Fifty Years of Family Planning in the Democratic Republic of the Congo

Front matter

Routledge Studies on Gender and Sexuality in Africa

FIFTY YEARS OF FAMILY PLANNING IN THE DEMOCRATIC REPUBLIC OF THE CONGO

THE DOGGED PURSUIT OF PROGRESS

PART I The Decades that Shaped the Congo Leopold I claims Congo for his own 3

The plunder of Congo commences 5

Missionaries arrive to civilize and convert 8

Tolerance runs out for Leopold IPs atrocities in the Congo 11

The Colonial administration embarks on developing the Belgian Congo 15

An early priority of colonial authorities: discouraging polygamy 16

The Belgian Congo supplies the global market during World War I 18

Demographic panic percolates in the 1920s 19

The Great Works program stimulates development in the Congo 20

The Depression of the 1930s reaches the Belgian Congo 23

The Congo supports the Allied forces in World War II 25

The postwar boom and the Ten-year Plan creates a Congolese middle-class 26

Resentment grows among the Congolese 27

Modernization brings changing social mores 30

The fever of independence grips Congolese leaders 32 vill Contents 3 The First Decade Post-Independence (1960-69)

Indépendance, cha...cha... 40

1960-65: la crise congolaise 40

Five years of freefall post-independence 44 1965-69: Mobutu assumes control 47

The sex ratio improves with urbanization 49 Societal norms favor large families 50 Reflections on the 1960s 51

PART II The Fifty Years of Family Planning 4 The 1970s: President Mobutu Authorizes Naissances Désirables

The country rides an economic rollercoaster in the 1970s 59

The problem of pregnancy-related deaths persists 61

Mobutu introduces the concept of Naissances Désirables 63 AZBEF is born 67

The Protestant missionaries become family planning pioneers 68 UNFPA opens an office in Kinshasa 77

A growing cadre of physicians embrace Naissances Désirables 77 Reflections on the decade of the 1970s 79

5 The 1980s: Zaire Experiences the First Golden Decade for Family Planning

Mobutu presides over an economically volatile decade 83

The nagging concern for the Law of 1920 hangs over Naissances Désirables 85

USAID plays a catalytic role 86

PRODEF tests the viability of community-based distribution 88

SANRU introduces Naissances Désirables to rural areas 94

Projet des Services des Naissances Désirables becomes the lead family planning agency 108

PSND in its infancy 110

AZBEF adjusts to its new role 123

Cliniques Universitaires de Kinshasa attempts to treat infertility 124

HIV/AIDS and the Zaire Social Marketing Project 126

The Kananga Project 129

UNFPA plays a major role in the 1984 population census 132

Contents ix

Kinshasa School of Public Health trains a new generation of health specialists 133

Key research advances knowledge of population and family planning 135

6 The 1990s: Development Work Paralyzed by Pillages and War 145

Family planning is well-positioned to build on the progress of the 1980s 145

Mobutu faces increasing opposition with fast-dwindling support from the West 151

Kinshasa erupts in violence and destruction: the pillage of 1991 152

International donors halt development assistance 154

The 1991 pillage leaves the PSND barely functional 155

SANRU struggles after the pillage 157

ASF and Johnny Loftin operate social marketing on a shoestring 158

AZBEF’s financial irregularities further hinder the organization 159

The Kinshasa School of Public Health loses its primary source of funding 160

The second pillage (1993) wreaks further havoc on the country 160

Resuscitating family planning in Zaire 164

Protestant missionary work evolves by the late 1990s 170

Kabila brings an end to the Mobutu reign 173

The US government reengages with DRC 174

7 The 2000s: Family Planning — Like the Country — Inches Back to Normalcy 182

Armed conflict grinds on despite efforts to wind down the war 182 UNFPA poised for leadership as the country reopens 185

USAID reopens in the DRC 188

PNND struggles to deliver on its mandate 190

PNSA 1s created 191

ASE/PSI benefits from first mover advantage 192

ABEF perseveres 196

First National Conference to Reposition Family Planning held in 2004 196

Political changes mid-decade brings new energy and resources to family planning 198 x Contents

With a new Population Officer, USAID/DRC sharpens its focus on family planning 198

