“Delay pregnancy until you can get out of IDP camp and earn an income”

SOMALI REGION, Ethiopia—At first, Trik Dulene and her husband agreed to use family planning to enable them to raise their two daughters within the limited resources available to them as a family. But the pressure from her in-laws to abandon this path became unbearable and contributed to the breakdown of her marriage.

It was a big blow for her when her husband, the breadwinner, left her to raise her daughters alone.

But then her situation grew worse. Ms. Dulene and her girls, aged 12 and 15, were displaced as a result of conflict and took refuge at Kologe-II Internally Displaced Persons (IDP) Centre, which had been established eight months earlier for those displaced by conflict and drought. The conditions at the camp were dreadful yet this did not deter her from speaking to others about the benefits of family planning – although it was something of an uphill battle.

“I talk to women [about] delaying pregnancy, at least until they [can] get out of here and start earning an income. But, fearing that their husbands would leave them for other women [if they do], they find it hard to accept this and they even cite my case as an example [for not using family planning]. But there are a few who want to use family planning. It [would be] good if it was available at the health post here in the IDP centre,” said Ms. Dulene. 

Somali women lack decision-making power

In the Somali Region, religion, culture and the clan system play an important role in the health-seeking behaviour of women, including the use of family planning and other sexual and reproductive health services. A group discussion held at Kolage-II IDP Centre showed the predominance of men’s views in these matters and the limited decision-making power of women.

To date, not much effort has been made towards demand creation and ensuring availability of family planning commodities at the centre’s health post.

The contraceptive prevalence rate in the Somali Region subsequently remains low at 1.5 per cent, compared to a national average of 35 per cent. The total fertility rate is high, at 7.2 children per woman, against a national rate of 4.6 (DHS, 2016).

The centre’s health post offers a limited choice in family planning commodities. As they don’t receive many such requests from clients, they in turn do not order a range of commodities, a health service provider said. To complicate matters, the negative attitude of male health service providers is a major impediment to promoting and availing to clients most family planning method choices – except for condoms, which are in high demand and use.

More women using family planning without seeking ‘permission’

Yet increasingly, women are asking for family planning methods, according to the health-care providers. “From time to time, mothers come and ask me [for] family planning methods without the knowledge of their husbands. But since we are not providing such services here, I tell them to go to the health centre,” said Shure Sherif, a nurse and coordinator of the Kologe-II IDP Centre health post.

Men need to be taught the benefits of family planning, to understand why their wives are interested in exercising their choices and support them, she said.

Nurse Suleman Ahmed at Elbahe Health Centre, the health institution to which eight health posts report, including the one at Kolage-II IDP Centre, said there was high demand for abortion services among women at Kolage-II IDP centre. But he was not aware that women at the centre were also seeking family planning services.

UNFPA ensures rights and choices

UNFPA has launched a project that builds resilience in the Somali Region of Ethiopia by ensuring universal access to sexual and reproductive health and rights, including family planning services. The three-year project, funded by the Embassy of Denmark, combines sexual and reproductive health and rights with humanitarian food distribution in the drought-affected Faffan and Siti zones. The project ensures access to information and services, including on family planning, gender-based violence, and adolescent and youth sexual and reproductive health services, to reduce vulnerability and enhance resilience.

At Kolage-II IDP Centre, Ms. Dulene is pleased that she is no longer alone in her decision, as more and more women are starting to demand and use family planning. She has no plans to remarry at this stage and instead, is focused on raising her children. “I want to raise my children well. I have sent them to my relatives in Jigjiga Town [to enable] them to continue their education,” she said.  

By Meron Negash