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.

Email: snjunwa@gmail.com

Reaching the Last Mile with Contraceptives: Parliamentarians Commit to Take Stock

On March 8th 2017, the Tanzania Parliamentary Association on Population and Development (TPAPD) made a number of commitments including;

  • Holding the government and its institutions accountable for allocating, disbursing, and utilizing resources for provision of reproductive health and family planning services; as well as
  • Engaging community leadership in promoting public demand, greater acceptance and use of the services so that the national contraceptive prevalence rate (CPR) target of 60% for all methods, (45% for modern methods) is attained by the year 2020.

Just three months later – on Thursday, June 22nd  2017 – TPAPD leadership and other members adopted an Action Plan to strengthen collaboration with key family planning partners such as the Advance Family Planning (AFP) project. The plan anchors on strengthening capacity in advocacy, and accountability to sustain efforts to catalyze community participation towards increased family planning uptake.

One critical issue that generated a lot of discussion was on how to monitor commodity stock levels in facilities in their respective constituencies. For some Members of Parliament (MPs) AFP’s Commodity Monitoring Tool introduced and validated last year was the option to facilitate their community work. TPAPD adopted the tool and demanded that it be used by its committed members beginning July this year.

TPAPD Chair Hon. Mary Mwanjelwa (Special Seat MP for Mbeya Region) and Secretary General, Hon Sebastian Kapufi (MP for Mpanda Urban in Katavi Region) made special appeals to parliamentarians to ensure that family planning remains at the centre of development planning, and see to it that sub-national level governments get serious with making contraceptives available everywhere all the time.

“This tool comes at the right time, as we see that maternal mortality and teenage pregnancies in the country are on the rise as a result of low coverage and use of family planning services. It will equip us with the ability to collect evidence and use it in decision making bodies in our respective constituencies” said a TPAPD member.

Rising rates of teenage pregnancy and maternal mortality have been mind-boggling issues that generated great concern given their impact on the status of girls and women, and especially on the overall movement to empower women – one of the key pillars in building a just and equitable society. About two-thirds (16) of Tanzania Mainland’s 26 regions have a teenage pregnancy rate that is above the national average of 27%, which in fact has risen from 23% in 2010.

Given the President’s directive recently on disallowing re-admission of girls who become pregnant while in school, efforts to ‘save’ this generation from poverty and deprivation as they become adult women become more complicated. This group of girls aged 15-19 comprises of a larger segment of society with more girls who are either married, divorced, or work as petty traders struggling to fend for themselves and their families after missing on education and other more decent opportunities.

Undoubtedly, at any one point, a generation of girls in this age group is lost because only a small percentage makes it to higher learning institutions including universities to enhance their knowledge and skills for presumably better paying jobs, or other opportunities for better lives.

Now as parliamentarians and other advocates take on this agenda to ‘save’ Tanzania’s girls, it is imperative to face this challenge head on: Equip girls and young women with information, knowledge, counseling on contraception, and provide contraceptives to those who are sexually active; invest in gender empowerment initiatives so that equal treatment and participation of girls and boys becomes a norm across all sectors; taking to task culprits who find comfort in preying on innocent girls.

This is called Prevention – it means taking responsibility of nurturing this future human resource, while remaining accountable to delivering on Tanzania’s Development Goal 2025 that states in part – “… to achieve a high quality of livelihood for its citizens; peace, stability, and unity; good governance; a well-educated society; and a competitive economy capable of producing sustainable growth and shared benefits”. It means girls will no longer be abandoned or condemned to figure out their own lives after pregnancy.

 

 

London Family Planning Summit, 11 July 2017: The Moment to Recommit for Progress

Family planning advocates around the world have been working tirelessly to accelerate the momentum towards attaining the July 11th 2012 family planning goal of reaching 120 million additional users with information, services and supplies. Progress recorded thus far is encouraging though falls short of meeting the set national and global targets.

This year’s Family Planning Summit, which takes place on July 11th 2017, is yet another opportunity for global and national actors to recommit to this noble goal when they convene in London. This time around, youth advocates from some of the 38 Family Planning committing countries will join global leaders – governments, private sector, multilateral organizations, and CSOs; to seek ways to transform key lessons into actionable interventions that countries would adapt within their contexts.

