Cablegate: Population Growth: Uganda's Ticking Time Bomb

DE RUEHKM #0955/01 2330857
R 210857Z AUG 09




E.O. 12958: N/A


1. (SBU) Summary: Population trends in Uganda are creating a
demographic time bomb that is undermining the country's recent gains
in economic and social development and threatening its longer-term
political, economic, and environmental viability. Few countries in
the world are growing as fast as Uganda. At current trends,
Uganda's population will double (from 30 to 60 million) in 20 years
and reach 130 million by 2050. This surge in population will stress
the natural environment and strain the government's ability to
provide basic health and education services, possibly to the
breaking point, resulting in chronic political instability and
social unrest. It's hard to see current trends changing anytime
soon given the pro-growth sentiments of Ugandan President Yoweri
Museveni. End Summary.

By the Numbers, Not in Good Company

2. (SBU) A rash of recent reports has drawn increased attention to
Uganda's unchecked population growth. An international study
commissioned by the British Parliament ominously observes that, "Of
the top 20 failing states, 17 have populations increasing at close
to 3% a year. In five of these 17 countries, women have an average
of nearly seven children each. In all but six of the top 20 failing
states, at least 40% of the population is under 15." Uganda has
traveled a long way from failed-state status, but tellingly, it
still ranks 21st out of 60 in the failed state index, in large part
due to demographic trends. Individual country data paint a gloomy

-- Uganda's population nearly doubled from 1987 to 2007 and is
increasing at an annual rate of 3.2%, fifth highest in the world.
The population is growing by 1.2 million people each year, one of
the highest absolute increases in the world.

-- Ugandan women have an average of 6.7 children (vs. 2.1 in the
U.S. and the 5.1 average for sub-Saharan Africa). Only four
countries worldwide have higher fertility rates.

-- More than 50% of the population is under the age of 15, and
according to a report published by the non-governmental Population
Reference Bureau (PRB), Uganda's ratio of those not in the labor
force compared to those currently working is the highest in the
world at 116%.

The Sheer Pressures of Population Growth

3. (U) Following a period of sustained economic growth over the past
decade, 31% of the very young Ugandan population still live on less
than $1 a day and the health of the population remains weak.
According to "The State of Uganda's Population Report 2008,"
published by the GOU's Population Secretariat with support from the
United Nations Population Fund (UNFPA), unchecked population growth
is contributing to an increasingly unhealthy and under-productive
Ugandan population: 12% of women of reproductive age are
undernourished, while 38% of children under five years old
demonstrate stunted growth.
4. (SBU) On July 11, World Population Day was celebrated in Uganda's
Teso region, an area hit hard by national food shortages. The sad
irony of the day was not lost on media outlets or the international
community, which recognize rapid population growth as a contributing
factor to the shortages. This rapid population growth is further
exacerbating the problem of poverty in Uganda. While the percentage
of Ugandans living in extreme poverty has decreased in the past
decade, absolute numbers have not dropped significantly. Janet
Jackson, UNFPA Country Director, made the case that, "Development
gains must not be jeopardized by the challenges and sheer pressures
of population growth. Population should be slowed down and
counterbalanced by an equal pace in growth of other sectors, for
example health, education, housing, utilities, job creation and food
production." There is growing fear, from Ugandans and donors alike,
that forward strides in these sectors may be negated by
unsustainable population growth, driven in part by unmet family
planning needs.
5. (U) At the current levels of unmet family planning needs and
population growth, policy makers will face increasingly tough
decisions on access to land, employment, energy, clean water,
education, housing, transportation, and health services. Even in the
unlikely event Uganda experiences a complete fertility transition
(from high to replacement level fertility) over the course of the
next 30 years, its population will still double during the same

KAMPALA 00000955 002 OF 004

period. Recent history in Kenya, Madagascar, and Nigeria does not
bode well for Uganda. When increasingly scarce resources are spread
thinly amongst a young, growing population, it only takes a spark
for violence to erupt, even in a growing economy. An estimated 80%
of civil conflict from 1970 to 1999 occurred in countries where at
least 60% of the population was under age 30. 76% of Uganda's
population was under age 30 at the time of the 2006 DHS.

