Kenya, Malawi, and Senegal rapidly expand access to and use of family planning

Half of all pregnancies among women ages 15-49 in low- and middle-income countries are unintended. These pregnancies can undermine women’s health and wellbeing, economic productivity, and education.

Three countries in sub-Saharan Africa are demonstrating a path forward – connecting women of reproductive age with an increasing variety of modern family planning options that allow them to decide whether and when to have children. Kenya, Malawi, and Senegal are three such countries that have leveraged evidence-based high-impact strategies, supported by years of research, to cut fertility rates.

In advance of his presentation at the International Conference on Family Planning, Director of the Centre of Excellence in Women and Child Health at Aga Khan University and Exemplars in Global Health research partner Zahid Memon shares findings from Kenya, Malawi, and Senegal, and discusses their success.

These findings will be incorporated into the Exemplars in Global Health platform in 2023.

Why focus on Kenya, Malawi, and Senegal?

Memon: Those three countries each achieved rapid progress in a short time across two measures: demand for family planning satisfied, and use of modern family planning methods.

In Kenya, modern family planning use has roughly doubled from 2004 to today – increasing from 22.7% to 53.22%. In Malawi, we see the same steep trajectory, with use of modern family planning increasing from 21.5% in 2000 to 45.2% in 2015. And in Senegal we see a rapid rise over eight years. From 2010 to 2018, modern family planning use increased from 8.9% to 18.9%.

Looking at these three countries, what are the similarities among the strategies they used to achieve this progress?

Memon: Our preliminary analysis confirms and adds to the evidence base supporting the high-impact practices that improve access to and use of family planning.

I’ll highlight six key high-impact strategies that these three countries shared: political commitment, health system strengthening, integrating family planning into essential health services, behavior change communications, promoting women’s agency and autonomy, and prioritizing adolescents.

First and foremost, each country’s leadership made a political commitment to improving access to and use of contraception. In fact, in Kenya and Malawi, we saw that political commitment expressed at the highest level, with the president speaking about the importance of providing women with access to family planning services. This creates an enabling environment and removes a lot of barriers at all levels, across governments and in communities.

But political commitment extends beyond pronouncements and must include a commitment of resources to family planning. In each of these countries, we saw funding levels significantly increase. Kenya and Malawi both created a separate budget line for family planning. And in Malawi, funding for family planning roughly doubled over the last decade.

Second, each country invested in health system strengthening. Malawi rolled out a one-stop-shop approach, launched mobile clinics, and promoted task shifting to increase access. Senegal also used task shifting. For example, previously, health workers needed a special license to administer injectable contraceptives. But now, lay workers, such as community health workers, can administer injectables. That makes injectables much more accessible within communities.

The third effective strategy is the integration of family planning into the broader health system. What we see in these countries is minimizing missed opportunities to deliver family planning information and services to women. They optimized each touch with the health system. Kenya, for example, promoted post-pregnancy family planning. So, when a mother brought her newborn in for immunizations, she was, at the same time, given information about or provided with contraception.

Fourth, each country leveraged community-based approaches to change behavior. For example, in 2011 Senegal launched a school for husbands. So, men became mobilized to learn about and support the health of their wives and their children. Malawi has trained community-based delivery agents, volunteers who spread awareness of modern family planning in rural communities.

Fifth, each of these countries moved toward supporting women’s agency and autonomy in their family planning strategies. Malawi, for example, launched mother and girl groups that create awareness of the consequences of child marriages and educated women and girls about the research demonstrating that a child's and mother's health are optimized if there are at least 24 months between pregnancies. The government also increased the legal age of marriage to 18 in 2012.

Senegal launched a campaign called “Moytu Nef” which means avoiding pregnancies that are too close together. The campaign educated women about the research on women’s health and birth spacing, and sought to give women the power to make informed decisions about their family size and timing. The program even included religious leaders to help support this message.

Lastly, each of the countries worked to increase adolescent awareness of family planning and connected them with services.

How did the countries reach adolescents?

Memon: Malawi launched a life skills basic education curriculum in its schools and created national standards for youth-friendly services. Kenya adopted its own youth-centered policy and services strategy in 2003, and Senegal rolled out adolescent counseling centers, among other efforts.

What if any impact did new contraceptive methods have?

Memon: The introduction of long-acting contraceptive implants and the wide usage of injectable contraception, including the option of self-injection more recently, especially in Malawi, was a large contributing factor to the increased access we documented across Kenya, Malawi, and Senegal.

What impact is this having on women’s empowerment in these countries?

Memon: Our research findings align with the evidence and validates existing knowledge on this subject: that underage pregnancy undermines the education, health, and economic activity of girls and women. Providing girls and women with the opportunity to plan and space their families allows them to make better choices for the health of their children. And themselves.

What’s next for this research project?

Memon: Our research is ongoing and currently different research methodologies, such as systematic review and decomposition analysis, are exploring different dimensions to current findings. We are now presenting the preliminary research finding. The three country case studies are still in progress so we will be continuing to gather insights and add more dimensions to all these findings, in terms of identifying and solidifying the best practices in the respective countries. Moreover, the generated evidence will help us inform investments and strategies of potential donors, influence policy, and practice changes in similar settings.