UNFPA increases activity in the late 2000s 204

PNSR gains stable leadership 205

PNSA launches youth-focused programming 206

ASE/PSI struggle to keep pace with increased demand for family planning 206

Second National Conference on Repositioning Family Planning held in 2009 208

Reflections on the decade of the 2000s 208

8 The 2010s: The DRC Experiences the Second Golden Decade of Family Planning 213

Plus ça change... 213

The family planning movement gains momentum 216 Traditional donors increase their support for family planning 225

New donors invest in family planning in the DRC 232

New organizations join the established government and NGO partners 239

Innovative, impactful work advances the field 250

Major events showcase DRC work 256

Research reinforces a culture of evidence-based programming 259

The fast-moving train encounters obstacles 267

Updating the family planning landscape since 2020 270

PART III Looking Backward, Pressing Forward 283 9 The Past, Present, and Future 285

How the Congo’s difficult past has shaped contemporary family planning 285

Why should donors continue to invest in family planning in the DRC? 295

How best to accelerate progress in family planning in the DRC 301

Index 307

Figures

1.1 1.2

2.1 4.1

4.2 4.3

44 5.1 5.2 5.3

5.4 5.5

5.6

5.7

5.8

5.9

View of Léopoldville station and port, 1884

King Leopold II of Belgium, who held the Congo Free State as his personal possession

Boulevard Albert ler, downtown Kinshasa, in 1950

President Mobutu Seso Seko Africanizes his name and authorizes Naissances Désirables in 1972

Mme. Jeanne Bokeleale greeting Florence and Ralph Galloway Baba Luta and Judith Brown discuss the growth chart of a young child during the Well-Baby Clinic Day near Bulape, Zaire (1975) Baba Luta talks with a mother about ways to delay her next pregnancy (1976)

A young Dr. Miatudila Malonga as Administrator of AZBEF

Dr. Nlandu Mangani on the Zaire River

Matondo Mansilu (left), Dr. Nlandu Mangani (right) with a local colleague in Bas Zaire

Jane and Bill Bertrand in a village in Bas Zaire, 1981

Tulane research assistants transporting questionnaires, Nsona Mpangu, Bas Zaire, 1981

USAID design team (left to right): kneeling on the ground: Jean- Pierre Muka, and colleague. Standing: Bill Bair, the main pilot, Miatudila Malonga, Rick Thornton, a Zairois union representative, Florence Galloway, Chirwisa Chirhamolekwa, Wilbur Wallace, Beverly BenSalem, the co-pilot, and Ralph Galloway. Seated in plane: Joyce Holfeld

From left to right, front row: Bombute w'Ekoliaka, Eileen McGinn, Chirwisa Chirhamolekwa. Back row: Dr. Sambe Duale, Ken Heise, Dr. Alexis Ntabona, Dr. Nlandu Mangani

Beverly BenSalem, Dr. Jean-Pierre Muka, and Mme Chirwisa Chirhamolekwa

Survey research team in Menkao village, 1988. From right to left: Bakutuvwidi Makani, Mme. Nabintu, Luya N’Lendi, Mbadu Muanda, Kashangi Chiruba, and Amundala Twaforla xii

7.1

7:2 7.3

8.1 8.2

8.3

8.4

8.5

8.6 8.7

8.14 9.1

9.2

Figures

Basketball legend Dikembe Mutombo brings star power to ASF/ PSI campaign; with Johnny Loftin (left) and U.S. embassy official (right)

Pharmacy of hope, 2008, Equateur Province

Meeting at USAID (2007): Left to right: Claude Disuemi, Arsene Binanga, Thibaut Mukaba, Jennifer Pope, Pelagic Saraza, Francois Kitenge, Ellen Lynch, Gisele Kasungi, and Marie-Claude Mbuyi

Boulevard du 30 juin in contemporary times

Dr. Marie-Claude Mbuyi, one of the female pioneers in family planning

Dr Arsene Binanga, CTMP coordinator, with Dr. Miatudila Malonga, President of SANRU Board of Directors, in 2018 Annoucing the availability of contraceptives at a community outreach event

Mr. Bitshi Mukengeshayi and Mme. Rachel Vacka supervising fieldwork

Dr. Théophile Nemuandjare at UNFPA outreach event, 2014 Dr. Anne Marie Tumba and Directeur Mbadu Muanda, outside the Clinique Libota Lilamu

A nursing student counsels a young mother on contraceptive use DKT’s “power poses” to encourage contraceptive use

PMA data collector using innovative smartphone app for survey interview

Trends in modern contraceptive prevalence: Kinshasa and Kongo Central (2014-22)

