GASHIKANWA, Ngozi, Burundi – "I had twelve children with my wife and five (have) already died because of poverty. A vasectomy was our only relief,” says Damien Gahutu. It is in his minority community of Batwa in northern Burundi that a radical transformation is taking place.
Those who are choosing to practice family planning report more fulfilled marriages and improved family lives.
My wife was (frequently) pregnant, she was very exhausted and we were seriously worried, especially as our children were dying one after another.
"Because of poverty, I could not provide for my family’s needs. I could not feed my children and couldn’t take care of them when they got sick, so we lost five children. My wife was (frequently) pregnant, she was very exhausted and we were seriously worried, especially as our children were dying one after another," he says.
Using family planning to reduce high maternal deaths
Not only does Burundi have one of the highest fertility rates, at an average of 6.2 children per woman, but it also has a tragically high number of maternal deaths. The maternal mortality ratio is estimated at 712 deaths per 100,000 live births.
These figures have prompted the Ministry of Health to invest in interventions that prevent maternal deaths by improving access to and use of family planning services, through its National Programme for Reproductive Health (PNSR). This is in collaboration with UNFPA, the United Nations Population Fund, through funding from the United Kingdom’s Department for International Development (DFID).
To achieve better outcomes, the community-based distribution of contraceptives was used at first to take family planning services directly to people, and the active participation of men was sought in the promotion and practice of family planning.
One of the recipients was Damien Gahutu. Before he received this information and chose to undergo a vasectomy, the future of his family looked bleak.
Family planning saves lives
It was at a meeting with a community-based distributor that Mr. Gahutu and his wife learned about the benefits of family planning and the different contraceptive methods available. But he considers the distributor their ‘angel’ because he not only provided information but also accompanied them to the health centre at Gashikanwa, where all their concerns about family planning were dispelled.
Together with his wife, Mr. Gahutu opted for a vasectomy. “Without the vasectomy, my wife would have continued to give birth,” he says.
My husband (has) kept his manhood like any normal man, and we are happy because we no longer fear (that we may) have other children.
To those who express their doubt over his ‘manhood’ post-vasectomy, his wife, Dalie Nsaguye, has this to say: "Let the families who hesitate to do a vasectomy hurry (to have one) and share with us this happiness. My husband (has) kept his manhood like any normal man, and we are happy because we no longer fear (that we may) have other children."
The positive impact on his family is the result of the ongoing work of community health distributors to raise awareness on family planning.
One such distributor is Christine Sibomana, in Gashikanwa: "(When we) talk about family planning in our communities, we base ourselves on the realities that these families are experiencing – poverty, illness, infant mortality and maternal deaths. Through their everyday experiences, they (come) to understand what they are (hearing from us).
“This helps us to overcome religious barriers as well. For this reason, community health distributors are men and women from different religions – even from those (that) do not favour family planning.”
Many are reluctant to use family planning, especially contraceptive methods, because of myths and misinformation. Adidja Hatungimana, 45, a mother of four children, was one of them. Her rejection of the community health distributor who approached her was aggressive – until she reached exhaustion.
"The rumours I heard about contraceptive methods frightened me but I was so exhausted that I recalled the community health distributor I had rejected before.” As she sought more informed advice, she came to realize that all her concerns were for nothing. “(With the) support of my husband, we eventually resorted to family planning. This was the best decision of our lives,” she says.
The success that the community health distributors have had in Gashikanwa has been due to their approach of first providing a positive example and then involving men, as the head of the household.
It's been three years since my wife (started using) the implant. Now I am making everyone aware of this. It's even easier when you share information about family planning based on your own experiences.
Hassan Miburo, a Community Health Distributor, says he did not understand the basis for family planning until he was exposed to the PNSR and UNFPA Burundi. He then talked to his wife and they decided to try family planning.
“It's been three years since my wife (started using) the implant. Now I am making everyone aware of this. It's even easier when you share information about family planning based on your own experiences," he says.
What results at national level?
While the national rate of modern contraceptive method use is 43 per cent, due to community participation and male involvement Ngozi province has taken the lead, with a rate of 73 per cent.
In addition, through DFID funding to the Government of Burundi through UNFPA, male participation as a key strategy to increase the acceptability of family planning services has contributed to an increase in the number of contraceptive users, from around 475,000 in 2015 to more than 508,000 in 2016.
In addition, the number of lives of women and girls saved at the national level has increased. In 2015, an estimated 733 maternal deaths were averted, compared to 785 in 2016.
By Queen BM Nyeniteka
