September 25, 2015
Written by Sara Stratton, Assistant Program Director, IntraHealth International
“Family planning saves lives, and women want it.”
My Nigerian colleagues summed up the success of a group of family planning projects to this simple reason. They’re right. It’s not complicated. When given the option, women choose contraceptives. Our job as reproductive health advocates and family planning program managers is to make sure all women have the option.
Use of family planning—or contraception—reduces maternal mortality by nearly a third. And we know when a mother dies her children are 10 times more likely to die within two years of her death. Ensuring that women and couples have access their choice of contraceptives can lead to better health for communities around the world.
In low- and middle-income countries, over 225 million women have an unmet need for contraceptives. These women want to avoid pregnancy but are not using a modern method of family planning. Most of these women are in sub-Saharan Africa and Southeast Asia. This often leads to unintended pregnancies, somewhere in the magnitude of 74 million per year. Some women attempt to end these pregnancies, and over half of these abortions are unsafe. For those who go on to give birth in these regions, their lifetime risk of maternal death is much higher than in the US (where it is 1 in 1,800), the Netherlands (1 in 10,700), or the UK (1 in 6,900). If you are a woman in Nigeria, the risk is 1 in 31, in Mauritania, 1 in 66, and in Niger 1 in 20.
And for each maternal death there are 20 more serious morbidities, such as obstetric fistula, chronic anemia, or infertility. Preventing these poor outcomes by providing access to high-quality family planning services and contraceptives can not only improve the lives of these women, but also reduce spending on other health challenges.
Across the Francophone West Africa region, IntraHealth International has been helping ministries of health and local communities increase access to high-quality family planning services and use of these services. This region traditionally has had low modern contraceptive prevalence rates, high fertility rates, and high maternal and neonatal mortality. In Mali, for example, the contraceptive prevalence rate is 10%, the average woman has 6.1 children, the maternal mortality rate is 368/100,000 live births, and the neonatal mortality rate is 34/1,000 live births
But the situation is starting to change. Contraceptives are becoming more accessible and acceptable across the region, and governments understand that investing in family planning is good for social and economic development.
It Takes a Village to Change Attitudes and Access
Such change requires a variety of voices, influencers, and interventions.
In Senegal, for example, where opposition has traditionally been strong, religious leaders are making a difference by speaking out in favor of family planning. They are making sure communities know that healthy spacing of pregnancies is supported in the Koran and that spacing is good for families. And health workers with new tools, training, and supervision are proactively asking women about their interest in family planning after they deliver babies and when they bring their children for well-child visits and immunizations. These interventions, along with improvements in supplies of contraceptives to facilities, have increased women’s and couples’ use of contraceptives. In two years, the modern contraceptive prevalence rate increased four percentage points – an unusually strong increase – from 16% in 2012-13 to 20.3% in 2014, and it is 29% in urban areas.
In Mali, women recovering from fistula—a devastating childbirth injury caused by prolonged, obstructed labor that leads to chronic incontinence and other health issues—are counseled on family planning options before they leave the hospital. These women now understand how contraceptives can keep them healthy and give themselves time to physically recover, regain independence, and establish a livelihood.
Youth ambassadors in Benin, Mali, and Senegal have become vocal family planning advocates. They are encouraging their peers, community leaders, and governments to ensure young people have access to contraceptives. They see contraceptives as an avenue to improving their lives. If youth can avoid early child bearing, they have time for education, establishing their professional lives, and marriage.
Across the region, governments are slowly increasing their investments in family planning. Making a range of contraceptive options available and making sure clients receive high-quality family planning counseling is working, and governments see an opportunity. Clients are more likely to continue to use family planning when they can select and rely on the method best suited to their personal needs. When couples have such options, health costs can go down.
For every dollar invested in contraceptives, governments save $1.47 in pregnancy-related care, freeing up funds for education, infrastructure, and other priorities.
This World Contraception Day, we salute all those health workers and advocates who are making contraceptives and counseling available for women and couples. You are helping save lives around the world, and paving the way for a healthy future for us all.
Follow IntraHealth at the 2015 International Conference on Family Planning in Nusa Dua, Indonesia, where we’ll be talking about these issues and more. Learn more about how health workers make family planning—and future planning—happen.
Photo by Trevor Snapp for IntraHealth International. A nurse discusses family planning options with a client at the Mathare North Health Center in Nairobi, Kenya.