Economics of Population Growth
6. (SBU) The GOU is sending mixed signals about whether it views
rapid population growth as a fuel for economic growth or as a
roadblock to its long-term vision of economic success. The revised
National Population Policy, whose theme is "Social Transformation
and Sustainable Development," aims to ensure that all aspects of
creating a quality population are addressed, including slowing the
population growth rate that is now too high for the country's
economy to sustain. Yet, President Museveni's own comments continue
to indentify the population boom as a foundation for growth and
transformation: "The wealth of a nation is not in the soils and
stones. It is in its people, its population. I do not agree with the
alarmism over the high rate of population growth...we need to
educate our children, give them skills and create an enabling
environment for employment and job creation. That way, we shall
create wealth, make savings and Ugandans will invest and spur
economic productivity and growth." Unfortunately, what Museveni is
unable to grasp is that while Uganda's economy has grown steadily
over the last decade, growth would need to increase dramatically to
generate enough government revenue and new jobs to keep up with the
ensuing population surge. Moreover, because the education system is
underfunded and failing to keep pace with population growth, an
overwhelming majority of young Ugandans are not acquiring the skills
and knowledge they need to be competitive, productive, and
prosperous in the 21st century economy.
7. (SBU) Ugandan policy-makers often remark on their desire for the
country to emerge as a strong middle-income economy by emulating the
performance of the "Asian Tiger" economies of the late 20th century
(e.g. Thailand, South Korea, and Taiwan). By 1965, each of the
Asian Tigers had established family planning programs and by 1995,
six of the eight Tigers had lower fertility rates than the U.S. The
resulting demographic shifts led to slower growth in the number of
school-age children, a lower ratio of dependents to working-age
adults and a reduced rate of labor force growth. Left alone, these
were not enough to create the educated workforce, high wages,
savings rates, and capital-intensive industries that now
characterize the Asian Tigers. But when linked to an innovative
business sector, sound government investment and an equitable
education system, demographic shifts soon fostered economic
opportunity. Economists credit declining fertility rates as a major
contributor to sustained economic growth in Asian Tigers,
attributing up to 50% of their high per capita growth to this
demographic dividend.

8. (SBU) Thus, while Uganda would like to emulate the Tigers'
success, it ironically appears unwilling or unable to follow the
formula that led to that success. To its credit, Uganda is
committed to sound economic policies, and has made some strides in
education through its commitment to universal primary education.
However, in reality, the education sector remains seriously
underfunded, leaving a surfeit of young people with just enough
education to get into trouble. Indeed, Ugandan women with no
education or only primary education have fertility rates of 7.7 and
7.2 respectively, while those relative few with a secondary
education have a rate of 4.4. Moreover, in sharp contrast to the
Tigers, the GOU has done little to curb population growth through
family planning programs.

9. (U) In short, as a 2004 study by Dr. Stephan Klasen argues, per
capita income will not improve if population growth continues to put
a "brake on physical and human capital accumulation, the key drivers
of economic growth." Uganda's current makeup (very young population,
comparatively few working age people, and even fewer elderly) is a
"demographic burden." Uganda has the potential to capitalize on its
demographic make-up, but only if fertility rates are reined in
quickly during this period of burden. But after a decade of
sustained economic growth in Uganda with no change in fertility
rates, it is clear that the economy and service delivery are
struggling to keep up, even at current population levels.

