At the bustling Kwapong Health Centre in rural Ghana, community health nurse Beatrice Nyamekye inserted contraceptive implants into the arms of several women while administering three-month hormonal injections to others. Although some women opted for condoms or birth control pills, the majority preferred longer-lasting methods.
“They prefer the implants and injections,” said Ms. Nyamekye. “These options free them from worry and are private. They don’t need to discuss it with their husbands or partners.”
The scene at the Kwapong clinic is mirrored across Ghana and sub-Saharan Africa, where access to contraception is the lowest globally. According to the United Nations Population Fund (UNFPA), only 26% of women of reproductive age in the region use modern contraceptive methods. However, this is changing as more women gain access to fast, affordable, and discreet reproductive autonomy. Over the past decade, the number of women using modern contraception in the region has nearly doubled to 66 million.
“We’ve made progress, and it’s growing. You’re going to see huge numbers of women gaining access in the near future,” said Esi Asare Prah, who manages advocacy for the Ghana office of MSI, a reproductive health nonprofit.
Factors Driving the Change
Three key factors are propelling this shift:
Education and Awareness: More girls and women are becoming educated and gaining knowledge about contraceptives, often through social media. Their ambitions for careers and life experiences make delaying childbirth more appealing.
Improved Contraceptive Options: The availability of affordable hormonal injections and implants has increased thanks to generic drug manufacturers.
Better Accessibility: Improved roads and logistics have made it possible to deliver contraception to rural areas, such as the nine-hour drive from Accra to Kwapong.
Tangible Benefits for Women
In Kumasi, at an MSI clinic, Faustina Saahene noted that women, especially from the large Muslim minority, appreciate the discretion of implants and IUDs, which allow them to space pregnancies without challenging husbands who prefer more children. These methods are also recommended for younger, unmarried women to prevent unplanned pregnancies that could limit their future opportunities.
“Your education, your career, even sexual pleasure: having children disrupts all that,” said Ms. Saahene.
Shifting Control of Contraception
Control over contraception has increasingly shifted from doctors to community health workers, despite resistance from physicians concerned about losing revenue. In many countries, health workers distribute birth control pills and administer Depo-Provera shots directly to women’s homes. Self-administered injections are also becoming available in stores, allowing young women to avoid judgmental questions from healthcare providers.
In Ghana, nurses like Ms. Nyamekye educate women on their options, including affordable and discreet choices. During a recent visit to a beauty salon, she sparked a lively conversation about contraception, addressing concerns and encouraging women to visit the clinic.
The Young and Growing Population
Sub-Saharan Africa has the world’s youngest and fastest-growing population, projected to nearly double to 2.5 billion by 2050. At the Kwapong clinic, a special room for adolescent girls provides a safe space for them to learn about and access contraception. Emanuelle, a 15-year-old, chose an injection after discussing her options with a nurse, preferring it over pills that might be discovered by her guardian.
Historical and Current Challenges
A decade ago, options in Kwapong were limited to condoms or pills, with occasional visits from a mobile clinic providing IUDs. Despite current progress, 19% of reproductive-age women in sub-Saharan Africa still have unmet contraceptive needs, according to the UN. Supply issues also persist, with clinics occasionally running out of certain contraceptives due to delivery delays.
Funding and Procurement
The procurement of family planning products in Africa is largely funded by international organizations such as the United States Agency for International Development (USAID) and UNFPA, with support from the Bill & Melinda Gates Foundation. This model has enabled significant gains in women’s health, education, and economic participation, although many African governments have not prioritized reproductive health in their budgets.
UNFPA’s recent push for low-income countries to assume more costs has led 44 governments to commit to increasing their contributions to reproductive health annually. However, a $95 million shortfall for contraceptive products persisted last year due to reduced funding from global donors, exacerbated by other crises.
Price Reductions and Increased Sales
Despite funding challenges, the prices of newer contraceptives have significantly decreased over the past 15 years. Hormonal implants, for example, have seen prices drop from $18 each in 2010 to $8.62 in 2022, with sales rising from 1.7 million units to 10.8 million in the same period. This has been partly driven by bulk order commitments from the Gates Foundation, supporting the appeal of long-acting methods for women in sub-Saharan Africa.
The strides made in increasing access to long-acting contraceptives are transforming lives across Africa, providing women with greater control over their reproductive health and futures. However, continued efforts are needed to address supply issues, funding shortfalls, and the remaining unmet contraceptive needs to ensure that all women can benefit from these advancements.
