(April 2008) For more than a decade, Francophone countries in West Africa have been working to update their reproductive health laws. The French anti-contraceptive law, enacted in 1920 and still in effect after the independence of France’s former colonies in Africa, banned advocacy for, knowledge of, or use of family planning methods. But given the health and economic benefits of family planning, a network of parliamentarians in West Africa began in the 1990s to develop a model law suitable for adaptation and adoption in the region.

The initiative for reform throughout Francophone West Africa was prompted by the 1994 International Conference on Population and Development. The conference’s Programme of Action gave rise to the reproductive health model law, written by the Forum of African and Arab Parliamentarians on Population and Development (FAAPPD).1

To date, 10 countries—Benin, Burkina Faso, Chad, Guinea, Guinea-Bissau, Mali, Mauritania, Niger, Senegal,  and Togo—have made advances in reforming the former colonial laws. One of the most recent legal reforms has been in Togo, which approved a new reproductive health law in 2006.

Togo’s Recent Reforms

The French law proved to be an overwhelming burden on pregnant women in Togo, contributing to unsafe abortions, high fertility rates, and frequent pregnancy-related disabilities. In 2005, Togo’s total fertility rate was 5.6 children per women. Only 9.3 percent of women of reproductive age used family planning methods—among the lowest rates in the region. In addition, only 49 percent of births were attended by skilled health personnel, further evidence of poor access to reproductive health services.2 Aided by the regional model law—particularly addressing contraception and obstetric care—stakeholders and parliamentarians in Togo began to raise awareness and improve the level of political commitment for reform. They are now writing the regulatory texts that provide guidelines and protocols.

This process has been delicate, especially given well-defined social roles limiting women’s decisionmaking power regarding family planning. To reform the law, lawyers, lawmakers, local NGOs, and traditional and religious leaders decided to work together on tailoring the model law on reproductive health drafted by FAAPPD to Togo’s health and social environment. This collaboration ensured the acceptability of the new law among Togo’s stakeholders and social leaders. One of the most important advocacy tools used to build support was REDUCE-ALIVE.

REDUCE-ALIVE is a computer simulation model that demonstrates the devastating effects of the lack of adequate reproductive health care. The model uses national and global statistics to estimate economic losses for a country from maternal mortality and lack of contraceptive methods.3 As part of its advocacy strategy, REDUCE-ALIVE estimates anticipated savings to a country from implementing a progressive reproductive health law that includes provisions for the widespread availability of maternal and neonatal health care.

While passing its new reproductive health law was a great step for Togol’s government and health system, policy implementation must follow. As with other West African countries that have embarked on the same type of legal reform, the approval of a reproductive health law provides a legal basis for procurement and distribution of condoms, reduced cost of emergency obstetric care, and dissemination of knowledge regarding family planning and reproductive health. While the content of these laws may be similar throughout the region, the ways they are implemented—either by making improvements to existing programs or by creating new ones—will vary by country. In Togo, the involvement of stakeholders in the process of drafting the new law was an important step in creating a team approach that would also be used to support the law’s implementation. With this base of support, Togo should see important improvements in maternal and neonatal health outcomes in the near future.

With the new law in place, Togo is primed to decrease its high fertility rate and lower its population growth rate (2.6 percent a year). Starting in 2008, the United Nations Population Fund will support the implementation of Togo’s new law with a $10 million dollar, five-year grant.4 The money will focus on the same areas the REDUCE-ALIVE method highlights: obstructed labor, unattended pregnancies, unsafe abortions, hemorrhage, condom distribution, family planning knowledge, and emergency obstetric care.


Stephen Russell is an intern at the Population Reference Bureau.


References

  1. Forum of African and Arab Parliamentarians on Population and Development (FAAPPD), “Framework of Model Law on Sexual and Reproductive Health,” adopted in Abidjan, Cote d’Ivoire, June 9, 1999.
  2. United Nations Population Fund (UNFPA) and Population Reference Bureau (PRB), “Country Profiles for Population and Reproductive Health: Policy Developments and Indicators” (Washington, DC: Population Reference Bureau, 2005), accessed online at www.prb.org/Reports/2006/PRBUNFPACountryProfilesforPopulationandReproductiveHealth2005.aspx, on March 25, 2008.
  3. Doyin Oluwole, “Application of ReduceAlive Advocacy Model and Implementation of the Road Map in Africa,” accessed online at www.icddrb.org, on Feb. 5, 2008.
  4. United Nations Development Programme and United Nations Population Fund, “Country Programme Document for Togo,” accessed online at www.unfpa.org, on Feb. 20, 2008.