Post from Tanzania: Control over birth control

There are lots of reasons why people choose to have kids, but for many women in Tanzania, the word ‘choice’ may not be the most appropriate one.

No one is arguing that the birthrate here isn’t high. The Daily News, one of Tanzania’s newspapers, recently listed the country as having one of the 10 youngest populations (aged 15 and under) in the world. The fertility rate is currently 5.6. That doesn’t take into account infant mortality: the US State Department estimates that 68 out of every 1000 babies die in their infancy. And despite the enormous sums of money flooding in from international donors, and the relative peace and stability over the 50 years since Tanzania’s independence, maternal and infant mortality rates are still high.

But still, Tanzanian families grow and grow. In a country where there is no pension to speak of, your kids are your retirement fund; it is they rather than the government who will house and feed you in your old age. The reality, of course, in a country with very little regulated or consistent employment is that often the children leave home in search of work when they grow up, or they remain unemployed and become another mouth to feed. In the meantime, sending seven children to school, keeping them clothed and fed, becomes a mighty task.

In the east of Tanzania, I met a Scandinavian woman who spent several months of each year working at a girls school in Tanga region. Her job is to teach the girls about women’s health and family planning. It’s a big ask, to say the least.

The teacher gave me the example she provides each new class with at the beginning of each term. ’30 years ago,’ she said, ‘Tanzania and Sweden had the same population. Now, Sweden has 9 million and Tanzania has 43 million’. That’s a lot of extra babies.

She then went on to tell me about a bright young girl who asked what she should do if her husband didn’t want to plan their family better. In a country where women get very little say over how many children they have and when, it was a valid (and bold) question. ‘Get yourself another husband!’ was the teacher’s answer. She knew very well that her answer was frivolous, but she believed that by making such bold statements and planting such seeds in young girls’ minds, that one day, when these girls had their own daughters, they might be able to pass on some of those ideas and start to create a stronger generation of women.

The realities in the west of Tanzania couldn’t be further removed. Talking to a doctor working in one of the UNDP’s Millennium Villages Projects, she explained that part of her job is to work towards developing sustainable health systems, particularly in pediatrics and maternal and sexual health. She is up against some mighty obstacles. She is working at a hospital in Tabora, in the northwest of Tanzania, trying to talk about sexual health in a community for which discussing AIDS is still widely taboo. Like in the east, there is the belief that all children are a blessing from God, with the added benefit of being a parent’s means of retirement. But for this doctor, her quiet concern is growing over the practice of covert contraception.

The doctor explained that is not uncommon for a woman to receive a long-term slow-release contraceptive, inserted under the skin, without the knowledge of her husband. It is a practice endorsed by a number of local health professionals, and yes, the intention is admirable. It is a way for a woman to start to control if or when she gets pregnant, and to increase the gap between the children she has. But in a society that encourages large families, the doctor is concerned about the long-term welfare of these women. ‘What happens when her husband finds out she has been secretly taking birth control? Or even if he doesn’t, what happens to their relationship if he thinks she can’t provide him with children?’ She described the already high rate of domestic violence in Tanzanian homes. Her role in Tabora is to develop sustainable health systems, and this secrecy is neither sustainable nor healthy. The doctor explained her fear that these women were putting themselves at risk of violence by choosing to take control of their bodies.

There are lots of reasons why people choose to have kids, and I know my female friends and I have had dozens of conversations around ‘if’ and ‘when’. But here, in addition to a thick layer of community expectation, perceived financial necessity and gender inequality, the choices women have to make around children are barely even discussed.

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