The distribution of methods reported by married users of modern contraception aged 15-49, Kinshasa, 2014 vs 2022

Jane Bertrand, Arsene Binanga, and Julie Hernandez in Maluku, 2022

One of many ways of promoting family planning

Estimated annual national government FP funding per capital, 2021; and Estimated FP funding per capita ($) from private and bilateral donors in DRC (2020) and in Ouagadougou Partnership countries (2019)

The DRC is favorably placed on the S-curve for accelerated adoption of contraceptive use

193 197

201 214

227 228

242 252 253 261 262 263

270 272

Boxes

5.1 5.2 5.3 5.4 5.5

8.2

8.3

Polygamy and matriarchal vs patriarchal societies Incentivizing large families

An early convert to family planning

Dr. Miatudila’s visit to the archbishop

Vanga: a family planning pioneer

A party guest in New Orleans

Why emphasize permanent contraception in a country still skeptical of birth spacing?

Dr. Miatudila and the Law of 1920

The origin of the iconic SANRU logo — father with baby The promising model of Vanga

Catholics and contraception

Protestant mission hospitals: the incubator for future family planning leaders

Mme. Chirwisa and the Catholic Church

Crispin and his three closely spaced children

Condom use was a hard sell

Having friends in high places

The military had wives, too

UNEFPA’s partnership with Gécamines

Life’s little challenges

“Get me to the church on time...”

From SANRU III to AXxes: the sad fate of Vanga

Chaos erupts over the reported decline in maternal mortality Refusing to define “sufficient inventory” as a success story USAID-funded projects in the DRC with a family planning component

International and local NGOs working in family planning in the DRC

So much for the quantity-quality trade-off

18 20 65 66 72 76

79 85 99 102 103

244 258

Preface

I began my career in international family planning in the 1970s, focusing on Latin America. I taught a course in Mexico, worked on a communication program in El Salvador, and conducted research on family planning in Guatemala. In short, my real-world education in family planning came from Latin America.

In 1979, my husband Bill Bertrand encouraged me to accompany him to Kinshasa, Zaire (the former Belgian Congo), where he had recently started a project. To close the deal, he quipped, “You have to go through Paris to get there.” A year later, I found myself starting a small USAID-funded project in Bas Zaire, which I then visited 3—4 times a year. Yet it was not until 1986 that as a family with small children, we took up full-time residence for four years in Kinshasa.

By the mid-1980s, Latin America was making remarkable progress in family planning. The percentage of women using modern contraception was rising steadily, and the desire for small families was so strong that voluntary female sterilization had become the leading method in several Latin countries. Yet my initial foray into family planning in Zaire had made me keenly aware that most Zuÿrois aspired to large families. I would need to work within a very different set of cultural norms in Zaire than I had experienced in Central America and Colombia.

In 1986, family planning programming in Zaire was in its infancy. My job was to set up an evaluation unit within this new Family Planning Services Project (PNSD). One of the perks of the position was having a driver, Kasui, who would pick me up from home each morning in a cream-colored Land Rover, the classic vehicle for development work in Africa at the time.

Kasui and I would spend hours together in the Land Rover, driving through Gombe, the administrative center of the city built by the Belgians in the 1940s and 50s. On other days we would navigate the almost impassable roads of the cité, the sprawling slums that encircled Gombe, to reach a remote health center. We traveled together down Highway 1 en route to the port city of Matadi, some five hours from Kinshasa, where we also had project activity. Kasui hoisted my three-year-old daughter on his shoulders as we strolled through Lac Ma Vallée, the park on the outskirts of Kinshasa.

Kasui looked to be around 40, medium height, with dark-rimmed glasses. Whatever personal struggles he might have had in raising a family on the meager salary of a driver, he never complained. Rather, he would arrive each morning with

Preface xv a smile, ready for the day’s assignment. His casual observations as we bounced around in the Land Rover were my daily education in “how things worked” in Zairian society. Yet decades of colonial rule were ever present in interpersonal relations between Zairians and mundeles (whites), invariably in positions of power. Kasui was open, outgoing, and friendly, but always deferential.

We had engaged in these casual conversations for several months when Kasui finally screwed up the courage to ask me the question that was on his mind.

“Madame Jane, I need your advice on a personal matter. You work in family planning.”

“Yes?”

“My wife and I have eight children, and we need to find a way to stop having more.”

I curbed my immediate instinct to suggest the option taken by so many women in Latin America: female sterilization. Instead, I asked: “Has your wife tried the oral pill?”

