PNG’s population is booming, but many women remain under intense pressure to have babies
Julie Waringi has been in the Mount Hagen Hospital in Papua New Guinea’s highlands for two weeks waiting to give birth to her sixth child.
After travelling several hours into town from her village, she went into false labour, but she decided it was safer to stay.
“I saw the setting here, they had doctors on call 24 hours. Because I’d had a lot of pregnancies, I decided to stay,” she said.
It was likely a wise decision: PNG has the highest maternal death rate in the Pacific. More than 2000 women die in child birth in Papua New Guinea each year.
After just two hours of labour she gave birth to a boy she named Isaac. Ms Waringi said it is sometimes hard providing for her children.
“It’s a bit hard. But it’s in the village, so there’s [plenty of] food and gardening. So it’s OK,” she said. Isaac is one of 6000 babies who are expected to be born at the Mount Hagen Hospital this year.
Big families are very common in Papua New Guinea, and children are seen as incredibly important because land is passed down through family lines.
On average each woman will have more than four children. In the highlands, the average is more than five.
As a result, the country’s population is booming, and there are serious concerns that services are not keeping up.
PNG’s government has acknowledged it needs to address population growth and it said family planning and contraception is part of that.
But in a country with strong religious and cultural beliefs, it is not always a simple task.
‘Whatever the men say, the women have to follow’
Papua New Guinea has a low rate of contraception use, with only 37 per cent of married women and 18 per cent of sexually active unmarried women on birth control.
Marie Stopes, a not-for-profit family planning service, runs outreach clinics across the country.
That in itself is a challenge; teams will sometimes have to drive, take a small plane, and then trek for hours to reach communities.
They are not always welcome and have been chased out of communities in the past.
Most of PNG has a strong patriarchal culture and women often have to get permission from their husbands to go on contraception. Cathy Tukne from Marie Stopes said one woman came to an outreach clinic wanting to go on contraception, but her husband came with guns to retrieve her.
“She cried when she left, and we couldn’t do anything,” she said. There are cases of women who have had a contraceptive implant put into their arms being brought back in to have it removed after their husbands have seen the scar. Sometimes, their husbands have cut it out themselves. Andy Henry, another Marie Stopes worker, said one woman got an IUD after her 14th child.
She opted for the device that is implanted in the uterus so that her husband would not know.
“In the community, people will usually say the man is the boss of the society. Women have to be under the man. Whatever the man says, the women have to follow,” Mr Henry said.
There also remains a promiscuity stigma for younger women using contraception.
Ms Tukne was forced to drop out of university when she became pregnant and her parents stopped supporting her.
“When I was doing grade seven, I had 13-year-old friends who were pregnant, who then got married. From that class of 15 girls, only five of us got to grade nine,” she said. Now the mother of two wants to see more women empowered to be able to make their own choices. But she concedes the tradition of the ‘bride price’, where the husband’s family gives money and pigs to the woman’s family to secure the marriage, can complicate family planning.
Women can also face pressure from their extended family and community about having children. “She can’t run anywhere because if she goes back to her people, they’ll say, ‘we got big money and pigs for you, you have to go back and submit to your husband’,” Ms Tukne said.
In the strongly Christian nation, religion can also be a deterrent, with some churches preaching against contraception and some pastors claiming the implants in particular were the work of the devil.
The man who walked for a week for a vasectomy
Many women in Papua New Guinea resist invasive procedures, making the most popular form of contraception an injection called Depo, but it only lasts three months. There are often issues with misinformation around the side effects of various contraception as well, including concerns about longterm impact on fertility.
But Mr Henry said things seem to be improving with education. “Most people have come to understand what family planning is,” he said.
While the Marie Stopes team regularly encounters resistance from men, they said they do have success when they can sit down with the husband and explain the benefits of family planning.
PNG has the highest take-up of non-surgical vasectomies amongst the countries Marie Stopes works in.
Forty-year-old Wayne Pinis trekked through the highlands to get the procedure.
“I walked for one whole week through the mountains to reach the nearest boat stop for crossing the Ramu River,” he said.
Once he crossed the river he could get to the highway and travel to their clinic.
After having seven children he said getting a vasectomy was “a dream come true” as it was the only way for him and his wife to “complete our family”.
“When my wife and I had three children we went to the nearest health centre, which is two days’ walk and she got Depo, but due to the remoteness of our village she did not come back for the repeat dose, which resulted in the other four pregnancies,” he said.
PNG has eight million people — or does it?
At the current rate of growth, Papua New Guinea’s population is expected to double every 30 years. The country is currently said to have a population of eight million people, but no-one knows if that is actually true.
It has been eight years since a census was conducted, and it was deemed a failure.
A new census will be carried out next year.
“I intend to get very, very clean data of the highest integrity coming out from our population census next year,” Prime Minister James Marape has said. Government ministers say accurate data will be vital for planning and development.
The Mount Hagen Hospital in the highlands has seen a 40 per cent increase in demand in the past three years, in part because of population growth.
Provincial Health Authority chief executive David Vorst said despite the hard work of Marie Stopes, the impact of family planning in the region was “marginal”.
“The numbers that are using this service have grown dramatically in those years and there’s no evidence to suggest that the birth rate is declining,” he said.
“Indeed the official figures, we believe, understate the population and certainly understates the birth rate in the highlands.”