Barriers to Family Planning for Women in West Africa

womenchildrensexual health

Aug 15

Written By Emma Gunn

By Emma Gunn

Published Summer 2024

Special thanks to Susan May Watts for editing and research contributions.

Summary+

In West Africa, access to family planning remains a pressing issue with far-reaching implications for women's health, education, and economic empowerment. Despite global efforts to promote reproductive rights and expand contraceptive access, significant barriers persist, hindering women's ability to make informed choices about their reproductive health. According to recent data, only 13% of married women aged 15–49 in West Africa use any form of family planning method. These low utilization rates are compounded by an unmet need for family planning among 26% of women in the region. Factors contributing to these barriers include limited access to accurate information, fear of side effects, societal norms, and inadequate access to quality healthcare services. Additionally, policy constraints and funding limitations further exacerbate the challenges, impeding progress toward improving maternal and child health outcomes. Despite these obstacles, there are promising practices, such as leveraging mass media campaigns, to disseminate information and challenge cultural stigmas surrounding family planning. Addressing these barriers requires a comprehensive approach that engages stakeholders, promotes gender equality, and prioritizes reproductive rights. By addressing these challenges head-on, women in West Africa can make informed decisions about their reproductive health, leading to healthier outcomes for individuals, families, and communities alike.

Key Takeaways+

Barriers to contraceptive use and family planning in West Africa stem from a myriad of issues, such as lack of adequate access to comprehensive information, social influences such as husband’s approval, and general access issues such as location and socioeconomic status.
Negative consequences of barriers to contraceptive use and family planning in West Africa, including unintended pregnancies, disruptions of education, limited economic opportunities, abortions, and higher risks of maternal and child mortality, threaten the safety of women throughout the region.
While challenges regarding contraception and family planning exist throughout West Africa, progress has been made as various actors have implemented best practices to address the barriers that hinder the safety of women.
The importance of leveraging mass media as a powerful tool to disseminate information and challenge societal norms has been demonstrated through successful interventions. Mass media campaigns, particularly using platforms like radio, have proven to be cost-effective and impactful in increasing awareness, changing behaviors, and bridging geographical gaps, underscoring the significance of strategic communication in addressing family planning challenges in West Africa.

Key Terms+

Birth Control Pills—Also known as oral contraceptive pills. There are two kinds of birth control pills: combination pills, also called combined oral contraceptives or COCs, and progestin-only pills, also called POPs or mini pills.¹ Combination pills are the most common and contain both estrogen and progestin and work by preventing the release of eggs from the ovaries.²^,³ Progestin-only pills work by thickening the cervical mucus in order to prevent the sperm and egg from meeting and prevent ovulation.⁴ With perfect, consistent, and correct use, both are 99.7% effective, and they are 93% effective if they are commonly used.⁵

Birth Spacing—Birth spacing refers to the period of time between the birth of one child and the conception of the next. Birth spacing is significant for the well-being of both the mother and the child because it allows the mother's body to recover from the myriad of physical and emotional demands of childbirth and can reduce the risks of maternal and infant health complications.⁶

Breastfeeding—Formally called lactational amenorrhea. It relies on continual breastfeeding to suppress ovulation and delay the return of menstruation in postpartum women.⁷ When measured over six months with perfect, consistent, and correct use, it is 99.1% effective, and as they are commonly used, it is 98% effective.⁸

Condoms—The two common types of condoms are male condoms and female condoms, which are also called internal condoms. Male condoms are worn on the penis during sex to cover it and collect semen as well as protecting against certain STDs.⁹ They act to form a barrier that prevents the sperm from meeting the egg.¹⁰ With perfect, consistent, and correct use, they are 98% effective, and as they are commonly used, they are 87% effective.¹¹ Female condoms are similar to male condoms but are placed inside the vagina rather than covering the penis to collect semen to create a barrier preventing the sperm from meeting the egg as well as protect against certain STDs.¹² With perfect, consistent, and correct use, they are 95% effective, and as they are commonly used, they are 79% effective.¹³

Contraceptive Herbs—Medicinal plants or herbs used for contraception may be used in many different forms using many different plants. Herbs may be in soup form, ground into a powder, and eaten or rubbed in an incision near the vagina.¹⁴ In a recent study in Nigeria, participants identified over twenty medicinal plants as contraceptives.¹⁵ Just over 50% of those surveyed shared that they relied solely on herbal contraceptives.¹⁶

Contraceptive Implants—The contraceptive implant is a thin plastic rod that is placed under the skin in your upper arm that releases the hormone progestin into your body to prevent pregnancy by thickening the cervical mucus, blocking the sperm from meeting the egg, and preventing ovulation.¹⁷ With perfect, consistent, and correct use, they are 99.9% effective, and as they are commonly used, they are 99.9% effective.¹⁸

