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Population Dynamics of Kenya 6 Socioeconomic and Program Factors Related to Fertility Change The analysis in Chapter 5 indicates the relative importance of several proximate determinants in the fertility decline that occurred in Kenya from the mid-1970s to the late 1980s. In this chapter we go beyond the proximate determinants to the underlying socioeconomic factors that, in turn, affect the increases in the age of marriage and the increase in the proportion using contraception. Our question is: What are the socioeconomic changes that have led to these behavioral changes on the part of women and men in Kenya? For many of these factors, it appears that the changes have been strongly affected by government policy and program initiatives. Thus, in this chapter we also look at the evolution and effects of these initiatives. ANALYTICAL FRAMEWORK In thinking about these changes it is helpful to have some analytical framework guiding our discussion. The essence of a fertility transition such as Kenya is experiencing is a movement from an uncontrolled natural fertility regime to a situation in which individuals plan their childbearing and attempt to reach some target family size using whatever means are at their disposal. The relatively constant total fertility rates of more than 8.0 during the 1960s and 1970s almost certainly indicate that natural fertility prevailed in Kenya at that time. As we have seen, this situation has changed dramatically in the last 10 to 15 years. There are now quite striking variations in fertility and also in the proximate determinants at the province and district level. Thus, it seems that natural fertility is giving way to planned fertility.
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Population Dynamics of Kenya If we accept this, what socioeconomic factors are likely to be associated with decreasing desired or intended family size and, consequently, with growing efforts to control fertility? More particularly, which policies and programs launched by the government of Kenya had the greatest effect on these changed fertility goals and processes? The most widely known theoretical framework found in the current literature suggests that couples do attempt to maximize over time the wellbeing of their immediate household/family group and that fertility plans are made in this context (Easterlin and Crimmins, 1985). That is, the expected benefits to the household or gains from children are balanced against perceived costs and disadvantages, and a target outcome results. Thus, socioeconomic factors affect fertility plans by affecting the perceptions of the benefits and costs of various family sizes. Government policies and programs also will have an effect on fertility through these channels. Fertility intentions become real fertility outcomes through the use of some technology to control fertility. The availability of modern contraceptives can also affect fertility outcomes by making couples more effective planners. Policy and program have effects, in this fashion, by introducing the means of contraception, or making them cheaper (Berelson, 1977). Without accepting all the tenets of this economic model, it is helpful to organize our discussion around this framework of demand and supply of children. That is, we assume that certain socioeconomic policies and programs affect the perceived costs and benefits of children and hence the demand for them by couples. Other programs affect the cost of controlling fertility. The potential supply of children can also be affected by socioeconomic policies and programs, but these appear less significant in the present case. In the next section, we discuss changes in reproductive preferences in Kenya, which serve as an indicator of the demand for children. We then outline the socioeconomic and program factors that are associated with changes in preferences and ability to meet them. CHANGES IN REPRODUCTIVE PREFERENCES The Kenya Fertility Survey (KFS), the Kenya Contraceptive Prevalence Survey (KCPS), and the Kenya Demographic and Health Survey (KDHS) collected data on ideal family size and preferences for bearing another child. These data serve as indicators of fertility norms and intentions and are useful in suggesting the demand for family planning. As discussed in Chapter 2, reproductive preferences in Kenya have changed dramatically between 1977–1978 and 1988–1989. The proportion of currently married women who desire no more children increased from 17.0 to 50.9 percent, and the mean ideal family size among all women dropped from 6.2 to 4.4 children. Such large changes (in percentage terms)
