Bill & Melinda Gates Foundation

West African Women Demand Family Planning

May 10, 2012

For many years, in large parts of West Africa, the percentage of women who use contraception has stalled at less than 10 percent, leading many to declare that there is very little or no demand for family planning (FP) in the region.

This couldn’t be farther from the truth.  

Among women—young and old, those who have had many children and those who have had few or none—there is a sea-change happening. These women are expressing their desire for family planning methods, and our approach towards integrating maternal and child health care services with FP is producing results.

In Liberia, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) is working with the Ministry of Health and Social Welfare to better integrate FP and child health services. The model involves having vaccinators share family planning messages and referrals with women who bring their infants for immunization services.

Women in West Africa are now clearly expressing the desire to plan their pregnancies.

It seems to be working. During recent training activities at local health facilities, more than half of the women who brought their infants for routine immunization services also wanted to get family planning services on the same day. And the story of one woman who visited a local health clinic reflects how important this work is.

This woman showed great interest when the vaccinator spoke with her about FP. She said that she had already been pregnant 10 times—including one unplanned pregnancy—and given birth to eight children, seven of whom had survived. She did not want to get pregnant again. When counseled about the variety of available methods, she expressed relief and opted for tubal ligation.  

We are witnessing the demand for long-acting methods such as contraceptive implants and intrauterine devices, and MCHIP is working hard to provide them to women where they can easily access services—at their community health centers.

For example, the program is providing support to train midwives, like Rosalyn.

Rosalyn works in an urban slum health center in Monrovia, a city in Liberia. Rosalyn expertly counsels and inserts implants for local women. After a supervision visit with Rosalyn, staff members of the program walked through the community only to hear one of the women that Rosalyn had just helped came running after them saying: “Sister, sister! Can you please give my friend an implant, too?”

While a great deal of progress has been made to extend services and women are responding by seeking contraception, we find that such programs are now struggling with ensuring access to these commodities in many countries.

Shortages of injectables and implants—due either to underestimation of demand (so not enough contraceptives are in place) or inadequate internal logistic systems (that do not distribute contraceptives in a timely manner)—result in frequent stock-outs in health facilities. In these cases, women seeking services are told to come back when contraceptives are supposed to be in stock, often discouraging women who desire to use modern methods.  

Another common barrier is cost. Many of the countries with the highest rates of fertility and maternal death are also the poorest in the world, and women must pay for contraception as well as transportation and sometimes additional services. As a result, we often see services swamped when methods are provided free during training activities. 

For women who would prefer a permanent method, these services are even more limited, often only available in regional or national hospitals once or twice a month. We frequently hear reports of wealthier women who schedule Cesarean sections to be able to also get postpartum tubal ligations. 

These challenges in ensuring accessible family planning services have been effectively addressed elsewhere in the world, so why not in West Africa? Women are now clearly expressing the desire to plan their pregnancies. It is an optimal moment to unite as a community supporting women’s health worldwide to ensure adequate supply and minimal cost for family planning services to the hundreds of thousands of women in West Africa who are seeking care.

Please take a minute to visit the TED storytelling site to hear more “ideas worth spreading."

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