Family Planning Research in Tonga

Ned Winn-DixAt the NSW State Library on 1st April 2015, Ned Winn-Dix spoke about his recent work in Tonga, taking us into a culture in which it has been unquestioned that young women would have children soon after marriage.

Ned presented insights about how receptive people would be in Tonga to a very practical new method of contraception, the implant. Scare-myths heard in some parts of the world, about contraceptives being linked to being invaded by the devil, do not present a problem in Tonga, and education can distinguish between possible side-effects and unrelated coincidental health ailments.

For modest young people, a long acting contraceptive is preferable because they don’t have to go so often into clinics, thus revealing that they’re having sex. A startling insight was that, for young people in an overwhelmingly Christian country, obtaining or carrying a condom is considered more dangerous than the sex itself, because having the condom is an admission of premeditation to have sex, no excuse of being carried away in the moment. There was a roll of laughter at a nurse’s quiz question, “Do you know what you call people who use the withdrawal method?” No. “Parents.” Surveys found that a small stick inserted under the skin in the arm is more acceptable than an IUD, because it is above the waist.

Tonga comprises 171 islands, 70 inhabited, affected by geographic isolation and a fertility rate of 4.1, with contraceptive prevalence of use at 22%. Family planning programs, with regular supplies or Long Acting Methods of Contraception (LARCs) are very much needed. Pills and condoms have to be remembered faithfully, but implants are even more effective than having tubes tied.

Ned described an effective visual way of demonstrating results of large family size to men; take a piece of paper to represent a man’s land, and then fold it in half to represent how much land each of two sons will inherit. Fold it again for four, fold again… and the amount of land for growing food can be seen to be not enough.

Ned Winn-Dix is committed to advancing comprehensive family planning through the use of better data to guide programs and influence donors. He has worked in Tonga and Nigeria, and he has now gone to work with Marie Stopes International in London, in the Management Information Team, to improve data capture and use. Having accurate evaluation will help to safeguard programs from political trends, where funding can be affected by political pressures. There will be clear evidential cases for cost savings resulting from the health and social benefits of contraceptives.