Let’s Talk Abortion

By Naisola Likimani

Let’s put the facts on the table. Evidence shows that abortion has been happening for centuries, way before the pro choice movement. Wherever sex exists, there will be unplanned pregnancy, because even contraception does not work 100% of the time, there is forced/unwanted/violent sex that takes away women’s choice to get pregnant or not, etc.

Additionally in African society there is reluctance to acknowledge that sex even takes place, so we rarely provide young people and women in particular information about sexual and reproductive health, therefore they are unable to make informed choices. Then most of our women (78%) who need contraception do not have access to it, either because of poverty, because it is not provided, or they are not empowered to make that choice.

Therefore when unplanned or unwanted pregnancies happen, some will want to terminate those pregnancies. Either it will happen safely or in a kiosk somewhere with an untrained person. Our middle/upper class women can and do procure safe abortion in private clinics, for themselves and their daughters when needed. It is our poor women, our rural women, our young women who cannot afford this, and resort to very desperate measures. Women do not resort to sticking hangars in themselves or drinking bleach out of a whimsical, thoughtless decision. Let’s give them at least that respect. Research shows that all kinds of women seek abortions for all kinds of reasons, and it is incorrect to say only immoral, promiscuous women seek abortions. I can tell you many heartbreaking stories including of girls raped by fathers or other relatives who ended up with unsafe abortions, injured for life. I believe we should take our religious and moral battlefield somewhere else, not on women’s bodies. Because it is resulting in about 30,000 African women dying every year and millions of injuries from unsafe abortion, while we continue to have this debate from the safety and luxury of our homes, churches and computers.

Everyone is entitled to their belief. But no one has the right to tell someone else what to do with their own body, based on that belief. The women getting abortions in Africa are also Christians, Muslims. They are people we know and love. Let them negotiate their choices with people they trust, yes, including their god. For the rest of us, let us work to make a society where women do not have to result to desperate measures to end a pregnancy. There’s a lot we can do including preventing unplanned pregnancy. But arguing over whether abortion is morally or religiously right or wrong is the most futile of all efforts. It has never and will never stop women from seeking abortions (including churchgoing women). All it does is keep people distracted and misinformed while women continue to die in large numbers.

PS. The restrictive abortion laws we have in Africa were inherited from our colonizers. Those countries have ALL since changed their laws and now no woman dies from abortion in developed countries. Meanwhile Africa continues to have almost half of all maternal deaths from unsafe abortion in the world. As Africans we should be very concerned about the imperialist nature of some of the anti-choice campaigners from the North. They live in a society where women have choice, but is it that Africans cannot make their own choices too? Why are people so comfortable with death, poverty and poor quality of life for Africans?

Naisola Likimani is a campaigner for African women’s rights. Connect with her @NaisolaL.

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Beauty versus Contraception in Bamenda

By Numfor Alenwi

When one hears that only 37% of demands for family planning in Cameroon are met, he may be tempted to think the determinants are the availability and affordability of modern options as is the case with many developing nations. Contrary to this, the need for comprehensive education seems to be the key demand for young girls in Bamenda as the fear of body deformation; sterility and cancer increasingly block usage.

Social enterprises and charity organizations in the last five years have greatly increased the availability of modern contraceptives in the Cameroonian city, Bamenda. Beside the female and male condoms which can be found in stores around town, IUDs, Jadelle, Depo-Provera and Nouvelle-Duo can be accessed from a majority of the health centers within the town. Despite this availability, 14 in every 100 girls aged 15-24 have conceived a baby with less than 5% of the pregnant adolescents (married or not) desiring a pregnancy. (UPSB 2011). What then are the key obstacles that make young people uncomfortable about accessing or using contraception?

‘I fear the side effects like weight increase, cancer, and sterility’ says Stephanie Nchum. ‘Condoms are very unreliable and the long term methods would destroy my sexy shape. I don’t want an ugly weight’ says Ruth Lum.  All 20 young women (15 -24 years) recently interviewed by Cameroon Agenda for Sustainable Development (CASD) in Bamenda, identified with Stephanie and Ruth on the fear of increase in weight if they take pills, inserted or injected contraceptives. The fear of sterility and cervical cancer also came up several times.

Mr. Ngang Peter, head of Family Planning Services at ACMS Bamenda also confirmed these allegations as the key obstacles to the use of contraception by young people in Bamenda. However, he makes it clear that sterility and cancer are only myths but weight increase is likely for the hormonal methods. ‘None of the family planning options causes sterility or cancer but the hormonal methods can likely cause weight increase for some people, the reason we often insist on counseling before choice’ says Ngang.

