International Development Journalism Competition: Is education the best contraceptive?
Saidi Mwema, Inspector General of the Tanzanian Police Force, enters a medical tent and takes a seat. The nurse sat in front of him pulls out a needle and draws blood. Saidi is undertaking an HIV test in one of Africa's worst affected regions- by doing so he encourages another 118 of his rank, followed by some 9500 police offers and their families to undergo a test.
Tanzania's police force is more than twice as likely to have HIV/AIDS than the general population. As a study by Marie Stopes International (MSI), the leading organisation in family planning and reproductive health has revealed, this is likely to be linked to long periods away from their partners, contact with injured victims and the stigma surrounding HIV/AIDS which prevents people from getting tested, and dealing with the disease.
Increasingly, development organisations are recognising the link between poor family planning provisions, the spread of HIV/AIDS and sexual and reproductive health. The benefits of using family planning methods, to decrease unwanted pregnancies, are incontestable. Pregnancy-related health risks, infant mortality, the spread of HIV/AIDS to infants, unsafe abortions, teenage and youth pregnancies and the disempowerment of women to control their own bodies- are all directly linked to the lack of access to family planning methods.
The right to family planning, as identified and endorsed by the UN, includes access to contraception. There are 13 different forms of contraception, as identified by the World Health Organisation, and yet over 200 million couples in the developing world, who would like to be using family planning, are not.
Reasons behind these high levels are complex and interrelated, whilst also differing between regions and socio-economic status of those affected:
"The greatest obstacles to family planning are linked to the poor, the remote and the young. All of which centres to an extent around education" explains Michael Tirrell, spokesman at MSI.
Poverty, as a barrier to family planning is no more clearly identified than in the poorest areas of Africa. International Planned Parenthood Federation reports show little change since the mid-1990s as one in five women of childbearing age continue to have an unmet need for contraception. Figures for unmarried women, unable to access or use contraception are hazy- as little attention has been paid to this group. Nevertheless, as of 2008 reports show that an estimated 818 million women in developing countries want to avoid pregnancies.
Poverty creates practical barriers to family planning: healthcare costs money, but Michael also identifies socio-cultural factors:
"Unmarried people are often unwilling to discuss family planning and their reproductive needs with service providers, due to the common cultural attitude that unmarried people shouldn't, and so don't, have sex. This is not the case anywhere in the world, at any time in history."
Even if access to contraception is improved, without the necessary education into how to use it, it remains untouched. Confusion over contraceptive use, and what methods exist, is a world-wide problem, yet in underserved areas- this translates into myths and misconceptions:
"In Sierra Leone, there is one brand of condom which is offered for free, it comes in a white packet. Rumours, untruths and gossip have developed into the belief that this condom causes HIV/AIDS." Such rumours need dispelling, if change is to happen, he adds.
Although the majority of contraceptives are made for female use, family planning has to remain a concern and priority of both genders. Without male understanding of why family planning is intrinsic to the development of societies- then concerns over the status of a large family, coupled with concerns over side effects and changes to the body due to contraception- will prevail.
Political initiatives, entangled with socio-cultural beliefs, have a very real role in family planning. In the Philippines, where premarital sexual activity is increasing, there exists a complex political approach to family planning. The Arroyo government uses the national budget to provide modern natural family planning- approved by the Catholic Church but does not support 'artificial' contraception including the use of the pill, the injection, IUDs or condoms. Instead methods such as withdrawal and fertility awareness are advised- which are neither reliable nor do they protect from STIs.
The Philippines has also been negatively affected by the withdrawal of US funding to public contraceptive services, upon which the industry was greatly reliant. PhilHealth, the national health insurance programme which now exists covers very few methods: the tying of the fallopian tubes, vasectomy and the IUD. It is also made more available to the upper echelons of society, failing to address the link between poverty and poor family planning.
Although it is in the developing world that inadequate family planning has the worst affects. The failure to prioritise family planning, sexual and reproductive health in Western international development agendas is a failure to tackle poverty, and so a failure to tackle at least six of the Millennium Development Goals.
In the United States, 14 states allow some health care providers to refuse to provide services related to contraception, whilst 18 states allow some providers to refuse to provide sterilization services- reasons for refusal include religious objections. If the need isn't recognised as a real one in a home country, then it is unlikely that it will be budgeted for in international development.
By adopting a 'client-centred' approach through outreach teams in rural communities, inner city slums and with the underserved- alongside spreading knowledge and education across the West, MSI is working to improve access and understanding of family planning, to those who need it the most.
"We will travel in vans, on horses or motorbikes, to make sure our clients are at the forefront of our work" says Michael.
"It's important that development organisations don't just jump on a plane, deliver condoms and fly home again- it needs to be sustainable."
"Our work is staffed and run by local people, who work with respected members of the local community. It is invaluable to have a complete understanding of an area, before addressing cultural barriers to family planning."
This feature was written for the Guardian International Development Journalism competition before 13 June 2011.