adminRoselyne Sachiti Features Editor
A FEW weeks ago, the International Family Planning Conference 2015, which was scheduled for Indonesia was postponed due to health and travel concerns following a volcanic eruption near Bali. Despite the rescheduling, the critical conversation continues in Africa, which still has to grapple with fact, myth and fears concerning contraception, as a method of family planning.
The Bali conference would have come at a time when Zimbabwe and nine other countries have been featured on the Spotlight on Family Planning Series (SFPS) released by International Planned Parenthood Federation (IPPF) through the Joining Voices campaign. The campaign aims to safeguard and strengthen financial commitments to reproductive health and family planning – and reinforce political leadership on universal access.
SFPS offers a snapshot on progress governments have made in delivering on their FP2020 pledges, made at the London 2012 Family Planning Summit.
At the 2012 summit, Zimbabwe made six pledges. The country pledged to increase the family planning budget from the current 1,7 percent to 3 percent of the health budget. However, because of various challenges the support for increasing budget allocations to family planning has failed to follow through and remains stagnant at 1,7 percent of the health budget.
Government also promised to increase access to a comprehensive range of family planning methods at private and public health facilities and surpassed their training target for long-acting reversible contraceptives (LARCs) in 2014.
However, the uptake of LARCs is relatively low; the most dominant method remains oral contraceptive. The Ministry of Health and Child Care (MOHCC) also scaled up procurement of LARCs and is distributing them to private services and public facilities such as hospitals and clinics.
The Zimbabwe National Family Planning Council has also been delivering training on LARCs (including tubal ligation and vasectomy) in the private and public sectors, in collaboration with the MOHCC and UNFPA.
Another pledge was to increase the availability of male and female condoms. This was successful as all public health facilities provide male and female condoms at no cost to the client. However, the condom distribution is dependent on donors who assist the Government to procure them. Also, it is important to understand that collecting condoms does not translate to usage and more needs to be done.
The country also pledged to integrate family planning services with prevention of mother-to-child transmission (PMTCT) and maternal and child health (MCH) services. However, integrated FP services within existing PMTCT and MCH services have been heavily dependent on donor funds for training and building capacity in supervision and support.
Notwithstanding financial challenges the country is going through, more resources are needed to ensure that all health facilities offer a comprehensive range of services like pap smears, voluntary counselling and testing.
At the 2012 summit, Zimbabwe also promised to improve and scale up gender-sensitive family planning services for vulnerable groups, especially adolescent girls.
Sadly, the country failed to improve and scale up government youth facilities.
There are many hindrances that include social, economic and cultural.
Zimbabwean society is clearly not ready for the debate on contraception for adolescents if recent events are anything to go by. The Ministry of Health and Child Care’s Strategy for Adolescent Health (2010-15) also does not include improving and scaling up youth facilities. But, despite the hindrances, the country also honoured its promise of eliminating user fees for family planning services by 2013.
User fees for family planning in public facilities were scrapped but some women in religious sects like the Johane Marange Apostolic sect do not access them because of their beliefs.
Also, some organisations that rely on g
Government funding to deliver services do not receive adequate support to cover their overheads and therefore un- able to offer family planning for free.
In addition, other problems and gaps have emerged and Government must address these issues urgently.
Thus, the need to engage parliamentarians both male and female, and chiefs to address the economic, cultural and social challenges is important.
Facilitating the active participation of girls and young women, including those who are marginalised and those living with HIV, in all aspects of national programming and decision-making relating to HIV and Aids cannot be overemphasised.
The commitment to women’s health should be strengthened by responding to the health impact of unsafe abortion, a major public health concern, by scaling up post-abortion care and reducing unintended pregnancies through expanded and improved family planning services.
There is also need to implement evidence-based HIV prevention programmes that address the needs of girls and young women, especially those living in prison or detention centres, others involved in transactional sex or child marriages, survivors of gender-based violence and orphans.
Despite the challenges, ZNFPC’s contribution to sexual and reproductive health services has been commendable. For example, the ZNFPC provided 1 858 531 couple years protection in 2014, a 3,823 percent increase from 2013.
ZNFPC services also resulted in 701 108 unintended pregnancies being averted in 2014, a 4,183 percent increase from 2013. They also provided family planning services to 15 415 new users in 2014, a 183 percent increase from 2013. Globally the debate is also still on with various challenges emerging. Nearly 225 million women still have an unmet need for modern contraceptives.
About four in every five unintended pregnancies (81 percent) occur among women who want to avoid pregnancy, but are not using an effective family planning method.
Perhaps most alarming: adolescent girls (aged 15-19) have the highest unmet need for family planning among any age group. Adolescent pregnancy is a major contributor to maternal and neonatal mortality. Meeting the unmet need for family planning could reduce the number of maternal deaths by one-third.
A new progress report by FP2020 is a ray of hope though progress has been slow. The FP2020 report, Commitment to Action 2014-2015, details achievements since the 2012 London Summit. It says more women and girls than ever who want to avoid or delay a pregnancy —290,6 million—are voluntarily using modern contraceptives in the world’s poorest countries, an increase of 24,4 million from 2012.
While significant strides have been made to reach the ambitious goal of enabling 120 million additional women and girls to access rights-based family planning by 2020, the report shows that FP2020 and its partners must take immediate action to speed up progress.
The additional 24,4 million women using effective contraceptives, in the past year alone, have averted 80 million unintended pregnancies, 26,8 million unsafe abortions and 111 000 maternal deaths.
The lessons learned, thus far, point to three areas where strengthening efforts will help accelerate progress: better understanding and meeting the reproductive health needs of adolescents, increasing the quality of services women receive and placing a greater focus on reaching the urban and rural poor.
Said Dr Chris Elias, president of Global Development at the Bill & Melinda Gates Foundation, and co-chair of FP2020’s Reference Group: “Our progress, while significant, is not matching our ambition. We need to take a hard look at the data, scale successful programmes and invest smartly. I’m confident that we can keep our promise to millions of women, but only if we act now.”
Beth Schlachter, Executive Director of FP2020, argues: “Our task is ambitious, but achievable. We know more now than we did three years ago and have data and on-the-ground experience to show what works and what doesn’t work. Through this global partnership, we have learned that we can make an enormous difference, but we must work together to empower women and girls to plan their own lives, families and futures.”
Family planning is frequently cited as one of the “best buys” for global development and expanding access to contraception will indeed play a critical role in our global efforts to achieve the Sustainable Development Goals. In fact, family planning is a triple win health intervention: it reduces maternal mortality, prevents child deaths, and contributes to an AIDS-free generation.
Yet, even with all this, Zimbabwe has made some progress towards its pledges, though existing efforts are not enough to deliver on its promises by 2020.
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