Strangely, the girls who fear weight gain consider every other contraceptive apart from condoms as hormonal. Even the Copper T 380 intra-uterine device (IUD) which is the most promoted in Cameroon is also dreaded for the same reason. Ngang Peter thinks the problem is not the weight issue but lack of information. ‘The choices are many. Through counseling, providers help clients make and carry out their own choices about contraception. There are eligibility criteria for all the family planning methods. Most people who don’t feel comfortable relying on the condoms are often advised to consider IUDs if no contraindications are found’ Ngang.

Truly, these girls spend a lot of resources to maintain what they call ‘sexy looks’. They are also aware that pregnancies make weight control more difficult. Thus, in as much as they prefer to protect beauty over contraception, they need contraception to maintain beauty. Presumably, young women want to know if there are possibilities of rendering the hormonal contraceptive to have local instead of systematic effects. Dr. Ngalla Elvis, a medical researcher and family planning expert with Cameroon Agenda for Sustainable Development (CASD) attempts an answer. ‘It’s possible to localize drug administration with nano technology but that is not a priority for contraception’. He continues ‘the challenge with young people and contraception use is not the hormonal effects. It is a lack of comprehensive education. Young people need to be informed that the IUDs which last longer than some hormonal methods are mechanical and cannot cause changes in body mass. They also need to know that the female condom is to give young women enough control before a sexual encounter. They also need to know that keeping fit during and after pregnancy is 4 times costly than making an informed choice on contraception ’’.

We need to make informed choices.

Numfor Alenwi is the Executive Director of Cameroon Agenda for Social Development. You can connect with him his blog and via email at nalenwi@yahoo.com. 

Family Planning is more than planning families

Rural children do not have to be malnourished….plan for your families!

By Nargis Shirazi

I find a woman who is on short term family planning and she has two children. Her husband is a local farmer and they have this beautiful small simple hut with a nicely kept surrounding. I was curious to ask why she was always jolly and happy at the beading center. She invited me to her home to know just why.

Her two children were at school the time I got there and she was cleaning the home. She told me her husband had taken ‘matooke’, a type of banana that is eaten as food in the area; into town to be sold. She was beaming when I complemented her nice figure and her lovely home. She told me she owed it all to family planning! So I wondered why….and she narrated.

She compared herself to the other women in the village. She had two children that were healthy, going to school and were not a burden. Her husband made enough money to keep the family happy and unlike her neighbours who had malnourished children, hers were well fed. “We always have enough! You know its difficult to have enough in the village, but we do! My husband is at peace…he always comes home happy! Of course I want may want to have one more child but do not want to have one accidentally. I love the pills because they help me plan. It was difficult taking them in the beginning but with time I got used to it. In fact we have decided that when we are ready to stop having children, we can look into some long term method! It was a bit difficult to convince him at first, about the pills but, the community health worker helped a great deal in making us both understand the benefits! I must say, I am very happy! I can go about with my beading and also bring in some income and contribute to educating our children!”

So after my one hour at her house, I am intrigued! I believe it is time we got role model family planning families and empowered them to empower their communities! I just pictured that lady taking part in community dialogue on family planning. We need more than facts and figures, we need people!!

 Nargis Shirazi is Community Based Quality Improvment Coordinator at UNOPS/MVP in Mbarara Ruhiira, Uganda. You can connect with her on twitter, or via email at suripsyc@gmail.com

For More on the MVP (Millenium Villages Project), please click here

A Call to Conscience, Reason & Action

By Yemurai Nyoni

Family Planning for young people is a call to social conscience, individual reason and collective action.

A Call to Conscience:

Young people are having sex, with 39% of females and 30% of males aged between 18 and 19 years reporting having had sexual intercourse before age 18. In addition to this, 92% of sexually active girls aged 15-19 are already in some form of marital union. Despite these relatively high levels of sexual activity, contraceptive use among girls aged 15 to 19 years is alarmingly low with only 38% of them using contraceptives and they have a higher than average unmet need for family planning of 17%. As a result, by age 19, nearly half (48%) of girls have started child bearing (ZDHS 2010-11).

