PRB

For many years, donors and governments focused attention on family planning in West Africa to both improve maternal and child health and enhance economic development. However, as fighting HIV/AIDS became a priority in the region, family planning received much less attention. Most experts agree that sub-Saharan Africa is undergoing a transition to fewer births per woman, although the use of family planning has increased slowly and remains relatively low. Early age at marriage, the social desirability of many children, and limited access to education are some of the factors that keep fertility from decreasing more rapidly.¹

Although family planning experts often take a regional view of family planning and refer to the West African region as a whole, this perspective runs the risk of masking the variations in prevalence, method mix, and user characteristics across countries. To compare West Africa to other regions, such averages are useful because they provide information at the macro level while other factors, such as the economy, governance, and disease, may be important determinants of contraceptive use at the individual level. However, when looking at the variation within a region, such as at the national or subnational levels or within specific groups, such as rural residents, the poor, or youth, we obtain a much clearer idea of how family planning efforts play out in different settings.

This article is the first of two articles that examine trends and patterns in the use of family planning in West Africa. The second installment will focus on three countries within the region—Burkina Faso, Ghana, and Mali—to illustrate similarities and differences. (Data are drawn from the Population Reference Bureau’s Family Planning Worldwide 2008.)

West Africa in Context

Over the past decade, use of family planning among married women in West Africa has increased from 6.3 percent to 13.9 percent.² Although family planning use more than doubled, West Africa still lags behind other regions of Africa, as shown in the figure.

Contraceptive Prevalence by Region of Africa

Percent of women ages 15-49 who use contraceptives

Notes: Estimates are based on the most current data available between 1998 and 2007.
These percentages refer to women who are married or in a union.
Northern Africa:  Algeria, Egypt, Libya, Morocco, Sudan, Tunisia.
Western Africa: Benin, Burkina Faso, Cape Verde, Cote d’Ivoire, Gambia, Ghana, Guinea,
Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo.
Eastern Africa: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi,
Mauritius, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia, Zimbabwe.
Middle Africa: Angola, Cameroon, Central African Republic, Chad, Congo,
Democratic Republic of Congo, Gabon, Sao Tome and Principe
Southern Africa: Botswana, Lesotho, Namibia, South Africa, Swaziland.
Source: Donna Clifton, Toshiko Kaneda, and Lori Ashford, Family Planning Worldwide 2008.

Because use of family planning remains low, the average number of births per woman in the region is exceptionally high at 5.7. Moreover, given the young age structure of West Africa, the number of women of reproductive age is expected to increase from 69 million in 2008 to 83 million in 2015. The combination of high fertility and a growing number of women of reproductive age sets the stage for continued rapid population growth and challenges to meeting the different needs of these people.

Oral Contraceptives Are the Region’s Most Common Approach to Family Planning

Of the 13 percent of married women who use family planning in West Africa, two of every three have used a modern method; the remaining one-third use a traditional method. In other words, fewer than 1 in 10 married women between ages 15 and 49 is using a modern, effective method of family planning, and the vast majority are not doing anything to avoid becoming pregnant.

Overall, the most commonly used method in the region is the oral contraceptive, used by 3 percent of women. The next most commonly used methods are injectable contraceptives, condoms, and periodic abstinence. Each is used by 2 percent of women in the region. The first row in the table below illustrates the contraceptive prevalence by method for West Africa.

Percent of Married Women 15-49 Who Use Family Planning, by Method, West Africa, 2003-2005

Note: Hormonal methods include the pill and injection.
Source: Donna Clifton, Toshiko Kaneda, and Lori Ashford, Family Planning Worldwide 2008.

While contraceptive use is relatively low, 23 percent of women of reproductive age in the region indicated that they would prefer to avoid becoming pregnant, but are not are not using any form of family planning. This phenomenon is referred to as unmet need for family planning. Among these women, 7 in 10 would like to space their births. They want to become pregnant at some time in the future, but want to delay the next pregnancy. A smaller share of women (3 in 10) indicate that they actually prefer not to become pregnant again, and want to limit their childbearing.

Family planning use is lower among poorer than among wealthier women. This wealth gap is frequently observed around the world with respect to a variety of health services. To assess family planning trends across economic groups, we divide women into five groups—each representing roughly 20 percent of the total—according to their wealth (measured by household assets). Among the poorest group of women in the region, only 4 percent use some form of family planning—either modern or traditional. In contrast, 20 percent of women in the wealthiest group use some type of family planning. Although five times higher than in the poorest group, prevalence is still quite low in the wealthiest group in West Africa compared with other regions. In Southern Africa, for example, the prevalence rate among the wealthiest group is 69 percent.

The next article in this series will take a closer look at variations in contraceptive use and unmet need for family planning in West Africa by examining trends in Ghana, Burkina Faso, and Mali.

Jay Gribble is director of the BRIDGE project at the Population Reference Bureau.

References

1. John Caldwell and Pat Caldwell “Fertility Transition in sub-Saharan Africa” (paper presented at Conference on Fertility and the Current South African Issues of Poverty, HIV/AIDS and Youth, Pretoria, South Africa, Oct. 24, 2002).
2. Donna Clifton, communication with author, 2008.