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Population Dynamics of Kenya TABLE 6-1 Percentage of Currently Married Fecunda Women Who Want No More Children By Age Group, KFS, KCPS, and KDHS Survey Date Age Group 1977–1978 1984 1988–1989 15–19 2 3.8 9.3 20–24 4 10.7 18.4 25–29 12 23.4 39.5 30–34 19 45.0 57.3 35–39 25 53.7 69.7 40–44 40 66.6 83.5 45–49 42 75.9 89.0 Total 17 31.5 50.9 a Women who state they are capable of having another child. in fertility preferences have not been documented elsewhere in sub-Saharan Africa. Table 6-1 shows the percentage of currently married women (by age group) who wanted no more children for all three surveys. The desire for no more children increased for all age groups from 1977–1978 to 1988–1989. For example, at the first period, only 25 percent of women aged 35–39 wanted no more children; in 1988–1989, 69.7 percent of women in this age group wanted no more children. The most recent data (KDHS) indicate that the percentage of women who wanted no more children is positively associated with the number of living children (data not shown). Although only 3 percent of women with one child wanted no more children, 82 percent of women with six or more children wanted no more children, indicating a strong desire to limit family size. There was also significant interest in spacing births. Approximately 50 percent of women with one or two children wanted to wait at least 2 years before their next birth.1 In summary, substantial changes in fertility preferences occurred over the 11-year period between the KFS and the KDHS. If women could have the ideal number of children they say they want, the total fertility rate in 1 Westoff and Ochoa (1991) used these fertility preferences data to measure unmet need for family planning, as indicated by the proportion of women who are exposed to the risk of conception, are not using a contraceptive method, and say they want to delay or limit childbearing. They found that in 1988–1989, 38 percent of currently married women in Kenya were in need of family planning, with about 60 percent of these women wanting to delay their next birth and about 40 percent wanting to limit childbearing. The measures indicate greater unmet need in urban than in rural areas and among women with primary education than no education or at least secondary education. Overall, unmet need increased 129 percent between 1977–1978 and 1988–1989.
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Population Dynamics of Kenya Kenya would drop by about two births (Westoff, 1991b). The discrepancy between actual and desired TFR indicates a strong demand for family planning as well as the likelihood that fertility will continue to decline. GROWTH OF GOVERNMENT PROGRAMS In Chapter 2, we allude briefly to the emphasis the government of Kenya has placed on improving the nation's physical infrastructure, and its education and health systems. Capital spending for these three objectives was heavy, particularly during the first decade of Kenya's independence. Recurrent expenditures for the latter two program areas have continued to be substantial (see Table 6-2). Currently, education and health alone account for nearly one-quarter of all government spending in Kenya. The development strategy followed by Kenya has emphasized the creation of social and capital infrastructure: human capital through education and health, and physical capital through roads, transport, communications, and other facilities. The linkages and economic spillovers generated from this infra TABLE 6-2 Central Government Expenditures in Kenya by Broad Categories (percent by fiscal years) 1975 1980 1985 1990 Administration 15.0 17.3 12.7 15.6 Defense 6.3 14.6 7.8 5.2 Education 21.2 17.7 20.2 18.9 Health 6.9 7.1 5.7 4.9 Social security and welfare 0.0 2.2 3.9a 3.7a Housing and community development 3.7 1.3 Agriculture 11.3 7.8 14.3b 17.3b Manufacturing and construction 2.2 1.9 Electricity and water 2.9 4.4 6.9c 6.9c Roads 8.7 6.5 Communication 4.5 2.5 Other 14.6 15.3 28.4d 27.1d Transfers to other government agencies 2.6 1.4 Total 99.9 100.0 100.0 100.0 a Includes housing and community development b Includes manufacturing and construction. c Includes roads and communication. d Includes transfers to other government agencies. SOURCES: World Bank (1983); Kenya (1991a).
