Jeremy J. Keele and Dr. Samuel Rushforth, Botany and Range Sciences
Zanzibar is a tiny archipelago nation associated with the East African country of Tanzania. Thanks in part to an ORCA grant, I spent the summer of 2000 living with the villagers of Matemwe, on the archipelago’s principal island, Unguja. While in Matemwe, I studied the condition of women’s reproductive health in the village. I conducted both quantitative and qualitative analyses through in-depth interviews with over 50 men and women in the village.
As in other 3rd-World countries, many of the men, women, and children of Matemwe suffer from the woes and dilemmas inherently associated with living in an under-developed area. Many of the villagers are under-nourished and lack important dietary variety. The physical suffering faced by the village women, however, seemed to me to be unsurpassed and I was immediately drawn into studying their lives, their health, and their stories.
Most of my efforts were concentrated on contraception and government-instituted family planning programs. The great majority of Zanzibaris are practicing Muslim, and contraceptive methods not approved of in the Qu’ran (sacred written text of the Islamic faith) are frowned upon by most members of the society (not least of which include the religious leaders and most village men). The Qu’ran mentions and approves of two forms of contraception only: prolonged breastfeeding, and coitus interruptus (withdrawal in sexual intercourse before ejaculation), both very ineffective means of contraception.
Other contraceptive methods, employed very infrequently and mainly by the village women only, include abstinence, self-sterilization (natural plants and roots), and the calendar method (intercourse only on days of the menstrual month when conception is not possible). Other contraceptive methods, although in theory sponsored by the government, have had little success in remote villages such as Matemwe. Birth control pills and injections are used very little, with only 2 percent of village women using either method. Condom usage, a method depending mainly on the man alone, may be even less than 2 percent in remote Matemwe.
Severe and dangerous ramifications accompany such a lack of family planning. Many of the village women have more children than they can possibly care for. A substantial percentage of Matemwe’s women suffer from Anemia (roughly 10 percent of the population reported having this problem—and the actual figure must certainly be substantially higher due to unreported incidences) and other maladies associated with blood-loss at childbirth. Once the baby is born, the woman may be too overworked and undernourished to provide adequate breast-milk for the newborn, in addition to giving attention to all of her other children. Because of the societal taboos concerning Western contraceptives, and not breastfeeding beyond the first 2 or 3 months of her child’s life, a young mother is prone to quickly become pregnant again.
This village-wide fatigue of reproductive-aged women has deep and painful repercussions for the entire village, at all levels of the society. Because so many babies are being born so close to one another, many children go undernourished and simply are not provided for by the struggling mothers. The mother’s themselves are oftentimes too overworked, or tired, or simply struggling with the normal effects of pregnancy, to perform regular household chores (traditionally women’s work in this society), and the entire family suffers.
Efforts geared at educating village women and men have been made locally over the last two decades. A Maternal and Children’s Health (MCH) Clinic has been established in Matemwe and a team of 3 midwives attempt to educate the village concerning contraceptive methods and other issues of women’s health. I studied extensively with the midwives and was involved in some of their educative efforts. Much work in this area remains to be done. After 20 years, a dismal 2 percent of village women participate in any sort of family planning method sponsored by the clinic, and most of the 2 percent take their contraceptive pills and injections in secret, to avoid the harsh criticism and gossip of other villagers, as well as the oftentimes severe reaction of husbands.
Another challenge facing Matemwe women involves their changing breastfeeding habits. Many women, for various reasons including fatigue and malnourishment, have started supplementing their babies breast-milk diet at a very early age. In this manner, the women are unwittingly depriving their babies of vital nutrients and antibiotics found so abundantly in breast-milk. Other preconceived notions complicate the issue further, for it seems that most women feel that their milk is not enough sustenance for the baby and that the newborn’s diet should be supplemented with fish and other solid foods. This early weaning, therefore, has detrimental effects on the baby’s health and immune system.
Some women also prolong the commencement of breastfeeding until several days or even weeks after birth. They give the baby to sisters, mothers, or friends to feed until such a time as they feel well enough to feed the baby themselves. This adds to the problem, for the baby is deprived of an important first food source called colostrum, a protein-rich fluid which precedes mothers’ milk in the breast the first 2 or 3 days after childbirth. A surprising amount of a child’s resistance to disease (even throughout life) comes from those crucial first few days of ingesting colostrum.
The women of Matemwe and Zanzibar in general, face grave issues concerning their reproductive and general health. These issues should be addressed by the men and women of Matemwe, by local civic government, as well as national and international governments and organizations. It is an important step for us as members of a great global community to seek to understand the complex conditions found in less-developed societies, and attempt to raise awareness on such issues with others around us.
Unless the women of Matemwe themselves can be educated on such important issues as family planning and exclusive breastfeeding, they will continue to suffer grave health problems and their suffering will be felt in the entire community. Women in Zanzibar represent the cornerstone of the family organization. It is no surprise that when such an integral part of society is hampered by health problems and fatigue, then the entire society will suffer. Perhaps most prone to suffer as a consequence of the ailing health of women, are Matemwe’s children themselves— the future of Zanzibar and East Africa.