We must understand that teenage pregnancy has great risks for young people, especially young women below 19 years whose reproductive systems will still be developing. The risk of maternal death is twice as high for girls aged 15 to 19 years than for women in their 20s, and five times higher for girls aged 10 to 14 years. They are more likely to experience complications during labour, including heavy bleeding, infection and eclampsia because they are not physically ready for childbirth. Their bodies are not fully developed and their pelvises are smaller, so they are more prone to suffer obstructed labour and obstetric fistula. In addition to this, babies born to young mothers are at great risk; if a mother is under 18 years; her baby’s chance of dying in the first year of life is 60% higher than that of a baby born to a mother older than 19 years (Every Woman’s Right Report – Save the Children 2012).

Tragically, close to 40% of our teenage mothers are delivering their babies at home and some 14% never receive any form of antenatal care.The lives of mothers and their children lie in limbo and are often lost because of our failure as a society and as a nation to avail our young people with information, skills and services for them to make healthy reproductive health choices.

A Call to Reason:

Access to Family planning information and services does not seek to grant a license to young people to engage in early sexual activity, instead it’s an effort to build the capacity of young people and avail the necessary tools to them so that they make responsible sexual decisions to protect their health and that of their future children.  It allows us to realize a return on the investment made by parents and government in providing education to young people by enabling them to complete their education and find decent employment that will make it possible for them to support their families. It would be unforgiveable for a nation or parent to make a 13 year investment on the education of a child only to hold back the services and information that would prevent them from having an unplanned pregnancy and dying from the complications of pregnancy and childbirth.

Investing in family planning also makes developmental sense, given the need for the country to fulfil its targets under the Millennium Development Goals. Progress on MDG 4 on countering child mortality and MDG 5 on reducing maternal mortality by 75% and achieving universal access to reproductive health are greatly reliant on the advancement of family planning for young people. If young women delay pregnancy, it gives their bodies more time to develop thereby reducing the risk of maternal mortality and granting their babies a greater chance to survive. MDG Target 5b on universal access to reproductive health gives specific focus to reducing adolescent birth rate, unmet need for family planning and increasing contraceptive prevalence rates. In addition to this, increased uptake of family planning will allow both young men and women to make academic progress and increase their prospects of eradicating household poverty and countering gender inequality.

A Call to Action:

In view of the immense benefits of investing in family planning for young people, a tactful approach must be adopted that allows for the comprehensive enhancement of the capacity of young people to plan their families. The first step to this rests in ensuring access by young people to reproductive health information through comprehensive sexuality and life-skills education in schools and in tertiary institutions, as well as through peer-to-peer education and facility based youth friendly services. Such education must equip young people with the competencies necessary to negotiate for safer sex, abstain and over-come peer pressure as well as drug and alcohol abuse. It must tackle myths, misconceptions and negative preconceptions about family planning, and inform young people on correct use of family planning methods as well as where to get related services.

Secondly, a deliberate focus must be directed to the empowerment of girls and young women through increasing their access to education and economic opportunities. Investing in girls’ education programs will allow for girls to stay longer in school, resulting in greater control over household resources, increased ability to communicate with their partners and greater awareness of existing health services. Availing of economic opportunities on the other hand will increase the disposable income available to young women and ensure the realization of family planning through a greater ability to procure relevant reproductive health commodities.

Thirdly, we must lobby for the transformation of harmful and retrogressive cultural norms limiting advancement of the family planning agenda. Early marriages and intergenerational relationships must be discouraged, given the difficulties experienced by young women in negotiating for safer sex or the use of contraceptives in such unions. Young men must be actively engaged in family planning programs to foster understanding and greater flexibility in making decisions on family planning with current and future sexual partners. In addition to this, families and other social structures like churches must be equipped with information and skills for them to transfer accurate family planning information to young people and counter the stigma attached to such important discussions.

Fourthly, youth friendly services must be decentralized and made affordable to the maximum extent possible whilst all health service staff must be trained in the provision of youth friendly services. Particular attention must be paid to areas with high rates of teenage pregnancy and low contraceptive prevalence, especially in rural areas. In an effort to ensure convenience and consistency of the standard of youth friendly services, a supermarket (one stop shop) approach must be considered, which integrates a holistic range of sexual and reproductive health services in one youth friendly space.

Finally, as young people we must take full responsibility for our sexual reproductive health and take deliberate steps to ensure planned families. Lets seek comprehensive information from health facilities and peer educators on the importance and means to prevent early pregnancy, space births and limit the number of children we have. We must also take further steps to utilize critical SRH services including contraceptives like condoms and pills, antenatal care during pregnancy, and skilled health care during delivery of babies. Apart from these immediate measures, we should engage ourselves in gainful economic activities and make full use of educational opportunities for long term benefits in enabling us to appreciate the need and increase our capacity to take up family planning services.

