Thoughts on modern contraceptives’ use in sub-Saharan African countries
By Marta Ribes SYP, GHMe 2019
Access to Contraceptives
It is estimated that 214 million women desire to use contraceptives but don’t have access to them. Figures show how tragic this is: 40% of the pregnancies worldwide are not desired and almost 20% of it ends up in abortion; every day, every minute, a woman days giving birth (1).
In the 2012 London Summit on Family Planning (FP2020), a program was launched to enable 120 million additional women to use modern contraceptive methods by 2020 in the world’s 69 poorest countries. This initiative expected to raise the estimated growth rate from 0.7 to 1.4% in contraceptive prevalence rates.
Recently, Ahmed and colleagues (2) assessed the outcomes of this program in 8 out of the 69 countries. They found that in Nigeria – after the FP2020 – the estimated annual growth rate in the use of modern contraceptives augmented 3 percentage points; 2.4 points in Ghana; 1.4 points in Burkina Faso, Democratic Republic of Congo, and Uganda; and only 0.9 points in Ethiopia. Each country has different societal values, religious beliefs, war conflicts and many more factors which might explain the differential success of modern contraceptives. For example, it is typically explained that the poorer a family is, the more children will be born. This might seem contradictory, but low-income families need more hands to put to work and the risk of losing them (child mortality rate) is higher, so a preventive measure is to have more kids (3).
Barriers to Use of Contraceptives
Even if modern contraceptives are available, other barriers must be overcome and other factors must be tackled in an integrated way. Education has proved to ameliorate many aspects of health, among which, delaying the age of the first pregnancy and having fewer kids. Educating girls allows them to raise their voice, reject generalized misconceptions and myths, and be empowered to decide for themselves the use of contraceptives. At the same time, the use of contraceptives facilitate access to education – young pregnancy makes young girls abandon schools –, work outside home and contribute to family income – which transforms the women into self-reliant, independent persons, with a say in household decision-making and respected by society –.
Thus, education and the use of contraceptives establish a virtuous cycle.
Educating girls might not be enough. Awareness about the benefits of contraceptive use needs to target also the traditional and community leaders to create a fusion of traditional and evidence-based beliefs. Otherwise, girls wanting to use them could be discriminated or stigmatized. Furthermore, not all modern contraceptives are equally accessible. Implants and intrauterine contraceptives (ICUs) require adequate facilities, trained professionals and follow-up after several years. Other options are cheaper and easier to use, like male or female condoms. However, there are some examples of successful management of treatments by non-health workers. In the Addis Ababa Fistula Hospital, women with little education were trained to conduct fistulae repair surgeries. The same has been carried out in Mozambique, Malawi and Tanzania with cesarean sections. This might seem unbelievable to western populations, but some posit that these are mechanical procedures which can be learnt without any knowledge in biology and can save many lives.
There are still many women being neglected, the suffering of misogynistic cultures and gender inequities. For this broader picture where modern contraceptives’ use is embedded, I recommend the book “Half the Sky” by Nicholas Kristof and Sheryl WuDunn, and Sheryl’s TED Talk on the same topic.
1. Kristof, N. and WuDunn, S. (2009). Half the sky. [Minneapolis, Minn.]: Highbridge.
2. Ahmed, S., Choi, Y., Rimon, J., Alzouma, S., Gichangi, P., Guiella, G., Kayembe, P., Kibira, S., Makumbi, F., OlaOlorun, F., Omoluabi, E., Otupiri, E., Oumarou, S., Seme, A., Shiferaw, S., Anglewicz, P., Radloff, S. and Tsui, A. (2019). Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys. The Lancet Global Health, 7(7), pp.e904-e911.
3. Rosling, H., Rosling Rönnlund, A. and Rosling, O. (2019). Factfulness. Paris: Flammarion.