BISSAU, 28 October 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.

In Guinea-Bissau 98 of 114 health centres now offer family planning services and 10 percent of women use contraception which while low is an improvement, said Antonieta Martins, a UN Population Fund (UNFPA) adviser to the Ministry of Health.

UNFPA estimates that giving women access to modern contraception could prevent 40 percent of maternal deaths worldwide.

In Guinea-Bissau one in 13 women dies in pregnancy or childbirth, according to the UN – one of the highest rates in the world.

The service

At San Domingos government hospital 90km north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.

UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.

Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too young and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.

They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages.

"Women want family planning here – we meet with very little resistance to our messages," he told IRIN.

But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said.

Dada Saar, 36, mother of five children, spoke to IRIN while waiting to receive her next contraceptive implant at Simao Mendes hospital in Bissau.

"Five [children] is enough," she told IRIN. "We don't have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn't want more."

Next to Saar sat Florence de Silva, 28, who has one daughter and wants another child, but plans to stop at two. "Otherwise I will not be able to educate them…even if I have just two and they are both educated, they will be able to look after me when I am older."

Economic security or better health?

Economics increasingly sways urban families' decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.

"In towns people are more conscious that they want fewer children. They understand life is expensive."

But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. "People have more faith in medicine working, so are starting to think their babies won't necessarily die [when ill]," Alves said.

Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed – a countrywide survey is due out in 2010 – health workers told IRIN maternal and under-five mortality is declining across the country.

While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates, Martins said.

Choices

Concerned about the slow progress of international efforts to reduce maternal mortality to meet 2015 Millennium Development Goals, health ministers, government officials, UN and NGO representatives from around the world gathered in Addis Ababa on 27 October to urge governments to make family planning a priority.

Reducing the rate of unintended pregnancies and stopping women from dying in childbirth worldwide would cost US$23 billion per year, they said in a communiqué.

However in Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 percent dependent on donor funding, deciding priorities is difficult, said Alves.

Martins said: "The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems."

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