More than 26 percent of married women in the Democratic Republic of the Congo (DRC) want to avoid pregnancy but aren’t using a modern method of family planning. Furthermore, meeting this demand for family planning is not an easy task in the DRC, where deep-seated traditional and religious views exist around family size, gender roles and the use of contraception.
USAID programs have worked to meet the needs of women in the DRC by expanding access to a wide range of family planning choices from short term to long acting reversible contraceptives and permanent methods. USAID has also identified the need to increase access to non-hormonal methods to increase options for women and couples. Since 2003, USAID and its partners have worked to incorporate fertility awareness-based methods into the DRC context, in particular, the Standard Days Method “SDM” (PDF), developed by the Institute for Reproductive Health with funding from USAID. Using SDM, women track their menstrual cycles with CycleBeads in order to avoid unprotected intercourse during their fertile days and by doing so can prevent pregnancy. Based on World Health Organization analyses (PDF), with perfect use, the SDM is effective 95% of the time, and 88% of the time with average use.
CycleBeads have a particularly strong acceptance in the DRC’s religious communities. I recently visited the capital city of Kinshasa and was lucky enough to attend a community training of young women on use of CycleBeads. A local Catholic organization, La Conduite de la Fecondité, conducts these trainings twice per week in thirteen integrated maternal and child health clinics all across Kinshasa. It was a moving experience for me as a development professional (even though I did not speak a word of Lingale!). The training incorporated singing, dancing and call-and-response, which created a fun atmosphere where learning could happen.
Later that day I also met with representatives from Maman An’Sar, a Muslim organization who advocates to local Imams to incorporate family planning messages (PDF) into their weekly sermons. Following a sermon, Maman sends out teams of community health workers who follow up with individuals and couples from the congregations to talk about what they heard. Faith-based organizations like Maman and religious leaders have significant potential to influence positive behavior change within communities and disseminate reproductive health messages.
The use of CycleBeads continues to grow in the DRC. Today, SDM has been scaled-up in 278 of 515 health zones, and CycleBeads are available in more than 1800 sites with trained providers ready to assist potential users. Moreover, SDM has been included in all Ministry of Health norms and protocol documents, ensuring long-term host government support of fertility awareness-based contraception as a key component of the contraceptive method mix.
Access to family planning information and services is only one health challenge in the DRC, but it’s an important one. The DRC has one of the highest rates of child mortality in the world, and enabling couples to determine whether, when and how often to have children is vital to safe motherhood and child survival. Research has shown improving access to family planning and reproductive health services could prevent up to 40 percent of maternal deaths across the world, and save the lives of 1.6 million children (PDF) under the age of five annually. Increasing access not only to hormonal methods of family planning, but also to fertility awareness methods is one way in which USAID and its partners are seeking to meet unmet need in the DRC and across the world.