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Population Dynamics of Kenya structure for the mainly private productive sectors of the economy have no doubt contributed to the rapid rates of increase in the gross domestic product (World Bank, 1980 and 1983). A fact well worth noting is that the high priority assigned to this social overhead investment, human and physical, was a Kenyan decision. Kenyan political leaders and their technicians believed that there was a deep-rooted, widespread demand throughout the country for health and education services; they also believed that improved internal communications and transportation were necessary to unite the country, and would also be popular with the masses. In retrospect, these appear to have been correct intuitions. But the donor groups, who were paying for a large share of the development budgets, frequently argued that Kenya was moving too fast and ''overinvesting'' in these areas. For example, a World Bank (1963:223) economic review commenting on educational issues stated, "Although the enthusiasm for education in Kenya and the striking advances that have been made are in many respects admirable, they will pose a major problem ... the mission urges policies of restraint towards further enlargement of primary education in Kenya." The same report advised against a planned expansion of hospital facilities and said, "While there is an urgent need to meet particular deficiencies ... we do not believe a general expansion of hospital and health facilities can be undertaken" (World Bank, 1963:309). The World Bank mission was equally skeptical about proposed road construction and, in particular, recommended against the reconstruction of the Nairobi-Mombasa highway. The report stated, "The mission considers that this work should be postponed until more essential projects have been undertaken, including those in other fields of development" (World Bank, 1963:333). Ten years later, another World Bank report sounded similar cautious notes about the pace and direction of much of Kenya's development spending. It singled out road construction and telecommunications and warned that a "momentum" had been built up that would be difficult to slow down. It added, "A similar situation can be seen within the social services ... no one can deny that education, health, and other services are justified on economic and humanitarian grounds ... but the past rate of increase is such that some curb is essential if it is not to run away with the budget" (World Bank, 1975:37). Other donor reports reflected a similar concern that Kenya was overinvesting in human and capital infrastructure, and was neglecting agriculture and industry. But the programs went forward anyway and achieved remarkable gains. Transportation and Communication In the case of roads, there was an increase from 50,000 to 64,000 kilometers between 1975 and 1991, a 25 percent increase. Given the fact
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Population Dynamics of Kenya that many of the existing roads were improved and upgraded as well, the overall expansion in the efficiency and usability of the system was even greater than these figures would indicate. More than one-third of this increase was in the Rift Valley Province. At the district level, Machakos in Eastern Province was the greatest beneficiary. The number of licensed public passenger service vehicles (buses, minivans, etc.) and freight transport vehicles increased by 50 percent, from 8,000 to 12,000, between 1980 and 1988, and the number of private motor cars, including those of the government, rose from 114,000 to 142,000 in the same period, an increase of some 30 percent. The number of telephones in use doubled between 1979 and 1988 from less than 90,000 to more than 180,000. Domestic mail traffic, as measured by the volume of letters handled, rose by 60 percent between 1980 and 1988, and so on. Other data point in the same direction, that internal movement and communication increased rapidly as a result of the improved infrastructure created by government programs (Kenya, 1991a,b). Education The achievements of the educational policy have been equally impressive and also highly visible. From 1976 to 1990, enrollment in primary schools in Kenya increased at an annual average rate of 4.4 percent. By 1990, primary school enrollment rates of the appropriate age cohorts were greater than 90 percent, with the enrollment rates for females only slightly lower than those for males. The number of primary schools roughly doubled during this same period, as did the number of teachers employed in the system (see Table 6-3). This expansion affected all parts of the country: The growth rates have been most rapid in the relatively remote districts of the northeast and west. Expansion of the secondary school system has also been rapid but has not achieved the near-universality of the primary system. As might be expected, only