From July 9–10, IntraHealth staff in Senegal welcomed Ms. Melinda Gates and coordinated opportunities for her to visit family homes, health clinics, and a mosque where she learned firsthand about the experiences couples, health workers, and religious leaders have had with accessing and discussing family planning.

Ms. Gates also met with representatives from the government, nongovernmental organizations, and the private sector where she probed deeply about the constraints the Senegalese face in using family planning and the challenges of providing and promoting these services.

In 2010, the Bill & Melinda Gates Foundation selected Senegal as the francophone site for the Urban Reproductive Health Initiative. Known locally as the Initiative Senegalaise de Sante Urbaine (ISSU), the goal of the IntraHealth-led five year project is to promote family planning in six cities in Senegal.

According to the 2011 Demographic and Health Survey (DHS), only 12% of married women use a modern method of contraception. In contrast, neighboring countries to Senegal’s north, such as Morocco and Egypt, have contraceptive prevalence rates above 60%. Similarly, total fertility rates in Morocco and Egypt average around 2.5 to 3 children per woman as opposed to Senegal’s average of 5 children per woman.

“If I had known earlier, I would have had three children, not seven.” A young mother shared this comment about family planning during a visit to her home, and it stuck with Ms. Gates.

During her visit, Ms. Gates had the opportunity to talk frankly and ask tough questions about how the project, staff, donors, and partners can overcome the restraints—from the logistical to the economic and political—that lead to a woman who wants three children taking on the physical, financial, and social challenges of raising seven.

Innovative Approaches to Increasing Access to Family Planning

Through ISSU, IntraHealth is addressing issues ranging from cultural norms to health system inefficiencies that contribute to Senegal’s low contraceptive prevalence rate.

The population of Senegal is about 95% Muslim, and many individuals seek guidance on all social, religious, and cultural matters from their spiritual leaders. The project engages Imams and religious teachers (Marabouts) and gathers their support for disseminating accurate family planning messages. The project also works in collaboration with a local nongovernmental organization, the Islam and Population Network, to promote open discussion on the topic of religion and family planning. Some Imams have said that before the project, they had never specifically discussed family planning because they lacked information and arguments to engage in healthy public debate.

Contraceptive stock-outs are also a significant challenge to the use of family planning in Senegal. One year of monitoring data from two urban districts showed that public facilities, which provide between 70% and 90% of contraceptives, experienced significant and extended periods without contraceptives (over 40% for Depo-Provera and 83% for implants between 2010-2011).These stock-outs were caused by a combination of inefficient logistic systems and issues related to contraceptive forecasting at the national level. ISSU is testing a new model for the distribution of commodities called the Informed Push model to track and minimize the risk of stock-outs. This new model has eliminated stock-outs in the pilot districts while the control districts continue to experience significant stock-outs.