Lusaka, 31st October 2011: Cultural norms and traditions remain one of the key barriers to providing sexual and reproductive health services globally. Zambia, with one of the world’s fastest growing populations, is no exception. In the slums of Lusaka, information spreads by word of mouth. Myths and rumours abound and it can be difficult for women to get accurate, objective advice about their sexual and reproductive healthcare choices. But through a partnership with the national non-governmental organisation Africa Directions, MSI Zambia is successfully tackling this barrier and educating women so they can access the full range of short-term and long-acting or permanent methods (LAPM) of voluntary family planning, and legal safe abortion services that we offer in their communities. We join them on an outreach trip to the Kalikiliki compound, where they’re using theatre to raise awareness and publicise MSI Zambia’s services offered in the nearby mini-clinic.
It’s 8am and the MSI Zambia team meet at their office in Roma. They’re busy printing leaflets and referral slips for community educators to distribute during the performance. From here, they drive to our mini-clinic in the Mtendere compound where they find the Africa Directions drama group finalising and rehearsing their script. They pick up the actors, musicians, dancers and community educators and move on to Kalikiliki, a nearby compound with limited access to health services and the location for the day’s performance.
Spreading the family planning message
They pull up in the heart of the compound at 10am and it takes the team just moments to set up on a piece of unused land. And then, local celebrity Miyoba Sumaili takes the stage to introduce the performance. Miyoba is the Drama Coordinator at Africa Directions. He also stars in a popular Zambian soap, Banja, and is well known to the audience. His celebrity status, as well as that of his co-star Chilufya Mifumbi, keep the crowd excited and alert to the unfolding drama.
Today, the focus of their performance is unsafe abortion. They’re telling the story of Faith*, a young woman, recently married. Although Faith and her husband decide they don’t want to start a family right away, she becomes pregnant because they aren’t using contraception due to lack of availability. She then turns to a traditional healer in her village who gives her herbs to abort the pregnancy. Faith collapses and is rushed to an MSI Zambia clinic where she is treated for the complications caused by her unsafe abortion. She also receives counselling from the clinic and is given access to a range of family planning services.
Within the crowd are Africa Directions and MSI Zambia peer educators. Their role is to speak to the audience about the performance and answer questions people may have about family planning and safe abortion. Women who are interested in accessing family planning services are given referral slips to our mini-clinic located in the nearby compound, a short walk from the performance. The mini-clinic is open five days a week, and family planning services are available free of charge.
Educating young women in their communities
One peer educator, Kaunda Ngulube, spoke to us about why his work is so important to the community: “We have a lot of women who get in to marriage at a tender age and who are not using contraceptives. So you find that 18-year-old girls are already married with three kids. Most of them are unplanned so we need to be telling people about condom use and contraceptives. Our work would be difficult without theatre. If you come with a drama group people are attracted to us. They come in numbers so it becomes easier for us to talk to them.”
Miyoba agrees: “Here in Zambia, [drama is] the most effective way of communicating with people. People don’t always accept what they hear in a one to one conversation but when they see a performance, they do. You play the drums, they come, you act. It’s easy for them to get information and ask questions straight away. Before we came there were a lot of abortions in the community but since we’ve been coming the numbers have reduced because they are using contraception.”
As with all of the educational performances, Faith’s story is a true one. Every day women across this southern African country turn to unsafe abortion providers because of high rates of unintended pregnancies and the barriers they face accessing safe, legal services. The outcomes are devastating. An estimated 30% of the maternal deaths in Zambia are a result of unsafe abortion.
What’s more shocking is that this is happening in a country with some of the most liberal abortion laws in sub-Saharan Africa. Two key reasons for the high rate of unsafe abortion are limited access to voluntary family planning services and a lack of knowledge about the legal status of abortion. By educating women about family planning methods and the facts around abortion in Zambia, and by getting accurate information in innovative and dynamic ways to these communities, MSI Zambia is reducing the number of Zambian women who, in desperation, risk their lives by turning to unsafe abortion providers.
The services provided by MSI Zambia in 2010 will avert 2,534 unsafe abortions.
View a slideshow from the visit on the Department for International Development (DFID) website
Find out more about our work in Zambia
*Her name has been changed to protect her identity.