a fraction of the primary school graduates go on to secondary school, but this fraction has been rising and as of 1990 stood at nearly half of the primary school graduates. Expansion of the secondary school system has been especially rapid in the last 10 years as the popularity of education has spread. Secondary school enrollments have been growing at about 5.0 percent per annum, more rapidly than primary school enrollments because of the lower base from which the former group started (Kenya, 1975, 1991a). In both primary and secondary enrollments, the female proportion has tended to grow more rapidly than the male. In 1970, only about 40 percent of primary enrollees were females, but by 1991 this proportion had risen to 49 percent. There was substantial variations in this proportion by province, with the Coast and Western provinces in particular showing a much lower
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Population Dynamics of Kenya TABLE 6-3 Growth of Social Programs in Kenya 1970 1975 1980 1985 1990 Schools Primary 10,817 12,936 14,691 Secondary 1,904 2,413 2,654 Number of teachers 129,040 161,840 193,683 Doctorsa 11.9 9.6 10.1 13.2 14.1 Registered and enrolled nursesa 63.7 72.8 97.2 102.7 107.5 a per 100,000 population. SOURCES: Kenya (1989b, 1991a). female enrollment. Nationally, as of 1991 the proportion of females in the secondary school population was a lower 42 percent of the total. Overall adult literacy has also grown steadily. Defined as the proportion of persons 15 years and older who are not students but who are literate, the proportion literate grew from 46 percent in 1976 to 54 percent in 1988. The rate of increase will climb sharply as the older age groups who passed through the school age years before the new policy was in effect die (Court and Ghai, 1974). Health Expansion of the health system has also been rapid (see Table 6-3). According to a recent World Bank (1991a) report, in 1960 Kenya had about 700 doctors, 2,000 registered nurses, and 11,000 hospital beds for a population of around 9 million. By 1969, the number of doctors and nurses had grown to more than 3,000 and 10,000, respectively, and the number of hospital beds had tripled. Since 1980, the number of all health facilities (hospitals, health centers, subcenters, and dispensaries) has increased by one-thd with nearly all of this growth occurring among subcenters and dispensaries, particularly in rural areas. As of 1989, there was one health facility per 12,000 people in Kenya, and more than 75 percent of the population had a health facility within 8 kilometers of their residence. There are, of course, regional variations in these averages, and medical personnel do tend to concentrate in urban areas, but even the more remote areas are reasonably well served by the health system, particularly by African standards. This system is public and private. About 70 percent of Kenya's hospital beds are provided in government facilities, and 70 percent of the rural health subcenters and dispensaries are operated by the Ministry of Health
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Population Dynamics of Kenya (MOH) (Kenya, 1989c). Private institutions and practitioners, municipally sponsored facilities, and church-related or other nongovernmental organizations (NGOs) provide the rest. The emphasis of the system has been on curative medicine, but the MOH has also had considerable success with its child immunization program. By 1987, 75 percent of children aged 12 to 23 months had received the recommended three doses of oral polio and DPT (diphtheria-pertussis-tetanus) shots, and 60 percent had received the measles vaccine (Kenya, 1991c). Other preventive programs include child nutrition through growth monitoring and prenatal care. Health education and out-reach programs have also been launched to deal with diarrheal diseases, stressing personal and household hygiene and safe water supply. The system has clearly created a demand for its services. Underutilization of facilities, which is a common problem with new, rapidly expanding health systems in other developing countries, was never a problem in Kenya. Indeed, in 1989 the government initiated fees for nearly all of its health services, partly to force clients to become aware of the costs involved and not to overuse the services (and in the case of hospitals, to overstay). Family Planning Family planning services in Kenya have been delivered under the MOH, and this system has grown along with the health system. It is worthwhile to look at how family planning policy and program evolved in Kenya. In Kenya, as in many other developing countries, organized efforts to promote family planning began with privately sponsored associations in large cities, such as Nairobi and Mombasa, in the years just after World War II. A grant to the new Family Planning Association of Kenya (FPAK) from the Pathfinder Fund in 1959 allowed it to hire its