J HEALTH POPUL NUTR 2009 Dec;27(6):784-793 ©INTERNATIONAL CENTRE FOR DIARRHOEAL ISSN 1606-0997 | $ 5.00+0.20 DISEASE RESEARCH, BANGLADESH Examining Perceptions of Rapid Population Growth in North and South Gondar Zones, Northwest Ethiopia Getu Degu Alene and Alemayehu Worku School of Public Health, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia ABSTRACT Ethiopia is one of the most populous countries in Africa and ranks second only to Nigeria. Rapid population growth has hampered the country’s development, making the eradication of extreme poverty and hunger difficult. This study which had two components—quantitative and qualitative—was aimed at exploring the perceptions of women and other social groups on the prevailing population pressures. The quantita- tive study involved 3,512 women aged 15-49 years. The qualitative study consisted of five focus-group discussions and six key-informant interviews. Over 90% of women (n=3,512) who participated in the quantitative study and nearly all the focus-group discussants and interviewees (n=39) felt that something should be done to keep the population from growing too fast. Most (over 90%) participants approved of the Government passing a law regarding the maximum number of children that a couple should have. It is, therefore, timely for the responsible bodies to exert maximum effort and commitment in responding to the emerging attitudes of the people by making the population problem a priority. Key words: Cross-sectional studies; Perceptions; Population growth; Ethiopia INTRODUCTION zones, which are further divided into woredas (dis- tricts). The Amhara region where the present study The development challenges facing sub-Saharan was undertaken is one of the regional states of the Africa are made greater by rapid population growth country. and poor reproductive health. The impact of other investments in the region will be undermined un- Women in sub-Saharan Africa continue to face a 1 less governments move quickly to address these in 16 chances of dying from pregnancy and child- problems (1). Enabling people to have fewer chil- birth when the risk for women in the industriali- dren, if they want to, helps to stimulate develop- zed world is 1 in 2,800 (3,4). Maternal mortality ment and reduce poverty in both individual house- (673 deaths per 100,000 livebirths) in Ethiopia is holds and societies. Smaller families have more to among the highest in the world (5). Similarly, ac- invest in education and health of children. Rapid cording to the 2005 Ethiopian Demographic and population growth contributes to environmental Health Survey (EDHS), the infant mortality rate is stress, uncontrolled urbanization, and rural and ur- also among the highest (77 deaths per 1,000 live- ban poverty (2). births). The Amhara region was observed to have the highest infant mortality (94 deaths per 1,000 Ethiopia, a federal republic, consists of nine region- live births) among the 11 regions of the country. al states and two city administrations. Its popula- The available facts show that high fertility exposes tion was projected to be 77.1 million in mid-2007 women to high rates of maternal deaths. Many (ranks second only to Nigeria). However, according researchers have also reported unequivocally the to the recent census, it was reported to be about association of an increased level of infant/child 74 million in 2007. The regions are divided into mortality with high fertility (6-8). Many studies Correspondence and reprint requests should be have also shown the influences of other biological, addressed to: behavioural, socioeconomic and cultural factors Dr. Getu Degu Alene on high fertility (5,9-11). Because of the negative School of Public Health influences of many direct and indirect factors, the Faculty of Medicine status of women in Ethiopia is very low and has Addis Ababa University Addis Ababa, Ethiopia tremendously affected their participation in the E-mail: [email protected] labour force (5,8,12). With all the prevailing back- Rapid population growth in northwest Ethiopia Alene GD and Worku A ground characteristics of women in the Amhara re- called ‘big towns’ while the centres of the selected gion in particular and in Ethiopia in general, rapid woredas are referred to as ‘small towns’. According- population growth has complicated the situation, ly, five of the 20 rural woredas in North Gondar and thereby making the eradication of extreme poverty three of the 10 rural woredas in South Gondar were and hunger very difficult. The country is caught in randomly selected. The other two woredas (Gondar a vicious cycle: efforts to improve living standards and Debre Tabour towns) were included to exam- and alleviate poverty are overwhelmed by the need ine the perceptions of women residing in big towns to provide basic services and jobs for ever-growing (centres of zone