By Dr Margaret Brown.

This is a true story from Bangladesh, helping us to understand several points about a family planning programme.

Fatima is the mother of five children. She lives in a small hut, on someone else’s land, in the middle of a village in Bangladesh. He eldest son is about ten and is just starting to be a source of income for the family. Her husband is usually out of work and gives Fatima almost no support. Fatima is extremely hard working, but any money that she makes is usually wasted by her husband. The children are malnourished. The local family planning clinic has been trying to encourage Fatima to use some form of contraceptive, but she can never remember to take the pill. Anyway, she and her friends in the village have heard some stories about unpleasant side-effects, so the general opinion is against the pill. The family planning staff cannot understand why Fatima will not have an IUD fitted.

Then one day, one of the staff members is in Fatima’s home chatting with a group of the women over a cup of tea. This is an informal, friendly visit but the subject turns to family planning. During the conversation, the family planning worker discovers that the women did not like to have an IUD because they believed that if they died with it still in place it would pollute them. The worker was not aware of this belief before. No wonder the IUD programme hadn’t taken off!

At about this time, the injection Depo-Provera become available. The family planning clinic ordered supplies through the government and started to encourage the use of this method in the village. Fatima discussed this with her friends and, after some hesitation, the idea was accepted and Fatima and many of her friends all came to have this new injection. Everything went well. This really seemed to be the right method.

Then disaster struck. For various political reasons, supplies of Depo-Provera completely stopped. The family planning staff tried as hard as they could to get more supplies, but they failed. The result was that later there was a tremendous baby-boom in the village – and Fatima is now the mother of six children. She and her friends are now disillusioned with the family planning clinic that seemed to promise so much, but finally failed them.

Discussion questions

  • Which people most influenced Fatima’s choice of method?
  • Her husband, her friends or the family planning staff?
  • What part did local beliefs play?
  • How did the family planning worker get to know about these local beliefs? Was it important for her to know? Could she have found out by another way?
  • Why did the use of Depo-Provera seem to be accepted so well?
  • What happens when supplies are not regularly available?
  • What other aspects of a family planning programme does this story make you think about?