Zambia Has Family Planning Covered

With financial and technical support from PAI, Observatorio de Mortalidad Materna en México empowers indigenous youth to work with health clinics to ensure providers are giving quality, nondiscriminatory and culturally relevant sexual and reproductive health care.

In 2015, in response to the country’s high teenage pregnancy rate, Mexico established a national strategy designed to strengthen young people’s access to sexual and reproductive health care. However, due to widespread discrimination, indigenous adolescents and youth continue to face significant obstacles accessing birth control and youth-friendly sexual and reproductive health care.

This is certainly the case in Chiapas, the country’s poorest state and home to one of its largest indigenous populations. Compared to young women nationally, adolescent girls in Chiapas have more children on average and have a higher unmet need for birth control. Deep discrimination and inequality among indigenous adolescents and youth undermine their right to access sexual and reproductive health care and drive high teenage pregnancy rates.

Observatorio de Mortalidad Materna en México (OMM) is working to change that. With financial and technical support from PAI, OMM created a program that trains indigenous youth to work alongside health clinic staff in Chiapas to ensure that they are providing quality, nondiscriminatory and culturally relevant care. This includes offering sex education materials in indigenous languages and banning the denial of care to young women in traditional dress.

As a citizen monitor, Cecilia Hernández, 16, travels to public health facilities across Chiapas to record how staff treats patients. In one instance, she saw that multiple contraceptive options were unavailable at a clinic. Cecilia knew this inventory was critical and when she asked staff members about it, they told her that the contraceptive methods requested from the Ministry of Health were overdue to arrive.

“This is harder for young people,” she explains, “because they don’t have money, they have a hard time asking for what is [available] and not that many pharmacies sell birth control.”

Social accountability, specifically citizen monitoring, is an important step in providing oversight to Mexico’s relatively decentralized public health system. The evidence OMM’s citizen monitors gather is used to educate the government of Chiapas on how to improve the quality and accessibility of care at the 45 public health facilities serving thousands of indigenous youth and women in the region.

In a region where indigenous people, especially youth, are left out of conversations about their well-being, the work of citizen monitors is helping to broaden those discussions and make sure that health clinics are meeting the pressing needs of the communities they serve. Cecilia and OMM are driving real change in their communities, and PAI is proud to support them in this essential work.

Meeting people in the health centers, getting to learn more about sexual and reproductive health and having the opportunity to travel to other communities — this job is a blessing.

Cecilia Hernández, citizen monitor, OMM

In early 2020, the Ministry of Health announced that family planning services — including a wide range of contraceptive options — would be included in Zambia’s new benefits package.

Countries around the globe are embarking on bold plans to achieve universal health coverage (UHC) and expand affordable health care to citizens. But as history has shown, if advocates are not part of the process, women and girls will be overlooked, and the cost of high-quality sexual and reproductive health services, including contraceptives, will remain a barrier for those who need them most.

Thanks to PAI partner the Centre for Reproductive Health and Education (CRHE), history won’t be repeating itself in Zambia.

When the government of Zambia introduced a new national health insurance initiative in 2018 as part of its UHC reforms, CRHE and PAI mobilized quickly, leveraging our collective strengths to ensure that family planning would be included.

CRHE advocates tapped into their local networks and experience with the Zambian political landscape to gain key intel on the process and timeline. PAI offered a technical analysis of the proposed health insurance plan and advised on the best opportunities to engage decision-makers.

With this analysis in hand, CRHE gathered Zambian family planning advocates and other stakeholders for a workshop. PAI was present to help clarify the policy implications of the new insurance program on sexual and reproductive health and supported attendees as they developed an advocacy strategy. At the end of the two days, members of the coalition left with a robust plan of action.

With PAI’s continued support, CRHE led the coalition as members pursued the advocacy agenda and worked with government decision-makers. In early 2020, their hard work paid off when the Ministry of Health announced that family planning services would be part of the new benefits package. This included a wide range of contraceptive options that would allow women to choose the one that works best for them, from birth control pills to implants, injectables, intrauterine devices and emergency contraception.

The decisions governments are making now around UHC will impact their citizens for years to come. It’s essential that organizations like CRHE are there to advocate for the health needs of women and girls and that PAI can provide them with the tools and resources they need to succeed.

PAI recognizes that advocacy requires a long-term investment and its support of CRHE has helped us achieve many wins for women and girls over the years.

Amos Mwale, executive director, CRHE