Commodity Availability: Focus on What Women Want

Most, if not all, reproductive health partners say: ”No commodity, no program,” as they ponder how best to reach women and girls with life-saving commodities including contraceptives. The focus has for many years remained on target number of those reached or to be reached with various services including contraceptives.

Yet ensuring access to family planning (FP) services is beyond setting target numbers only. But also, and increasingly important, is to ensure clients rights are upheld, which includes many more aspects beyond meeting clients’ needs for information, counseling and their method choice through informed decision-making. It also means empowering them to participate, provide feedback on services rendered and be involved in accountability issues.

Studies in a number of developing countries shows that ensuring method mix, choice and having adequate skilled service providers in place, have been a constant struggle and challenge. Coercion to using contraceptives methods or to pregnancy by service providers or intimate partners, respectively, continue to characterize a number of family planning programs worldwide.

A recent post-London FP Summit consultative meeting that brought CSOs from the North and the South, donors and researchers, explored the rights-based approach (RBA) and acknowledged the need for doing ‘business unusual’. This means apart from focusing on quality, voluntary, informed choice and decision making as well as addressing privacy and confidentiality, the FP movement (governments, CSOs, donors, private sector, etc) should be more intentional in ensuring that services are non-discriminatory and equitable.

They also ought to put in place clients’ empowerment, their autonomy, and participation, while engaging different structures, processes, and actors including youth, to promote and ensure accountability at all levels. It means applying a human rights lens in the family planning / reproductive health program.

Admittedly, the RBA move is complex because it interrogates socio-cultural practices, and political contexts and is subject to different interpretation, but based on evidence the good news is that once integrated in FP program, RBA contributes to increased reproductive outcomes, and reduced coercion and intimate partner violence.

There is already evidence that shows that increasingly countries and donors are thinking about how to incorporate human rights into the design and execution of family planning programs, because globally, respecting, protecting, and fulfilling rights of individuals is acknowledged as key to advancing family planning and the broader sexual and reproductive health and rights (SRHR) agenda.

Admittedly, “rights” is an unfinished agenda in FP and SRHR arena, however, given the existing Results-based family planning index, that adheres to human rights and empowerment principles for FP, and other protocols, there is great hope for progress.

As countries begin to implement their respective FP2020 commitments made in 2017, RBA will certainly feature in national consultations, as well as Costed Implementation Plans (CIPs). Contributing to global 120 million more users with family planning information, services and supplies by 2020, also means paying attention to women’s, girls’ and men’s human rights as they relate to family planning.

Youth: The Pillar of Social Transformation

One of the biggest wins at the London Summit on Family Planning held on July 11th, 2017, is the engagement of young people in almost all panels and consultations, underscoring the reality that youth are both beneficiaries and key actors in sexual and reproductive health interventions across countries.

About 15 young people from a number of developing countries formed the Summit’s Youth Advisory Group that demonstrated the dynamism young people have, once empowered and given opportunities to act. And youthful countries have no choice but to open doors to these upcoming champions and youth networks in their respective societies.

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“I have listened and learnt a lot from the various sessions at the Summit, and I see a lot of opportunities to rally other young people around SRHR issues in my country,” said Qaisar Roonjha from Pakistan. Globally adolescent and youth constitute the largest group of over 1.2 billion people aged 10 – 19 years, the majority of whom (89%) live in developing countries.

Meaningful youth engagement through knowledge building, funding of youth-led programs, and sustained mentorship, is an opportunity for countries to harness youth potential in transforming their respective societies. And the SRHR focus, which includes family planning services, is an investment towards attaining socio-economic development.

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Today, a number of countries in sub-Sahara Africa, Tanzania included, are grappling with high fertility rates within a resource-stricken environment leading to high dependency ratios and poverty. Unfortunately, adolescents and youth are among those who contribute to and impacted by these conditions.

Therefore, with the right investment in engaging young people, building their knowledge, and granting them opportunities to access and make contraceptive choices, transformation in developing countries is inevitable.

The Summit’s Youth Advisory Group move to develop an Accountability Framework to guide the Group members in mobilizing fellow young people at country level to undertake youth-led social accountability and advocacy initiatives, is a solid step forward.

The framework will open doors for youth to participate in as well as monitor implementation of commitments made by their governments intended to scale up SRHR access. Success is more likely if this growing ‘army’ of knowledgeable youth across countries is tirelessly mentored to acquire greater heights in life while resources continue to be directed to youth-led initiatives.

