Family Planning Policy Environment in the Democratic Republic of the Congo: Levers of Positive Change and Prospects for Sustainability

The Democratic Republic of the Congo (DRC)—with a population estimated at 67.5 million1—is the third most populous country in sub-Saharan Africa and the most populous francophone country. Since its independence from Belgium in 1960, the country has had a tumultuous history. During the dictatorship of President Mobutu Sese Seko (1965–1997), when the country was named Zaire, the repressive government provided periods of relative stability but at great cost to the country and to its citizens. In 1991, Mobutu lost control over the population; political turmoil and social unrest, known as the pillage (plundering), created a highly volatile environment that caused foreign investors and international donor agencies to withdraw completely or reduce support to the country, plunging the country further into poverty. The First Congo War (1996–1997) resulted in Mobutu being overthrown by the Rwandan-backed rebel leader Laurent-Desire Kabila.2 The Second Congo War (that involved 9 neighboring countries) occurred primarily in the eastern part of the country between 1998 and 2002, resulting in further economic devastation. By the early 2000s, life in the capital city of Kinshasa and some other provinces began returning to normalcy, although the threat of war continued to simmer in the eastern provinces bordering Rwanda and Uganda.3 Because of the ravages of war, political uncertainty, external exploitation, inadequate investment in human capital, and widespread poverty, the DRC—one of the richest countries in the world in minerals—ties for last place among 187 nations on the Human Development Index.4 The DRC is typical of African countries that are just beginning the demographic transition, with a total fertility rate of 6.6 as of 2013,5 a doubling in population size every 23 years, and a very young population (46% are under the age of 15). Almost three-quarters (71.3%) of the population live below the poverty line, and 45.9% live in severe poverty.5 With its high maternal mortality rate of 846 per 100,000 live births5 and large population base, the DRC is among the 5 countries that contribute the greatest number of maternal deaths to the global total.6 Although the country established a national family planning program (Projet National des Naissances Desirables, or PSND) in the early 1980s, it became inactive in the early 1990s in the wake of the pillage. In the mid2000s, external donors and technical organizations tentatively began to resume operations in the DRC. With a myriad of challenges facing the government from every sector, family planning was low on the priority list; the government had more important problems to address. Although the government established the National Program of Reproductive Health (Programme National de Sante de la Reproduction, or PNSR) in 2001 to address maternal mortality, family planning, and related issues, it drew little attention or support from higher levels of government. While maternal mortality did register as a national priority, family planning did not during the first decade of the millennium. The Growth and Poverty Reduction Strategy failed to mention family planning, although it did touch on leprosy, onchocercosis, and tuberculosis7; family planning was mentioned in the second edition released in 2010. For decades, there was little evidence of government interest in family planning. Some have questioned if the Roman Catholic Church has been an obstacle to family planning in the DRC. The Ministry of Health estimates that 40% of health facilities in the DRC are managed by the Church.8 In some cases, these facilities refuse to offer modern contraceptive methods; in others, they turn a blind eye. To the extent that the Roman Catholic Church in the DRC has attempted to exercise its influence in terms of family planning, it has been to promote natural methods over “artificial contraception.” In contrast to selected countries in Latin America and to the Philippines (where the Church has tried to block government or NGO family planning programs), it does not constitute a source of organized opposition to family planning programming in the DRC. Beginning in 2012, the DRC government took a number of actions that demonstrated its commitment to family planning, which has taken the international family planning community and many local observers by surprise. The purpose of this article is to document the evolution of the family planning policy environment in the DRC, analyze events that led to positive change, and identify factors that could influence the durability of this change.