“Yes, but she didn’t tolerate it well.”

“How about the IUD? Have you heard of that method?”

“No, that wouldn’t work for her,” he replied.

“You could use condoms.”

“No, I don’t like condoms.”

And so the conversation went on until I had mentioned every available contraceptive method except sterilization. Having exhausted all other options, I asked, “Are you aware there is a permanent method? A woman can get her tubes tied, and she never has to worry about pregnancy again.”

There was a long pause in the conversation. Finally, Kasui turned to me. “Madame Jane, you don’t understand. We have eight children, and our marriage is rocky. I’m not sure we are going to stay together. And if we do split up, my wife will need to have another child with her new husband.”

I quickly came to realize that I still had a lot to learn about family planning in this country.

KREKKKK

By 2023, I had been a university professor for 44 years — 36 at the Tulane School of Public Health and Tropical Medicine and eight at the Johns Hopkins Bloomberg School of Public Health. For 24 of those 44 years, I worked on family planning in the Congo: from 1980-89 when the country was named Zaire, and then from 2010-23 by which time it had been renamed the Democratic Republic of the Congo (DRC). As I neared the end of my 44-year academic career, I felt compelled to write this book on the five decades of family planning in Zaire/ DRC. To satisfy my curiosity, I wanted to better understand how the pieces of the puzzle fit together, especially during the years when I was working elsewhere. For professional reasons, I felt that it was important to document the progress made and the challenges encountered in implementing family planning in a fragile country shaped by extreme political turmoil and devastating economic crises.

xvi Preface

The financial support for this family planning work came from international donor agencies. From 1980-89, USAID contracted with Tulane to collaborate with Congolese organizations — both government and private — on different aspects of family planning programming. Between 2010-2023, multiple donors funded Tulane’s work: the Bill and Melinda Gates Foundation, the David and Lucile Packard Foundation, DFID (the UK development agency, renamed FCDO in 2020), the Norwegian government via the Central African Forest Initiative/FONAREDD, UNFPA, The Clinton Health Access Initiative, and a private individual in Boston who made his donations anonymously. The funding since 2010 supported project work across a range of activities: advocacy/policy, service delivery, pilot testing of innovative strategies, monitoring and evaluation, and other types of applied research.

During most of these 24 years of working in family planning in Zaïre/DRC (divided by a 20-year hiatus from 1990 to 2009), I maintained my residence in New Orleans, Louisiana, but traveled 3-5 times a year to the country to work with Congolese and expatriate colleagues on our projects. Only from 1986-89 did I live full-time in Kinshasa. During this highly rewarding period, I was able “to do international family planning” ten minutes from my front door.

This book is not a memoir, although it does capture some of the work Tulane has undertaken in Zaire/DRC. Nor is it an attempt to distill the published literature of over 40 years on the topic. Rather, it is an individual narrative, based on three main sources: existing publications (books, articles, reports, news stories), some hundred interviews conducted with individuals who played a role in this history, and the 24 years of working off and on in-country. My aim is to capture this slice of history and to extract the lessons it provides for the future of family planning in the DRC.

Whereas the history of family planning in the Congo starts in 1972, the factors that have shaped the country to this day date back to the colonial era: King Leopold Ils Congo Free State (1885-1908) and the Belgian Congo (1908-1960). The book is written in three parts. The early chapters provide an abbreviated history of the political, economic, and social context leading up to the 1970s, with an emphasis on events that shaped women’s lives and their reproductive aspirations. Part II starts with the 1970s; each chapter provides a historical account of family planning against the backdrop of the political and social conditions of each decade. The 50 years of family planning captured in this narrative run from 1972-2022, although the chapters are organized by decades. Part III summarizes the influence of the country’s history on individual contraceptive practice and family planning programming today. It addresses a series of provocative questions about future funding, and it concludes by identifying six conditions that need to be in place to accelerate progress in family planning in the future.

Since independence in 1960, changes have occurred in the name of the country; the number, names, and delineation of the provinces; and the names of the major cities, the currency, and the major river running through the country. Where provinces are cited in a given chapter, they refer to the administrative delineations in effect in that decade.

