By Alison Bodenheimer
Two women in Senegal discuss long-acting family planning methods. ©2011 Adrienne Allison, World Vision, Courtesy of Photoshare.
Family planning in West Africa has lagged far behind the rest of the world, held back by economic, geographic, and policy barriers—but IntraHealth’s President and CEO Pape Gaye sees momentum building for change, particularly on the economic front.
As part of an exclusive GHN series, Gaye, who is from Senegal, spoke recently with Alison Bodenheimer, a program officer of the Advance Family Planning initiative of the Bill & Melinda Gates Institute for Population and Reproductive Health.
Gaye pointed to previously untapped forces, including the growth of civil society and private sector investment and the demographic dividend—the boost in economic growth that can result from declining fertility rates—that could help advance family planning in the region.
This interview is part of a series of Q&As leading up to the International Conference on Family Planning (ICFP), January 25–28, 2016, in Nusa Dua, Indonesia.
AB: West Africa, especially Francophone countries, has lagged behind East and South Africa in terms of just about every development indicator, including those relating to reproductive health. Why is this the case?
PG: If you want to talk about general economic growth and economic progress, sub-Saharan Africa is enjoying some progress. It’s the only continent in the world that has enjoyed positive economic growth in the last 5 to 10 years; most countries are growing at a rate close to or a little above 5%. That does include countries in West Africa.
However, if you focus on health and human development in general, it is true that that part of the continent is lagging far behind. Besides a couple of countries that have been showing progress in the MDGs, the indicators are still lagging, and family planning is certainly lagging far, far behind the rest of the world. When it comes to family planning and reproductive health, we are still dealing with traditional barriers that we’ve been talking about for 30 years: the economic barriers, the geographic barriers, and the policy barriers. Economic barriers [are significant] because the region is poor. People will think about surviving and eating and drinking safe water before they think about anything else.
Proper attention has not been given to the role of family planning and reproductive health in general and the importance of focusing on women as the engine of growth and the engine of development. That’s been the primary reason we have not been able to move the needle in that region when it comes to family planning.
Because a lot of these countries now are almost there in terms of reaching medium-level income, I think we have momentum. The economic development argument [for family planning] is going to be easily understood now.
I also think that civil society is mobilizing in a way we have not seen. We’ve got some good examples of what civil society can do, i.e. the HIV/AIDS movement. As long as we keep the space open for civil society—and we shouldn’t take that for granted, because there are still a lot of forces against the rise of civil society. But if we harness the potential that exists in civil society and we harness the improved climate for private sector investment, we can make progress faster than we’ve been able to make so far.
AB: In your recent article in the Huffington Post (“Let’s Not Be Squeamish About Family Planning’s Fiscal Benefits,” September 24) you mention that our field is often hesitant to promote the economic gains that can result from good access to family planning. Why is that the case, and what can we do to change it?
PG: Our field has arguments for the health benefits of family planning. People know how to talk about it. It resonates with everybody. The reality is we don’t know how to message to the non-health stakeholders. If you’re talking to the Ministry of Health or health NGOs, they can understand that [health] argument. We have tried to use that argument to convince the finance people and economic people; it just doesn’t work. We’ve never had the language to speak to them.
With the demographic dividend, we have the language to speak to these very important stakeholders. They want to hear about return on investment. The idea that every dollar that you invest into it will actually help you grow and help you make savings for educating more children or feeding more people—that’s going to sell. Ten to fifteen years ago, it might have been a little bit premature. Now I think people will hear it.
AB: What do you anticipate will be the top factors affecting global health work in the next decade—either positively or negatively?
PG: Positively, the formidable uptake of global health as a field is actually quite interesting. In the last decade, the number of global health institutes that have been created in American universities and European universities [has jumped]. And what is fascinating too is that [global health is] attracting people from all fields. It’s not just health; it’s people from the IT world, people from management schools.
The fact that some countries are beginning to experience economic development, particularly in sub-Saharan Africa—that’s going to be a big positive factor. If countries do it right, we should be seeing a lot more domestic investment in global health. At least, there are expectations from the donors that countries are going to start putting up their own money. The fact that people are beginning to see a combination of economic growth and urbanization happening—those 2 factors alone will be catalysts for more uptake of family planning and global health in general.
Finally, the number of new players coming into the scene. This used to be a fairly reserved field; you had basically government and the NGO sector. If you count in the new social entrepreneurs that have come into the scene in the last few years, it’s just incredible. We have a plethora of mostly millennials entering this field, with a very positive and forward-looking attitude that is so different from us, the old folks. It’s kind of, “We can do it, and we can do it in 2 years rather than 20 years.”
Academic institutions want to play, but they want to engage more robustly than they did before. There’s a lot more appetite for internships and fellowships nationally. I know it’s a little confusing, because there’s a push for doing things at the country level, but you also have a whole new upcoming generation of global health leaders. You look at all of these new corps—Barbara Bush’s Global Health Corps, Vanessa Kerry’s [Seed Global Health], CGI [Clinton Global Initiative]. Between the new social entrepreneurs, the academics wanting to be involved more robustly, and private sector ready to engage in ways they have never engaged before—not just through corporate social responsibility, but they want to make their footprint on development. They want to do that by doing their core business, whether it’s FedEx wanting to bring logistics or Coca-Cola wanting to help bring water.
These are great opportunities that are going to bode well and help advance global health in ways we’ve never seen before. But there are going to be some challenges. With the multiplication of actors, you also have a little bit of chaos. In the field of technology we are seeing way too many tools being developed, and people are focusing on the next big thing—you know, after you develop this tool, you want to move on to the next tool. A lot of these tools are great for data collection, but we are not doing much with the data. Because we are in a learning curve with the private sector, I think we will probably make a few major mistakes and hopefully quickly learn from them. You need to fail a few times before you find a good thing.
More about ICFP: The International Conference on Family Planning is a strategic inflection point for the family planning community worldwide. It brings together thousands of researchers, advocates, policymakers, and representatives of national and international organizations to disseminate knowledge, celebrate successes and identify next steps toward increasing access to voluntary, high-quality family planning. ICFP is co-hosted by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the National Population and Family Planning Board of Indonesia (BKKBN).
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