Family Planning and MDGs:
More Bang for Your (Donor) Buck

KAMPALA 00000955 003 OF 004

10. (SBU) Lack of adequate family planning services in Uganda
continues to be a key driver of population growth and the numbers
(dire even by sub-Saharan African standards) tell the story. One in
four Ugandan girls will get pregnant before the age of 20; only one
in four married women use any form of contraception, while "unmet
need" (women who say they prefer to avoid pregnancy but are not
currently using a contraceptive method) stands at 40.6%, revealing a
severe dearth in delivery of and access to family planning services.
In contrast, at least 75% of married women use contraception in
Vietnam, Colombia and Brazil, while only about 7% of women in these
countries have unmet need. Although poverty in Uganda has been
reduced considerably from 56% in 1992 to 31% in 2006, infant and
maternal mortality has remained nearly stagnant with 76 deaths per
1,000 live births and 435 deaths per 100,000 live births,
respectively. These data, when combined with the high levels of
unintended pregnancies and induced abortions, make it clear that a
continued lack of family planning services has grave implications
for the health, and thus the productivity, of Uganda's women and

11. (SBU) A recent USAID study indicates improved family planning
services in Uganda could help it achieve its Millennium Development
Goals (MDGs). By fulfilling unmet need for family planning, 450,000
child deaths and 5,500 maternal deaths could be averted between 2008
and 2015. In addition, more than 10,000 HIV-positive births per year
could be averted. Consequently, the MDGs could be achieved faster
and at a lower cost. An investment of $1 in family planning would
yield a $2 savings in reaching goals in other sectors such as
health, education and environmental sustainability. These figures
are particularly eye-catching for donors and aid-recipients who have
pledged, as the United States and Uganda have, to overcome poverty
and address many of the most enduring challenges of human

USG Role

12. (SBU) USAID and UNFPA are the GOU's largest partners in
supporting programs that provide and strengthen family planning
services. After several years of stagnating resources, USAID's
family planning budget increased to $10 million in FY2008 and to $15
million in 2009. USAID expects modest increases in allocations to
continue in light of the new Global Health Initiative, in which
family planning figures prominently. In early 2009 USAID awarded a
$39 million five-year project to focus on improving family planning
services in terms of access and quality, as well as child survival
in 15 of Uganda's 80 districts. USAID also regularly supports the
procurement of contraceptive commodities. Together, USAID and UNFPA
provide the lion's share of Uganda's contraceptive supply. While
such donor programming is a step in the right direction, all of
Uganda's political and economic gains of recent years are in
jeopardy unless the GOU itself adjusts course and takes action now
to address its impending demographic disaster.

13. (SBU) Comment: The Population Secretariat's report is evidence
that some GOU officials understand Uganda's demographic challenges,
but Museveni's own staunch, pro-growth position is probably the
single greatest obstacle to turning the tide in Uganda. While the
GOU has developed policies for reproductive health and family
planning, in coordination with UNFPA and donors including USAID,
political commitment to implementation of those policies is lacking.
The GOU has not spent funds on contraceptive commodities in the
past two years, and few high-level officials outside of the
Population Secretariat have ever made statements contradicting the
President's position on this issue. Family planning needs to play a
central role in Uganda's development plans, as it is crucial to
reducing poverty, improving education, health and the environment,
safeguarding women's health, and enhancing the standard of living.
But without an about-face from the country's leadership on this
issue, we remain pessimistic that family planning will play such a
role, with potentially dire consequences for the country's long-term
socio-economic viability.

14. (SBU) Comment continued: Collectively, the USG also needs to
think seriously about population trends in Uganda (and probably
elsewhere). While the USG laudably spends billions of dollars
saving lives through programs like PEPFAR and the President's
Malaria Initiative, we are underplaying at best and ignoring at
worst the fact that the gains made through these programs are being
simultaneously undermined by runaway population growth. Moreover,
it's no coincidence that the Failed State Index takes population
trends so heavily into account. Where we now have a relatively
stable ally in Uganda, the future may bode much worse given current
population trends. Perhaps it's time to think about an emergency

KAMPALA 00000955 004 OF 004

plan or a presidential initiative for family planning. End

© Scoop Media

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