Family Planning and the Politics of Population in Tanzania: International to Local Discourse

Family Planning and the Politics of Population in Tanzania: International to Local DiscourseAuthor(s): Lisa RicheySource: The Journal of Modern African Studies, Vol. 37, No. 3 (Sep., 1999), pp. 457-487Published by: Cambridge University PressStable URL: http://www.jstor.org/stable/161873 .

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The Journal of Modern African Studies, 37, 3 (I999), pp. 457-487. Printed in the United Kingdom ? i999 Cambridge University Press

Family planning and the politics of population in Tanzania:

international to local discourse Lisa Richey*

ABSTRACT

Population politics in Tanzania reflect multiple understandings of the 'problem' of population. While Tanzania has a long history of family planning service provision through its childspacing programmes, a national population policy was not adopted until i992. This work explores the ambiguity and ambivalence reflected in the discourse surrounding the Tanzanian National Population Policy. Although an international consensus on questions of population and family planning may have been reached at the I994 Inter- national Conference on Population and Development in Cairo, when we look at actual cases of policy formulation and implementation, the discourse reflects ambiguity and conflict rather than consensus. The Tanzanian case suggests that this ambiguity may be strategic. Competing 'positive' and 'negative' approaches have been articulated from the level of national policy negotiations to that of local implementation. This enables the Tanzanian government, promoting a 'positive' view of population, to ally itself with proponents of an expanded reproductive health agenda without alienating the elements of the population establishment that pushed for a population policy and fund its implementation.

INTRODUCTION

Tanzania has an ambivalent history with regard to issues of family planning and population. In I959 it was one of the first countries to introduce family planning services through the independent Family Planning Association of Tanganyika (later Tanzania) (UMATI), yet it has been one of the last countries in Africa to prepare a comprehensive national population policy. Former President Julius Nyerere was a supporter of family planning for child spacing, yet some leftist group

* Department of Political Science, University of North Carolina at Chapel Hill. Funding for this research and writing was provided by the J. William Fulbright Foundation and the Royster Society of Fellows. I would like to thank Deborah Barrett, Stacie Colwell, Susan Geiger, Betsy Hartmann, Ngeta Kabiri, Catherine Newbury, Julius Nyang'oro, Stefano Ponte, Katherine Wildman, and two anonymous reviewers for reading and commenting on various drafts of this article. As always, any shortcomings in the work are the sole responsibility of its author.



458 LISA RICHEY

and religious leaders have been outspoken in opposition to family planning and even forced the closure of clinics during the I970s.0 After five years of negotiations and revisions, the National Population Policy (NPP) was adopted in I 992, and the National Family Planning Programme (NFPP) developed as one of its implementing arms.

The formation of a national population policy in Tanzania was difficult to achieve, because two different approaches to the 'problem' of population were used: a 'positive' and a 'negative' approach.2 These competing discourses were articulated from the level of national policy negotiations to the level of local NPP implementation. This article will argue that while an international consensus on questions of population and family planning may have been reached at the I994 International Conference on Population and Development in Cairo,3 when we look at actual cases of policy formulation and implementation, the discourse reflects ambiguity and conflict rather than consensus.4 However, the Tanzanian case suggests that this ambiguity may be strategic. It enables the Tanzanian government, promoting a ' positive' view of population, to ally itself with proponents of the expanded reproductive health agenda that emerged from Cairo, without alienating the elements of the international population establishment that reflect the remnants of Neo-Malthusianism that characterized the push for a population policy.

This article explores the discourse of population in Tanzania to show how the 'problem' of population is being viewed through differing 'negative' and 'positive' lenses.5 This dual interpretation leads to corresponding ambiguities in formulation and implementation of the NPP from the international to the local level. To contextualise my analysis, I begin in the second section by describing my use of the terms 'negative' and 'positive' as approaches to population, and trace the theoretical and international context of the problematisation of population in Tanzania. In the third section, I show the history within Tanzania of how the interpretations of the population 'problem' have varied, and how the 'positive' lens has been subjected to the 'negative' one by analysing the discourse of donors and lenders on Tanzania's population 'problem' and relevant solutions to it. In section four, I show an ongoing ambivalence around the central role of family planning within the NPP. The fifth section shows how the same conflicting discourse seen at the policy level reappeared in the implementation of the NPP at the local level. The final section draws conclusions and suggests possible directions for changing interpretations of the NPP in Tanzania.



FAMILY PLANNING IN TANZANIA 459

POSITIVE AND 'NEGATIVE APPROACHES TO POPULATION:

TRACING A HISTORICAL AND THEORETICAL TRAJECTORY

This article examines what policy makers and implementors involved at all levels of the NPP say about population and family planning: how population is described as a 'problem' and family planning as its solution. This discourse can be understood as a conflict between two different lenses, 'positive' and 'negative '.6 The ability to define population differently to meet different needs has made the discourse and resultant policy decisions around it more acceptable. The way that the 'problem' of population is approached parallels Amartya Sen's usage of 'positive' and 'negative' theories when speaking of freedom (I995: 9I). Sen explains that:

The negative view sees freedom exclusively in terms of the independence of the individual from interference by others, including governments, institutions and other persons. The positive view, which can be characterized in many different ways, sees freedom not in terms of the presence or absence of interference by others, but in terms of what a person is actually able to do or to be. The distinction may be quite central to different approaches to the idea of freedom and its implications.

The 'negative' view of population in the Tanzanian discourse focuses on the independence of individuals and society to develop without interference from excess population competing for resources. The ' positive' view sees the population issue as a question of what Tanzanians as individuals or in society are able to do or be.

'Population' is defined in the 'negative' sense as something quantitative - increasing numbers of people which leads to problems of 'development'. These problems result from population over- burdening the systems which provide for development opportunities and resources.7 The environment, the health care and educational systems, even the family, are perceived as buckling under the demands of an ever-increasing population. This concept of population in the 'negative' sense attributes underdevelopment to an escalating population eroding the opportunities and resources available. Increasing quantity is viewed as a destructive force in the development process, rather than as a productive one.

'Population' may also be defined in a 'positive' sense by focusing on issues of the quality of people, not the quantity. Improving the quality of a population emphasises the attributes of systems and their ability to provide for meaningful development, rather than focusing on simply whether or not people have access to these systems. This 'positive'



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notion of population, like Sen's 'positive' freedom, focuses on people's productive capacities, rather than their destruction of resources and opportunities. When population is used in this 'positive' sense, it is a way of calling for more development programmes such as increased social sector spending, employment creation and state assistance to vulnerable groups.

Tanzania has historically taken a strong stance on its 'positive' approach to population. As one of the most outspoken advocates of focusing on the 'development problem' instead of the 'population problem', Tanzania's stance at the I974 Population Conference in Bucharest is well known.8 Mkini (I 980: 64) describes how 'the head of the Tanzanian delegation noted that almost all countries in Africa had suffered severely from colonialism and slavery, hence this experience had taught the African countries that, 'for us, people, population are a development asset, the present history of continuing decolonisation is a great testimony of this ... the creative and over abundant power of the people to surmount all obstacles'.

Again, in response to the I976 Third UN Inquiry among governments on population policies, Tanzania clarified for the international community the official position on the lack of a population 'problem'. Tanzania stated that its rate of population growth was considered beneficial because it

contributes positively to economic and social development by permitting conservation of environment for future use by providing sufficient population for: environmental maintenance, economic exploitation of natural resources including food production, supply of manpower for economic expansion ... [and provides] demographic dynamism sufficient to maintain national innovative capacity, achieve desired levels of replacement of population and to support a national and cultural identity (UNFPA, I979: 2I).

The government also stated that 'the present rate of fertility contributed positively to family well-being by making possible achievement of the desired number of children, providing support for aging parents, ensuring continuity (descendancy) of the family, and providing sufficient family labour' (ibid.: 22). The government was clearly reiterating its stance from Bucharest that development, not population growth, was the major problem for Tanzania. How did the Tanzanian discourse shift so that the 'development' problem became superseded by the 'population' problem?

