A conversation on sexual and reproductive health

Reproductive health is a wide topic that is usually met with a lot of taboo topics and awkward silences in many of our communities.

Proactive action in this regard is also very low, mostly out of misconstrued notions of stigma and very poor understanding.

This, paired with our socio-cultural norms, religious practices and poor exposure to options, leaves many in a bind when faced with infections like STIs and HIV/AIDS or unplanned pregnancies.

Many companies come and go with ideas on how to tackle reproductive and sexual health and unfortunate as it is, this burden is not just restricted to Tanzania as many other societies still struggle to beat the awkwardness that comes with these seemingly uncomfortable conversations.

In Tanzania, the Ministry of Health (MoH) has earmarked reproductive and child health as an important focal point and created programs that address various issues along these lines. Some of these programs include Family Planning, Safe Motherhood Initiative and Adolescent Reproductive Health.

According to the MoH website, family planning is a major component of reproductive and child health services. “The goal of the Family Planning Program is contribute to improved sexual and reproductive health, social and economic wellbeing of women, men, adolescents and children including new-borns, through provision of quality family planning services,” it states.

Objectives of the program are:

• To ensure availability of adequate contraceptive commodities and functioning logistics systems;

• To ensure that service providers in the health sector have the necessary family planning (FP) clinical skills for effective delivery of integrated family planning services;

• To increase the visibility and support for FP among government leaders and development partners, program managers, service providers, and raise community awareness;

• To increase access and utilization of quality, affordable and sustainable family planning services;

• To strengthen family planning management systems and monitoring and evaluation, to ensure effective program implementation.

To better understand the understanding of availability of choices availed to our communities, Your Health had an exclusive conversation with the DKT International Global Chief Operating Officer, Daniel Marun and Country Director, Kevin Hudson.

DKT International is a non-profit organization that was co-founded in 1989 by Phil Harvey and Tim Black to focus the power of social marketing in some of the largest countries with the greatest needs for family planning, HIV/AIDS prevention and safe abortion.

According to Daniel, “In the early 80s, Phil founded Population Services International which then turned into DKT International and since then, we have been operating in countries with a large population as well as middle to lower income.”

“We are all across the world; Asia, Africa, South America and our main goal is to empower couples on their reproductive health and build a world where couples have a say in how many children to have and one where every child is wanted,” he adds.

Question: Why did you choose Tanzania as one of the countries to have our presence in?

Daniel: Tanzania is a big and important country and one we believed we could make a difference in, in terms of the health impact. We measure our success by how many people and how many couples we impact every year.

Kevin: DKT’s aim to focus on countries with high populations as well as middle to lower income populations to benefit those most in need has led to the emphasis being on emerging markets. In terms of our unique skill set then, Tanzania presented an opportunity for us to widen our ability to improve more lives, give people choice and helping every child feel wanted. We then registered and set up in 2015.

Q: What have been the wins thus far?

K: Our goal is social impact. In 2021, we impacted 54 million people’s lives across the globe by providing them with quality products so they can make a conscious choice on how they want to conduct their activities. So that measurement of social impact is what we are trying to achieve and expand.

Q: What are the kinds of products and services available?

K: Condoms, emergency contraceptive pills, IUD devices, implants, safe early termination pills that are administered by trained medical professionals; which also help prevent a lot of maternal deaths especially in incidents where a woman finds herself opting for a clandestine abortion and risking her life.

We are also involved in counselling women in terms of what their options are as well as on their choices. All DKT products are sanctioned by the Ministry of Health and the Tanzania Medicines & Medical Devices Authority (TMDA) and are sold in Tanzania.

According to a report titled ‘Costs of Post abortion Care in the United Republic of Tanzania’ by the Guttmacher Institute in partnership with the Muhimbili University of Health and Allied Sciences (MUHAS) that was published in September, 2021; In 2018, an estimated 77,800 Tanzanian women received post abortion care, and public facilities provided 64 percent of this care.

The total national cost associated with post abortion care in 2018 was estimated to be 10.4 billion Tanzanian shillings with the majority of the total costs nationally incurred at midlevel facilities.

In hindsight, these numbers would be a lot better had the understanding of reproductive health been less of a taboo and the option to freely choose family planning methods been better communicated.

Q: Considering the stigma and societal prejudice towards sexual conversations, self-care and proactive choices and even awareness; what is the state of reproductive health in Tanzania amongst the youth?

K: The youth are a focus for DKT because they are the early adopters. Part of that process is in educating and we do so within the regulatory environment. There is a lot of stigma and myth about what certain reproductive health products can do so we look at being factually accurate in terms of what options are available to people and to provide choices for people.

The youth as early adopters are going to be able to provide opportunities for their children and in doing so, we provide them with choice and giving them the option to participate in their reproductive health.

Unburdening the contraception burden placed sorely on women

Family planning methods are still treated as hush-hush, regardless of whether they are legal or not. This fact goes on to speak to the nature of openness and understanding of family planning methods as well as the options availed to consumers.

Q: How does DKT International tackle the issue of the contraception burden placed majorly on women?

K: Unfortunately, this is not a Tanzanian problem alone, it is global. Men expect women to sort the contraception issue. Prior to bringing Kiss to the market, the majority were very masculine; Bull or Dume. We brought Kiss out to try and combat the stigma that when a woman has a condom in her bag, she’s regarded as loose; a fact that is not necessarily the case in other parts of the world.

Part of this process in bringing these products to the market is to try and ensure that women have an equal say in terms of their reproductive health, rather than men assuming that women are just going to take care of things.

D: However, prevention of pregnancy is not the only goal. The biggest difference between now and the early 2000s is that HIV is not seen as terminal anymore and it is common to find young people who after the second or so date, easily and completely abandon their protection which is very unsafe.

According to data shared by MoH, Tanzania’s progress towards 95-95-95 currently stands at 88 percent being aware of their status, 98 percent on antiretroviral therapy (ART) and 96 percent virally supressed.

The 95-95-95 strategy is a tracking strategy that aims to see 95 percent of people living with HIV knowing their HIV status; 95 percent of people who know their status and are on treatment; and 95 percent of people on treatment with suppressed viral loads by the year 2030.

DKT International has a variety of condoms, tested and approved that cater to a variety of tastes and preferences. It is no secret that as it stands, the barrier methods, i.e condoms, are the only types of protection that are successful in keeping HIV/AIDS infections at bay.

Future goals in Tanzania

DKT International aims to keep working to ensure people are aware of their options, understand them through education and counselling as well as be able to make informed choices that best suit their individual needs.

A change in how sexual and reproductive health issues are approached in our various communities remains a conversation and a work in progress. A lot of unconditioning, un-learning and re-learning needs to be done for us to reach a stage where men and women can take charge of their sexual health without feeling the sting of stigma.

There is also a need to sensitize both genders to understand the equal role and responsibilities they each bear in ensuring unplanned pregnancies, needles sexually transmitted infections and clandestine abortions are a thing of the past.