Dar es Salaam is definitely a beautiful city. The people are great and food is delicious. But one thing that has not gone unnoticed the immense amount of poverty around the city. Although it is the largest city in Tanzania (and contrary to popular belief it is not the capital) and has many features that cities in developed countries have, it does not change the fact that many of the city’s inhabitants are poor. Tanzania has an annual gross national income per capita of $1,440 US dollars. The poorest quintile shares 6.8 percent of the nation’s income (World Bank). Moreover, Dar lacks a certain infrastructure that sets it apart from more developed cities. Through my experience I have seen the several aspects of society affected by these impoverished conditions. Even within the basic infrastructural services offered by the government, including transportation, education, and water and hygiene sanitation, there are faults. One particular sector affected is Tanzania’s healthcare system.
As a progressive nation, Tanzania has made great strides in improving its healthcare sector, as seen through the efforts of the Ministry of Health and Social Welfare (MOHSW). Although there are several areas of the health sector, that are deficient including HIV/AIDS and maternal and child care, family planning is the most critical area that needs urgent attention. This week I was blessed with the opportunity to attend Tanzania’s first annual National Family Planning Conference. From this experience I was able to gain insight into the state of family planning in Tanzania.
Tanzania is one of the fastest growing nations in the world. In 1967 Tanzania had a population of 12.3 million. As of last year the population had nearly quadrupled to 44.9 million citizens. With a 2.9 percent population growth rate, Tanzania is expanding exponentially. It is projected that in 2035 Tanzania will have a population of nearly 100 million people. As mentioned, despite being one of sub-Saharan Africa’s more progressive and prosperous countries, Tanzania remains a low-income country. The government of Tanzania simply does not have the capacity nor can it afford to support 100 million citizens. Resources for supporting such population growth in terms of health, education, housing, jobs, food, water, and security do not match the growth Tanzania is facing. In certain areas, the resources aren't even enough for the current population.
Contributing to Tanzania’s rapid population growth is its high total fertility rate (TFR). As of 2011, 5.4 children are born per woman of childbearing age, according to the World Bank. This rate is astounding. However, one in four women cannot access the family planning services that they need; this unmet need for contraception is a major impact on Tanzania’s TFR. There are also high rates of teenage pregnancy, with 23 percent of females ages 15 to 19 who have had children or are currently pregnant. Early marriage which also fuels this high fertility rate.
With one-third of Tanzanians living under the poverty line, the poorest girls are the most vulnerable. They are the ones most likely to get married earlier and become pregnant at a dangerously young age. This vicious cycle has been embedded within Tanzanian society, especially in rural areas, for many decades. Fatma Mrisho, the chairperson for Tanzanian’s Commission for AIDS (TACAIDS), thoroughly expressed her concern regarding teenage pregnancy and early marriage; “We need to tell Tanzanians we don’t need so many children, and let’s do so unapologetically. We must educate ourselves.” In reference to early marriage, she said, “We’re using the politically correct term ‘marriage’ but what it really means is sex and risk.” Mrisho was unapologetic throughout her speech and emphasized the increasing need for family planning services.
According to Mrisho’s research, meeting family planning needs can prevent 54 million unintended pregnancies per year, thereby resulting in 26 million fewer abortions and 79,000 fewer maternal deaths. Furthermore, it prevents the spread of HIV/AIDS and other STDs and promotes responsible development and environmental sustainability.
The severity of the situation has been thoroughly understood in Tanzania as seen by the dedication of the MOHSW and many other Tanzanian partnerships to increase family planning as a means to meet Millennium Development Goal 5. There have been efforts to incorporate family planning and other sexual and reproductive health services into the national health scheme. Young women especially are becoming impacted by the lack of family planning services. Tanzania as a nation must address family planning; it is essential for survival and development. It is critical that family planning works with all other elements of the health system. Despite the progress made, there is more that needs to be done to strive for a demographic transition from high fertility, mortality, and rapid population growth to a more sustainable society free of those repressive outcomes.