Preface xvii

True to my academic roots, I have peppered the book with citations, especially for the decades prior to the 1970s when I depended entirely on the work of other authors and sources for historical insights. When multiple ideas came from a single source, I have indicated the page range rather than repeatedly naming the source. Starting in the decade of the 1970s, much of the material draws on interviews with colleagues who worked in family planning in Zaire/DRC at some point in the past five decades. I have not cited the source of these interviews in the endnotes of each chapter, especially where I obtained sensitive information given to me in confidence. Often the reader will be able to surmise my sources from the names in the narrative.

I have tried to make this book as factual as possible, yet there is inevitably an aspect of subjectivity that creeps in: in the topics included, interpretation of events (especially those I experienced personally), and reflections in the final chapter.

Some readers may wonder why I have chosen to focus narrowly on family planning when the field has expanded to a more inclusive approach known as sexual and reproductive health and rights (SRHR). Contraception is one component of SRHR, alongside maternal and newborn health, HIV/AIDS and other sexually transmitted diseases, gender-based violence, safe abortion, infertility, and reproductive cancers, among others. In fact, family planning is often delivered through “integrated programs” that offer a range of services as part of a more comprehensive approach. But as one Congolese colleague put it, “What good is it to have family planning in name only in an integrated project if there are no contraceptives on the shelves?” Whereas the field has benefited from colleagues who have dedicated their lives to other aspects of SRHR or have worked to promote SRHR as a package of interventions, I have opted to work specifically in family planning. I remain as convinced as I was when I started graduate school in family planning in 1972: contraception is a game-changer for women, for their families, and for entire countries.

This book was written as a tribute to the men and women who have worked tirelessly to promote family planning in a country where public health work is often challenging and this topic remains controversial. To this group, I hope I have been faithful in telling the story that is rightfully yours.

Jane T. Bertrand October 9, 2023, New Orleans, LA, USA

Acknowledgments

I owe a debt of gratitude to the many individuals whom I interviewed for this book, most worked in family planning in Zaire/DRC in one or more of the decades since the 1970s. To a person, they were generous in sharing insights that allowed me to weave together a narrative spanning over 50 years. I am particularly appreciative of those to whom I returned repeatedly to review entire chapters, provide context, or confirm obscure details of events occurring decades ago: Franklin Baer, Julie Hernandez, Malonga Miatudila, Thibaut Mukaba, Bitshi Mukengeshayi, Mbadu Muanda, and Théophile Nemuandjare.

I was fortunate to have four superb research assistants in compiling this book: Lindsay (Charlie) Brink, Jennie Racher, Sydney Sauter, and Gael Compta. Awen Southern edited all aspects of the French. Others who supported this effort included Pierre Akilimali, Maria Carolina Herdoiza, Emma Powers, Annie Mongay, and Candelaria Martinez.

Bill Bertrand, who correctly takes credit for my first visit to Zaire in 1979, had valuable institutional memory for all things public health in the DRC. His insights, acts of service, and excellent culinary skills contributed greatly to the completion of this book.

Sadly, Ruth Anne Galloway, who provided documents and photos of her parents Ralph and Florence Galloway, passed away before she could see their work memorialized in this book.

Tulane’s project activity in the DRC over the past decade would not have been as effective or rewarding without the hard work of the Tulane International staff, based in Kinshasa: Arsène Binanga (Country Director), Franck Akamba, Rianne Gay, John Kimfuta, Deborah Kiwele, Paul Lusamba, Zénon Mujani, Claude Nduku, Delphin Ngoie, Cathy Putela, Maria Sebo, and Joyce Visi.

Thanks to Helena Hurd, Senior Editor/Global Development and African Studies, and Katerina Lade, Editorial Assistant, at Routledge for their patience and advice at all stages in the publication process. Nick Taylor did a superb job with copy editing, and Matthew Twigg oversaw the production process. I am grateful to Ashley Farley of the Bill and Melinda Gates Foundation (BMGF) for encouraging the open-access publication of this book.

Finally, I am appreciative of the organizations and persons who supported my efforts in writing this book. I am fortunate to hold the Neal A. and Mary Vanselow Endowed Chair at the Tulane School of Public Health and Tropical Medicine,

Acknowledgments xix and I thank Dr. Thomas LaVeist, Dean, for granting my sabbatical year. The BMGF (INV-033621) and the David and Lucile Packard Foundation (grant 2022-73375) also supported my sabbatical. I am grateful to Perri Sutton and Temple Cooley for their invaluable oversight of Tulane’s work in the DRC, as well as the friendship of many years.