Contraceptives—Contraceptives are a range of methods, devices, or medications used to prevent or control pregnancy by inhibiting the conception or fertilization of an egg by sperm. Contraceptives play a crucial role in family planning, enabling individuals or couples to make informed choices about the number and timing of their children. These methods are integral to safeguarding the health, well-being, and human rights of individuals, particularly those of reproductive age.¹⁹

Injectables—Also referred to as the birth control shot, injectables are a shot received once every 3 months that contains the hormone progestin to prevent ovulation, thicken cervical mucus, and block the sperm from reaching the egg.²⁰ With perfect, consistent, and correct use, they are 99.8% effective, and as they are commonly used, they are 96% effective.²¹

Intrauterine Devices (IUDs)—An intrauterine device (IUD) is a small device inserted into the uterus to prevent pregnancy. It offers long-term contraception that is reversible and is considered one of the most effective methods of birth control available. There are hormonal IUDs and copper IUDs. Hormonal IUDs thicken cervical mucus in order to block the sperm from meeting the egg.²³ With perfect, consistent, and correct use, they are 99.5% effective, and as they are commonly used, they are 99.3% effective.²⁴ The copper in copper IUDs damages the sperm and prevents them from meeting the egg.²⁵ With perfect, consistent, and correct use, they are 99.4% effective, and as they are commonly used, they are 99.2% effective.²⁶

Modern Family Planning Methods—Modern family planning and contraceptive methods include the pill, female and male sterilization, intrauterine devices (IUDs), injectables, implants, male and female condoms, diaphragms, and emergency contraception.²⁷

Morbidity—The measure of the frequency of a disease or condition in a given population. It is commonly represented through prevalence or incidence. Prevalence indicates the percentage of the population exhibiting a particular symptom or characteristic, while incidence reflects the rate at which individuals in a specific population acquire a specific symptom or characteristic.²⁸

Mortality—The number of deaths caused by a disease or condition in a given population. It is commonly presented as a rate per 1,000 individuals.²⁹

Periodic Abstinence—Also referred to as the rhythm method, calendar method, moon checking, the standard day method, or other methods where a couple abstains from intercourse during potential fertility tracked by a woman’s menstrual cycle.³⁰^,³¹^,³² With perfect, consistent, and correct use, standardized methods, such as the standard day method or the two-day method, are about 95% effective, and as they are commonly used they are about 87% effective.³³ The effectiveness of the calendar method or rhythm method, as they are commonly used, is about 85%.

Placental Abruption—Placental abruption happens when the placenta detaches from the uterine wall prior to childbirth. This detachment can lead to oxygen and nutrient deprivation for the baby and potentially severe bleeding for the mother.³⁴

Postpartum Abstinence—Refers to abstaining from intercourse after the birth of a child.³⁵

Reproductive Rights—Reproductive rights are a set of fundamental human rights related to an individual's ability to make decisions about their reproductive health and to have control over their own body and reproductive choices. These rights encompass various aspects of reproductive health and family planning and are recognized as essential for the overall well-being and autonomy of individuals, especially women.³⁶ For purposes of this brief, reproductive rights include access to contraceptives and family planning education.

Sustainable Development Goals—The Sustainable Development Goals are a set of 17 interconnected global objectives adopted by the United Nations in September 2015 as part of the 2030 Agenda for Sustainable Development. They aim to tackle a wide range of global challenges, from poverty and inequality to environmental degradation and climate change, by promoting economic, social, and environmental sustainability.³⁷

Traditional Family Planning Methods—Traditional methods of birth control include periodic abstinence, withdrawal, breastfeeding, use of traditional herbs, and postpartum abstinence.³⁸^,³⁹^,⁴⁰

Unintended Pregnancy—A pregnancy that occurs when an individual or a couple did not plan or intend to become pregnant, including pregnancies that are mistimed.⁴¹

Unmet need for contraception—Defined as the number or percentage of fertile women of reproductive age not using contraception yet do not wish to become pregnant.⁴²

Waistbands—Waistbands, belts, or beads are tied or worn around the waist or even the arm and contain traditional herbs meant to prevent pregnancy.⁴³

West Africa—The western region of Africa. Specifically, Benin, Burkina Faso, Côte d’Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo.⁴⁴

Withdrawal—Also known as coitus interruptus, involves the male partner withdrawing the penis from the vagina before ejaculation to prevent sperm from entering the uterus and thus avoiding pregnancy.⁴⁵ With perfect, consistent, and correct use, it is 96% effective, and as they are commonly used, it is 80% effective.⁴⁶

Context

Q: What is family planning?