It is indeed in this spirit that the Advance Family Planning (AFP) and partners – HDT and TCDC – embarked on a partnership journey November last year with the Tanzania Adolescent and Youth SRHR Coalition (TAYARH), also represented in the Youth Advisory Working Group, to push for youth meaningful engagement in SRHR especially family planning.

Global Family Planning movement re-energized

The London Summit on Family Planning ended on July 11th with at least 49 countries committing to improve family planning services, and many more are making commitments towards attaining the 120 million more users by 2020 – a goal set in 2012.

The family planning movement gained an impetus at the first London Summit five years ago, and today the landscape has changed; the global community has accumulated a number of lessons, substantive data and evidence, strengthened supply chains, and stronger partnerships.

Committing countries – 38 prior to the second London Summit – are not only committing domestic resources to family planning, but also mobilizing leadership at national, sub-national level, and enlisting cultural, religious and influential leaders to rally communities behind family planning.

“In 2012, the goal was purposefully set high: 120 million reached with family planning information, services, and supplies,” said Melinda Gates during a plenary session. And the Summit was a demonstration of collective accountability and a reflection of increased dedication to the cause.

The global community remains optimistic, and re-energized to accelerate progress to attaining voluntary, quality family planning services, despite reaching 30.4 million women thus far. The gathering witnessed a number of commitments made: a total of 64 new policy and financial commitments in developing countries, donors, civil society organizations, and private companies; USD1.5 billion in new financial commitments by countries in Africa and Asia, USD 660 million in new donor financing, and USD 19 million in new private sector commitments.

Reframing family planning within the sexual and reproductive health agenda would bring in a cross section of actors to work towards the goal, but most importantly, situate family planning as a tool to alleviate poverty. A number of speakers at the Summit reframed family planning as an anti-poverty intervention, a message likely to resonate with most governments especially in developing countries.

So as the dust settles after the Summit, all actors – donors, governments, private corporates, CSOs – are now challenged with putting the commitments to action, building on the work done so far, and more strongly, using the generated evidence towards implementing more effective interventions.

Photo caption: From left to right: Dr. Natalia Kanem, Acting Executive Director, UNFPA; Hon. Minister Marie-Claude Bibeau, Minister of International Development and La Francophonie for Canada; Hon. Dr. Jane Ruth Aceng (Achang), Minister of Health, Uganda; and Melinda Gates, Co-chair of the Bill & Melinda Gates Foundation

This is why teen mothers shouldn’t be left in the cold (from The Citizen)

This article was originally published in the Citizen newspaper on Sunday, July 2nd 2017, available here.

By Stella Barozi

When Deonisia Joseph, 28, looks at her 14-year-old daughter Linda today, her mind travels back 14 years when she dropped out of school due to pregnancy in 2002. Like Linda, she was 14 at the time and in Form Two, just like her daughter.

When Deonisia Joseph, 28, looks at her 14-year-old daughter Linda today, her mind travels back 14 years when she dropped out of school due to pregnancy in 2002. Like Linda, she was 14 at the time and in Form Two, just like her daughter. Deo had her first sexual encounter in July 2002 and when she missed her period thereafter, she did not worry she could be pregnant but rather hoped she would soon get her period again. She learnt she could be pregnant five months later after confiding with friends at school.

“A Form Four girl advised me to drink very strong tea or a mixture of ashes with water to terminate the pregnancy. I did not try any of these because I did not want to die. I think it was God’s plan to give Linda to me,” says Deo who lives in Sinza, Dar es Salaam. Having suspected she could be pregnant, teachers sent for her parents without Deo’s knowledge. They told her father about their suspiscion and advised him to take her to hospital for a pregnancy test. At just a touch at her breasts and stomach, the doctor told her father there was no need for taking the urine test. He confirmed she was between seven and eight months pregnant. Deo is glad her parents did not judge or scold her but were rather very supportive throughout her pregnancy. They enrolled her at another private school in 2004, nine months after she gave birth to Linda on April 12, 2003.

“I don’t know how my life would be like today had they decided to punish me for getting pregnant while in school,” says Deo, vividly grateful and proud of her parents. Deo’s father, Joseph Dilunga says he took Deo back to school after delivery because he and his late wife wanted the best for their children.“Education is the foundation of a good life. When our daughter accidentaly got pregnant, we did not want to punish her although it pained us. But there was nothing we could do since it had already happened,” says Dilunga. They wanted their daughter to at least complete secondary education. “We counselled her and assured her that all was not lost and that we would be there for her,” says the dotting father.