Acronyms

ABEF-ND: Association pour le Bien-Etre Familial-Naissances Désirables (the Association of Family Wellbeing — Desirable Births)

AcQual: Accès et Qualité (Access and Quality)

ADEL: Alliance des forces démocratiques pour la libération du Congo-Zaire (Alliance of Democratic Forces for the Liberation of Congo)

AED: Academy for Education Development

AFEAC: Association des Femmes Avocates de la RDC (Association of Women Lawyers in the DRC)

AFP: Advance Family Planning Project

AfriYAN: African Youth and Adolescent Network

ASD: Action Santé et Développement (Action for Health and Development)

ASF: Association de Santé Familiale (Family Health Association)

ASSP: Accés aux soins de santé primaires (Access to Primary Healthcare Project) ASSR: Appui au système de santé en RDC (Supporting the Health System in the DRC) AVSC: Association for Voluntary Surgical Contraception

AXxes: Integrated Health Services Project

AZBEF: Association Zairoise de Bien-Etre Familial (The Zaire Association for Family Wellbeing)

BCK: Compagnie du chemin de fer du Bas-Congo au Katanga (Bas-Congo Railway Company in Katanga)

BCZ: Banque commerciale du Zaire (Commercial Bank of Zaire) BHR: Bureau of Humanitarian Affairs, USAID

BMGEF: Bill and Melinda Gates Foundation

BRHi: Basic Rural Health Project

CA: Cooperating Agency (of USAID)

CAFCO: Cadre Permanent de Concertation des Femmes Congolaises (Permanent Consultative Group of Congolese Women)

CAFI: Central African Forest Initiative CBD: Community-based distribution (or distributor) CBZO: Communauté baptiste du Znire-Ouest (Baptist Community of West Zaire)

CCP: Center for Communication Programs, John Hopkins University

Acronyms xxi

CDC: Centers for Disease Control and Prevention CDR: Centrale de distribution régionale (regional warehouse for commodities)

CECAP: Cellule de coordination des activités en matière de population (Population Activities Coordination Unit)

CEPLANUT/ PROPLANUT: Centre de planification de nutrition / Programme national de nutrition (Center for Nutrition Planning / National Nutrition Program)

CMC: Mennonite Church of Zaire CNND: Comité national des Naissances Désirables (National Committee of Desirable Births)

CNPPND: Conseil national pour la promotion des Naissances Désirables (National Council for the Promotion of Desirable Births)

CODESA: Comité de développement sanitaire (community health committee) CONAPO: Conseil national de la population (National Population Council) COP: Chief of Party

CPF: Counterpart fund

CPS: Contraceptive prevalence survey

CRESAR: Cellule de recherche en santé de la reproduction (Research Unit on Reproductive Health)

CSM: Contraceptive social marketing

CTMP: Comité technique multisectoriel permanent (Multisectoral Permanent Technical Committee)

CYP: Couple-years of protection

D4I: Data for Impact

DEP: Direction des études et planification (Direction of Research and Planning) D6: Direction de l’enseignement des sciences de santé (Direction of Health Sciences Education) DFID: Department for International Development of the UK

DHIS2: District health information software 2

DHS: Demographic and Health Surveys

DPP: Direction provincial du plan (Provincial Department of Planning)

DPS: Division provinciale de la santé (Provincial Department of Health)

DRC: Democratic Republic of the Congo

DSSP: Direction des soins de santé primaire (Primary Healthcare Directorate) EC: Emergency contraception

ECC: Église du Christ au Congo (Protestant Churches of Congo)

ECZ: Église du Christ au Zaire (Protestant Churches of Zaïre)

EGPAF: Elizabeth Glazer Pediatric AIDS Foundation

EPSS: Evaluation des prestations des services de soins de santé (Evaluation of Healthcare Service Delivery)

FAA: Foreign Assistance Appropriation FAO: Food and Agriculture Organization (United Nations) FCDO: Foreign, Commonwealth & Development Office of the UK

FOMECO: Fonds médical de coordination (Medical Coordination Fund)

xxii Acronyms

FOREAMI: Fonds Reine Elisabeth pour Vassistance médicale aux Indigènes du Congo belge (Queen Elisabeth Fund for Native Medical Assistance)

FP CAPE: Family Planning Country Action Process Evaluation FP: Family planning

FPIA: Family Planning International Assistance

FSN: Foreign service nationals

GAO: Government Accountability Office

GEAS: Global Early Adolescent Study

GFF: Global Financing Facility

GHSC-PSM: Global Health Supply Chain — Procurement and Supply Management project GNP: Gross national product

GOZ: Government of Zaire

GUG!: Growing up Great!

