Family Planning Workforce

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    © 2011 Adrienne Allison World Vision, Courtesy of Photoshare

    Two women in Senegal discuss long-acting family planning methods. © 2011 Adrienne Allison World Vision, Courtesy of Photoshare


    West African countries have the highest fertility rates in the world, with an average of 5.5 births per woman; they also have the lowest levels of contraceptive use.

    As a longtime physician and family planning/reproductive health trainer at IntraHealth International, I see several reasons for this. When I started training male health providers in family planning services in West Africa in 1997, I was met with a lot of resistance. Many men thought that female clients wouldn’t want to talk to male health providers. But I told them, “It depends on how they see you. When you return to your facility, you need to tell people what you can do for them, advertise your new skills in family planning services, encourage women to come with their husbands so they can trust you as a couple, and build trust within community.”

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    Women receives Implant.

    Photo by Carol Bales, Courtesy of IntraHealth International.

    Kicker: Plenty of obstacles stand in the way of health workers who provide contraception to their clients. And personal bias is one of them.

    We know three big truths about contraception and family planning.

    First, family planning is one of the smartest investments a country can make in its own future

    When a country strives to make sure that every pregnancy is wanted and mothers are able to space their children for optimal health, its population transforms. More children finish school. The economy flourishes. Abortion rates and maternal deaths plummet as gender equality draws nearer. And everyone—especially young people—benefit.

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    To me, [community health workers] are very helpful because in most cases I am busy. They have taken over that heavy work. You see, family planning needs a lot of talking to clients and yet I am always busy at the unit with deliveries, antenatal, immunization and many others. So with them I get helped. They have really taken off a big burden from me. 

    ~Achieng Rose, Midwife, Bulumbi Health Clinic, Busia, Uganda

    Global health worker crisis

    © 2013 Todd Shapera, Courtesy of Photoshare

    Community Health Worker Marie Chantal walks into her village of Batamuliza Hururiro, near Rukumo Health Center, Rwanda. © 2013 Todd Shapera, Courtesy of Photoshare

    Right now, we are 7.2 million health workers short of meeting the global population’s health care needs. By 2035, that shortage will reach 12.8 million. Twenty-nine of the 46 sub-Saharan countries are below the World Health Organization’s (WHO) lowest category of 2.5 doctors per 10,000 individuals. Moreover, medical providers are unevenly distributed; in most low-resource countries, doctors and nurses typically live and practice in urban areas, yet the majority of the populations in those countries reside in rural areas. Family planning services, in particular, suffer from grossly inadequate numbers of providers to meet the needs. A 2012 Guttmacher Institute estimate calculated 222 million women with an unmet need for modern contraception in low-resource countries.

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    © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

    A family planning mobilizer refers a client, Modinat Bamidele (L), during a visibility parade near Orolodo primary health centre in Omuaran township, Kwara state, Nigeria. © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

    In 2007, I visited the Centre de Sante in Mukono, Rwanda. Staff enthusiastically gave me a tour of the facility, which had recently undergone renovations to partitioned private rooms for family planning counseling. The facility also had a variety of family planning commodities available including pills, condoms, and injectables. It was remarkable to see staff so motivated to serve their clients and even more so to see the waiting room filled with women and men waiting for family planning services.

    This sunny day seven years ago had a noteworthy impact on my career in global health. It highlighted the importance of providing comprehensive family planning services to clients, especially in rural areas, and of having a motivated and well-trained health workforce to deliver those services. In the years since, I have committed to supporting countries in addressing health workforce challenges, and particularly to improving family planning services.