Tanzania's shift came at the same time that many other Third World countries were changing their official statements and policies on issues of population.9 It also came at a time when Tanzania's economy was



FAMILY PLANNING IN TANZANIA 46I

hitting rock bottom, dramatically altering its relationship with donors and international lending institutions. Finkle and Crane (I985: I)

describe the radically different environment of the I984 International Conference on Population held in Mexico City, compared to the I974

Conference in Bucharest: 'this time, the developing countries were in a different frame of mind. They no longer spoke of international population assistance as racist, genocidal, or imperialistic, or accused Western nations of advocating population control as a substitute for foreign aid...' A significant reason for this change, noted by Finkle and Crane, was that indebtedness and dependence on aid made Third World countries careful about damaging their relations with the West. Therefore, to understand the changing discourses of population in Tanzania, we must consider the international climate into which these discourses were received.

The ongoing debates over the population 'problem' and family planning as its solution are well known. For the most part, US policy has reflected a mainstream consensus that a 'population bomb' or 'population explosion' is taking place in the Third World for which population control through family planning is the primary answer (see e.g. Abernethy I993; Erlich & Erlich I990; Lyon & Reid I972;

Malthus I914). However, these generalizations have been called into debate by Third World leaders,'0 and feminist scholars and activists (see, e.g. Bandarage I997; Birke et al. I990; Finkle & Crane I975; de Barbieri I993; Dixon-Mueller I993; Hartmann I995; Petchesky I987; Snow I 994; Stanworth I 987). Emerging from the I 994 Cairo Conference, a so-called 'landmark consensus'11 embraces a new paradigm of women's reproductive health as the foundation for a different generation of approaches to population.12 As elaborated by the United Nations Population Fund:

reproductive health is a positive state, not merely the absence of disease or infirmity... [It] exists in a broader context... [which] includes action towards gender equity, including equal access for women to health care and education, income-generating opportunities, and work in the professional, academic and political spheres. (UNFPA I994 c: 8)

Hodgson and Watkins (997) suggest that the Cairo consensus reflects a fragile alliance between American Neo-Malthusians and American feminists.13 However, they conclude that the future of the Cairo consensus rests with the South. Arguing that 'many Southern governments are currently staffed with officials who hold strong neo- Malthusian beliefs', Hodgson and Watkins suggest that Southern states



462 LISA RICHEY

may support the Cairo Programme of Action if they find that it is strategic for procuring donor funds. As I demonstrate in this article, the population landscape in Tanzania consists of historically rooted competing discourses. The Tanzanian state, while maintaining its historical commitment to a 'positive' agenda, acts strategically in interpreting its NPP and in negotiating its implementation through donor-funded projects. While Hodgson and Watkins argue that any longevity in the Cairo agenda may rest with Neo-Malthusians in the South, I believe that countries such as Tanzania, lacking a clearly articulated neo-Malthusian or developmentalist position, may provide a more fertile ground for implementing an expanded reproductive health agenda. By maintaining a strategic ambivalence, the Tanzanian state has been able to appease donors when they offered assistance to promote subtly different demographic objectives. It will also be able to embrace, perhaps even more strongly, offers of assistance under the Cairo rhetoric.

Mr U. P. K. Tenende, project coordinator of Tanzania's Population Planning Unit,'4 described the 'positive' and 'negative' approaches to population in his introductory remarks at the National Planning Commission's 'Workshop to Prepare the National Population Pro- gramme Work Plans' :15

A population policy is always an integral and central part of a development policy. It has two basic elements: i. The number of people (Population is a material concept. That is why it is important to specify what population you are talking about - the concept is purely inanimate. When you count people, it is just the same as counting stones. We want to put some meat into that counting. There is a difference between counting people and counting stones.) 2. The quality of the individuals which constitute the numbers of the population.

From this definition, it is easy to understand that Tanzanian policy makers do not want to be identified with 'counting stones'; they want the focus of population to be on people. Twelve out of the nineteen NPP workshop participants completed a written questionnaire which provided an indication of government members' opinions of the NPP. Their responses emphasised the importance of both lenses in the Tanzanian discourse on population. They described the most significant problems that can be addressed by the NPP in terms of health, demographics and national development. Specifically, they wrote that the NPP can address high infant and maternal mortality, high levels of fertility and population growth, and low quality of life, relating to socioeconomic development. The chairperson of the workshop, S. B. Buberwa, noted that the focus on human beings was an old idea. He




went on to say: 'In the independence period, we had this in mind, but were taken off track by the economic programs of the Ig8os.'16

While the government here was putting forward a 'positive' approach, in the realm of implementation, they had to negotiate with the 'negative' discourse generally promoted by donors.'7 In the post- Cairo environment, donors pay lipservice to the 'positive' approach, while their discourse reflects the understanding that a large quantity of people competing for limited resources precludes development. Therefore, the NPP implementation focus for donors was family planning programmes.' Attempts within the 'negative' approach to teach Tanzanians to think demographically have been fairly effective when targeting policy makers and implementors; however, to gain acceptability amongst local women, family planning must be linked with other issues of concern such as health and education. No one involved in post-Cairo family planning wants to be identified with the 'negative' approach to population and demographic goals, but only with the 'positive' approach and 'development' goals.

These 'positive' and 'negative' definitions of population must be considered together, used interchangeably, and often conflated altogether for the logic of the population discourse to continue. The way this is achieved is through the use of an argument known to logicians as a fallacy of equivocation. This fallacy takes the form: (I)

all banks have money; (2) every river has two banks; therefore (3), all rivers have money. The fallacy, of course, consists in changing the meaning of one of the terms of the syllogism in the middle of the discussion.' With the population discourse, it goes like this: (I)

maternal mortality/child health/female education/women's status (or any other 'quality' issue) are population problems; (2) population problems ('quantity issue') are solved by increasing family planning; therefore (3), maternal mortality/child health/female education/ women's status/etc. are solved by increasing family planning. In the population fallacy of equivocation, the meaning of 'population problems' changes in the middle of the argument from a 'positive' one to a 'negative' one, but the logic continues to sound reasonable.

The population fallacy of equivocation is important because it demonstrates how it may appear that the Tanzanian government and its donors are in agreement over population issues: they are speaking the same words, but it is not in the interest of either actor to admit that they are not talking about the same things. The ambiguity on both sides is strategic. Thus, the government can refrain from acknowledging the 'negative' agenda of the donors and continue to accept their



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funding, and the donors can continue to promote their identity as philanthropists interested in humanistic goals of 'development'.

However, the 'positive' and 'negative' approaches to the 'problem' of population are not identical, nor are the solutions which would be given priority in solving them. This creates an ongoing tension within the NPP, as 'negative' and 'positive' approaches to the 'problem' of 'population' compete for scarce resources. A member of the Planning Commission explained the position of the Tanzanian government in strategising such issues. He said:

It is important to develop strategies that show that we [the Tanzanian government] understand all aspects of the population problem. Each country or donor has its own interests in decreasing population growth. It's the main goal of the ICPD [International Conference on Population and Development, known as the Cairo Conference], but it's hidden - not mentioned anywhere - only the larger factors affecting it are addressed ... We must develop a Tanzanian plan or we will be subjected to universal solutions ... reducing the population growth rate is not the central feature of the policy [NPP]...20

From this statement, we can see that the Tanzanian government clearly recognises the donors' ' negative' agenda; however, the possibility still exists for developing a 'Tanzanian plan' that will deal with a broader, 'positive' approach to population. Indeed, the actual policy itself is a vague and extremely broad statement which shows that instead of fully embracing the discourse of population as a 'problem' or clinging to earlier stances on the primacy of the development problem over the population problem, the government included both.2'

SHIFTING IDEOLOGIES AND COMPETING EMPHASES BETWEEN

THE 'POSITIVE AND 'NEGATIVE APPROACHES TOWARDS THE

POPULATION PROBLEM'

We cannot talk about the history of the NPP without placing it in the context of the relations between the Tanzanian government and its donors and lenders. This section briefly traces the history of the population 'problem' as it was conceptualised in Tanzania. Then it demonstrates the evolution of the 'problem' of population in the relationship between the government, the IMF and the World Bank, pointing out the gap between ideas of the i980s and those which had come before. Finally, it describes the ideology on these issues of some of the members of Tanzania's donor community. It is important to note




that donor ideology toward Tanzanian population is very similar, if not identical, to the donor discourse in other Third World countries, and thus, it reflects not a country-specific strategy based on the political and demographic realities of Tanzania, but a larger strategy for dealing with the 'problem' of population at the global level (Warwick I982).

