Photo Essay

Our Growing Numbers | Accessible Contraception in East Africa


As unemployment remains high and the region’s resources are rapidly being swallowed up by the booming population, family planning is something that every family should consider here in East Africa.  In Amuria, Uganda where I live, 57% of all people are under the age of 17.  When one compares that to my home town of Richmond, Virginia, in the US, that number falls to 22%. Uganda’s youthful population of 32 million has nearly doubled in the past twenty years.  It has one of the highest growth rates in the world.  If the current trends stay on track, the country will be home to more than more than 130 million people by 2050. 

I’ve recently been working with PSI, Population Services International, in Tanzania and Uganda. PSI works in a number of areas in Global Health, but I’ve been specifically documenting their family planning services here in East Africa. Working in both rural and urban areas of East Africa, PSI educates women and families about family planning and provides them with birth control solutions such as condoms, IUDs, and oral contraceptives. According to the organization, PSI prevented an estimated 3.5 million unintended pregnancies and over 17,000 maternal deaths in 2009 alone. Fewer pregnancies and spaced births provide families with a more sustainable way of life, and further boost the chances of survival for existing children. Above, women visit a family planning clinic in Dar es Salaam, Tanzania.

Most Ugandan women average seven children in their lifetimes. Here large families are needed to work the land, but the number of children a family has also determines that family’s, and larger clan’s, social hierarchy, especially in rural areas. However, when children reach adulthood they often find themselves in deeper poverty than their parents because their parent’s land must be divided among such a large number of children. Families who have large numbers of children in turn find it a struggle to come up with enough money to educate them all. Often families must choose which children to send to school and which ones to keep at home. When parents do choose education for their child, it is often in overcrowded classrooms, averaging about 70 students per teacher in Uganda. In my district this number reaches 120 students per teacher. Above, children learn in a crowded classroom in Tororo, Uganda.

Above, Sylvia Mkuteni (name changed) is twenty-five years old and lives in Masaka, in southwestern Uganda. Her husband lives and works in Kampala and only comes home once every few months. She has a hard enough time raising their five children on her own, and so, despite her husband’s wishes for a larger family, she’s decided not to have more children. Three months ago she received an IUD through PSI’s services. She hasn’t told her husband about it and doesn’t plan to.

While access to contraception in Africa is widely available in most cities, those in rural areas may be a day’s journey from any family planning services. In East Africa, PSI works to make their products and services available to all by establishing programs in small private clinics in both urban and remote, rural areas. Often women first hear about their option to plan families through PSI’s informational adverts on the radio.

While most women can pay for their contraception, PSI has designated one day a month in Masaka as a discount day, where women can receive services at a highly discounted rate. They’ve been extremely successful at stamping out common misconceptions about contraception that are whispered between women in the village: contraception makes you sterile, contraception causes abnormalities in future offspring, breast milk decreases during use, etc.

Above, Bashir Hassan (left) sells Salama brand condoms in his general store in Dar es Salaam. PSI is the manufacturer of these the most popular and widely available brand of condoms in the country.

Despite the large presence of the Roman Catholic Church (42% of Ugandans are Catholic), the nuns and clergy here are quietly supportive of family planning operations, directing parishioners to where they can receive such services or even handing out condoms. Above, Sylvia Mkuteni (right) examines an IUD at Kawoko Muslim Health Centre in Masaka District, Uganda.

PSI has programs in over 65 countries throughout the world. Reproductive Health is just one of the areas in which the organization works. Others include malaria and TB prevention, HIV/AIDS and water treatment. If you’ve ever wondered how many residents we have on our planet and at what point humans will outgrow the earth’s resources, this recent David Attenborough/BBC documentary suggest that things may get pretty tough within the next forty years. As the average American consumes as much of the world’s resources as 300 Tanzanians, it’s a topic in which we have a vested interest. Take a look. It’s thoroughly interesting. Take a look.

Jun 26, 2010 by Jake

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Oceans apart – the other side of Tanzania


It’s not really what you think of as Africa, but neither is it the Middle East. The island of Zanzibar, otherwise known as Unguja, is in part its own entity, and the center of Swahili culture in East Africa. In an area of the world where political unrest is not uncommon, it’s a wonder Zanzibar has been in union with the Tanzanian mainland for as long as it has.

The Sultanate of Zanzibar, an archipelago nation off the Indian Ocean Coast of East Africa, merged with the East African nation of Tanganyika in 1964 to form the United Republic of Tanzania, a hybrid name reflecting both countries. Earlier that year Zanzibar, a newly independent state itself, experienced a revolution in which over 12,000 ethnic Arabs and Indians on the island were massacred overnight. In the wake of the revolution most of Zanzibar’s wealthy and educated fled the country never to return. Its president, facing a potential coup by extremists and a devastated economy, had little choice but to join forces with the mainland country of Tanganyika.

