Barriers to family planning are hurdles to maternal health
25 February 2008
Source: Public Agenda (Ghana) - AAGM
Dr. Kodindo, former chief of maternity at the Ndjamena general hospital in Chad and now working at the maternal mortality program of Columbia University in New York, argues that both young age and the low status of women in society often leave them with little power to determine if, when and with whom to become pregnant.
A nurse providing maternal and child care in Sierra Leone.
Credit; UN Photo/H BMW
Lack of choice
Women also have little choice in the number and timing of their children. "Women should be able to decide the spacing of their children," she told Africa Renewal. "But in Africa the woman cannot make this decision freely. Her status in society is often determined by how many children she has, and women often have children even when they don't feel like having more. Many men don't want family planning because they want the status that more children bring."
Family planning reduces unsafe abortion
In 2004, WHO reported that about four million abortions take place annually in Africa. Since abortion is illegal in most countries, most of these are performed in unsafe conditions, contributing to nearly 30,000 deaths, about 13% of all maternal deaths in Africa.
WHO believes that some 90% of all abortion-related deaths and injuries could be avoided if women who wanted to avoid pregnancies were able to use contraception, yet overall, less than 25% of African women are able to obtain contraceptives. In West Africa, fewer than 10% can. "If family planning could be made available, we would reduce maternal deaths," says Dr. Kodindo.
Promising signs of change
She is optimistic. "We are seeing positive indications. The economic burden of many children is making men more cooperative." Such a shift is especially notable in the Democratic Republic of Congo, Dr. Kodindo observes. "My only regret is that it is only in the urban areas. There is much work to do in the rural areas."
Harmful cultural practices
Cultural practices can also affect women's health risks. WHO cites genital mutilation, early marriage, multiple pregnancies and women who have undergone infibulation, a form of genital mutilation where the external genitalia are stitched, are more likely to suffer from obstructed labour. UNFPA data show that girls who give birth between the ages of 15 and 20 are twice as likely to die in childbirth as those in their twenties, while girls under 15 are more than five times as likely to die.
"Adolescent girls face the highest risk of premature delivery," says Dr. Grace Kodindo, "Because their bodies are not yet fully mature, they risk obstructed labour. This is why we encourage young women to postpone their first pregnancy."