“As the global population is projected to rise from 8.2 to a peak of 10.4 billion by the 2080s — driven largely by growth in sub-Saharan Africa — historians and demographers are re-examining the colonial roots of African demographic change,” said Hilde Bras of the Department of History at the University of Groningen. “This project contributes to that debate by centring reproductive health and gender dynamics in Southeast Africa from 1890 to the present. Focusing on four communities with Catholic mission hospitals in Uganda and Malawi, the project examines the long-term demographic impact of missionary medicine and missionaries’ cultural interventions in women’s intimate lives.”
Bras started her presentation by focusing on and showing some of the “vibrant, powerful contemporary artwork” she has encountered while in South Africa. She highlighted the work of artists Canon Griffin Rumanzi, Nomusa Makhuba and Thato Toeba which she described as “works of art that resonate with my research”.
Stalled demographic transition
“Most of the global population increase by 2050 will be in sub-Saharan Africa,” she said. “The current population of 1.3 billion is expected to double by mid-century. By 2100 most people in the world will be in Africa and Asia.”
“Africa has a stalled demographic transition with declining mortality but also a stalling decline in fertility which equals large population increases. There are, on average, four children per woman in Africa – some of which is due to unintended births and poor access to contraception.”
At the same time Africa also experiences high maternal and infant mortality. “Thirty-nine per 100 babies died in Africa in childbirth in 2023,” said Bras. “Maternal deaths are also higher than elsewhere at 395 per 100 000 births. This is all influenced by factors including socio-economic, education, religious and ethnic group differences, and gender inequalities.”
‘Of course, such population growth itself also has an impact on many factors including energy scarcity, education, conflict and healthcare.”
“To understand this better you need a historical perspective,” she continued. “Specifically, to understand how the colonial era and its particular set of actors including missionaries influenced and helped to change the course of reproductive health disparities.”
“By tracing these legacies across the 20th and early 21st centuries, the project offers new insights into the historical roots of reproductive health disparities and demographic change in Africa.”
She explained that the work integrates historical demography with the history of medicine, health and healing.
“Demography is about the size and distribution of the population and looks at life-course events such as marriage, childbirth, fertility, mortality and migration,” she explained. “While the history of medicine, health and healing is about mapping and understanding historical changes in diseases, the development of biomedicine, and indigenous healing practices.”
She also described different hypotheses about the role of colonialism in healthcare and demographic change. One is that colonial rule caused declines in mortality due to access to better healthcare and medicines. While the counter argument is that colonialism brough new interventions like cash cropping and tax which had a detrimental effect on survival. Some also argue that biomedicine was an institution of empire to create a healthy workforce while also saving souls, thus boosting the numbers of children women had. However, there is scanty evidence available to test these hypotheses, and this is what Bras and her colleagues hope to contribute to.
“We want to put qualitative and quantitative data side by side,” she said. ‘We are trying to assist in explaining population growth. Giving a more comprehensive understanding and connecting it to the bigger picture of global healthcare and population change.”
MUD
She also explained her approach titled MUD – for multi-paradigmatic, untapped and diverse.
The work will combine multiple paradigms to try to understand how illness and key life events are understood, practiced and managed. The aim is also to access untapped, muted voices including the perspective of missionaries (particularly female) as well as patient experiences using resources like oral histories, diaries and patient files.
“We also need to focus on diversity,” she added. “The variation is immense. There is no one history.”
Drawing on letters, diaries, annual reports, parish registers and patient records, the project explores how biomedical practices and family models introduced by missionaries intersected with local norms to reshape social roles, care practices and reproductive outcomes.
“We are also looking at education and religion as possible tools of control in colonial rule,” she added. “Where a system meant to teach or save may have also disciplined bodies and minds.”
Overall, the project involves six study sites in Uganda, Tanzania and Malawi although the work in Tanzania has not commenced due to delays in obtaining ethics approval. In all field sites the focus is on the White Sisters, a female missionary group founded in France in 1869. In Uganda, the team also studies the Bannabikira Sisters founded by the White Sisters in 1910 and recognised as the first indigenous Catholic women’s religious institute in sub-Saharan Africa who are still involved in education and healthcare. In some locations, they have been able to access hospital and parish archives, including series of patient files, birth and death registrations and other data going back nearly 100 years.
Bras explained that one part of the research is to understand changes in medical and nursing practices in maternal and child health; to understand how things were done and how to interpret the practices; and, to critically analyse the archival documents, looking for incidences of agency and adaptation.
“We also want to understand how biomedical practices were adopted by local communities, the overlapping of healthcare practices and systems (medical pluralism) and the role of traditional healers; as well as the meaning of health and its religious dimensions.”
‘We are trying to understand the impact of all of this on reproductive legacies,” she added.
She noted that although some of the information available is selective with categories imposed by the missionaries, it still provides a wealth of information and a unique window onto the past.
Preliminary results from Uganda are showing that those who were closer to the missions married earlier and had higher fertility – especially Catholics – with closer referring to both geographical proximity as well as being socialised in Catholic thinking and lifestyle.
So how can Catholic nuns impact reproduction? In this Bras referred to letters from one of the White Sisters who outlined the aim of education as assisting women to escape from polygamy; transferring Catholic norms of motherhood to the population; and, aiming to create values to be passed from generation to generation.
Bras explained that next they hope to look at other data like rainfall, cotton prices and other economic data, spousal-age differences as a proxy for gender power differentials.
“Our initial focus was on the colonial period but we are also interested in what happened afterwards – and hoping to understand more about the impact of structural-adjustment programmes, HIV/AIDS and wars and conflict. We also hope to delve into the impact of female empowerment from the 1960s onwards and what this meant for female education, career options, age of marriage and decisions about motherhood.”
“The colonial legacy may be less important than has always been stressed,” she continued. “There is likely a mixture of colonial and post-colonial influences.”