The NHS has been pestering me. I was ignoring their letters, but they haven’t gone away, thank God. At 29 they’re reminding me that I’m overdue my smear test. The fact that I moved house and delayed registering at the doctor’s, have a slightly irregular period and generally don’t want a complete stranger to stick something up my… sorry, TMI. Anyway, I’ve been putting it off.
When I finally get to the surgery there’s more pestering:
“When did you last have your period?”
“Any sexual health concerns?”
“Are you taking any hormones?”
“Have you got a new partner, any unusual discharge?”
“Are you interested in long-term contraception?”
After getting over my deep-seated British discomfort at talking about such things, I realised how grateful I am that someone cared – or was paid – to ask. How brilliantly lucky I am to have been born in the UK, at a time when my health as a woman is considered to be something worth investing in. That a nurse is willing to talk these things through with me; to remind me not to ignore my test results and the risk of cervical cancer, but also to find out whether I need contraceptive help, which she would then be willing and able to provide for free. It’s nice to be reminded that my cervix is worthy of the attention.
Eight weeks ago I was in Burundi, meeting women who are not so lucky.
I’ve always assumed that I would, at some point, become a mum. But I’ve never really fully comprehended what a privilege it is to know that I will have at least some say in when that is, and how many children I might want to have. Now that I’m married and approaching 30, the abstract notion of becoming a mum is something I’m actually considering the reality of, and to be honest, feeling slightly overwhelmed by.
Burundian women the same age as me are more likely to be looking after six children than deliberating about whether or not they’re ready to become pregnant.
A land-locked country in East Africa, Burundi is one of the world’s poorest counties, with a high population density and high levels of hunger and malnutrition. Typically, women don’t have the resources, knowledge or power to negotiate on decisions about their reproductive health. That means that many couples end up having more children then they can afford to care for. And this further perpetuates the poverty and lack of power that results in far too many young women dying during pregnancy and childbirth. Early pregnancy, or having children very close together, carries a greater risk of death of ill health for both mother and baby.
Globally, a woman dies in childbirth every 90 seconds. Sad you might think, but difficult to fix. But as Mahmoud Fathalla, former president of the International Federation of Gynecology and Obstetricians, said: “Women are not dying of diseases we can’t treat… they are dying because societies have yet to make the decision that their lives are worth saving.”
The government of Burundi has made that decision: women are worth saving, and it has set targets to reduce maternal and child mortality, as well as cut severe childhood malnutrition. A key factor in achieving the targets will be increasing knowledge of, and power to choose, family planning methods.
In a majority Christian society, one current barrier is faith leaders ignoring the issue or preaching only that we have a responsibility to “go forth and multiply”. As one preacher told me: “The government has been trying to educate people, but the message won’t get through until they hear it from their pastor.”
Which is why a new Christian Aid project to work with local church and faith-based partners to break down those barriers has powerful potential. The project will help train church and other community leaders to talk accurately about family planning from a Biblical foundation, and ensure faith leaders also refer women on to medical help where required.
Another church leader told me: “I didn’t know that having many children was a factor of bad health for women and for their children. [The training] really opened my eyes.” He gave me confidence that the government of Burundi will eventually reach their targets.
Which is good news because we’re not really talking about targets – we’re talking about women’s lives. Women just like me who might have been feeling more than a little overwhelmed by motherhood and yet had no other choice. We must stand alongside those who have made the decision that their lives are worth saving.
Cover photo: 29-year-old Francine Ndayikengurukiye lives in southern Burundi and has five children.