SAMBA-KOUNI, Grande Comore, Comoros – “I remember very well when the midwife told me that women should (wait) at least two years before giving birth to another child,” says Rahamatoullah Mohamed Maâmoune, 31. “Because a woman who is pregnant less than two years after (giving) birth is more likely to die due to complications, or have premature babies born at low birth weight.”

This mother of two young children, aged five years and nine months respectively, was sharing her experience of family planning while at Samba Kouni Hospital Centre. After giving birth to her first child in 2012, the midwife spoke to her about the benefits of family planning.

 “When my child started eating and drinking water, I went back to the family planning unit for more information on modern family planning methods. I chose this time the Pill (which I took) for two years and I thank God I never (had) any complications or adverse effects. After two years, I stopped (taking the Pill) before falling pregnant again.

“Today I have a child of nine months and I returned to the family planning service to get Implanon (a contraceptive implant), a new contraceptive method which is a thin stick about 4cm long by 2mm in diameter, and (is) implanted in the arm. It is active after 24 hours, and (lasts) for 3 years on average. I think it will go well and of course, I can remove it as soon as I want.”

Pregnancy should be by choice, not chance

Modern contraceptive methods are recommended to allow women and their partners to choose the number and timing of children, including the spacing of children to ensure healthier mothers.

When it comes to improving maternal health and reducing maternal deaths, the Comoros is one of the region’s success stories. The maternal mortality rate has decreased substantially in the past two decades – from 517 deaths per 100,000 live births in 1996, to 380 per 100,000 in 2003, and 172 per 100,000 in 2012.

This positive trend can be attributed to the following factors:

• At least 92 per cent of pregnant women have antenatal consultations with qualified staff; and at least 49 per cent make the recommended four antenatal visits;
• The rate of deliveries attended by qualified personnel is at 82 per cent, while 76 per cent of deliveries take place in hospitals.
• Sero-prevalence surveys, carried out up until 2012, show an HIV prevalence of less than 0.5 per cent, which places Comoros among the countries with a weak epidemic.
• Since the beginning of HIV surveillance, the country has invested in preventative actions. In 2014, the country adopted a national strategy to eliminate mother-to-child transmission of HIV, as well as a law establishing the rights of people living with HIV and their involvement in the national response.

Unmet need remains high

While many women wish to use family planning products, not all have access to them, however. According to the EDSC (Demographic and health survey with multiple indicators, MICS II 2012), the demand for family planning was estimated at 32 per cent. In other words, one third of women aged 15 to 49 years needs contraception but does not have access to it. However, around 14 per cent of all women have this need satisfied, accounting for only 41 per cent of the total demand.  

The use of modern contraceptive methods is higher in urban areas (21 per cent) than in rural areas (11 per cent). Ndzuwani Island, for instance, has a slightly higher prevalence (15 per cent) than Ngazidja (14 per cent) and Mwali (9 per cent).

Access to and use of family planning services is limited by inadequate awareness of the local context, the influence of religious and cultural beliefs, non-involvement of men in reproductive health programmes, and the level of education of users. The contraceptive prevalence rate decreased slightly from 21 per cent in 1996 to 19.4 per cent in 2012.

In the Comoros, UNFPA supplies contraceptives to the Ministry of Health, which in turn distributes them to hospitals and health centres across the country. These products are distributed free of charge to users who wish to adopt modern family planning methods.

UNFPA also supports the building of capacity among midwives in emergency obstetric and neonatal care, emergency obstetric care and maternal mortality, and the use of modern contraceptive technology.