Zambia in a dilemma over contraceptive recommended age

 Report By DOREEN NAWA
In a bid to reduce the number of women who die in pregnancy related complications, a cross section of people in some of Zambia's community have suggested that contraception be given to every woman in the reproductive age group. That includes girls between 14 and 18 years.
But still others have opposed the suggestion.
In Zambia over 16 women die in pregnancy related complications every day. And for every one woman who dies, more 15 develop pregnancy related complications including fistula. This is according to latest statistics at the Ministry of health.
This statistic takes the country way short of Millennium Development Goal 5 of reducing maternal mortality by three-quarters by 2015, barely less than 1000 days to go.
In a bid to  advocate for the access to contraceptives as a way of preventing unwanted pregnacies, Ipas Zambia Director Felicia Sakala said it was "unethical" to allow these women to keep dying from preventable deaths.
She said that while the major causes of maternal mortality were known and ranged from over bleeding, to high blood pressure, malaria and many more, many women die aborting.
"We have an age bracket of 14 to 18 years. Many of these teenage girls get pregnant but, they are not ready", said Mrs Sakala said.
"They can't tell their parents that they are pregnant. They can't tell their teachers. And the boys who have made them pregnant are usually their class mates and they can't help. These girls usually end up trying to get rid of the fetus and at times they die."
She said it is not time to bury heads in the sandy but instead prepare to find ways in which to avail contraception to girls in this age bracket.
"The is need to set up youth friendly corners at their schools, hospitals, where they can go and get helped," said Mrs Sakala, adding that there should also be room to provide condoms and pills on top of counseling.
"You don't know what some of these girls go through," said Mrs Sakala. "When they can't confide in anyone and are desperate to get the fetus out they will do anything."
"At times they use sticks. She will push a stick through the vagina to perforate the uterus. But many times they do it badly and bleed to death or end up perforating the rectum or the bladder and they contract a fistula," added Mrs Sakala said.
Swebby Macha, one of Zambia's renowned gynaecologist, stressed the need of birth spacing, even for women above 18 years, to avert the numbers of women who die in pregnancy related complications.
He said that every woman should have a child by choice, not chance. "Of the women who get pregnant, a half of them have not planned for the pregnancies, their pregnancies are unwanted."
"Now, we can't want to reduce the numbers of women who die while giving birth and not want to provide women with contraception that can reduce their fertility," said Dr Macha.
"It's easy, reduce the numbers of women becoming pregnant and you reduce the number of women dying in pregnancy related complications." Dr Macha added.
However, the challenge is that advocates to this cause will have to first convince many before government's plan of availing condoms and pills to every woman who needs to control birth including school going teen girls is implemented seeing as our culture is overly conservative.
Zambia's fertility rate stands at 6.7. However, statistics show it is women in rural areas, the hard to reach areas, the areas without enough qualified midwives who produce twice as many children.
Today, nearly half the world’s population is under the age of 25. These 3 billion people – the largest-ever generation of young people – are the future and the present. Each has an indispensable role to play in achieving international development goals, driving economic and social development, and shaping the course of history. 

Yet around the world, young people are all-too-often unable to make critical choices that impact their futures. We hear it straight from the young people, particularly adolescent girls and young women, we work with every day – they are unable to access the information and services they need to protect their sexual and reproductive health and plan their lives.

In the world’s poorest countries, contraception use is low, and one in three women has a child before the age of 18. In sub-Saharan Africa, 53 million women want, but do not have access to, modern contraception – and the unmet need is greatest among women under the age of 20.

For far too long, the issues of reproductive health and family planning for adolescents have been taboo, and in many parts of sub-Saharan Africa, the issues have been almost completely ignored. Consequently, pregnancy- and childbirth-related complications remain the leading killer of teenage girls in developing countries – and sub-Saharan Africa has the highest rates of maternal mortality in world. And countless more girls who drop out of school due to early pregnancies do not learn the skills they need to gain paid employment and contribute productively to their families, communities and nations. These facts cannot be ignored, and what we urgently need now is more support from every sector of society. 

First, we need developing country governments and donors to prioritize and scale up youth sexual and reproductive health programs. This includes comprehensive sexuality education that teaches young people about their rights and their options, as well as programs to ensure that girls and young women have access to a range of contraceptive methods. We also need government to pass supportive policies that impact reproductive health like increasing the legal age of marriage in countries where child marriage is still prevalent.

At the July 2012 London Summit on Family Planning, the Zambian government committed to double its budget for family planning commodities in an effort to improve universal coverage and increase method mix, especially for underserved populations. These pledges are a sign of Zambia’s commitment to provide Zambian girls and women with the family planning services they want – and deserve.

Second, we need to reduce the stigma associated with youth sexuality. Even when girls and young women are informed about family planning and services are available, many do not access the services due to fear of reproach or criticism. To lower cultural and social barriers to care, we must engage community leaders – including political and religious leaders in Zambia – as champions for youth sexual and reproductive health and rights. We also need to train health care workers to provide services to young people confidentially and without judgment.
Third, we need to encourage and empower young people to be their own advocates and agents for change. Young people in Zambia  and everywhere have the right to the knowledge, tools and services they need to make informed decisions about their bodies and live full, healthy and productive lives. In many communities around the world, young women and men are working tirelessly – both individually and collectively – to demand access to sexual and reproductive health and rights.
For too long, these young leaders have been on the sidelines of the global dialogue about health and development. We must bring them into the conversation. Recently, Women Deliver brought 100 Young Leaders to its third global conference in Kuala Lumpur, Malaysia, with the goal of building youth capacity to advocate for issues around maternal and reproductive health. At the conference, these 100 Young Leaders spoke passionately about the challenges youth face, and shared their strategies to fight for change. Giving youth a voice at international forums like these is an important first step forward.
And, finally, we must involve boys and men in the process. That’s why the 100 Young Leaders program includes almost 40 young men. And, that’s why we are excited about the amazing work that’s being done to increase male involvement in sexual and reproductive health and rights. For example, we’ve seen great success through programs like the Learning Centers Initiative in Zambia and Uganda, run by the Sonke Gender Justice Network and supported by the Swedish Association for Sexuality Education (RSFU). These centers encourage boys and men to be equal partners in their relationships; access sexual and reproductive health services themselves; and promote their peers’ adoption of these behaviors.
By enacting supportive policies, bringing new voices into the conversation, and implementing effective, age- and culturally-appropriate family planning programs, we can make a real and lasting impact on the lives of young people everywhere and help ignite a virtuous cycle of development.
September 26 was World Contraception Day on September 26^th,  2013 and as this days has passed let’s all take up the charge – across generations – to make sure that young people have the information, services, and support they need to become agents of change for girls and women around the world.