World Population Day 2013 – A spotlight on adolescent pregnancy
Thursday marked World Population Day 2013, the annual event spearheaded by the UN which seeks to raise awareness about population issues. This year’s theme focused on adolescent pregnancy which Dr Babatunde Osotimehin, Executive Director of UNFPA, the United Nations Population fund was keen to expand upon.
Speaking with Dr Osotimehin, he says ardently: “The facts speak for themselves, around 16 million girls between the ages of 16 to 19 give birth a year, nine out of 10 are already married.”
Dr Osotimehin, a physician and public health expert, reminds me of some of the difficulties associated with adolescent pregnancy such as obstetric fistula and stillbirth, complications of what he describes of “ a child bearing a child”. He describes how adolescent pregnancies tend to be distributed mostly amongst low and middle income countries and within the low socio-economic classes, where morbidity and mortality are high, whilst a further three million girls will undergo unsafe abortions.
Dr Osotimehin’s describes his pragmatic approach, explaining further: “The starting point is the evidence. Evidence is our best instrument, presenting evidence to the people.”
Nevertheless many of the countries that UNFPA work with on the ground are Christian or Muslim predominant where discussions on family planning are highly sensitive. So I put forth the question of how does a global organisation such as UNFPA address these issues whilst also navigating around and being sensitive to the local, cultural and religious context?
Answering confidently he says: “It depends on the country,” explaining that there is actually uptake of family planning in the Muslim world, listing Algeria, Tunisia, Morocco and Iran to name but a few. Further adding: “Countries such as the Philippines, despite the issues with the Catholic Church, have a high contraception rate, which implies we are doing a good job, enabling every girl has access to information.”
“It’s about public policy, the ability to engage with governments. Give them the evidence and explain what it means for the country in terms of maternal survival and development.”
However, given that in many countries women are influenced by men and patriarchal society, I wonder where men fit into the family planning equation?
“We look at family planning and contraception in a holistic way, we talk to men and women, as well as communities,” answers Osotimehin. Expanding further, he says, “We aim to ensure each programme offers a range of choices, choice is part of the work we do.”
He explains that there are a myriad of approaches of family planning on offer, in some parts of the world non-reversible methods are preferred; men opt for vasectomies, women opt for tubal ligation, whilst in other regions, condoms are favoured.
“We tend to forget about condoms when talking about contraception, we supply zillions of them at UNFPA.”
Adding: “The important thing is that there is a whole range of choices and people have the freedom to make choices.”
Notwithstanding, there has been both scepticism and criticism from both the left and right, with many people believing that issues around population are less about choices and more about ‘controlling’ the population because of access to resources.
He strongly believes that discussing population is about “putting people at the centre of development” and explains that the central driving force at UNFPA is human rights and not targets or numbers. “The freedom to decide when and how many children to have, to empower women and give them information and to do so without coercion.”
Explaining further, Osotimehin recounts a past visit to the Philippines, where he had met mothers who had up to 11 children, mothers whom did not have access to information, who wanted less children than they actually had and wished to make choices for themselves. The case of family planning in Philippines is a one I am somewhat familiar with, having travelled to Manila last year to see the work of Marie Stopes international.
Marie Stopes International has worked in the region for decades and is well versed on issues of adolescent pregnancy, in the past girls became pregnant by the age of 13 or 14. In fact, one of the outreach doctors told me that up until five years ago they would see women requesting tubal ligation only after delivering their 12th child.
I spoke with a number of women in the Philippines about their perspectives regarding family planning which resonated with many of the points made by Dr Osotimehin. One 32-year-old mother of eight children recounted how she had her first child at 18 and wanted only three children but her husband wanted more.
“I’m tired of being pregnant”, she said sighing. “It’s very hard looking after eight children and we can only afford to send one of our children to school.”
I ask her what advice she would give to her daughters when their time came and she responded promptly and without hesitation, “don’t get married early”.
Another lady I spoke with was a 33-year-old mother of four awaiting IUD adjustment, who described her views on family planning.
“It changed my life, after having the IUD inserted. I was not worried about having babies all the time.”
It is telling that the account described by the mothers in the Philippines were comparable with the words reiterated by Dr Osotimehin; namely, “empowerment” and “choice” and it is these words that need to be at the forefront of discussions around population issues.
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