Why Pathfinder Works in Guinea and West Africa
Adolescent girls and young women bear a particularly high burden of poor sexual and reproductive health. Globally, adolescents ages 15-19 have a higher risk of maternal mortality than older women, they are less likely to space pregnancies at least two years apart than older women, and they have lower contraceptive use and higher unmet need for contraception than older women.
Data in Guinea, Burkina Faso, and Niger reflect these global trends. West Africa has consistently lower contraceptive prevalence rates as a region than the rest of Africa, and has some of the highest unmet need for contraception in the world. In particular, adolescent girls and young women in the region confront a myriad of sexual and reproductive health challenges ranging from early marriage to unintended pregnancies to gender-based violence. Despite the poor sexual and reproductive health indicators, young women, especially young married women, continue to be an underserved and vulnerable group who are socially isolated, have less access to quality sexual and reproductive health services, are not empowered to advocate for their sexual and reproductive rights, and are often missed by current reproductive health programs.
Pathfinder recently opened an office in Guinea to address the many sexual and reproductive health problems faced by youth by capitalizing on the current momentum around sexual and reproductive health and family planning in the region. In Guinea and other countries in West Africa, national governments and donors alike have made commitments to improve sexual and reproductive health as evidenced by the 2011 Ouagadougou Family Planning meeting and resulting action plans and budgets. Pathfinder brings years of experience in the countries of West Africa including projects for adolescent and youth sexual and reproductive health (AYSRH) in Ghana and most recently, improving the contraceptive supply system and reducing female genital cutting in Guinea. Pathfinder works with the Ministries of Health in both Guinea and Burkina Faso to support their efforts to develop strategies for adolescent reproductive health, and local partner organizations to implement community-level activities in both countries. A regional technical meeting is being organized for late summer, where international and local organizations will be invited to discuss best practices in adolescent health and to explore ideas that may enhance country-level work planning and implementation around reproductive health strategies for youth.
Building Capacity, Strengthening Systems
In Guinea, the median age at marriage among women 20-49 years old is 16, one-quarter of women aged 20-49 were married by age 15, and 85 percent of women aged 20-49 were married by age 20.
Pathfinder’s technical and program management team are providing technical support, ongoing mentoring, and supervision to contribute to the strengthening of the responsiveness of the health systems to adolescents and youth and further develop the capacity of local partners in AYSRH technical strategies, program implementation, and monitoring.
Project interventions were designed based on the following logic:
- Supporting the Ministry of Health to advance national AYSRH plans, standards, and guidelines and integrate youth-friendly services at public sector sites will lead to improved Ministry of Health capacity to implement quality sexual and reproductive health services that meet the needs of young married women and their partners.
- Training facility providers in youth-friendly services will improve their skills in providing contraceptive services, including long-acting reversible contraception, to young married women.
- Training Community-Based Distribution agents will improve their capacity to reach young married women and their partners with contraceptive counseling and methods.
- Training Community-Based Distribution agents and volunteers to do home visits and outreach will improve their capacity to reach young married couples and key household gatekeepers/influencers (mothers-in-law) with messages about the importance of contraceptive use for healthy timing and spacing of pregnancy.
- Engagement of traditional and religious leaders will lead to their increased participation in activities supporting healthy timing and spacing of pregnancy and sexual and reproductive health for young people.
Together, these activities will contribute to increased use of contraception among young married women and increased support for healthy timing and spacing of pregnancy at the community, household, and individual levels in project areas. Activity outcomes are expected to improve young married couples’ ability to delay and space pregnancies through the use of contraception, which will ultimately contribute to reproductive health impacts such as reduced levels of early and unintended childbearing, lower lifetime fertility, and reduced maternal and child mortality and morbidity. Delaying the first birth and spacing subsequent pregnancies will also enable young women to finish school, develop skills for work outside the home, and participate more actively in communities and civil society.
Pathfinder is laying the groundwork to address the great need for contraception and sexual and reproductive health services in West Africa, a region with some of the lowest contraceptive prevalence rates and highest maternal mortality in Africa.
In a year of remarkable achievement, including Pathfinder’s landmark victory at the US Supreme Court and our return to Bangladesh with a $53.8 million project, what was most exciting? The answer—integration—is the theme of Pathfinder’s 2013 Annual Report.
The first time Almaz, a teenager living in rural southern Ethiopia, went to the crowded health care clinic in her village to get contraception, she was told they only helped older women with children. The second time, she waited hours only to find out that her preferred method of contraception was out of stock. Almaz is just one example of the many adolescent girls and young women around the world with unmet needs.