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Population Growth Rate
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Case Study 1: A Day in the Life of a Traveling Health Care Worker, Cameroon

I park my motor scooter at the bottom of the hill and begin my trek up the dirt path. As a traveling health care worker employed by the Cameroonian government, my job is to bring education about family planning to those living in the remote, rural areas of our country. Holding today's session in a new corn mill that is part of the government-funded women's food cooperative seemed the best way to reach a majority of residents, particularly women since they are the principal cultivators of food crops. But family planning can be a controversial issue. As I crest the hill and walk toward the mill office, I am not sure how many citizens will actually show up.

My anxieties prove unfounded. I hear the hum of voices even before I open the office door. About fifteen women, representing a broad spectrum of ages, are seated on wooden benches some with small children on their laps.

"Good morning," I say. "My name is Christy Ngam, and I've come from the Ministry of Health to talk with you about family planning. After introductions, I'm going to make a brief presentation and then look forward to hearing your thoughts and concerns on the topic. Shall we begin?"

After the introductions, I spend the next hour talking about responsible parenthood and birth spacing as well as sexually transmitted diseases (STDs), including AIDS. Afterwards, I open the floor to discussion. Several participants raise their hands. I gesture for Benedicta, a forty-year-old mother of seven, to begin.

"I agree that having smaller families makes sense," she begins. "My oldest son, however, is always pointing to all the improvements in our village-this mill, the roads we have dug, our new school-and arguing that we have the resources to sustain a growing population. What shall I say to him?"

"It's good to be proud of the progress we've made," answers another woman, "but your son needs to understand that our growing population affects the land. In our village, with so many mouths to feed, the pressure to produce more food has forced us to clear a lot of our forest. This has caused soil erosion, a serious problem. As farmers, the soil is our lifeblood."

Bih, in her mid-twenties, raises her hand. "It's very important to my husband that he have many strong sons to help him raise and harvest the coffee. We've been married for five years and have two daughters so far, but only one son. If I don't have more sons, my husband may take another wife," she adds, her voice quivering.

"For many of us, a large family is a symbol of success, wealth, and prestige," I agree. "But, by spacing apart our pregnancies, we give both our sons and daughters a better chance of being born healthy and staying that way."

"As I tell my daughters, when you space your children, you can give more to the ones who are already born," says Nambang, a white-haired grandmother wearing the traditional kaba, a long, flowing dress. "There's more money to pay for food, clothing, and medicine."

"And education!" chimes in Sarah, in her mid-thirties. "My hope is that one of my daughters may go to school."

"The fewer children we have, the larger each child's portion will be when we pass on," adds Juliana. "They won't have to struggle as much as we do to support their own families."

I nod enthusiastically. "Yes, I agree with you all. Family planning means so much more than just having fewer children. It contributes to the health and well-being of the whole family."

"But what about our well-being when we are old? If we have fewer children, how can we be certain that there'll be anyone to take care of us?" asks a fifty-year-old mother of six.

I pause to frame a response, but Nambang answers for me. "I've had ten children, but only five have lived to grow into men and women. That's how it was when I was raising a family. But so much has changed in a generation. The government water and sanitation project has piped clean water into our community for the first time. Children born today are healthier than ever before. Now that we have a health centre in our village, many more babies stay well. We no longer need to have many children in the hope that a few will survive."

Kali, a teenager sporting a bright orange t-shirt, confides, "When I was growing up, my mother was always pregnant or nursing a baby. My older sister has been married for only two years and already her second child is on the way. Like my mother, she often seems tired or ill."

"I'm glad you raised that point, Chia." Turning to the others, I add, "Frequent pregnancy can harm the mother's health as well as the quality of family life."

Chia nods and says, "My fiance‚ and I are getting married next month. We want to raise a family, but we also want a different kind of life."

"It's good that your young man feels as you do, because many don't," says Rita. Standing, she addresses the group. "Look around this room. Who has come today? Women, that's who, and yet it takes both a man and a woman to make a baby. We must find a way to involve men, to make them understand that planning for and raising a family is not the responsibility of women alone!"

Around the room, heads bob and voices murmur in assent.

"It won't be easy, " states Vivian, a middle-aged woman whose toddler plays at her feet. She shakes her head. "At the last village council meeting, some of the men were angry that outsiders were trying to meddle in our private affairs."

"I share your concern," I answer. "In many of the villages I've visited, the men have been slow to come around, but many have eventually." I glance down at my watch. "It's time to break for lunch. I've certainly learned a lot from our discussion, and I hope you have too. When we return, perhaps we can talk about how to bring the whole community, especially husbands, into the discussion."

The women file outside into the bright sunshine, but I notice that Kali hangs back.

"Chia, what can I do for you?"

She gives me a shy smile. "I would like to arrange a time to talk more with you about how to set up an appointment at the health clinic."

Returning her smile, I reach for the appointment book.

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