No contraceptives - no choice

Posted: 7 September 2004

A worldwide shortage of contraceptive supplies is setting back efforts to bring reproductive health to women in many developing countries - a crisis highlighted by the Countdown 2015 conference of non government agencies, held in London last week to review progress in meeting the population goals agreed by 179 nations in Cairo ten year ago. What this actually means to poor women in Africa is revealed in this report from Florence Machio, in Kenya.

Women in Kenya have been wondering why contraceptives have been unavailable for the past several months. Take the clinic run by Fardhosa Ali Mohammed in Eastleigh, to the east of the Kenyan capital, Nairobi.

Most women who come to her clinic prefer injectable contraception. Mohammed says: "That's the only way they can control how many children to have without their husbands interfering." Her clients are generally poor. Most local residents are refugees from neighbouring Somalia and have no source of income. "They prefer buying drugs at local pharmacies and come to my clinic to be injected," she says. They have been complaining lately that they are unable to get the drugs. "What they don't know is that there has been a shortage of contraceptives in Kenya for the past nine months," says Sam Orero, a Nairobi gynaecologist.

Unwanted pregnancies

The risks to women are great, because lack of contraception is synonymous with unwanted pregnancies and unsafe abortions. Women here depend on the Family Planning Association of Kenya and Marie Stopes International for their reproductive health needs, and these in turn rely on donors for funding. The two organisations enjoy a wide geographic presence, national reputation, depth of clinical services and the expertise to deliver quality reproductive health care.

With the risk of dying during pregnancy and after childbirth high in Africa, it is imperative to nip the problem in the bud by simply providing contraception. But since the Bush Administration introduced the Global Gag Rule, these organisations have closed 35 clinics in rural areas. The US' Gag Rule restricts foreign NGOs that receive US family planning funds from using their own, non-US funds to provide legal abortion services, from lobbying with their own governments for abortion law reform, or providing accurate medical counselling or referrals regarding abortion. This has created a further void in the unmet need.

Most developing countries, including Kenya, received advance warning in 2001 to start investing in contraceptives during the world conference on contraception commodities held in Istanbul, Turkey. In essence, they were told to stop relying on donor funding. Kenya was among the countries placed under the eight-year phasing off period. Three of those have flown past and women have already started feeling the pinch.

Reproductive health experts were hopeful that in the 2003 budget the cost of contraception would be reduced and that they would be made easily available to all women.

The health care budget in Kenya totals US $6 per person per year. Assuming that a woman chooses to use Depo Provera as her family planning drug of choice, one-third of this amount would go towards preventing pregnancy.

Lack of resources

The key question then is why the Kenya government has not seen it fit to invest in family planning? Peter Odongo, Chair of the Reproductive Health Committee, Kenya Medical Association, explains: "The government does not have enough resources to put into primary health care. At the moment, family planning is treated as a luxury. When a woman needs contraception, she is not sick and, therefore, her situation is not an emergency."

Odongo adds that contraception prevalence is quite low at the moment and is not affordable to many Kenyans - cause enough for alarm. "What we are asking is that the government invest in family planning, even if it is on a small-scale. This will reduce the number of women who have to seek abortion. What we are asking is that the health care budget should include subsidised contraception so that all women can access their first shot at safer motherhood."

Women want to see their fundamental right to health care entrenched in health care systems. It does not take an expert to determine that more women's lives are lost without contraception and information. According to Don Levy, a senior social marketing expert with the Washington DC-based Futures Group International, "If governments make an investment in primary health care with a strategic plan involving the private sector as well, then we are on the road to contraception security."

If governments remove the barriers that affect the private sector with a move to encourage them to invest in contraception, then contraception security would be real. He adds: "Such measures have worked in developing countries such as Turkey, the Philippines, Bangladesh, Nepal and - gradually - Uganda and Ghana. In fact, Ghana is an example of what a review of government policies can do to the health care system, especially contraception."

Government commitment

Odongo remembers that it took a year for the Kenyan government to allow social marketing of the female condom. "The government needs all the help it can get and for its own benefit."

Orero adds: "Most governments have not committed to family planning commodities. We are depending on donor funding, yet more donors want to see government commitment before they continue funding this part of the health care system."

According to Ipas' Vice-president for Africa, Eunice Brookman-Amissah, governments can start taking small steps towards securing safe motherhood. "Free education for girls up to university, access to information and emphasis on basic needs has transformed countries like Romania and Sri Lanka into success stories." Unless women are empowered, Africa will surely lose the battle for safe motherhood. Experts believe that even small measures at the policy level can change the health care system for the better.

It is imperative that we don't put the women at Mohammed's clinic out of our minds. According to the United Nations Population Fund, simply meeting the need for contraceptive services could reduce maternal mortality by 20 per cent or more. Let us not forget that 190 women (worldwide) face an unwanted or unplanned pregnancy every minute. In places where emergency obstetric care is not available, access to contraception may literally be a matter of life and death.

Florence Machio is a Nairobi-based journalist with a special interest in gender and development issues.

Source: Women's Featur Service, Delhi India.

Related links:

UN Population Fund (UNFPA)

The International Planned Parenthood Federation