first full-time organizer-secretary and to affiliate with the London-based International Planned Parenthood Federation (IPPF) in 1962, thus becoming the first sub-Saharan African affiliate of IPPF (Radel, 1973). When Kenya became independent in 1963, the question of controlling population growth was, in a sense, already on the nation's agenda. As early as 1955, the East African Royal Commission on Land and Population had called attention to the rapid population growth and to the growing scarcity of new, arable land (Henin, 1985). The 1948 and 1962 population censuses documented the rapid growth in population and led to much discussion in the press. When, in 1965, the ruling government party issued its statement of national philosophy and purpose, the document expressed concern over the implications of unchecked population growth in Kenya. Shortly afterward, with technical and financial help from private foreign donor groups, most notably the Ford Foundation and the Population Council, the government invited a team of international experts to analyze the demographic
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Population Dynamics of Kenya situation in Kenya and make recommendations. This group's report, issued in August 1965, argued that rapid population growth was indeed a serious economic and social threat to Kenya's future, and urged a national policy and program to reduce fertility. The report was accepted by the cabinet after some spirited discussion and debate. It provided the basis for a similar analysis of population effects on development contained in the First Five-Year Development Plan adopted in 1966 and the announcement in 1967 of a National Family Planning Program. By 1968 the MOH had issued guidelines covering family planning to all its facilities and had opened the first explicitly family planning centers in the Central Province (Fendel and Gill, 1970; Radel, 1973; Henin, 1987). Thus, only a few years after gaining independence, Kenya had adopted a national population program, making it the first country in sub-Saharan Africa to do so. This initiative inevitably raised hopes abroad that fertility reduction would follow quickly, but it did not. The Kenyan approach saw the family planning program effort as inescapably linked to the creation of a general rural health system; hence one could move only as fast as the other. Construction of facilities, training of staff, and procurement of equipment and supplies all had to precede effective delivery of services. A substantial amount of educational and public relations work was also required because in spite of the official policy there was great skepticism in and out of government about the need for the program. A data base and a capacity for program evaluation and research were built up slowly at the Central Bureau of Statistics and through the creation of the Population Studies and Research Institute at the University of Nairobi. This early, almost preliminary, period of building physical and human capital infrastructure consumed nearly the entire first decade of program activity. Various organizational and administrative structures were proposed, employed, and then modified as program activity and experience grew. By 1982, program activity had become sufficiently multisectoral and complex to require a new overall coordinating body and the National Council on Population and Development (NCPD) was created (Henin, 1987; Oucho, 1987). The council's creation had strong support within the government of Kenya, including from President Moi himself, as well as from major foreign donor groups. The NCPD was not designed to replace the existing MOH service delivery network. It was created to coordinate the incorporation of other government agencies into the program, the expansion of private sector and NGO activities, and the development of a renewed public information and education emphasis (Saunders and Mbiti, 1979). The 1980s, especially the last half, were the period during which the program began to take hold and show rapid growth. For example, between 1981–1982 and 1987–1988 the number of health workers trained in family planning grew from 1,027 to 2,170; the number of contraceptive service