Culturally, Zanzibar is almost quite literally oceans apart from its mainland counterpart. The population today is overwhelmingly unhappy with what they see as the destruction of their conservative Islamic culture brought on by relaxed travel rules between the island and the mainland and their limited autonomy as part of the union government. However, each cycle of elections, the results of which are usually disputed by international observers, sees victory for CCM, the party favoring closer ties to the mainland. The union government has survived to this day, but the marriage has never been happy.

These photos were taken over a four-day period while practicing my Swahili in Stonetown, known as Mji Mkongwe to speakers of the language. I intended to get out of Stonetown and photograph a bit more of the island, but the myriad of winding alleyways, hidden rooms and endless cups of fresh coffee brewed over open coals on the street were enough to keep me wandering around in town for more than a week.









Jan 18, 2010 by Jake

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Shoreculture II: Lake Malawi

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More like an ocean, Lake Malawi runs almost the entire length of this Southern African country. I went to one of the least developed parts, the northern town of Karonga, on my way down to a recent assignment shooting Gucci funded UNICEF projects for Marie Claire Magazine.
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Dec 14, 2009 by Jake

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KEEPing the rainforest alive – Kenya’s Kakamega Forest Reserve

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I was recently in Western Kenya. What was intended to be a quick stopover en route to Uganda turned into four days of rummaging through a rainforest with my camera wrapped in plastic shopping bags. As my “hotel” was without it, I had to hitch a ride on the back of a motorcycle to the nearest place with electricity so I could download images and charge batteries every night.
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Not too long ago Africa’s midsection was a band of almost solid rainforest, stretching over six million square kilometers from West Africa along the Atlantic, through to the Central African Republic and the DRC, into East Africa. Today, the Guineo-Congolian rainforest, as it is known, is now just a remnant of what it once was, its canopies having suffered the impact of logging, oil and mineral exploration. In the case of the Kakamega Forest, large areas were cleared during colonial times to make way for large tea plantations. Below, children stand in front of tea fields along the the forest’s periphery.
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While vast ares of the rainforest are still present in Central Africa, only a tiny section of it remains in Kenya, where it is now a protected area. The Kakamega Forest Reserve occupies 240 square kilometers in Western Kenya and contains huge varieties of birds, insects, snakes, plants and small mammals. Many of the plants in the forest are highly medicinal.
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The most exhilarating of events for me came as I accompanied a group of forest rangers on their daily rounds through the reserve. Following behind these soldiers with loaded weapons in tow, through thick vegetation and winding streams, really got my adrenaline going. At one point we were in hot pursuit of some poachers who were cutting down a tree, but they managed to escape.
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The area around the forest, though rural, is one of the most densely populated areas in Africa, with around 400 people per square kilometer on average at its western and southern perimeters. As the communities around the forest are impoverished, the pressure is great to exploit the forest for its vast stocks of wood to be used as firewood or made into charcoal. Arrests do occur here every day. Steep fines accompany arrests and increase with repeat infractions.
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KEEP (Kakamega Environmental Education Program) is the government agency responsible for the care and protection of the forest. It also provides guides for tourists wishing to visit the reserve. These guides double as educators who teach environmental education awareness classes to children at the reserve headquarters on weekends, and also in public schools around the forest. Below, Mr. Abraham Imbai speaks to the Environmental Management and Conservation Club at Lunyu Secondary School.
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“If we destroy the forest we lose rain.” says Maurine Cecilia, below, whose corn and herb gardens rely on the (usually) daily rainfall that results from the evaporation of the mist from the forest. Indeed, the land around the forest is extremely fertile, and farmers often reap several harvests a year because of the year-round rain. Soil erosion, a serious problem in most other parts of the county, is not an issue here.
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Still many who live around the forest have little choice than to operate on the one day at a time mentality. “I know its illegal but its my responsibility to cook food for my family,” says one poacher (below, left) who along with her children have cut several fresh trees down and have to risk making three trips through the forest to take it all home.
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Villagers are willing to risk fines in order to pilfer the abundant, free, firewood that comes out of the forest, especially if they can turn it into valuable, slow burning, charcoal. Though the production of charcoal is illegal, its lucrative rewards tempt some around the villages to produce and sell it. Below, men in the village of Virembe, on the forest’s western perimeter, smolder wood for charcoal.
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“Right now there’s a total ban, but we’d like to allow it in order to bring prices down and discourage lucrative poaching,” says head Forester George Aimo. “If it was allowed under certain circumstances the forest would be better protected.” While there is an outright ban on charcoal production, it is permissible to collect dead wood in some areas of the reserve as long as the scavenger bears a receipt costing 100Ksh (USD $1.25) per month. The fine for a first time offense of collecting dry wood without a receipt, or felling trees or limbs is 2000 Ksh ($25 USD). Below, Mr. Patrick Asutzi, a KEEP employee, prepares seedlings for planting at the central ranger station.
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Other problems in the forest include illegal logging, grazing and grass cutting. The A1 highway runs along the western edge of the forest making guerrilla logging easier. Villagers also graze their cattle in the periphery of the forest or even in the forest itself causing long term problems. “Overgrazing degrades the soil and inhibits regeneration of trees,” says Forester Aimo. Below, a man cuts grass in a high glen in the forest.
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Above, a Black and White Colobus Monkey hides in the treetops. Its numbers have boomed back in the forest since the time when they were hunted for their fur, which was used in ceremonial garb. Today the monkey is still endangered, as the tree whose leaves are crucial to its digestion, the sandpaper tree, is also in danger due to logging and predation from pest trees in the forest. These predator species wrap themselves around other trees and over years suffocate them to death (see below).
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We can never convince an entire generation that it must make sacrifices in order to provide quality of life for those to come, but for the most part KEEP is succeeding in this. Though serious problems exist, the forest not only remains but in some areas is growing. For the moment life is abundant here, though it is not without heavy cost and toil.
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Nov 3, 2009 by Jake

