By: Kunle Adeniyi
Two years ago, specifically in April 2016, I arrived in The Gambia to lead the UNFPA team. It was a time of immense political tension and strife. The April riots had just happened, leading to the death of some political activists. People did not talk and it was difficult to get an honest and reasoned opinion on anything. Fast track two years later, and a whole lot has changed. The country ended 22 years of dictatorship, returned to participatory democracy, citizens freely express their freedom of speech, association and other fundamental human rights. A lot has really changed in the positive. Indeed The Gambia received a breath of fresh air.
Sadly, this change appears muted for the people most in need, the demography that is almost always forgotten in the grander scheme of things. Ironically, these people are the bedrock of our society, the cornerstone in the home, the care givers, home makers, and handlers of the care economy – The Gambian woman and girl!
Across the world, many development interventions are designed and implemented, without particular attention to women. Same can be said of sub-Saharan Africa, where The Gambia belongs. While issues affecting women and girls’ empowerment are varied and include access to education, work, equal pay, quality healthcare, gender-based violence and many more, which I may return to in due course, today, I will address family planning, its importance to the Gambian woman in particular and the nation in general.
Fifty years ago in Tehran, Iran, nations gathered and unanimously proclaimed the right to determine freely and responsibly, the number and spacing of one’s children as a basic human right of parents. By inference, family planning was declared a human right. A reaffirmation came at the 1994 International Conference on Population and Development (ICPD) where a resolution stated “Every couple and every individual, has the fundamental right to decide freely and responsibly on the number and spacing of their children and to have the information, education and means to do so”. This in essence, makes the woman the right holder to family planning, while nations and governments bear the duty to provide her with information, education and services on family planning.
Following this landmark proclamation, there has been immense progress in development of safe family planning methods and access to services by women and young people. Unfortunately, many more have limited opportunities to exercise the right to plan their families. Despite the well documented benefits, over 214 million women today, do not have access to modern contraceptives. In West Africa, 25 percent of women who are married, have an unmet need for family planning. The Gambia mirrors this statistic.
Despite the misconceptions about family planning, millions of people still wonder, why family planning.
So really, why Family Planning?
Available evidence suggests that, women who choose spaced childbirth by using modern contraception, are healthier and face lower risks of maternal death. Too many women die of preventable causes while trying to bring life. While progress has been made, maternal mortality is still high in The Gambia. Let’s view it this way, for every 150 deliveries in The Gambia, we lose a mother to preventable causes. The death of a mother results in vulnerable families and even when the infants survive, they are more likely to die before reaching their second birthday. Equally, children born to women who space their pregnancies, are more likely to be healthier and face reduced risks of death in their first five years of life. Hence, family planning remains one of the most effective tools to end the preventable death of our mothers.
Also, women who practice birth spacing by making informed choices through access to reproductive health services, are more empowered and will contribute better to the society. In the words of Dr. Natalia Kanem, Executive Director, UNFPA “When a woman can plan her family, she can plan her life. She can pursue more education, seek and keep better jobs and contribute more to her family, her nation and to global prosperity”.
Although often sidelined, family planning is an effective tool in fighting poverty. Indeed, it is the most cost effective anti-poverty strategy as it creates conditions that enable and free up women to enter into the labour force, while encouraging families to devote more resources to each child, thereby improving family nutrition, and educational level and by extension living standards.
In 2018, The Gambia will be blessed with 80,000 babies. 46 % of the Gambia’s population is under the age of 15 and over 65% below age 25. These are age brackets with limited productivity, but require critical investments in health, education and social services. By adding 80,000 to our population annually, we will require 2,600 classrooms annually on the average. This is besides hospital beds, roads, water, power and other services. With the global and national economic realities, how much of this can the Government afford to provide? Given that, effective family planning programmes slow down the population growth rate, thus reducing the cost of providing social services as demand eases for water, food, education, health care, housing, transportation and jobs. Most importantly, it allows the policy makers to focus on qualitative education and services as opposed to quantity.