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Population Dynamics of Kenya delivery points (SDPs) increased from less than 100 to 465; and new acceptors increased from less than 100,000 annually to more than 300,000 (Henin, 1987). Two-thirds of this increase in trained health workers and four-fifths of the openings of SDPs occurred during the latter half of the period. In the last 2 years, the rate of training workers and creating SDPs accelerated notably (Kelley and Nobbe, 1990). Private sector and NGO activity also expanded rapidly. A private sector family planning project was launched in 1985, and a community-based contraceptive distribution scheme was initiated through FPAK in 1986. The privately sponsored Kenya Association for Voluntary Sterilization began work in 1982 and grew rapidly (Bertrand et al., 1989). All these agencies increased the outreach and also the popular support for contraceptive usage (see Table 6-4) (Phillips and Kiragu, 1989). Thus, it seems fair to say that in spite of early disappointments and a series of premature and negative judgments from some observers, the Kenyan family planning program had by the second half of the 1980s become an effective mechanism for delivering services in Kenya. Its original strategy of working through the growing health network appears to have been sound. The program as it stands is by no means perfect, and its reach and influence are uneven across the country. But one in three women in Kenya is now contracepting, and some two-thirds of these women obtain their supplies and other assistance from official service delivery points. The program is an important part of why contraceptive prevalence is rising (Kelley and Nobbe, 1990; Miller et al., 1991; World Bank, 1991b) Land Policy One other important facet of Kenyan government policy since independence remains to be discussed, namely, land policy. One of the first major goals of the independent Kenyan government was to undo the longstanding colonial government policy of reserving for white settlers some 3 million acres of prize agricultural land in the rift valley and the highlands of north-central Kenya. Between 1962 and 1972 a redistribution program, the "million acre scheme," was implemented and about 34,000 black Kenyans acquired land. These lands were purchased by the government and were obtained either from white owners who were leaving the country or from areas not being cultivated there to fore. Something less than a million acres was actually transferred but the average new holding was still 20 acres, well above the average of small subsistence farms in most regions of Kenya (Okoth-Ogendo, 1981; Heyer et al., 1976; Bates, 1989). The second stage of land redistribution was the creation of 12,000 Shiraka plots, or farms, that gave the cultivator limited ownership and control subject to some traditional communal ownership rights. Many of the preexisting white Kenyan farms took on black Kenyan coowners, and the white
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Population Dynamics of Kenya TABLE 6-4 Kenya Family Planning Performance Data (thousands) Year First Visits Revisits Acceptors 1967 2 8 3 1968 12 18 9 1969 30 73 26 1970 35 114 31 1971 41 139 41 1972 45 172 43 1973 50 211 47 1974 51 233 49 1975 53 244 51 1976 61 272 53 1977 73 284 55 1978 62 303 67 1979 65 308 60 1980 65 350 61 1981 59 297 64 1982 65 344 63 1983 68 348 67 1984 83 370 82 1985 82 361 99 1986 93 366 92 1987 377 1,333 336 1988 257 682 251 1989 280 245 277 NOTE: The coverage of the data collection system varies from year to year, thus, year-to-year changes should not be interpreted too literally. However, we believe the trends indicated are broadly reliable. SOURCES: Krystall et al. (1978); Kenya (1989d). monopoly on the most fertile land effectively ended. However, a dualistic pattern of land holdings has persisted in Kenyan agriculture, with one-quarter of the high-and medium-potential arable land being farmed in large units that produce more than half of all agricultural output (Bates, 1989). The remaining one-half of total output is produced by small-scale farms on three-quarters of the high-and medium-potential land plus the low-potential land, which is four times as large as the richer-grade land. Thus, 20 percent of the farms, occupying 5 percent of the total arable land, produce half of the total agricultural output. This half is the major exportable surplus that flows to the urban areas and abroad. Along with the land redistribution policies the government attempted to rationalize the pattern of land tenure through the "registration, adjudication, and consolidation program." The program was an effort to provide legally
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Population Dynamics of Kenya correct, secure, freehold tenure for individual owners so that they would be encouraged to invest in the land and, hence, increase productivity and output. The old communal holding system and growing land squatting were thought to militate against increases in agricultural productivity. To this end, land surveys were undertaken, and a legal procedure for obtaining clear titles, as well as procedures for settling disputes, was established. These processes continue into the early 1990s but have not by all means eliminated disputes or led to a clear understanding regarding ownership of all land (Okoth-Ogendo, 1981). On balance, the World Bank and other observers believe that land has been more widely distributed in Kenya in the last several decades (World Bank, 1980, 1983). The nationalization scheme has, however, been a mixed blessing for smallholders because frequently the procedures for obtaining