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Women’s Work

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Gender roles are strictly divided in Sub-Saharan Africa – more so here than in any other place I’ve traveled. Women perform most of the tasks here from fetching water, to washing clothes, to taking a child to the hospital. However, few roles are solely set aside for men, except perhaps playing football or napping in the afternoon shade. A breach of code whereby men venture into women’s work is a sore embarrassment and one not to be done publicly. For the majority of those living on this continent life is hard. For women, the burden is harder still.
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Oct 13, 2009 by Jake

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So long, farewell

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Frank & Salome got married recently. While I photographed their wedding as well, I thought the images from the farewell were a bit more interesting. The farewell is when the bride formally says goodbye to her family and is embraced into that of the groom’s.
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In this case, there was a lot more hoopla and fanfare here than at the wedding, which occurred two days later. The day showcased a melange of tribal customs; Salome is a Masai, Frank a Chagga. My favorite of these was the lavishly ornate, roasted goat, also known as “the cakie”. The event, which took place on the slopes of Mt. Meru, served as a reminder that while Africa is modernizing, its deep-seated traditions remain.
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Jul 6, 2009 by Jake

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Photo Essay

Motor City, West Africa

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On Monday I had a few hours of time on my own to explore the city of Bamenda, in the North West Highlands of Cameroon. Away from the steamy jungles of the South and Center, the North West has a cooler climate than the rest of the country, which contributed to my desire to get out of my hotel room and explore the city. I came to Cameroon expecting to practice my French each place I went, but found that Pigeon English was more widely spoken in this region than any other language. I never really got a grasp on it.
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In the North West, the motor bike is king- the quickest and cheapest form of transportation around the city and a must-have for any young bachelor looking to find a date for the evening. I found a driver with whom I could communicate and we agreed upon a price for him to show me around the city for the afternoon. At the time, I only deemed my ride on the back of the bike, camera in tow, a small risk – one that was worth taking for the exhilaration of riding through the markets and neighborhoods of this dusty, sprawling town. Besides, everyone else was doing it.
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At times we’d pause on the street and snap photos, chatting with the subjects. I picked up some new Congolese music for 50 cents a CD and a new pair of Ducci sunglasses. After a couple hours of riding, the chain derailed off our motor bike. We pulled over at the side of a large intersection and got to work on removing the chain’s metal housing.
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As my driver, Frankie, was just getting his hands dirty on the greasy chain, we heard a loud crash in the intersection and looked over to see a large cloud of brown dust billowing from the road into the sky. A few seconds later, a man came running from the cloud saying something like “I tink go man die.” The Pigeon English took a second to process.
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I raced to the accident. At first it was to see if those involved needed any help, but there was already a crowd surrounding the victims- the drivers of two motor bikes and a taxi cab, their faces bloodied and limbs contorted. The cab had apparently swerved into a bridge after hitting an oncoming motor bike. The driver was knocked from the car and into the river below. Camera already in hand, I continued to shoot as the taxis, which doubled as ambulances, arrived on the scene to transport the victims to the hospital.
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Slightly delayed and perhaps not as shaken as I should have been, I made it back to the hotel in time for dinner with the crew. This is Africa, and this is sort of thing is commonplace.
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Mar 10, 2009 by Jake

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Armenia, Stuck in the Middle.

