Halima Athumani, 30, from Mvuha village in Morogoro rural represents many women who have more children than they want because of limited access to their preferred method of contraception, resulting in unintended pregnancies.
At her current age, Halima has three children. She gave birth to all three of her children between 2013-2019 with multiple men. Her firstborn is 6-years-old while the second is 19-months-old and her last born is 6-months-old.
Though her first born was planned, Halima confesses that her second and third pregnancies were unintended with as little as 13 months of age gap.
She narrates to Your Health that she has been abandoned by all the fathers of her babies; taking a new role of a single mother who has to be their father too.
“I had to start a brand new path, because it’s what I need to do to survive and ensure survival of my children,” Halima tells.
Currently, she sells maandazi (doughnuts) from home to sustain economic hardship and put food on the table.
It wasn’t too late
In order to avoid another unintended pregnancy, Halima recalls that she sought advice from her colleague Tuhuma Ramadhan—a trained peer educator at the village.
Together with her colleague, Halima in February this year attended a mobile outreach project in her village called ‘Sauti project’ - an initiative that is part of the government of Tanzania’s commitment to provide quality health services to its citizens, especially those who live in remote or rural areas, reduce the transmission of HIV and, ultimately, save lives.
During that session, Halima received knowledge on voluntary family planning, sexually transmitted diseases (STDs) and HIV/AIDS.
The project is supported by The United States President’s Emergency Plan for AIDS Relief and funds the project through the U.S. Agency for International Development, led by Jhpiego.
Since 2015, the project is working with the Ministry of Health Community Development Gender Elderly and Children and Tanzania Commission for AIDS to implement the National Guidelines for a Comprehensive Package of HIV Interventions for key populations in 12 priority regions.
Without the programme, Halima would have had to travel to a health facility two kilometres away from her village to seek for voluntary family planning services.
My right to decide
Through the programme, Halima preferred to use the birth control implant as her contraceptive method— and following the successful procedure, she returned home with one less thing to worry about – a pregnancy she was not yet ready for.
Birth control implants are thin rods about the size of a matchstick, according to medical sources—the contraceptive method works by slowly releasing the hormone progestin into the user’s body, which thickens their cervical mucus to stop sperm from being able to swim to an egg and fertilise it.
To use the implant, a doctor inserts it under the skin on a person’s upper arm and it can remain in place for up to five years. When it is removed, fertility returns to normal.
Despite the struggles, for Halima every child is a blessing. She wants to have a fourth child and that will be the last. But the difference here is, as Halima says, “I can now ‘decide’ when I want to have the fourth one,” adding, “My life has changed for the better. I am mentally happier, I feel secured and I can now decide with whom and when I want to have my last child.”
In Tanzania, the contraceptive prevalence rate (CPR), modern methods, among currently married women (aged 15-49) is 32 per cent, according to the national statistics. The modern family planning (FP) methods include; injectables, pills and condoms.
Lilian Mbise, a certified and registered nurse working with Jhpiego under Sauti project says the programme is vital as it provides the information and means for women and their partners to responsibly decide the number, spacing and timing of their children.
“Not all women can reach clinics, so we must meet them where they are,” says Lilian in an interview with Your Health.
In order to further extend family planning services coverage in Morogoro region, Jhpiego has launched a mobile unit with a view to taking the FP services to some of the most remote and underserved communities in the region. The unit also offers various health-related services such as voluntary male circumcision and HIV testing, to mention a few.
Speaking of the negative effects of family planning, Ms Lilian highlights that some common side effects may include irregular bleeding, headaches, nausea and weight gain/loss, citing that it can also affect the menstrual cycle to some users.
“Some women may have lighter bleeding, and others may skip their periods entirely,” says Ms Lilian.
Contraception saves lives
Medical sources indicate that access to voluntary family planning improves the health and well-being of women and their children. The global evidence shows that a reduction in unintended pregnancies, combined with full care for all pregnant women and newborns, would result in a 73 per cent decrease in maternal deaths (from 308,000 to 84,000) and a similar decrease in the proportion of newborn deaths from 2·7 million to about 538,000 annually.
If the unmet need for modern contraception was met in developing regions, there would be approximately a three-quarters decline in unintended pregnancies (from the current 89 million to 22 million per year), a decrease in unplanned births (from 30 million to 7 million per year), and a reduction in induced abortions (from 48 million to 12 million per year), according to 2018 United Nations Population Fund’s (UNFPA) fact sheet on family planning.
The 2030 Agenda for Sustainable Development (for United Nations Member States including Tanzania) makes the realisation of reproductive rights a specific aim for every individual and couples, no matter where or how they live, or how much they earn.
This includes dismantling all the barriers — whether economic, social or institutional— that inhibit free and informed choice.
The maternal mortality ratio (MMR) in Tanzania, as estimated in the most recent Demographic and Health Survey 2015/16, is 556 deaths per 100,000 live births. This means that 11,000 women die every year during pregnancy, childbirth, or within 42 days of the termination of pregnancy, irrespective of the cause.
“Family planning allows for the spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing as well as prevent pregnancies in older women who face increased pregnancy-related risks,” says Dr Faustine Ndugulile, Tanzania’s Deputy Minister of Health, Community Development, Gender, Elderly and Children (MoHCDEC).
He was speaking during an interview with Your Health and further noted that the access to voluntary family planning leads over time to fewer children and proportionally more resources available to invest in each child, contributing to economic growth by facilitating changes in a country’s age structure.
“Improvement of the education system under Free Education Policy has helped in reduction of early pregnancies among young girls in the country particularly in the rural areas, regarding the fact that the majority of them can now access free education,” says Dr Ndugulile.
Policy framework in Tanzania
There is a supportive policy framework for the provision of family planning services in Tanzania such as the Health Sector Strategic Plan IV 2015-2020 (Tanzania Mainland): Family planning is prioritised to delay the age at first birth, to promote birth spacing and to give women the choice to decide on the number of children they have.
Moreover, the government in March this year lifted the suspension of family planning advertisements imposed last September. The advertisements were suspended with the government saying it wanted to review the messages. The ban came a few weeks after President John Magufuli said during a tour of the Lake Zone that those who embraced family planning were “lazy”.
The benefits of investing in voluntary family planning
Studies have demonstrated that investing in family planning is a development ‘‘best buy”.
Analysis has shown that meeting the contraceptive needs of all women in developing countries more than pays for itself; for every single dollar spent on contraceptives, four dollars are saved.