In conclusion, our focus must be to ensure that every pregnancy is wanted and that young people have children when they are emotionally, physically, financially and socially prepared to do so. Re-invigorating efforts to increase access to family planning and fulfilling unmet need holds the key to saving babies’ lives and preventing adolescent girls from dying in childbirth. The decision lies in our hands, and young people will continue to look to us to enable them to make informed choices in safeguarding their sexual reproductive health and rights, and I choose to ACT!

Yemurai Nyoni is the National Facilitator at Zimbabwe Young People’s Network on SRH, HIV and AIDS. Connect with him on his blog, twitter or email: yemurain@gmail.com

Universal Access to Reproductive Health Services

By Felogene Anumo

This year, World Population Day was celebrated on 11th July 2012 with the theme Universal Access to Reproductive Health Services, pushing UNFPA’s vision, a world where every pregnancy is wanted, every childbirth safe, and every young person’s potential is fulfilled. It was marked by The London Summit on Family Planning co sponsored by The Bill & Melinda Gates Foundation, United Nations Population Fund (UNFPA), UK Aid and UK Government’s Department for International Development (DFiD).

Facts
Access to sexual and reproductive health is a key element to the fight against poverty. According to UNFPA, some 222 million women who would like to avoid or delay pregnancy lack access to effective family planning. Nearly 800 women die every day in the process of giving life. About 1.8 billion young people are entering their reproductive years, often without the knowledge, skills and services they need to protect themselves.

Despite these glaring facts and the harsh reality, most young people lack the information and resources necessary to make healthy choices, including protection against HIV/AIDS, other sexually transmitted infections (STIs), and the development of healthy relationships. The health and social-economic consequences of teenage pregnancy are enormous. Early parenthood is likely to affect educational achievements with significant employment and socio-economic ramifications, while health complications for both teen mother and her unborn child or infant child are very high. The UNFPA estimates that 1 in 22 women in sub-Sahara dies from maternal causes, compared to 1 in 120 in Asia and 1 in 7,300 in developed countries.

The situation in Africa
Africa, home to one billion people, is the world’s second most-populous continent, after Asia. Africa is also the continent with the world’s highest birth rate and the highest projected population growth rate in 2050 of 1.2 billion people. Modern contraceptive use in Africa is low; in 2012 an estimated 645 million women of reproductive age (15–49 years) in the developing world are using modern contraceptive methods — 42 million more than in 2008, while less than 10% of women in Middle and Western Africa use any modern contraceptive method.

This makes family planning difficult, leading to unwanted or miss-timed pregnancies, which often leads to many adolescents resorting to unsafe abortions which contribute immensely to maternal mortality.
• Women and girls with unsafe abortion complications account for 50-60 percent of all gynecological admissions in major urban hospitals.
• Additionally, up to 2 out of 3 of the abortion-related patients are young woman between the ages of 15-24 years.
• Reproductive health problems remain the leading cause of ill health and death for women of childbearing age worldwide.
• It is also estimated that over half of all new cases of HIV infections occur among young people of this same age group.

One of the objectives of the African Women’s Decade to accelerate the implementation of gender equality and women empowerment is on women’s health, maternal mortality and HIV/AIDS. Reproductive Health Services are core to achieve this thematic area.

Chance and Choices
At the ICPD, governments committed to protecting and promoting individuals’ human rights and empowering them to make informed and healthy choices. The ICPD Programme of Action highlights and endorses the provision of universal access to family planning and sexual and reproductive health services and reproductive rights. The principal goal of the ICPD—universal access to reproductive health services by 2015—is reinforced in the Maputo Plan of Action.
Though this goal seems straightforward, if by all means easy to achieve, reproductive health needs of young people are increasing at an unprecedented high rate. While we cannot overemphasize the role of mobilizing the political will and financial resources to make these services available, ensuring access to reproductive health services is also about enhancing partnerships and developing innovative service delivery systems that are acceptable to the young people and women and especially those that meet their special needs. To achieve this goal, we must accelerate our efforts dramatically.
Ultimately, the decisions and choices we make today will determine the opportunities we harness or the challenges we face tomorrow. We must not leave this to chance. Let us strive to ensure that every pregnancy is wanted, every childbirth is safe and every young person has access to information and education on sexual and reproductive health care.