A: Family planning is the process and decision made by sexual partners to determine the number, spacing, and timing of their children.⁴⁷ Family planning service use is often measured by the unmet need for contraceptives or the number of fertile women of reproductive age who do not wish to become pregnant yet are not using contraception.⁴⁸ These services include a variety of methods, from contraceptives to educational resources.⁴⁹ Modern contraceptive methods include a range of options such as birth control cills, Intrauterine Devices (IUDs), condoms, contraceptive implants, and injectables.⁵⁰

However, in West Africa, indigenous or traditional methods of contraception play a large role in preventing unwanted pregnancy.⁵¹ The most common forms of traditional contraception indigenously used in West Africa are periodic abstinence, withdrawal, breastfeeding, use of contraceptive herbs, postpartum abstinence, and waistbands.⁵² In many West African societies, healers may be the ones who disperse family planning knowledge and prepare traditional methods.⁵³ Traditional herbal medicine, often dismissed as primitive by Western medicine, has been a source of pharmaceutical inspiration, with many drugs modeled on phytochemicals derived from it.⁵⁴ Yet obstacles persist in the form of poor quality control, safety issues, and limited scientific documentation of medicinal plants.⁵⁵

Bright picture of different contraceptives

While traditional methods are not as reliable as modern methods of contraception, they are much better than no form of contraceptive and should be taught correctly to increase their effectiveness, especially in areas where access to modern methods is inconsistent, and women are already using traditional methods. Women in West Africa feel comfortable working with these healers whom they consult regularly for other health problems as well.⁵⁶ Current family planning programs and services are starting to involve and educate local traditional healers, allowing traditional healers and Western medical professionals to work together.⁵⁷ The effectiveness of dispersing modern medicine through traditional practices can be seen in a 2021 study on HIV testing rates in Cameroon, where researchers demonstrated that by involving traditional healers in offering testing services, they achieved a 100% testing rate among patients, whereas only 57% of the control group received testing; moreover, 70% of those tested were successfully connected to care, contrasting with the control group where none were linked to care.⁵⁸ However, traditional methods of family planning and birth spacing have gradually reduced in prevalence despite the uptake of many modern methods not yet being fully adopted.⁵⁹ In order to better incorporate traditional and modern health practices, the World Health Organization encourages the incorporation of traditional practices in modern health care and has issued its second edition of comprehensive guidelines to help states better regulate traditional medicine.⁶⁰

Tree diagram with different resource planning options

Q: Who is benefiting from family planning?

A: A five-year global study found that 121 million unintended pregnancies occur each year—roughly 230 per minute.⁶¹^,⁶² Yet, an estimated 257 million women globally who want to avoid pregnancy are not using safe, modern methods of contraception.⁶³ Family planning services provide women and families with safe and reliable options for effective birth spacing. Family planning improves reproductive, maternal, and child health, helps girls stay in school, contributes to women’s economic empowerment while supporting higher family income and educational opportunities for children, combats gender inequality, reduces pressure on natural resources by allowing women to space births, and is proven to be cost-effective.⁶⁴^,⁶⁵^,⁶⁶ Enabling individuals to plan and space pregnancies contributes to healthier outcomes for mothers and infants.⁶⁷ Rates of unmet needs for family planning are disproportionately higher among adolescent girls aged 15–19 at a rate of 43%.⁶⁸ As a result, family planning plays a crucial role in keeping girls in school because unplanned pregnancy interrupts education and prevents girls from using their time for educational purposes; therefore, family planning enables girls to have increased education opportunities.

A study in West Africa found that every extra year of schooling has the potential to further future income by a minimum of 10%, lower the risk of maternal mortality by 20%, and lower fertility rates by 0.26 births.⁶⁹ When girls have the ability to plan or prevent their pregnancies, they are more likely to stay in school, breaking the cycle of early pregnancies and promoting educational opportunities for young women.⁷⁰ Moreover, family planning contributes to women's economic empowerment by allowing them to pursue education and career goals, resulting in higher family income.⁷¹ Family planning enables individuals to make informed choices about when they wish to start or expand their families. Furthermore, a comprehensive examination of global family planning trends highlights its remarkable cost-effectiveness. Investing just $1 in addressing the unmet need for contraceptives can result in up to $120 of annual long-term benefit.⁷²

Q: Why is Family Planning a prominent issue in West Africa?

A: It is estimated that 160 million women and girls around the world have unmet family planning or contraception needs.⁷³ The issue of family planning holds significant prominence in West Africa due to several key factors that underscore the urgent need for improved access to and utilization of contraception methods. West Africa includes Benin, Burkina Faso, Côte d’Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo. A study from 2008 found that only 13% of married women aged 15–49 in West Africa use any form of family planning method, and only 1 out of every 10 opt for modern, effective methods.⁷⁴

Furthermore, a 2008 study found that around 23% of women express a desire to avoid pregnancy but are not currently using any family planning method, leading to an unmet need for family planning.⁷⁵ The World Bank’s current data places that number even higher with 26% of women expressing an unmet need for family planning.⁷⁶ The wealth gap also influences family planning use in West Africa, with prevalence lower among poorer women. In the poorest group, only 4% use a form of family planning, compared to 20% in the wealthiest group.⁷⁷ However, even in the wealthiest group in West Africa, the prevalence of unmet needs is still lower than in other regions in Africa, such as Southern Africa, whose wealthiest group has a prevalence rate of 69%.⁷⁸ Addressing the challenges surrounding family planning in West Africa, including low utilization rates, unmet needs, and disparities based on wealth, is essential for ensuring the reproductive health and well-being of women and girls in the region.

