Wednesday evening, a young woman around my age delivered a baby boy. I had initially had high hopes for this particular birth. It was her third child, there had been no difficulties during the pregnancy that we knew of, and I was actually able to be helpful during the delivery (nothing medical, of course, but still exciting). Yet, when the baby was born it had great difficulty breathing. Rachel and Olivia suctioned his lungs and nose, but the respiratory distress continued for quite some time. His cry was weak, Rachel could feel that his lungs were not inflating, and he was very clearly struggling. As Olivia administered a homeopathic, Rachel inspected the placenta, indicating that portions of it had calcified in the womb, meaning that those portions had stopped working. The reason? Malnutrition. With two children and a husband at home in this very poor region of the country, a pregnant woman was unable to eat, jeopardizing both her health and her unborn baby’s. The homeopathic worked, by the way, and the baby and mother were discharged three days later, but we can’t know for sure what the future repercussions of the respiratory distress and calcified placenta will be.
Later that night, a 15-year-old girl arrived at the clinic to deliver her first baby. The father, nowhere to be seen, is 16-years-old. What were all of you doing at 15 and 16? She had a long, difficult labor through the night. The baby’s heart rate was dangerously low and by the next morning Olivia and Rachel were pushing to get the baby out as soon as possible. After difficulties, a baby girl was born, weighing in at 2kg. Her heart rate steadied and both mama and baby spent the day recovering from labor. The next day, the father’s mother, who is 32-years-old, arrived to take the girls home. I sat in on a conversation Olivia had with the girl and grandmother about family planning and safe sexual health. Olivia told the grandmother that she needed to speak with her son about the importance of family planning, how to avoid pregnancy, and how to be a father. The woman’s response? He is too young to have that conversation! So, a 16-year-old is old enough to have sex, old enough to get someone pregnant, and old enough to be a biological father, but he is not old enough to learn about abstinence, to learn how to use a condom, to learn how to space pregnancies, or to learn why these things are important?
Conversations like these happen frequently at the clinic and the evidence is all over the community. At the district health office expired condoms meant to be given out for free and stacks of educational brochures forgotten in corners. I have met women with as many as eight children and barely enough resources to sustain the whole family. Some women plan to have many children, but there are plenty of women who do not and who simply are not in an educated position to avoid pregnancy. The repercussions of this, as I saw last week, may be difficulties in labor or dangerously stretched resources at home, but this lack of family planning also contributes to maternal and neonatal mortality in a region where the provision of healthcare is weak.
In one of my modules at LSE we spent a couple classes on why people have large numbers of children and why the fertility rates are higher in Africa than elsewhere in the world. Some people have argued that it’s an economic decision. The more children you have the more people you have to farm and to contribute financially to the family in the long run. People may also have more children because they anticipate that some will die, which is often the case in poor parts of sub-Saharan Africa. I think large families and motherhood at such a young age may simply be embedded in the culture. I have been asked by several TBAs here why I don’t have children yet, how many will I have when I do? When my response is “maybe two, but I don’t really know yet,” I am greeted with shock. “You should have at least four!” they say, incredulously. But why? A part of why people may have large families here is that they are expected to at a cultural level. While I am here to immerse myself as much as a white American can in the culture of Atiak, Uganda, and while throughout my career in international development I will focus on respecting and participating in culture, some cultural expectations are dangerous. Having six children at 23 in this environment is not the best for mother or child, nor is becoming a mother at 15.
In the past week or so I started looking into some organizations that focus on reproductive health and family planning, thinking that I might like to shift my focus or include those aspects in what I hope to do with maternal and child health in the future. These issues need to be a significant focus in the field of international development. I think that with greater importance placed on reproductive health and family planning we will see healthier families, more educated people, and, hopefully, an empowered gender identity for women.