By Michael Gwarisa in Gwanda
The risk of unplanned pregnancies is very high in the absence of Long-Acting Reversible Contraceptives (LARCs) Family planning methods. Women in low-resource settings experience interruptions that may increase the risk of unintended and unplanned pregnancies. In most cases, the poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet need for contraception.
In Gwanda, Matabeleland South, women such Florence Kungai (31), from Gwanda who in the past experienced two separate occasions of contraceptive failure due to interruptions in her schedule, now prefer long-acting contracteptve methods.
Even though I was on a contraceptive, I conceived and had two unplanned pregnancies on different occasions as a result. However, I am now using the IUD method and it’s been a year. I think this will work better for me,” said Florence.
An intrauterine device (IUD), also known as an intrauterine contraceptive device (IUCD), is a small T-shaped plastic device with copper banded around the transverse arms, which is inserted into the uterus to prevent pregnancy.
“I am enjoying using this family planning method. I have not experienced any side effects or mood changes like i used to using other methods.”
Following outreach programs by healthcare workers in Gwanda, the uptake of modern reversible contraceptive methods has increased over the years.
Thando Nkala (24) from Mawabeni, who now resides in Gwanda is contemplating switching to a longer-term method as she is actively looking for a job and wouldn’t want an unplanned pregnancy to block her from working.
“I am now on Depo-Provera,” says Thando. “I get my shot here at Phakama Polyclinic. However, I believe getting something that lasts longer such as an implant will help me achieve my dreams. I have a certificate in Care work and i now want to work and gain experience.”
Family planning information provided by Phakama Polyclinic in Gwanda shows that 296 women were on the injectable methods during the first quarter of 2023, however, the number has gone down to 268 women in the first quarter of 2024 as more women are now opting for Longer Term methods.
“We are having an increased uptake of family planning services. For 2023 first quarter, uptake for IUCD was 75 women and for 2024 first quarter for IUCD, we had 84 women,” said Sister Samukelisiwe Nyathi the Acting Sister in Charge and State Certified Midwife at Phakama Polyclinic in Gwanda.
“In terms of long-term contraceptive uptake, a total of 241 women received implants in the first quarter of 2023 and for the first quarter of 2024, 324 women received the implant method here at Phakama Polyclinic.”
The increase in the uptake of modern reversible family planning methods in Zimbabwe and Gwanda in particular can be attributed to support being rendered under the Health Resilience Fund (HRF). The HRF is funded by the United Kingdom (UK) Government, the Embassy of Ireland, the European Union, and GAVI while the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) together with the World Health Organization (WHO) provide technical support to ensure Zimbabwe achieves targets espoused in the National Development Strategy (NDS1) as well as the National Health Strategy (NHS 2021-2025).
According to the HRF motto, the most cost-effective way to reduce maternal and newborn mortality is to reduce the unmet need for family planning which is by ensuring that pregnancies are by choice not chance. Increasing access to family planning (contraception) to support birth spacing and families of a desired size is a public health intervention to reduce maternal and neonatal mortality.
In Zimbabwe, the operationalization of the matched funding mechanism for the procurement of contraceptives between the Government of Zimbabwe and the UNFPA Global Supplies Partnership has resulted in increased (and ring-fenced) domestic financing for the procurement of contraceptives.
UNFPA Zimbabwe representative, Miranda Tabifor in an interview with HealthTimes applauded the government of Zimbabwe for increasing domestic funding towards Family Planning services.
“When we look at the Family Planning Program in the country, Zimbabwe is always applauded for having a very promising and progressive Family Planning program in the region. One of the critical interventions that we are having right now is how this Family Planning has brought about domestic resources in the country. The government of Zimbabwe is matching the funding that we are providing and we applaud the government for having that vision,” said Tabifor.
Through the ‘Compact of Commitment’, in 2023, the Government of Zimbabwe procured US$1.5m worth of contraceptives which resulted in an additional US$1.5m from the UNFPA Global Supplies Partnership. The Compact of Commitment between UNFPA and the Government of Zimbabwe states that there will be matched funding through the UNFPA Supplies Partnership and the Government.
The Government of Zimbabwe approved the national budget for 2024 has ZW$20 billion set aside for the procurement of contraceptives. This was equivalent to about US$2 million at the time of the budget. A maximum of US$2 million will be availed under the UNFPA Supplies Partnership to match government contribution and an additional US$1.5 million under the HRF.
Matabeleland South has been receiving financial support from the Health Resilience Fund since 2022. The Health Resilient Fund is also aligned with Zimbabwe’s National Development Strategy (NDSI) as well as the National Health Strategy (NHS) 2021-2024. The Ministry of Health and Child (MoHCC) is coordinating the activities of the HRF with support from the UN agencies. With regards to Family Planning, the HRF has capacitated healthcare workers to administer Long Acting
Mrs Mildred Senda, the Reproductive Health Officer for Matabeleland South in the Ministry of Health and Child Care (MoHCC) said through support from the HRF program, the coverage of modern contraceptives in the province has moved from 67 percent to 87 percent.
“Before we implemented the HRF program, as far as Family Planning is concerned, we did not even have much to say even when it comes to long-term reversible contraceptives, we didn’t have anyone who was trained in LARCs in our facilities. We had people who could offer oral contraceptives only. For other contraceptives where we needed to use certain skills and where we needed instruments, we would struggle because we didn’t have someone trained in that. We have now trained our service providers to insert and remove Jadelle and the IUCD and that hasboosted our uptake,” said Senda.
Data from Zimbabwe’s Vital Medicines Availability and Health Services (VMAHS) survey show that as compared to other essential medicines stock-out rates for contraceptives were much lower. According to the DHIS data, a total of 2,792,917 contraceptive dispenses were made in 2023. Thirty-five per cent of these were for women under 24 years. As a result of contraceptive use 760,000 unintended pregnancies were prevented, 190,000 unsafe abortions and 2,200 maternal deaths averted. The percentage of women estimated to have their demand for family planning met with a modern method of contraception was 84,6 percent.
