Social Networks Give Family Planning a Boost

Maternal health indicators for Malian women are harrowing. One in three deaths among women of childbearing age is the result of pregnancy and childbirth complications. Maternal mortality is among the highest in the world--121 deaths per 1000 live births. Disintegrating facilities, poor quality equipment and a scarcity of trained health care providers are the most visible causes of maternal mortality. Despite these formidable challenges, however, contraceptive prevalence has begun inching upward.

The benefits of family planning cannot be overstated. Greater contraceptive use not only reduces child and maternal mortality, but also improves maternal health. Fewer high-risk pregnancies, unintended pregnancies and unsafe abortions translate into fewer maternal illnesses and deaths.

Although the numbers are modest, more Malian women are using contraception today than ever before. Married women are gradually embracing modern contraceptive methods, and other women are taking note. In 1987, contraceptive prevalence was just 1.3% compared to 8.8% in 2006.

In this traditional society, Malian women rely heavily on their social networks for advice. Beginning in 2004, Keneya Ciwara allied itself with women’s groups, health care providers and outreach workers to increase community interest in family planning. As part of their preparation, participants received training and educational tools—canvas tote bags with counseling cards on twenty-six reproductive health topics, contraceptive method brochures for clients and referral slips to Community Health Centers.

Under the Terikunda, or Friend-to-Friend, approach, women’s group leaders are educated about critical family planning and child survival. After the training, each group pledged to reach a target number of households. These women are volunteers and receive no salary, only a modest stipend for each educational session they conduct. The program provided them with the tools to do their work—oral rehydration salts, treated bednets, sample contraceptives and educational materials.

After a national launch in Bamako, Keneya Ciwara initiated family planning campaigns in fourteen districts across the country. Political, religious and community influentials presided over well-attended public rallies supporting family planning. Widely broadcast on community radio, these events brought family planning out in the open.

During the campaign, some 4,000 outreach workers promoted family planning throughout their districts, organizing home visits and distributing family planning products. Terikunda conducted educational sessions with members and referred interested women to Community Health Centers for services.

The number of referrals and family planning consultations skyrocketed during the campaign. In 2006, new contraceptive users increased 44% over the previous year, in the project districts. Similar increases in contraceptive sales confirmed that demand for family planning products and services was rising.

The program achieved more than increasing contraceptive use alone. Social networks proved to be a remarkably effective approach for promoting family planning. The endorsement of modern methods by outreach workers and Terikunda leaders influenced community and household acceptance of family planning. Moreover, social network involvement strengthened ties between households, communities and local health centers.

Similarly, the Keneya Ciwara project also collaborates with traditional men’s groups – Grins – under the Men for Life initiative. Group leaders have been oriented to engage in personal advocacy with their peers, in support of their partners’ use of maternal health services, including family planning, and child survival services. The 3-day training program empowers group leaders with advocacy and dialogue skills. Key objectives of the program include: increased acceptability of family planning and increased open dialogue with their partners on family planning and other reproductive health services. So far, more than 12,500 men have been reached through this initiative. A major result of this initiative is the fact that men no longer regard family planning and other reproductive health issues as “women’s issues” but they get involved in their partners’ and children’s health, with various levels of support in the use of those services.