This is the third post in the "Imagine a world …" series from Marie Stopes International.
Every day I see the difference that access to contraception makes to women in my country, Zambia. And every day I see the very long distances that women travel to have choice in their lives: whether and when to have children; making sure that births are well spaced; all to make sure they can care for the children they already have.
My name is Mukanga Sindazi, and I lead one of our seven outreach teams – three community health workers, a driver and me – in Central Province. We’re out six days a week here, taking contraceptives and counselling to some of our nation’s most hard-to-reach and under-served communities. In Zambia, two-thirds of the population live in our sparsely populated countryside, and without outreach, it’s hard to imagine how the women in these remote communities could even learn about contraception, much less have access to it. And our health system struggles to get it out to them.
I hear stories of women who have to travel over 10km, often on foot or on a bicycle, to get to their nearest health clinic. And, on arrival, they often find that contraceptive supplies have run out.
So we go to them.
One of the communities I visit regularly is a small fishing village called Waya. It’s 45 miles from the nearest town, and women still travel up to two hours from the surrounding communities to attend. On a typical outreach visit, we see up to 60 women. For some of them, our visits mean they have a wider choice of family planning methods. So many only know about condoms, which some menfolk will not use. For others, they are learning about the possibility of using contraception for the very first time.
I remember one woman whose story touched me. She had never had a choice, not really. She’d given birth to six children, with her youngest dying soon after birth. Soon after this, she found out she was HIV positive. So she and her husband knew they didn’t want to have any more children, but didn’t know where to turn. Sure, she’d been able to use pills and condoms, but she kept getting pregnant, because of all the pressures of everyday life.
So, having heard about our visits to Waya from a community worker who travels around the community to raise awareness about our services, she came to one of our outreach sessions. We talked to her, told her all her options, after thinking about it, she chose an implant. She was able to have it fitted there and then by a trained member of the team. I remember her saying to me: “We are so happy. We’ve been looking for something to help for such a long time.”
Right now in Zambia, there are nearly 700,000 women who want to avoid pregnancy, but who don’t have access to the kind of contraception that can help people like her, long term. We do our best to help, and with our partners now work in 83 rural locations to serve Zambian women.
But we’re still far from a Zambia where all women, particularly those in rural communities, can access the contraceptive of their choice.
So we have to imagine a world where country girls have the same chance in life as girls and women in the city. We can imagine this if we continue to grow, and take our services where others don’t go. We must – and do – commit to this, as part of our mission to serve every woman we can in Zambia.
At the family planning summit in London next week, I hope world leaders will recognise the challenges facing rural women. Zambian women want choices in family planning, but as I see every day, so often they do not have them. So our hope is that we can all come together to remember the girls and women of the countryside. Our hope is that they can imagine a world where, however isolated your community, having contraception is a usual thing - and not a luxury.