Medina Sabakh: A Success in the South
This blog is one of the long drafts written for a USAID Success Story. These are essentially recaps of how USAID & their Partners programs are creating a positive and effective impact. The final draft cuts about 200 words and will be submitted to USAID to be published on their website in the coming months.
“With family planning, the women of Medina Sabah now have the chance to do ‘something’ with their lives, they have choices. I believe in the life choice family planning creates, do you?” posed Madame Yade, head of the small Senegalese maternity ward in Medina Sabah. Located in the Kaolack region in southern Senegal, Medina Sabah is home to a host of obstacles in the effort to open access to family planning: necessary consent from males, a taboo of going to a health clinic in the first place, stigma against any older woman using family planning, the Senegalese value of having a large family, and single room health facilities that leave little room for discussion over subjects as sensitive as contraception. USAID and IntraHealth International’s paired vaccination-family planning program is making promising steps to remove these hindrances, change the discussion surrounding family planning, and empower the women at the base of everything.
“Accessibility and information are our biggest obstacles in meeting the demand for family planning methods” says Mariame Yade, head of the Medina Sabah maternity ward. “ This being said, through the vaccination-counseling program, we are beginning to truly address these needs.” In Senegal, weekly mass vaccinations are held in more populated areas while monthly vaccinations are held in smaller districts such as Medina Sabah. Now regardless of who brings in a child to receive a vaccination, the accompanying adult is also counseled on family planning options. In the four months since its inauguration around Medina Sabah, there has already been a 57% increase in patients using family planning, a number that has been on the rise each month.
This pairing of vaccination and family planning jumps many previous obstacles. The national vaccination program is perhaps the most publicized of all health efforts in Senegal and has a long history of public engagement, where local representatives continuously remind and update people about upcoming vaccinations. Additionally, families with children of vaccination age are the primary group who need and want family planning. By using the in place vaccination schedule, dispersal of information, and the target population of the vaccination effort, the integrated counseling program opens the opportunity of access and information to far more people.
Combined counseling is changing the dynamic that family planning holds in people’s lives and the discussions they now have surrounding it. Because of cultural taboos regarding age, sex, marriage, and preferred family size, going to a health clinic, much less using contraception is a touchy subject. By holding regulatory counseling in tandem with vaccinations, the political sensitivity of the topic is bypassed as patients use vaccinations as the reason for going to the clinic.
Once at the health center, the subject of family planning is broached. Discussion revolves around contraception in a setting where the dialogue can be moved away from individuals and into a context sans blame or stigma. Madame Yade graciously smiled as she explained “when we didn’t have a group discussion on family planning one day, a group of patients came to us asking for the “waxtan,” the discussion. How wasn’t there one today? Now people want to talk about family planning because it has been integrated [with the vaccinations].” Additionally, in single room cas de santés the integrated program individually treats patients in a private space instead of public consultation and treatment which is the norm. In this way, people can ask questions without embarrassment and receive their method on site.
In the five cas de santés visited this past month, an astonishing 92.5% of contraceptives prescribed were long term methods, from DUI’s to injections. Yade pointed out that many citizens used to cross the Gambia border to use their health clinics, but since long term family planning methods have become more accessible, these patients are staying with the closer Senegalese health facilities. Resoundingly so, the joint vaccination-counseling program is helping to address both access to and information about family planning for Senegal’s population. At the end of the day, family planning boils down to the women, children, and families affected by it, or as Madame Yade puts it, the liberty of choice in life.