Signs of progress are appearing on one of Africa's toughest battle fronts: population control. Behind the flow of grim statistics on the continent's rapid growth rate - the world's highest - there is evidence of changing attitudes and expanding family planning efforts that could lead, experts say, to a slowing of the growth rate. Some indications are:
Acceptance of family planning is on the rise in Africa, according to African and US family planning experts. More and more African government leaders are endorsing the need for population control. And in some places, people want more information and contraceptives than are now available.
Key strategies to make family planning information and materials more widely available are being expanded. Among them:
1. Family planning professionals are training local residents, who then visit their neighbors to promote family planning. This method by-passes the long lines at often-distant clinics and may be reaching people too embarrassed to go to a clinic for information.
This approach is ``spreading like wildfire'' across the continent, says Eric Metzner, regional director in Nairobi for Planned Parenthood Federation of America.
2. Several African nations, including Zimbabwe, Ghana, Nigeria, and Kenya, are beginning to make contraceptives available at various public outlets, such as pharmacies or tiny village stores. In some countries, radio and television ads are being used to promote family planning.
The battle to slow the African population growth rate (3 percent in sub-Saharan Africa) has high stakes. In some African nations, population pressures are speeding a deterioration of the environment, according to a new report by Worldwatch Institute, a Washington-based private research organization.
As the population grows, the demand for firewood increases, and trees that add nitrogen to soil and slow erosion are being cut down. Land not suited for good farming is being worked to provide food for larger populations, hastening transformation of the land to desert conditions, according to the co-authors of the report. Denuded soils produce less food and can add to famine conditions.
The United Nations Population Division predicts there will be about three times as many people in sub-Saharan Africa in 40 years as there are today. Fertility rates (average number of children per woman ages 15-49) in the region appear to have leveled off, however, and the UN predicts they will begin to decline after the turn of the century.
Experts in Africa and Washington say perceptions of family planning in Africa are changing in ways that could lead to greater use of contraceptives. But these experts quickly point out many remaining obstacles to greater use, including more talk than action by most African nations on the topic, cultural and religious barriers, and lack of money for family planning and related health programs.
Zimbabwe has shown a major increase in use of contraceptives, but most African nations, including Kenya, are showing no more than a slight increase.
Africa's high fertility rates have been encouraged by low levels of education, a high percentage of rural residents, and by low incomes, says Tom Goliber of the Population Reference Bureau in Washington. And, he says, in many traditional African societies, ``women receive status from their ability to bear children - especially sons.''
Yet Africans are showing more interest in family planning, according to two Africans who are family planning experts.
``I've seen a distinct change in some of the attitudes,'' says Dr. Ayo Ajayi, regional director in Nairobi, Kenya for Pathfinder Fund, a Boston-based family planning organization. ``It's getting easier and easier to convince someone to the point where they keep quiet and think about it [family planning].''
Interest in family planning has ``changed dramatically,'' according to Dr. Peter Lamptey, a Ghanaian working in the US for Family Health International, which charts use of new contraceptives in the US and in developing nations. Interest has grown because of the greater availability of information, a worsening economy in many places, and increased educational levels.
African women who are getting more than a few years of education and those among the growing urban population are paying more attention to family planning. People are realizing they cannot afford big families, he says.
In rural areas near Accra, the capital of Ghana, surveys have shown that 90 percent of the residents are interested in family planning, but family planning services are available to only about 10 percent of those residents, says Dr. Lamptey. Many African nations are short of health services and lack the money and training needed to provide them.
To promote family planning, several countries are using a concept known as social marketing - advertising and selling contraceptives at subsidized prices.
Zimbabwe has just approved a plan to sell contraceptives in pharmacies and doctors' offices at about half the usual retail price, with support from the US Agency for International Development.
Nigeria and, to a lesser degree, Ghana are using a similar approach.
But a ``Madison Avenue'' advertising approach to family planning worries some political leaders, who apparently see greater use of contraceptives leading to ``increased promiscuity,'' says Dr. Ajayi.
In many of these African nations, women must have the written consent of their husband or father to use contraceptives, says Mr. Metzner of Planned Parenthood.
Once people have contraceptives, counseling is needed to encourage them to keep using them and to use them properly, says Sharon Camp of the Population Crisis Committee in Washington.
There are indications that contraceptives in some parts of Africa are being used primarily to help women space child birth rather than limit family size, though in some instances such spacing does result in fewer births.