Erin’s Tuesday — Thinking about Family Planning

Whenever we visit clinics and talk with health authorities, we’re amazed by health statistics that impact women.

Whenever we visit clinics and talk with health authorities, we’re amazed by health statistics that impact women. For example, here in Uganda, the average number of children each woman has is 6.2. That keeps Uganda at the very top of global fertility rates. Since 6.2 is an average, that means some women have more. As a mother of two, I have a hard time wrapping my mind around the idea of adding four or five more children to my family. Yet, that’s a reality in many developing countries. It’s also a major factor that contributes to high maternal mortality ratios in Uganda and specifically in the districts where we’re working to reduce preventable deaths caused by pregnancy and childbirth.

The correlation between high maternal mortality rates and maternal deaths is undeniable and these deaths aren’t caused just by the strain multiple pregnancies inflict on women’s bodies. They’re also caused by the cumulative affects of poverty. And these deaths don’t just strain the family. They also caused a major developmental strain and a country and they impact the health and wellbeing of everyone whose life that mother touched.

The reality is that most families simply can’t afford to feed and educate six or seven children. While the survival of children under age five is improving, newborn and child deaths are still a big problem.

One of the biggest reasons why women have so many children here is because they don’t have access to family planning services and products, even if they want them. Certainly some families want to have a lot of children, but other families simply can’t avoid it. There are many factors that seem to be encouraging women to have large families regardless of the poor birth outcomes and toll on women and children’s lives. There are influential people who encourage family growth, especially in certain districts here where they believe they are still replenishing the population after some devastation. In some areas, there are also strong cultural preferences for a boy child to carry on the family name. But in many cases here in Uganda and many other parts of the world, there simply aren’t enough options to help people control their family size. In fact, the demand for family planning options is huge. But like many other places in the world there are not enough options to help people control their family size despite an enormous demand. The United Nation’s Population Fund (UNFPA) provides some startling statistics:

• Worldwide, around 200 million women say they want to delay or prevent pregnancy but are not using effective contraception. Either they have no access to it, they think they will not get pregnant, they fear side effects or their families object.
• Researchers estimate that universal access to family planning could save the lives of about 175,000 women each year. Increasing birth intervals to at least 36 months could also prevent the deaths of 1.8 million children under age five.
• Fewer than 20 per cent of sexually active young people in Africa use contraception. Apart from lack of money, barriers include insufficient knowledge, fear of social disapproval, side effects and misperceptions about the partner’s opposition.

After pondering this conundrum for a few days I was confronted with the issue head on today after a clinic visit. We had arrived early in the morning before most women had come in for regular visits and there was just one woman in the postpartum ward. As we were getting ready to leave, a motorcycle (called a “boda boda”) screamed into the compound and headed for the back of the clinic where the delivery room was located. I jogged back around just as a VERY pregnant woman was unloading and heading into the delivery room, assisted by the medical officer. Kiizwa was in labor with twins- for the SECOND time. This was her tenth pregnancy and she was about to deliver her 12th and 13th children.

I don’t know if Kiizwa was educated on her options or if she had tried to access family planning in the past. I don’t know how much time she’d been able to put between these pregnancies or what toll 10 pregnancies and two sets of twins had taken on her young body. I asked the community volunteer (who had been working with Kiizwa in her village to encourage her to deliver at the facility) if she’d discussed family planning options with this mother and her husband. I was told there hadn’t been time. Kiizwa was likely never educated on her options or the danger of having so many births. But the look on Kiizwa’s face when she told me how many pregnancies and children she had revealed that she might be ready for that conversation now.