Whilst modern contraceptive use worldwide has nearly doubled from 36 per cent in 1970 to 64 per cent in 2016, contraceptive prevalence in The Gambia is very low; only 9 percent of currently married women, use a contraceptive method of any kind, and only 8 percent of currently married women in the Gambia are using a modern method of contraception.
Despite these figures, I am positive and convinced that, an informed rights-based approach to family planning is the most cost-effective intervention for tackling maternal death, poverty and boosting prosperity. Ensuring universal access to reproductive health services, including family planning, can ultimately speed-up a country’s progress towards reducing poverty and achieving national and global development goals.
It is noteworthy, that pregnancy and childbirth-related complications, are the number-one killers of girls aged 15 to 19 in developing countries. Access to information and contraceptives, can therefore protect young people’s lives – the more information they have, the better choices they can make to be able to fulfil their futures. -*
Thus, it gladdens my heart to share that, in 2017, contraceptives provided by UNFPA globally, had the potential to reach 27 million users with a choice of modern family planning methods. In The Gambia, through this investment in 2017:
· 15, 288 unintended pregnancies and 33 maternal deaths were averted;
· 56, 286 new family planning acceptors were reported through the Health Management Information System, which reflects an increase of 9.7% from the 2016 figure which stood at 53,765.
Evidently, population and development, are inextricably linked – empowering women and meeting people’s needs for education and health, including reproductive health, are necessary for both individual advancement and balanced development. We recognize the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information, education and means to do so.
In 2016 and 2017, UNFPA initiated a nationwide Family Planning Campaign targeting mostly young people, adolescents and women, using a multi-disease approach, through sports, art competitions and the provision of free family planning and other reproductive health services and information. At one of our stops in the Upper River Region of the country, students were asked to depict on paper, their idea of an ideal family unit. To our surprise, ninety percent or more of the participants, drew families of not more than four children, a home, food on a table, a playground and some other basic amenities, the necessities of life and some extras. Who says young people should not aspire? The images also showed children of different ages indicated by height. Child spacing was clear in the pictures. What we must not forget in all this, is that, these young ones who have little or no information about family planning, but have depicted the picture of their ideal families, have a reason for doing this. To this day, those images encourage us as an agency and inspire us to invest more in providing reproductive health information for our young ones. We believe that, it is only through them, that we can build healthy and prosperous communities, who are self-sufficient and active participants in the country’s and the world’s development.
However, we are aware that, universal access to voluntary family planning, requires commitment from a broad range of partners: men as well as women, religious and traditional leaders, international organizations, Government, civil society and the media, as the right to family planning permits the enjoyment of other rights, including the rights to health, education, and the achievement of a life with dignity.
On July 11th, UNFPA The Gambia and the government of The Gambia, joined the rest of the world to commemorate World Population Day, on the theme “Family Planning is a Human Right”. This year’s theme could not have come at a better time, as 2018 marks 50 years since family planning was proclaimed a human right as I mentioned earlier. It is noteworthy and heartwarming to state that, the points I adduced earlier were articulated by senior Government functionaries no less than the Honorable Minister of Health of The Gambia, Dr. Isatou Touray. A gender activist herself, she argued passionately for family planning and committed to Government’s allocation of funding for family planning commodities, information and services.
Should we be able to walk the talk, the Gambian woman can indeed begin to reap the dividend of democracy, rather than being left behind. It will demonstrate that we care for our caregivers, and demonstrate our commitment to holistic women empowerment.
All the benefits of family planning uptake mentioned earlier, drive us to one point – the need to educate our young ones about their reproductive health and to prepare them to make informed choices in future. As such, when I return with another publication, we will discuss Comprehensive Sexuality Education. Do not hurry to condemn this idea. I am sure we will agree fully after understanding what it entails and the value it has in the lives of our soon to be adults.
I will be back.
Kunle Adeniyi is a UNFPA Representative, The Gambia