Tuesday 7 August 2012

[wanabidii] Family Planning Is No Substitute for Development

Zainab Usman argues that new family planning strategies could obscure
wider deficiencies in governance.

"I want to stop giving birth... because of the difficulties I
encounter each time..."

Hadiza Damina received a contraceptive jab in a rural part of Jigawa
state, Nigeria. Damina, who has had three children and six
miscarriages, falls into two categories of women.

She is one of the millions of women contributing to Nigeria's rapidly
growing population - it is projected that the country's population
could reach 400 million by 2050 - and part of a trend that has
prompted the Nigerian government to mull over birth control
legislation. On the other hand, she is the subject of renewed
international focus - one of the over 200 million women in poor
countries who, according to the recently convened London Summit on
Family Planning, jointly organised by the Bill and Melinda Gates
Foundation and the UK government, lack access to family planning and
contraceptives and are thus at risk of pregnancy-related deaths.

Bringing family planning back on to the global agenda will ensure that
deserved attention is given to socially and economically marginalised
groups of women. However, the suggested international approach also
carries substantial risks: top-down, prescriptive policy may provide
short-term gains but at the same time obscure wider structural
deficits in domestic health and education sectors.

A "family planning cures all" approach

Nigerian women are some of the 200 million women in poor countries who
lack access to contraceptives. These are the women that the London
Summit seeks to aid in this regard by mobilising "global policy,
financing ... and service delivery commitments to support ... an
additional 120 million women and girls in the world's poorest
countries to use contraceptive information, services and supplies by
2020".

Birth control is advocated as both a solution to developing countries'
rapidly growing populations, and as a means of improving reproductive
health. According to Melinda Gates, this is the route to empowering
these voiceless women.

Conveners of the London Summit posit that women's access to
contraceptives could result in over 200,000 fewer women and girls
dying in pregnancy and childbirth and nearly 3 million fewer infants
dying in their first year of life. According to this logic, making
contraceptives widely available to women in developing countries would
improve maternal and child health, reduce female school drop-out
rates, improve literacy, reduce poverty and hunger, and save
governments revenue on public services.

Addressing the symptoms without considering the causes

However, the focus on family-planning as a solution to reproductive
health challenges downplays the underlying governance issues which are
the root causes: public sector corruption, mediocrity, waste and
mismanagement. For instance, in Nigeria these problems helped to
establish an inefficient healthcare system where surgeries are
sometimes performed by flashlight or lantern, with decaying
infrastructure and lack of basic medical equipment and supplies.

Yet the Summit convenors regard the wide availability of birth control
pills or the Depo-Provera injection, as the panacea that would
drastically reduce Nigeria's maternal mortality rate of 630 deaths per
100,000 live births due to pregnancy-related complications, and ensure
young women stay in school, allowing the government to redirect freed-
up funds to the provision of other public goods.

This approach leaves the needs of other groups of women completely
unaddressed. As Wendy Wright of the Catholic Family and Human Rights
Institute rightfully noted, contraception "does little to address the
true needs of (already) pregnant women... or newborn children". To
address maternal and child mortality, discussions need to be had about
building affordable medical centres, paying skilled birth attendants,
providing emergency obstetric and other basic medical care, building
better roads to clinics, particularly in rural areas.

The Summit fails to consider how developing countries' deplorable
health care systems, still grappling with treating malaria, typhoid
and post-partum bleeding, would manage the side effects of long-term
usage of hormonal contraceptives such as the birth control pill and
especially the contraceptive injection on a large scale. It's
difficult to imagine how rural women, at the bottom rung of the socio-
economic ladder, would deal with possible harmful side effects to
their hormonal balance - these have been known to include thinning of
bones, an increased risk of osteoporosis, an increased risk of STDs,
breast and cervical cancer. The many who will require follow up
treatment will be left unattended - especially if governments divert
funds from a sector they view as being fixed.

Top-down and prescriptive

This "big push" to bring family planning back onto the global agenda
is prescriptive and ignores the dynamics of different societies. It
carries with it an overtone of cultural neo-imperialism.

The Gates Foundation have proclaimed that "more than 200 million women
and girls in developing countries want to delay, space or avoid
becoming pregnant" but do not have access to contraceptives,
"resulting in over 75 million unintended pregnancies every year".
However, not every pregnancy in advanced economies is intended. By
outwardly seeking to empower women, are they indeed robbing these
women of their agency? How faithfully have the views of women in
developing countries been represented?

Should the Contraception Prevalence Rates in Nigeria (15%) be equal to
France's 71% or the United Kingdom's 84%, given the disparity in the
levels of development? Do Nigerian women, with an average birth rate
of six births, want to have two children given the dynamics of such
societies where polygamy and large families are the norm among the
urban middle classes or the rural poor? The risk of curtailing a
country's cultural norms looms large.

International examples have not been encouraging. Top-down family
planning approaches have led to the coercion of many vulnerable and
poor people by governments eager to meet targets of population control
in China, Namibia, Peru and India. Setting numeric targets, such as
giving 380 million women access to contraceptives by 2020, risks
tampering with people's legitimate reproductive rights. The approach
fails to address the genuine concerns raised by those sceptical of the
family planning agenda for religious or cultural reasons or for fear
of a coercive population control agenda. These groups have genuine
reasons to be concerned given the length some governments have gone to
achieve targets in reducing population--such as the on-going forced
sterilisation in India (an initiative part of a programme funded by
the UK's Department for International Development).

Polarising and contradictory language

So how have these risks been glossed over? At the level of semantics,
the language employed by birth control discourse presupposes its
benefit. By subsuming women's rights and human rights within its
purview, it polarises the debate: pro-family planning advocates are
seen as moral champion of women's rights, other groups with legitimate
cultural oppositions - religious and otherwise - are seen as out of
touch with them.

Family planning has been framed within a human rights narrative as
giving the world "a moral obligation to help ensure that everyone,
equally, has the right to access family planning". At the outset,
religious leaders are shown to oppose family planning, without giving
the organisations an opportunity to defend their work in development.
It is worth noting that well-known abortion providers such as the
International Planned Parenthood Federation and Marie Stopes
International were partners of the London Summit.

Going forward

The concern is that the London Summit approach to family planning will
mask wider structural change. Sub-Saharan African women need access to
affordable and quality education, better health care services and
economic opportunities. As Ms. Theo Sowa, CEO of Africa's Development
Fund noted at the London Summit "Education is one of the best family
planning techniques we have, so let's educate and empower our women".
A study by the United Nations Population Fund in Nigeria shows that
the contraceptive prevalence rate increases with education, literacy
and wealth. Thus, a government's socio-economic policies are a
precondition for women voluntarily deciding to have more manageable
family sizes.

There are no shortcuts to economic and social development. Political
leaders should not be given reasons to excuse their governance
failures towards citizens - education and health care, employment and
economic opportunities--by blaming population growth or a lack of
contraceptives. Service delivery rests with reform-minded leaders
implementing transformational economic and social policies, not with
birth control policies.

Zainab Usman studied International Studies at Ahmadu Bello University
Zaria for her Bachelors degree. She is currently based in the United
Kingdom where she is pursuing an M.Sc. in International Political
Economy and Development at the University of Birmingham. She is
passionate about making a positive difference in Nigeria. She
regularly blogs at zainabusman.wordpress.com. Follow her on twitter
@MssZeeUsman.

Read the original of this report on the ThinkAfricaPress site.

--
Karibu Jukwaa la www.mwanabidii.com
Pata nafasi mpya za Kazi www.kazibongo.blogspot.com
Blogu ya Habari na Picha www.patahabari.blogspot.com

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