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| Splendidly Alive People Within Limited Environmental Resources | |
Part IV: Of Pohl and Paarl
Dr Pohl de Villiers of Paarl long ago started to limit the population of Paarl and its surrounding districts and thus to contribute towards reducing community and personal poverty. He did this by making sure that all aspects of family planning motivation, support and services were in place.
1995 Report by Dr Pohl de Villiers
The following is a report by Dr Pohl de Villiers, Principal Gynaecologist and Obstetrician in the Department of Obstetrics and Gynaecology at Paarl Hospital:
A total of 8 956 postpartum sterilisations were carried out at Paarl Hospital between 1971 and 1993 (16,62% of the 53 889 mothers delivered).
In 1970 20,3% of mothers still had 10 or more children. No such mothers existed after 1989.
In 1971 only 10% of patients sterilised requested a postpartum sterilisation. This increased to 83% in 1991 and 87,9% in the first 6 months of 1994.
Mothers sterilised with 3 children were 57,6% in the first 6 months of 1994.
The average number of children at time of postpartum sterilisation has dropped from 7,3 in 1972 to 3,46 in 1994. At present 19,8% of mothers are sterilised with only two children.
Paarl's success is based on a distinct policy: "One is best, at most two, never a third." Postpartum sterilisations are available on a 24-hour basis, even on Saturdays, Sundays and public holidays.
Interim sterilisations are increasing all the time. The total has grown from 170 in 1989 to 235 in 1993. Already by November this total has grown to 252. The average number of children with interim sterilisations was 2,91 in 1993.
Dr de Villiers is the only person in South Africa who has combined promotion of population limitation with family planning motivation and services.
(Taken from Population Growth - Our Time Bomb by Johannes Jordaan 1991, page 125)
At Paarl hospital the main emphasis is on adequate counselling for all women. As part of her primary care ', each patient is informed of the benefits of sterilisation, the different methods are explained and various audio-visual programmes are presented.
As far as possible the husband is involved as well. There is a programme in Xhosa for illiterate Xhosa women, and a more sophisticated programme for literate Xhosa women. Film and slide programmes entitled "Jan en Marie besluit" and "Twee is genoeg", especially for farm labourers and for those who have become urbanised, are also screened, as well as a film on vasectomy.
Patients attend small group discussions, and two counsellors lead the discussion on the benefits and practical implications of family planning and sterilisation.
These counsellors are permanent employees who provide continuous counselling and motivation. They try to make each patient understand very clearly what it is all about. They also expand on the advantages of having only two children.
All patients who decide on sterilisation are asked to sign forms of consent. They are made aware of the fact that there is a slim chance that the sterilisation process may fail. If they would rather have a reversible procedure they are advised to postpone sterilisation and to use another form of birth control. They have to realize that sterilisation is a permanent form of contraception.
(From a final conversation with Dr Pohl de Villiers, February 1995)
1. AVAILABILITY and ACCESSIBILITY. There is transport. There are telephones.
2. We emphasize birth control as a fundamental right.
3. Management and organization:
Myself
The clinical sister in Outpatients Other hospitals in the area.
Link up availability with management. See that the job gets done TODAY AND NOT TOMORROW.
4. Motivation of staff: "When I come in on a Monday morning - for instance this Monday after I had spent the weekend in Hermanus - I say to my doctors: How many steris did you manage this weekend? They said 5! I was very complimentary."
5. There is nothing as compelling as a blueprint. "My clear-cut policy has paid off. Five years ago none of my sisters would advocate the two-child family. Now they all do."
6. Marketing - but this is a "fringe". It is secondary to the rest.
We put up posters, hand out pamphlets and so on.
There is no point in having marketing if there is no service.
7. Constant analysis. This reinforces what we do. It pinpoints defeats and successes.
8. Political commitment. There is a lack of will and decision making. This is partly because the ANC has so much else to think about. The Paarl ANC do not emphasize population.
9. Teenage policy. The teenage pregnancies in Paarl have fallen from 38% of all pregnancies to 17%
Why? "I can only think that it's publicity and exposure. If you expose it you solve it. I went around saying 'Paarl's got the highest teenage pregnancy rate' - and I suppose this made some impact."
In Holland only 1% of all teenagers fall pregnant - even though 70% are sexually active at 16.
STDs The STDs in the Paarl area have doubled from 5% to 10% in the last 10 years. One in 100 are HIV positive.