A booklet describing the role of UNFPA in Tanzania states: 'Tanzania's population problem is not one of absolute numbers or density, but rather the rate at which the population is growing in relation to the country's capacity to meet people's basic needs' (UNFPA I 994 b: 7) . Mainland Tanzania has a total population of 28-8 million people in an area of 945,000 square kilometres, or a population density of 30 5 persons per square kilometre (World Bank I 996: I 88) .22

Not surprisingly, the Tanzanian government has not historically viewed its numbers as a problem. The 'problem' of population in the strictly numerical sense - too many people - is only perceived as legitimate for a few areas of the country such as Kilimanjaro and Kagera Regions, but not for the country as a whole. Unlike many other Third World countries where the national population density is great enough to attest to the existence of a population problem, the Tanzanian population must be problematised in a different way.

In tracing the concern with population and perceived over- or underpopulation during the early independence period, Ian Thomas (I 979), a demographer who was involved as a consultant for the population policy preparation, wrote that after the colonial period when population growth was clearly seen as a necessary component of economic development, there was some debate over both what the population actually was doing and what it should do.23 The colonial and early independence government followed the recommendations of a I979 UN study that recommended a more rapid increase in population; however, it also noted the need for population re- distribution from areas of high density to those of low density.

A I969 speech given by former President Julius Nyerere has been noted in almost every discussion of the history of the NPP. In the concluding section, which set the stage for population discussions in the country, Nyerere (I973: 87, 88) stated:

Giving birth is something in which mankind and animals are equal, but rearing the young, and especially educating them for many years is something which is a unique gift and responsibility of men. It is for this reason that it is important for human beings to put emphasis on caring for children and the ability to look after them properly, rather than thinking about only the numbers of children and the ability to give birth. For it often happens that



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men's ability to give birth is greater than their ability to bring up the children in a proper manner.

In his statement, fertility reduction and family planning are not seen as synonymous with population, nor are they put forth as its solution. Nyerere's speech was named by many of my informants as an important moment in setting the direction and perspective of the Tanzanian government's 'positive' approach to the 'problem' of population. A member of the Planning Commission described how the Tanzanian government had historically viewed its population:

Nyerere, as president and chair submitted the plan and gave a speech, and among other areas, he talked about the impact of population growth. He gave the famous statement on how easy it is to have children, but it takes time before they are self reliant ... the government didn't come up with clear programmes to do something about population growth... they had the idea that development would make people realise on their own.24 (emphasis added)

According to this interpretation, the Nyerere quote is meant to show that the independent Tanzanian government had concerned itself more with the 'positive' approach to population, concentrating on development as a means of dealing with population growth. Similarly, the Country Report which Tanzania submitted to the I994 ICPD Conference in Cairo also emphasised that: 'The government of Tanzania has recognized since the i960s that much more efforts were required in the field of socioeconomic development in order to keep up with the needs of a population growing at an increasing rate of growth

[sic]' (United Republic of Tanzania I 994: 5). The method of increasing development to accommodate population as taken historically by the Tanzanian government is not the one recommended by donors and lenders; the latter call for decreasing population to accommodate low levels of development.

In describing the trajectory of the problematisation of population in Tanzania, UNFPA wrote:

until the mid-i970s, Tanzania and many other African countries didn't see increasing population as a problem. In fact, the government considered its population to be small.25 However, the country's leaders have shifted from this pro-natalist position to one of planned population growth and the balancing of population and development objectives.

How did this shift come about? My research shows that the discourse surrounding population has changed over time through workshops and sensitisation seminars emphasizing the 'negative' approach of the donors who funded them. However, interviews with policy makers and




implementors show that while the discourse has shifted, the debates remain unresolved.

During the I98os, change began to take place in the perceptions of Tanzanian officials about their population 'problem' and appropriate solutions: the 'positive' approach to population was being overtaken by a 'negative' one. Of course, this shift did not come out of nowhere. It was embedded in a changed way of thinking about Tanzania's overall approach to development. The formulation of the NPP involved the intersection of government, donors, lenders, and international organisations.26 Diverse organisations with different but convergent goals gained influence in Tanzania simultaneously, and while this did not have the overt intention of a common front organised to bombard the government with anti-natalist propaganda, it did have that outcome.

After the economic crises in the middle I 980s, almost no government funds were available for financing the NPP, in part because of squeezed government budgets under short-term socioeconomic recovery programmes. The government stated that: 'due to these budget difficulties the national population programme is mainly financed by multilateral and bilateral assistance' (United Republic of Tanzania I994: 28).

Therefore, the discourse of donors and lenders set the tone for both the conceptualization and the implementation of solutions to the population 'problem'. 27

The World Bank statement given at the Consultative Group for Tanzania meeting in June i986, the first such meeting since I977,

stated: 'We also expect to initiate studies on longer term issues such as education and training needs in Tanzania, and we will in response to the minister's request examine the possibility of support in the population field' (World Bank i986: 3, 4). The Bank used careful language to avoid any possible implications that its policies had an impact on the decision of the Tanzanian government to develop a national population policy. However, a University of Dar es Salaam professor stated that 'Tanzania was forced into a policy by con- ditionalities which are not written down' because donors want to control population if they are to give aid.28

The World Bank Social Sector Representative at the Dar es Salaam Mission Office stated in an interview that he could not remember if the Bank had been involved in any way with the formulation of the NPP, but he did not think that they had.29 He also stated that the Bank supports a health and nutrition project worth $47 million, which includes a 'tiny component to support the PPU' (Population Planning



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Unit).30 According to the Bank's own data, the 'tiny component' was $9 5 million (World Bank I 994: I I8). The position of the World Bank and IMF on Tanzania's population 'problem' is rarely discussed in official documents, as the Bank is reluctant to be identified with pushing for a population policy. However, from the documents and records of the Paris Club Meetings, we can observe their stance on these issues.

The I 988 World Bank report to the Paris Club meeting marks the first time that population is described by the Bank as a 'problem' for Tanzania's national economic development. The report states:

In addition to these key priorities for economic management, there are longer term development challenges which face Tanzania. Among these are the preparation of a population policy, to reduce over time Tanzania's present high rate of population growth, and to take account of its impact on the urban areas and on the provision of social services. The present growth rate of close to 31 percent per annum imposes an intolerable strain on basic services, on the labour market and on the environment. It needs to be brought down to a manageable level as rapidly as possible. (World Bank I 988: 8, emphasis added)

According to the World Bank, Tanzania's population is a 'problem' which needs immediate attention. In the I989 Paris Club report, the Bank states; 'Tanzania faces a serious population problem, not in terms of the current absolute number of people in the country, but because of the rapid rate of growth ... and its long-term demographic impact on the environment and on the ability of Government to provide necessary social services' (World Bank I989; 20, emphasis added). The Bank spells out the solution to its 'negative' approach to population:

To achieve these objectives and more, over the coming years it will be necessary for Government and for donors to concentrate efforts on expanding family planning services and provision of contraceptives throughout the country, improving integration of such services with STD and AIDS programs and strengthening and expanding family life education programs in schools, in addition to the strengthening of the health service delivery capacity noted above.

