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Recent Successes

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2021

IGWG Spring Dialogue Led by Members in USAID Priority Countries

On May 26, PACE convened the Interagency Gender Working Group (IGWG) “Spring Dialogues: IGWG Members Lead the Conversation,” a platform for IGWG members based in USAID priority countries to lead discussions on priority issues identified by the network. Over 50 participants representing 12 countries participated in the event. Facilitators based in India and Nigeria led roundtable discussions on the efficacy of gender-transformative approaches in adolescent-focused programs, including during the COVID-19 pandemic; strategies to advocate for gender-transformative change within our organizations; and how to establish referral networks between healthcare and GBV service providers and ensure self-care for providers dealing with GBV issues. Common themes across discussion groups included taking gender equality ideas from “paper to practice” through stronger accountability of decisionmakers at all levels; the essential role of engaging stakeholders from all sectors, including religious and traditional leaders, to advance gender equality and prevent GBV; working within local sociocultural and gender norms for more effective programming; and prioritizing organizational support for gender-transformative approaches, such as offering paid parental leave and childcare and equal pay for women.

District Demographic Dividend Action Plans Shape Priorities in Uganda

With PACE assistance, the National Population Council of Uganda (NPCU) targets national and subnational decisionmakers with evidence-based messages and materials that demonstrate the impact of voluntary family planning for healthy families, communities, and multisectoral development. NPCU is finalizing a suite of advocacy resources and preparing for workshops focused on ensuring that family planning is included as a strategic objective in new five-year district development plans. With support from NPCU, three districts to date have developed Demographic Dividend Action Plans, which include objectives on increasing male engagement in family planning and reducing teenage pregnancy. NPCU has also trained a cadre of 15 “demographic dividend champions” in the Busoga region, who will advocate for integration of key priorities including reducing teenage pregnancy and child marriage, improving access to family planning, increasing male engagement in reproductive health, and improving maternal and child health in district development plans.

Youth Advocates Champion Policy Change

PACE’s capacity strengthening of youth advocates and youth-led organizations to lead targeted, data-driven advocacy initiatives is generating policy change and new financial commitments for family planning and reproductive health. In northern Nigeria, PACE-trained fellows at Bridge Connect Africa Initiative (BCAI) are using mobile technology to create videos and other multimedia tools utilized in campaigns through social media, community platforms, and with local policymakers. BCAI earned commitments from the Governor of Kano State and state House of Assembly leaders to advance the Child Protection Bill, which would criminalize child marriage. The bill passed the lower chamber in February 2021 and BCAI are working to strengthen language around age of marriage and girls’ education as it proceeds to the upper chamber for review. In Uganda, youth advocates trained by PACE and GOAL Malawi on strategic communications and integrated Population, Environment, and Development (PED) approaches have succeeded in securing allocations of municipal funds for PED sectors, including family planning, in two districts in 2020.

County Budget Advocacy Garners Family Planning Wins

In the past year, PACE Kenya has amplified its impact by elevating lessons learned in county-level family planning resource mobilization to the national level through a strategic relationship with the Council of Governors. The Council comprises the governors and their offices in Kenya’s 47 counties and provides a mechanism for consultation and sharing of best practices across county governments. In January 2021, in the context of discussions about closeout of World Bank funding for family planning, PACE was invited to share lessons learned on county budget advocacy with the county economic planning teams. During the plenary discussions, the counties committed to PACE’s recommendations to 1) establish designated budget line items for family planning, and 2) sensitize county assembly budget and health committees to the importance and high return on investment of family planning. The Council of Governors has indicated continued interest in close partnership with PACE and will be following up with all counties to ensure implementation of these commitments.

2020

Kano and Kaduna State Leaders Commit to Ending Child Marriage Following Advocacy From PACE-Trained Youth Leaders

Nigerian youth advocates trained by PACE secured policy commitments from local leaders by creating videos focused on ending child marriage and increasing access to family planning services. Bridge Connect Africa Initiative (BCAI), a youth-led organization launched with support from PACE, aided local youth advocates to widely disseminate the videos across popular social media platforms and in community-level policy dialogues with seven influential leaders from both the traditional and political governing structures in northern Nigeria.

