In much of the Western world, I feel that it’s relatively easy to access family planning advice: you can ask your doctor, your school nurse or pharmacist next door, or even just pop online.
In Lesotho, it’s not quite that simple. To find out why and what Médecins Sans Frontières/Doctors Without Borders (MSF) is doing to improve the situation, I met some patients at an MSF-supported project in the small university town of Roma, Lesotho.
MSF’s family planning project
It’s just past 9 am and Roma is bustling; streams of students are walking to university, road workers are shouting at a taxi driver and countless stalls are doing a roaring trade. The smell is intoxicating and the view of the hills in the distance is stunning.
I walk past the mayhem, turn left up a dirt track and arrive at St Joseph’s District Hospital, where MSF’s pop-up family planning clinic is literally ‘popping up’ in the form of tiny marquees like you’d have in your garden. It’s here once a week and there’s already a queue of at least 50 women.
Within minutes I start chatting to Makeneuoe Khosi who tells me she left home at five am this morning to get here, and arrived at 8 am. “It’s the only service like this near me,” she explains.
I find out she has two children and didn’t previously know there was such a thing as birth control. “This service will help a lot of women and allow them to have babies only when they want to,” she says.
Lack of access to contraceptives
In Lesotho only 47 percent of people take contraceptives, and this falls to 22 percent for those in rural areas. I discover that family planning is hard to obtain.
It is often costly, which acts as another barrier, and while the Christian Health Association of Lesotho (CHAL) refuses to stock contraceptives, this MSF service is available just around the corner and it is free.
Next I meet Matsokolo Phajoli, who has five children. “I don’t want any more children,” she tells me. “Had this service been available I would definitely have had fewer children, especially as I also have a heart condition.” She’s excited to tell her whole family about the service, especially the younger members.
In a country where the use of contraceptives is low, many of the women who are admitted to hospital are there because of attempted abortions. Post-abortion complication is the second highest cause of maternal mortality, in a country where termination of pregnancy is illegal.
Cultural barriers to family planning
The problem is compounded by most husbands in Lesotho being against any form of birth control – especially if they haven’t had a son – and that Lesotho is a devout Catholic country. Although Lesotho has the second highest HIV prevalence rate in the world, condoms are a rarity.
In Semongkong, a very rural area where MSF has a regular project, construction workers on the side of the road often stop the organisation's passing cars, begging for condoms.
As for long-lasting contraceptive methods for women such as the pill, intrauterine devices (IUD) or long-lasting injectable contraceptive, finding them often enough to ensure regular use is challenging.
“I already have four children, my husband wants more. He wants a son,” says Matabello Tsoeu. “I had to take two taxis to get here; my husband thinks I’m visiting a relative.”
For the next few minutes she talks passionately about how these services should be everywhere: “They’d help so many women, and possibly educate the men too.”
Taking control
Matabello’s remarks bring us nicely back to where we are. In this university town you can see the dynamism of the country all in one small snap-shot. It’s great to see and I’m not surprised to learn that literacy rates are at 80 percent, one of the highest in Africa.
Meisi Tikiso simply tells me: “I have one child and want to stop now so that I can accomplish something in my life first.”
Throughout the day I meet more women, all with their own story, but the central theme remains; they just want a little control, whether they choose to have children or not, something I sense this clinic gives them. They’re just eager to share it with everyone, and we should be too.
