Delivering Birth Spacing Services to Somaliland’s Doorstep

By Corinne White, Program Coordinator, East Africa, PSI

In Somaliland, “Kala-koriye” is all PSI community health workers have to say to be recognized when conducting home visits to discuss birth spacing options.

This Somalilander term for birth spacing is synonymous with PSI’s delicate work around this sensitive issue.

“Some of our workers have faced a lot of adversity from their relatives,” points out Ahmed Yoonis, PSI/Somaliland’s Health Services and Quality Assurance Manager. “They say things like ‘why are you working with this organization that wants to control our population? You are sinning against Allah. You will go to hell.’”

In a country where large families are the norm, only 9.8 percent of women use any method of contraception, traditional or modern. For Yoonis, it’s proven crucial to advocate that women should space birth by at least 24 months, rather than suggesting that women have fewer children. PSI only recently received government approval in October 2016 to begin inserting implants.

Recently, Somaliland’s government has placed unprecedented emphasis on birth spacing and family planning in national commitments and plans. This includes fulfilling the country’s ambitious FP2020 goal of attaining nine percent modern contraceptive prevalence rate by the year 2020.

Yoonis, who recently completed his postgraduate studies in public health, grew up in Hargeisa, the capital city, with five siblings, sharing a home with his father’s second wife and two half-siblings. He considers himself lucky that his parents were able to practice birth spacing, which some husbands refuse. As Yoonis remarks, “big families are prestigious, and can even yield political advantages.”

As he spoke, the evening call to prayer echoed in the background, a reminder of the religious influence in the country. About the time Yoonis’ work around birth spacing began, some religious leaders used Friday congregational prayers to accuse PSI of trying to control the population, and a few local newspapers shared this sentiment in editorials. However, this did not keep the kala-koriye message from spreading.

“Somalis, they talk a lot; they know each other,” jokes Yoonis. “It’s a strongly bonded community. Maybe that’s why we have survived through the years of conflict.”

PSI’s work is paying off. The modern contraceptive prevalence rate in Somaliland has increased from 4.3% to 5.5% since the project began. This is thanks to strong training practices, the creation of social franchises for pharmacies, and interpersonal and mass media communication programs to promote birth spacing.

If the community health workers face misconceptions or adversity during a home visit – some women believe methods like implants or oral contraceptives will cause babies to be born with preternatural sins – Yoonis or another member of the PSI team will accompany them to the household the next day.

“It’s a kind of environment where one completes the other,” he said.

Banner photo: © Population Services International / Banner Photo by: Sebastiano Rossi