Mijadala baina ya Vizazi Hushughulikia Miiko ya Upangaji Uzazi nchini Mali

In Mali, adolescents’ and young people’s reproductive health is a national concern, as this life stage from 10-24 years is marked by immense potential as well as critical vulnerabilities, like sexually transmitted infections, early and unwanted pregnancies, unsafe abortions, and other risky behaviors. Results in the Mali Utafiti wa Idadi ya Watu na Afya regarding family planning and reproductive health (FP/RH) for adolescents and young people are alarming, with high unmet need for family planning and low use of modern contraceptives (see Table). Despite this, only about half of youth have favorable attitudes toward FP/RH services.

Table. Key FP/RH Indicators for Mali, 2018 DHS

The Barriers That Young People Face

Young people lack information and health services tailored to their specific needs. They are also living in a context marked by instability, poverty, unemployment, and violence, including gender-based violence, all of which increase vulnerability and limit the conditions and opportunities for their personal and professional development. A study published in 2020 on adolescent girls and young women in Mali revealed that lack of knowledge about contraception was a major obstacle to the use of these methods, as well as restrictive gender norms that strongly encourage fertility and limit the decision-making power of women, particularly young women. Additionally, the persistence of beliefs and myths about family planning, inadequate communication between parents and their children, and geographic and economic constraints also contribute to low contraceptive use.

MOMENTUM’s Intergenerational Dialogue Approach

While the country has made efforts to make family planning services accessible, available, and offered based on informed and voluntary choice, young people’s use of contraceptives remains low. For this reason, Ustahimilivu wa Afya wa MOMENTUM (MIHR), in collaboration with the government of Mali, is implementing demand creation and social behavior change interventions to promote positive attitudes and supportive cultural norms for family planning and related health services, particularly for youth. To this aim, MOMENTUM recruited four local organizations: the Malian Association for Sahel Survival (AMSS), the Association for the Development of Community Initiatives in Sahel (ADIC Sahel, formerly known as the Association for Tangassane Development) in Timbuktu, the Reflection Group for Development Initiatives (GRIDev) in Gao, and Tassagth, also based in Gao. These organizations implement key FP/RH demand creation interventions in the Timbuktu and Gao health districts, primarily to address the needs of adolescents and young people.

With financial and technical support from MIHR, these organizations identified youth leaders across 38 health catchment areas to lead educational and intergenerational dialogues to address the negative effect of myths and stigma related to family planning. The youth leaders facilitate discussions with diverse groups of young people tackling issues such as:

• the role of Islam and societal norms for accessing and using contraceptive services
• birth spacing for individual, family, and community economic development
• women’s and young people’s sexual and reproductive health and rights
• the links between gender and decision-making for family health

The Impact: Reducing Stigma and Improving Use of Contraception

From June 2023 through January 2024, 1,077 youth (786 girls and 291 boys) participated in 15 intergenerational dialogues and educational discussions organized by the local organizations in collaboration with community actors like religious and traditional leaders, youth and women’s associations, and community health workers.

MOMENTUM staff followed up with the young leaders and participants who shared that these dialogues have made a positive impact on their own relationships and personal development as well as in their communities. Youth leaders noted that following the dialogues, they noticed young people were more informed about family planning, and people were more accepting of talking about family planning, even encouraging more parents and children to discuss together. Ibrahim Mama, a youth leader in Château, Gao, added that due to the stigma, women often used to go to the health center at night to avoid people seeing them, but after several information sessions about family planning and its benefits, accessing and using family planning services is becoming more normal.

Ibrahim Adramane, Youth leader and mobilizer, GRIDev, Château, Gao

Husbands’ or partners’ support of family planning is often a key determinant in whether a young woman uses contraception. After the sessions, several youth leaders and young women who participated shared that men became more accepting of contraceptive use, and some have even started accompanying their partners to health appointments and family planning counseling, which one youth leader described as “practically impossible before.”

Many credited the success of the sessions to the organizations’ approach of harmonizing these messages with the teachings and practices of Islam by focusing on birth spacing and the well-being of the family. Oumar Youmoussa, a youth leader in the Berrah health catchment area, shared that sociocultural constraints are significant in their communities as family planning is often associated with limiting births, which is considered forbidden under Islam. By focusing on birth spacing, public debate has shifted more and more toward religious acceptance of family planning.

Agaicha Cisse, Participant, Kabara, Timbuktu

These sessions have also motivated other young leaders to carry on this work with others. After participating in a session about family planning, the president of the local association, Smile at Hope, saw how important these discussions were and got his association involved in mobilizing more young people in similar sessions. He shared, “It should be noted that the lack of intergenerational communication is very significant in our context because of the weight of tradition that makes sexuality a taboo for parents and children to discuss. [ADIC Sahel] helped spark these discussions. Now, we are seeing more and more young people taking part in discussion sessions about family planning and reproductive health – averaging 30 people per session – which was virtually impossible in our region in the recent past.”

These sessions have been important platforms to challenge people’s attitudes and beliefs about family planning; openly discuss issues of gender, sexuality, religion, and young people’s needs; and open lanes of communication between generations. Since these sessions began, the number of adolescents and young people using a contraceptive method has increased by 18% in Gao and 25% in Timbuktu. With better information and reducing the stigma of family planning, more women and young people are able to access services and better plan for their futures.