Now a front desk receptionist for a private company in the city, Deo who also has a one year-old son is grateful that her parents gave her a second chance because she now is able to take care of her two children. According to Population Reference Bureau (PRB)’s World Population Data Sheet 2015: Focus on Women’s Empowerment, education is a critical pathway out of poverty for girls and women. It says many studies show that when girls stay in school, it can help boost women’s earning power.

Need to talk about sex 
PRB’s Carolyn Lamere says in an August 2013, ENGAGE presentation titled ‘Harnessing the Demographic Dividend’ that; “Investments in education can have quick returns for families, because each year of schooling is associated with an increase in wages of up to 10 percent.” She says being in school helps delay early marriage and that it gives girls more opportunities to participate in the labour force. Deo and her father advise parents to be friendly with their children and that they should talk with them about sexuality. Deo says parents should be open to their children. “I wish my parents were more open. They used to just tell me to be careful with boys.

They were not so open about sex.” She does not blame them though. It was and is still a taboo in her Luguru culture for parents to discuss such matters with their children. This is the role of aunts. Katja Iversen, CEO of Women Deliver, a leading global advocate for investment in the health, rights and wellbeing of girls and women, with a specific focus on maternal, sexual and reproductive health and rights says the government’s recent decision to prevent teen mothers from returning to school is fundamentally at odds with international agreements and with it’s own commitment to gender equality and girls’ and women’s human rights.

Neglected population segment
“From a social and economic standpoint, this decision is also shortsighted. By denying adolescent mothers a quality education, the government will dramatically increase the chances that both they and their children will be trapped in cycles of poverty that prevent them from reaching their full potential and hold entire nations back,” says Katja.

A gender and family planning advocate, Halima Shariff, concedes saying that we cannot simply let these young souls ‘wonder in the cold’ without any support as this will only sustain the poverty cycle and deny the country of a human resource that could contribute to national development. Halima says youth below 24 who are the largest population in Tanzania are the most neglected in society as far as empowering them with life skills is concerned. “We as adults would desire for the young people to behave in a certain manner-especially with respect to abstaining from sexual activity and not falling prey to early pregnancy, yet apart for policy documents and supportive statements in favour of youth’s health, we do not provide protective measures and safety nets for young people even though studies show that sexual activity starts as early as 12 years.”

With globalisation and free access to all kinds of information amidst minimum or absence of solid guidance on sexuality issues, Halima says we probably do not have the right as adults, to point fingers at young people’s bad behaviour. Halima says adolescence is the stage in life that requires serious counselling, information, nurturing, reassuring, and clarity on reproductive health issues. “It is a period of making mistakes and expecting guidance and support. It is a time when things can simply go wrong in life, and especially in our context where extended male family members and strangers can take advantage of young innocent girls. And all the time these cases are condoned to save the face of families or clans,” she notes.

Halima thinks the president’s school ban could make matters worse, for most young girls who will get pregnant, and many at the first sexual encounter, like Deonisia may go for an abortion and risk their lives. The weaker ones may commit suicide. On the plus side, Halima thinks the ban may trigger a positive change as it may give some leaders, parents and advocates the opportunity to stress on the need for information and education on sexual and reproductive health for adolescents and youth. This will empower them to make informed decisions and enable them to detect risky environments or most importantly be able to report on any sexual advances or rape.

A societal responsibility
She advises the education ministry, the health ministry and the ministry responsible for youth to consider how best to have safety nets for those who end up becoming pregnant. She says this is a societal responsibility that has to be addressed. Colette Rose, Senior International Communications Manager at the Guttmacher Institute, a research and policy organisation committed to advancing sexual and reproductive health and rights in the United States and globally says it is far more important to aim efforts at preventing unintended pregnancies in the first place. She says preventing unintended pregnancy is essential to improving adolescents’ sexual and reproductive health and their social and economic well-being.

“One important strategy to help adolescents avoid unintended pregnancy is to provide comprehensive sexuality education in schools. Comprehensive sexuality education is integral to ensuring that adolescents are equipped with the information they need to achieve healthy sexual and reproductive lives and to avoid negative health outcomes.” According to her, teaching students about contraceptives can help protect young people who are already sexually active or are considering becoming sexually active from pregnancy or STIs, but evidence has shown that this does not encourage adolescents to become sexually active. Colette says there is absolutely no evidence that suggests allowing students to return to school to finish their education will encourage promiscuity or lead to more pregnancies.

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