• [Image: Holo Hochanda]

    Holo Hochanda

    Zambia

    BroadReach Healthcare

    “If we strategically support the government through policy formulation, which will help to scale up reproductive health services and commodities. I think over time we can have bigger impact by supporting them to develop policies, strategies and creating guidelines, than we would if we were in the streets holding placards. That’s an important strategy as well, but maybe not for us to do.”


    “I think sometimes you can be more effective with the First Lady approach, where the government is the husband and president, and we are the First Lady, making issues more palatable and going beyond figures and putting faces to these issues. We are not only advocates who always condemn, but we are partners who should also give solutions.”


    “In terms of family planning among African women, I think for a long time there were a lot of assumptions, especially about women in rural areas. For example, there were assumptions that they don’t know or want or are against family planning because of tradition. Those were mostly myths started by people from the West. I worked in communities and we reached around 500,000 women over four years, and in every case there was curiosity about family planning, and not community resistance.”


    “At community level, even religious leaders understand the need for family planning because they are close to the issues. Catholic hospitals counsel women about child spacing and then tell them where to access contraception, because the service providers themselves don’t care about the politics at higher levels in the church.”


    “I think there is unmet need because people want the contraceptives but can’t get them, particularly in rural areas. The pill is the easiest to get, some can access implants but only at level 2 or 3 hospitals, where they can do minor surgeries.”


    “The husbands we’ve talked to are very supportive and understanding, but I don’t think we have the time or resources to explain why people need family planning.”


    “In my experience at community level, working with men and women, separately and collectively as couples, there was minimal resistance but a lot of curiosity. I don’t question the demographics that say knowledge of family planning is at 96%. People know about the pill and other methods, they may have misunderstandings, but the biggest problem is that they can’t access it. And I think what is really required is an increase in choices related to family planning. This requires a lot more funding, outlets for distributing it, and quality control in relation to the contraceptives themselves. I think people are skeptical of generic brands including condoms. They think it’s not as good as the one that’s branded.”


    “I think apart from the diminished funding, family planning would be the easiest thing to do if we had adequate resources. I also think there’s a lot of opportunity to integrate family planning more fully into existing programmes, such as HIV prevention and maternal mortality reduction programs.”


    “I used to blush in these sessions with women – old women talking about sexual positions and clapping and laughing, and talking about how men don’t know how to please us, and sometimes you don’t even realize they are done! They looked like my grandmothers! This sort of talk is something I’ve found working and living in those communities.”


    “We need to have a more empowering and positive approach to promote the family planning agenda. It’s the same with a lot of development issues on equality and gender. There are positive things happening in many communities, and we should capture those. For example, there is an area in northwestern province in Zambia where the Chief has declared that any husband whose wife doesn’t deliver at the facility will be fined. Since then, maternal mortality went way down and attended births went up, and that Chief is a man! This is an example of finding people who are willing to be the flag-bearers and engaging with them in a positive way. My focus is being positive with the government, so that we can develop trust and see that their agenda is also our agenda, and vice-versa.”


    Other quotes

    “I think the most important resource that distinguishes those of us in IPPF from the rest is that we’ve been active for a long time – if you think of family planning, you think of IPPF. But over time we have forgotten how to be pioneers.”


    “Partly because our existence means we need strong partnerships, not to be completely “in bed with” government, but also not to be seen as antgonizers, either.”


    “One unique situation was when we went to a Catholic community which was established around the diocese, the Catholic priest became like the Chief. We went there and the Catholic priest said that, ‘publicly, “I have to be seen not to support you, but I won’t stand against you” We were there for seven days, and talked about family planning and distributed contraceptives.”


    “The expats come from outside and make and publish their negative assumptions about the situation in African communities, and it brings in support and makes them feel they are empowering women in these communities. But we need to change this.”