According to the Bank, the NPP is clearly meant to be a family planning policy.

Tanzania's donors have been similarly interested in seeing an explicit population policy that problematises population in a particular way. The 'problem' of population must be amenable to what James Ferguson calls a 'development intervention' (I 994) -one which is technical and apolitical - that is, one that a 'development agency' is capable of launching. In describing a speech given in December I 990,

an ODA report noted that '[the Planning Commission principal




secretary] was more circumspect about family planning, accepting its role as part of maternal and child health services, but expressing reservations about the necessity to promote family planning as a means of regulating population growth' (Overseas Development Adminis- tration I99I: 7). In the discourse of donors, population growth must be controlled before the issues of quality can be addressed. The I99I/92

Demographic and Health Survey (DHS)31 states the donor position which has also become the 'official understanding' of the 'problem' of population for Tanzanian development:

As in other countries in sub-Saharan Africa, rapid population growth has been associated with poor economic performance. The consequences of rapid population growth are felt acutely and visibly in the public budgets for health, education, and related fields of human resource development. It is obvious that expansion of and improvements in the quality of these services is unlikely to happen withoutfirst controlling the rapid population growth. (Ngallaba et al. I99I/2: 2, emphasis added)

This interpretation suggests that the rapidly growing population has led to Tanzania's economic problems, and thus, that the population growth must be tackled before expanding or improving the services related to 'development'.

Yeager (i982: 489) discusses the rift between national policymakers and 'certain foreign assistance specialists' over 'what should constitute the major components of an effective population policy and on the degree of emphasis that should be placed on family planning as opposed to other less direct forms of demographic management'. Yeager states that 'for its part, the USAID has maintained that Tanzania is presently facing a fertility-related problem of development and possibly even of national survival' (ibid.: 490). He quotes USAID's statement that 'unless the current rate of population growth is arrested, Tanzania will find it difficult to sustain its current development achievements, let alone move toward self- sufficiency' (ibid.). According to Yeager, even in the early 1980s, USAID was intent on viewing the population 'problem' in Tanzania as responsible for the country's lack of development, and it was promoting a 'vigorous population planning policy' with an emphasis on fertility reduction through family planning.

A USAID Population Sector representative explained to me how 'there has not been one single factor responsible for the shift, but there has definitely been a change in the climate for family planning ... between Bucharest and Cairo'. 32 He explained this shift as a direct result of donor intervention:



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In I974, Tanzania was one of the luckiest African countries in terms of aid - because the government was socialist, credible and egalitarian. We need to look at how the population has grown during this time. There is no government that can ignore that because health service systems, educational systems, road systems are developed for that population. Now 20 years later, health system, educational system, etc. have nearly collapsed... they can't keep up with the demands of a growing population ... Donors have exerted a pressure. Can the population problem be ignored? - No!"

The 'negative' approach to population as the problem, and family planning as the solution, was still a point of conflict between donors and the government in the I 990s. A high-ranking member of the Planning Commission explained how for donors 'the time element is important - bring the population growth to zero as quickly as possible. Donors thinks this is urgent and government should be more active and quick.'34 The decision by the Tanzanian government to focus on development before population growth met with resistance from the international donor community.35 The adoption of the NPP was a sign that the government had come around to a perspective that was similar to that of the organizations that would be in a position to fund its implementation. However, while the fact that a NPP had been announced was clear, the meaning of the policy and the role of family planning within it were still dispersed, with the battle lines drawn along both 'positive' and 'negative' approaches.

AMBIGUITY ABOUT THE CENTRAL ROLE OF FAMILY

PLANNING WITHIN THE NATIONAL POPULATION POLICY

A 'negative' approach to population led to a focus on limiting fertility and the resulting need for modern family planning. Warwick (I982:

34) argues that a similar focus on family planning has been the result of donor-driven population policies throughout the Third World: 'beguiling in its simplicity and appealing in its politics, this master idea [family planning] was sold to the developing countries as the answer to their population problems'. The official announcement of the NPP in I992 signified the triumph of the international organizations and donors in shifting the discourse of population from 'positive' to 'negative', such that the Tanzanian government had officially recognised its 'problem'. However, in the post-Cairo rhetorical environment, neither government officials nor donors want to be perceived as supporting family planning strictly for demographic reasons, so the 'positive' approach to population and family planning's role in addressing issues of quality are emphasised.36 An official from the Planning Commission told me: 'population policy is very basic to




the development of this nation. Therefore, the central thing is not family planning as such. It is not everything in the population policy.'37 Tanzanian officials were trying to defend the NPP from being interpreted as just a family planning policy.

In the opinion of government officials, the 'negative' approach to population with its corresponding emphasis on contraception took a back seat to a 'positive' approach. Nearly all government officials responding to my questionnaire at the NPP implementation workshop agreed that there had been a drop in Tanzanian fertility levels in the past five years. However, they disagreed as to the most significant reason for this decline, and 'increasing use of contraceptives' was ranked after 'decreasing levels of infant mortality'and 'increasing secondary education for girls'. Scarcity of land was not perceived to be a significant cause of fertility decline. This implies that these officials do not believe that demographic constraints involving land are causing Tanzanians to reduce their fertility. Health and larger 'development' issues are seen as equally important to family planning in causing fertility decline. This also coincidentally reinforces the role of the state - that is, the state's policies towards broadening girls' educational opportunities or decreasing infant mortality rates were perceived to be more responsible for the change than individual reactions to land scarcity, over which the policy makers have little influence.

Government respondents to my questionnaire noted that implementation of the NPP in Tanzania faces moderate constraints, and ranked the two most significant impediments as 'lack of available funding by government' and 'lack of available funding by donors'. Shortage of funds is a commonly cited problem in any area of 'development', but the notion that some areas within the NPP are better funded than others makes it a more contentious issue. Family planning is the aspect of the NPP which receives the most attention, and therefore funds, from donors. In response to the question 'In your opinion, why are donor countries interested in a reduction of fertility levels in Tanzania and how does this affect their funding assistance?', the most common statement was that 'donors are interested in a reduction in population growth, and that they will finance family planning services but not other sectors'. This indicates that government officials believe that the 'negative' perspectives on population are most significant to donors. Not surprisingly, when asked 'which aspects of the existing implementation program have been most effective or are likely to become effective in the near future?', over half of the respondents named 'family planning/reproductive health'.



472 LISA RICHEY

Indeed the issue of which projects under the NPP get funded and by whom is central to understanding the parameters shaping implementation. Rhetoric and public support for family planning, or for larger development issues, are important, but the bottom line is always a competition for resources. One indication of the level of government political commitment to the NPP is its financial and administrative commitment. According to UNFPA (I994a: 44):

Since i990 more and more population projects have been included in annual plans. This is mainly due to the fact that the government is committing more and more resources towards population projects, and because of this Government commitment it is a requirement that projects must be included in annual plans and budget books if Government resources are to [be] spent on these activities.

However, despite promises to the contrary,38 in November i996 the implementation work plans for the NPP were still not finalised, because of debates over whether or not they would be included in the rolling plan which would make implementation obligatory. A professor from the University of Dar es Salaam explained that 'even the position of the government, although it supports family planning, when it comes to implementation, they don't actually support it financially. They don't do the things they promised... rhetoric in politics and what happens in practice are not the same.'39 In response to the question, 'Are there any issues which are addressed or projects which are implemented which are less relevant, but are carried out because they are fully funded by outside donors?', one anonymous government official wrote, 'So far, all of them are funded simply because donors are behind them'.

