Case study

Family planning: Senegal


By Bill and Melinda Gates

Perhaps the best way to describe the importance of family planning is this: Achieving the family planning goal makes it more likely that we’ll achieve virtually every other Sustainable Development Goal.

Poverty. Maternal mortality. Child mortality. Education. Gender equity. They all get better when women can plan their pregnancies so they are physically and economically ready when they have a child.

But norms around sex and family life are powerful. In many countries, families haven’t typically planned. The work of giving them options is not just technical—raising more funding, developing new products, and repairing broken systems. It’s also deeply cultural.

Despite these challenges, many developing countries have started to prioritize family planning, because they understand the impact it has. In the past several years, more than 40 countries have launched rigorous national family planning plans.

We asked two people instrumental in one of the most successful family planning programs, in Senegal, to write about their experience. Fatimata Sy is director for the coordination unit of the Ouagadougou Partnership, an alliance of the nine francophone West African countries committed to reaching more women in the region with family planning information and services. Imam Moussé Fall, a founder of the Islamic Network on Population, helps his fellow imams think about how family planning fits into their theology.

Together, Mrs. Sy and Imam Fall demonstrate both the breadth and depth of work necessary to make sure all families can make decisions to unlock their full potential.

Modern contraceptive prevalence rate in Senegal
Progress to date
National Family Planning Action Plan launched

From the field

Fatimata Sy

Director of the Coordination Unit for the Ouagadougou Partnership

In 2011, increasing access to sexual and reproductive health services in Senegal and across West Africa was little more than a dream.

Our cultures and norms dictated that women have lots of children, and most people didn’t understand the health risks of frequent pregnancies—or how to avoid them. Sadly, those who did often found that public health facilities didn’t have the contraceptives they wanted.

But everything changed when we launched the Ouagadougou Partnership, and when Senegal took the lead to develop the first national action plan for family planning in the region. Everyone in Senegal was involved in developing this plan.

The government set the tone, with ambitious policies to change the status quo as well as the funding to back them up. Civil society followed, with virtually every interest group in Senegal represented: religious leaders, community advocates, youth, and others. For the first time, there was momentum for change.

Senegal revamped its supply chain to make sure that a woman seeking contraceptives never got sent home empty-handed.

The action plan addressed many interconnected challenges in creative ways, including strategies to increase the demand for and the supply of reproductive health services. For instance, to increase demand, Senegal launched a public awareness campaign about how frequent pregnancies affect the health of women and their children.

For a year, the press spoke constantly of family planning on TV, on the radio, and in newspapers and magazines. There were debates. There were posters everywhere. This was a monumental shift in a country where such subjects had long been taboo.

On the supply side, Senegal decentralized its contraceptive supply chains, with the guidance of private sector partners, to make sure that a woman seeking services never got sent home empty-handed. When we started, some types of contraceptives were in stock as little as 20 percent of the time, but now that number is over 98 percent, nationwide. I still think of the slogan they used: “When there are no products, there is no program.”

Senegal’s progress took the world by surprise, and now the other countries in the Ouagadougou Partnership are making extraordinary gains, too.

What excites me even more is that now it’s not just ministers of health who want to hear about family planning. It’s ministers of finance, population, and education as well. They get that family planning isn’t just about health, which is “somebody else’s problem.” It’s about the future, which we’re all responsible for.

For so long, life in Senegal has been about the lack of things. Lack of water. Lack of electricity. Lack of schools. Lack of jobs. Lack, lack, lack. But for the next generation, life can be better. It’s possible. It’s my dream, and it’s becoming a reality.

From the field

Moussé Fall

Imam and founder of the Islamic Network on Population

My mother had eight kids. I was second-to-last. She passed away when she was 43. From that moment on, I had to face the dangers of the world alone.

We realized that the main cause of her death was pregnancies that were too close together. I didn’t want that to happen to anyone else.

When I got older and started studying Islamic thought, I noticed how many religious authorities opposed family planning. The Qur’an is authentic, but religious authorities have to interpret it based on the reality of their time. We have Skype today, but no one’s looking for Skype in the Qur’an. However, all the Qur’an’s themes related to communication can apply to Skype. That is the intellectual effort that religious authorities must take on. We try to help them do that.

For example, the Prophet of Islam encourages women to space births because they have a duty to breastfeed for two full years. Hadiths corroborate that. In the most commonly used one, the Prophet speaks about losing his son, named Ibrahim, when he was a year and 10 months old. The Prophet says, “My son has left this world although his nursing time was not yet done.” The imams we work with know all the verses. After we study them together, they usually agree with our arguments. The next steps are to try to normalize the subject and reserve it for couples duly bound by the sacred ties of marriage.

What we’ve achieved can happen throughout West Africa. Senegal’s successes can be a source of inspiration.

In every district in Senegal, we offer training sessions with local doctors and influential imams. We cover both theological and medical issues, so that imams also understand how contraceptives work and what the side effects can be. This is hard and continuous work. We’ve trained over 3,000 imams who are now on our side. At the start, they were really against family planning.

I’m sure that what we’ve achieved in Senegal can happen throughout West Africa. Our realities are not different, considering it was the colonists who drew borders between the countries. We have the same values and nearly the same languages. We received Islam at the same time. Senegal’s successes can be a source of inspiration.

What I wish for is people who can use their strengths in building a better future. I believe the work we’re doing together is progress toward this goal. Inshallah.

The stories behind the data

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