PACE-trained Bridge Connect Africa Initiative team members meet with the Queen of the Kano Emirate Council to present their video on child marriage and discuss the passage of the Kano State Child Protection Bill in Kano, Nigeria.
PACE-trained Bridge Connect Africa Initiative team members meet with the Queen of the Kano Emirate Council to present their video on child marriage and discuss the passage of the Kano State Child Protection Bill in Kano, Nigeria.

Following their outreach, the governor of Kano state made a public declaration to end child marriage by committing his support to the Child Protection Bill, an executive bill co-sponsored with the Office of the Attorney General. The principal private secretary of the Attorney General met with BCAI and PACE-trained advocates for a private screening and confirmed that the governor had seen the online campaign and video before making his declaration. While the legislation is still pending, sections of the bill that provide for compulsory schooling for all children as a method to reduce child marriage have been adopted into a state-level policy. In Kaduna, the governor’s chief of staff committed to sharing a video message to call on the state government to promote availability and access of family planning services for women and young people.


PACE’s Budget Advocacy Drives Adoption of Family Planning Line Item and Increases in Samburu County’s Health Budget Allocations

For family planning advocates, no greater success exists than a dedicated and adequately funded line item in the health budget. PACE’s strategic approach to budget advocacy has paid off in Samburu County where concerted advocacy activities led to a first-ever budget line item for family planning as well as an increased percentage of the county’s budget allocated to health in FY2020/21. Over a period of months, PACE facilitated workshops to support the county health management team (CHMT), sector working groups, and departmental representatives to identify priorities for county budgeting. This continuous engagement with the CHMT has enabled them to effectively advocate to the Finance Department and County Assembly for increased funding for health and family planning. Specifically, in developing the Health Sector Working Group Report, the CHMT, Finance Department, and other sectors recommended that the County Assembly allocate an increased percentage of the county budget to health programs, despite an overall decrease in the county budget, and to dedicate a new budget line and funding specifically for family planning (KES 12,000,000, or approximately $112,000). PACE will be leveraging this important success in Samburu as an example to other counties about what is possible.

PACE Collaboration With National Population Council of Uganda Advances Districts’ Commitment to Family Planning

The National Population Council of Uganda (NPCU) presented advocacy materials co-developed with PACE to district governing authorities at 22 Local Government Budget Framework Consultative Workshops, which are organized by the Ugandan Ministry of Finance, Planning, and Economic Development to establish budget strategy and execution for the coming fiscal year. The video and fact sheet developed with PACE draw on evidence about the benefits of age structure change for “dividends” across three sectors—child health, education, and economic growth—to increase multisectoral commitment for family planning. Presentation of the family planning advocacy materials by NPCU representatives at each workshop, including during breakout sessions to address questions from participants, was a strong demonstration of NPCU’s institutional capacity to champion voluntary family planning programs and is expected to lead to increases in district family planning budgets. Through these efforts, NPCU has been invited to provide further assistance to five districts for forthcoming district development plans, an exciting step towards consolidating district-level funding for family planning. The additional technical assistance will include development of tailored advocacy products that contextualize the multisectoral benefits of investment in family planning at the district level, and technical assistance to help the districts identify key demographic dividend investments, especially voluntary family planning, to be prioritized in their district development plans.

PACE-Trained Advocate Fosters New Population, Environment, and Development Commitments in Madagascar

Johnnah Ranariniaina, Livelihoods Component Lead with the Wildlife Conservation Society (WCS) in Madagascar, shared several exciting outcomes he achieved building on his participation in the 2019 PACE Population, Environment, and Development (PED) Policy Communication training in the six-month post-training survey. Ranariniaina has applied the policy, advocacy, and communication skills he honed during the training in multiple ways that will enhance the protection of Makira Natural Park, a conservation priority in northeastern Madagascar, and improve human health and livelihoods in communities adjacent to the park through an integrated PED approach. Using increased family planning/reproductive health knowledge from the training, Ranariniaina successfully advocated for an updated Makira Natural Park livelihoods strategy to address early childbearing and high birth rates, particularly among adolescents, as a critical health issue in local communities. To address this strategic shift, WCS established an agreement with a private sector family planning partner to provide family planning services in communities around the park. Ranariniaina’s PED advocacy further led to the WCS Madagascar country program adopting PED as a cornerstone of their conservation approach in their new 2020-2025 strategy, which affirms the organization’s commitment to champion an integrated approach to population and development in Madagascar.

