KISANGANI, DEMOCRATIC REPUBLIC OF CONGO — Natacha Itondo Amunga, 33, is watching TV in her living room, surrounded by her three children, ages 6, 4 and 2.
Having been married for eight years, Amunga says it’s a miracle that she has only had three children.
She grew up in a family of 11 children and remembers the struggles of going to bed hungry because her parents had too many mouths to feed. So, when her first daughter was born, she and her husband talked to her gynecologist about using contraceptives to lengthen the time between pregnancies.
Family planning, she says, is not common in Kisangani.
“It had a profound effect on me; it has helped me and my husband by making it possible for us to take care of our family properly,” Amunga says of the birth-control shots she received.
About eight years ago, local doctors say, access to contraceptives began to increase in Kisangani, the capital of Tshopo province and one of DRC’s largest cities.
But in recent years, contraception has become harder to come by here. Clinics with previously reliable stocks cite different reasons for the current limits. Access is even more complicated for unmarried women, because local custom prioritizes access for married women whose husbands support their access to contraceptives. Some local clinics do hand out condoms, but women say they often can’t negotiate condom use with husbands or partners. And now more women are citing adverse health consequences after buying fake or expired contraceptives at local pharmacies.
A partnership between the Ministry of Health and the Association de Santé Familiale (ASF), a nonprofit health association, began distributing contraceptives here in 2012 to promote family planning. But the partnership ended in 2015, when funding dried up.
Alain Fembo, 48, a program officer at ASF, says the group distributed 2,000 cartons of contraceptives to each health zone, a group of hospitals or clinics serving one geographic area, every year between 2012 and 2015.
Fembo says they are now scraping by with a small fraction of the previous budget and no other sources for contraceptives. ASF today provides a total of 200 cartons of contraceptives to surrounding health zones. Unmarried women and women whose husbands do not support the use of birth control have faced the consequences.
While there is no law that requires a woman to have her husband’s permission to use birth control, nor any regulation that formally prioritizes married women, nurses and doctors in local hospitals and clinics are responsible for determining who receives their limited supplies.
Julienne Asani Melamala, 35, a mother of five, says she wasn’t able to get a prescription from a clinic, and her husband didn’t want her using birth control.
“My husband never wanted me on birth control, but given the difficult situation we’re experiencing today, I can’t continue to give birth,” Melamala says. “To find a way, and make it happen, I chose to stop by my neighborhood pharmacy and get contraceptives.”
She bought expired, over-the-counter birth-control pills from a local pharmacy and experienced adverse health effects, she says.
“I picked up contraception from my neighborhood pharmacy and ended up having problems,” she says. “I’ve had stomachaches since I used the contraceptives, but I had no idea what was going on.”
Common side effects of expired birth control – generally tablets that are marked as oral contraceptives – include nausea and bacterial infection. And, of course, they don’t work.
Because she is unmarried, Dorcas Amuri, a 28-year-old entrepreneur, was denied access to contraception at a hospital.
“I’m not legally married, and I have a friend,” she says. “But giving birth is not part of my plans. Raising children can stand in the way of my business.”
After purchasing pills labeled as contraceptives from several local pharmacies, she began experiencing a variety of problems, from cramping to diarrhea.
Pharmacy owners would not speak on the record. But Kombozi, a local pharmacy employee who asked to be referred to only by his first name, says they sell cheap oral contraceptives from India. He says he is unaware of any complaints of side effects.
But with local hospitals doling out limited supplies mostly to married women, unmarried women say they rely on pharmacies.
Léonie Lisalama, a 31-year-old waitress at a nightclub, says that, because she’s unmarried, she can’t get contraception at any hospital or clinic in town.
“If I choose to go to the hospital, I know they won’t give me anything, just because I’m unmarried,” she says. “And every time I need contraceptives, I turn to pharmacies, because they’re the easiest places to obtain contraceptives anytime I want.”
ASF has not secured any other private donations and is hoping the national government will step in to help.
“Today, we’re unable to continue to operate as we’ve always done,” Fembo says. “We need support from the government, and this is a matter of urgency.”
Ndahayo Sylvestre, GPJ, translated the article from French.