Family planning began late and was accepted slowly in Zaire. In 1972 the Mobutu regime officially expressed interest in limiting births to "desirable" ones and thus promoted family planning for reasons of health and as a human right. In 1973 a presidential decree created an official clearinghouse committee for familyplanning information. It was not until 1978, however, that the state established a nongovernment organization dedicated to family planning, namely the Zairian Association for Family Well-Being (Association Zaïroise pour le Bien- Être Familial--AZBEF). It was formed in order to acquire technical and financial aid from the International Planned Parenthood Federation. Evaluation teams sent in 1981 were unable to evaluate the impact of the early programs because of the lack of data and the small numbers of acceptors.
Not until the launching of an AID-funded program in 1982--the Project for Planned Birth Services (Projet des Services des Naissances Désirables--PSND)--did family-planning efforts begin in earnest. Problems in coordinating PSND efforts with AZBEF led to the establishment of three systems working in parallel, PSND, AZBEF, and Rural Health (Santé Rurale--Sanru), a rural family health care project with a family-planning component.
PSND statistics have been the most complete. PSND selected fourteen urban areas with a target population of about 800,000 women and aimed to increase contraceptive use from 1 percent to 12 percent by 1986. Early returns were disappointing, with only 1.6 percent usage reported by a mid-term evaluation mission in 1985. Later trends were more encouraging, including a 1984-87 quadrupling of family-planning acceptors (see table 10, Appendix).
In rural areas, AZBEF family-planning units and Sanru have been active, although the numbers of personnel were insufficient to reach the bulk of the population. To supplement their efforts, AID funded efforts to make contraceptives available through communitybased distribution projects. A Tulane University program distributed birth-control pills, condoms, and contraceptive foams in Bas-Zaïre in a pilot project; the effort demonstrated that such distribution was less effective than making supplies available in health facilities. Companies such as Gécamines that operated health care facilities received aid from PSND to promote family planning among company workers and their families. Most significant were commercial marketing projects. Forty pharmacies in three zones of Kinshasa spread information on contraceptive methods and products and sold attractively packaged and well-priced contraceptives, which were quite popular. Recent efforts in social marketing organized by Family Health International have had promising results in their test areas, although the collapse of the economy in the early 1990s has compromised any precise evaluation of their overall effectiveness.
Barriers to acceptance of family planning remain, however. As long as child mortality remains high, both men and women will continue to value large families. Demand for family-planning services remains low. In fact, the availability of such services has been almost unknown by the community, even in the immediate neighborhood of family-planning units. Although occasional radio, television, and press programs have been generated, and T-shirts, posters, and brochures bearing family-planning messages have been distributed, follow-up has been lacking and evaluation of familyplanning informational campaigns has not been done. Given the relative lack of success in promoting family planning and birth control, Zaire faces a continued high rate of population growth, which will exacerbate deteriorating social and economic conditions.
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Periodicals provide the best source of current social and cultural information on Zaire, although many of the best are either in French or unavailable in many libraries. Still, the curious reader can find may good and widely available books on Zaire in English. Crawford Young and Thomas Turner's The Rise and Decline of the Zairian State provides a good overview of the country's institutional history and development since independence. The extraordinary scope of state corruption is painstakingly documented as it pertains to Équateur Region by Michael G. Schatzberg in Politics and Class in Zaire and in The Dialectics of Oppression in Zaire; David J. Gould's Bureaucratic Corruption and Underdevelopment in the Third World: The Case of Zaire does the same on a national scale.
Zairians' strategies of adaptation to their ongoing impoverishment have been well documented in several more recent works. Edited anthologies such as Georges Nzongola-Ntalaja's The Crisis in Zaire: Myths and Realities and Janet MacGaffey's The Real Economy of Zaire both contain accounts of the dynamic informal economy and the varying survival strategies used by different ethnic groups, classes, regions, and genders. The literature on women's roles in adaptation is particularly well developed in books such as Jane L. Parpart and Kathleen A. Staudt's Women and the State in Africa. Articles by Catharine Newbury and Brooke G. Schoepf in this volume as well as in the volume edited by Janet MacGaffey provide insights into the ways African women have confronted state oppression by forming local alliances and by creatively exploiting the potential of the informal economy.
Students of Zairian ethnography interested in an overview would do well to start with Jan Vansina's recent Paths in the Rainforests; its bibliography contains references to more specialized studies and ethnic groups that the reader could subsequently consult. People interested in Zairian religions would profit from reading any of Wyatt MacGaffey's several books on the Kongo people, the most recent of which are Religion and Society in Central Africa and Astonishment and Power.
Finally, for those interested in health care, the complexities of its provision are detailed in The Social Basis of Health and Healing in Africa, edited by Steven Feierman and John M. Janzen. The volume includes discussions of indigenous concepts of disease and modes of diagnosis and therapy, elements not always considered in public health delivery planning. (For further information and complete citations, see Bibliography.)
Data as of December 1993