PACE Bolsters Kenya Council of Governors’ Case for Prioritization of Reproductive Health Amidst COVID-19 Pandemic

As the Government of Kenya grapples with the impact of COVID-19 on its citizens, PACE analysis helped protect strong commitment to family planning and reproductive health services among subnational decisionmakers. Recognizing the significant pressure on county governors to redirect health funding to the COVID-19 emergency response, PACE conducted a rapid analysis of county health budget planning and Health Information System data in Samburu, Busia, Narok, and Baringo counties after COVID-19 restrictions were implemented. This evidence, which showed a significant disruption in delivery of essential services, informed a May 27th letter to 47 governors from the chairman of the Council of Governors. Advising that county governors “put in place measures to balance the demands of responding directly to COVID-19 while ensuring continuity in essential health service delivery to address the impact of COVID-19 on reproductive, maternal, and child health,” the chairman’s letter affirmed the country’s political commitment to these essential services, despite the unprecedented challenges of COVID-19.

Ugandan Youth Achieve Population, Environment, and Development Commitments in Two Municipalities

Two Ugandan youth Population, Environment, and Development (PED) advocates trained by PACE and GOAL Malawi have successfully leveraged their skills to advance local policy goals. Tonny Muzira successfully advocated to the Nansana Municipality Council in Wakiso District to allocate municipal funds in the FY2020/21 budget to support various sectors relating to PED, including family planning provision. Members of the Municipal Council have invited him to advise on the use of allotted funds to PED activities. James Onono Ojok, a conservation advocate working with a community-based group that protects indigenous tree species, convinced council members in Gulu District of the link between family planning and environment programs to support a healthy community. In response, the council both tripled the budget allocation for family planning to support 31 lower health units’ community outreach during the COVID-19 pandemic and funded a community tree seedling distribution program to enhance sustainable economic opportunities for local households.

PACE Convenes Inaugural Policy Communication Fellows Program in West Africa

PRB’s policy communication training program for young researchers has expanded to Francophone West Africa for the first time. Launched on October 22 in collaboration with the Ouagadougou Partnership Coordination Unit, PACE’s 10-day course trains 15 policy fellows on best practices and essential skills to promote evidence-driven decisionmaking. The West Africa program includes facilitators from three prominent West African research institutions: the Institut de Formation et de Recherches Demographiques (IFORD) in Cameroon, the Institut Superieur de Santé Publique (ISSP) in Burkina Faso, and the Institut de Population Développement et Santé de la Reproduction (IPDSR) in Senegal. Prof. Parfait Eloundou-Enyegue, Chair of the Department of Development Sociology at Cornell University and himself an alumnus of the policy fellows program, is serving as the program’s master trainer. Over the course of the year, PACE will provide further training to the facilitators and participants, positioning them to cascade their learning to graduate students in their respective institutions and creating a network of institutionally-based policy communication trainers around the region. 

Sustaining Success: PACE Insights on Family Planning Policy and Program Priorities

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Over the last two decades, many sub-Saharan African countries have realized remarkable increases in the use of modern contraception. More women and couples are using effective methods to choose when and how many children to have—benefiting their health, their children’s health, and the economic prospects for their families. Examples include Malawi, where the rate of married women using modern contraception more than doubled from 26 percent to 58 percent between 2000 and 2015-16; and Ethiopia, where the rate more than quintupled from 6 percent to 35 percent between 2000 and 2016.[1]

As the COVID-19 pandemic unfolds, many countries are experiencing both demand and supply disruptions in access to essential services like family planning and reproductive health. Moreover, many leaders will likely face difficult choices balancing their budgets against competing health priorities. Overcoming these challenges to sustain and accelerate progress in expanding access to voluntary family planning will make high impact, cost-effective strategies more important than ever. Fortunately, a large body of research identifying best practices in family planning programs exists, led by the Family Planning High Impact Practices initiative.

High Impact Practices (HIPs) are a set of evidence-based family planning practices vetted by experts against specific criteria and documented in an easy-to-use format. HIPs help programs focus resources for greatest impact. Learn more at www.fphighimpactpractices.org.

