Academic journal article International Perspectives on Sexual and Reproductive Health

Young Women's Access to and Use of Contraceptives: The Role of Providers' Restrictions in Urban Senegal

Academic journal article International Perspectives on Sexual and Reproductive Health

Young Women's Access to and Use of Contraceptives: The Role of Providers' Restrictions in Urban Senegal

Article excerpt

Family planning services were introduced in Senegal in the early 1960s at the private Blue Cross Clinic in Dakar, but it was only in 1981 that the government developed an administrative structure capable of directing a national program and began to provide information, education and counseling support and family planning services. Wider provision of family planning prior to 1981 was prohibited by a law passed during the 1920s, when Senegal was a French colony, (1) and repealed only in 1980. In 1988, a national population policy was issued, giving official and political approval of the family planning program and paving the way for progress in family planning in Senegal.

But despite changes in Senegal's legal and regulatory environment in regard to family planning, contraceptive prevalence has been slow to increase. According to the 2010-2011 Senegalese Demographic and Health Survey (DHS), only 12% of currently married women used a modern contraceptive method, compared with 8% in 1997 and 10% in 2005. (2) This slow change can be attributed to low demand for contraceptives, as well as to supply-side barriers. For instance, most African countries have been providing oral contraceptives and injectables through community-based distribution programs for decades; however, Senegal pilot-tested such a program only in 2012-2013, a delay caused by illogical restrictions on which types of providers can supply oral contraceptives and injectables. (3)

Nearly 30% of currently married Senegalese women have an unmet need for family planning--that is, they want to either postpone their next birth for at least two years or stop childbearing altogether, but are not currently using a contraceptive method; (2) the current level is slightly lower than in 2005 (32%). The level of unmet need in Senegal--especially for spacing (29% among currently married women)--is higher than in other West African countries, such as Burkina Faso, Ghana, Mali and Nigeria. (4)

Factors contributing to unmet need for family planning in developing countries include lack of contraceptive knowledge; poor quality of and access to family planning services; method cost; women's concerns about side effects; and women's, husbands' or family members' objections to contraceptive use. (4,5) According to a descriptive analysis of Urban Reproductive Health Initiative data, women's beliefs and misconceptions about contraceptives, husbands' objections to contraceptive use and the poor quality of family planning services are the most frequent reasons deterring women in urban Senegal from practicing contraception. (6)

Youth constitute a key target in reproductive health strategies and, in Senegal, appear to have particularly low levels of contraceptive use. For example, in 2010-2011, only 2% of all 15-19-year-olds and 6% of all 20-24-yearolds reported using a modern method; (2) the proportions among currently married women in those age-groups were slightly higher (5% and 8%, respectively). Access to reproductive health services remains an issue for young women and men because of cultural, medical and financial barriers. (7-9) For example, although there are no legal restrictions to providing oral contraceptive pills to unmarried young women, results from simulated client studies suggest that providers are reluctant to do so and tend to promote abstinence instead. (7,9) Consequences among young women of lack of access to reproductive health services are increased risk of unplanned pregnancy; unsafe abortion; STIs, including HIV; and early school dropout due to pregnancy. (7)

Previous research has stressed the importance of helping young people in developing countries to be effective contraceptive users. (10-12) As the medical mediators between clients' knowledge and fears and their use of contraceptives, health providers are also key to ensuring access to, and adoption and continued use of, contraceptive methods among youth. Health providers' knowledge and training influence access to specific contraceptives. …

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