21 Oct, 11 | by BMJ Group
I was pleased to learn that Hawa Ali, a 27 year old woman whom I met at a maternity shelter in Garissa, in Northern Kenya, recently delivered triplets. Hawa had been in the shelter for four months because of the high risks associated with her pregnancy. Dozens of other mothers who also arrived in the shelter were weakened because of the lack of food, coming from remote villages where there is no access to medical care. It is great to know that thanks to our efforts, Hawa was able to get a caesarean and the postnatal care she needs.
UNFPA’s implementing partner, the Kenyan Red Cross, has been offering women in the region a wide range of reproductive health care services, including the distribution of clean delivery kits in the eventuality that women cannot give birth in a health facility.
Hawa and her husband, who already have nine children, were also counselled by UNFPA’s partners about voluntary family planning methods. Due to her current circumstances, Hawa chose to use long-term family planning through the use of implants.
Despite regular food shortages and high infant mortality, the Horn of Africa’s population has more than doubled since it was hit by major droughts in 1974, spurred by factors such as limited contraceptive use and a tradition of large families.
In times of crisis when skilled birth attendance and emergency obstetric care may not be readily available, an unplanned pregnancy can be fatal.
Birth spacing, as some prefer to call it, is a sensitive cultural issue to discuss with mothers and their husbands, especially in Somali communities. According to Kenya’s recent National Demographic and Health Survey, the preferred number of children in Northern Kenya for women aged between 15 and 49, is of nearly nine children.
Mohammed Abdi, a 56 year old man who also lives in Garissa, is expecting his 25th child. His family, which includes three wives, lost 200 head of cattle during the drought. Mohammed can only afford to send nine of his children to school. “Even if I had only two or three children, how would I pay for their school fees when all my livestock is dead?” he says, “I’ll have children until I die. Without my cattle, my children are my safety net.”
As UNFPA will be marking our world reaching 7 billion people in October, we need to think about how we can better educate people about the different choices that can be offered to them. The international community has agreed that access to family planning is a basic human right. But without access to relevant information and high-quality supplies and services, that right cannot be exercised. It is important to help families to have children when they want to have them and choose a number which they can educate and provide for within their own context.
UNFPA and its partners have been scaling up its family planning services since the onset of the recent crisis in the Horn of Africa. As with Hawa’s case, we are noticing a progressive increase in the uptake of birth spacing methods. But because change cannot happen overnight, we are committing resources in the long term and adapting our work as the situation on the ground evolves.
Babatunde Osotimehin, executive director, UN Population Fund, UNFPA.