CATHERINE MUMBA, Muchinga
MARY Munyenyembe, 28, of Muyombe area in Mafinga district, Muchinga Province wants to have a small and manageable family. Though family planning services are not easily accessible in rural areas, this is one challenge she is determined to overcome.
“I noticed that it is not easy to raise many children when you are struggling financially.
“Apart from the children not being adequately catered for, they can be affected psychologically because if a mother is stressed, she may not be able to bond with each of her children. Probably the mother will pay attention to the youngest child at the expense of the other toddlers,” she said.
Mrs Munyenyembe started receiving contraceptives from Muyombe Rural Health Centre a few months after giving birth to her first child, now aged eight.
“The only challenge was that I had to walk a long distance to access family planning pills. However, I was never discouraged because I knew the benefits of spacing my children,” explains Mrs Munyenyembe.
She has three children aged eight, five, and two who are all in school and growing well.
Having a small family which they can afford to look after enabled Mrs and Mr Munyenyembe to save some money which they used to build a house.
But for some women, child spacing is not a compelling reason for walking long distances to the nearest health centre.
Many end up having unplanned for children because health centres are located far away from their communities.
However, the introduction of Community Based Distributors (CBDs) of family planning services by the Society for Family Health (SFH) in 2015, has made life easier for Mrs Munyenyembe and many other women in rural communities.
“In 2014, I started using Depo Provera, an injectable contraceptive which lasts three months. But in 2015, we started receiving contraceptives right within our communities. This means we do not have to walk long distances anymore to get family planning services,” says Mrs Munyenyembe.
CBD’s have been trained to distribute contraceptives in their communities and also to counsel people on the importance of family planning.
This has been made possible by the SFH’s Sexual and Reproductive Health for All Initiative (SARAI) funded by the United States Agency for International Development (USAID). Under this programme, CBDs are trained to deliver family planning services closer to the people.
Jack Kanyika, a family planning services distributor in Chikondo zone in Mafinga district, has been providing family planning services to people in his community from his home every Tuesday. He also distributes condoms on daily basis.
“I am able to administer injectable contraceptives and pills. I also give out condoms which provide a double protection from unwanted pregnancies and sexually transmitted diseases. We normally refer beginners to rural health centres for thorough health check-ups before putting them on any family planning method.
“So we offer different types of family planning and clients just choose what they want. But for certain methods of family planning like implants, only health centres are permitted to do that,” Mr Kanyika says.
When the SARAI project was launched in 2015, the uptake of contraceptives was low mainly due to misconceptions and religious beliefs from potential users.
Some women, such as members of the Catholic Church, said they preferred Natural Family Planning (NFP) based on religious beliefs.
NFP is an umbrella term for certain methods used to achieve and avoid pregnancies. These methods are based on observation of the naturally occurring signs and symptoms of the fertile and infertile phases of a woman’s menstrual cycle.
Couples using NFP to avoid pregnancy will abstain from intercourse and genital contact during the fertile phase of the woman’s cycle. No drugs, devices, or surgical procedures are used to avoid pregnancy.
“In fact, NFP represent the only authentic approach to family planning available to husbands and wives because these methods can be used to both attempt or avoid pregnancy. When learning about NFP, it is important to know that,” says the United States Conference of Catholic Bishops.
They further argue that the NFP upholds the dignity of human beings within the context of marriage and family life, promotes openness to life, and recognises the value of the child. By respecting the love-giving and life-giving natures of marriage, NFP can enrich the bond between husband and wife.
But what if a woman miscalculates her fertile days and ends up having a child without planning for it?
Mr Kanyika says this is one of the factors that have compelled women to discard NFP and embrace family planning services.
Injectable contraceptives are preferred because, according to users, they guarantee a higher degree of safety compared to pills which one can easily forget to take.
Mr Kanyika attends to over 20 clients every week, an indication that the uptake of family planning services in his area has improved.
CBDs have been given bicycles for field work and some other incentives since they spend a lot of time distributing contraceptives and counselling people.
Astridah Simasiku, a CBD in Mafinga district, says people are happy to receive contraceptives right from their communities. Adolescents are among those benefiting from the SARAI project.
In Nakonde district, CBDs have helped improve the uptake of contraceptives.
District health director Chola Kaunda says access to family planning services, especially for those in typical remote areas has been a challenge.
“But since SARAI came and brought us CBDs, the number of people, including adolescents, receiving contraceptives has increased. The other major problem was misconceptions surrounding contraceptives because people thought it would make them barren, but all that has been somehow addressed,” Dr Kaunda said.
The SARAI project which will run for five years from 2015 to 2020, aims to increase access to modern contraceptives by two percent annually in 15 districts.
The project is being implemented with guidance from the Ministry of Health in conjunction with partners like Development Aid from People to People, Child Fund and Population Services International.
The districts that are benefiting from the SARAI project are Chililabombwe, Chingola, Kalulushi, Kitwe, Mufulira, Ndola, Chienge, Lunga, Mansa, Nchelenge, Kawambwa, Mpika, Mafinga, Shiwangandu and Nakonde.