Investing in the future

Health

By David North

The birth rate in the Marshall Islands has fallen by one third in the last five years.

With a tiny land base, and with an ever

larger percentage of the population living

in Majuro (the capital), the nation’s leaders decided a few years ago to make a major effort to cut the birth rate and they succeeded.

In 1989 the birth rate was 35 per thousand; families until quite recently had an average of eight members; half the babies were born within two years of an earlier birth; and teenage pregnancies were increasing. As a result of all this, the 1988 census showed an annual increase in population of 4.2 per thousand, a statistic that topped some of the world population

growth tables, as reported by international

health agencies. For 1993 the rate had fallen to 23.5 per thousand, a remarkable decrease in such a short time.

How did Marshall Islands do it? First,

the religious objections which complicate

family planning activities in some Catholic areas were not a factor. Second, the government had enough up-front money and enough courage to make use of a relatively new technique called Norplant.

This involves a minor surgical procedure in which six tiny tubes are inserted into the upper arm of an otherwise fertile woman.

The operation can be done quickly, and leaves the woman with a slightly sore arm and a band-aid for a few days.

It also leaves her highly unlikely to become pregnant for the next five years, or until the tubes are surgically removed from her arm.

The up-front costs of the procedure, however, often discourage individuals and governments from using Norplant.

According to Mona Miller of the Planned

Parenthood Federation in Washington, this amounts to about US$5OO a person. While five years of birth control pills cost about as much, that cost can be spread over the five years.

The Marshalls, with (for the next few years anyway) a continuing flow of Uncle Sam’s dollars, decided to go ahead and make the investment, as well as mounted other family planning programmes through its public health clinics.

According to a story in Saipan’s Marianas Variety, Marshalls leadership was chagrined by the nation’s standing in the published population statistics. Micheal Jenkins, a health planner, said, “A lot of the figures (that got quoted) are based on the 1988 Census. It was 4.2 percent ... but if that

figure is left unchecked it does not show any

change (until the next census).”

Marshall’s falling birth rate took place despite a major effort on the part of the government to improve the birth-reporting s y stem > f" intervention that probably decreased the number of unreported births.

Further, there is a strong likelihood that while there are fewer babies, the ones born re healthier than their older siblings. RMI * s spending money to encourage pregnant women to attend pre-natal clinics, and urges them to g i ve birth m t h e hospital.

This involves, among other things, trans porting outer-island pregnant women to Majuro in time for the expected birth another costly process, but again, an investment in the health of the next

generation. □