Since launching in 2015, the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health project (PACE) has delivered high-quality, evidence-based resources to help decisionmakers implement best practices. The PACE resources synthesized in this article highlight how building government commitment, reducing inequity, responding to the needs of youth, partnering with community leaders, and ensuring quality of care including contraceptive method choice contribute to increasing use of modern contraception in sub-Saharan Africa.

Modern Contraceptive Use Has Increased Across a Range of Sub-Saharan African Countries, From 2000 to 2018

Source: Demographic and Health Surveys, various years.

Targeted Advocacy Strategies Are Effective in Building Government Commitment

PACE policy advocacy activities helped secure budget commitments and contributed to an enabling environment for family planning policies and programs. In Kenya, PACE advocates tailored their strategies to secure commitment from decisionmakers at different levels of the devolved government. At the national level, communication activities made the case for how family planning contributes to the country’s development goals. At the subnational level, evidence-based advocacy and accountability efforts targeting county leaders have increasingly yielded budget lines to support local family planning programs. The resulting strong government commitment has been a driving force in dramatic growth in the share of married women using modern contraceptive methods, rising from 32 percent to 53 percent in just over a decade (2003-2014) after years of stagnation.[2] For countries like Kenya, with a high modern contraceptive prevalence rate (mCPR), continued commitment to strengthening the quality and reach of family planning programs is critical to sustaining progress.


Source: “Family Planning and Kenya’s Progress Towards the Sustainable Development Goals,” National Council for Population and Development and Population Reference Bureau, Video, 2017.
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Reducing Family Planning Inequities Requires a Systematic Approach

Ensuring equitable access to modern contraception, especially for the poorest communities, is one of the most entrenched challenges in providing all women with the ability to plan and space their pregnancies. A systematic approach to addressing inequity can minimize this barrier. Data from Malawi illustrates this; the country stands out in sub-Saharan Africa for having one of the narrowest gaps in the mCPR between the richest and poorest groups of women in 2015-16. Over the previous decade, the Government of Malawi invested in task shifting—allowing lower-level health providers to administer modern contraceptive methods—as well as used program and survey data to systematically identify and address barriers that the poorest women might face in accessing family planning care. Rapid increases in mCPR for all women in Malawi during this period were achieved in part by Malawi’s efforts to close the gap between the wealthiest group of women and the poorest group of women, which fell by half between 2000-2015/16. PACE analysts argued that the increases in mCPR for all women show that the family planning program was effective in reaching poor and rural women with voluntary family planning and increasing their use of modern contraceptive methods.

Modern Contraceptive Prevalence Rate and Demand Satisfied for Modern Methods, Malawi

wdt_ID Survey Total % mCPR Richest % mCPR Poorest % mCPR Poorest % mCPR Total %mCPR Poorest % mCPR Total % Demand Satisfied Richest % Demand Satisfied Poorest % Demand Satisfied
1 1992 7 17 4 4 7 4 15 28 8
2 2000 26 36 20 20 26 20 43 57 34
3 2004 28 38 22 22 28 22 45 57 37
4 2010 42 48 35 35 42 35 58 65 51
5 2015-16 58 61 53 53 58 53 75 77 71
Source: Kaitlyn Patierno, Imelda Feranil, and Meghan Reidy, “Enhancing Family Planning Equity for Inclusive Economic Growth and Development” (Washington, DC: Population Reference Bureau, 2018).
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Responding to the Needs of Youth Is Essential For Reproductive Health Programs

Across sub-Saharan African, 43 percent of the population is under age 15.[3] Family planning programs must respond to the unique needs of this large cohort of youth in order to be effective in enabling all women and couples to delay, plan, and space their pregnancies. Understanding youth fertility intentions—such as their desire for when and how many children to have—can help to better meet the contraceptive needs of this large cohort. Compared to older women, youth often use contraceptive methods for shorter periods and discontinue use for reasons other than wanting to become pregnant. Youth often cite side effects, as well as stigma from community members and health providers as reasons for discontinuing contraceptive use, even if they wish to avoid a pregnancy. In many places, youth face additional barriers in accessing long-acting reversible contraceptives (LARCs), which are some of the most effective modern methods of contraception.

