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There hasn't been adequate emphasis on family planning
Joyce Mulama, Inter Press Service (IPS)
September 19, 2006

http://allafrica.com/stories/200609200001.html

The problem of limited access to contraceptives is taking centre stage at an African Union (AU) meeting currently underway in Maputo.

Since Monday, health experts have been holding talks in the Mozambican capital about a plan of action that seeks to provide comprehensive sexual and reproductive health services across the continent. This comes ahead of a gathering of AU ministers of health (Sep. 21-22), who are expected to adopt the plan.

"There hasn't been adequate emphasis on family planning as a strategy, and yet it is a cost-effective thing," says Chisale Mhango, a public health expert at the AU's Department of Social Affairs.

"When you provide family planning, you are reducing unwanted pregnancies and therefore maternal mortality -- including deaths from abortion."

Statistics from the United Nations Population Fund (UNFPA) indicate that sub-Saharan Africa has the highest number of maternal deaths in the world: 241,000 every year, almost half of the 529,000 maternal deaths that occur worldwide.

Put differently, a woman living in sub-Saharan Africa has a one in 16 chance of dying during pregnancy or childbirth. For her counterparts in the developed world, it is one in 4,000.

Funding shortfalls have played a significant role in the "inadequate emphasis" Mhango refers to.

A Jan. 20 report* by the United Nations Economic and Social Council (ECOSOC) says donor funding for family planning declined considerably from 1995 to 2004. (A similar ECOSOC report issued in January 2005 notes that funding for family planning programmes decreased by 36 percent from 723 million dollars in 1995 to 461 million dollars in 2003.)

These decreases can be traced back to the AIDS pandemic, which has absorbed an ever-greater share of financial assistance. And unfortunately for family planning advocates, the migration of funds to HIV initiatives shows no signs of abating.

"Given the increased emphasis on addressing the global AIDS pandemic, including the Millennium Development Goal of combating HIV/AIDS, malaria and other diseases and the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President's Emergency Plan for AIDS Relief, the shift towards funding for STDs/HIV/AIDS is expected to continue and to be especially prominent among donor countries," notes the 2006 ECOSOC report. (STDs stands for "sexually-transmitted diseases.)

Add to this the pressures of population growth, and the picture becomes even grimmer.

"Countries in Africa are overwhelmed by the increasing numbers," Jotham Musinguzi, director of the Population Secretariat at Uganda's Ministry of Finance, Planning and Economic Development, told IPS.

"With the high population growth, governments are not able to provide infrastructure for their people, including reproductive health care."

The extent of the challenge facing those involved in family planning can be seen in the misunderstandings that flourish about certain forms of contraception.

"Information is lacking. That is why you hear women in the rural areas talking about the intra-uterine device moving up to the brain. This wrong information spreads from one woman to the whole village," Josephine Kibaru, head of reproductive health at Kenya's Ministry of Health, told IPS in Maputo.

According to the 2003 Kenya Demographic Health Survey, the latest study of its kind, 34 percent of women of reproductive age who want to use contraception lack access to it.

As regards the female condom, there is not so much misinformation as lack of awareness. Kibaru says efforts have yet to be made in her country to tell people about the device, introduced in public health facilities just two years ago.

Cost is also a barrier to widespread use of the female condom. While a pack of three male condoms sells for just under 15 U.S. cents in Kenya, a single female condom costs about four dollars -- something of a luxury in a country where 56 percent of the population lives on less than a dollar a day, according to government figures.

Those who manage to overcome these obstacles to have a supply of female condoms on hand may benefit in a number of ways.

"The female condom is the only product available for women to protect themselves during rape, thus preventing HIV/AIDS as well as unwanted pregnancies. It is critical in sub-Saharan Africa that women should have the power to protect themselves," Jadish Upadhyay, head of the UNFPA's Technical Support Division, told IPS.

Nonetheless, the condoms failed to get a warm reception in Ethiopia during a pilot project which saw about 20,000 of the devices provided by donors in 2004 -- to test reactions to the female condom.

Women did not investigate the product, says Hany Abdallah, deputy director of DELIVER. This is a project of John Snow Incorporated, a Boston-based firm that carries out research and consultancy on public health issues. DELIVER focuses on improving the supply of products needed for health and family planning initiatives.

The lack of enthusiasm stemmed, in part, from men's reluctance to have their partners use the female condom, Abdallah told IPS.

This has highlighted the need for greater involvement of men in the family planning process.

"We need to incorporate the men," says Mhango. "It is good for them to be able to know that it is important for sex to be safe."

* 'Flow of financial resources for assisting in the implementation of the Programme of Action of the International Conference on Population and Development'

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