When family plans hang on a tight health budget

Everything went as expected for Veronica Joseph (37), a mother of four children, when she embarked on her plans to give birth to the number of children she wanted. However, the future may no longer remain predictable following latest cuts in healthcare spending in Tanzania and continued reduction in foreign aid.

Ms Joseph secures her modern contraception methods through government-run health facilities near her home and according to the 2016 Tanzania Demographic and Malaria Indicator Survey (TDH-MIS), six in 10 modern contraceptive users obtain their methods from government/parastatal suppliers.

“I decided to start using contraceptives and most especially the implant after I had my four children in just eight years and I was in danger of conceiving another if I had not taken action immediately,” says the resident of Tegeta, a suburb in Dar es Salaam.

She tells Your Health that she has been relying on a contraceptive implant, a small flexible plastic rod that’s placed under the skin in the upper arm. Doctors say the implant releases a hormone known as progestogen into the bloodstream to prevent pregnancy and lasts for three years.

So, every after 3 years, she goes to a nearby hospital located at Kibaoni, Tegeta suburb in the city to get the service and, she is due to have another implant in the next one and half years.

Family planning appears now a priority for Ms Joseph and most women in Tanzania. But, is this a current priority for the country’s policymakers?

The Ministry of Health, Community Development, Gender, Elderly and Children has shown the commitment to top up its family planning budget from 14 billion in 2017/18 to 17 billion by 2020. However, challenges still abound in the implementation of the budget commitments.

Far from being ideal

Despite the fact that the government has shown commitment, a health advocacy NGO, Sikika, says that funds from the 2017/18 family planning budget which was pegged at Sh14 billion, haven’t fully been disbursed. Only Sh2 billion had been disbursed by February 2018, says Sikika.

But, the demand for family planning in Tanzania is rising. The number of married women who are using modern contraceptives has increased over the last one decade—from 20 percent in 2004-05 to 32 per cent in 2015-16, says the 2016 DHS-MIS. Yet, the country’s birth rate is one of the highest in the globe ranking 16th out of 225 countries.

Cuts in healthcare spending

Will the government’s drive to increase family planning services remain unaffected by the latest cut in the health budget? The parliament in April approved a Sh893 billion budget for the heath sector for the 2018/19 financial year, cutting it by about 19 percent of the previous budget which was Sh1.1trillion.

According to experts, the decrease in health budget means that the country’s family planning drive takes a hard hit, amid Tanzania’s escalating population.

The National Bureau of Statistics (NBS) Projection Report of 2018 has predicted a 54 million population in 2018, with 44 per cent of this number being the young people, under the age of 15 years.

The young population is, according to family planning stakeholders, driving up the country’s fertility rate even more. Tanzania’s adolescent population currently has three times as many more children than their global counterparts.

This also happens at a time when Tanzania’s unmet need for family planning stands at 22 per cent among married women aged 15–49 years and 23.5 per cent among young women aged 20–24, according to the 2016 TDH-MIS.

Trump factor

The future may appear bleak now, considering that the US President Donald Trump has already proposed a budget cut of 50 per cent in funding for international family planning and reproductive health (FP/RH) programs in developing countries.

Reports from the Reproductive and Child Health Section of the Ministry of Health, Community Development, Gender, Elderly and Children, show that the actual cost for family planning commodities for 2017 were Sh36 billion and for 2018 are Sh33 billion.

But, the Advocacy and Technical Manager for Advance Family Planning (AFP), Mr James Mlali, confirms to Your Health that the demand for contraceptives is still higher than supply. He says that 22 percent of women who need family planning services still do not get them.

According to him, factors behind the situation include stock-outs of the commodities at the facilities, low numbers of skilled family planning providers, and lack of health facilities in rural areas.

Mr Mlali explains that the most used contraceptive method in the country are injectables. He says injectables provide women with confidentiality in cases where their spouses are resistant to family planning use.

“However access is limited due to shortage of skilled family planning providers and lack of health facilities in some rural areas. Also, government does not allow Community Health Workers to provide Injectable Contraceptives,” says Mlali.

He explains that pills are not preferred because they are slightly demanding and one has to be disciplined enough to take them daily, and also don’t provide confidentiality.

He further noted that condoms require mutual consent between partners or spouses, a situation that puts women in a disadvantage due to the male dominant culture, while permanent methods are more dependent on availability of skilled family planning providers.

Regional differences

Currently, married women in Tanzania Mainland are substantially more likely to use modern contraceptive methods than women in Zanzibar (33 per cent versus 1 per cent).

In Zanzibar, married women in Unguja are more likely to use modern methods (16 per cent) than married women in Pemba (9 per cent).

There is a notable difference in contraceptive use across zones and across regions. Modern contraceptive use is highest among currently married in the Southern Zone (51 per cent), followed by the Southern Highlands Zone (44 per cent), and the lowest in Zanzibar (14 percent).

In the regions, modern contraceptive use ranges from a low of 7 per cent among currently married women in Kusini Pemba to a high of 52 per cent of women in Lindi and 51 per cent in Ruvuma.