administrations). numbers of people. With a population doubling Although this particular investigation consisted of time of less than 30 years, Ethiopia is at the cross- a number of outcome variables relating to popula- roads of taking serious measures that will enable tion pressure, there appeared a difficulty in getting the country to escape the trap of abject poverty. similar studies undertaken in the country which Ethiopia needs to break into the vicious cycle by could be used as a basis for computing the required reducing the excessive population growth to a level sample size. The study carried out by Ezra in the which is manageable and that can go in line with drought- and famine-prone areas of northern Ethi- the economic development of the country (13). opia which had documented a proportion of 75.7% (opinions of respondents on the population size of Accordingly, this investigation was aimed at ex- their communities as too large) was a bit old (14). ploring the perceptions of women and other social Therefore, it was decided to use a potential propor- groups on the prevailing population pressure and tion of 50% to compute the sample size. This as- at finding out their views towards the control of sumption usually gives the largest sample size and the present rate of population growth. minimizes the amount of sampling error. MATERIALS AND METHODS Accordingly, with the estimated proportion of The study had two parts. The first one was a quan- 50%, a 95% confidence interval, and a 2.5% mar- titative study which involved women of reproduc- gin of error, a sample size of 1,537 was initially tive age. The second part was a qualitative study computed. However, by taking into account the which consisted of different social groups. The to- type of sampling method used, a design effect of tal population of North and South Gondar zones 2 was employed. Finally, together with a 5% con- where the present study was carried out was esti- tingency for non-response, a total sample size of 3,228 was proposed. On the other hand, there were mated to be 5.6 million in mid-2008. About 28% of 3,547 women aged 15-49 years in the selected clus- the Amhara people live in these zones. ters and localities (kebeles), and data were collected Quantitative study from 3,512 of them, giving a response rate of 99%. A cross-sectional survey aimed at exploring the Twenty health professionals (health officers, nurs- perceptions and views of women on the prevailing es, and environmental health technicians) who re- population pressure was undertaken in North and ceived a three-day intensive training with practical South Gondar zones from mid–October to mid– exercises collected the required data. Five health December 2007. Women, aged 15-49 years, who officers/sanitarians were assigned to supervise the were permanent dwellers of the selected areas were data-collection process and the investigators han- eligible to be included. A woman was considered dled the overall coordination. A standardized struc- a permanent dweller if she had been living in the tured questionnaire with closed and open-ended area for at least six months. questions was used for collecting the required data. Pre-testing of the questionnaire was carried out be- A multistage cluster-sampling method, which was fore undertaking the collection of main data, and stratified by urban and rural areas, was used for se- some adjustments were made accordingly. In addi- lecting the required study subjects. In total, 10 dis- tion to the usual demographic and socioeconomic tricts were covered. About two-thirds of the study characteristics, variables pertaining to population subjects (n=2,277) were from rural areas of the pressure and the views of respondents towards alle- two zones. The remaining (n=1,235) subjects were viating the associated problems were incorporated. drawn from the two big urban centres (Gondar and Qualitative study Debre Tabour towns) and from the centres of the randomly-selected district (woreda) administrations. During the process of data analysis, there was an In this study, the centres of the two Gondar zones, emerging phenomenon, which necessitated fur- which have the status of woreda administration, are ther inquiry into some issues not captured by the Volume 27 | Number 6 | December 2009 785 Rapid population growth in northwest Ethiopia Alene GD and Worku A quantitative research methods. Therefore, to sup- Of the 2,097 rural households included in the plement and clarify some findings from the quanti- study, about 7% did not have any farmland. Of tative data, five focus-group discussions (FGDs) and those households who reported as having some six key-informant interviews were carried out in land were further examined; nearly 70% had less the same study areas and in the capital of the Am- or equal to a hectare. The possession of farmland hara region (Bahar Dar).