As the world scrambles to rein in overpopulation, African women are weighing their reproductive choices

Amidst Africa’s population growth, women are proving family planning methods are not a tool in addressing population growth but are fundamental parts of their sexual and reproductive health and rights.

When contraceptives started to become an integral part of health care systems in Africa, women like Tolu had no idea what they were. “They just asked me to take it immediately after sex and said it would prevent me from getting pregnant. I thought it would tie up my womb”, she said.

Born into a Nigerian home of 7 children with a year gap between each, Tolu was convinced that was the ideal number of children for a family. After all, she has 11 uncles. Her ideology isn’t far-fetched.

In 2012, contraceptives were an alien concept for many African women. Their bodies were for, owing majorly to lack of knowledge, producing offspring to carry on the family name. They were not in absolute control over their decisions.

“The real challenge at the beginning was social norms. You know, the initial desire to still have large families. We know that for example in Nigeria, the last time there was a survey in 2018, the ideal family size was 6 children and that’s very different in other countries,’’ said Dr. Jason Bremner (Ph.D. MPH), Data and Performance Management Senior Director, FP2030.

Today, African women have a different view. “Look at me, I am now a lawyer and an advocate for women's empowerment. I never thought I would be able to decide I want to have just 2 kids and now I have decided I want other women to discover they have the power to choose when they want to give birth,” Tolu said to me.

And as though the continent was listening, changes began to happen. Africa made the greatest gains globally in modern contraceptive use from 20% in 2010 to more than 26% of women of reproductive age today. Countries particularly Kenya, Zambia, Ghana, and Burkina Faso recorded huge successes.

“I think that without a doubt when we looked across the regions that were participating in FP2020, the progress in East and West Africa exceeded expectations. Most countries set goals in their commitments and many countries in East and West Africa including Southern Africa exceeded their goals and had to even rethink setting ambitious goals or goals about equity and leaving none behind. So without a doubt, the region really saw great success,” Dr. Bremner confirmed.

So what is the reason behind this cultural pivot? The answer is simple. Global partnerships like FP2030 identified a low starting point but a real desire among women first, then among governments to improve their maternal and reproductive health. “We saw overtime investments in availability new methods, improved healthcare systems, rising use and by the end of the FP2020 partnership in 2020 there were some countries in West Africa where almost a third of women of reproductive age had decided to use a contraceptive method,” Dr. Bremner said.

Another interesting turn of events is the choice of use of contraception. While women in many other parts of the world have resorted to using the pill, African women have turned to injectables and implants as their first choice. As an African woman myself, after seeing decades of generations subjected to unintended pregnancies, the desire to see my fellow women engage in the most effective form of contraception is not surprising.

“If you turn to East Africa, injectable contraceptives really took off and is still the most common form. But in West Africa, implants were becoming available. I think the emergence of the availability of implants and the timing of when contraceptive use has taken off in West Africa has resulted in a pattern of use that’s different and it's interesting to see that implants have become the most common method. Now, it is followed by injectables, so it's really implants and injectables that are the two most common methods in West Africa by far,” Dr. Bremner shared.

“When you provide women with a choice, family planning can have amazing benefits. Benefits that are for the woman herself, benefits that are for her family and for the community, for states and countries. But it really does start with each woman having a choice and supporting that choice, whether she wants to use family planning or not. We need to be supportive of that”.