AHUA, Côte d’Ivoire – As the crowds poured into the fairground in Ahua Village, in rural Côte d’Ivoire, it was clear that this would not be an ordinary festival. Instead of games and prizes, the village square was filled with midwives, health workers and educators directing people to private consultations on family planning.
Attendees received pregnancy and HIV testing, cervical cancer screenings, family planning counselling, and free contraceptives. Hundreds of these fairs – organized by the Ivorian Ministry of Health and HIV activists, with support from UNFPA – have been held throughout the country, aiming to improve reproductive health, increase maternal survival and lower rates of sexually transmitted infections (STIs).
Interest in these events has proved strong. The fair in Ahua, held at the end of May, was announced the day before by a town crier, and drew crowds not only from Ahua but also from the surrounding villages.
Saving lives
Côte d’Ivoire’s maternal mortality rate is one of the highest in the world. As is often the case in countries with high maternal death rates, the country’s fertility rate is very high, with an average of nearly 5 children per women.
Family planning would go a long way towards improving maternal health and family well-being. Contraceptives reduce pregnancy-related injuries and deaths. They also empower families to plan the number and spacing of their children, enabling women to return to school or the workforce.
The need for improved reproductive health care is clear. "We have no maternity centre or ambulance. When a woman has to give birth, we transfer her by car to Dimbokro," said Nana Kouassi, the chief of Ahua, referring to the nearest town. "Providing contraception is good for our village," he added.
Still, only 14 per cent of married Ivorian women, aged 15-49, are using a modern method of contraceptive, according to the most recent data. Much of this is due to lack of information or access. There are also widespread misconceptions about family planning and reproductive health.
Dangerous misconceptions
Kouassi Ernest Krah, a family planning educator, met with men in Ahua Village to explain how contraceptives contribute to good health. "We want to help parents… by showing them how to protect themselves from STIs. We also explain why women would use contraceptives. Some men want to have up to 10 children. We tell them that family planning helps women to rest and properly educate their children," Mr. Krah said.
Ms. N'Guessan explained that rumours like these can lead to unplanned pregnancies. "I was barely 16 when I got pregnant… I had to abandon my studies.”
Her experience was not unique. Coulibaly Issouf, a gynaecologist at the regional hospital in Dimbokro, sees many pregnant adolescents. He blames a belief among “girls from 15 to 16 years old that if they do not already have children, this is abnormal.”
It is a dangerous idea, Dr. Issouf added, because underage girls face higher risks is childbirth. "They come anaemic, often with haemorrhaging... This is because girls do not have the physical maturity of a woman to carry a baby and give birth," he said.
Deborah Bah, a mother of four, said she became pregnant with her first child at age 17. Because of her experience, she wants young people to know about "abstinence and also that contraception is available."
Supporting families
Between 2011 and the end of 2014, 234 fairground consultations were held, supported by UNFPA's programme on reproductive health commodities. Over 23,000 women have been counselled about family planning at these events.
Patricia, 23, came to the fair knowing very little about the subject; she had never even heard of contraceptive pills before. But she was intrigued. "My first child came by accident, and I'm not working. I do not want to have more children now because I do not have the means to support them," she said.
Twenty-five-year-old Evelyne said family planning would help her better support her one-year-old son. "If I get the right information, I will take it because I do not want to have more children right away,” she said.
