The concept of family planning in Tanzania is not new. What is new are the contraceptive methods which are given as part and parcel of the Maternal and Child Health services in a medical setting. Child spacing, as we call it in Tanzania, has been practised from time immemorial throughout the length and breadth of Tanzania. Thus, traditional child spacing was practised to enable mothers to breast feed their babies over a long period of time (say, two years and over). This practice of breastfeeding was underpinned by the belief that if a mother conceived before her previous baby was two years old, the baby’s growth would be deterred and the mother’s health would be endangered. Breastfeeding was advocated among all the tribes because it was religiously believed that if a child continued to breastfeed when its mother was expecting another baby before the baby had been weaned, the baby was likely to fall victim to some incurable disease. Such beliefs were responsible for the evolution of instructions in child spacing knowledge and personal hygiene among many of the tribes before and after young people got married.
Most of the child spacing practice was done through abstinence among couples. In polygamous marriages, the gap between children was very often even wider. The traditional child spacing practice still exists among some of the rural population. This, in a way, has greatly helped the acceptance of modern child spacing practice. Thus, the older generation looks at UMATI (Chama cha Uzazi na Malezi Bora cha Tanzania), the Family Planning Association, as a movement which has been established to revive Tanzania’s old but good traditional practices.
Initially, the Family Planning Association of Tanzania, which is now known as UMATI, was started by a few individuals interested in the wellbeing of mothers and children and the nation as a whole. Among them were doctors, housewives and nurses. It was started as an Association for Dar es Salaam. It was therefore known as the Family Planning Association of Dar es Salaam until 1967 when the association was registered as a national organization. The Association was charged with the responsibility of supplying contraceptive materials and of providing family planning clinical services in voluntary agency hospitals and clinics. Today child spacing services are available to all women who attend MCH clinics throughout the country.
UMATI is a member of the International Planned Parenthood Federation (I.P.P.F.). Apart from subscriptions from its members and fund-raising efforts, UMATI receives most of its assistance from IPPF. As a voluntary organization UMATI depends on donations and voluntary support for the success of its activities. Much of what has been achieved is due to the voluntary spirit of many individuals and organizations such as IPPF and OXFAM. The Ministry of Health directive, issued in 1969 to the Regional Medical Officers requesting them to render child spacing services as part of Maternal and Child Health services, accelerated the demand for both contraceptive services and training of personnel to provide services. Most of the clinical services became the responsibility of the hospitals and clinics directly receiving both supplies and advice. This expansion of work brought about a new demand for skilled workers to manage child spacing clinics. The Association, consequently, found itself responsible for starting a training programme for paramedical personnel from government and voluntary hospitals and for the association’s own needs. The training programme was set up in 1971. Initially, it was only possible to conduct a two weeks in-service training course for nurse/midwives and medical assistants. Now such training takes four weeks, and only a limited number of trainees (9-12) can be taken at a time because of the limited facilities for theory and practical training activities. To train their students in these skills the Medical school of the University of Dar es Salaam and the School of Nursing (in Dar es Salaam) make use of the Association’s training programme facilities. Once a year, the Association conducts a training course for tutors from nursing schools in the country. The Association also works closely with the Institute of Social Welfare in training matters.
The extension of family planning work has been possible through the involvement of government and voluntary agencies in clinical services. The Association too has found it necessary to extend its educational programme to the remotest areas possible. This has been one of the main objectives since 1972 when the Annual General Meeting of the Association stressed the importance of the element of responsible parenthood. At that meeting the role of the Association was expanded to include spacing of births and caring of children, thus advocating and stressing the responsible parenthood element as well. Since then the name of the Association, Chama cha Uzazi Bora, had to be changed to Chama cha Uzazi na Malezi Bora. In implementing and stressing responsible parenthood other aspects had to be included in the day-to-day activities of the Association’s staff as in the teaching/training material. Advice on nutrition, breast feeding, immunization, personal hygiene, family welfare, sanitation and environmental care became important parts of the teaching of child spacing work in Tanzania. An integrated approach to family planning is therefore in practice in Tanzania.
In order-to create awareness throughout the country, the Association, over the past six years, worked hard to form branches all over the country to enrol volunteers (since the Association cannot afford to recruit enough paid staff) and supporters at grassroot level. Until December, 1977, there were about 60 district centres and more than 300 village branches. The Association has 22 UMATI educators (Walimu wa UMATI) in all the regions. The formation of branches has also created an understanding and appreciation of UMATI’s activities among the local communities as well as leaders at regional and national levels. Leaders and members at UMATI district, regional and national levels act as good ambassadors of the Association. These volunteers are supported by full-time UMATI educators in the regions. The educators conduct educational programmes as well as coordinating UMATI activities with those of the government, the party and other voluntary agencies. Much of the Association’s work very much depends on the hard work and dedication of volunteers at all levels as well as the support and understanding and appreciation by both the government and the party.
In 1973, UMATI went through a critical but important phase of development when it was severely attacked by the local press through ignorance. The Association was eventually saved by the then party’s (TANU) pronouncement at its National Executive meeting in September, 1973, when the party issued a directive that the work that was being carried out by UMATI was very important for the development of the nation and that it should be encouraged. The Ministry of Health was called upon by the party to help the Association in its endeavours as much as possible. Thus, following this party pronouncement in 1973, more and more of the child spacing clinical services became the responsibility of the Ministry of Health activities. For this reason child spacing services now are seen as vital services for mothers at their daily comprehensive MCH clinics. As stated earlier, after the government inclusion of child spacing services in their MCH programme since 1974, UMATI expanded its activities and acquired a new role in one way or the other by putting emphasis on education and training. The following are the main activities of UMATI:
(i) Information and Education to the general public; through seminars, printed material (leaflets, posters, pamphlets)radio and films.
(ii) Training of medical and paramedical personnel.
(iii) Distribution of contraceptive supplies and equipment (until such time that the government is able to get its own supplies).
Through its educators in the regions, UMATI plays an active part in training Maternal and Child Health Aids in the 18 national training centres of the Ministry of Health established throughout the country. The training is given to primary school leavers and lasts 18 months. The training instructions include antenatal care, immunization, family planning, nutrition evaluation, general health education, simple deliveries, malaria chemo-suppression and simple treatment of disease. The main objective of this kind of training is to equip trainees with knowledge and skill that will enable them to provide basic health primary care in villages. In this way UMATI’s work is a necessary input in rural development which is Tanzania’s main development strategy in her war against poverty, disease and ignorance among her people. UMATI is therefore playing her part in our national development effort.
UMATI provides services that are not readily available and therefore supplements and catalyses the nation’s effort to eradicate these important enemies of the nation which militate against the improvement of the quality of life among our people. UMATI, therefore, is seen as an important agent for our national socio-economic development effort.
Christina M. Nsekela