Dr. Stephen Karanja is the former secretary of the Kenyan Medical Association and a noted OB/GYN. He also serves as a member of PRI’s advisory board. PRI president Steve Mosher recently interviewed Dr Karanja about population control in Kenya.
Mosher: Dr. Karanja, there is a very powerful population control movement in Kenya, Tell us a little bit about the history of that movement in Kenya. How did it get started?
Karanja: The population control movement in Kenya is maybe more powerful than the government of Kenya. The family planning movement in Kenya was started in 1955. That was about eight years before our own national independence. The first clinic was set up in the capital city and one year later the famous port city of Mombasa started the second family planning clinic. These two merged in 1957 to form the Family Planning Association of Kenya (FPAK). This association was affiliated to the International Planned Parenthood Federation (IPPF) in 1963, the same year that our country got its national independence.
Mosher: So from the very beginning of Kenya’s life as a nation, the population controllers have been there trying to convince the Kenyan people to have fewer babies, to try to promote legalized abortion, sterilization and contraception.
Karanja: Steve, the strange thing about this country is that at the beginning when we became independent and our first national population census was not done until seven years later in 1969, we were only 7.9 million. What is striking is that by that time, just like today, our country is still empty. It’s a large country, with a very little population, very few people. In 1963, the dawn of our national political independence, our people were very enthusiastic, full of hope for the future. The issue of contraception was like the sword of Damocles hanging over our head. A free country, basically empty, and from the beginning we were told that one of our major problems was that our population was too large. And that we had to do something about it.
Mosher: Here you have this vast empty land with less than eight million people and they were telling you that your country was overpopulated. Is Kenya overpopulated, Dr. Karanja?
Karanja: Kenya is still basically an empty country. We had a national census last year, and by the time we were having our census, the population people were telling us that our population was somewhere between 30 and 35 million. In fact, the census said that we are only 28 million people. In this empty country, 28 million people are very few. The population growth rate in Kenya is falling very rapidly not only because of the population control movement but because other factors have come into play, such as HIV/AIDS.
Mosher: The AIDS epidemic is the scourge of Africa, and I know it’s hitting Kenya very hard. How many AIDS victims are there now in Kenya? How many people have tested HIV positive?
Karanja: HIV/AIDS in Kenya is a national nightmare. In 1998, when the national census of the people was released, about two million Kenyans were infected with HIV. Already 800,000 had died. Already 1.2 million had full blown AIDS. Two years later, by September of this year the number of those infected is now between 4 and 5 million Kenyans with this disease, which cannot be treated. Between 1.2 and 1.5 million people have already died. But 1.5 million are full blown AIDS. Literally walking emaciated human beings, among the number of the youngest and the strongest and the most energetic members of our country.
Mosher: These are mostly young people, teenagers, people in their 20s, early 30s who’ve contracted this deadly disease. It’s taking the very heart out of the Kenyan population, leaving the elderly on the one hand and children on the other. What a tragedy for Africa and for Kenya. What sense does it make in that situation for the developed countries to be pouring population control money into Kenya, when the population is already suffering from this horrible pandemic of AIDS?
Karanja: Seventy percent of these infected people are below age 24. They are just kids; they are in college; they are in secondary school; they’re in primary school. In Africa this disease kills within two to live years. Unlike in the developed world where you have antiretroviral drugs, in Africa, you catch this disease and within two to five years, you’re dead. We have more than 1.5 million orphans. We have homes now being headed by kids aged 12 years because there are no parents. In this quagmire, in this very, very difficult situation, the population control movement is still telling our people that, after the pandemic of AIDS is over and this empty shell of a country stares at us, that we still need population control, that our population is still a problem.
Mosher: How does that make you feel as an African and a Kenyan, that you have these foreign countries, including Great Britain which was the country that ran Kenya as a colony for many years, telling you that, despite this massive epidemic, you have too many people? What do you think is going on in the minds of western countries?
Karanja: Either they do not know what is happening, which cannot be true, or there seems to be a sinister idea of somehow destroying the whole population. One thing is clear to me: that with population control and with the AIDS pandemic, it is possible to totally destroy the population of Kenya. And when I look at the western world, they are spending a lot of money on this. Then one question I would want to ask them is why, why do you do this? It is not true that the west does not know that this is happening.
Mosher: Early this year, we were able to expose some problems in population control programs in Peru, and as a result, Congress, using our research, said that they were going to cut the budget for population control programs by $169 million. At that point the population control movement came back and said if you’re not going to give us $169 million for population control, give it to us for AIDS education programs, so that we can help to save lives in Africa. Do these programs save lives or do they cost lives? Do they help stop the spread of AIDS or do they encourage its spread?
Karanja: Steve, all the money that is being sent to fight against AIDS is being used to fund the pandemic. I say to fund the pandemic, literally, because this money is coming to supply contraceptives or condoms, as a way of preventing this disease. Over and over we have seen it in Africa — condoms do not stop HIV/AIDS. HIV/AIDS, being a sexually transmitted disease, mainly affects young people, condoms literally help spread it. In the last two years in Kenya, more than 100 million condoms have been used. One of the other parallel happenings is that the number of HIV/AIDS people doubled. See, stopping HIV/AIDS is a behavior thing. It is a thing to do with young people not having sexual activity outside of marriage. It is a thing about married people being faithful to their wives. And they have no choice about it. The only choice they have is the choice to be chaste and only then can Africa stop HIV/AIDS.
