BISSAU, Guinea-Bissau — Florence de Silva, 28, has one daughter and wants another child, but plans to stop at two. “Otherwise I will not be able to educate them…even if I have just two and they are both educated, they will be able to look after me when I am older.”
Out of 114 health centres in Guinea-Bissau, 98 now offer family planning services and 10 per cent of women use contraception, which, while low, is an improvement on previous figures.
UNFPA, the United Nations Population Fund, estimates that giving women access to modern contraception could prevent 40 per cent of maternal deaths worldwide. That could save the lives of many women in this country, where 1 in 13 dies in pregnancy or childbirth – one of the highest rates of maternal mortality in the world.
Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant health care improves and family planning messages start to sink in, say health officials and UN staff.
Offering a variety of methods – while stocks last
At San Domingos’ government hospital north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.
Dada Saar, mother of five, says she does not want any more children and now uses a contraceptive implant. Photo: Anna Jefferys/IRIN
UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry. Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too soon and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.
They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages. “Women want family planning here - we meet with very little resistance to our messages.”
But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said. Dada Saar, 36, mother of five children, waited to receive her next contraceptive implant at Simao Mendes hospital in Bissau.“Five [children] is enough. We don’t have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn’t want more.”
Economic security or better health?
Economics increasingly sways urban families’ decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.
“In towns people are more conscious that they want fewer children. They understand life is expensive.” But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. “People have more faith in medicine working, so are starting to think their babies won’t necessarily die [when ill],” Alves said.
Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed – a countrywide survey is due out for 2010 – health workers say maternal and under-five mortality is declining across the country.
While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF figures. This perpetuates high birth rates, Martins said.
In Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 per cent dependent on donor funding, deciding priorities is difficult, said Alves. Martins said: “The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems.”