Bill & Melinda Gates Foundation

Motherlode Asks: What Prevents Family Planning Programs From Helping All Women?

December 04, 2013

When you think about family planning, what do you think of? For many women, it's all about planning for the children you want to have, preventing pregnancy if you decide, and spacing pregnancy and child birth in a way that makes the most sense for you and family. But for women who live in extremely poor regions, like a slum in Nairobi, Kenya, for example, having children does not necessarily equate to having this type of control over one's life - yet. 

For many women, the chance that the children they do bear will survive past childhood is far too slim. It's exactly this reality and the accompanying fear, writes Jane Otai in her blog post for the New York Times' Motherlode, that may be preventing traditional family planning programs from truly helping women:

"In such societies having numerous children is a kind of social insurance, a guarantee that those who do survive will help the parents financially and take care of them in old age. Traditional family planning campaigns have stressed the benefits of spacing births for both the children and the mother. Fewer children means each would receive more attention and resources, and the mother would be able to regain her strength before giving birth again.

But in my work for Jhpiego’s Tupange project, an urban health initiative offering access to family planning in Kenya, I have learned that it is not enough to attempt to convince them that smaller families are a good idea. For family planning programs to succeed in helping women have smaller, healthier families, it is necessary to vastly improve basic medical care so they can begin to believe that their children will survive.

Today in Nairobi’s slums where three-quarters of the city’s population lives, only 44 percent of children are vaccinated against measles, pneumonia and rotavirus (diarrhea), compared with  73 percent in Nairobi County as a whole, according to African Population and Health Research Center. Of every 1,000 children born in slums, 139 die before reaching their fifth birthday.

Better access to these vaccines, along with aggressive education campaigns about their benefits, could dramatically reduce the number of childhood deaths."

So, what does this mean for women who desperately need family planning, along side a host of other health care? Otai shares:

"When a mother does take a sick child to a health facility or for immunization, it is critical that the health provider who attends to her also be skilled in family planning services to provide her with information and contraceptives on the same visit...For many of the women who visit slum health care facilities, family planning is not a priority; the survival of their children is."

Read the entire post here. 

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