“If we had started planning earlier, we would have a better life”
How a community-led programme is strengthening family planning on Idjwi, a remote island in Eastern DRC with one of the highest fertility rates in the world
The island of Idjwi on Lake Kivu in the Democratic Republic of Congo has a population of approximately 220,000 people. It is one of the most remote and deprived areas in Kivu, with the majority of people living on less than $1 per day.
One of the highest fertility rates in the world
Research conducted in 2015 by the Harvard Medical School with 2,093 households found that Idjwi has one of the highest fertility rates in the world, with an average of 8 live births per woman. Family planning services are largely unavailable, and rapid population growth has led to widespread food insecurity and environmental degradation. The research revealed a strong desire amongst local women for modern methods of contraception and directly linked this unmet need to the island’s high fertility rate.
A response designed and led by the community
With support from Ensemble, UFIN — the largest women’s co-operative on Idjwi — has launched a sensitisation programme amongst the islanders to increase awareness of the benefits of family planning and modern forms of contraception, and to enable women to access contraceptive implants.
UFIN, led by Madame Esperance — the wife of the Mwami, or King — has over 1,000 members and plays a vital role in community life. They run a compound where women can meet, cook, garden and learn to sew. Ensemble has also partnered with UFIN to set-up several businesses including a bakery and cassava mill.
The family planning and contraceptive services programme launched in 2016. Ensemble has helped UFIN to secure funding for 89 women to receive a contraceptive implant that will last 3–5 years. UFIN has also started to run innovative awareness-raising activities across the North of Idjwi targeted at both women and men.
Perceptions towards family planning and contraceptive services
Last year, the Ensemble team in Bukavu worked with UFIN representatives to conduct research amongst 94 women and men who have participated in the UFIN programme. The aim was to assess both their perceptions towards modern methods of contraception and family planning, and whether their decision to get a contraceptive implant had led to any positive changes in their lives.
Interviews were conducted with 52 women and 42 men aged between 15 and 50 were interviewed, 88% of whom already had children. In fact, 49% had between 5 and 11 children, pointing to the high fertility rate on the island. Before making the decision to have an implant just 27% of respondents had used other forms of contraception, and the majority (48%) had used the calendar method to track the length of a woman’s menstrual cycle.
The vast majority chose to get an implant either because they did not want more children or in the case of those without children, were keen to be able to plan when they had their first child. Chronic poverty also informed many people’s decision. 48% of respondents are farmers, whilst others work as merchants, teachers, nurses and builders. A further 9% are currently unemployed. Many respondents pointed to concerns about their ability to feed their existing children and a new baby, as well as the health implications for both the mother and children.
Enabling choices that empower local men and women
Of those 94 people interviewed, 89 were members of households who had already received an implant. 87% felt that the implant had led to positive changes in their lives.
Women pointed to their increased ability to work, a greater sense of independence and improved health. Both men and women noted improvements in the happiness of their family, their ability to support their existing children and the potential to plan for their life.
“I managed to finish high school and my husband was able to study” Women, 30–34 years
“I am proud to see my wife in good health” Man, 35–39 years
“I can now do what I planned and my family is healthy” Women, 30–34 years
The research also suggests that UFIN’s sensitisation activities are making gradual inroads, especially amongst local men.
“You do not know that having many children without having anything to feed them is not good” Man, 30–34 years
38% reported that they had heard about the implant programme through UFIN activities. 11 men had raised the issue directly with their partner, and a further 10 women responded that the idea of getting an implant had been suggested by their partner. 57% of all respondents reported that their decision to get an implant had been taken jointly with their partner.
“Planning allows us to be healthy and have the strength to work” Man, 30–34 years
“We can now plan according to the means we have” Man, 40–44 years
Reaching even more people
Informed by this research, UFIN is now working with Ensemble on further sensitisation strategies.
UFIN recently ran its first public education event on women’s health and family planning. Ensemble worked with them to secure the support of two local comedians, Dina Baganda and Reagan Baruzi who by making the event fun, engaging and accessible to the whole community helped to challenge some of the stigma around family planning and modern contraception methods. The response was fantastic — over 150 people attended and UFIN was able to increase awareness of its local support services.
Ensemble and UFIN also produced a series of five radio programmes that were broadcast in Swahili across Bugarula in North Idjwi. The programmes featured UFIN coordinators as well as couples who had participated in the contraceptive implant programme. They shared practice advice and their own experiences on family planning, contraception and women’s health.
Faced with addressing one of the highest fertility rates in the world and working with just a small budget, UFIN’s passionate and committed team are helping to address the previously unmet need for family planning programmes and contraceptive implants on Idjwi.
Their work is empowering both men and women to make positive, informed choices about their lives and families, with the potential for widespread benefit to people across Idjwi.
To learn more about UFIN’s programme or life on Idjwi please contact Ensemble’s Head of Partnerships, Vicky Nida (email@example.com).