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Family Planning: Be an Example

This week, I am in Dakar for the 2011 International Conference on Family Planning. What I hope to see come out of this conference is a plan to make real change and an action plan for how we will measure and monitor that change.

When it comes to reproductive health and family planning, there have been so many international and regional meetings—including Maputo (September 2006), Kampala (November 2009), Ouagadougou (February 2011), and Addis Ababa (June 2011)—but what has actually happened?

The answer is not enough.

From politicians to community and international leaders, we all need to be more engaged in supporting couples to make informed choices about family size. We need leaders who can talk about the benefits of family planning, educate communities, and set an example.

Even if you are wealthy enough to support a large family, you are still using community resources. Communities build the schools and roads, but we all send our children to schools and use those roads. We all have to be responsible—for ourselves, for our kids, and for the future. To do this, we need more collaboration between the public and private sectors including civil society, nongovernmental organizations, media, and health providers.

Part of my message is: do your part. Be an example. We are all responsible. Spread the information. If you are a health provider, an educator, or a social worker, offer your services; don’t be a barrier. Help those who come to you. Share information even with those who don’t ask. See each patient as a whole person—not someone coming in for one service. If a woman has a malnourished child, is pregnant or might be soon, talk to her about what she wants for her family and how you can help her achieve it. I’m not saying give family planning to everyone; I’m saying ask questions. There are expressed and unexpressed needs—we need to explore both.

In West Africa, a region I worked in for many years, there are still so many countries where contraceptive prevalence is less than 10% and fertility is high. This contributes to high maternal and infant mortality. There are many contributing social and cultural factors, but the fact that many people have difficulty accessing services or receive poor-quality services remains a barrier. I do not ignore significant progress in some countries in the region with contraceptive prevalence around 17% (e.g., Benin, Burkina Faso, and Togo). Over the past decade, use of family planning among married women in West Africa has increased from 6.3% to 13.9%. Although family planning use more than doubled, West Africa still lags behind other regions of Africa (Population Reference Bureau). This pace of progress cannot absorb unmet needs that will increase rapidly with a growing population of young people.

As I talked about in my last blog, health workers play a key role in making services more accessible and in examining how their own attitudes may influence patients’ attitudes and opinions of family planning. Gender discrimination, the low status of women, and gender-based violence also influence women’s choices about health care and family planning.

In West Africa, it is common for girls to marry young, often before age 18. This can be dangerous for them, their pregnancy outcomes, and any children they already have. Many of these young women and girls are not physically or emotionally mature enough to carry a pregnancy or care for a child. Keeping girls in school—offering them an education—is important. If girls stay in school and are not forced to marry early, they are more able to decide their own future and discuss openly with their future husbands what they want for a family. Early age at marriage, the social desirability of many children, and limited access to education are some of the factors that keep fertility from decreasing more rapidly.

In West Africa, family planning for the purpose of spacing births is a message that passes easily. But we don’t need to talk about birth spacing only. We need to make sure that women who don’t want any more children have the information and services to prevent pregnancy. We need to reach people who don’t understand family planning through the media and through education when they come in for other health services. Any health care visit can be an opportunity to talk about family planning and how a woman or a couple wants to space or limit children and what kind of family they want.

Involving men is also really important. So many physicians, nurses, and midwives don’t get enough training about how to reach men and what they can do for men’s health. They are taught a lot about women and children, but we can do more for—and with—men. When you meet women who are interested in family planning, you can also ask them to bring in their husbands the next time. Some women will not want their husbands to know they are using a method; we have to respect their wishes. But for women who are willing, you can also reach their husbands. Ask men these questions:

  • Do you want your wife to risk dying with the next pregnancy?
  • Do you want your children to be malnourished?
  • Do you want your children to be able to go to school?
  • Would you be able to pay for their tuition?
  • Do you want to have a better house?
  • Do you want better clothes?
  • How can you help your wife in your reproductive life?
  • How is your sexual life?
  • Have you ever been examined in your life (e.g., body mass index, blood pressure, cholesterol, diabetes, prostate tumors, colon cancer, sexually transmitted infection/HIV, depression)?

Men, too, want a better life, to stay healthy at any age, and to have a healthy family. Sometimes they need help and care to make that happen.