s rights and advocacy group in Mozambique. If the woman fails to deliver children, she may be returned to her family, which may resist taking her back because it would entail giving a refund to the husband who rejected her.
Ms. Samo argues that leveling the playing field for women and men requires not only interventions by the state and non-profits, but also by families, which can have a tremendous influence on how girls—and boys—perceive themselves and each other in society. While it’s important to socialize girls in a way that encourages them to recognize their strengths and possibilities, it is equally important to change the way boys are socialized so they understand early in life that gender equality for men and women benefits everyone, she says.
Early marriage is associated with lack of education and high fertility
In Mozambique as in many other countries, early marriage, which is associated with high fertility, is more common among girls with little or no education. The Government outlawed marriage before the age of 16, and since 2004 when a new Family Law went into effect, a child may not marry before reaching 18 without parental consent. But the law is difficult to enforce, particularly in remote areas.
“I wanted to go [to school], to learn to write, to count the years and remember when I got married,” says Sofia, 22, from Mossuril, in the North. But ‘some years ago’ her family said it was time to start a family. So now she has four children – three boys and one girl – from different marriages. With no education, Sofia survives from what she grows in her own machamba, a piece of land she cultivates not far from her hut.
She likes the lectures promoted by UNFPA in the village, where she learns how to space children and avoid infections. “Now that everybody goes [to the lectures], I started to try [to stop having children],” she says.
Education is key to empowerment
It seems clear that women in Mozambique would have fewer children if they were empowered to make or participate in the decisions that affect their lives. Central to that empowerment is education, says Samuel Mills, senior health specialist at the World Bank in Washington, D.C. Contraceptive use around the world tends to be more prevalent among women with more education.
In Mozambique, among women with no formal education, only about 1 in 10 women uses a contraceptive, while nearly 4 in 10 women with at least a secondary education use contraceptives. And higher levels of education are also associated with improved reproductive health outcomes, which include healthier mothers and healthier babies, according to an April 2011 World Bank profile of reproductive health in Mozambique.
The fertility rate in the capital, where women are generally more educated and have easier access to contraception, is three, about half the national average.
Fewer than half of girls go to secondary school
The Government has made great progress in giving girls at least a primary education and is now taking action to step up enrolments of girls in secondary school, according to Eurico Banze, the National Director of Special Programmes at Mozambique’s Ministry of Education.
Still, nationwide, fewer than half the country’s girls finish grade 7, about the time that many girls become pregnant and drop out. “If girls can stay in school past grade 8,” Banze says, “they are more likely to delay their first pregnancy.” If girls manage to stay in school until grades 10 or 11, they are more likely to become aware of their potential role in society and start thinking about career possibilities, giving them a greater range of choices and possibilities, he adds.
Cremilda Hilario, 20, counts herself as lucky. She received a scholarship from the Mozambican government to study Foreign Relations in Dar es Salaam, Tanzania, and doesn’t even think about getting married yet.
“Not many of us have this opportunity. I have two more years to go. When I finish my studies I’ll go back to Maputo. I have many things to do.”
Large families a form of social protection
Breaking the cycle between fertility, poverty, poor health and lack of education is particularly difficult in rural areas. Although large families may be harder to support, they also serve as a form of social protection in a country with high infant mortality and few social safety nets.
“Children represent family capital,” says Ms. Samo. “Having children has been seen as a way of getting power.”
Seeing children as wealth may make sense to families in a country where cash is scarce and family members can help with chores. But at the country level, it means that even Mozambique’s fast-growing economy – it grew at an average of 8 per cent annually between 1996 and 2008—is not robust enough to fully offset the country’s population growth rate and has not alleviated poverty.
The Government does not try to discourage anyone from having lots of children, according to Dr. Chavane. Instead, he says, it appeals to the universal desire to have healthy children and healthy mothers -- and this means encouraging couples to delay their first pregnancy and to leave at least two years between pregnancies. He says the Government has launched a campaign that shows how spacing births translates into healthier—and more economically productive—families.
“My mother, she had six children,” says Sofia Ibraim. “Maybe I’ll have another after this one,” she adds, looking at Basili, 2, the youngest of her four children. “Or maybe not.”
— Reported by Richard Kollodge and Etienne Franca