Special forums dubbed Spotlight Events will be interactive sessions to discuss how best to build on what has worked, as well as generate advocacy messages to promote and sustain change. These dialogues will further underline the role of family planning in promoting socio-economic development with a focus on six thematic areas namely, – i) Innovative financing; ii) Commodity financing; iii) Supply Chains; iv) Expanding method mix; v) Humanitarian approach – leaving no woman behind; and vi) Adolescents and youth.

The London Summit coincides with the World Population Day (WPD) marked globally every July 11th, with activities revolving around fertility, population growth, and development. World leaders make statements on #WorldPopulationDay #WPD to further rally different players around population-related issues.

While the global community gears up to the Family Planning Summit, country-level Satellite activities in committing countries will be running at various times during #WorldPopulationDay. These activities will take different forms and shape but all have family planning as one common agenda. Taking on board this year’s WPD theme (Family Planning: Empowering People, Developing Nations), family planning stakeholders in Tanzania plan on providing family planning services and conducting demand-creation activities. These will be held at the national level at Mwembeyanga grounds in Temeke Municipality in Dar es Salaam.

To cap it all, family planning partners will be hosting a breakfast meeting with the private corporates to deliberate on how best public-private partnership for family planning could be strengthened. This forum, to take place on #WorldPopulationDay, is expected to revitalize private sector commitment and broaden partnerships for change.

The private sector has played and continues to play a critical role in the country’s development efforts in all sectors, education and health in particular. A number of companies complimenting government efforts to fight malaria – The Malaria Safe Consortium – have acknowledged the benefits of supporting family planning initiatives towards increased productivity. Better-planned families reduce demands on man-hours for child rearing and absenteeism due to illness, among other things. In any production work this is considered ‘lost’ time.

By 2020, Tanzania should witness significant progress in ensuring that family planning services are universally available and that women and girls are better able to access contraceptives of their choice. This should be possible with the government’s continued budgetary commitments for family planning at both national and sub-national levels, as efforts to reach the ‘last mile’ are granted serious attention.

Congratulations midwives for saving lives

May 5th every year, midwives around the world mark the International Day of Midwives. This day is aimed at rallying support and recognition of the noble task of this cadre of health providers in delivering midwifery services towards promoting the health of mothers and infants.

This day calls for some reflection on the increasing demand of these services on a small number of midwives, many of whom are overworked and many times, underpaid. Yet, under enabling environment, midwives contribute immensely not only to delivering babies and ensuring safety of mothers and their newborns, but also in deepening the knowledge on better care of mothers and child health.

The role of midwives is indeed invaluable. From keeping mothers and communities informed about the valuable benefits of breastfeeding, the importance of good nutrition and hygiene, and supporting prompt medical health check-ups during the pre- and post-pregnancy period, and reproductive health in general, midwives provide one of the strongest foundations for a healthy start for both mothers and their newborns.

The Tanzania Association of Midwives (TAMA) was established in October 1992 and supports midwives to provide high quality care, as well as enhance their recognition, visibility and valuable contribution. TAMA conducts week-long activities in collaboration with other key actors such as the Ministry of Health, Gender, Community Development, Elderly and Children to raise public awareness of critical midwifery-related issues, but more so, to render services such as breast cancer, HIV/AID testing, nutrition education, reproductive health, and family planning. Such activities are normally implemented across all its branches in the country.

Investing in increasing the number of skilled midwives will go a long way in ensuring that more and more women in Tanzania deliver in health facilities. Current data (TDHS 2015) shows that about 53% of expectant mothers seek medical services at health facilities, while the remaining 47% deliver at home with the help of traditional birth attendants.

Adequate midwives would also contribute to increased acceptance and uptake of family planning, one of the key preventive interventions to the country’s high maternal deaths of 546 women (in the reproductive age) in every 100,000 live births.

The 2017 International Day of Midwives theme of midwives, mothers and families are partners for life! recognizes that by working in partnership with women and their families, midwives can support them to make better decisions about what they need to have a safe and fulfilling birth. Let us join hands and support this partnership by creating an enabling environment for midwives across our country.

