Naciima is a 17 year old girl from Somalia. Unlike most 17 year olds who are enjoying life as teenagers, Naciima has already experienced adulthood; she is a mother of four and although her youngest is less than six months old, Naciima is already pregnant with a fifth baby. Naciima was married and became a mother when she was just 13 years old.

Naciima lives in a community for internally displaced persons (IDPs). Her family had to move from her original home to an area near Garowe, Puntland because of conflict and drought. Most homes in the IDP community have no running water or electricity and unemployment is widespread. They have little income to sustain themselves.

Naciima told UNFPA that she was pushed to marry an older man at such an early age because of poverty, cultural acceptance and family pressure.

Despite her challenges, Naciima is able to seek skilled attendance during pregnancy and while giving birth. She makes sure she sees a midwife and she has previously given birth in the local birth centre and the main maternity unit in Garowe Hospital, helping them to survive in a country where so many mothers and newborns die every day. One in 22 mothers in Somalia currently die from complications of pregnancy and childbirth, and Naciima is determined not to be one of them.

Naciima in her midwifery consultation with a midwife 

“I am responsible in my pregnancies. I take folic acid to protect my babies from some abnormalities combined with ferrous sulphate iron tablets to keep me strong and help to ensure that the baby is safe,” said Naciima.

Naciima knows she has too many children for a girl her age. She had heard that breastfeeding gives some protection from pregnancy but she did not realise that this meant exclusive breastfeeding.

In August, 2017 Naciima attended the UNFPA-supported Barwaaqo maternal and child health centre that opened just this year, with her youngest baby in her arms. The team of midwives, led by midwife Muxubo, welcomed her for a consultation.

“Naciima had been supplementing breastfeeding with water and other foods. This removes all potential protection from pregnancy, so it had never worked for her,” said midwife Muxubo.

Muxubo the lead midwife of Barwaaqo maternal and child health centre

When birth spacing is mentioned Naciima says she has thought about it, but, she says she is unable to refuse her husband sexually, which she thought she would have to do to delay her next pregnancy. Her little awareness of modern contraceptives is very much clouded by rumour and misconceptions, but the qualified midwives in the clinic begin talking this through with her, helping her to understand that she has a choice, she can be protected from pregnancy without refusing her husband, and with some types, such as the contraceptive implant, she can also still breastfeed. She will be counselled by her midwives throughout pregnancy, and offered suitable methods after she gives birth, to help her to recover properly and give her space until she decides she may want another baby.

Consent for contraception in Somalia is complex, with the husband being the usual decision-maker for such issues. This may be challenging, as there are some in Naciima’s community who think it is against Islam to use contraception.

With the support of UNFPA, Professor Abdel Rahim Omran, a high ranked Islamic religious scholar, published a book ‘Family Planning in the Legacy of Islam’ where leading global Islamic theology experts and jurists discussed and shaped the Islamic approach to family planning. This was recently translated into Somali, giving clarity on the position of their religion relating to contraceptives, enabling local families to make choices without confusion from their religion. This is now helping families to realise that spacing their births is not against Islam, and women like Naciima can benefit from modern contraceptives, enabling them to have healthier families by reassuring them that ‘kala korinta ilmuhu waa arrin bannaan’ – child spacing is allowed in Islam, and ‘waa la isticmaali karaa dawooyin si uurka loo kala dheereeyo haddii ay faa’iido ugu jirto hooyada aaneyna ku keeneyn wax dhibaato caafimaad ah’ – medicines can be used to space pregnancies if not causing any harm to the health of the mother.

As a mother of several children at such a young age, Naciima will now be able to work with Muxubo and the Barwaaqo midwives to help her choose a contraceptive after she gives birth, giving her time to focus on her young children’s health, as well as her own.

– Emily Denness

###