The level of involvement of non-governmental organizations and donors vis-a-vis the government in implementing various aspects of the NPP is an indication of the government's priorities.40 A professor from the University of Dar es Salaam suggested to me that: 'one thing that can assist you in understanding the position of the government is to look at the government budget - how much money are they putting into family planning - none! The moment that USAID and UNFPA withdraw, there is no money which will support family planning.4" They will say, "we have other priorities".'42 It is not clear whether the Tanzanian government has singled out family planning for neglect, or whether the government, knowing that donors are willing to fund these sorts of projects, strategically shifted its own monies elsewhere. However, the symbolic meaning of the lack of government funding was clear to the USAID representative at the i996 Annual Country Programme Review Meeting. He asked the principal secretary




of the Ministry of Health (MOH) for a line-item in the budget for family planning, suggesting the need for a 'government contribution to show that there is will'." His request was never addressed.

While the government's will to support a NPP weighted heavily toward family planning may be questionable, the will of donors to support implementation of such a policy is not. In its Midterm Review of the Family Planning Services Support Project, USAID states

The main intention of the N.P.P. is to strengthen F.P. services, promote the health and welfare offamilies, and eventually reduce population growth. The major target of the policy is to reduce the total fertility rate (T.F.R.) from 6-3 (as measured in the i99i T.D.H.S.) to three by the year 2000. (USAID I994: 7, emphasis in original)

USAID is straightforward in stating its interpretation of what the NPP is, in the light of what USAID thinks it should be - a demographically oriented policy. The main document describing Tanzania's Structural Adjustment Programme in the early I 990s, reflecting the interpretation of the IMF and World Bank, states: 'this policy [NPP] aims to assure that population variables are given more consideration in development policy and to reduce birth rates and population growth over the medium term through voluntary regulation of fertility' (United Republic of Tanzania I99I: 38). The stated means are within the positive' approach, but the goal to be achieved is clearly 'negative'.

A donor-constructed agenda taking a 'negative' approach for dealing with population is not unique to Tanzania. Warwick (I982:

97) shows in his eight country study that even though their styles and power vary, 'donor influence extends from creating the conditions that lead governments to become aware of a "population problem", through defining the organizational forms and dominant emphases of family planning programs, to pressuring for specific results in implementation'.

The tension between the Tanzanian government's historical 'positive' approach, and international donors and lending institutions' ' negative' approach, complicated by the mixed justifications for achieving either 'positive' or 'negative' results and the post-Cairo agenda shift, has important consequences for the relationship between Tanzania and its donors. The government has officially shifted its position to one more compatible with donors' concerns; however, this shift has not been embraced completely at all levels of the government. When I was handing out a description of my research proposal which included the statement: 'After five years of negotiations and revisions, the National Population Policy was adopted with the National Family



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Planning Programme as its implementing arm', a member of the Planning Commission took me aside and swiftly informed me that the NPP was more thanjust family planning. He also said that he had been trying to tell USAID the same thing!

While government representatives continued to remind me that the NPP was 'more than just family planning', it seems that perhaps the crucial message of this policy was its symbolic value in the family planning realm. The existence of a population policy was understood by donors, NGOs and MOH as a gesture of political support for family planning. Knowles, Bollen and Yount (I 994) argue that political support is an important determinant of the demand and supply of family planning services, and of the other factors in the programme policy environment.44 Even without unanimous support for family planning as the centre of the NPP, simply declaring a population policy had the effect of supporting family planning. As shown by Barrett and Tsui (I998: 37), '[population] policies indicate countries' receptivity to outside assistance, flashing the "green light" to donor agencies seeking appropriate beneficiaries'. In their quantitative cross-national study,45 Barrett and Tsui (ibid.: 36) found that the existence of a population policy holds symbolic value for international aid money. The existence of a population policy proved to be the most reliable predictor both of whether a country receives population aid from USAID, and of how much money it will receive, even figured on a per capita basis. If a country adopts a population policy, it is I 25 per cent more likely to receive USAID funding, and of those countries having received funding, adopting a policy increases the countries' expected assistance nearly threefold. In the Tanzanian case, USAID population money increased one and a half times in the year following the official adoption of the NPP and has continued to increase substantially.46 The ambiguous meaning of the NPP as a 'green light' for family planning but at the same time, as more than just family planning, comes out of conflicting agendas held by the Tanzanian government and the donors, lenders and international organizations involved with the policy.

POSITIVE' AND 'NEGATIVE' APPROACHES TO IMPLEMENTING

THE NPP AT THE LOCAL LEVEL: WHAT ROLE FOR FAMILY

PLANNING?

While it is clear to policy makers that the population 'problem' is a rallying point for aid money, how do those implementing the NPP on




the ground view the population 'problem' and family planning ?7 A regional medical officer told me:

Family planning issues are national and international priorities - they are not local health needs. If you do any assessment, they never come up as local needs. We need to market family planning and create demand.48

He noted later in the same interview that family planning:

is an issue on the agenda of international donors, but there has been a past ambivalence at the national health level. They expressed approval for family planning, but didn't really do anything about it. Now since I992, because of the National Policy, they have to support it... all the donors put family planning as a priority. That is the pill which we are given. It is one which we can really give to people for them to swallow or not.49

Here we see that the symbolic value of the NPP as a statement in favour of family planning is primary to MOH personnel who are responsible for implementing programmes in the regions. The links between the international donor agenda and the national policy are clearly made, and the need to 'market' these priorities to local people rests in the NPP implementation. Tanzanian officials find themselves in an intermediary positions negotiating the donor-dependent agenda of the NPP within the context of their work with local people. These priorities, no matter how conflictual, depend on each other for their success. While the 'negative' approach to population and its goals of fertility reduction may be important for donors, local people describe their more immediate needs in terms of social and economic quality issues (such as health care, education and employment) that deal with population from a 'positive' approach.50

A high-ranking official at the regional level explained that women are feeling the stress of worsening economic conditions and that this had made them receptive to using family planning to limit their fertility:

Family planning has always been a health priority for health managers. We feel that it is not a health priority for the community as a whole... It still has to go in the background of the social context of the community. Women must have children and more children means more respect. With the new economic changes - the market economy - there is increasing pressure on women to limit their fertility. The costs of children, health, education, etc. Women are feeling the pinch now, but are also involving their husbands. The closer they are to an urban area, the more it is felt.51

A similar perspective was given by a district level maternal and child health coordinator. I asked her: 'Why do women now think of children



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in terms of resources spent or money per child? When did this start?' She responded:

People have seen problems. The increase in family planning clients began about three years ago [I993], when times became tough and things became expensive... Also, now they have been sufficiently informed, whereas in the past, they didn't know about family planning. They just had children.52 The perceived ability of family planning to combat economic problems, and thus allow families to prosper, is compelling enough to overcome other obstacles to family planning, such as opposition from the church. In a highly Catholic research locale in Ruvuma Region, a family planning service provider at a small urban clinic told me. 'the real debate is over family planning. The priests are forbidding it and telling people that it is a sin.' She said that the tough conditions were what brought family planning clients in, and that they considered it in a relative context: 'Which is a bigger sin, using family planning or not taking care of your children?'53

Emphasising family planning as a way to take care of children, instead of as a way to prevent them, is a way of providing the 'negative' solution to the population 'problem' defined from a 'positive' perspective. However, like the previously discussed fallacy of equivocation, the fact that the nature of the problem to be solved has shifted, leading to an incongruous solution, is not recognised. It is important for implementors of the NPP who work at the local level to ensure that a demographic justification for family planning is not used, lest family planning services be associated with goals of population reduction. A i984 report from an UMATI project on integrated family planning states: 'U.M.A.T.I. has repeatedly emphasized the fact that its goal is not to spread family planning for the purpose of population control but rather to enable families to have healthier children and to protect the health of the mother and ultimately the whole family will be healthy and lead a happy life' (Maro & Kihamia I984: I).

Some research in other areas has suggested that locally based NGOs function as grassroots organizations which are more connected and therefore more likely to represent the perspectives of their constituents. Indeed, UMATI wisely promotes this interpretation by stressing that it is a voluntary organisation, and its participants are referred to as 'members' not clients.54 However, Bulatao (9I 93) argues that northern-based NGOs have a history of implementing the agenda of their funders, not of their clients. My research suggests that in the Tanzanian case, the agenda of funders is significant, regardless of the northern or southern-based nature of the implementing organisation.




