Guest Blog Post by: Ash Rogers
Opening access to Family Planning is the most powerful tool the world has for increasing child survival, decreasing maternal mortality, and unlocking the economic potential of women. And yet, 220 million women in developing countries who don't want to get pregnant lack access to family planning services.
It is in this context that Addis Ababa holds the International Conference on Family Planning this week. International nonprofits and foreign aid entities will present important research on new contraceptive methods soon to hit the market and innovations in distribution that are proving effective. However, the most important lessons for improving access to family planning don't always come from these heavyweights, but from the women on the ground for which the stakes are immediate and personal.
At Segal Family Foundation we support 130 organizations working across 18 countries in Sub Saharan Africa. The heart of our portfolio is a group of grassroots organizations that are deeply embedded in communities. Their passionate leaders innovate local solutions based on listening to the voices of people in these communities. From them, comes this list of the 3 barriers only women understand:
1 - Men, the elephant in the bedroom
Family planning programs nearly universally target women. This seems logical given that the most widely available reversible methods (pills, injections, implants, IUDs) are for women. The focus on women also stems from a rights-based approach that supports women's agency to make their own reproductive choices.
However, women know that these choices are limited if their partners, fathers, and uncles don't share the same knowledge and values. Leaving men out of family planning programming places the burden on women to pass on information and negotiate family planning use. In countries with strong patriarchy and high rates of physical and sexual abuse, this burden is quite heavy.
Penda Health - a Kenyan chain of affordable health clinics targeting women - sees men as partners and promoters of family planning. Through listening to their female customers they realized they'd be most effective in providing for women's reproductive health if they opened the clinic to the entire family. Penda wins trust by delivering affordable care when patients are sick, and uses that as an entry point to discuss family planning with men and women. And it's working - the second most common reason that patients visit Penda clinics is for family planning services.
2 - Myths, magic, and menstrual blood
There are many myths about family planning: IUDs floating to your brain, susceptibility to witch craft, lifetime infertility, etc. What makes the situation even more confusing is that there are also real side effects: irregular bleeding, weight gain, changes in mood, decreased libido, etc. The overburdened health clinics of developing countries often fall short of engaging in empathetic conversations that dispel the former and explain the later. Without these conversations, expected side effects serve to justify stories of black magic and run-away IUDs.
When real side effects are reported, they often aren't taken seriously. Though irregular bleeding, changes in mood and decreased libido may not be of clinical concern, women know that these effects have real costs. This is especially true in contexts where women's activities are restricted during menstruation, feminine hygiene products are pricey, and denying sex with a husband is taboo.
Lwala Community Alliance - a grassroots community development organization in Western Kenya - is working to make the health system there more empathetic to women. Lwala has integrated family planning throughout their hospital with family planning services available at every intake point. Perhaps more importantly, 62 community health workers counsel women in their own homes, dispel common myths on sexual and reproductive health, and help women find the method that works for them. Lwala also has 23 Youth Peer Providers that specifically target youth with family planning education and information on available services. Since these programs began, Lwala has seen an increase in the average number of monthly family planning visits from 93 to 150. And, despite widely believed myths in the community about long-term methods (implants and IUDs), the number of women receiving long-term methods has more than doubled in the last 6 months.
3 - Economists' pillow talk
Economists teach us that if birth rates remain unchanged, the world population will be 11.9 billion by 2050, putting stress on the global economy while exacerbating climate change. These big numbers open markets, money and political space to put family planning on the global agenda.
However, women know that these macro-economic points loose their virility next to the cultural, spiritual, and personal considerations that influence sexual behavior. In many societies, large families are seen as a signal of wealth, and children as valuable economic contributors. Casting them instead as drains on the global economy and accelerators of environmental degradation doesn't play.
This is why FVS-AMADE - a Burundian nonprofit working with 1,170 village groups - based their family planning programs on deep community dialogue and tied it to individual economic opportunity. FVS layered their family planning messaging on top of village savings and loans groups which provide opportunities for families to save money and access capital for small businesses. While these groups discuss financial goals, they also have a local facilitator who introduces information about family planning. The group discusses ideas about family planning in a truly participatory format. Through this bottom-up approach communities define their own arguments for family planning.
Ash Rogers is the Director of Operations at Segal Family Foundation (SFF). She is based in Kampala, Uganda, but travels regionally, directing SFF's funding and capacity building support in Africa.