A graph showcasing contraceptive prevalence

Q: When did Family Planning become a topic of discussion, and how has it grown since?

A: Family planning became a prominent topic of discussion during the early to mid-20th century, marked by the emergence of global movements advocating for reproductive rights and the development of effective contraceptive methods.⁷⁹ Margaret Sanger was one such activist who was pivotal in the formation of organizations such as the American Birth Control League in 1921 that laid the groundwork for the widespread recognition of the importance of family planning in addressing population growth as well as improving maternal and child health.⁸⁰ While the birth control movement initially focused on the individual woman and her well-being, concerns about the adverse effects of large populations, particularly in the face of falling death rates in the twentieth century, led to actions worldwide to tackle the potential problem of population explosion.⁸¹ In 1968, the United Nations made a significant declaration at the International Conference on Human Rights affirming that it is a fundamental human right for parents to have the freedom and responsibility to decide how many children they want and the timing of their births.⁸² The World Population Plan of Action document, created in 1974 at the Bucharest Conference, eventually led many countries to begin to implement family planning programs under the category of maternal and child health care, leading to what is called the golden era of family planning—20 years where reproductive revolution unfolded across every region but sub-Saharan Africa.⁸³ In the 1970s, the first population census on the African continent revealed a population growth averaging about 30–40 births per 1,000 people, a growth that doubles every 20 years.⁸⁴

Since the 1974 and 1984 conferences, many African countries have recognized the high population growth and have begun to implement family planning programs.⁸⁵ The increase in fertility on the continent seen from 1950 to 1980 was followed by a gradual decrease after 1980.⁸⁶ From 1980 to 2010 fertility shifted from 7.05 to 6.08 children per woman by 2010.⁸⁷ By 1994, global changes and the women's movement prompted another paradigm shift, marked by a move of family planning towards reproductive health and rights, challenging the previous focus on population and fertility rates.⁸⁸ The shift diminished the emphasis on population growth as a central concern in global development, leading to decreased resources for family planning and a shift in global priorities toward issues like HIV.⁸⁹ In West Africa, the emphasis on implementing family planning to improve maternal and child health and enhance economic development lost momentum with the AIDS epidemic.⁹⁰ While successful and high-quality programs have been developed across Africa, there is a notable difference in family planning indicators across various regions.⁹¹ For example, Eastern Africa has been credited with stronger family planning efforts compared to Western Africa, resulting in the wider availability of modern contraceptive methods in the region.92 West Africa’s adoption of family planning efforts and contraception is incredibly slow compared to other regions of the world.⁹³

Contributing Factors

Limited Access to Information, Fear of Side Effects, and Misinformation

A primary contributing factor to barriers to family planning in West Africa is a lack of access to information and knowledge among individuals in the region. Without accessible sources of accurate information, women cannot make informed decisions regarding family planning. Of the 257 million women not using safe, modern methods of contraception, 172 million are using no method at all.⁹⁴ Factors affecting contraceptive knowledge include age,⁹⁵ education level,⁹⁶ household economic status,⁹⁷ religious belief,⁹⁸ marital status,⁹⁹ and understanding of family planning methods.¹⁰⁰

A study from 2012–2015 found that the percentage of women across various West African countries who received family planning information during recent contact with a health service provider was extremely low. The percentage of women in Burkina Faso was 37.1%; in Senegal, it was 22.2%; in Togo, it was 20.1%; in Niger, it was 16.9%; and in Guinea, it was 6.6%.¹⁰¹ A major source of the knowledge gap in West Africa is attributed to the lack of comprehensive sex education, reproductive health information available, and properly trained and informed health care providers, particularly in rural and underserved areas.¹⁰²

Additionally, many women fear the side effects associated with contraceptives. Mistrust of modern contraceptives use and effectiveness has been shown to be a significant factor in an individual’s use or avoidance throughout West Africa and beyond.¹⁰³ This mistrust is evident in the large discrepancy between the 70% of West African women who desire to space their births and the 21% of West African women who use any form of contraception.¹⁰⁴^,¹⁰⁵ For example, in a study conducted in Nigeria, 42.9% of individuals reported misperceptions about its safety, believing that contraceptives are dangerous and that chemicals in contraceptives can damage their reproductive system.¹⁰⁶ Women’s reluctance to use modern contraceptives likely stems from a lack of effective education and information that could be resolved by providing evidence of the effectiveness of family planning and contraception.¹⁰⁷^,¹⁰⁸ A recent 3-year study in sub-Saharan Africa found a significant decrease in early and unintended pregnancies of young girls who received comprehensive sexual education in school and health providers who received training to be more responsive to adolescents.¹⁰⁹ The fear of health service providers is compounded by an abundance of misinformation spread by word of mouth.¹¹⁰ In Ghana, 5 out of 7 family planning providers stated that the primary concerns preventing access to modern contraceptive methods are misconceptions and rumors.¹¹¹ Addressing this knowledge gap is vital to ensure that women can make informed decisions about their reproductive health and have access to safe and effective contraceptives. Further, the strong patriarchal systems in play in West Africa leads to a greater risk of unintended pregnancies occur each year—roughly 230 per minute.⁶¹^,⁶², because relationship dynamics are unequal and women have little reproductive autonomy.¹¹² Without proper education and information, individuals may engage in sexual relationships without a clear understanding of contraceptive methods, leading to higher rates of unplanned pregnancies.