UMATI is dependent on foreign assistance for up to 96 per cent of its budget, about 6o per cent of which comes from IPPF (Mpangile I994: 49). Therefore, UMATI, like the Tanzanian government, must use the 'positive' and 'negative' approaches strategically to appease both international and local audiences.

At the local level, linking family planning use with larger development benefits is done through a reverse logic of sorts - what would happen if you did not use family planning. In the course of my participant observations at Maternal Child Health/family planning (MCH/FP) clinics, I heard this often. The example which follows is from a clinic in a regional hospital. I was listening to a MCH service provider who was being trained in family planning basic skills. Together with an experienced family planning trainer, she was counseling an 'at-risk'55 client. The client came in and said that she wanted 'kufunga' (literally, 'to close the womb'), so they began counselling her about female sterilisation, but as it turned out, she wanted instead 'kufunga kwa muda' (literally, 'to close for a time') not something permanent. Still, the service providers tried to persuade the woman, who was in her mid-thirties with six children, to consider not having any more children at all. They told her about the health risks of having children for women who are 'at risk', and used an interesting strategy to try to persuade her to stop having children.

First, they asked her if she had had any problems with any of her other births. When she told them that she had experienced some problems, they nodded in understanding, as if that was what they had expected since these things are likely to happen with high parity. Then, they asked about her children, if they were all still in school, which for the older ones would mean continuing on to secondary school. Some were not, to which the service providers again nodded as if this were certainly no surprise, as if the stories of youths who did not continue into secondary school were typical of all large families.56 The idea that the service providers were trying to convey was that if this woman had not had so many children, she would not have had difficult pregnancies and her children would have been able to succeed in completing a secondary school education. When the client remained unconvinced about permanent contraception, they concluded by counselling her about using Norplant.57 Here we see the 'negative' solution - limiting family size - being put forth as the answer to issues at the forefront of the 'positive' approach - education and health care.

Another example of the way that local women are convinced to use family planning by linking it with the health of women and children is



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seen in village level 'sensitisations'. When service providers go to a new area to introduce the idea of family planning they conduct a sensitisationn' where they bring in national level trainers to hold a meeting in each village with local leaders and villagers. In convincing the villagers that family planning is something they need, demographic arguments are not used. As we have seen before, a reverse logic of what bad things will happen if you do not use family planning is used. A district level maternal and child health coordinator described the introduction of the Community Based Distribution programme in the district where she worked. She described how the importance of family planning is discussed by teaching villagers about the following issues:

i. What is family planning? 2. What are the advantages (faida) of family planning for the child, father and

mother? 3. Death [of the mother] can happen during pregnancies which are closely

spaced. 4. Death of the children who are born from pregnancies too close together.

'Wasifariki kutokana na uzazi' - 'people shouldn't die from childbirth' !58

Linking family planning to decreased infant mortality is a highly compelling argument in Tanzania, where it is estimated that one child in seven will die before reaching the age of five. However, not everyone working to implement the NPP in the field is in agreement over the necessary links between family planning alone and improved maternal and child health. One regional medical officer gave an interesting perspective on this sort of justification of family planning.

Family planning is a need, but not a felt need. Of course, there is a need as we profess - see from the data - but there is no demand from the population. It is less important for them. Because people don't realize that family planning is important, we are forcing the services on them- by showing the data, maternal mortality, etc. - while the problem is not family planning. It is income... They say that if we have income, our children will not die, they will not get anemia. Some argue that maternal deaths [result from] poor service - defective health service - not associated with family planning... I find family planning important because, of course, you should plan your family. I understand, but to convince other people is difficult because... as I have said, the issue is income.59

Issues of economic hardship and poor health are ever present in the lives of ordinary Tanzanians, who are constantly looking for solutions to these problems. However, it is unlikely that family planning alone will provide a sufficient remedy. A district medical officer explained to me that the objectives of family planning that he understood were: '(I) to reduce the number of pregnancies per woman; (2) to reduce the




number of children in each family and in the nation; (3) to improve maternal health; and (4) to improve child health'. He distinguished the first two as 'direct outcomes', and the final two as 'indirect' outcomes and clarified that

regardless of whether a mother is on contraceptives or not, there are other risk factors for her mental and physical well-being and for that of her child... in order for family planning programs to succeed, they have to go hand in hand with other programs like Maternal and Child Health Care which do take care of the health of the mother and child in a direct way.60 (emphasis in original)

Still, presenting family planning as intended primarily for its health benefits for mother and child makes it much more palatable politically, and ignores the ambivalences behind the reasons donors are willing to fund planning in the first place.

The theoretical and ideological debates over defining issues of 'population' are far from being resolved and, in the words of Jan Knippers Black (i99i: I39), 'the ambiguities, inconsistencies, and outright but unacknowledged conflicts are pushed out of the assembly rooms and boardrooms and into the field'. I was struck by how the competing interpretations as to the goals of family planning at the village level reflected the same issues in national and international debate. For example, when I was working in a larger village in Morogoro Region, family planning service providers at the rural health centre told me that it is easier to get supplies for family planning than for other areas of health care because the medicines are given by donors. When I probed further, they explained that: 'donors see that women get many problems from having too many children and so they are willing to give supplies'.61 This quote shows an interpretation of family planning responding to the problem of population as defined from a 'positive' approach, as opposed to simply trying to reduce its number. Accordingly, the role of international donors is understood as benevolent.62 In contrast, a local informant, Mzee Lema63 was told quite a different story in casual conversation with an old man outside the government offices in the same village. The elder told him: 'We have seen a "mzungu " (white person, referring to me) come here with UMATI, and we know she wants us not to have children' ('Anataka tusizae'). The man's erroneously linking me with UMATI and the corresponding assumption that I wanted to limit Tanzanian fertility exemplifies both the perception of family planning as a foreign import, and the belief that family planning means limiting procreation. Specifically, that at least some villagers believe that family planning means white people wanting Tanzanians not to have children, reflects



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many of the international debates seen at Bucharest. While these debates supposedly have been resolved by the Cairo consensus and an overall emphasis on the 'positive' approach to population, it is clear that local level interpretations of these issues are still ambivalent.

The meaning of 'population' in the discourse as well as the NPP itself is vague. This is symptomatic of a larger problem in development discourses, where actors are using the same words but not talking about the same things. However, this is not necessarily detrimental for policy implementation. Indeed, this imprecision in the Tanzanian discourse is functional in allowing strategic interpretations which are context- sensitive in both the 'positive' and 'negative' senses of population. For example, a high-level government official directly involved in formu- lating the NPP explained to me why he believed that donors wanted a national policy so quickly:

Bilateral relationships - donor countries are not merely philanthropic, committed to assisting the poor. Behind that assistance there are things which are of interest to their countries. Population elements are important to them. What happens in other countries will have an impact if not today, then later... It is hard to say why they [donors] do things. Many of us have no access to information beyond project documents. We are grateful to donors. We believe it should not be of our concern what is behind it - as long as it doesn't affect us, we make the best of what is given.64

Here we see a government official, far from being naive about donors' interest in population in Tanzania, describing the importance none the less of 'making the best of what is given'. This article suggests that the ambiguous nature of the NPP, reflecting both a 'positive' and a 'negative' characterization of the population 'problem', is well suited to the ongoing international debates underlying the Cairo consensus.

After the I994 ICPD in Cairo, resources are being mobilised for the implementation of projects from all sectors which fall within the goals of the population programme, so that ongoing activities may be able to receive funding from the population sector. This opens up an area of great importance for the 'positive' approach to population. If issues of population quality are given as much emphasis as population quantity, then development strategies in other areas will have to be reconsidered. In particular, it is interesting how this notion of using the NPP and the upsurge of interest/funding in this area may in fact be used to implement social programmes, or 'human-centred' programmes which run counter to economic reform and cost-recovery.