 

Rising Teenage Pregnancy – A National Disaster

They are young, innocent and ill-informed about sexual and reproductive health (SRH) issues especially about how to avoid early pregnancy. These are the 15-19 year-old girls in Tanzania, 27 percent of who are either mothers or expecting their first child.

Sadly, the number has risen (from 23% in 2010), and has generally stagnated: between 25% in 1999 and 27% 2015. This means 27 out of every 100 girls in this age group risk becoming mothers, and subjected to a cycle of poverty, helplessness and dependency.

Slide1

This predicament is by no means accidental; it is an outcome of inertia in policy implementation across sectors and administrative structures; cultural insensitivity to adolescents’ SRH needs, and low political commitment to take bold steps to save adolescents lives. In many ways, neglecting this growing challenge denies the country of a potential work force that would otherwise, acquire high level education, and skills, to effectively contribute to socio-economic development.

A 2016 study Global Youth Family Planning Index by the Population Reference Bureau (PRB) that measured the favorability of current national policy and program environments for youth uptake of contraception, ranked Tanzania high among the four countries studied (Kenya, Nigeria, and DRC). Yet, with respect to teenage pregnancy rate, Tanzania is second to DRC whose policy indicators leave a lot to be desired.

Why should this situation be allowed to prevail when 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (THDS-MIS) shows negligible progress in reducing the high fertility of 5.4 children per woman in the reproductive age, and increasing the contraceptive prevalence rate now at 34% (modern methods) – critical ingredients to lowering the rapid population growth of 2.7% per annum.

If left unchecked, the high teenage pregnancy trend would certainly compound poverty and dependency now is at 9:1 given its demographic profile whereby 65% of its population is under 25 years. Under these circumstances, Tanzania, whose population is project at 80 million by 2030, is unlikely to harness its demographic dividend.

Therefore, more investments and serious attention is needed to reverse the trend if the country is determined to attain a middle-income economy status by 2025; hence a national campaign to address teenage pregnancy is justified; and enhanced adolescent SRH knowledge and access to services should be the campaign’s driving force!

 

Tanzania Advocates Call for Higher Family Planning Allocation

Budget trend for family planning

As members of parliament get ready for the 2017/18 budget session, advocates for family planning are pleading for a higher allocation for family planning. While commending the government for recently announcing a 7bn Tanzanian shillings (Tshs) allocation of FP in 2017/18, representing a 2bn Tshs rise from the current financial year, some members of the Tanzania Coalition for Demographic Awareness and Action (TCDAA) appealed for more given the dwindling donor support.

“With the US government, a major donor in RMNCAH programs worldwide, cutting its funding to UNFPA, a key global actor, family planning programs will more likely be negatively impacted,” a TCDAA member said. This would be felt in the area of commodity supply, as well as capacity strengthening initiatives that have steadily contributed to increased number of family planning providers.

Although Tanzania is making progress in infant, child and under-5 mortality according to the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS), the indicators for maternal mortality and teenage pregnancy have worsened over time. A comparison of the indicators from TDHS reports shows below:

Trends in teenage childbearingMMR trend

Evidence abound on the association of family planning and maternal mortality where the latter can be reduced by 44%. Investing in family planning also contributes to reduction of teenage pregnancy rates. Although there has been an encouraging trend (figure below) on the government keeping its FP2020 promise – to increase resources for family planning – the allocated and disbursed amounts over the years fall short of an estimated need of 20 billion Tshs as per the National Family Planning Costed Implementation Plan (NFPCIP) 2010 – 2015.

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Advocates are therefore, calling upon the government to increase 5 billion Tshs every financial year between 2017/18 to 2020/21 with a targeted allocation for the latter estimated at 22 billion Tshs. Conversely, Local Government Authorities also ought to increase their allocations and disbursements to strengthen family planning program reach and provide oversight on sustained contraceptive availability as well as demand generation. These efforts will enhance Tanzania’s resolve to accelerate its attainment of a 45% and 60% targets for contraceptives modern, and all methods, respectively and meet its commitment to reduce maternal mortality to 293/100,000 by 2020.

