Improving contraception access in francophone West Africa a journey of 'a thousand miles of steep, uncharted terrain'

In 2011, West Africa’s nine francophone nations had the lowest modern contraceptive prevalence rates (mCPR) in the world. Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo – countries whose populations comprise almost 150 million people – all lagged on this fundamental indicator of health, development, and women's empowerment.

But, as a result, they also lagged on other indicators. As the WHO has stated, a country’s mCPR also “serves as a proxy measure of access to reproductive health services that are essential [including] those related to child mortality, maternal health, HIV/AIDS, and gender equality.”

It is said that a journey of a thousand miles begins with a single step, but trying to solve the problem of mCPR in francophone West Africa meant we were facing a thousand miles of steep, uncharted terrain.

Prohibitive family planning laws, an outdated colonial code, social, cultural, and religious barriers, and a historical lack of information available to women made increasing mCPR an enormous challenge. Add to that the disparate funding for family planning – for every US dollar spent in anglophone or Southern Africa, around 75 US cents was spent in the francophone countries – and it seemed this was an unconquerable journey.

But rather than being dissuaded by our place at the bottom of the mCPR mountain or our lack of resources to climb such a steep hill, these disadvantages fueled the nine nations to for the Ouagadougou Partnership, a movement to accelerate the voluntary use of family planning services in the countries.

After our initial gathering in Burkina Faso at the 2011 Regional Conference on Population, Development and Family Planning, we decided our partnership would focus on better collaboration and cooperation at national and regional levels to meet high rates of unmet family planning needs, as well as better coordination between donors to optimize their support.

Knowing our collective voice was stronger than our individual ones, we banded together to influence policies on the international stage and secure funding. Joining forces with countries that shared cultural similarities, but also understood our differences, gave us demographic weight and the ability to scale programs. Ours was an ambitious first step, but we took it.

Our vision was crystal clear: we would help ensure easy access to family planning services in francophone West Africa to save lives. Our first goal was to increase the number of modern contraceptive methods users by at least one million between 2011 and 2015, and by 2.2 million between 2016 and 2020.

Early on our journey, we made a point to engage ministries of health. We advocated for more ambitious family planning goals, better communication, and increased domestic resource allocation to meet the unmet needs in the nine countries. We also paid attention to cultural differences across the region. Some countries were more comfortable framing messages around birth spacing rather than contraception. Others were more progressive. Emulation and experience sharing between countries of similar cultures were the first steps towards achieving the our goals.

We also recognized early on that, particularly for issues relating to sexual and reproductive health rights (SRHR), being supported by people who shared the same backgrounds and values as our end users would be important. For us, decolonizing global health was not a catch phrase. It was an understanding that programs about ideas traditionally seen as “being imported” would have a better shot at success if they were designed and implemented by those who shared commonalities with women and communities in the countries. The messenger would be as important – if not more important – than the message. Ours would be a program from West Africans, for West Africans, and by West Africans.

When we created the partnership, we also understood that operational efficiencies would become our superpower. Creating the Ouagadougou Partnership Coordination Unit, or OPCU, would guide and keep the movement alive. It would also ensure no one country took – and then dropped – the lead.

While it has been flattering to be approached by other organizations seeking to stack education or gender equality initiatives onto ours, we have used these invitations to recommit to focusing on family planning alone. It has kept us from spreading ourselves too thin and allowed us to keep our eyes glued firmly on the road ahead, even while understanding that many other social issues influence SRHR and women’s health in general.

So how has our journey been going? The Ouagadougou Partnership met and exceeded its goals by helping to reach over 3.8 million additional modern contraceptive methods users in its nine member countries between 2011 and 2020. That means most of our countries doubled their contraceptive prevalence rates.

It is a tremendous success story. And, just as we'd hoped, our sense of accomplishment is now fueling us to do more. We will now work to reach 13 million women by 2030. We know that doubling our current 6.5 million number will require additional support and more local ownership, so to support us with our administrative and financial services, we’ve selected Speak Up Africa, a Dakar-based hub of experienced communication and advocacy experts who understand the power of connections, empower strong local leadership, and works to help develop a strong civil society in various health sectors.

Their story, in some ways, mirrors ours. Headquartered in Dakar, they started small – as we did – working to cultivate solid relationships with key decision makers, driving policy change and advocacy across the region. And just as the OPCU recognizes it needs agency over its history and narrative, Speak Up Africa does, too. They understand the importance of local ownership, from civil society to religious leaders, from youth to implementing partners, in advancing this journey. They also understand that we need to work with donors to ensure investment strategies are localized to solidify regional leadership.

But there are many more reasons our partnership with Speak Up Africa quickly became so successful. Ours is a relationship embedded on mutual respect, appreciation for each other’s contributions, and a genuine desire to help each other succeed in our similar missions. Furthermore, we joined forces while having a shared realization that this story and journey was bigger than both our organizations and could potentially provide a story of successful transfer to ambitious and triumphant local ownership.

And importantly, our story has inspired global initiatives to localize and transfer meaningful powers to regional and country talents, trusting their ability to pilot and spearhead global health programs and partnerships. While donors have the responsibility to ensure they are providing a safe ecosystem for local organizations to thrive – and we were fortunate to have the support of our former U.S.-based host in this transition – it is also incumbent upon local organizations to reflect and organize their requests for what their needs are to set them up for success.

As we look ahead, our goals are to expand our work to turn local youth from beneficiaries to influential changemakers, help ensure countries can make up for any lags they are experiencing, focus on family planning in humanitarian settings, create demand, and improve our behavior change communications, so we can tackle the social norms that are hindering family planning uptake. We also want to focus on research that we can disseminate so governments, civil society, and donors can make better decisions but also, so that academia and other research institutions can see where research gaps remain and strengthen their contribution to this partnership. Importantly, we are doing all of this with a precise shared lens, one that ensures every francophone West African woman’s life and values are considered when decisions are deliberated.

In the same way that a journey of a thousand miles begins with a single step, ensuring we increase mCPR in francophone West Africa is journey we must take for all the women in the country – now and in the future.