Familial Influence and Attitude

Familial pressures and attitudes are a significant factor in shaping norms of family planning throughout West Africa, influencing decisions regarding contraceptive use and access. Even though 42% of young Ghanaian women face an unmet need for family planning, 77% of them report access to modern contraception.¹¹³ Studies have shown that women choose to accept family planning or choose a particular method because of the norms perpetuated by their family and community.¹¹⁴ A research study in Burkina Faso revealed that women who engaged in communication with their husbands about family planning and received positive responses were 4.64 times more inclined to opt for modern contraceptive methods than women who received a negative response.¹¹⁵ A study on spousal support of contraceptives in low-resource areas found that women who had high levels of partner support reported a significantly higher rate of use of modern contraceptive use at 34% compared to the 21% of women without partner support.¹¹⁶ However, various studies have found that few men discuss family planning with their sexual partners or wives and there is limited male engagement or interest in family planning.¹¹⁷^,¹¹⁸^,¹¹⁹ A study in West Africa demonstrated that three-quarters of men and women had not discussed family planning in the past year.¹²⁰ Still, a study in Nigeria found that 74.9% of women cited their husband’s approval or disapproval as a determinant of any form of contraceptive use.¹²¹ Partner's disapproval is a significant barrier to the use of contraceptive services across the region.¹²²^,¹²³

Societal norms and stereotypes in West Africa shame or stigmatize contraceptive use. Many married men even believe that it promotes promiscuity.¹²⁴ This finding is supported by a study in Ghana on societal perceptions of family planning that revealed while knowledge of at least one family planning method was widespread among women, male partners largely did not view family planning or contraceptive methods as an appropriate option for their partner due to religious and economic desires for a large family.¹²⁵ Male partners who opposed contraceptive use were found to have a significant influence on whether or not women used contraceptives or methods of family planning at all.¹²⁶ In fact, one study found that the majority of women who used birth control were encouraged by their partners to use it.127 In a study of nearly 200 new and expectant mothers in Ghana, 77.8% of women were unable to access services as a result of family members making decisions for them, 49.2% of women stated that their husband was the final decision maker in terms of access to care and services, and only 2.7% were the final decision makers on accessing maternal health services during their pregnancy.¹²⁸ Research has consistently found that married women or women in unions often rely on the support and cooperation of their partners when it comes to contraceptive use.¹²⁹ Further prominent scholarly works have shown that male partners can be responsible for the discontinuation of contraceptive use through male partners disallowing its use, denying payment for contraception, denying transportation to a clinic, reporting the use of contraceptives to a woman to relatives or friends, or denying money for cooking and eating.¹³⁰ The study showed that male partners who restricted the use of contraception denied access to money in 24% of cases to prevent partners' use.¹³¹ Conversely, the study also found a significant relationship between male partner support and awareness about contraceptive use, level of education, and social class.¹³² The interplay of societal norms, partner dynamics, and cultural perceptions underscores the complexity of family planning initiatives in West Africa, emphasizing the urgent need for comprehensive strategies that engage both men and women to ensure equitable access and utilization of contraceptive services.

Access to Care: Proximity and Quality

Accessibility is another contributing factor that creates a barrier to family planning services in West Africa, specifically in terms of proximity to care and quality of services. Access is a significant factor for individuals considering family planning methods.¹³³ Proximity to health facilities is strongly associated with modern contraceptive use.¹³⁴ A study in Ghana observed a relatively consistent contraceptive prevalence rate among women residing within 2 km of a service facility but noted a 5% drop-off in modern contraception usage for women who live more than 2 km from a health facility.¹³⁵ In fact, multiple studies in West Africa determined that having a family planning center within 5 km from one’s home was statistically significant to family planning use.¹³⁶^,¹³⁷ Researchers found that the significance of distance and travel time to facilities remained a relevant barrier even after accounting for socioeconomic factors, although those in higher socioeconomic status were more likely to be able to afford both the service and travel costs to health facilities.¹³⁸^,¹³⁹ A study in Nigeria found that contraceptive use was significantly associated with healthcare visits, and the researchers argued that this finding backed up the belief that one of the main factors limiting contraceptive use was access to facilities.¹⁴⁰ Further, there is a significant impact of having local access to free or discounted family planning information and services. In Mauritania, the family planning services reported 5.5 times more clients per day when discounted services were provided.¹⁴¹ When such services are readily available and accessible, more women and girls are empowered to take control of their reproductive choices, leading to better planning of pregnancies.¹⁴²

