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Family planning: The grim reality in rural areas

MRS Bwalya with some of her children at their home in Kasama recently. PICTURE BY DOREEN NAWA

ALTHOUGH most Zambians have embraced family planning to ensure healthy and manageable families, it is not yet time to celebrate.
Most women, especially in rural areas, lack a voice to confront their husbands and convince them to allow them to take up family planning methods.

This is a reality in the life of Justina Bwalya, 40 of Kansobe area in Chief Chitimukulu’s area in Kasama.

For Mrs Bwalya, now a mother of 10, she learnt about family planning during her routine visit for antenatal during her fourth pregnancy.
But introducing what she learnt at a nearby clinic to her husband has not been easy.
“I learnt about the benefits of family planning for the good of our children’s health and my health too.
She got married at 17 and her first born child is 23.
She says despite being married for close to 24 years now, she still does not have powers to even negotiate for safer sex.
“The situation of most of women here in Kansobe is gloomy. I don’t have power to open my mouth and tell my husband about this good news. It is not only beneficial to us as a couple when it comes to child spacing, the children too benefit a lot when you space them,” says Mrs Bwalya.
Asked why she has not extended the antenatal invitation to her husband, Mrs Bwalya says asking her husband to escort her to the clinic for antenatal check-ups each time she is pregnant is a risk to her marriage.
“It has not been easy, I have had complications during and after pregnancy, but my husband is not interested in coming to the clinic with me. The spacing we usually have is a year and below for all the 10 children we have had. The youngest child is two years old,” Mrs Bwalya says.
While many women understand the value of contraceptives towards birth control and family planning, many still fear because of misconceptions about contraceptives. Others give up just a few weeks or months after using them.
Georgina Kabungo 24, also of Kansobe area started using birth control pills following a recommendation from her friend. After a week, Mrs Kabungo complained of discomfort and side effects like headache, small swellings on the legs and fatigue.
“I consulted my friend again. She told me that I should always expect such side effects with the pills except if I rely on natural birth control which is not possible with such tradition here. As a wife, I cannot deny my husband his conjugal right. It is ‘yes’ to sex each time he wants it,” she explains.
Many women, like Mrs Kabungo, still fall victim of misconceptions regarding the use of contraceptives.
There are many myths and misconceptions surrounding family planning methods that many women would rather risk their lives than use them.
Some women think contraceptives always bring about serious side effects while others shun them because they fear becoming barren.
The government and non-governmental organisations have directed a lot its energy and money to preach the message of contraception because reproductive health is at the very heart of development.
The rural populace has painted a depressing picture surrounding family planning methods, and the myths and misconceptions are spreading like bush fire.
Mrs Kabungo’s husband James says he is not comfortable with his wife taking a pill because of the many stories he has heard on the side effects.
“Most men here find it hard to approve the use of family planning because of the many stories we have heard. I know that different contraceptive methods like a condom and a pill. Resistance to condom use is because my wife associates condoms with promiscuity,” Mr Kabungo says.
He says the fears of use of a female condom also applies to men too.
“I cannot allow my wife to use a female condom because of suspicions on its use and promiscuity too,” Mr Kabungo says.
Some of the misconceptions include rumours that contraceptives reduce a woman’s libido, make her gain weight or harm her health.
While it is not contested that all drugs, including contraceptives have side effects, medical experts agree that this notion has been blown out of proportion.
“In the pharmaceutical world, no drug is minus side effects, even painkillers. Women need to make intelligent decisions when choosing a family planning method and to tolerate the minor side effects that come with it,” says renowned gynecologist and obstetrician Swebby Macha.
Dr Macha agrees that there is a lot of misinformation on the side effects of contraceptives.
“The truth is that contraceptives are safe because they are tailor-made for each woman, depending on her health conditions. All medicines have side effects and women must realise that a contraceptive that worked for one woman won’t work for another,” says Dr Macha.
The myths and misconceptions is a big challenge in the rollout of reproductive health services.
On July 11, 2017, Zambia made a commitment at the Family Planning Summit in London to scale-up efforts to reach the Family Planning 2020 goals and ensure that more women access family planning, and are able to plan their families and their futures.
Minister of Health Chitalu Chilufya says the country is committed to increasing its modern contraceptive prevalence from 33 percent to 58 percent by 2020 through comprehensive policy and programming in response to women’s expressed needs.
“With a modern contraceptive prevalence of 45 percent in 2014, the country needs further evidence-based programming to help meet the contraceptive needs of women and men,” Dr Chilufya says.
Dr Chilufya says the country has also established a strong co-ordination mechanism by having a family planning programme established with a budget line provided for in the yellow book.
According to Centre for Reproductive Health executive director Amos Mwale, access to sexual reproductive health services should be available to all health centres and should be friendly enough to give even young people the information they need.
Mr Mwale says the Family Planning 2020, commitment is a perfect scale-up plan devised to push family planning accessibility from 33 percent to 58 percent but need concerted efforts to be a reality.
The challenge in rural areas is real, although some married women are willing to use contraceptives, the problem comes when their husbands feel otherwise.
Zambia’s progress on access to contraceptives has been slower especially in rural areas. Due to the many myths and misconception, the trend has not changed significantly in the last 40 years.


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