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Family Planning
Aug 18, 2007 By: Susan O'Neill(Originally published May 8, 2006)
ZAMBIA -- There is no doctor on staff at the Palabana Rural Health Centre (RHC).
No laboratory facilities and no running water. Yet the one-storey building, located in the Chongwe District, is an invaluable resource for the more than 7,000 villagers it serves.
It is here where women come for prenatal and postnatal care. Where men come for free condoms. And where young people can access information on how to prevent the spread of HIV/AIDS and other sexually transmitted infections (STIs).
Palabana is one of 10 sites across the country that are taking part in an outreach program called the Zambia Family and Reproductive Health Project. Implemented by the Planned Parenthood Association of Zambia (PPAZ), in conjunction with the Ottawa-based Canadian Public Health Association (CPHA), it aims to inform people about their family planning options, increase awareness about the transmission of STIs and make contraceptives more available.
”Our focus is on youth and women. But we never forget the men,” said Dr. Fwasa Singogo, director of PPAZ, noting, “men are the decision makers in most of the homes.”
And that includes deciding whether or not the family will practise birth control.
It’s one of the challenges in addressing reproductive health and family planning in Zambia, a country in which the issues are complex, Dr. Singogo said.
Discussions about anything to do with sex are considered taboo between parents and their children, he noted. It is the grandmothers or village elders who traditionally discuss such issues with young people. Although things are slowly changing, Dr. Singogo says “traditions are strong and deep-rooted.”
The nation’s extreme poverty, the tradition of polygamy and the historically low level of education among women further serve to compound the promotion of safe sex and family planning.
The majority of Zambian women give birth to an average of six to eight children. However, Godwin Munsanje, an environmental health technologist and psychosocial counsellor who has headed the Palabana RHC for the past two years, said women are beginning to have fewer offspring.
“In most places where they don’t have this program, they don’t have family-planning products. We are providing male condoms, female condoms, oral contraceptives and injections (which are good for two months),” Mr. Munsanje said, explaining that some women choose injectables because they are more convenient and because they don’t want their husbands to know they are using birth control.
Despite the obstacles, the CPHA reported that the project is having an impact in rural communities. PPAZ has branches in 38 of Zambia’s 73 districts and the organization is hoping to add another four this year. That wouldn’t be possible without the more than 400 volunteers who serve as community-based distribution agents (CBDAs) and peer educators. The distribution agents undergo 10 days of intensive training in reproductive health, STIs and youth-friendly services.
“They provide information within the community in which they live,” said Hildah Wina, a regional manager with PPAZ. “They distribute condoms and oral contraceptive pills and refer clients who require injections or implants.”
Ephraim Mbindawina has been serving as a CBDA since 2003. He lives six kilometres from the Palabana RHC and visits the 250 households he is responsible for monitoring by bicycle, which was supplied by PPAZ.
“We had a lot of problems before these services. So when we heard about donors who could help us with family planning and prevention of HIV, I became involved,” he said. “I already do such work at my church. It was a pleasure to me (to join PPAZ).”
He noted people are receptive to learning more about family planning.
“We have seen the benefits... a lot of young men and women had a lot of STIs before this program. Those STIs have reduced drastically,” Mr. Mbindawina said.
But with a greater emphasis on the use of contraceptives, the number of births has declined.
“At that time (before the program) deaths were common during birth,” he said, adding that, too, has changed.
“Infant mortality in Zambia remains high, but there has been a drop in recent years in the number of women dying from pregnancy-related issues,” Dr. Singogo said.
Mr. Munsanje added that most women in rural areas prefer to deliver at home with the assistance of a traditional birth attendant.
“Where we have trained traditional birth attendants, they are able to identify the risks and can refer a woman (to hospital) on time,” he said.
But that wasn’t always the case in Palabana, and certainly isn’t true in many other rural communities throughout Zambia, which has one of the highest rates of maternal mortality in sub-Saharan Africa.
According to the United Nations, the nation’s maternal mortality rate is 750 of every 100,000 live births. It is estimated that one in 19 women will die in childbirth in Zambia.
Cecilia Siachiwena, a midwife with the Chongwe District Health Management Teams (DHMT), regularly monitors the activities at the Palabana RHC and said the facility is doing a tremendous job.
“We’re not having unsafe abortions anymore because people can access the services from here,” she said. “We hope in the future, after training, we’ll be able to offer long-term family planning.”
Ms. Siachiwena reported that the quality of life for the women has been improved. “The women now have control over their lives. They can decide how many children they want to have. That is a big difference from other communities who don’t have the program.”
The incidence of STIs has also decreased in the areas where PPAZ has been running clinics, Dr. Singogo said.
“There is that openness in the community and people are more aware,” he said. “People have become empowered with information.
The PPAZ project is funded 100 per cent by the Canadian International Development Agency (CIDA), which has provided the CPHA with $3.1 million over a five-year period to implement the second phase of the project.
CIDA funded the first phase from 1997 to 1999 and then committed resources to fund Phase 2. That funding comes to an end this year and the CPHA and PPAZ are preparing to hand over the administration of the program to the Zambian government’s local DHMT. It is intended that the Zambian people will continue to run the program themselves.