title favor the wealthy and the better educated at the expense of the real cultivators. Land prices have risen, leading some smallholders to sell unwisely simply to support current consumption. All in all, landlessness has probably increased (Harbeson, 1971; Collier and Lal, 1980; World Bank, 1983). Overall, these land policies have had the effect of increasing output and broadening the base of ownership, but have done little to aid the smallholder or the landless. The sheer weight of population increase alone would cause rising land prices and pressure on all existing holdings. Kenya's population has roughly doubled since independence, whereas cultivable land has increased little if at all. Limited evidence suggests that Kenyans are aware of these changing circumstances. Scarcity of land was cited as one of the primary motives for voluntary surgical contraception in four districts in Kenya (Bertrand et al., 1989). Focus group studies by Hammerslough (1991 a) indicate that lack of arable land was a key factor in the decision to use contraception. EFFECTS OF GOVERNMENT INITIATIVES ON FERTILITY Let us now return to the decision process by which fertility has been led to decline in Kenya. We have suggested that once controlled fertility becomes the norm and replaces natural fertility, couples attempt a purposeful balancing of the expected gains and losses (or benefits and costs) from various family sizes and then act accordingly, using whatever controlling technology is available to them. Coale has interpreted the essence of what goes on in a fertility transition as three interrelated steps (Coale, 1973). First, couples must come to understand and fully accept that fertility can be controlled (without physical or moral harm to anyone); second, couples must then desire control over their own fertility, plan, and act accordingly; third, couples must have access to some means of effecting control and implementing their plans, which promises a reasonable probability of suc-
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Population Dynamics of Kenya cess. Coale has called this the "ready, willing, and able" rule, and we can view the economic model as becoming applicable when people come to understand that control is possible, desirable, and feasible. The economic model centers on the desirability aspect and articulates the various factors that affect the benefits and costs of children and hence the "demand" for them. What most family planning programs are all about is making it easier for couples to plan and implement their fertility goals effectively (Berelson, 1977). Thus, the thrust of a great deal of Kenya's development effort has been toward the creation of better social infrastructure and improving the quality of the human capital stock. In a single generation, Kenyans have become literate, geographically mobile, consumer goods-oriented, health-seeking economic beings. In short, they have experienced a profound change in basic orientation, attitudes, and aspirations. Government policy has contributed to this transformation in the following specific ways: Achieving near-universal primary school enrollment has resulted in mass literacy for the below-40 age groups being achieved and a strong desire for still-higher education being implanted in nearly all households. Literacy affects fertility in a variety of ways including opening couples to new ideas and new information, increasing modern sector labor force participation of both men and women, and leading to an aspiration for fewer, but higher-quality (better-educated) children. The actual approach to education pursued by the government has been a cost-sharing one. That is, although no fees are charged for primary school enrollment, the villagers are responsible typically for building and maintaining the schools, and must also bear the cost of textbooks, supplies, and uniforms, which can be substantial, particularly for a large family. This cost sharing has served as a constant reminder that there is an out-of-pocket cost connected with children for the parents. In addition, primary schooling has been mandatory since 1978. The large government investment in the health system has helped reduce the level of mortality and morbidity, particularly among infants and young children. Couples in Kenya are now aware that most children born will survive to adulthood and hence there is less need for "excess" births to achieve any given target of family size. The growth of the government health system, with the parallel NGO network, has also had the effect of building confidence in the usefulness of such services. When the clinics and personnel are there and are helpful, people tend to return and to become "health seekers." Because of the close link between the family planning program and the general health system, the growth of public confidence in the health system has paid substantial dividends for the family planning effort as well.
