I’m marking World AIDS Day from an interesting vantage point. This week, I am in Dakar, Senegal, attending the 2011 International Conference on Family Planning, hosted by the Gates Institute. The conference brings together world leaders to discuss best practices, share research, and find a way forward to achieving universal access to reproductive health care. I am inspired by the great leadership from traditional donors, emerging economies, and developing countries, including a statement from our own Secretary of State Hillary Clinton who said that we must accelerate our efforts to ensure that all women have access to family planning and reproductive health care and services.
As we commemorate World AIDS Day on December 1, it is a particularly fitting time to think about how we can better integrate family planning and reproductive health into HIV and AIDS services. We know that HIV and AIDS, reproductive health, and child survival are interconnected, are matters of human dignity and of life and death. A consistent, integrated approach to these challenges has been an elusive goal that the international community knows it must realize. As UNFPA’s Dr. Babatunde Osotimehin recently stated, these issues must be addressed simultaneously in global development efforts.
Senegal provides a fascinating case study. Senegal is considered a success story – it has maintained one of the lowest HIV-prevalence levels in Africa, with HIV rates holding stable at under 1 percent of the adult population since 1997.
On Tuesday, I had the opportunity to visit a USAID-funded health hut that takes a comprehensive approach to preventing the spread of HIV. The health hut is located in the village of Kignabour, about 70 km outside of Dakar, and provides services to the rural, Muslim population. The community is faced with many challenges: The literacy rate in the village is approximately 20 percent, for example, and girls are typically married by age 16.
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I met Astou Ndour, a community health worker and traditional birth attendant, who gave us a tour. In her health hut, they educate community members about HIV and AIDS. Additionally, the health hut provides other health services related to issues such as malaria and neo-natal care. They educate individuals on ways to prevent the transmission of HIV by promoting the use of condoms. On a community level, they do outreach and education and conduct screening to prevent mother-to-child transmission of HIV. A study estimated that adding family planning to services for preventing mother-to-child transmission (PMTCT) of HIV in 14 high HIV-prevalence countries would double the impact of providing PMTCT services alone.
There is a separate room in the hut that is used for family planning counseling. The process includes a welcome, a list of products available, a discussion of side effects and benefits, and choices of methods appropriate for the client. The contraceptive methods include cycle beads, condoms, female condoms, and birth control pills.
The health hut staff arranged a fascinating community dialogue to identify the biggest challenges related to voluntary family planning, forming two separate discussion groups, one for young mothers and one for grandmothers. In the course of the afternoon, it became clear that while the husband is “chief” of the family, often in this community, the grandmothers make the decisions regarding contraception use. In this group, they try to encourage conversations about family planning, often through singing, storytelling and dialogue. The grandmothers are viewed as integral partners in creating a space for dialogue around voluntary family planning.
In the young mothers group, Mariana tells us that women are not aware that they have the right to make their own decisions about family planning. Conversations like these are critical to empower young women with the knowledge that they can make decisions about the number, timing and spacing of their pregnancies.
Staff of the health hut notably address not only health care services but also the social customs that allow for discussion of health issues and lead to behavior change. USAID currently supports 1663 health huts in Senegal. These USAID-funded health huts are providing valuable front-line education and health services to address HIV and AIDS and provide reproductive health care for low-resource, rural populations. Integrating family planning with other services can enhance the path to economic growth and development. Offering these services together is also cost effective – the net savings and benefits realized by health systems outweigh the initial costs of integrating family planning. Additionally, integrated services save women time, enabling them to be more active in income producing activities, and invest more in their own – as well as their children’s – health, education, and well-being. Clearly, these health huts are a sound investment.
At the United Nations Foundation, I lead an initiative to strengthen U.S. leadership on international reproductive health and family planning. Currently there are 215 million women who lack access to quality reproductive health and family planning services. By investing in community health clinics like the one I visited, we can get closer to our goal of universal access to voluntary family planning. After seeing the impact that family planning can have on the lives of women, their families, and communities, I know now more than ever that investments by the U.S. in family planning are critical to empowering women, reducing poverty, reducing transmission of HIV/AIDS, and saving the lives of women and children.