Uganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). In the past 10 years, the country – about half the size of France in land area – has added 10 million people, growing from 24 to 34 million. That growth, paired with other factors like poor governance and long-standing insecurity, has made providing basic services a difficult task for a government that is one of Africa’s most aid-dependent.

Newfound oil wealth might provide the financial resources to help Uganda overcome its development challenges, but poor management could also make it another victim of the “resource curse” – a combination of corruption, weak land tenure, poor governance, and environmental mismanagement that has contributed to insecurity and dysfunction, rather than prosperity and health, in similarly resource-rich Angola, the Niger Delta, and the Democratic Republic of the Congo.

A Rapidly Growing Population

Six years ago, when Uganda’s population growth rate was 3.1 percent, Population Reference Bureau (PRB) Demographer Carl Haub said, “no one would consider such a rate of growth to be sustainable.”

Unfortunately, Uganda’s growth has shown few signs of abating, and has in fact increased to 3.2 percent – ninth fastest in the world, according to the latest UN data. The UN’s most optimistic projections, which assume the greatest drop in current growth rates, put the country on track to still more than double in size by 2050, growing to 83.5 million people. By comparison, similarly-sized Senegal would be home to 25.2 million under low variant projections. Under the UN’s more likely medium variant projections, the country is expected to grow to 2.7 times its current size, to 94.3 million people. Median age is projected to remain under 20 until the 2040s.

President Yoweri Museveni has repeatedly tied population growth to economic growth in public statements, but that rationale has put him at odds with the country’s central banker, Emmanuel Tumusiime-Mutebile, who has argued that so long as the country’s growing population is under-skilled and underemployed, a bigger population will do little to help its economy. In a rare public critique of Museveni, Tumusiime-Mutebile, who is credited with sustaining Uganda’s macroeconomic stability over the past two decades, recently told the Financial Times, “the extremely high population…growth is one of the major things I oppose him about.”

The growing number of Ugandans struggling to earn some kind of living backs up Tumussime-Mutebile’s concerns. Four out of every five Ugandan youths ages 15 to 24 (which account for 21 percent of the total population) are unemployed – a higher rate than anywhere else in Africa. And even though the country’s poverty rate has been halved over the past two decades, in terms of sheer numbers more Ugandans now live in poverty than when Museveni took power in 1986.

Struggling With Public Health

As the country’s population continues to grow, the majority of that growth will take place in rural areas, where access to health services is extremely limited. Public health has long been underfunded throughout the country, to such an extent that one in two Ugandans seeking medical treatment must use private instead of public clinics “because the latter are unable to provide services,” according to a CSIS report.

In part, public health is suffering from the government’s own misplaced spending priorities. Last spring, in a move that earned the government widespread criticism, Museveni spent $740 million to purchase six Russian fighter jets – nearly triple the previous year’s spending on public health.

Meanwhile, in northern Uganda, the so-called “nodding disease” has spread to infect thousands of children, and the government’s slow response has frustrated local communities, especially in light of the jet purchase.

The disease sends children into fits of seizures and, of the estimated 3,000 Ugandans infected, the health ministry estimates that nearly 200 have died since 2010. Without knowing what causes the disease, care is largely palliative. Eating can worsen seizures and children with the syndrome often end up malnourished, even dying from starvation. While the government has set up a response plan to study and fight the disease – including recently opening up clinics in three of the hardest hit areas – insufficient funding has hampered implementation.

Even in areas where Uganda’s health system used to excel, the country is now struggling. In spite of once being a public health success story for its “ABC” prevention work against HIV/AIDS (“abstain, be faithful, use condoms”), Uganda now has the same number of people living with the disease as the United States, 1.2 million. The country has been criticized for allocating too little of its own money towards the disease, even as international funding is shrinking. In 2010, when the government announced its spending priorities for revenue from oil royalties (which included the fighter jets), HIV/AIDS went unmentioned.

Sidelined Family Planning and Reproductive Health

Perhaps predictably given the public health situation, family planning and reproductive health have long been sidelined in Uganda. Even as some government officials acknowledge that large family sizes are “becoming an impediment to the speed of economic growth and social and structural transformation,” the government has fallen short of adequately and consistently funding family planning and reproductive health services.

Unmet need for family planning is highest in rural areas – 43 percent of rural women report wanting, but not using, contraception to space or limit births, compared to 27 percent in urban areas – and yet, government funding for contraception is insufficient to meet even the urban demand alone, according to the Population Reference Bureau.

In October 2010, Jennifer Anguko, a lawmaker from the remote corner of northwest Uganda that borders the Democratic Republic of the Congo and South Sudan, bled to death over 12 hours while waiting for help in a maternity ward. In Mityana, a city an hour outside of the capital Kampala, Sylvia Nalubowa, a mother of seven, bled to death at a maternity hospital when she couldn’t afford money to bribe the attending nurses. Together, the two deaths spurred a lawsuit against the Ugandan government, arguing that its failure to provide basic maternal care was a violation of these women’s right to life.

Anguko and Nalubowa are vivid examples of the state of maternal and child health in Uganda. Throughout the course of their lifetimes, Ugandan women have a 1-in-35 chance of dying due to pregnancy-related causes; every day, 16 women die in childbirth. The country’s infant mortality rate is one of the highest in the world. At 79 infant deaths per 1,000 live births, Uganda has the 23rd worst infant mortality rate in the world, not far behind places like Afghanistan (136 deaths), the DRC (116), and Somalia (107).

Meeting Needs Today to Ameliorate Problems Tomorrow

If all Ugandan women with an unmet need for family planning began using some form of contraception, the country’s total fertility rate could fall by more than half, according to an analysis of Uganda’s 2006 Demographic and Health Survey by USAID, from the current rate of 6.2 children per woman to just 2.9. Even if just 10 percent of unmet need were satisfied, total fertility rates would drop to 4.9, putting Uganda only slightly above Rwanda’s current rate of 4.7 – a rate that is the result of a concentrated effort by the government, as New Security Beat contributor Elizabeth Leahy Madsen writes.

Reducing unmet need would impact more than just women and child’s health. USAID’s RAPID Model has shown that investments in family planning to meet existing demand can save millions in future education and health costs, helping to lighten the burden on overtaxed infrastructure and government capacity.

As Uganda’s growth spurs greater demand for increasingly overstretched public services, from health care to education, meeting the Millennium Development Goals – already a challenge for the country – has become more and more difficult. Meeting family planning needs could not only make it easier to achieve those goals, but also to achieve cost savings of nearly $100 million along the way, according to a USAID report.

The 2006 discovery of oil – estimated to be worth as much as $2 billion annually – has introduced new potential and new complexities into Uganda’s ability to meet its MDG targets. “The next generation of Ugandans could grow up in a very different country to that of their parents and grandparents,” wrote advocacy group Global Witness in a report on the country’s newfound resource, “but the risk of the resource curse phenomenon taking hold in Uganda cannot be ignored.”

Read part two of this series, on Uganda’s humanitarian, natural resource, and governance challenges.