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Population Dynamics of Kenya Improving transport and communications has increased the mobility of people as well as ideas in Kenya. Improvements in literacy obviously also interact with the technological changes, and the result has been the creation of a more sophisticated and aware public. The improved transport and communications system has worked to increase the efficiency of government services. Rural clinics and schools are less isolated than a generation ago, and supplies and personnel move more quickly back and forth. The most remote government facility in Kenya today is at most a day's drive from the headquarters or a few minutes away by phone or wire. Unlike some nations, Kenya has from its beginning assigned a high priority to making its programs work for and with the women of the country. Kenyan female labor force participation and gainful economic activity have always been high by international standards, but certainly modern sector involvement has risen as a result of numerous government programs. Women's groups of all sorts—church, political, community service, cooperatives, and so on—are common in rural Kenya, and government programs frequently have worked through and with such groups (Hammerslough, 1991b). As women have become more literate they have also naturally sought modern labor force jobs and assumed a greater decision-making role within the household. Policy is at least partly responsible for that (World Bank, 1991 a). (See Chapter 7 for data on the educational attainment of women and female employment in the modern sector.) Thus, these government policies and programs have probably all decreased the demand for children by raising aspirations for high-"quality" children, who are relatively expensive, and by increasing the spread of modern ideas and information, including a material goods orientation and a small-family norm, from urban to rural areas. These government influences have helped convert couples who were "ready" into couples who were "willing" family planners. The growth of the family planning infrastructure has made available better technology, which has made them more ''able" to achieve their goals. One additional and important point needs to be made, and this concerns the possible effect of income on fertility during the last two to three decades. Received theory says that the demand for children (for the enjoyment of child services) should under ordinary conditions be related positively to income changes. That is, if income goes up, so should the demand for children and vice versa. What we have sketched above concerning Kenya's development thus far suggests that a profound economic and social transformation has occurred. But although Kenya has come close to attaining modernity in outlook and aspirations in a generation, nothing we have reviewed indicates that the average income of the ordinary household unit in Kenya has experienced any marked improvement. In so far as the data
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Population Dynamics of Kenya allow us to draw conclusions, we would suggest that income rose for many sectors in the first decade after independence, but leveled off, and then probably fell in the early 1980s, at least in per capita terms. Thus, Kenya did not have to contend with any possible effect of income increasing fertility. Indeed, it could be argued that the reverse has been true; that from the late 1970s to the mid-1980s there was a slow but steady squeeze on the standard of living of the great majority of Kenyan households precisely at the time that they were becoming more sophisticated, goods-oriented consumers. The growing pressure of population on the size of land-holdings and the rising price of land are other important influences. In other words, there may have been a slight economic reversal at work in Kenya, even while an economic and social transformation was under way. This reversal was not a deliberate goal of policy, but the result is real all the same. Finally, there are aspects of government policy and programs that do not fit very well into the categories of the microeconomic theory of fertility that we have chosen to use as our analytic framework in this chapter. The qualitative changes in aspirations that we have discussed is one such factor. These changes have been called ''ideational changes" (Wilson and Cleland, 1987), and they fit badly in the simple economic model, except as an influence on tastes. So also does the important role of leadership in promoting the spread of the small-family norm and family planning services. Nearly all observers agree that the family planning program became energized because of the strong and public endorsement in 1980 of family planning by top government leaders including President Moi. Presumably this support helped legitimize the whole notion for many people and moved many couples from the ready to the willing category. Such strong top leadership also affected program effectiveness and increased the ability to plan families. SUMMARY An exploration of the socioeconomic factors affecting demographic changes in Kenya reveals the importance of several government policies and programs. Substantial resources were devoted to building the nation's physical infrastructure through the expansion of roads, transport, and communications and to investing in human capital through improvements in education and health systems. Although the family planning program grew by fits and starts, it evolved into one of the most effective programs in sub-Saharan Africa in the 1980s. Political support for these development programs certainly contributed to their success. Such policies and programs had their effect on fertility by changing the attitudes and aspirations of the Kenyan people. High rates of primary school enrollment have produced a very literate population under the age of 40. It is thought that participation in the educational system has exposed people to
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Population Dynamics of Kenya new ideas, increased employment in the modern sector, and contributed to smaller desired family sizes as parents invest in the education of fewer children. Expansion of the health care system has undoubtedly reduced infant and child mortality rates and inspired public acceptance of the usefulness of health, as well as family planning, services. Improvements in physical infrastructure have connected most communities with the modern sector and increased the flows of people and ideas. Finally, these programs have not neglected women and have probably contributed to their improved status.
Representative terms from entire chapter: