Monday, September 17, 2007

On the Ground

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker.

The RuxinsThe Ruxins

My daughter Maya was born last Friday at 2 a.m. in San Francisco. Maybe I should blame the acute sleep deprivation I’m enduring (yes, thank you, I know I don’t have to get up for every feeding, but I’m doing it anyway), but I am finding fatherhood to be staggeringly hard work. Even with a doting family, electricity, running water, access to quality health care, lactation consultants, an array of parenting books and whatever else we need to ensure our child’s well-being, doing a halfway passable job of parenting requires enormous reservoirs of energy. (Mom, Dad: Respect.)

The past few sleepless days have heightened my appreciation of the daily achievements of the billions of parents who make do without the resources my wife and I are enjoying during our time back in San Francisco. For more than a decade now, my work has brought me into daily contact with parents who are not only among the world’s poorest, but commonly managing four, six, even nine children. Far removed from the luxury of worrying about early stage developmental learning techniques, they’re concerned with just keeping their overflowing household alive with resources too meager to support even a small family.

How do they cope? From my rocking chair here amid the abundance and safety (give or take an earthquake or two) of California, it’s hard to imagine.



In the wee hours, between feeding times, my mind has been dwelling on family planning. (Irony or consequence? You decide.) I wonder how Rwanda can get ahead – economically and educationally — without slowing its population growth. Happily, the Rwandan Government appears to be taking the issue increasingly seriously. (Check out Stephen Kinzer’s revealing piece in The New York Times and his superb analysis of Rwanda in The New York Review of Books).

Even in predominantly Catholic Rwanda, policy makers are focusing on population demographics. In 1994, roughly 15 percent of Rwanda’s population was slaughtered, and yet since then Rwanda’s high population growth has already brought its overall population to levels notably higher than before the genocide.

Today, the nation has one of the highest population densities in the world and an average per capita annual income of only $280. Only about 10 percent
of women utilize modern family planning methods. The average Rwandan woman gives birth to six children – nearly three times the United States rate – and at current rates, Rwanda’s population of 9.7 million will double by about 2032.

With more than 90 percent of the population reliant on agriculture for their livelihoods, the ramifications are staggering. There are already
approximately three people per arable acre, and even with advanced agricultural techniques there is scarcely adequate land remaining to produce subsistence levels of food. A few months ago, a 44-year-old woman came to one of the health centers that my programs support to give birth to her ninth child. In tears after the birth, she said that she had no way to feed any of her children.

Rwanda is fast becoming a perfect Malthusian storm: limitations of food productivity are resulting in stunted growth in kids and, in severe instances, starvation. As a result, Rwandan President Paul Kagame has announced that he is preparing a major initiative to reduce Rwanda’s birth rate by at least half. The model for Rwanda, in this case, comes from the Far East – Thailand in particular.

Between 1965 and 1990, Thailand’s fertility rate dropped from Rwandese levels to roughly United States levels (about two births per woman), and during the same period its per capita income – a crucial factor in improving health care – tripled. The bedrock of Thailand’s success is just what Rwanda is considering today: universal access to free birth control methods; training of health care workers in every setting to provide these options; and a national advocacy campaign in support of access to family planning services.

All of us in the rich world have a stake in ensuring that the children in the poorest countries have the same opportunity to develop and thrive as
our children do. The future families of Rwanda would best be served if their meager assets could be spent nurturing a few children, rather than being forced to watch their many children go hungry and stay poor.

As I look at Maya’s newborn face, and begin to sense the extent to which she already has me wrapped around her little one-inch pinky, I’m more deeply aware of the grief parents anywhere must feel when they can’t support their families. I’m also more acutely conscious, having felt the tug on my parental heartstrings, that every Rwandan child – every child for that matter — deserves a running start at having a quality life.


8 comments:

Anonymous said...

Congratulations! They partially cope by using different expectations and methods. Feeding baby is not a big deal as infant sleeps with mother and breast is available. After the first week baby becomes proficient at proper suction and latch-on and nursing can be managed with mother hardly noticing in the middle of the night. Infant is worn on the mother and can be easily put on the breast with a bit of shifting. Nursing and wearing baby meet almost all the needs of the baby( food, warmth, liquid, stimulation, love.) Dr. William Sears advocates attachment parenting which I have followed with my four kids, the oldest now a 32 year old lawyer. I never understood the way mothers talked about infancy in the magazines...it didn't seem that hard to me. Wearing my babies kept me in shape and once they were a few months old they graduated to a good structural backpack and shopping, cleaning, cooking, even socializing, was quite simple. I felt free and unencumbered and even went to cocktail parties wearing baby. The babies weight gain was so gradual that my body just adjusted. When baby fell asleep in the backpack I got good at setting it down, taking it off, and removing baby to safe bed. Or, in a restaurant, just removing pack and holding it between my legs while baby slept and I ate.
But still, pregnancy and infancy expend enormous energy, and mothers trying to do that in Rwanda, without adequate nourishment, is heartbreaking. I have only spoken to the cultural differences in baby practices where I think American practices make infancy and the first three years much more difficult than need be. In and out of various plastic containers, wheeled paraphenalia, trying to entertain them and stimulate them (when all they want is to be part of your world, watching and listening to your activities which are the most fascinating of all), fretting all the time, trying to get them to fit in to all kinds of schedules...silliness....turns a joy in to a chore.

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