If the goal of focusing on population issues is to decrease fertility, lowering the quantity of the population, then family planning programmes are a valid solution. However, this is quite different if the goal of focusing on population is to improve the quality of the population, where the solution is far more nebulous. The foreword to the NPP itself states: 'the main goal of the National Policy is to extend the horizon of the country's development plans whose principal objective is to move Tanzanians away from poverty and extend their horizon of standard of living' (United Republic of Tanzania I 992: iii). The NPP is a policy with tremendous scope including issues of integrated maternal and child health, women in development, children, youth, the elderly, the disabled, agriculture, food and nutrition, environment and rural development. Certainly family planning can not be counted upon as the solution in all of these areas. In this context, it is understandable that 'population' broadly defined may be a more politically palatable concept that 'family planning'. However, family planning programmes are one of the determinants of fertility which are amenable to large-scale inputs of capital, control from above, and less- partisan political activity, making them ripe for development projects.

The 'new' agenda of 'women's reproductive health' as a replacement for family planning had begun to creep into the population discourse of donors, but it had not yet made any substantive inroads in either the implementation of projects or in expanding the local discourse on population. The much-needed shift from demographic priorities to women's priorities in the international discourse opens up opportunities for new alliances between state level actors and international health advocates. The government's ambivalence in recognising the population 'problem' with the NPP, yet struggling to interpret the policy to meet larger 'development' needs, may be even more strategic as the 'reproductive health' agenda contributes a new language for the articulation of a more comprehensive approach to population. In a time of economic liberalization, social sector cuts, cost sharing, etc., the NPP may have the potential to call for much-needed increases in spending on social sector programmes under the auspices of controlling Tanzania's population 'problem'.

NOTES

I Omari (I989: 35) describes how UMATI came under fire in the early I 970s from leftists who objected that 'modern family planning practices and methods, especially as perpetuated by the multinational corporations are an imperialist and capitalist tendency and agents which are not supposed to be allowed in a country that is trying to develop a socialist ideology'.



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2 'Positive' and 'negative' are not value judgements; see Section 2. 3 For an insightful tracing of the history of the consensus between feminists and Neo-

Malthusians seen at the I994 Intergovernmental Conference on Population and Development, known as the Cairo consensus, see Hodgson & Watkins (I997).

4 While this article focuses on the case of Tanzania, similar dynamics may be taking place in other Third World countries. For a more general, aggregate discussion of approaches to population see Najam (i996).

5 This work is part of a larger project based on qualitative methodology conducted in Tanzania betweenJune I995 and November i996. The sources of data used in this article include: (i) consultation of documentary sources (including scholarly work by Tanzanian researchers; project documents, reviews and evaluation reports; surveys and demographic statistics; minutes from meetings of donors, government and NGOs); (2) observation at planning meetings and conferences concerning the NFPP; (3) interviews with persons involved in the formulation of the NPP and the implementation of the NFPP at the national level (including representatives of the Ministry of Health (MOH), the Population Planning Unit (PPU), NGOs (including UMATI), donors, the Bureau of Statistics and the Demographic and Training Unit at the University of Dar es Salaam; (4) interviews with persons responsible for implementing the NFPP in each of three regions (including MOH officials, family planning service providers, local project managers, doctors and Community Based Distribution (CBD) agents); and (5) participant observation at family planning clinics. I conducted research at national level in Dar es Salaam, and at local level in one primary region (Morogoro) and two satellite regions (Ruvuma and Kilimanjaro). Interviews in Swahili translated by author.

6 The 'positive' approach could also be characterised as 'developmental' and the 'negative' as 'demographic', in terms of their underlying logics. While it is obvious that these two are not discrete, by the end of the article it will become clear how they reflect divergent approaches to conceptualising the 'problem' of population, and to the formulation and implementation of the policy intended to grapple with this problem.

7 It is important to note that while a 'negative' approach does imply freedom from interference, it does not preclude state intervention altogether. In fact, in the 'negative' view of population, the state has the obligation to protect individual freedom from encroachment by others, hence, the possibility of a proactive population policy arising out of a 'negative' view of population.

8 The Bucharest Conference is famous for the ideological confrontation of Third World countries against Western countries over disparities in the international economic order and the necessity of linking population issues to larger development issues. See Finkle & Crane (I975).

9 Although it could be argued that Tanzania lagged behind other African countries in this reorientation. UNECA notes that between I974 and i989, the proportion of member states finding their population growth rates 'satisfactory' declined from 58 per cent to 36 per cent and those finding them 'too high' increased from 20 per cent to 54 per cent (United Nations Economic Commission for Africa I990: 2).

io Most notable is the outspoken resistance by Third World leaders at the World Population Conference in Bucharest in I974; see Finkle & Crane (I975).

i i For a discussion of how this 'consensus' was manufactured by a few powerful actors see Hartmann (I 995). Some feminists also argue that reproductive health is a rhetorical shift, but not a substantive one. For example, Bandarage (I 997) argues that the ICPD Programme of Action still embraces an instrumentalist approach to women's rights, and the Beijing Platform for Action makes no specific financial commitment to its proposals for improving women's lives. Without becoming entangled in this ongoing debate, this article will show how, in the case of Tanzania, the discourse shift to reproductive health did not have a significant effect on the formulation of the NPP, nor had it led to substantive changes in policy implementation by i996. However, concluding that the shift to 'reproductive health' was purely cosmetic would be premature at this stage.

I 2 For a literature review on reproductive health see Lane (I994).

I3 Hodgson & Watkins (I997) emphasise that while many actors, including those from the South, participated in the Cairo process, American Neo-Malthusians and feminists had the greatest impact in determining the present cast of international population policy, and the US will be responsible for funding much of its implementation.

I4 The Planning Commission of the President's Office established the Population Planning Unit in the Human Resources Planning Department. The PPU is responsible for coordinating the




activities of the NPP, including population IEC, population and development activities, publications, mass media, seminars and workshops for policy makers at the national, regional and district levels (United Republic of Tanzania I994).

I 5 This workshop was intended to gather government representatives from the various sectors which would be affected by the National Population Policy, along with relevant NGOs and donors. As was the case in similar meetings organised by the government, several sector representatives, NGO officials, and, most notably, donors, did not participate in this sparsely attended workshop. While donors and NGOs may have held differing reasons for not attending, their absence may indicate that they did not expect the decisions made within the realm of the state to have had a significant impact on their activities. This suggests that perhaps the decisions that counted were those made by the funders, not the drafters or implementors of the policy. The workshop did offer an opportunity for hearing how government leaders talked about population when donors were not present.

i 6 Buberwa refers to the structural adjustment programmes and their consequences of reduced social spending. Also, Buberwa's address alluded to what Najam (1 996: 3) has termed the concern for 'additionality': the South's worry that greater donor assistance to population will translate into less assistance for other development projects.

I 7 The main donors financing the NPP are USAID and UNFPA. USAID began with a budget of $20 million for I900-97, providing just over 56 per cent of the financial support to family planning, and increased this to $30 million over the life of the project. UNPFA provided $2 I million for its five-year programme (i992-96). From Bureau of Statistics (1997: vi); UNFPA (i996: iv); USAID (i990: I; i996: 40). Other donors included IPPF (International Planned Parenthood Federation), ODA (Overseas Development Administration), GTZ (German Technical Assistance Agency), NORAD (Norwegian Agency for International Development), and JOICFP (Japanese Organisation for International Cooperation in Family Planning). While there are, of course, differences in donor philosophies, the international population discourse as set by the major donors shapes how population is problematised under the NPP. USAID was primarily responsible for determining the discourse on population in Tanzania, which is not unlike its role in other Third World nations; see Warwick (i982).

i8 USAID states: 'Because of U.S.A.I.D. assistance, Tanzania's family planning program is one of the top performing population programs in Africa' (USAID i996: xiii).

i9 This example comes from Ferguson (I994: 55), who uses it to illustrate a similar sleight of hand in the larger 'development' discourse.