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A small nation with a big heart, Armenia has nearly been whittled away by its neighbors over the centuries. Today, most Armenians live outside the country’s borders in diaspora communities throughout the world. Its ancient traditions remain strong and intact, however, despite years of invasion, persecution, occupation and displacement. Even though conflict continues to this day, Armenia’s hospitable and vibrant people have not lost their disposition to live life to the fullest, seemingly oblivious to current and past upheaval.
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Armenia has been called a master of geopolitics. Straddling Eastern Europe and Western Asia, and in the peripheral vision of both Tehran and Moscow, it maintains excellent relations with the two while looking more toward the West for its model of government. Above, Leyli learns to walk in Gusangagyugh Village, Shirak Region.
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The Caucasus region is no stranger to turmoil. Nearby Georgia experienced the most recent eruption of conflict in the area this summer. The brief Russia-Georgia war was a reminder of the competing spheres of influence in the world, and that this narrow strip of land between the Black and Caspian Seas is still as strategic as it has ever been. Above, Naira Sargsyan (36) feeds her youngest of eight children, Leyli. Large families are common in Armenia, as they are throughout the developing world.
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The Capital city of Yerevan is the only bustling metropolis in this small nation of 3.2 million in the Caucasus Mountains. Above, the doorway of an indoor food market in central Yerevan.
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Despite Yerevan’s wealth and western feel, conditions outside the capital city are less developed, and the post-Soviet collapse is still evident. Often it feels like stepping back in time. Below, potato harvesters in Saramedj village, Lori Region.
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A statue of Mother Armenia stands sword-in-hand looking toward the Turkish border in a Soviet-era plaza in Yerevan. Turkey and Armenia have never experienced normal diplomatic relations with each other since Turkey’s refusal to acknowledge the Armenian Genocide of 1915.
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Above, a view of the valley from an earthquake-damaged home in Saramedj village. The great Spitak earthquake of 1988 killed at least 25,000 people in this area and prompted Mikhail Gorbachev to call for foreign aid in the Soviet Union for the first time since World War II.
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Twenty years later, residents like Tsaghik Frangulyan (31) and her children still live in “temporary” trailers brought in by the Soviet government’s FEMA equivalent.
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My visit to Armenia coincided with harvest time. I’ve never tasted such rich, flavorful produce than in the Caucasus. Much of life outside the capital centers around agriculture and farming. Above, Susanna Karakhanyan harvests vegetables from her organic garden. Below, a bit of her freshly harvested, all-organic vegetables.
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A farmer negotiates rush hour in Lori Region.
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Above, a view of Berkaber village along the Azerbaijan/Armenia border. The center lake marks the countries’ boundary. The two nations continue to exchange cross border gunfire several times a week in spite of a 1994 ceasefire agreement.080926_280s.jpg
Residents in Berkaber like Mr. Yura Tamrazyan and his wife Siranuysh Mantashyan must remain vigilant. Several villagers have been killed by sniper fire in years past.
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At the source of the conflict between the Armenians and Azeris is a portion of land within the borders of Azerbaijan known as the Nagorno-Karabakh, whose population is predominantly ethnic Armenian. This month, Russian president Dmitry Medvedev sat down in Moscow with the presidents of both countries, successfully persuading them to engage in future talks on a political solution to the stalemate.
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Wood and dried cow manure are stored for winter fuel in the shell of an old Lada in the village of Gusangagyugh, Shirak Region. Extreme Canadian-like winters last until April or May throughout much of the country.
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Hrach Nalbandyan (66) and his wife Zubeida (60), in the village of Gusangagyugh in Shirak Region, with pickled vegetables stored for consumption during the harsh winter ahead. 080929_270s.jpg
Yerevan residents attend a jazz concert at the Opera House.
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Armenia was the first nation to adopt Christianity as its state religion. It did so in the early 4th century. Since then, the Armenian Apostolic church continues to play an important role in the lives of citizens here. The church made history again this century as the only one in the Soviet Union to operate openly in staunch defiance of Soviet policy. Above, a Sunday service at St. Karapet Church (circa 1227) at Noravank Monastery near Yeghegnadzor.
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A tomb from around the turn of the first millennium, Areni Village, Vayots Dzor Region.
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New generation: Hripsime Hovhannisyan (5) sits on her living room couch with her grandparents Artavazd (82, left) and Siranuysh (79, right) Karakhanyan, in the village of Areni, Vayots Dzor Region.
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Church leaders from around the world tour the Armenian Genocide Memorial and Museum in Yerevan. Karekin II, who is the Catholicos, or head of the Armenian church, walks in the center holding a staff. Below, the eternal flame.
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In 1915, the Ottoman Empire began its systematic campaign of destruction against the Armenian people living within its borders. Most Armenian diaspora communities were established as a result of the genocide which ended in the extermination of up to 1.5 million Armenians.
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Mount Ararat, the Genesis account’s final resting place of the ark. Even though the mountain was ceded to nearby Turkey in 1923, following the invasion of the Red Army, Mount Ararat continues to be the symbol of Armenia today, keeping its place on the coat of arms and dominating Yerevan’s skyline.
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Nov 23, 2008 by Jake

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