“Car rapides,” the overcrowded and flamboyantly decorated minibuses that serve as the public transportation system in Dakar, Senegal, speed down city streets while young men cling to their back steps. Child beggars known as talibés swarm taxis and crowd sidewalks. The barefoot young boys hold out tin buckets and ask locals and tourists alike for coins to take back to their religious teachers.
These everyday scenes are part and parcel of Dakar culture and way of life. But they also point to another crisis unfolding in West Africa — not the Ebola outbreak that has devastated Senegal’s neighbors, but one similarly capable of undermining economic progress and fueling poverty — the crisis of a surging population.
Today, the effects of rapid population growth in Senegal are highly visible in the coastal hub of Dakar — a city whose metropolitan population has risen by nearly 2 million in 25 years.
The government of Senegal and its partners are ramping up efforts to make family planning methods available to women — and acceptable to highly religious and conservative communities. But deeply ingrained religious traditions, the looming threat of losing overseas development assistance, and a large youth population make their task far from easy.
Dakar’s child beggars often come from large families ill-equipped to take care of them. They’re sent to learn the Quran at religious schools called “daaras,” where teachers send them out to beg on the crowded Dakar streets in order to bring back funds for the school. Many talibés are beaten if they don’t meet a set quota.
These child beggars — numbering over 30,000 in the Dakar region, according to a 2014 government census — have caught the attention of human rights organizations, including Human Rights Watch. And according to Pape Gaye, president and CEO of IntraHealth International, they’re the tragic symbol of an avoidable cycle of poverty.
What’s needed is a focus on “prevention,” Gaye told Devex, adding that family planning can be one of the best ways to address the issue.
In 2012, the Senegalese government heeded the concerns of health professionals and family planning champions such as Gaye, who not only want to end a cycle of poverty, but also stifle the region’s high maternal and child mortality rate — in part the result of unspaced births that can be detrimental to women’s health. The government doubled its budget for contraceptives and announced a national family planning strategy with the ambitious aim of boosting the country’s contraceptive prevalence rate from 12 percent to 27 percent by the end of 2015.
With the support of donors such as the U.S. Agency for International Development and the Bill & Melinda Gates Foundation, Senegal succeeded in boosting the contraceptive prevalence rate to 16 percent by 2013 — a significant achievement according to Nomi Fuchs-Montgomery, deputy director of the foundation’s family planning program.
“It is extraordinary … we haven’t had this ability to measure year-on-year results with this kind of achievement, and the government needs to be congratulated,” Fuchs-Montgomery said Monday during a panel discussion at the Center for Strategic and International Studies in Washington, D.C.
The Gates Foundation has funded family planning efforts in Senegal since 2009 with a particular focus on the Senegal Urban Health Initiative — a program designed to make contraceptives available to poor women in urban areas. Under this initiative, which is implemented by IntraHealth, community outreach and media campaigns target women in need, while private sector engagement through a model known as the Informed Push Model, allows for effective distribution.
As the world’s largest bilateral donor, USAID has tripled its funding for family planning and reproductive health in Senegal since 2008 — from approximately $5 million then to $15 million in fiscal year 2014, according to a USAID representative.
And according to a December 2014 CSIS report, USAID today funds a strategy in which the Senegalese health system integrates family planning sessions into immunization services, so that when women bring in their children to receive vaccines they can learn about the benefits of family planning.
Religious barriers and funding challenges
Despite progress, Senegal faces significant hurdles to increasing access to family planning.
Many imams and other religious leaders in the majority Muslim country look down upon family planning as immoral and contrary to the Quran. And many community members rely on their religious leaders for guidance when making decisions about whether to adopt forms of birth control.
Further, most women feel pressured to secure their husband’s permission to start family planning, so even if a woman feels contraception is the right choice, her husband might dissuade or prevent her from accessing it.
Family planning advocates point to the Quran’s acceptance of breast-feeding and spaced births. Advocates engage religious leaders by stressing health benefits for mothers and their families, according to the CSIS report, which also points out that the Senegalese organization known as Réseau Islam et Population has trained about 1,000 imams in the past four years about the benefits of family planning.
Financing presents another challenge.
Emerging economies like Senegal’s could soon graduate from certain forms of overseas development assistance — Gavi, the Vaccine Alliance, for example — according to Katie Taylor, deputy assistant administrator for the bureau of global health at USAID, who also spoke on the CSIS panel. Taylor stressed the need to boost domestic resource mobilization in Senegal in order prepare for such a shift.
Gaye too called on more private sector commitment to family planning.
“If you take out the pharmaceuticals who clearly have an interest in this thing, we’re not seeing a lot of private sector engagement in family planning,” Gaye said, adding that companies in the extraction and logistics industry can play a critical role.
“If people want to go beyond corporate social responsibility and they want to make their footprint on development, family planning would be a good way to do that, and we need that message to be loud and clear,” he said.
Family planning taboo among adolescents
Senegal’s expanding youth population presents yet another obstacle. Today, approximately 60 percent of Senegal’s population is under the age of 25, according to Awa Marie Coll-Seck, Senegal’s minister of health and social action. Yet discussing family planning and reproductive health among youth — many of whom aren’t married — is considered taboo in many communities.
Marie Stopes International — an international nongovernmental organization with a focus on family planning and reproductive health — is running a youth center at the University of Dakar with the support of USAID in order to expand access to family planning and reproductive health services for young people.
“The level of knowledge that these students — educated — have about their reproductive health is quite shockingly low,” Maaike Van Min, Marie Stopes International’s country director in Senegal said Monday in Washington, D.C.
Van Min emphasized the general perception in Senegal that unmarried, sexually active students don’t exist in the country.
“But they do. And we know that they do,” she said.
The Senegalese government’s current strategy to expand family planning services focuses on ensuring that services are put in place and that supplies are available, according to Coll-Seck.
But as the government official told Devex, their communication plan does not yet delve into expanding family planning services specifically for unmarried youth.
“We are putting our communication very broad … we are trying to be open,” said Coll-Seck, adding that focusing too heavily on unmarried women can be counterproductive.
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