For more info:
UN Secretary General Ban Ki Moon’s message
UNFPA Director Babatunde’s message

Felogene Anumo is an Advocacy Intern at FEMNET, based in Nairobi. You can connect with her via email: fganumo@gmail.com

This post was originally posted on FEMNET’s blog.

Broken Childhood

These children have a right to being children

By Nargis Shirazi

I am a woman, when I think I should actually be a girl! I am 15 and I just had a baby last night. I live right next to a school that reminds me of when I was in a school, until I fell pregnant. I did not sleep last night, the baby was crying. I almost died last night! The traditional birth attendant said I was too small. I am alone; my mother lives in another village. I do not know how to handle this baby. My 40 year old drunken husband is asleep from a night out at the village bar. He heard the baby cry at night, and wondered if it was ours. I am crying…I know not anything else I can do. I look out of the broken window and see the school children again. I wish I could still play dodge ball like they do, but I cannot. I had to be given to this man, to bail my family out of poverty. We were 13 in our home and stricken by poverty. I rescued my siblings only to end up in these chains! I had no choice. My mother told me she wanted to have less children…she had no choice…and neither will I.

This may sound like any other story to you…but is more than a story to others, it is a reality. Child marriage most often occurs in poor, rural communities. In many regions, parents arrange their daughter’s marriage. That can mean that one day, she may be at home playing with her siblings, and the next, she’s married off and sent to live in another village with her husband and his family. She is pulled out of school. She is separated from her peers. And once married, she is more likely to be a victim of domestic violence and suffer health complications associated with early sexual activity and childbearing- International Center for Research on Women.  In Uganda more than 4 out of 10 women wish to access modern contraception but cannot. There is an unmet need for family planning. Family Planning alone would reduce the country’s maternal mortality ratio by 33%.Uganda has one of the highest teenage pregnancies in Africa (one of every four pregnancies occurs in a teenager.) By 15 years of age, 24% of girls and 10% of boys are sexually active (debut 16.6 for girls and 18.1 for boys). Yet only 11% of sexually active young people are using contraception-The Citizen Journalist, July 16, 2012.

We need voices to rise up against the girl child early marriages! The time to stand up and speak about access to family planning is now! Let us come together, let us be the voices that need to be heard!

Girls have a right to prepare for their future.

 Nargis Shirazi is Community Based Quality Improvment Coordinator at UNOPS/MVP in Mbarara Ruhiira, Uganda. You can connect with her on twitter, or via email at suripsyc@gmail.com

For more on child marriage, see campaign website for Girls Not Brides

For More on the MVP (Millenium Villages Project), please click here

Family Planning & Young People

By Yemurai Nyoni

From a young person’s eyes, Family Planning as we know it has been a subject for old married women who have had enough children for the family to bear financially. It’s viewed as a topic championed by elderly health care workers waiting for their age-mates to come and receive guidance and services for them to manage their fertility. We see it as a social privilege for married women, who are considered as having the ‘right’ to access sexual healthcare to support their ‘acceptable’ sexual activity.

Family Planning for young people has been a battle against social condemnation, ignorance and neglect at the detriment of the health and future of young people. It’s a perilous area characterized by under-informing by teachers and parents for fear of giving young people the tools to experiment; and the filling of that knowledge gap with hazardous information from ill-informed peers, fantastical movies and magazines. It’s a matter of smuggling condoms in books for fear of discovery, and out-smarting till operators with cunning speech to justify the inclusion of condoms in a young person’s grocery. It’s a secretive affair of sneaking into clinics and youth centers to get pills, advice and other commodities whilst suffering accusing glances from older patrons and harsh prejudicial rebuke from health workers who believe that a young woman who has never been pregnant cannot use family planning and occasionally threaten to share private information with parents and guardians who are their friends.

We undoubtedly live in a society that makes it difficult for young people to realize their sexual reproductive health and rights particularly regarding family planning. We must realize that there is more to family planning than we have perceived, and at this time and point in our nation it has become imperative for us to enable young people to make healthy reproductive choices. One young columnist wrote, “When people can plan their families, they can plan their lives. They can plan to beat poverty. They can plan on healthier mothers and children. They can plan to gain equality for women.” Family Planning for young people is a call to social conscience, individual reason and collective action.

Yemurai Nyoni is the National Facilitator at Zimbabwe Young People’s Network on SRH, HIV and AIDS. Connect with him on his blog, twitter or email: yemurain@gmail.com

Stay posted for his subsequent posts calling for conscience, reason and action.