Global Gag Rule, Reproductive Health Supplies

Mind the Gap: Contraceptive Stockouts in Zambia

Our car has absolutely no
business driving this rocky (small boulders, really) dirt/mud road—loaded down
with four passengers, no less. A sagging
bridge up ahead taunts us to attempt the crossing. But we make it across in order to reach the
Palabana district rural health center, surrounded by fields of corn and
pumpkins, with a few tethered goats thrown in for good measure. A mere 45 kilometers from downtown Lusaka, we
could be in far off Western Province in this beautiful rural landscape.

7.jpgWe arrive at the center
and are led to a circle of benches under the generous shade of the large acacia
tree. We’re meeting with assembled village leaders and health workers to
discuss the loss of the five-year sexual and reproductive health (SRH) project
that ended in 2006.

With support from
the Planned Parenthood Association
of Zambia
(PPAZ), the center recruited and trained seven community-based
distributors (CBDs) and six youth peer educators—male and female—to do
outreach, provide contraceptives and condoms, as well as referrals to Palabana
center for sexually transmitted infections (STIs), ante- and post-natal care
and other health services. The
incidence of infant and maternal death dropped significantly, they tell us, and
the benefits of family planning were crystal clear to everyone.

“When PPAZ was here, we
never ran out of supplies and our volunteers had working bicycles to reach
families living farther away,” reported one village elder. The government has not maintained the level
of support that PPAZ gave us. Our
volunteers are not as motivated and several have drifted away.”

We soon discover that Palabana
center has no contraceptives, save male and female condoms. They ran out of oral contraceptive pills—the
most popular method—two months ago. Women
are frustrated they can’t get their method of choice, we’re told. To make matters worse, Depo Provera, the
injectable contraceptive, was pulled from the shelves
six weeks ago by the Ministry of Health, following a lab technician’s
sensational report that a vial tested positive for HIV when he ran it through a
rapid HIV test. (Independent tests are ongoing and it is expected that the
Minister of Health will soon lift the ban. 
Meanwhile, one has to wonder whether the damage done can be
reversed. Anecdotes of women and health
care workers saying they won’t use Depo again are common.)

Later that day we travel
to the Kazimva rural health center on the opposite side of town. The story is much the same. Just 12 kilometers beyond city limits—and on a
far shorter dirt road where vestiges of this year’s flooding
are apparent—the health center is also out of contraceptives. We meet with the remaining CBD agents, peer
educators and the community’s traditional birth attendant who report that they
ran out of contraceptive pills more than a month ago.


“We’ve had a communication
breakdown with the district since PPAZ support ended. Our orders for pills and other contraceptives
go unanswered and no one from the district has come to oversee our efforts,”
comments a spry older woman wearing an oversized CBD t-shirt over her
traditional Zambian chitenge. “We lost
several volunteers when supplies began running out. It’s hard to continue doing this work when we
have little to offer women and men. We
have condoms but we ration them as we’re worried they, too, will run out. Couples are using condoms, but they complain
about the smell. We’re seeing a rise in
unplanned pregnancies in our community.”

One volunteer says she’s
worried the accusations that Depo is laced with HIV are true, that it could be
an American scheme to deliberately infect Africans with HIV/AIDS. The PPAZ program manager, George, who’s
accompanied us here, assures her these allegations are false, that Depo is fine,
rapid HIV tests are designed for human blood, and that the Ministry of Health
will soon reverse the temporary ban. She
smiles and nods in response, yet it’s hard to tell whether she’s really

Overall, during our week
looking at the impact of U.S. assistance and policy in Zambia, we’ve heard
consistently about contraceptive shortages around the country, in both rural
and peri-urban communities as illustrated above. Last year, Zambia experienced three distinct stockouts
of oral contraceptive pills. Many
providers and advocates argue that not enough contraceptive supplies are coming
into Zambia to meet growing demand. Also, they point out, Zambia’s procurement and logistics system for getting
essential drugs and supplies is weak. USAID/Zambia is now investing heavily in this side of the equation
(through its DELIVER
and SCMS projects) and hopefully will
coordinate with the government and other donor agencies to boost contraceptive
shipments in the years ahead.

NOTE: The Planned Parenthood Association of Zambia
(PPAZ), the leading SRH provider in the country, refused the terms of the Global Gag Rule (GGR) in 2001 and immediately
felt the impact from the loss of U.S. assistance and donated contraceptives. PPAZ has had to curtail its programs
significantly and has undergone a major downsizing since the GGR. PPAZ’s extensive CBD network—notably in
Eastern Province—collapsed and neither the government nor another NGO has the
capacity to fill this role. Their
popular “Success” condom marketed to Zambia’s youthful population, no longer
exists. Please see PAI’s documentary, Access
Denied: U.S. Family Planning Restrictions in Zambia
for more background
on GGR impact in Zambia.


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