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Imagine a World...Where You Don't Know Contraception Exists

July 10, 2012

This is the fourth post in the "Imagine a World..." blog series from Marie Stopes, International.

With the London Summit of Family Planning coming up, my team and I are seeing a never ending stream of reports and statistics. We need this evidence and I like to read it, but what they say about Senegal I already know: it is one of the worst places in the world for a woman to get contraception.

A tiny 12 percent of married women in Senegal use modern contraception, and in rural areas we don’t even make double digits.

Our Senegal programme is one of the newest in Marie Stopes International’s 42-strong global partnership, opened just last year, and this kind of statistic makes it crystal clear why we chose to come here: there’s nowhere we are more needed.

When I talk to women in other countries, they often don’t understand at all. How can women not even know that contraception exists, they ask? But that’s one of the reasons contraceptive use is so low here. Even before the problems with supplies running out, the huge number of providers who need training and the cultural barriers here to family planning, each and every day we need to overcome this most fundamental barrier – that huge numbers of women want to stop having children, but have never heard of family planning. 

If you’d never heard of contraception and having a baby every year was perfectly normal to you, just nature’s way, can you imagine the mental adjustment it’d take if someone starting telling you there were these pills you could take, or a rod in your arm that would stop the babies coming?

It’s hard to imagine. But imagine it we must.

Even for the women who do know, exercising their right to use contraception is hard. A few months ago I travelled for two days with our outreach team to Mbour and the Dakar suburbs, sites they visit regularly to offer family planning. No matter how many reports outline the barriers preventing women from accessing contraception, I think the women themselves tell the story best.

One woman, Mbayang Ndiaye (photo on the right), told me:

“I was married when I was thirteen years old. At fifteen I had my first child. Now I’m 35 years old and I have seven. The youngest is my daughter Amy Diaw, who’s here with me today. She’s one year and three months old. I thank almighty Allah for my children. After all, there are women who can’t have babies at all. But seven is more than enough. So I came to this Marie Stopes International Senegal clinic to have an implant. My body is begging for a rest.

“Also there is always a big lack of money in our household. My husband does not have regular employment, he works as a day labourer, and he has a second wife to support too. I am trained as a hairdresser, but I can’t work because I have to take care of so many children. I am struggling everyday to raise them decently. Feed them well, send them to school.

“My husband does not know that I am here. I am not sure that he would approve if he did find out. But my mind is set, I need to get this implant. I thank God that Marie Stopes International is providing us with this service.”

A younger woman, Ndeye Wade (photo on the left) said to me,

“My husband knows I’m here and he’s perfectly fine with it. I’m lucky, because not all men are like that. Many don’t want their women to use contraception. Because God does not like that, they say, or because they think contraception will make their wives sleep with other men. Or that it will make sure that their wives can never have babies again. But I am positive. Slowly we will convince these men that what they think is nonsense, and that contraception brings them great benefits.”

It’s because of these women that in Senegal, the youngest of Marie Stopes International’s overseas programmes, we have big plans. We are going to dare to imagine a world where women know they have a choice.

The government here has set a target of increasing the contraceptive prevalence rate to 27% by 2015, no easy task. But big dreams need big partners, so in Senegal we plan to go from one clinic at the end of 2012 to nine clinics by 2015. From three outreach teams to 18, and from 60 partnership social franchises to 200 – funding permitting. Truly nationwide coverage is what we’re aiming for, to support the government in their dream.

Although it’s the government’s dream, the biggest impact of our imagining will be for women like Mbayang and Mdeye: we estimate that we will provide 850,000 family planning services to 650,000 women in Senegal over the next five years. This will save our country millions and millions of francs for families and the public health system.

But for me – and the women of Senegal – there are other numbers that matter much more:  the family planning services we deliver will prevent almost 1200 mothers from dying and 11,500 child deaths.

As a midwife, I couldn’t ask for any more.

Do you believe every girl and woman should have the opportunity to determine her own future? Spread the word that contraception is not controversial. Take the pledge, share your own story, and ask your online communities to do the same!

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