When two should tango

Roselyne Sachiti Features Editor
Memory Moyo (29) started using contraception after the birth of her first child six years ago. Her choice, the pill, was the least expensive and easily accessible. Together with her peers she travels once every three months to the nearest clinic, Tongwe in the Gukunde area, Beitbridge, Matabeleland South, for supplies of the contraceptive.

Here they access their chosen methods of birth control.

At a cost of US$2 per three packets, Moyo and others say they simply cannot afford it anymore.

As few husbands have an interest in their wives’ reproductive health matters, there is usually no allocation in family budgets for contraception.

The family planning role is usually left to the woman.

Aware of the implications of unplanned pregnancies and the importance and benefits of child spacing, the women have made arrangements with the clinic to get the pill on credit.

“I usually settle the debt at the end of the year when I have extra money for Christmas shopping. We want Government to provide free contraceptives,” she said.

In dry rural areas like hers, getting a dollar per day is never easy.

Their income usually comes from the sale of cattle or when their husbands relocate to South Africa and send money home.

Yet despite their economic status, women in some parts of Zimbabwe are still expected to pay for contraception which is offered free in other areas.

But in spite of the challenges, Zimbabwe is one of few countries with the most equitable distribution of contraceptive use across socio-economic groups, meaning that more women and girls throughout the country have access to contraceptives regardless of wealth.

The country is a signatory to the 1994 Cairo ICPD/programme and as a result some national policies, strategies and guidelines that include the national guidelines on family planning (2011), among others, were developed for a co-ordinated implementation of sexual and reproductive health (SRH).

Zimbabwe also made some pledges at the Family Planning 2020 meeting in London (2012).

The country committed to increase the contraceptive prevalence rate from 59 percent to 68 percent by 2020; to reduce unmet need for family planning from 13 percent to 6,5 percent by 2020; and to reduce adolescent girls’ unmet need for family planning services from 16,9 percent to 8,5 percent by 2020.

The unmet need for family planning is one of the indicators used to track progress towards achieving the Millennium Development Goals 4 and 5 which aim to reduce child mortality and improve maternal health respectively.

Zimbabwe National Family Planning Council (ZNFPC) assistant director (marketing and communication) Mr Isaac Mukaronda said contraception should not only be a woman’s issue because men also enjoy the benefits of family planning.

“The role of men in family planning is crucial and critical.

“Zimbabwe is a patriarchal country hence the use of family planning methods is determined by the men in most instances. There are also some methods of family planning which require male co-operation and contribution such as condom use.

“Both the male and female condoms cannot be effectively used without involvement and participation by both the men and women,” he said.

Mr Mukaronda added that they offer men’s services such as vasectomy and voluntary medical male circumcision (VMMC) through provision of comprehensive integrated sexual reproductive health services.

He said one in four women were using family planning to limit the number of children they have.

However, he said, 59 percent of these women were using a modern method with 41 percent on the pill.

“Therefore the family planning method most commonly used is the pill (41,3 percent) followed by injectables (8,3 percent),” he said.

He also revealed that the use of modern contraceptive methods among women increases with age, from 35 percent of women aged 15-19 to 63 percent of women age 30-34, after which it falls to 41 percent of women aged 45-49.

“An increase in the use of the pill is evident in younger age groups from 30 percent of married women age 15-19 to 49 percent in age group 20-24,” he added.

He also explained that use of modern family planning methods was higher among sexually active unmarried women (62 percent) and for currently married women (57 percent).

While 30 percent of sexually active unmarried women use male condoms, only 3 percent of currently married women use them, 18 percent of sexually active unmarried women use pill versus 41 percent of currently married women.

Women in rural areas are less likely to use contraceptive methods than their counterparts in urban areas (57 percent) compared with 62 percent.

Use of contraceptive methods is highest in the provinces of Mashonaland Central (64 percent) and Mashonaland East (63 percent).

Matabeleland South has the lowest contraceptive prevalence rate among currently married women (46 percent).

Contraceptive use is positively associated with women’s level of education. At least 43 percent of currently married women with no education use contraceptives, 67 percent of those with secondary education use contraceptives. Similarly, women in lowest wealth quintile (54 percent) are less likely to use contraceptives compared with women in the highest wealth quintile (65 percent).

