Family planning as part of reproductive health, including the HIV / AIDS aspects, in Zimbabwe and Southern Africa

Abstract

This thesis explores the demand for family planning (FP) in the region and demonstrates that just at the time that demand takes off the brain drain and economic situation make it unlikely that the required services will be provided. This, increasingly, results in unsafe abortions. FP in Zimbabwe is overwhelmingly based on the pill (little effort of health workers needed) with huge failure rates. In South Africa injectables are the mainstay of FP with less failures but with many discontinuations because of side effects. Furthermore women between 40-50 years of age using this method do not know when they can safely stop. The dissertation discusses the role of the Roman Catholic Church in sabotaging proper access to and information about FP. Also teenagers do not get the proper education they need to protect themselves against HIV, another result of the attitude of the above church that only believes in the abstinence message and not in factual information. Another chapter is about bourgeois women from the First World who succeed in undermining trust in injections and implants and hence adding to the problems of their African sisters by limiting their choice. FP and HIV is discussed extensively. The author demonstrates with fake patients that health workers are unfriendly and incompetent when the "morning-after pill" is needed. The author presents two studies the results of which will make it easier in view of the restraints in staff availability to offer women a sterilisation. One study shows that at follow up months later women do not remember a sterilisation under local anaesthesia as much more painful than an operation under GA. Another study shows that it is ethically acceptable to ask if a sterilisation is wanted together with a (emergency) caesarean section (CS) in high parity women. Those asked are 6x as often satisfied as those not asked. Regret is seen 22 times as often in those not sterilised in this situation as those who are. It is claimed that for some women it is more likely that they will die of the next pregnancy (with a scar in the uterus) than that they will regret giving permission for a sterilisation in a stressed situation. Of course it would be even better to discuss the possibility of a CS and the inherent option of a sterilisation with all higher parity women during the antenatal period and document their wish. A pre-printed text on the antenatal card would be best. One other large study follows-up with success 2000 sterilised women and 1000 controls. The regret rate is very low in those sterilised and high in the other group. The same applies to depression and loss of libido. If the facilities, staff and motivation would be available voluntary sterilisation would be an excellent option for many woman in Africa. For example in the Netherlands in 1970 there were an estimated combined total of 1700 women and men sterilised (the total of all sterilisations in the past 20 years) in the year 1983 there were 63.000 of such operations performed in one year. In the US 50% of women between 40-45 are sterilised in Zimbabwe 6.9% while Zimbabwe has the highest figures for southern-Africa excluding South Africa.