Family Planning Has Yet to Take Hold in West Africa-But Change Is Coming
West African countries have the highest fertility rates in the world, with an average of 5.5 births per woman; they also have the lowest levels of contraceptive use.
As a longtime physician and family planning/reproductive health trainer at IntraHealth International, I see several reasons for this. When I started training male health providers in family planning services in West Africa in 1997, I was met with a lot of resistance. Many men thought that female clients wouldn’t want to talk to male health providers. But I told them, “It depends on how they see you. When you return to your facility, you need to tell people what you can do for them, advertise your new skills in family planning services, encourage women to come with their husbands so they can trust you as a couple, and build trust within community.”
Now, 17 years later, I do not think that much has changed. Last year, when we were training mentors and tutors on a range of high-impact services, there were no male participants at the family planning training sessions. In health centers, the midwife is in charge of all maternal health services, including antenatal care, deliveries, postnatal care, and immunization. The male nurse is in charge of curative care. This division in exclusive territory limits clients’ access to services.
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