When access is not enough for family planning

A community health worker visits with Dorcas Owino.
A community health worker visits with Dorcas Owino and her family.

Sauri, Kenya – Efforts are increasing to bring family planning access to some two hundred million women around the world.

Melinda Gates launched a new effort at the London Summit on Family Planning in July 2012. Shortages and a lack of options present significant challenges to many women. However, access is not the only issue in family planning.

There is also the matter of convincing men and communities to support the decisions of their partners. In some cases, availability of family planning methods does not determine whether or not a woman uses them.

Dorcas Owino, 30, opted for an intrauterine device (IUD) after giving birth to her fifth child. She and her husband, Joseph, were educated on the importance of birth spacing. With a total of seven children to care for, Dorcas decided to put things on hold.

Questions about family planning are a part of the conversation between community health workers (CHWs) and households. More often that not, it is the mother who is home. It is during this time that women can speak privately about their options.

Joseph Owino tells the CHW that he wants to talk about his wife's FP use.
Joseph Owino tells the CHW that he wants to talk about his wife’s FP use.

On the most recent visit to the Owino household, both Dorcas and Joseph were there. The questions from the CHW about Dorcas and her youngest child proceeded as the two women discussed the importance of using bednets to protect against malaria carrying mosquitoes and the need for better nutrition for the children.

Joseph nodded to the CHW at the end of the conversation.

“I want to talk to you about this family planning,” he said.

She said that she will make another visit in order to have the conversation. Joseph did not know that his wife was using a method of family planning and he will likely talk to the CHW about making her stop.

“I want three more children to have balance,” said Joseph. “Then I can have five boys and five girls.”

As it stands now, there are four girls and three boys in the Owino family. Having boys is important to Joseph. He hopes that he can have at least five or six. The balance he seeks is less about the same amount of boys and girls than it is about having all boys.

Joseph wants his wife to give birth to the three children and then go on family planning. He is confident that she will do so and that he will be able to provide support for them. Their two-room mud home reveals that income is not terribly high. Though he has big dreams.

“I want all of my children to go beyond secondary school,” he declared.

The CHW using her phone during the home visit.
The CHW using her phone during the home visit.

Dorcas and Joseph work together by selling utensils in the market. They have a small farm plot that produces some food for the family, but their hope is to expand the current business by gaining access to a loan.

Joseph is not alone in his opposition to family planning. The CHW says that most men in the region are opposed to it. She will meet with Joseph and then report on the conversation to the head CHW. He will then likely have to go and speak with Joseph to make the case for the socioeconomic impact of more children.

For women like Dorcas, the ability to take family planning in her own hands is available. She went ahead and had an IUD inserted. Though it may not stay for long due to her husband’s insistence on more children.

The health clinic that sits next door to her home and offers a host of family planning options couldn’t be any further away.

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About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.