By Ruth Kedikilwe
If this place had to be described with a colour, it would have to be grey, the mood would be somber and the feeling would have to be painful. A visibly pregnant young woman who’s age cannot be guessed by merely looking at her makes her way outside her one roomed house followed closely by five other children. This is not a setting in the rural parts of Botswana nor is it a plot of a television show but the reality of a family living in dire poverty in the outskirts of Gaborone by the Tlokweng boarder gate.
The first question would have to be why so many children despite the circumstances? It all comes down to the availability and awareness with the tools of sexual reproductive health which enables effective family planning. According the United Nations Population Fund (UNFPA), sexual reproductive health is the state of complete physical, mental and social well being in all matters relating to the reproductive system. It also entails full access to facilities and information pertaining to the efficient and effective use of all methods used for sexual reproductive health to safeguard women and girls from potentially deadly situations like illegal abortions, unwanted pregnancies, reduce maternal and infant mortality rates and the spread and transmission of HIV and other sexually transmitted infections.
Botswana Family Welfare Association, BOFWA is one of the organizations whose mandate is to ensure that Batswana have access to family planning programs. Projects Officer Senzeni Makhwaje says “BOFWA gets its family planning commodities including modern contraceptive methods from the Ministry of Health and Wellness (MoHW) through Central Medical Stores (CMS). We provide all the methods that the MoHW has availed, except for the permanent/surgical methods like Vasectomy and Tubal ligation.” The available methods are; CONDOMS IMPLANTS, INJECTABLE DEPO-PROVERA, COMBINED ORAL CONTRACEPTIVE PILLS (CoCs), PROGESTERONE ONLY PILLS (PoP), INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD)/LOOP and EMERGENCY CONTRACEPTION.
In order to open channels of communication between partners regarding sexual reproductive health, Bofwa encourage clients to come to the clinic with their partners for initial and subsequent family planning visit but in most cases females come alone because male partners view family planning services as a women thing and their role starts and stops at consenting or denying for their female partners to use contraception method.
Only a few clients come for these services as a couple and our observation is that clients receiving couple counselling tend to adhere to the contraception method better as opposed to those receiving counselling as individuals. The couples receiving counselling together get to appreciate the advantages that come with using a contraception method, the side effects as well as the management of the side effects.
Makhwaje further stated that there is sometimes some resistance towards specific family planning methods, mostly because of the irregular bleeding patterns caused by hormonal contraceptive methods. The male partners usually complain of interruption of sexual intercourse caused by the bleeding. In most cases, female clients start a contraceptive method without discussing with the male partner first and that tends to cause conflict and resistance. There are also said to be a lot of myths and misconceptions around certain contraceptive methods, particularly the IUCD. The public generally have very limited knowledge about the method and the lack of knowledge can be directly attributed to the fact that for a long time now, service providers in public health facilities have not been promoting the method and the service is rarely available. Most of the service providers in public health facilities lack the expertise and skills with regards to the IUCD, which is available at BOFWA.
Makhwaje also put emphasis on the dual mode of protection which entails the simultaneous use of condoms and contraception of choice since it will not only reduce the chances of unwanted pregnancies but also the transmission of sexually transmitted diseases.
We are in an era where reproduction is left to the hands of our maker, socio economic pressures require the monitoring of family size, this is closely linked to reproductive rights, causing a ripple effect ultimately affecting the right to heakth, education and employment.
According to the 2018 UNFPA report titled, “The Power of Choice: Reproductive Rights and Demographic Transition,” in the foreword by Executive Director it is stated that, “Choice can change the world.” The report further states that, “When a woman has the power and means to prevent or delay a pregnancy, for example, she has more control over her health and can enter or stay in the paid labour force and realize her full economic potential, no country can claim that all of its citizens enjoy reproductive rights at all times. Most couples cannot have the number of children they want because they either lack economic and social support to achieve their preferred family size, or the means to control their fertility. The unmet need for modern contraception prevents hundreds of millions of women from choosing smaller families.”