Republicans in Congress have gone on the warpath this budget season against family planning programs at home and abroad. To illustrate the stakes, let me share a Mother’s Day story about a pregnant 30-year-old Somali woman named Hinda Hassan.
Ms. Hassan lived in a village near this remote town of Baligubadle in Somaliland (a self-ruling enclave carved from Somalia). She never used family planning, for none is available within several days’ walk. When her eighth child was still an infant, she became pregnant again.
“I was happy when she became pregnant,” said her husband, Muhammad Isse, who tends a herd of 13 camels with his family. “I was very happy, because I had faith in God.”
When Ms. Hassan went into labor, she was looked after by two traditional birth attendants, both of them unschooled, untrained and unequipped. “We try to wash our hands with soap and water,” one of them, Amina Ahmed, told me. “But sometimes we don’t have soap. And if there is no water, we rub our hands in the sand to clean them.”
Ms. Hassan’s labor did not go well. After 11 hours, her husband paid a man with a pickup truck $50 to drive her three hours to the clinic here in Baligubadle. The clinic couldn’t help Ms. Hassan and sent her on another two-and-a-half-hour bone-rattling drive in the back of the pickup to the Somaliland capital of Hargeisa. Shortly after Ms. Hassan arrived at the Edna Adan Maternity Hospital (mentioned in my last column), she died.
Her death was infuriatingly unnecessary — and I felt doubly saddened when I met some of her eight orphans.
There are any number of ways that Ms. Hassan’s life could have been saved. She had an off-the-charts hemoglobin level of just 4, reflecting a stunning level of anemia. A trained midwife could have given her a deworming pill and iron supplements early in the pregnancy, addressing that anemia and strengthening her. Later, Ms. Hassan developed a complication called eclampsia that would have been detected if she had had pre-natal care.
Yet maybe the simplest way to save her life would have been contraception. If Somali women had half as many pregnancies (they now average six births), there would be only half as many maternal deaths. But modern contraception doesn’t exist in this part of Somaliland.
“The only method of family planning we have is breast-feeding,” said Nimo Abdi, the midwife at the clinic here, noting that breast-feeding reduces the likelihood of a new pregnancy. Ms. Abdi thinks that some local people would accept modern contraceptives if they were available.
“If I had injectables and condoms, people would accept them,” she said. “They would want them.”
I wonder if that isn’t a bit optimistic; in a place like this, family planning requires much more than just handing out contraceptives. Ms. Hassan’s husband told me that he had never heard of contraception, and he sounded wary of the idea.
Many people in poor countries want large families, partly to ensure that some will survive despite high death rates. Or a woman may distrust contraceptives or fear her husband’s reaction if she is caught using them.
By United Nations estimates, 215 million women worldwide have an “unmet need” for family planning, meaning they don’t want to become pregnant but are not using effective contraception. The Guttmacher Institute, a widely respected research organization, estimates that if all the unmet need for contraception were met, the result would be 94,000 fewer women dying of pregnancy complications each year, and almost 25 million fewer abortions each year.
Greater access to birth control would also help check the world population, which the United Nations warned a few days ago is rising more quickly than expected. The U.N. now projects the total population in 2100 will be 10.1 billion.
Yet this year, Republicans in Congress have been trying to slash investments in family planning. A budget compromise last month cut international family planning spending by 5 percent, but some Republicans are expected to seek much bigger cuts in future years.
If they succeed, the consequences will be felt in places like this remote Somali town. Women won’t get access to contraceptives, and the parade of unwanted pregnancies, abortions, fistulas, and mothers dying in childbirth will continue.
Ah, but there was one Republican-sponsored initiative for family planning in Congress this year. It provided contraception without conditions — for wild horses in the American West. It passed on a voice vote.
Maybe on Mother’s Day, we could acknowledge that family planning is just as essential for humans as for horses.