The Government of Ethiopia recognized this gap and made a number of policy commitments to address the family planning and reproductive health needs of youth, including pilot programs to increase uptake of LARCs among this population.[4] Although unmet need for family planning among young married women who wish to delay or space their next pregnancy remains high, Ethiopia has made dramatic progress. The use of modern contraception among married youth ages 15 to 19 increased from 3 percent to 32 percent between 2000 and 2016.[5] Expanding contraceptive choice for youth through policy actions—specifically to ensure LARCs are available and accessible—can better meet their contraceptive needs and prolong their use of modern methods.

Family Planning Users Ages 15 to 19 Are More Likely to Discontinue for Reasons Other Than the Desire to Get Pregnant


Source: Ann Blanc et al., “Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons With Adult Women,” International Perspectives on Sexual and Reproductive Health 35, no. 2 (2009): 63-71.
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Partnering With Community Leaders Can Counter Misconceptions

Community leaders, including religious leaders, often play a pivotal role in shaping the decisions women and couples make for their families. PACE recognizes partnering with religious leaders can help family planning programs respond to misconceptions that religion may prohibit the use of modern contraception. In fact, many religious leaders agree that family planning can boost health and well-being among their communities. In Senegal, an interfaith group of religious leaders has spoken out about how family planning supports religious doctrine for family health. Religious and local leaders’ commitment is one factor in building community support for contraceptive use in Senegal, where married women’s use of modern contraception has increased from 10 percent to 25 percent between 2005 and 2018.[6] As trusted advisors, community and faith leaders can have significant positive impact on contraceptive uptake and continuation to meet women’s and couples’ preferences.

Source: Population Reference Bureau, Senegal ENGAGE: Religion and Family Health, ENGAGE Multimedia Presentation, 2019. See Also:

Ensuring Method Choice Can Increase and Prolong Contraceptive Use

Prioritizing quality of care in programs is essential to respond to the family planning needs of women and couples and sustain increases in the use of modern contraceptive methods across sub-Saharan Africa. All of the strategies described here are facets of high-quality family planning programs. In addition, quality of care in service delivery includes ensuring that clients have access to a full range of contraceptive choices.

Yet in many countries, the majority of contraceptive users rely on only one or two modern methods, which may indicate that users lack access to a full range of choices. In Uganda, PACE analysis of contraceptive switching behavior and reasons for discontinuing contraceptive use showed that “concern about health or side effects” was the primary reason for discontinuing a modern method. With the majority of the population relying on implants and injectables, women who preferred a different method may not have had access to another option. Expanding the number of modern contraceptive methods available to users requires policy changes to remove legal barriers to method choice, improve the quality of contraceptive counseling, and allocate domestic resources for contraceptive supplies. These investments can support greater use of modern contraception and for longer periods of time.

Percent of All Women Ages 15-49 Using Contraception By Method Used

Source: Toshiko Kaneda and Charlotte Greenbaum, 2019 Family Planning Data Sheet (Washington, DC: Population Reference Bureau, 2019). See Also:

Sustaining Success in Family Planning Programs

By building government commitment, intentionally tackling inequity, identifying and responding to the needs of youth, partnering with community leaders, and ensuring method choice within high-quality service delivery, family planning programs can increase and prolong gains in the use of modern contraception. Prioritizing these strategies when making difficult choices about family planning program investments will benefit the health and well-being of families across the continent. PACE resources and country partners can offer evidence-based guidance as advocates and decisionmakers work to sustain success in increasing the use of modern contraception across sub-Saharan Africa.

This web article was written by Marissa Pine Yeakey, PRB consultant, with contributions from PRB colleagues Eve Brecker, Barbara Seligman, Kaitlyn Patierno, Toshiko Kaneda, Elizabeth Leahy Madsen, Heidi Worley, and Anneka Van Scoyoc.

Sources

  1. Demographic and Health Surveys.
  2. The DHS Program, “Kenya,” www.dhsprogram.com/Where-We-Work/Country-Main.cfm?ctry_id=20.
  3. Toshiko Kaneda, Charlotte Greenbaum, and Kelley Kline, 2020 World Population Data Sheet (Washington, DC: Population Reference Bureau, 2020).
  4. Family Planning 2020, “Ethiopia: Commitment Maker Since 2012,” Aug. 19, 2020.
  5. Ethiopia Demographic and Health Surveys, 2000 and 2016.
  6. Senegal Demographic and Health Surveys, 2000 and 2018.