Defying Norms and Advocating for Family Planning for Women of All Ages

Henriette Tossa is a mother of two and a community health educator working and living in southern Benin where according the Benin Demographic and Health Survey (DHS), the total fertility rate is 4.9 children per women and the contraceptive prevalence rate of modern methods is 8 percent. Long-acting reversible contraceptives (LARCs) remain stigmatized and unpopular relative to other methods; with intrauterine device (IUD) use at .5 percent and implants at 1 percent.

Henriette Tossa is a mother of two living in Benin.

Henriette is a second wife, which is not uncommon in Benin. According to Benin’s DHS, 35 percent of women in the country and 55 percent in Henriette’s region, Couffo, are in polygamous unions. However, Henriette is truly unique. In a country where the median age of marriage is 19.8, Henriette waited to marry until she was 31. In Benin the median age at first childbearing is 20.7 years, but Henriette had her first child at age 32 – and her second four months ago at age 37.

Recently, I sat down with Henriette to talk more about her family planning decision-making.

Why did you delay getting married?

I thought about it, and saw that living is expensive. There are things I wanted to have before getting married and having children, like a job, an education and a house, so I waited until I had finished my Baccalauréat [a post-high school exam that qualifies students for university studies] and had completed my training in facilitation before getting married.

Why did you want a small family?

Kelli Schmitz, Peace Corps Volunteer, Benin*

In order to support a child, you need to fulfill their fundamental needs of being fed, clothed, housed and given an education. I want just two children because I do not have the means to support more than two children.

My husband I thought a lot about their future also. I want them to go on and attend university. When you have a lot of children, you do not have the resources to support all these children and provide them a future like this. My husband and I discussed and decided we should have just two children since that was the number we could reasonably support.

What led to you wanting to use family planning?

To not have an unwanted pregnancy, which can negatively affect the life of the mother and the existing children, Currently, I am using the [lactational amenorrhea] method, but am in my fifth month of breastfeeding. (Lactational amenorrhea is a natural FP method where mother breastfeeds exclusively for first six months of her baby’s life to prevent ovulation.) I decided I should choose Jadelle (Implant) to plan my pregnancies, and plan to get it inserted at the end of this month…. Since I am 37 years old now, with the five years of protection of Jadelle, I hope to be protected until menopause.

Why did you choose a long-acting reversible method?

I talked to many other women and heard that Jadelle does not have a lot of side effects or inconveniences. Also, I have used pills before and it was hard to remember every day, leading to me taking them inconsistently. My life is busy with work and my children, so having a method that I can use and not have to think about for five years is important.

Why do a majority of women in Benin not use family planning, specifically LARC methods?

Many women do not use family planning methods because, firstly, they do not know about the different methods available and the importance of using family planning. Also, there is a large fear of the side effects … especially with LARC methods, and not enough access to education sessions countering these fears and providing factual information. There must be stronger training and education … to counter the existing fear [and] to increase utilization of family planning, and this needs to start at the health center before a woman even gives birth.

What is the biggest pregnancy risk in Benin?

The biggest risk for women in Benin is having multiple pregnancies. This tires out her body and leaves her with little time to rest, lowering her state of health. With this, the children suffer. Their children will not be as … capable as children from smaller families because their parents cannot support them fully. Thus, the economy and health of the whole household suffers.

If you were to have a daughter in the future, what advice would you give her in regard to family planning?

I would advise to start using either an IUD or Jadelle when she becomes an adolescent to preserve her education. A LARC would prevent her from becoming pregnant and stopping her education prematurely. Ultimately, choosing a LARC method gives her a future.

Resources

SBCC tools on increasing LARCs acceptance among youth

SBCC implementation kit on addressing advanced maternal age and high parity pregnancies

*The opinions expressed here are my own and do not represent those of the U.S. Government or the Peace Corps.