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More and more women in Africa are using long-acting contraceptives, and their lives are changing

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On a busy day at the Kwapong health center in rural Ghana, Beatrice Nyamekye inserts contraceptive implants into six women and gives eight or nine women three-month hormone injections to prevent pregnancy. A few seek condoms or birth control pills, but most want something longer-lasting.

“They like the implants and injections the most,” said Ms Nyamekye, a community health nurse. “It’s worry-free and private. They don’t even have to discuss it with their husbands or partners.”

The busy scene at Kwapon’s clinic is shared across Ghana and much of sub-Saharan Africa, where women’s contraceptive rates are among the lowest in the world: Only 26% of women of childbearing age use a modern method of contraception (something other than the rhythm method or injectables), according to the United Nations Population Fund (UNFPA), which works on reproductive and maternal health.

But this is changing as more women gain access to quick, affordable and discreet methods to increase their reproductive autonomy. In the past decade, the number of women in the region using modern contraception has almost doubled to 66 million.

“We have made progress and it is growing: in the near future you will see a large number of women gaining access to the internet,” said Essi Asare Pura. He heads up advocacy for the Ghana office of MSI, a nonprofit reproductive health organization.

Three factors are driving this change. First, more girls and women are educated: They have more knowledge about contraception, often through social media, which reaches even the most remote corners of the region. They have greater ambitions for careers and experiences that are more achievable if they delay having children.

Second, the variety of contraceptive options available has grown as generic drug manufacturers have brought more affordable hormonal injections and implants to the market.

Third, better roads and planning have enabled the delivery of contraceptives to rural areas such as this one, a nine-hour drive from the port in the capital, Accra, where they are shipped from manufacturers in China and Brazil.

Improved access to contraceptive services has brought tangible benefits to women. Faustina Saahene, who runs a busy MSI clinic in Kumasi town, says the country’s Muslim women appreciate the discreet nature of implants and IUDs, which allow them to space pregnancies without publicly challenging husbands who want them to have more children.

She also encourages young, unmarried women to do the same, as they may be overly optimistic about their current partner’s commitment to raising a child and may not realize how much pregnancy would limit their options.

“Your education, your career, even your sexual pleasure: Having a child affects your life,” Ms. Saheny said before ushering another customer through the door of the exam room.

Across the region, control over contraception has largely been taken away from doctors, even as doctors’ associations, fearing the loss of a reliable source of income, oppose its use. Community Health Workers Door-to-door sales of birth control pills, on-the-spot injections of Depo-Provera. Self-injectable birth control pills are increasingly common in corner stores, where young women can buy them without worrying about judgmental questions from nurses or doctors.

In Ghana, nurses like Ms. Nyamekye are telling women that they have cheap, discreet options. Not long ago, as she passed a roadside beauty salon, she chatted with women sitting on wooden benches waiting for their hair to be braided. She asked only a few questions, but a lively conversation ensued: One woman said she thought the implants might make her fat (a possibility Ms. Nyamekye conceded), and another said she might come to the clinic for injections, prompting her braider to tease her about her burgeoning relationship with her new boyfriend.

Sub-Saharan Africa The youngest and fastest growing population in the world; The population is expected to nearly double to 2.5 billion by 2050.

At the Kwapong clinic, there’s a room just for adolescent girls, with movies playing on a large TV and a specially trained nurse ready to answer questions from shy girls in school uniforms. Emanuelle, 15, said she had just started having sex with her first boyfriend, and after chatting with the nurse, she opted for the injection. She plans to tell only her best friend. It’s better than the pill, she said – the only method she knew about before going to the clinic – because her uncle, who lives with her, might find the pills and know what they are for.

Ten years ago, the only options Ms. Nyameki offered women in Kwapong were condoms or the pill, she said. Or, once a year, MSI would come to the town and set up a clinic on a bus, where midwives would insert IUDs into the waiting women.

Despite the progress made, the UN report says 19% of women of reproductive age in sub-Saharan Africa have an unmet need for contraception In 2022, the last year for which data is available, this means they wanted to delay or limit childbearing but were not using any modern methods.

Supply problems also persist. For the last three months, the Kwapong clinic has been short of everything except pills and condoms due to a shortage of supplies in Accra.

This shows how difficult it is to get contraceptives to these places in today’s system, where global health agencies, governments, pharmaceutical companies and shipping companies often have more power over which contraceptives women can choose than women themselves.

Most family planning products in Africa are procured by the U.S. Agency for International Development or the United Nations Population Fund, with support from the Bill & Melinda Gates Foundation, a pattern that dates back more than half a century to when rich countries tried to control fast-growing populations in poorer nations.

Major health agencies around the world invest in expanding family planning services as a logical complement to reducing child mortality and improving girls’ education. But despite the enormous benefits that family planning brings to women’s health, education, economic participation, and well-being, most African governments exclude it from their budgets.

Dr. Ayman Abdulmosen, Chief of the Family Planning Section at the UNFPA technical department, said countries with limited budgets often choose to pay for more important health services, such as vaccines, rather than reproductive health costs because these costs produce more immediate returns.

But the United Nations Population Fund recently pushed low-income countries to shoulder more of the costs, prompting 44 governments to sign up to a new funding model that commits them to increasing their annual spending on reproductive health.

Even so, the world still had a serious shortfall of about $95 million to buy products last year. Donors currently pay for most of the products, but their funding for 2022 has fallen by nearly 15% from 2019 as the climate crisis, the war in Ukraine and other new priorities shrink global health budgets. Support for these programs from African governments has also stalled as countries grapple with soaring food and energy prices.

The good news is that prices for newer birth control pills have fallen dramatically over the past 15 years, in part because of large bulk order commitments brokered by the Gates Foundation, which is betting that long-lasting birth control will appeal to many women in sub-Saharan Africa. For example, the price of hormone implants made by Bayer and Merck fell from $18 per implant in 2010 to $8.62 in 2022, while sales rose from 1.7 million to 10.8 million in the same period.

But the price remains a challenge for low-income countries, where government health spending averages $10 per person per year. Birth control pills and condoms are more expensive in the long run, but the upfront cost of long-acting products is a barrier.

Simply bringing contraceptives to clinics is not enough: Health care workers must be trained to insert an IUD or implant, and someone has to pay for it, Dr. Abdelmoossen said.

Hormonal IUDs remain scarce in Africa and cost more than $10 each; Dr. Anita Zaidi, director of the Gates Foundation’s gender equality work, said the nonprofit is investing in research and development of new long-acting products while also looking for manufacturers in developing countries that can make existing products more cheaply.

The foundation and others are also investing in new efforts to Trajectory data They also want to better track which contraceptive methods African women want, and why those who say they want to use contraception aren’t using it. Is it cost? Is it access? Or is it cultural norms, such as providers’ reluctance to provide contraception to unmarried women?

Gifty Awaa, 33, who works at a small roadside barbershop in Kwapon, takes contraceptive shots regularly every three months. She gave birth to her first child while she was at school. “I didn’t plan when I got pregnant at 17 – family planning wasn’t as accessible as it is now,” she said. “You had to go to town and pay: it cost a lot of money.”

She had to drop out of school after she became pregnant; if she had had the choices she has now, her life might have been different. “If things had been like this, I wouldn’t have gotten pregnant,” she said. “I would have kept going, I would have studied, I would have been a judge, or a nurse.”

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