KAMPALA, Uganda — In her one-room house in Kampala, Faridah Nalubega calculates what it costs to take care of a child. “School fees, meals, treatment, clothing …” Then, she multiplies by six.
“I’m still young, but I have many children …” she said. Faridah thinks about the fish she will have to sell. The money she will make. She worries if it will be enough. “The way they eat, there are many and the more they grow, the more they consume … And yet I earn very little.”
Faridah, 26, didn’t want it to be this way. She planned to have two or three children — a number she felt she could afford with the money from her small fried fish business. But when she tried to get a contraceptive injection to prevent additional pregnancies, local health workers told her they had only pills available.
Faridah couldn’t use pills. Her husband wouldn’t allow her to take them. She returned home empty-handed.
“I felt so bad because they couldn’t provide what I wanted,” she said. “And because I was provided a method I didn’t want, I ended up being pregnant. I didn’t want another baby.”
Faridah is one of an estimated 215 million women worldwide who want to space or prevent childbearing but lack access to modern contraception. In sub-Saharan Africa, where health facilities can be scarce and travel difficult, women tend to seek out longer-lasting methods such as intrauterine devices, injectables and implants — only to find too often they are not available.
The result is unintended pregnancies and bigger families. Faridah is not an anomaly. A Ugandan woman will give birth to an average of 6.7 children in her lifetime. Such large family sizes in developing countries are linked to poverty, poor nutrition, low education levels and even health dangers, as a woman’s risk of maternal death increases with each birth.
In the developed world, only one in 7,300 women die in pregnancy or childbirth. In sub-Saharan Africa, that rate is one in 22. Family planning is effective in reducing maternal mortality, but right now the region has just one-eighth of the funding required to meet its demand for contraceptives.
The effectiveness of existing family planning support is also hindered by limited human resources, weak transportation and outdated inventory systems — causing major problems in getting supplies into women’s hands. Tragically, contraceptives sometimes sit in storage while clinics experience severe shortages, and women like Faridah are turned away.
It doesn’t have to be this way for the next generation. Faridah wants her daughters, when they grow up, to have better information about family planning. She wants a condom bank, where condoms are accessible even to young women who may be too shy or embarrassed to ask for them. She wants a full range of options, including long-lasting family planning like injectables and IUDs.
“Everyone in this community needs family planning,” she said. “It would help all women to space their children and have healthy families. And they would be able to look after their children well. Because for me, I have a lot of stress and problems.”
For contraceptive access to improve, international donors, including the United States, need to meet their commitments and increase funding for critical family planning programs. Developing country governments would have to include reproductive health supplies in national development plans, and provide more funding for budget lines dedicated to supplying contraception. Community health workers and advocates would also have to help address supply chain challenges at the local level.
Making contraceptives available to every woman who wants them would prevent approximately 53 million unintended pregnancies, 150,000 pregnancy-related deaths and 640,000 newborn deaths worldwide. That’s the big picture.
But for Faridah and other women, it’s the small, less-quantifiable differences that matter, like the ability to buy more nutritious food, or the confidence of knowing her children can all go to school.
Looking through her eyes, it becomes simple: Give women access to contraception, and you give them a chance to create better lives for themselves and their families.
Nathan Golon is an independent filmmaker and director of "Empty Handed: Responding to the Demand for Contraceptives," a film produced by Population Action International and The Reproductive Health Supplies Coalition.