MPH and Bixby Doctoral Fellow | Luanda Province, Angola | Summer 2012
“…she had very little formal training in family planning, and none in health education…”
I spent the summer in Angola with my classmate Aidan, interviewing women about their decisions related to childbearing and contraception. One of the broader goals of that project is to improve access to family planning to women in Luanda Province, an area where doctors and other highly skilled health providers are scarce and where community-based provision of family planning has great potential. While we were there, Aidan and I learned a lot about the important role that community-level health workers can play in delivering family planning counseling and services.
We were assisted by the field team of our local NGO partners, led by a nurse named Filomena. Filomena is a devout Christian and has been working as a family planning nurse for decades. She sees access to family planning as an issue of public health and human rights, and she’s been a proud supporter of expanding access to these services in her country. On one of our first outings with Filomena, we attended a women’s meeting at a local church. The church group had asked Filomena to give a talk about the benefits of modern family planning and Aidan and I jumped at the chance to see her in action.
Filomena began her presentation in a way that seemed truly unique to me: she put the focus squarely on the group’s religious beliefs, emphasizing that there was no contradiction between those beliefs and modern family planning. She mentioned that, as wives, mothers, and members of their church, the women in the audience had an obligation to care for their families and look after one another, a task that could become impossible if they were faced with an unintended pregnancy.
After introducing family planning in this way, Filomena proceeded to give an informative and amusing presentation on modern family planning methods, even offering tips and stories from her own life. She handled potentially uncomfortable moments with humor and warmth, often playing up graphic or funny details to put the crowd at ease. It was obvious that Filomena was a pro – she knew her material inside and out, and she was great at encouraging questions and responding to them thoughtfully and honestly. When misconceptions arose – for example, when one woman expressed concern that the contraceptive implant was actually a “chip” designed to record her sexual activity for the government – Filomena managed to correct them firmly but respectfully.
Filomena’s performance seemed especially impressive to me when she told me that she had very little formal training in family planning, and none in health education. She simply thought of herself as someone who cared deeply about giving women the right to control whether and when they got pregnant. When the Angolan government started its official family program in the 1980s, she signed on enthusiastically, earning a basic level of training that allowed her to provide counseling and services related to family planning. Although she’d initially hoped to gain more specialized training, Angola’s decades-long civil war and the lack of health and education infrastructure made it impossible to advance her knowledge formally. Her detailed, up-to-date understanding of family planning methods and her phenomenal skills as a public speaker were learned on the job, first as a government worker and then as an NGO employee, encouraging women one by one to use family planning to take control of their bodies and their lives.
Seeing Filomena’s presentation reminded me of how important community-based action is to the work that we do, especially in settings like Angola, where opportunities for women to interact with highly skilled health providers tend to be few and far between. Filomena’s ability to connect with her audience comes in large part from the fact that she’s a member of the communities in which she works. As a Christian, Angolan woman who has used modern family planning, Filomena is able to build relationships with these communities based on characteristics like their shared faith and to use those relationships as a way to connect women to the family planning services they need. Supporting these types of community-based efforts will be a crucial step for us as we work to expand access to these critical health services.