But our friends, the west, can help us do it. They can help to give more and more information to our people, more information to affirm them, to help them realize it is easy to say no to promiscuity. See, Steve, I wish to point out very clearly that HIV, the virus, does not ambush people. The virus does not rain on people. The virus, someone rationally decides to go for it. You go and have sex, you catch AIDS. Between 80–90 percent of transmission in Kenya where I come from is sexual. Sex does not happen to you. You look for it. Educate the people clearly about the relationship between irresponsible sexual behavior and AIDS, and you can stop this pandemic in its tracks.
Mosher: So the answer is not the massive distribution of condoms. The answer is teaching young people to be chaste until marriage, and to he faithful to their spouse after marriage. And if you do that, of course, you’re absolutely protected. Not absolutely, but chances are you won’t contract AIDS.
Karanja: No, it’s not chances. You are absolutely protected in Africa. I am an old man. I have never had a blood transfusion. If I’m going to get this disease, I’ll get it sexually. Blood transfusion is a very rare thing. Our problem is to focus on the main cause — sexual irresponsibility. The developed world needs to help us to educate our people on self-respect. Educate them on behavior and we can stop this disease in its tracks and we can save Africa. If AIDS is going to destroy the population it would appear absolutely irresponsible at the same time to continue giving our people contraceptives and otherwise to continue to push population control.
Mosher: And yet we see this continued push of population control. Now $80 million a year is coming into Kenya. That is a huge sum of money being spent on so-called “reproductive health care,” being spent on population control programs. Has that improved the health care system in Kenya at all, or is it entirely being used just for the promotion of lower birth rates, for sterilization and contraception?
Karanja: The health sector in Kenya has collapsed. It has collapsed despite the use of all this money. You go to any health center in Kenya and you find children, women and elderly dying of simple diseases like malaria, pneumonia, simple tropical diseases. The medicine costs very little. With one dollar you can treat 50 patients. But there are no drugs or money. You can’t buy medicine because all the money available is being used for contraception. In these health facilities we have no medicine at all. All the stores are stockpiled with contraceptive stores. You can fill the whole village with contraceptives, but the child who becomes sick with malaria will die. These contraceptives are bought with money that comes from developed countries.
Mosher: How do these contraceptives affect African women? Are they informed about the side effects of these devices? Are they given follow-up care, for example, after they’re given Depo Provera, Norplant or these other devices?
Karanja: Steve, if you are to give any woman any contraceptive — and especially hormones, which are very strong drugs medically — if you are to give pills, Norplant, Depo Provera, you will first of all do a clinical examination on this woman. You need to take a very good medical history. This is never done in Kenya. They are given these without this. So you have now an accumulation of side effects, like high blood pressure. High blood pressure was never really a major African disease, but now we have blood clots, liver problems, problems with bleeding. In Africa where tropical diseases already cause women to be weak with poor blood levels, when they start bleeding irregularly or continuously because of these contraceptives, you literally reduce them to cripples. The woman is the center of the African family. If you want to destroy the African family, attack the mother. And I ask myself why does the US, why does your country, why does the west, attack the center of the African family? These women walk around with difficulty because of anemia, with swollen legs, with livers damaged. There are women who are going into heart failure because of bleeding, because of drugs we give them.
Mosher: It must be very difficult as a medical professional to see these sorts of things and to have women come to you asking for help, to have women saying they need, for example, an operation, and you can’t reserve an operating theater because it’s reserved for sterilizations only. Tell us about that story.
Karanja: You see, in Africa there are operating theaters which are being used and equipped today, everyday, every week, everywhere and especially in Kenya and for one purpose only — for sterilization. These have drugs, have instruments of all types but if any women, if any child, if any member of the family needs emergency surgery, there are no gloves, there are no instruments, you can’t perform operations because there is no equipment, no materials. The operation theater isn’t working. But if it is for sterilization, the theater is equipped.
Mosher: These operating theaters are set up, fully equipped with top of the line equipment, but they’re reserved for use for sterilization. And if women have other health problems, you as an OB/GYN can’t get access to these operating theaters.
Americans support foreign aid for the most part because they think their money is doing some good overseas. And there is good to be done overseas if we provide, as you suggest, malarial tablets, or vitamin supplements, for poor children, food aid programs, but pouring money into population control in Kenya has only caused heartache for the Kenyan people.
Karanja: The tragedy, Steve, is that if my patient has problems, I can’t help them. If contraceptives caused problems, I cannot treat the complications that come. The contraceptive movement has taken over all the maternal/child health facilities where we used to educate our people on simple hygiene, on nutrition, on simple preventive measures that our people could use to help themselves and to prevent disease. Now, 90 percent of all the education taking place in these facilities is indoctrination into contraception. Everywhere you listen there is this message about the beauty of one or two children. The smaller the family, the better. This is not enough. If they would take only health facilities, but the national media in Kenya, the radio and TV, is controlled by the government and because the contraceptive movement is so powerful they use the national media for the purpose of propagating this information. It is tragic because the young people now, the children, our children, are coming up believing in these things and without remembering that in Africa the most important things that any family has are its children. For me even as a doctor, a doctor for over 20 years, the greatest things I have are my children.
Mosher: Dr. Karanja, what would you say to citizens of developed countries about these programs and what they’re doing?
Karanja: I would say to them that Kenya, like Africa, needs a lot of help in agriculture, a lot of help in health, a lot of help in developing infrastructure to become a better country. But one thing we do not need. We do not need the African family to be attacked. We need you, the west, to help us strengthen our families and above all to respect our values. Help us, respect us, let us strengthen our culture with your help. Do not destroy our families.