Advocacy Now More Than Ever: Recommitting to FP2020

From the East to the West Coast of Africa, to far and beyond the Asian continent, family planning advocacy partners converged in Baltimore, one of the oldest cities in the United States. These Advance Family Planning (AFP) project implementers spent the last week of March 2017 to take stock of the work they embarked on a few years back to influence favourable policies and increase investments in family planning programs. Click here to learn about the AFP partners meeting 2017.

The ultimate deliverable that unites all partners across countries is to contribute to the FP2020 goal: reaching new 120 million women and girls with quality voluntary family planning information, services and supplies. Therefore, one week of collective reflection annually, is what AFP does to acknowledge advocacy quick wins, determine new approaches while learning from lessons to enrich the project’s interventions across the ten focus countries and a number of partners.

Joined by their main funder, the Gates Foundation, the community of advocates noted with great concern the current challenges that threaten stability of family planning (FP) programs. These ranged between unpredictable political systems in some partner countries, gloomy economic times, and a fast changing global environment. Evidently, the funding cuts by the new US government – the biggest funder of FP programs.

20170331_215122But given the advocacy wins gathered by all partners across countries that have by and large seen more domestic resources channeled to family planning, and policy barriers being overcome to improve FP access, “advocacy was needed more now than ever before” said AFP’s Principle Investigator Duff Gillespie.

In his upbeat presentation at the beginning of the annual meeting, Duff highlighted possibilities and opportunities for strengthening FP advocacy through sustained engagement of working groups, coalitions and maintaining personal contacts with decision makers to ensure local ownership and sustainability of FP programs.

Going forward, AFP implementers using SMART advocacy are determined more than ever before to take FP advocacy to the next level: building on advocacy wins, strengthen advocacy collaborative by drawing in critical CSO actors in focus countries; maximize use of evidence/data to promote accountability; and enhance tracking and measuring success.

 

 

 

MoU: TAYAHR advocate for Family Planning & Sexual Reproductive Health Rights in Tanzania

The Tanzania Youth and Adolescent Reproductive Health Coalition [TAYAHR] founding members bring youth together to advocate for Family Planning & Sexual Reproductive Health Rights in Tanzania.

The Memorandum of Understanding (MoU) constitutes an agreement by and between the Founding Members of TAYAHR. The  main objective of this MOU is to express the willingness of TAYAHR founding members to engage in an effort of bringing youth’s together to advocate for Family Planning (FP) and Sexual Reproductive Health Rights (SRHR) in Tanzania.

Advance Family Planning (AFP) Tanzania has been instrumental in establishing this coalition.

The MoU TAYAHR (2017) can be accessed here.

Mara regional leaders show ownership to family planning programs

After succeeding in raising its contraceptive prevalence rate (CPR) in the past five years, the Mara Regional leaders recently directed all its local government authorities (LGAs) to set aside 5% of its budget towards improving family planning services.

A letter dated February 28, 2017 containing the directive and signed on behalf of the Mara Regional Administrative Secretary, expressed concern over the slow pace in CPR growth at national and regional level, and underscored the need for intensifying efforts to improve family planning performance.

Mara’s move is exemplary and underscores leadership commitment to own and promote family planning. Mara is also one of the leading regions that have been successful in recording a major leap in CPR increase from 13% in 2010 to 29% in 2015-16, according to the Tanzania Health and Demographic Survey, Malaria Indicator Survey (TDHS-MIS 2015-16).

Located in the Lake Zone, Mara is among 12 regions that the Advance Family Planning (AFP) project has been working in since 2015. LGAs in the regions have strived to allocate between 2% and 5% of their district and health budgets, respectively to family planning. The directive therefore is meant to ensure sustained efforts to the family planning agenda.

AFP through its partners – Health Promotion Tanzania (HDT) and Tanzania Communication and Development Centre (TCDC) – has successfully engaged about 72 LGAs in phases with the majority of them heading to the call by making budget allocations and commitments from their own resources.

In 2017/18 financial year, fourty-four 44 LGAs in 6 Regions – Kigoma, Tabora, Dar es Salaam, Coast, Katavi and Manyara-  have allocated 2% of their ‘own’ funds for family planning services in the 2017/18. Investment in family planning is critical in reducing the high fertility of about six children per woman in reproductive age contributing to Tanzania’s rapid annual population growth rate of 2.7%.