Mr Mukaronda bemoaned funding challenges as ZNFP was giving out free contraception.

“In these harsh economic times funding is a problem internationally and nationally and ZNFPC is not spared.

“If in these circumstances the Government managed to set aside 15 percent of the National Budget for the health sector and in turn the Health Ministry also sets aside 7 percent of its budget for family planning the situation would be more comfortable for council,” he said.

He explained how male involvement in family planning would increase uptake and reduce the discontinuation rate of contraceptive use.

“It will increase the acceptability of the permanent method of contraception (vasectomy).

“Zimbabwe will benefit by achieving its family planning goals through a number of ways that include maternal and child health benefits,” he said.

Family planning, he added, helps in preventing pregnancy-related health risks in women and also reduces the need for unsafe abortion.

“Illegal abortions are a danger to lives of women and a major cause of maternal mortality,” he explained.

He added that family planning also has economic benefits.

“By investing in family planning the nation will be saving for the future and allowing one to have the children they want, a number they will be able to sustain and maintain.

“It also allows couples to have more disposable income and time.”

Family planning, he added, also has benefits to other areas of development, such as the Millennium Development Goals (MDGs).

Secretary in the Ministry of Health and Child Care Dr Gerald Gwinji said despite funding gaps, Zimbabwe has made commendable progress on family planning.

In fact, he said, the country’s family planning coverage is one of the best in the world.

“We have also recorded a reduction in our unmet need for family planning what we now have to do is ensure continued funding.

“There are funding gaps for most health programmes hence family planning has not been spared. We operate in the same constrained environment that most of Government is operating in.

“Funding from partners is also becoming harder and harder to get as they too have begun facing constraints.

“What we seek to do is increase efficiencies to get maximum benefit from whatever comes our way,” he added.

Challenges women face regarding family planning methods are not only confined to Zimbabwe.

Globally, women face similar challenges, too, as explained by Women Deliver Chief Executive Officer Katja Iversen.

“Some of the most common challenges to contraception include: poor access to sexual and reproductive health education, particularly youth-friendly information; inadequate and costly health services, including limited contraception options; and, socio-cultural norms that stigmatise or discriminate against women seeking family planning.

“The good news is that these are all challenges that can be overcome with continued investments in girls’ and women’s health and rights. With a new sustainable development agenda on the horizon, now is the time for policymakers to deliver on their promises to girls and women and renew their commitments to their health, rights and well-being,” she said.

She added that contraception use varies around the world.

“In some countries, women may choose to use intrauterine devices (IUD) and in others, women prefer long-acting injectables – the key word there is ‘choice.’

“Each woman, everywhere, should have access to affordable contraceptive options, so that she can make an informed choice about which family planning method works best for her,” she added.

Of the 1,5 billion women of reproductive age (15-49) in developing countries, 645 million women used modern methods of contraception in 2012. “Contraception use among sexually active women varies across the SADC region: from 76 percent in Mauritius, 60 percent in Zimbabwe to 6 percent in Angola.

“It’s likely that married and unmarried women across the SADC region face a wide range of barriers to contraception – from poor access to sexual and reproductive health education to inadequate family planning services and contraception options.

“What’s clear is that there are serious gaps and inequities in contraception use across the region that must be addressed,” she said.

Globally, she said, men have an important role in family planning.

“Men make up half of the world’s population, and still remain the majority of the world’s leaders. They run the most powerful institutions, companies and governments, and in many places, remain the primary decision makers in their communities and households.

“Yet, too few men are choosing to use their voice to advocate for sexual and reproductive health and rights – for themselves and their partners”.

“Imagine what could be possible if every man in every family, community and nation joined the reproductive health movement and prioritised family planning: fewer girls, women and babies would die during pregnancy and childbirth, and instead, more would survive and thrive,” she pointed out.

By investing in family planning, Zimbabwe is taking positive steps toward improving the health and well-being of girls and women thereby making strides towards realising MDGs 4 and 5.

In other words, investments in family planning services reduce the overall costs of maternal and newborn healthcare, and save lives.