Family planning as a nutrition intervention in Zaire: a rationale and case study.

Despite the fact that problems of drought underproduction civil strife and worldwide recession have created endemic levels of malnutrition in many African countries there is still strong resistence at higher administrative levels to population control programs as a development strategy. This paper reviews the evidence supporting family planning as a nutrition intervention that is relatively inexpensive and feasible within the current African context. A number of researchers have demonstrated that given similar income levels families with more children have proportionately less food to divide as the number of children increases and theoretical statements have outlined the paths that rapid childbearning may take in affecting overall infant morbidity and mortality. The few existing studies of the specific nutritional outcomes of family planning interventions should be updated with larger data sets and multivariate methodology. The Zairian National Nutrition Planning Center (CEPLANUT) developed a periodic surveillance scheme covering a large population in Kinshasa. Family planning and family size questions were added to the usual socioeconomic and nutrition related survey indicators. A number of independent variables were constructed to measure such factors as socioeconomic status utilization of health services and health knowledge and the variables were regressed on nutritional status using the MSLR program for logistic regression. Using 2 different definitions of clinical malnutrition (75% of weight/age and 90% of weight/age) about 1/3 and 1/2 of 2100 children under 5 years of age were classified as malnourished. The 3 most important variables in predicting malnourishment were the socioeconomic status indicator the size of the family and the utilizaiton of health services by the mother; all were statistically significant. Improving the socioeconomic status of the family and increasing the utilization of maternal health services are likely to be relatively insensitive to interventions over the next 5-10 years because of the serious economic problems in Zaire but family planning appears to be a vertical relatively inexpensive program that would influence family size and help improve nutritional status. Although it was expected that this recommendation would attract little support among policy makers the direct use of nutrition data to support the argument was convincing to many and the deep involvement of Zairian scientists and CEPLANUT lent further support. In the end the government of Zaire was more open than expected to the implementation of family planning programs as part of the overall health strategy and much family planning activity has occurred since 1980.