Last year I was part of a team that conducted a focus group discussion on family planning and abortion with young women in Zambia. As you can imagine, it was an amazing learning experience. Focus group discussions are always a great way to get information from people themselves. This case was no different.
When we were discussing access to family planning services, one of our participants raised her hand and asked something along the lines of “…why do I need it? Even the name says family planning, planning of the family. If I’m not married what am I planning for?” As soon as the gravity of what she was asking hit me, I realised that underneath my empowered, feminist exterior, I felt the exact same way. Why should I, a single young woman, have any claim whatsoever to products and services that seemed to be branded exclusively for married women with families?
In 1972, women in Zambia were given the chance to make a conscious effort to regulate the number and spacing of births through modern contraceptive methods. It was a giant leap for women and reproductive health services. A report by the Central Statistical Office in 2001 showed that contraceptive use in Zambia had increased from 15% in 1992 to 26% in 1996. By 2001, it was up to 34%. The report went on to show that knowledge of contraceptive methods was widespread and almost universal, with 98% of all women and men aware of at least one method of family planning.
Today almost 50 years later, the rate of contraceptive use has increased to 49%. This seems like tremendous progress, but a closer look at the Zambia Demographic Health Survey (2013-2014) shows that 61% of the sampled sexually active unmarried women were not using any family planning method. That percentage goes up to 81% for young women aged 15-19. Now I’m sure by this point you are thinking that those numbers can be attributed to any number of things. But when you look at contraceptive use among married women the numbers tell us an interesting story. Only 4% of currently married women who had no children were actually using a family-planning method, while for married women with 1-2 children, contraceptive use was 48%. Most theories will attribute this discrepancy to myths about the negative effects modern family planning methods have on women’s fertility, but I think it goes beyond that. A woman who has had one or two children does not suddenly stop worrying about infertility and if they do, these women who experience a paradigm shift cannot account for a difference of 46%.
If you Google, ‘barriers to family planning access’, you are guaranteed to be spoiled for choice with all the results you come across. Among the barriers listed you will probably find: opposition from partners, infrequency of sexual encounters, myths and misconceptions about the use and side effects of modern contraceptives, lack of information about the different options and services that are not youth friendly, etc. But I strongly believe that when it comes to young women, the language and branding around contraception is at the top of any list of barriers to access. Susan Wilson in her article Beyond Birth Control talks about how family planning and birth control is not the same thing:
“The issues surrounding family planning are extremely complex. They are deeply rooted in culture, sexuality, and the most intimate family matters. In short, it is simply not possible to separate “family planning” from “family” – and yet, in many instances, this is exactly what we do. The term “family planning” has become virtually synonymous in our culture with modern methods of birth control, but prevention of birth is only one small part of the matter.”
And Allan Kent, in his article Are you and your target market speaking the same language, talks about how tailoring the language surrounding your intervention to your target market is essential for the success of any business:
“All trades and professions have their own jargon and acronyms, their own language to some extent…however, your clients/customers probably won’t have the same terms in their vocabulary and the danger is that if you talk to them in ‘your speak’ you run the risk of losing them, worse still even alienating them…You’ll be fighting a massively uphill battle if you try to educate your audience to adopt ‘your speak’. Instead you have to change yours to suit theirs.”
Family planning initiatives have put all women -young, middle-aged, old, married, unmarried and both women with children and those without children- in one large category. They are ‘selling’ a one-size-fits-all intervention. This is ill-considered and, in my opinion, the reason why so many young women aren’t accessing family planning services. Essentially the question that these initiatives think they are asking young women is, “Do you want the power to decide when and whether you want to have children? If yes, here you go…”
Taking what is handed to you if you say yes to this question entails choice. It means you have power over your life and the next decisions you make are in your hands. Unfortunately what they are really asking these young women who have jumped dozens of cultural, societal and religious hurdles by the time they consider birth control is, “Do you want to plan your family?” In my experience, the answer to this question will be “no, actually I don’t.” As our focus group discussion participant said, “I don’t have a family, what am I planning for?”
The issue of access to contraceptive services needs to go beyond just making them available at health centers and hospitals. It goes beyond sensitising communities and health care providers on the benefits to individuals and communities. The issue of access needs to address the problem of who the targeted end user of the service is.
The first definition of the word “family” I ever heard was that it comprised of mother, father and children. Mother and father were always husband and wife. I am a young woman and I believe I can do and be anything as long as I set my mind to it. I understand how my body works and I work on my self-esteem every day. I know how to protect myself and others from disease and I am comfortable in my skin. I know I am not ready to have children right now and I am excited to plan for them when I am. I have also learned through exploration and exposure to different cultures and ideas that ‘family’ can mean many different things. I am one of the privileged few that can say these things. But when I walk to the health center and I see the poster that has the initials ‘FP’ (Family Planning) and an arrow showing me where to go, I feel like I have no business walking down that corridor. That’s just me, but how many other young women are slipping through the cracks?
This article by Zambian Feminist Chibuye Angel Chelwa was first published on www.ghcorps.org. Main image taken from www.bet.com.