Women wanting fewer children swim against the tide

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.

Rosalina's third child may be her last. Photo: Etienne Franca/UNFPA

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. Raising children is expensive and she would rather use the money to build a new house, one that has four rooms.

At an impromptu market on the outskirts of Maputo, Asucena, a 22-year-old tomato vendor, says she wants three children only. The women working in the adjacent stalls all say they want two or three children only.

Rosalina Amores, 30, earns approximately $100 per month as a cleaning lady at a five-star hotel. She had finished middle school when she married at the age of 26. Pregnant with her third child, she thinks it’s time to stop at this number.

Skipping meals to scrape by

The average Mozambican woman has six children in her lifetime, and those who live in some rural areas have an average of seven. Many families don’t have enough resources to feed their large families.

Fatima, 38, has six children but finds it difficult 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 kilogram of fish costs less than $3 but they can’t afford this. Bananas and bread – at 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 have it.”

High fertility rates a 'public health issue'

Women in rural Mozambique, especially in the north, typically do all the farming. If pregnancy or poor health stops 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 the northern province of Cabo Delgado, where one in three girls is married before the age of 15 and where only three per cent of the female population uses modern contraception, the figure is closer to two thirds (59 per cent).

A malnourished child, Dr. Chavane adds, is at risk of becoming cognitively or physically stunted, jeopardizing his or her chances of 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 leave 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

The question is why there is a disconnect between the number of children women say they want or can support and the number they actually have. According to 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 choosing how many children to have or when to have them, says Carlos Arnaldo, a demographer.

Pressure from their peers and family members leave little room for women to make their own reproductive decisions. In many areas of Mozambique, if a woman secretly obtains contraception 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, who 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 violence. Or he 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 affects power dynamics and fertility

Sofia, mother of four, is considering whether she wants another baby. Photo: Benedicte Desrus, SIPA Press/UNFPA

Early marriage in Mozambique is another force that chips away at a woman’s right to determine her reproductive destiny and often results in early and numerous pregnancies. According to a study by Mozambique’s National Statistics Institute, more than half of women between the ages 20 and 49 married before the age of 18, and about one in five married before the age of 15.

“At school, adolescents are taught to wait, but this clashes with what their families say,” 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 or 13 and are deemed ready for marriage afterwards. "It’s a powerful thing when someone from your family, someone you respect and 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 lobola, where a man offers gifts or money to a woman’s parents in exchange for her as his 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 produce children she may be returned to her family, who may refuse to take her back because it would entail refunding the lobola to the husband who rejected her.

Ms. Samo argues that levelling the playing field for women and men requires not only interventions by the state and non-profit organizations, but also by families, who 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 a lack of education and high fertility

Mozambican women average six children. Photo: Etienne Franca/UNFPA

In Mozambique, 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 came into effect, a teenager may not marry before the age of 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 the 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 higher education.

Among Mozambican women with no formal education, only one in ten uses contraception, while nearly four in ten 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 city, Maputo, where women are generally more educated and have easier access to contraception, is three children – about half the national average.

Less than half of all girls attend secondary school

Cremilda has earned a scholarship to study in Tanzania.  Photo: Etienne Franca/UNFPA

The government has made great strides in giving girls at least a primary education and is now taking action to step up enrolments 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, which is 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 lucky. She received a scholarship from the Mozambican Government to study foreign relations in Dar es Salaam, Tanzania, and is not yet considering marriage. It is her future and the contribution she can make that occupy her mind. “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,” she says.

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 is seen as a way of gaining power.”

Equating children with 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.

Nor does the government attempt to discourage anyone from having many 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 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