Starting from zero: family planning in the newest country in the world

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13 Dec 2013

‘Fragile states’ are characterised by poverty and insecurity, but in South Sudan, Marie Stopes International and other NGOs face the more unique challenge of working in a country that is in its very earliest stages of development.

Rather than starting from a ‘clean slate’, South Sudan is heavily burdened by the political, social and economic repercussions of over 40 years of war. These make it incredibly challenging for us to deliver sexual and reproductive healthcare services. At the same time, the opportunities to have a positive impact are huge.

High unmet need, great potential for change

Although no firm data exists, it is estimated that South Sudan’s health indicators are some of the lowest in the world and the proportion of women dying from pregnancy-related causes is among the highest globally.

Despite this, political instability means that the largest share of national expenditure still goes towards security – 28% compared to just 4% for health. Some 70% of health services are provided by NGOs, highlighting both the value of international aid and the desperate need to build local capacity.

Technical support is crucial, but what is really exciting about working in South Sudan is that the government fully recognises the value of investing in healthcare. And because we are there at the very earliest stages of the country’s development, we have a unique opportunity for advocacy work that puts family planning on the agenda right from the outset. The potential for South Sudan to develop progressive sexual and reproductive health policies is huge and the benefits will be felt across the country.

Starting from zero clients in 2011, Marie Stopes South Sudan provided services to more than 3,500 clients in 2012 and is on track to deliver over 25,000 CYPs in 2013. This success has been achieved in the face of wide-ranging challenges which can teach us a lot about operating in fragile states.

Instability and security

South Sudan’s independence brought peace to the country, but as in other fragile states, security remains a real issue. Decades of conflict mean that weapon ownership is high and political instability and tribal wars persist, making our staff and services vulnerable and comprehensive security measures essential.

Infrastructure and outreach

South Sudan’s limited infrastructure makes travel problematic, making it challenging to reach many in need of our services. For a war-torn Sudanese generation, roads have only brought enemy troops and trouble so many have fallen into disrepair. This means large parts of the country are inaccessible for up to 8 months in the rainy season. To get round this, we operate flying outreach teams to deliver family planning services to cut-off areas.

Diverse cultures and communities

The sheer ‘newness’ of South Sudan as a nation means that among its people, there is no common idea of how society should function or what services they should be entitled to. This poses challenges in communicating the idea of family planning – a problem exacerbated by the fact that different forms of Arabic are spoken in north and south and literacy levels are low.

MSI South Sudan has found that word-of-mouth is the most powerful way of overcoming cultural barriers and traditional attitudes. Key to this has been communicating the idea that family planning increases potential, rather than limits a family’s or the nation’s natural resources.

Lessons from South Sudan

Progress is slower than in more established countries and the cost of getting services to each person higher, but we have seen considerable success in raising awareness of and demand for sexual and reproductive healthcare. Working in South Sudan can give us valuable lessons about working in fragile states, where our services are often needed most.

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