Another key barrier to the availability and accessibility of family planning services in this region is the subpar service quality, frequent commodity shortages, and lack of qualified healthcare providers.¹⁴³^,¹⁴⁴ Many women admitted to not seeking out services because they felt their healthcare providers were unqualified.¹⁴⁵ The belief that healthcare providers lack qualifications led to a diminished trust in information from healthcare workers compared to information shared in the community.¹⁴⁶ This skepticism was underscored in a nationwide study in Benin that found that over half of healthcare providers lacked thorough family planning guidelines, and approximately one-fourth demonstrated an incorrect understanding of its advantages.¹⁴⁷ There are significant discrepancies in the knowledge, attitude, and practices of health providers regarding family planning guidelines.¹⁴⁸ The lack of family planning knowledge among providers not only hampers the delivery of essential services but also undermines the quality of care, making it difficult for individuals to access accurate information and reliable contraception options. Addressing the barriers of proximity and quality in accessing family planning services in West Africa is crucial for empowering women and girls to make informed reproductive choices and ultimately improve pregnancy planning.

Policy Makers

Additional societal norms, such as governmental policy, inhibit access to family planning methods. Attitudes of foreign and local policymakers towards family planning and contraceptives have consistently been unengaged and unmotivated to address core issues in sub-Saharan Africa.¹⁴⁹ The leadership in West African countries has not taken the initiative to assist their citizens in family planning. Policy and legal restrictions persist in restricting access to comprehensive sexual education and other family planning services across the majority of African nations. While many West African countries provided some form of sexual education in response to the HIV epidemic, it remains far from comprehensive and is primarily centered on abstinence. Abstinence-only sexual education is not recommended due to its lack of effectiveness, potential harm to adolescents, and withholding or distorting health information.¹⁵⁰ Policies that facilitate a lack of sexual education and knowledge among West Africans creates significant barriers to family planning and contraceptive use in the region.

The Mexico City Policy that the US enacted in 1984 is a significant international policy that has affected West African family planning use. This policy states that foreign health centers can only receive US funding and aid if they do not offer any services related to or supporting legal abortion.¹⁵¹ Initially introduced by Ronald Reagan following the 1984 Mexico City conference, Donald Trump reinstated and expanded this policy as one of his initial presidential actions in 2017.¹⁵² However, the Mexico City Policy impacts a wide range of programs beyond abortion services, including initiatives aimed at expanding contraception access, preventing and treating HIV/AIDS, combating malaria, and enhancing maternal and child health.¹⁵³ Additionally, studies have found that reduced US funding as a result of this policy actually increases rates of abortion in sub-Saharan Africa.¹⁵⁴ The rule hinders access to healthcare, stifles local advocacy efforts, and undermines reproductive rights on a global scale. Numerous African countries rely on donor funds to support their family planning programs. The Mexico City Policy has had a substantial impact by significantly reducing funding for health programs and clinics, limiting access to contraceptives for millions of women in Africa.¹⁵⁵

Even though the policy was rescinded in 2021, this action alone has not completely reversed the inadvertent negative effects of the policy. Many of these programs and clinics offering basic family planning services that were forced to close or reduce their services remain so as they wait for funds to reach them.¹⁵⁶ For instance, Non-Governmental Organizations (NGOs) working in countries that were affected require time to re-establish relationships and family planning services that were disrupted.¹⁵⁷ Many organizations seek a renewed investment in comprehensive sexual and reproductive health information and services from both the US government and national governments.¹⁵⁸ This investment is essential for the purpose of rebuilding and strengthening national health systems and contraceptive supply chains and ensuring that women's healthcare needs are adequately addressed and supported. Yet, because the Global Gag Rule was an executive action and has the potential to return with each president, it creates uncertainty for foreign providers who are hesitant to initiate programs or partnerships that could be abruptly terminated if a future US president reinstates the policy.¹⁵⁹

Consequences

Effects on Education and Economic Opportunities

Unintended pregnancies resulting from women not being able to plan the spacing of their births through family planning have far-reaching and devastating consequences for women in West Africa. As per the United Nations, nearly half of all pregnancies are unintended.¹⁶⁰ Satisfying all unmet need for contraception in developing regions could potentially lead to a reduction of approximately three-quarters in unintended pregnancies One of the most significant impacts of unintended pregnancies is their detrimental effect on education. Young women who find themselves facing unplanned motherhood are often forced to make painful choices. In many cases, they are forced to discontinue their education or put it on hold indefinitely.¹⁶²

