Family planning programs in sub-Saharan Africa

In the 1980s, signs that sub-Saharan Africans would welcome family planning in numbers sufficient to make a difference in fertility rates were scattered and weak. Pessimists cited formidable cultural and socioeconomic barriers; optimists provided resources for pilot projects, coupled with research to document results and to guide expansion and replication. Among projects with measurable achievements in acceptance of family planning in settings that were less than promising were the Ghana Registered Midwives Project, the Ruhengeri Project in Rwanda, and the Sudan Community-Based Family Health Project. All were associated with the Operations Research Program of Columbia University's Center for Population and Family Health. In Ghana, midwives in private practice were trained and given other support to initiate family planning services. In Rwanda, rural community development volunteers added family planning to their educational activities. In the Sudan, rural catchment areas and work assignments of rural primary health care personnel were changed to introduce family planning and strengthen other child survival services. Positive results were evident from quantitative measures of service delivery and, in Rwanda and the Sudan, from an increase in contraceptive prevalence in the project areas. Other criteria for success included improved management skills, motivation for replicating successful programmatic elements, and potential for continuity. Questions remain as to why attitudes changed, when contraceptive use for family limitation will be practiced widely, and how applicable the experiences reported here are to other locations. These projects do not provide the answers. They do, nonetheless, support an optimistic view for the future offamily planning in sub-Saharan Africa.