Monday, 10 March 2014

Providing a choice for an alternative future

As described in the previous post, the Vezo people are facing high social vulnerability as a result of poverty, physical isolation and complete dependence on natural resources. I also mentioned that their reproduction rate is high, almost 7 children/woman (as opposed to the national average, which is 4.6 children/woman). At the same time, 1 in 11 children die before the age of 5, from causes including malaria, diarrhea or malnoutrition. Additionally, in this region, vaccination rates are extremely low.

Blue Ventures’ community health programme, Safidy first began with family planning and then extended to ante- and postnatal care, and to hygene education. The programme is now 6 years old, has trained over 30 “community based distributors” (CBDs), local women who serve as health focal points in their respective villages and provide some of the above services. Family planning methods include condoms, oral and injectible contraceptives, and a few of the CBDs are even certified to provide Intrauterine contraceptive Devices (IUDs). Safidy also has a long lasting collaboration with the Marie Stopes International on long lasting contraceptives.

Safidy does not set itself goals or targets in terms of the number of people using its services- its overall objective is to provide access to services within a 5 km distance.

People in Andava start to have sexual relations at a very young age (some girls are pregnant already around the age of 13-15). I was told that some young girls have a child before getting married- to demonstrate that they are fertile. This is also a sort of “safety measure” for women, because in case of divorce this child would belong to them, unlike the ones she has with her husband, for which he will be the exclusive guardian.

Safidy has set several objectives for this year and one of them is to increasingly support youth and make the family planning services more "youth-friendly".

T-shirts have proven a very efficient way to raise awareness about the benefits of using contraceptives, and communicate other health messages. During the last two weeks I was involved in designing T-shirts with the following messages:
  • ‘My life is sweet therefore I won’t forget this condom.'
  • ‘The choice I make today will help my future.’
  • 'Clean hands make you healthy and wonderful’.
A local artist, Nady prepared three posters which are around the issues of exclusive breastfeeding, condom use and the importance of contraceptives for schoolgirls. Once all these designs were prepared, we gathered three focus groups (adults, teenage girls, teenage boys) and discussed with them in detail about the designs- whether the message comes accross, whether the images speak to them and to see if we should change anything. It was a fascinating experience for me, because their responses revealed a lot about the culture and their value system.

I enjoyed the discussion with the teenage girls the most- they were giggling a lot (like any group of teenage girls I guess ;-) and were giving very good responses. It was clear that they properly thought about our questions and debated among themselves. Surprisingly, despite the positive feedack from all three focus groups, one of our designs stirred quite a bit of water in the village.
It was a photo with the first message (‘My life is sweet therefore I won’t forget this condom.’) showing a young couple, hugging one another, with the man holding up a condom. Both of them were smiling and looked relaxed. I went to take the picture with a Malagasy colleague and he asked them whether this would be alright. Circumstances led us to work with people who are not a couple in real life, but they didn’t seem to mind giving their faces to such a campaign. Public opinion in the village thought otherwise and a few days later we heard that there is quite a bit of resentment towards these two people and even some rumours that the woman might be a sex worker... We immediately decided to pull back the photo and reconstruct the image with local Safidy colleagues- the community is aware of the work they do and will hopefully not invent unfounded stories about them!

I can’t wait to have the T-shirts ready, I will be thrilled to see them on people. During the women’s day celebrations in a nearby village, dozens of people were wearing Safidy shirts- both with the handwashing and the family planning messages. It makes me smile to see men in bright pink shirts encouraging condom use and I wonder how many of the people I know back home would be open-minded enough to do the same... ;-)

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