HCB: Huileries du Congo belge (Oil mills of the Belgian Congo) HPP-Congo: Humana People to People — Congo

ICFP: International Conference on Family Planning

ICPD: International Conference on Population and Development ICRC: International Committee of the Red Cross

IEC: Information-Education-Communication

IFFLP: International Federation for Family Life Promotion IMCK: Institut médical chrétien du Kasai (the Christian Medical Institute of Kasai) IME: Institut médical evangélique (Evangelical Medical Institute) iNGO: international non-governmental organization

IPPF: International Planned Parenthood Federation

IRC: International Rescue Committee

IRH: Institute for Reproductive Health/Georgetown University IUD: Intra uterine device

TYDA: Integrated Youth Development Activity

JSI: John Snow, Inc

KSPH: Kinshasa School of Public Health

LAD: Large anonymous donor

LAM: Lactational amenorrhea method

LMIC: Low- or middle-income country

LMIS: Logistics management information system

MAF: Mission Aviation Fellowship

MCH: Maternal and child health

MCPR : Modern contraceptive prevalence rate

MCZ: Médecin chef de Zone (Chief District Medical Officer) MDGs: Millennium Development Goals

MERLIN: Medical Emergency Relief International

MICS: Multiple Indicator Cluster Surveys

Acronyms xxiii

MNCH: Maternal newborn and child health MOH: Ministry of health

MONUC: Mission de l'Organisation des Nations unies en République démocratique du Congo (United Nations Organization Mission in the DR Congo)

MONUSCO = Mission des Nations Unies pour la stabilisation en RD Congo (United Nations Stabilization Mission in DR Congo)

MSE: Médecins Sans Frontières (Doctors without Borders) MSH: Management Sciences for Health

MSI: Marie Stopes International

NGO: non-governmental organization

NIAID: National Institutes of Allergy and Infectious Disease NIH: National Institutes of Health

ODSEF: Observatoire démographique et statistique de l'espace francophone (Demographic and Statistical Observatory of the francophone Area)

OR/TA: Operations Research and Technical Assistance OTI: Office of Transition Initiatives OXFAM: Oxford Committee for Famine Relief

PARSS: Projet d'appui à la réhabilitation du secteur santé (Project of Support for the Rehabilitation of the Health Sector)

PDSS : Projet de développement du système de santé (Health Services Development Project) PEPFAR: President's Emergency Plan for AIDS Relief

PES: Post-enumeration survey

PEV: Programme élargi de vaccination (Expanded Vaccination Program)

PHC: Population and Housing Census

PI: Principal investigator

PID: Project Identification Document

PMA: Performance Monitoring for Action

PMA2020: Performance Monitoring and Accountability 2020

PMTCT: Prevention of mother-to-child transmission (of HIV)

PNAM: Programme national d’approvisionnemet en médicaments (National Program for Essential Medicines)

PNND or PND: Programme national de Naissances Désirables (National Program for Desirable Births)

PNSA: Programme national de santé de Vadolescent (National Program for Adolescent Health)

PNSR: Programme national de santé de la reproduction (National Program for Reproductive Health)

PPE: Personal protective equipment PRODEF: Projet d’éducation familale (Family Education Project)

PROMIS: Programme de mise à Véchelle de la planification familiale (Project to Scale up Family Planning)

PROSANI: Programme de santé intégré de l'USAID (Integrated Health Program, USAID)

PSI: Population Service International xxiv Acronyms

PSND: Projet des services des Naissances Désirables (Desirable Births [Family Planning] Services Project)

RAISE: Reproductive Health Access, Information and Services in Emergencies

RAJECOPOD: Réseau des Adolescents et Jeunes Congolais en Population et Développement (Network of Adolescent and Young Congolese in Population and Development)

RAPID: Resources for the Awareness of Population Impact on Development RBF: Results-based financing

REEJER: Réseau des Éducateurs des Enfants et Jeunes de la Rue (Network of Educators of Street Children and Youth)

RIG: Regional Inspector General RPF: Rwanda Patriotic Force

SANRU: Projet des soins de santé primaires en milieu rural (known in English as the Basic Rural Health Project)

SCEV: Service central d'éducation à la vie (Central Office for Family Life Education)

SCOGO: Société congolaise de gynécologie et d'obstétrique (Congolese Society of Gynecology and Obstetrics)