An Imperative to Act: Family Planning in West Africa

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By: Pape Gaye, President and CEO, IntraHealth International

The following was originally posted on the IntraHealth International blog. Reposted here with permission. Cliquez ici pour lire le blog en français.

Earlier this month, I was in Ouagadougou, Burkina Faso with delegates from eight French-speaking West African countries* for the conference, “Family Planning in the context of Population and Development: the Urgency to Act.”

What I heard was a lot of talk: conversations I have heard before about the need to convince people of “the importance of family planning,” and the desire to focus on family planning only as a means of birth spacing rather than as a critical tool that people need to exercise their rights to make informed choices about pregnancy and childbearing.

Although millions of dollars have poured into West Africa to support family planning, it is clear that progress is slow. The World Health Organization’s recent publication “Family planning in sub-Saharan Africa: progress or stagnation?” shows that approval for family planning remains low in West Africa as does demand, particularly for limiting births. Although many people in West Africa report being unwilling or unready to use family planning, many are also uninformed about family planning methods and where to get contraceptives. Bridging the knowledge gap is critical.

This made the meeting in Ouagadougou all the more important as a venue to galvanize new energy and resources for a region that lags far behind the rest of the world. Although in some West African countries modest economic progress has been made, the fight against poverty is far from being won. West African countries are among some of the world’s least developed nations and report some of the lowest contraceptive prevalence rates and the highest fertility rates globally.

  • Togo, the country with the highest contraceptive prevalence rate—17%— in the region, still ranks 139th on the human development index. Other West Africa countries also rank at the bottom of the development rankings from 142nd to 167th.
  • West African countries report some of the world’s highest fertility rates: women in Niger bear an average of 7.1 children, and women in Mali have an average of 6.6 children.
  • In West Africa, the risk of death from pregnancy-related causes is still 3.5 times higher than in other developing countries and as much as 500 times higher than some developed countries.

Given these realities, it was heartening then that in Ouagadougou there was a strong showing of high-level commitment for family planning in the region, but many continue to forward the argument that in West Africa family planning should be promoted as a means of “child spacing.” No one can argue with the clear benefits of increasing the time between births. I am afraid, however, that limiting the discussion of family planning to child spacing fails to recognize the many benefits of family planning. When people have the information and services to plan their families, women can avoid unwanted pregnancies; maternal deaths can be prevented; fewer babies will die; and communities can flourish. Family planning is a means of spacing, timing, and preventing unwanted pregnancies. And it is essential if these countries are to realize their dreams of achieving Millennium Development Goals 4 & 5 and becoming emergent nations.

Rather than point fingers elsewhere, leaders in this sub-region should demonstrate commitment through their own policies and actions. To really seize on the new opportunities and overwhelming interest in and support from the international donor community for family planning in Francophone West Africa, I think that we need:

  • More robust leadership from the highest-level decision-makers and opinion leaders, who are willing to make budget commitments and unambiguous statements on the importance of family planning and its critical role in development. This also requires greater emphasis on accountability and personal commitment.
  • Full engagement of civil society and its active participation in the follow-up and monitoring of family planning commitments made by ministries and organizations. Civil society also has a pivotal role to play in fostering community dialogue and holding leaders accountable for making family planning accessible, affordable, and acceptable.
  • The media including social media, and young people, including the budding community of social entrepreneurs, also have an important role to play in spreading accurate information about family planning, which people need to make informed choices.
  • More strategic involvement and engagement of the private sector, including ways to make companies more aware of their development footprint. Public-private collaboration should generate and innovate the base of the pyramid of solutions for greater access to quality reproductive health services.

Recently, The Bill & Melinda Gates Institute for Population and Reproductive Health announced that the next international family planning conference will be organized in November 2011 in Dakar, Senegal, building on the Kampala 2009 conference. That meeting will provide a golden opportunity to maintain the momentum created by the Ouagadougou meeting and pledges made by the French government and other donors. The conference will also provide a platform for following up on country plans developed by the eight participating countries.

I challenge us to turn the talk into action so we can celebrate our marked progress in the next nine months when we gather in Dakar.

* Benin, Burkina Faso, Guinea, Mali, Mauritania, Niger, Senegal and Togo. Cote d’Ivoire, a leading economic power in the region was absent due to ongoing political turmoil.