Condomize and Stay Alive: Access to Contraception in West and Sub-Saharan Africa

West and Sub-Saharan African countries have some of the lowest rates of contraceptive use and highest rates of fertility and infant, child, and maternal mortality. According to the World Health Organization (WHO), 75.7 percent of the world’s need for modern contraceptive methods has been met. Yet, less than 50 percent of this need is satisfied in West and Sub-Saharan Africa. Not only does the United Nations Human Rights Office (OHCHR) designate access to contraception as part of women’s right to health, but providing access to contraception is necessary to save lives as Africa’s population continues to grow exponentially. Supporting continued improvements in access to contraception protects and betters the lives of women and young people, and leads to sustainable development that benefits all.

Causes of Low Contraceptive Rates

These drastically lower rates of contraceptive use stem from financial, socio-cultural, and infrastructural barriers. Financial constraints—due either to a lack of governmental funding or personal poverty—negatively impact local clinics and, consequently, the women that rely on them. The lack of infrastructure and limited stability on much of the African continent also hurt efforts. Frederick Okwayo from the United Nations Population Fund said concerning family planning projects in the Democratic Republic of the Congo that “the logistics of providing care is difficult because of the bad infrastructure. But we try to go to the refugee camps and help people there, and also hold family consultations.”

Fatimata Sy, director of the Coordination Unit for the Ouagadougou Partnership, a cooperation effort between nine francophone West African countries with the goal of increasing access to contraception, says that her work in the region is particularly difficult due to a combination of religious factors, social and gender norms, and taboos. Furthermore, cultural and religious beliefs, often stemming from patriarchal communities, undermine women’s control over their bodies. Sy recounts the story of Amy Colle, a young Mauritanian woman, who was in an arranged marriage as a teenager to be a second wife. Despite taunts of infertility from her husband’s family, Colle used modern contraceptives to delay her first pregnancy: “She understood that to get the respect of her husband, the respect of the family, she had to be independent economically. And being independent economically is tied to the fact that she could control her pregnancies.”

Progress

Despite lagging globally in meeting women’s need for contraception, there have been many advancements throughout West and Sub-Saharan Africa in the last 15 years. According to the Family Planning 2020 (FP2020) report, from 2012 to 2020, the number of women and girls using modern contraception has increased by 66 percent—from 40 million to more than 66 million. FP2020 director Beth Schlachter finds that the key to success has been expanding “contraceptive supply chains to clinics or community centers.” In Ethiopia, the government has refocused on health, education, and creating new job opportunities. This program has led to the steepest drop on record in birth rate in Sub-Saharan Africa—from 7 children to 4.5 and an increase in life expectancy from 60 to 66 years. In addition to providing communities with basic healthcare, the Ethiopian government has also trained more than 40,000 female health officials to work in rural areas, where access to medical services is particularly limited. Following the remodeling of the healthcare system after the 1994 genocide, women’s use of contraception in Rwanda increased by 60 percent. Even more, the Rwandan startup Kasha, which delivers condoms and contraceptives to rural areas through text order, has become remarkably successful. In Niger, reproductive health campaigns are publicly backed by both the president and prominent athletes, with support through investments from the German Development Bank, Kreditanstalt für Wiederaufbau (KfW). In Burkina Faso, the government has increased spending on women’s health by 30 percent, which has been correlated with an uptick in donations aimed at reducing pregnancies, integrating young people into family planning counseling sessions, and the distribution of free contraceptives. Between 2011 and 2020, the Ouagadougou Partnership has increased contraceptive users by over 3.8 million women and girls in Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo.

Expanding Access

Potential avenues for continuing to expand access to contraception include increasing funding and minimizing logistical challenges for local health workers, as well as providing consistent funding for contraception. Men play an integral role in combating the social barriers of stigmas, misconceptions, lack of knowledge, religiosity, and cultural values that impede access to contraception and spreading awareness on the advantages of having less children. Thus, a method to combat these social barriers is sensitization programs that specifically target men. An extension of these kinds of programs could include increasing awareness on social norms among young people and providing contraceptives in schools. This earlier exposure to the ideas of family planning and modern contraception can modify norms to better empower girls and women.

These targeted solutions must exist in tandem with increases in income so people will not have to rely on having a large number of children to provide financial stability. Continued increases in income will also bolster the strength of political will needed to support the modernization of values surrounding contemporary methods of contraception. By 2050, half of the world’s population increase will come from the African continent. Given this rapid population boom, continuously increasing access to reproductive healthcare in West and Sub-Saharan Africa will not only ensure women’s human right to healthcare, but also save and improve lives.