Interview with Makur Kariom, Director of Reproductive Health for South Sudan
JUBA, Jul 11 2008 (IPS) – With few roads and almost no health and education infrastructure for the estimated 10 million people of South Sudan an April census has yet to release any results health care workers have an enormous task ahead of them.
Competing priorities and cultural resistance are slowing down adoption of family planning techniques Credit: Neil Thomas/IRIN
South Sudan experienced 50 years of war broken by just one 10 year period of peace, before the 2005 Comprehensive Peace Agreement gave southern rebels control over administration of a semi-autonomous region. The government of South Sudan, Africa s youngest, also won control of 50 percent of all oil revenues generated in the south: around $1.5 billion a year.
Almost all of the government s money is spent maintaining an overblown civil service and a massive former volunteer army that U.N. officials have guessed stands at around 160,000. The peace deal is fragile and constant negotiating with Khartoum over its implementation swallows vast amounts of political energy.
Bringing in almost completely new ideas like family planning and the structures needed to make it work seems almost impossible.
But with South Sudan facing the world s worst maternal mortality rate of 2,054 per every 100,000 births one in fifty women die the pressure is on to find solutions.
Family planning would reduce unwanted pregnancies, often the most dangerous for women, and so ultimately would have an impact on the number of women dying giving birth, according to the director of reproductive health for Southern Sudan, Makur Kariom.
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IPS reporter Skye Wheeler talked to him about the challenges he expects.
IPS: Where is the Government of Southern Sudan on family planning now?
Makur Kariom: There is actually no policy on the ground at the moment. In the draft policy document on reproductive health in South Sudan there is mention of family planning as one of the important issues the government must address. In the meantime we try to seize any opportunity to talk to people mothers and parents about it.
But we want to see contraceptives fully integrated into the health system by the end of this coming year. It will be a challenge.
IPS: What s the level understanding of family planning now in the South?
MK: The prevalence of contraceptives in the South is under one percent according to the (joint U.N. government) South Sudan Household Survey. From that figure you can clearly see how low the uptake is. This is because of a lack of adequate knowledge about the importance of contraception and low availability, and the lack of qualified staff who can impart knowledge required for an informed decision.
If you go to most of the outreach primary health care centers in the villages, you will find piles of condoms in the stores. Nobody is using them.
There are cultural issues involved. People think of contraceptives as to do with immorality and prostitution. Some people believe the use of these is something imported from white people trying to reduce our population and some people believe that using condoms you can not enjoy sex.
But without family planning we will not be able to curb our high maternal mortality rate.
IPS: There is a political issue with population, in South Sudan, isn t there?
MK: Our people believe that the more children you have the stronger you get the more respect you will get in the family and in society. It goes back to the nature of our tribes, particularly the Nilotic (primarily pastoral) tribes. If you are more in number, no one will try to steal your cattle or fight you. So that element is among our people and it was reinforced by the war.
Having lost over 2 million people means our population has gone down and we need to compensate. The threat of war is always there with the north, we will not be able to face that threat unless we have many strong men to fight.
Personally I think, we should produce fewer children and over time the number will increase and here you will have achieved a high population growth and a healthy population at the same time.
It s not easy to sell that idea to the population but I think over time they will buy it. People are already beginning to feel the burden economically of having one person with a new government job and a whole family of about 20 people dependent on them.
As a government we re not telling people to have smaller families. It is easier to tell them whether you want more or few children that s your choice, but try to plan and to use the little resources we have in the wisest way.
IPS: Where can you start, bearing in mind that 92 percent of Southern women are illiterate?
MK: You begin at the health facilities. That s the best point to talk to people. And also we will use important personalities in the communities like chiefs and traditional midwives, people trusted by the people. We will educate these people and then they can pass it on.
IPS: What is the good news?
Most of the contraceptives, from oral contraceptives to barrier methods, are available free of charge in hospitals and some clinics and health centers and can also be purchased from the market.
We don t have figures but according to HIV people there s been an increase on the market of condoms.
And the outreach is going on very well in the army. They are taking it very seriously. They talk about it on their daily parades.
