Rural women struggle to access modern contraceptives

By Nyasha Dube

Women have been presented with various choices and access to contraceptive methods as there are both modern and traditional methods at their disposal.

Morden methods include male and female sterilisation, the pill, intrauterine device, injectables, implants, male and female condoms among others, while traditional methods include periodic abstinence, withdrawal and use of herbs.

But for women in rural areas, their plight regarding choice and access to family planning remains worrying.

Tryphine Sibanda is a 24-year-old mother of three from Murowa under Chief Mazvihwa of Zvishavane.

She is in a polygamous marriage.

Sibanda says she has to walk for about 8 kilometres to the nearest health facility to access family planning, and for some methods other than the pill she has to book before collection.

“I have to walk long distances to access the clinic and sometimes when we get there we are told to book for family planning methods like Jadelle and implants as they won’t be readily available,” said Sibanda.

“At times I don’t have enough time to keep on making trips to the clinic so I end up not using contraception and falling pregnant. My last born for instance was not by choice,” added Sibanda.

Besides having to book for family planning, Sibanda says the cost as well has gone beyond what many can afford.

“The other methods are actually expensive and we end up opting for the pill, which we fail to afford sometimes, so it is a case whereby when contraception is available we fail to meet the costs. We are no longer getting family planning for free as we used to, and the $1 to $5 charged for the contraceptive pill is too much for us,” says Sibanda.

Sibanda also says there are efforts by community health workers to educate women on various family planning methods, but their husbands are rarely involved, which creates barriers in use.

“My husband is not interested in how I use family planning. It’s a topic I can never discuss with him. Even when I fail to take my pills he says that is not his problem but mine,” says Sibanda.

For women like Sibanda who are in a polygamous marriage, there is always pressure to give the husband as many children as possible.

“Sometimes my husband tells me not to use family planning because he wants a baby boy. And because of the fear of being divorced and shaming my family I end up doing whatever he wants against my will,” Sibanda said.

Sibanda’s story is no different from other women in rural areas who undergo similar circumstances, and one way or the other end up being deprived of their right to choose what happens with their bodies.

This shows how effective provision of family planning can be part of women empowerment, as their right to choose will be recognised.

Provision also must be accompanied by knowledge as most women in rural areas are not aware of how they can use other methods besides the pill.

The involvement of the husband in the woman’s uptake of family planning has long been emphasised by health practitioners, however, men say they have their own reasons why they are not involved.

Benard Sibanda (32) of Mazvihwa village says he does not have time to accompany his wife to the clinic to seek more knowledge on the use of contraceptives.

“I am always busy trying to provide for my family, I cannot make time to go to the clinic that is why I let my wife go on her own,” says Sibanda.

Others say they are not keen because of patriarchal beliefs.

Tatenda Msaigwa of the same village believes family planning is a woman’s responsibility.

“According to the way I was raised, family planning is a woman’s responsibility. As men we have more important things to do,” said Mhofu.  

Murowa Youth Centre, an organisation based in Mazvihwa, Zvishavane, which deals with the uptake of contraceptives by adolescents, says the low uptake of contraceptives by girls and women of adolescent age is even more worrying as they are the most sexually active group.

According to the youth centre’s research, very few girls come to seek knowledge on contraception due to fear of stigma and being labelled immoral.

The research goes on to reveal that two to three people collect family planning within a period of a month, showing the gap between the number of sexually active young people against the uptake of family planning.

Health practitioner Sister Noleen Hove from Zvishavane says most rural women opt for short-acting methods such as Depo-Provera, the pill and condoms.

“This is because of myths and misconceptions on these modern methods. Other barriers as well include the shortage of stock, and health caregivers are not trained in methods such as the insertion of IUDs,” said Sister Hove.

Sister Hove also added that most women are reluctant to use methods like Jadelle and some go back for removal because of abnormal bleeding, whereas the loop is unfavourable because of its side effects that include cramps and abnormal menstrual bleeding.

Reports by the Zimbabwe National Family Planning Council show that 63% of women of childbearing age in rural areas are on contraceptives compared to 71% in urban areas, the most common methods used is the pill followed by injectables and implants.

This shows how women’s choices regarding the use of family planning are limited due to different reasons.

Zimbabwe’s national family planning strategy is to increase contraceptive prevalence from 59% to 68% this year.

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