Zimbabwe's Change of Heart

Amid a flurry of controversy and criticism from international family planning officials, in 1981 the government of Zimbabwe severely restricted the use of Depo-Provera in that country. Approval of the drug was limited to treatment of cancer of the kidney or uterus or to use by women above the age of 35, women with five or more children, or "mentally disturbed women who may be abused." At the time of the restriction, the Salisbury Herald reported that over 100,000 Zimbabwean women had been using the drug. Explaining the government's action, then-Minister of Health Dr. Herbert Ushewokunze warned that the drug "may at this very moment be posing a serious threat to the health of our women and children."

Ushewokunze criticized the advocates of the drug, charging that "safety and unwarranted side-effects evidently rank low in their list of priorities. The official position of international agencies on Depo-Provera is not necessarily scientific or well-informed," he said. "It clearly reflects the political orientation, male dominance and perhaps undue influence of the pharmaceutical industry at policy-making levels."

Zimbabwean health officials have recently had a surprise change of heart. In a statement to the Zimbabwean parliament last November, the country's deputy health minister that the government was thinking of re-introducing the drug, with strict monitoring.

Zimbabwean officials seem to have conflicting information on the current status of Depo-Provera. The Secretary for Health, Dr. Office Chidede, was quoted in the Herald of Harare in early December as saying that there were indications that Depo-Provera might soon be approved for marketing in the U.S. In the course of an interview in Harare one week later, this writer informed Chidede that a recommendation by an advisory committee of the U.S. FDA had suggested that the restrictions on Depo-Provera marketing in the U.S. should be maintained. Chidede then qualified his public statement. "One of the political reasons that had prompted us to restrict Depo-Provera remains, and that is that it is not marketed in its country of origin," he said. "Until such time that somebody can tell me that it's safe, which will be evidenced by the FDA accepting the drug, we will not accept it because the country of origin believes it's not safe to use on its own people."

But Chided was later contradicted by the director of the state-funded Child Spacing and Fertility Council, Norbert Mugwagwa. In a January 4, 1985 article in the Harare Herald, Mugwagwa declared that "because of an increase in demand from the public, the Minister of Health is planning to relax the criteria so that the drug is readily available to a greater number of people." A doctor who has worked on fertility issues in Zimbabwe confirmed that according to new policy guidelines from the Ministry of Health to the Child Spacing Clinic in Harare, Depo-Provera could be "used more freely."

There has been considerable pressure exerted by both health practitioners and women to legalize what was once the most popular form of contraception in Zimbabwe. The Ministry of Health seems caught between standing by its oft-stated policy requiring home-country marketing approval for any drug to be registered for use in Zimbabwe, and the widespread demand for the drug. So far, the Ministry has stopped short of public policy reversal, but has loosened its guidelines in practice. Many eyes in the Ministry are now on Washington. "Whatever happens (in Zimbabwe) will depend on what is going on elsewhere in the world," explains Chidede. "We are carefully monitoring what is going on in the U.S., and the whole debate there." Thus, the decision of the FDA commissioner will have immediate and international consequences, for people and corporate stockholders in North America as well as for African villagers in Zimbabwe.

David Goodman is a member of the editorial collective of Science for the People magazine.