This paper provides a case study of the politics and practices of family planning (FP) in the province of South Kivu in the Democratic Republic of the Congo (DRC). It is underpinned by research exploring the use (and non-use) of family planning services (FPSs) by women and men of reproductive age and young people, via 40 face-to-face one-to-one interviews and six focus-group discussions, along with five focus-group discussions with healthcare employees in various health centres and Panzi Hospital in Bukavu city. Thirty-one qualitative face-to-face interviews and meetings were conducted with policymakers and service providers from the government, churches and international agencies.
The study finds that family life is changing rapidly in eastern DRC. Monogamy has become a norm in marital relationships and polygamy is rarely found in men over 50 years old. Families of research participants were smaller in size than their parents’ generation. The study has also discovered a high number of first unwanted pregnancies happening out of wedlock, reflecting a lack of contraceptive use in non-marital sexual relations. The major obstacle to FP is thus related to societal norms rather than state fragility, the paper argues.
Despite positive efforts by the provincial government, this research finds a number of problems with the governance of FP, including issues with payment of health providers and community liaison officers (CLOs). Together, these have resulted in a mechanical FP system; government health facilities are geared towards maximising the adoption of FP, which is sometimes unduly enforced. Churches tend to better understand the importance of couples’ free choice more than CLOs and some healthcare employees, but continue to convey a bias towards natural methods.
The paper concludes with recommended actions donor, political and practitioner audiences could take to improve the services and practices of family planning in DRC.