Trusting the process: family planning and contraceptive uptake in Somalia.

Trusting the process: family planning and contraceptive uptake in Somalia.

UNFPA Somalia Representative, Mr. Niyi Ojuolape Speaking at World Contraception day 2023

Celebrated on every 26 September, World Contraception Day highlights the necessity of family planning in the lives of people around the world. Nearly 30 years ago, delegates of 179 governments affirmed the ICPD Programme of Action, which recognized voluntary family planning as foundational to development. It was also captured that healthy families are created by choice and not by chance. Hence, there is a need to recognize women and men’s right to information and services regarding their reproductive health, enabling them to choose the number, timing, and spacing of their children. Contraception is often central to a family’s decision-making for the avoidance of unintended pregnancies, abortion, and wider related benefits of reduced maternal deaths and child mortality.

Somalia is one of the countries with negative maternal and infant health indicators. The maternal mortality rate for Somalia is 692/100,000 live births, with an infant mortality rate of 73 per 1000 live births and an under-five mortality rate of 115 per 1000 live births. Family planning is integral to seeing a reduction in maternal, infant, and child mortality. Also of concern is that the contraceptive prevalence rate for modern contraceptive methods is still very low in Somalia, ranking at 1% according to the 2020 data from the Somali Demographic Health Survey (SDHS). Worryingly, there are about 29% of women in Somalia who would like to use family planning but do not have the means to do so.

Family planning still remains a sensitive topic to freely discuss in Somalia due to many deep-rooted myths and misconceptions, as well as social-cultural barriers surrounding the use of modern contraceptive methods. There is also strained maternal and child health services, followed by a low socioeconomic status and insecurity in parts of Somalia. This has led to a low uptake of birth spacing. The above barriers also account for reduced access to information and services on modern contraceptive methods. The lack of birth spacing services means higher chances of women developing childbirth complications that most often than not lead to both maternal, neonatal, and infant mortalities and morbidities. Yet, until improved access to family planning services is achieved, women and men will not be able to freely choose and use contraceptive methods. This hampers the universal goal of reducing the unmet needs for birth spacing and reducing the high maternal mortality in Somalia.

Without birth spacing, infants often stand the risk of malnutrition and inadequate care, both of which are potentially harmful to the well-being of the mother and child. Apart from the health imperative for contraception, there is an inherent economic value in adopting child spacing practices as it allows women to participate in formal or informal channels of economic life.

Leveraging key stakeholders
Several national partners have been integral to UNFPA’s family planning advocacy in Somalia, and as legitimate representatives of the people, they have created an encouraging environment to provide information and access to family planning for those seeking it. Working with the Federal Ministry of Health, Puntland Ministry of Health, Somaliland Ministry of Health and Development, and Somaliland and Somalia Nurses and Midwifery Associations, we have found easier ways of communicating key messages on what is a sensitive matter within a peculiar territorial context.

In our work with government partners, we have co-developed a training curriculum for family planning, stressing the need for value clarification and attitude transformation regarding birth spacing. We have also focused on ensuring adequate training of service providers in ways that enable them to reflect on their own beliefs and ensure the effective delivery of determined objectives. Additionally, we have discussed human rights principles in family planning in the curriculum, such as the right to information, the right to informed decision, and the right to family planning services for women. We are optimistic that these messages and conversations are currently transforming attitudes in Somalia and will continue to do so.

Current momentum and optimizing our approach
Despite deep-rooted misconceptions regarding contraception or family planning in Somalia, we are finding key partners and new ways to advance the right messages. Incidentally, some of these misconceptions can only be challenged by religious leaders and faith-based organizations (FBOs). For example, the need for women to have the freedom to access information regarding family planning is crucial for their families. The challenge, however, is that they are unable to access this information without the physical presence of their husband. As such, the expected outcome for the access to information is not maximized. Given our long history and trusted approach to working hand-in-hand with FBOs, we will be unveiling soon a high-level transnational event that will bring in Islamic scholars from outside and within Somalia to achieve the desired understanding of our family planning messaging.

Of note also is our 5-Year Roadmap agreed upon with Somalia and Somaliland, which will leverage vital implementation plans to increase the contraceptive prevalence rate. In effect, while uptake has steadily increased since 2019, we are confident that these measures will, by 2028see a quadruple improvement in the CPR. As the only United Nations agency addressing family planning, UNFPA remains committed to establishing the conditions for reduced maternal and infant mortality and improved family health through optimal access to family planning services throughout Somalia and Somaliland..

Niyi Ojuolape, Country Representative, UNFPA – Somalia

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