20 Interview 95GDoib, I3 Aug. I995. 2I The policy discourse is in some parts a clear representation of the anti-natalist

problematisation promoted by donors and international agencies; however in other parts it could have come directly from the early independence notions of population. Therefore, what we see in the policy is actually two discourses simultaneously used without a clear prioritisation of one over the other, leaving much room for manoeuvre with regard to implementation.

22 For comparison, the population density in the US is 27-8 persons per square kilometre; in the world, it is 42-0; in all high income countries, 26-7; in middle income countries, 25-6; and in low income countries excluding China and India 78-8 (World Bank i996: i88-9).

23 Thomas (I979: i2) cites Caldwell (i968) as reporting that the independent government's position was in favour of a larger population and that the birth rate should be higher.

24 Interview 95GDoIa, I3 Sept. I995. 25 It is worth noting here that the United Nations conducted a study of the demographic

situation in Tanganyika in I949 and recommended that a faster increase in population was needed; see Mkini (ig80). The colonial and early independence governments followed these recommendations.

26 The omission of NGOs here is important: my research shows that NGOs had comparatively little power in shaping the agenda of population in contemporary Tanzania. The only NGO considered as a non-governmental organisation by my informants was UMATI. While UMATI has historically played an important role in promoting family planning, its influence was reduced from I 974 with the government's involvement in family planning and continuing with the advent of the National Family Planning Programme. Due to a combination of its reduced influence and its dependence on donor funding, UMATI has little opportunity to speak as an independent voice in the current discourse on Tanzanian population. Other NGOs were either left out of consideration by my informants or were referred to as 'donors'. There were however, other NGOs working in Tanzania family planning. For example, a Kenya-based NGO, Marie Stopes,



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provided women's reproductive health services, although these were limited on the mainland to Dar es Salaam and Arusha, and thus had negligible national impact. Other NGOs and international organisations such as Pathfinder, the Population Council, and UNFPA were amongst the actors referred to as 'donors'. While they are not 'government' organisations, they are not 'local' ones either. Thus, their directives, motivations and most of all, funding came from outside sources, usually Western governments. SDA (Seventh Day Adventists) on the other hand, seemed to be thought of more as a church organisation, perhaps giving aid in the health sector as missions have done historically, but with a 'modern' twist of offering family planning services in their clinics and paid Community Based Distribution (CBD) services.

27 For an example of how the IMF and World Bank have come to dominate the African health sector see Turshen (I995).

28 Interview 95NDoi, 25 Aug. I995. 29 Interview 95DDoi, 30 Aug. I995. 30 He went on to explain that the PPU was supposed to be co-financed by UNFPA, but due

to some 'mistake of communication', the Bank is financing the whole thing. 3 I The DHS was conducted by the Tanzanian Bureau of Statistics and the Washington-based

Macro International at the request of, and with funding from, USAID. 32 Interview 95DDo0a, 29 Jan. I 996. 33 Ibid. 34 Interview 95GDoIb, I3 Aug. I995. 35 The process by which Tanzanians were taught to 'think demographically' involved ongoing

sensitisation seminars aimed at helping officials to recognise the population 'problem' facing the country.

36 Warwick (I 982: 33) describes a similar scenario during the implementation of the Kenyan national population policy. Government leads 'compartmentalised' the debates around the policy: 'privately they admitted that the basic purpose of the program, and the reason that it was so generously funded by foreign donors, was to lower the birth rate. Publicly they affirmed that its aim was to promote maternal and child health.'

37 Interview 95GDoIa, I3 Sept. 1995. 38 The principal secretary from the MOH told the Annual Country Programme Review

Meeting in January I 996 that 'government is preparing to take population issues into the general national planning procedures and make them part of the rolling plans'. From participant observation fieldnotes 95DDo6, 3I Jan. i996.

39 Interview 95NDO2, I2 Dec. I997. 40 Ekanem (i988: 13) shows that the low priority placed on population issues is common in

African countries, where family planning is a sensitive political issue and governments must tread carefully.

4I Indeed, sustainability is a major concern of donors. USAID, through its affiliates, funded research in 1993 to determine the government contribution to family planning. The report from this study found that 'government expenditure on family planning service provision per health unit is minimal' (Kessy and Neukom I 994: I) .

42 Interview 95NDO2, I2 Dec. I997. 43 From participant observation fieldnotes 95DDo6, 3I Jan. i996. 44 The programme policy environment includes (I) the degree of political support for a family

planning programme; (2) the programme's organisational structure; (3) its legal and regulatory environment; (4) the resources available to it; and (5) its use of provider and acceptor incentives and cost recovery (Knowles et al. I994).

45 Barrett & Tsui (I 999) use a time-series regression and time-varying covariates on a sample of II 4 Third World countries covering the period from 1973 to I992.

46 For the case of Tanzania, Barrett & Tsui's data show USAID contributed $4,444,000 in 1992 and climbing to $6,709,000 in 1993, and $7,84I,000 in I994. Email communication with Deborah Barrett, 14 May I998.

47 Because the focus of this article is on the population discourse as it is presented to women, not on how it is received by them, I will not take up analysis of women's interpretations of or ideas about family planning and the population problem. As a reviewer pointed out, individual responses to such discourses in their contraceptive decision-making are an important part of the larger study of family planning in Tanzania, but to speak to this issue would greatly extend an already lengthy article. I would argue that the context in which contraceptive decision-making is made is significantly shaped by the problematisation of population by those providing both the




contraceptives and the arguments for using them. Contraceptives are never a 'neutral' technology; see, for example, Bandarage 1997; Corea et al. I986; Snow 1994; Stanworth I987. This makes the context in which they are delivered, from the policy level to the clinic level, an important issue for analysis.

48 Interview 95GOo6, I 2 Aug. i996. 49 Ibid. 50 For example, when I asked Marjorie Mbilnyi of the Tanzania Gender Networking

Programme about the importance of family planning issues for Tanzanian women's NGOs, she responded that: 'Within women's N.G.O.s employment and incentives are the major issue now. Family planning just doesn't come up as a burning issue, whereas maternal mortality does' (interview, Dar es Salaam, I Sept. I995).

5I Interview 95G06, i2 Aug. i996. 52 Interview gSGMo7, I 2 July I 996. 53 Participant observation fieldnotes, 95GRi9. 54 Its membership is over 200,000 and its volunteer structure includes 8oo Branch Committees,

83 District Committees, 20 Regional Committees and a National Executive Committee (USAID, I990) .

55 The term 'at risk' (along with others such as 'informed choice' and 'reproductive health') was consistently used in English, in the midst of family planning discussions in Kiswahili. This use of a foreign language to describe foreign concepts recurs in the Tanzanian context.

56 According to the Bureau of Statistics, Ministry of Community Development, Women Affairs and Children (1995: 92), fewer than 15 per cent of primary school graduates go on to secondary school; this is one of the lowest percentages in Sub-Saharan Africa.

57 Participant observation fieldnotes, 95GMio. 58 Interview 95GRo8, 20 Aug. i996. 59 Interview 95GRog, 20 Aug. I996. 6o Email communication, 95GR26, 2 May I998. 6i Interview with Service Providers 95GMI4, 30 Apr. i996. 62 This interpretation may rest in the position of the family planning service providers

themselves, whose status is improved by the prioritisation of family planning and its funding from outside. Clinic workers have become professionalizedd' in some of the ways called for by Demerath (I973). However, this 'professional' status is not indigenously created. Local service providers are the ones wielding power of the 'white man's' expertise; see Booth ( 995) for a discussion of these dynamics in relation to AIDS treatment in Kenyan clinics.

63 Not his real name. 64 Interview 95GDoib, I3 Aug. I995.

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Family Planning and the Politics of Population in Tanzania: International to Local Discourse

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