The Power of Choice

The Power of Choice

Publication info

Maureen Mubanga

Rose Lesa Milembo of Nseluka village was 17 years old when she married her husband. Today, at age 33, she has seven children. While many of us would consider this a satisfactory (and impressive!) number, Rose’s husband would like to expand his family to 12, adding at least five more members to the list.

However, having so many children in such a short amount of time has many risks in a country where the maternal mortality rate stands at 591 deaths per 100,000 births, and the infant mortality rate is 34 per 1,000 births. By spacing out her pregnancies by an average of a year and three months (versus the recommended two-year period), Rose was putting herself in danger of maternal complications such as anemia, rupture of the uterus, post-partum hemorrhaging and even death. This also meant that her children were being weaned too early, exposing them to malnutrition and reduced mother-child bonding.

Until recently, Rose never questioned whether having so many children was in her or her family’s best interest, and never did she think about using any modern family planning methods. Then, two years ago, she met Grace Katongo, a community-based health volunteer, who changed the way Rose thought about her future.

Grace is part of CARE’s Private Sector Social Marketing (PRISM) project, which employs community-based volunteers to distribute health-related products such as SafePlan contraceptives, male and female condoms, and household chlorine, in remote rural districts in four provinces across the country: Luapula, Northern, Eastern and Southern.

The project aims to promote behaviour change at the community level by increasing access to health-related messages and products and following up to encourage that clients use them afterwards. Topics range from water treatment and sanitation to avoid illnesses like cholera and diarrhea, to limiting the spread of HIV/AIDS and other sexually-transmitted infections and preventing unplanned/unwanted pregnancies.

“Grace shared with me the importance of spacing out my pregnancies and the benefits of family planning,” says Rose, who liked what she heard and discussed taking oral “SafePlan” contraceptives with her husband. It took a lot of convincing, but in the end, he agreed.

Having the option to delay more pregnancies meant that Rose could begin thinking differently about her role as a wife. She became more active in the family business (ordering and selling produce at Nseluka market) and began contributing to the family’s income. She notes that in the last few years, she has experienced many benefits in her life.

“I have more energy for my domestic and business activities than ever before,” says Rose. “My health has improved greatly and I am less tired. I also have more time to work at the market since my youngest baby is three years old.”

When discussing her decision, Rose is quick to point out that the benefits she has experienced in the last few years don’t end with her. She says her youngest child is very healthy, having been breastfed for almost two years. She also adds that her family is able to save more money, which will help her send her children to school.

That same sense of empowerment can be attributed to Grace, who is now able to make a living by distributing these products to people in her community. Thanks to PRISM, professionally trained community-based volunteers like Grace are reaching households and individuals in communities that other programs do not reach. Not only does this empower the volunteers, who are able to make a living from what they sell, but it also helps the Ministry of Health reach women and men in the most remote and rural parts of Zambia, where even health facility staff rarely travel. It also allows the government to collect valuable information about the health of its citizens.

The success of PRISM means people like Rose now have access to more information and health products, and are empowered to make the best decisions for themselves and their families. That translates to stronger and healthier Zambian communities, no matter how far off the beaten track they are.

Strength and health are evident when talking to Rose, who is happy to share her story. She says that today she ensures she is always carrying her family planning pills close to her. When asked about her plans for the future, Rose says she wants to delay having more children for another few years, during which time she wants to concentrate on working to raise money for her family. Thanks to Grace and CARE, this is a choice that Rose and her husband have been able to make together.