Family Planning in Zambia

By Brenda Zulu 

The focus on this article is on women who are sexually active because these women have the greatest risk of exposure to pregnancy and the need for regulating their fertility. 

According to the Zambia Demographic Health Survey (ZDHS) 2007, contraceptive methods are grouped into two types: modern and traditional methods. Modern methods include female sterilisation, male sterilisation, the pill, intrauterine device (IUD), injectables, implants, male condoms, female condoms, diaphragm, foam/jelly, lactational amenorrhoea (LAM) and emergency contraception. Traditional methods include the rhythm methods (periodic abstinence) and withdrawal. 

This also includes folk methods. Zambians widely know modern than traditional methods. Among traditional methods, withdrawal is the most commonly known among women. Similarly to women, the most common known method among men is the male condom. It is worth noting that among the men they are as likely as the women to know of implants. 

Younger women aged between 15 and 19 and women living in western province are least likely to know of a contraceptive method. For men, knowledge of any family planning method is almost uniform regardless of age, residence, province, educational level or wealth quintile. The pill is the most common method of contraception followed by the condom and injectables. Implants, IUD and the emergency contraception are the least used methods with less than 1% of women having ever used any of these methods. Cycle beads are the least used. 

Among males less than 1% have used sterilisation. For the traditional methods, withdrawal is more common than rthym method. On the knowledge of family planning preference, Elijah Kabwe, a married man with two children said he did not trust the Norplant which his wife has inserted on her arm and as a result he has continued to use the withdrawal method as he did not want to have another child. Asked if he would then choose to go for vasectomy, Mr Kabwe said he wouldn’t as he was already satisfied with his family planning method of choice. 

 For Zambia, the use of family planning method increases with age from 10% in the age group 15 to 19 years to 40% in the age group 25 to 29 years and then starts to decline to 24% in the 45 to 49 age group. The female condom is the least used modern method for women (1%). The contraceptive prevalence rate for modern methods has increased from 7% in 1992 to 25% in 2007. Contraceptive use is higher among women in urban areas than among women in rural areas. Eastern province has the highest proportion of women currently using family planning methods, followed by Copperbelt. The lowest proportion of married women using a family planning method is in Luapula. In general, women do not beg to use contraception until they have had at least one child. Contraceptive use among women increases with educational attainment compared to women who are uneducated. Condom use has more than doubled from 2% in 1992 to six percent in 2007. 

The proportion of married women undergoing female sterlisation has remained relatively stable between 1992 and 2007 at 2%. Among pill users the brand commonly used are safe plan and Microgynon and Oralcon. Among women using injectables, 56 % use DepoProvera and 42% use Noristerst. The most common brand of male condom used is the Maximum classic. 

 “From one menstrual period to the next, are there certain days when a woman is more likely to get pregnant if she has sexual relations?” 

A woman is most likely to conceive halfway between two periods. Users of natural family planning methods are more knowledgeable about their fertility period. Couples use family planning methods to limit family size or delay the next birth. Couples using family planning as a means to control family size adopt contraception when they have already had the number of children they want. When contraception is used to space birth, couples may start to use family planning earlier with the intention to delay a pregnancy. This may be done before a couple has had their desired number of children. In a culture where smaller family size is becoming a norm, young women adopt family planning at an earlier age than their older counterparts. 

 Women start using contraception at a younger age while some use contraception before they have any children. Timing of sterilisation for many women is at 34 years. The many women who use modern methods contraceptives obtain them from the public sector, mostly government health centres while private medical institutions are the second most common source of contraception with non medial sources being the least common. There has been a shift away from reliance on private medical sources for contraceptive methods. 

The proportion of current users relying on private medical sources has declined from 32% in 1992 to 17% in 2007. Contraceptions for people who use modern methods get them for free and or not so many people buy contraceptions. About 8 in 10 women who obtained their family planning methods from public sector facilities were informed people while about two thirds of women who used methods with related problems were taught on how to address the problems should they occur. 

There are some married women who have no intention of using any method in the future and 5% are unsure of their intentions. Reasons for women not intending to use contraception in the future include fertility related reasons which include infrequent sex, no sex, menopausal, had hysterectomy, sub fecund, in fecund and wants as many children as possible. Opposition to using contraceptives is also prevalent due to many other reasons which include religion and the fact that some people are no longer sexually active.