The long road to family planning
Taking the choice of contraception to the most hard-to-reach places
Growing up in the remote hills of western Tanzania, Irene Lyanzile never heard about family planning.
By 18 she was married and pregnant; now, aged 33, she has four children. But she wants to take charge of her family's future.
"I don’t want another child. I need to be able to take care of the children I already have," she says, cradling her 11-month-old baby in her arms.
Irene has come to a mobile family planning clinic that has arrived in her village for the day.
Run by Marie Stopes Tanzania with the support of UK aid, the team travels to Tanzania’s most hard-to-reach regions to bring women the choice of contraception.
Travelling by 4x4, the Marie Stopes team drives along bumpy tracks, past mud and thatch houses and grazing cattle, to reach the village of Idunda.
At the village health centre the team unpacks the vehicle. They set up an information stall outside featuring a display of leaflets about family planning, and inside the building they turn one of the rooms into a temporary clinic.
The local health centre has limited contraceptive supplies, usually condoms and the pills that frequently run out.
But Marie Stopes Tanzania's vehicle is fully stocked to broaden women's choice to other contraceptive methods such as implants, injections and intrauterine contraceptive devices.
In the last few days, outreach workers have announced the team's visit, and there is a steady stream of women arriving.
Among them is 26-year-old Veronica Boniface, a married mother of two who runs a small shop and restaurant.
She has been having the contraceptive injection since the birth of her second child.
While Veronica waits for a nurse, Marie Stopes driver and outreach worker James Ambrosse offers her advice.
"We move from place to place and I have seen what women go through without family planning," says James, who also runs counselling sessions for young people.
"You can tell many women cannot manage. When they come for services it makes me very happy that I've educated them."
Informing people about family planning and breaking down misconceptions is one of the major tasks the team faces.
"People think if you use family planning you won't be able to have a child, or you'll get sick and even die," says Perpetua Mligo, a local health worker.
"But as we continue educating people it reduces the number of people who believe in misconceptions."
Inside the clinic, Irene sits down with Marie Stopes Tanzania team leader Emma Shinyaka who explains how family planning works and what contraceptive methods she could choose.
Irene selects the IUCD, also known as the coil, and has it inserted straight away. Not long after she returns back home to her family, safe in the knowledge she can plan if and when she has another child.
UK aid also works in Tanzania with Population Services International, which takes its family planning expertise to public health centres.
In the coastal town of Bagamoyo, a group of women holding babies has gathered to hear nurses explain the family planning services on offer.
Each Population Services International nurse is accompanied by a public sector nurse, who learns specialist family planning knowledge from the partnership.
Thirty-year-old Wastala Saidi, a single mother of two, has come along to the clinic with her mother, Zuhura Mnyamani, 62, who had 10 children and gave birth for the first time when she was just 16 years old.
Wastala has started using the contraceptive implant following encouragement from her mother, who never had access to family planning services.
"When I had my children I didn't get an interval between pregnancies and I didn't always feel ready for another child. Now you can wait many years.
"These days it's not unusual for women to go to family planning clinics. That's a great improvement," says Zuhura.
Eighteen-year-old Happyness Daudi took matters into her own hands after several friends had to drop out of school after becoming pregnant.
She was 14 years old when she first got the contraceptive implant, after her aunt advised her to go to a family planning service when she heard Happyness had a boyfriend.
She uses the contraceptive implant so she only has to return to the clinic every few years.
"I want to be an entrepreneur and I wish I could get a loan so I could grow grapes in Dodoma that are exported for wine."
Family planning in Tanzania is important to empower people to shape their own lives and take good care of their family, which can help lift the country out of poverty.
The average number of children per woman in Tanzania is 5.2. With the majority of people living on less than $1.25 a day, many struggle to feed their families.
Around 7,900 women die in pregnancy and childbirth every year.
Surveys show that two thirds of Tanzanian women want to delay or completely stop having children.
However only one third of women use family planning because barriers get in the way, such as the costs of contraception, supplies running out and misconceptions about women who use it.
UK aid is supporting work to increase women's use of family planning in Tanzania to reduce maternal mortality and improve women's lives by giving them control over when and whether they have children.
Through our partners Marie Stopes Tanzania and Population Services International, we aim to provide family planning services to one million women and train 1,000 health care workers in Tanzania by 2019.
On 11 July 2017 the UK is hosting an international summit on family planning with the Bill & Melinda Gates Foundation and UNFPA.
The summit will bring together partners from around the world and aims to boost global commitments to increase access to family planning services for women and girls in the world's poorest countries.
For more information visit the summit website: http://summit2017.familyplanning2020.org
Words: Anna Dubuis/DFID. Visuals and interviews: Sheena Ariyapala/DFID.