In Sierra Leone, an estimated 20% of girls drop out of school prematurely due to pregnancy or child marriage, as the responsibilities of motherhood can create an insurmountable barrier to pursuing their academic aspirations. Consequently, they miss out on opportunities for personal growth and economic empowerment, entrenching a cycle of disadvantage that hinders their future prospects.¹⁶³

Economic opportunities for women are equally affected by unintended pregnancies. Mothers who become parents prematurely are frequently confronted with numerous challenges when it comes to securing employment and earning the wages necessary to care for themselves and their children.¹⁶⁴ Most men in the region view themselves as supervisors and providers, noting that it is shameful for them to participate in roles that are traditionally maternal, such as caregiving.¹⁶⁵^,¹⁶⁶ These roles include cooking and shopping.¹⁶⁷ However, many men in West Africa admit that they are often selfish with their money and forget about providing for their family, leaving mothers little to actually care for their household.¹⁶⁸ Unintended pregnancy as a result of a lack of family planning options leaves women’s financial stability further compromised as they may not be able to work during pregnancy or after, and they may struggle to provide for themselves and their children. This economic hardship exacerbates the cycle of poverty, limiting their ability to break free from its grip and create a better life for themselves and their families.¹⁶⁹

Abortions that are Unsafe for the Mother

The absence of comprehensive policies for family planning access in West Africa and the social stigma attached are significant consequences of the barriers to contraceptive use and family planning. Women who experience unintended pregnancies occur each year—roughly 230 per minute.,⁶¹^,⁶² are faced with limited options such as abortion, adoption, or caring for a child without appropriate financial, physical, and emotional resources.¹⁷⁰ Unintended pregnancy in West Africa often leads women to resort to abortion. In many cases, the abortion practices endanger the mother’s health.¹⁷¹ Approximately 19–20 million abortions are performed annually by individuals lacking the necessary skills, in environments that do not meet minimum medical standards, or both.¹⁷² In Ghana, induced abortion stands as the second leading direct cause of maternal mortality, accounting for 20.7% of such fatalities, and it poses a particularly severe risk to younger women.,¹⁷³^,¹⁷⁴ The repercussions of such abortions not only jeopardize the immediate health and safety of these women but also impose a considerable burden on healthcare systems that must address the complications and aftermath of these abortions.¹⁷⁵ It is estimated that effective contraceptives could prevent approximately 90% of morbidity and mortality As a result, access to contraceptives could help overcome challenges related to abortion and mortality throughout the region.

Across the African continent, the share of unintended pregnancies occur each year—roughly 230 per minute.,⁶¹^,⁶² ending in abortion has surged from 30% to 42% in recent years, underscoring the urgency of the situation.¹⁷⁷ The consequences of abortions are not only medical but also social and economic, as poorly performed abortions may lead to long-term health issues and financial burdens for individuals and their families. A study in Senegal found that economically disadvantaged women were considerably more prone to abortion complications and less likely to receive treatment for such complications compared to their more affluent counterparts due to a lack of post-abortion care.¹⁷⁸ Approximately 31% of pregnancies in this study were unintended, and 24% of these unintended pregnancies occur each year—roughly 230 per minute.,⁶¹^,⁶² resulted in abortion.¹⁷⁹ A study in Nigeria found that 7.4% of total gynecological admissions in 2013 were patients who received treatment for complications arising from abortions that endanger the mother’s health.¹⁸⁰ Another study at Washington University found that providing contraceptive access to women cuts abortion rates by a range of 62–78%.¹⁸¹ Because women lack family planning options such as access to education and contraceptives, they often put their lives at risk by undergoing abortions from unqualified practitioners.¹⁸²

Higher Risk of Maternal and Child Mortality

Unintended pregnancies occur each year—roughly 230 per minute.⁶¹^,⁶² in West Africa that come from a lack of family planning care have a direct and concerning impact on obstetric outcomes, increasing the risk of maternal and child mortality. The UNFPA states that more than 60% of unintended pregnancies result in abortions, with roughly 45% of these procedures considered unsafe for women. This practice contributes to 5–13% of all maternal deaths.¹⁸³ Women who experience unintended pregnancies do not often receive adequate prenatal care and support, thereby raising the likelihood of complications during childbirth.¹⁸⁴ The majority of maternal deaths are preventable, as there are many modern medical solutions. Access to skilled health professionals can be the difference between life and death for women during childbirth. Severe bleeding, infection, and pre-eclampsia are just a few of the complications of childbirth that may be deadly unless treated by a medical professional that proper access to family planning provides.¹⁸⁵ With unintended pregnancy occur each year—roughly 230 per minute,⁶¹^,⁶² women are not likely to receive prenatal care until after the first trimester, if at all.¹⁸⁶ Many women who are not actively trying to get pregnant may not realize they are pregnant until after the first trimester, which may lead to detrimental effects of tobacco and alcohol on the fetus. A child born from an undesired pregnancy faces an increased likelihood of being born with a weight below 2,500 grams (about 5.5 pounds), likely because closely spaced births are associated with lower birth weights.¹⁸⁷ These children also have a higher risk of mortality within the first year of life, a greater susceptibility to physical and emotional abuse, and decreased access to essential resources for healthy growth and development.¹⁸⁸

