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February 07, 2011

Teens in Africa found to have negative attitudes toward family planning

Ministerial Leadership Initiative for Global Health
  Rosann Wisman

Dr. Alex Ezeh, Executive Director of the African Population & Health Research Centre, gave a compelling talk on family planning in Africa last week in a forum in Addis Ababa, Ethiopia.

Of all the facts and figures he laid out, one stood out to me:

“The trend is that 15 to 19 year olds in Sub Saharan African (SSA) are now more likely to have negative attitudes toward family planning,” he said at a meeting organized by The David and Lucile Packard Foundation of grantees and partners.

After years of declining global donor support for family planning, most of the statistics in sub-Saharan Africa are not surprising. I had heard much of the bad news before:  Mothers in 31 of 34 countries in SSA have an average of five or more children.  There are 14 million unintended pregnancies each year.  One in 16 women in the region die in childbirth, a rate that is more than 100 times higher than women living in any other country in the world. Across the world, two-thirds of women use contraception but in sub-Saharan Africa, the number is only 25 percent.   And over the next 40 years, the population of sub-Saharan Africa could increase from 1 billion to 2 billion. 

But it was the attitudes of young people that really surprised me. Dr. Ezeh cited the example of Kenya where the proportion of adolescents aged 15–19 years who disapproved of family planning increased between 1998 and 2003 from 13.4% to 22.4. How, in this world of social networking and, even in the most remote villages, ready access to cell phones and growing access to the Internet, could increasing numbers of young people think that family planning and contraception is a bad thing? 

Dr. Ezeh explained that in the last decade due to lack of funding, public information and education campaigns about family planning have all but ended.  Teenagers in most of Africa are just not hearing positive messages about the importance of family planning. 

While the Packard Foundation has never waivered from its generous support for this work, there is other good news.  There is a resurgence of interest and support for family planning among international donors. Donors like USAID and the Bill & Melinda Gates Foundation are renewing their commitment to the importance of family planning. 

The support, in part, seems to be spurred by the challenge of reaching Millennium Development Goal 5, which calls for improving maternal health and achieving universal access to reproductive health. Progress towards reaching MDG 5 has been slower than any other MDG.  Statistics back up the importance of family planning, showing that effective family planning can decrease maternal mortality by 30 percent.

All five MLI countries are working in reproductive health and expanding access to family planning is a priority.

Here are two examples:  Ethiopia’s Federal Ministry of Health’s teams of health extension workers advocate family planning in over 15,000 villages throughout the country.  Maternal mortality, while still high, has decreased to 400 per 100,000 from a high of 700 per 100,000.  Contraceptive prevalence has increased in Ethiopia to 15 percent, from 8 percent.

Second, in Senegal, a Gates-supported Urban Reproductive Health Initiative (URHI), is working to increase access to modern family planning methods among the urban poor.  Dr. Bocar Daff, Director of the Reproductive Health Division at the Ministry of Health and Prevention in Senegal, is leading a new community health worker program to increase family planning awareness in rural areas. 

Dr Ezeh concluded his sobering review of data with recommendations.

His No. 1 recommendation: Increase access to family planning.

What is needed to make that happen?  Again and again, conference attendees identified political leadership as essential.  Political will and leadership has played a major role in countries that have seen significant advances in access to family planning and reproductive health and related decreases in maternal and child mortality.

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