Practices

Spread of Information Through Mass Media

In the realm of family planning initiatives in West Africa, leveraging mass media channels emerges as a highly effective best practice for addressing issues throughout the region. Mass media, encompassing television, radio, and online platforms, serves as a tool for disseminating information on family planning methods and resources. A West African study published in April 2024 found that if women had been exposed to mass media, she was about twice as likely to use traditional or modern methods of contraception compared to women who were not exposed to mass media (3.3% and 1.6% use of traditional methods and 20.7% and 12.9% use of modern methods, respectively).¹⁹⁵ The impact of employing mass media for family planning communication in West Africa is multifaceted. Firstly, it facilitates the demystification of misconceptions surrounding family planning methods, allowing for informed decision-making. Notably, a study in Sierra Leone found that exposure to family planning information through mobile phones or radio increases your likelihood of using modern contraceptives.¹⁹⁶ A study in the region found that the main source of information and identification for male’s knowledge of family planning came from mass media, of which 70% was from radio.¹⁹⁷ Sources, including USAID, agree that Family Planning messaging exposure is significantly associated with intention to use contraception in the future but suggest that mass media campaigns are not reaching the younger populations in West Africa and need to be adapted to support the dissemination of information through media types like social media or SMS.¹⁹⁸^,¹⁹⁹ USAID argues that campaigns need to be designed with your target audience in mind and release content aimed towards the target audience on sources that the target audience uses.²⁰⁰ Therefore, leveraging mass media channels, particularly through radio and mobile platforms, emerges as a highly effective best practice for disseminating family planning information and increasing the uptake of contraceptives and family planning services, ultimately leading to healthier reproductive choices. In West Africa, adaptations are needed to ensure broader reach and engagement among younger populations.

Impact

One prominent example of the role of mass media in disseminating information in West Africa can be seen in the work of Development Media International (DMI). In a randomized control trial in Burkina Faso, DMI set out to determine how effective such media campaigns are in changing behavior.²⁰¹ DMI ran a radio campaign promoting family planning and found that it was a cost-effective and powerful means of improving large-scale outcomes. Subsequently, researchers used the information they gathered from rural focus groups about personal barriers to family planning usage to create a motivational radio message.²⁰² In these focus groups, results showed that many people lacked adequate information, feared the side effects of contraceptive use, possessed entrenched views of family size, and held limited decision-making power for women. DMI researchers broadcasted 30–60-second spots 10 times a day every day for 30 months across 8 radio stations in 6 languages.²⁰³ The campaign produced a 20% increase in contraceptive use in intervention areas. Evidence also found that after the campaign women in the area were 14% more likely to argue that they should have control of the number of children they have, and the whole campaign only cost an equivalent of 7.5% of Burkina Faso’s national family planning budget.²⁰⁴ Therefore, by incorporating appropriate content through methods such as radio and utilizing local languages, mass media campaigns can effectively resonate with the diverse population of West Africa, fostering a deeper understanding of family planning practices.

Gaps

Despite the efficacy of mass media in disseminating family planning information, notable gaps persist in its implementation. Accessibility remains a challenge and primary gap, particularly in remote and underserved areas throughout West Africa, where infrastructural limitations hinder the reach of television and radio signals. A study of the effect of spatial and socio-demographic determinants in the Upper Region of Ghana revealed a statistically significant association between ownership of a functional mobile phone and the use of contraception, with 21% of women who owned a functional mobile phone using contraceptives as compared with only 10% of those who did not have a functional mobile phone.²⁰⁵

This association means that lack of access to media and communication technologies such as phones has the potential to detriment family planning access. Additionally, disparities in literacy levels may pose barriers to fully harnessing the potential of media platforms in accessing information. In Senegal, researchers found that access to printed family planning messaging and textual literacy were not indicators of increased family planning use.²⁰⁶ Additionally, cultural nuances play a significant role; thus, tailoring content to align with diverse cultural contexts is crucial for effective communication. Addressing these gaps requires a nuanced approach that integrates community engagement, infrastructure development, and the promotion of media literacy to ensure equitable access to family planning information across all segments of the population in .

Footnotes

Preferred Citation: Gunn, Emma. “Barriers to Family Planning for Women in West Africa.” Ballard Brief. August 2024. www.ballardbrief.byu.edu.

Viewpoints published by Ballard Brief are not necessarily endorsed by BYU or The Church of Jesus Christ of Latter-day Saints

Africa

Emma Gunn

Emma was born and raised in Pennsylvania but has been a world traveler since a young age. She has always had a passion for learning from and about others around her. She is the youngest in a family of health professionals and has always been deeply interested in women's health. She plans on continuing her advocacy for women and children in her future studies and to actively engage in initiatives aimed at improving social opportunity and care.