Mali has one of the highest fertility rates in the world, with an average of more than 6 children per woman. Closely spaced births also contribute to maternal mortality (587 deaths per 100,000 live births) and infant mortality (68 deaths per 1,000 live births). Oxfam’s Saving for Change programme reaches 500,000 women – rural and urban – across Mali, organizing women into saving groups and then using those groups as a platform to deliver other capacity-building programming, like trainings on entrepreneurship and Ebola prevention. Last summer, Oxfam and local partners began a pilot program, Saving for Change + Reproductive Health, designed to link the power of savings groups with much-needed training on family planning.
The savings groups participate in seven training modules, which cover methods of contraception, sexually transmitted diseases, and how to broker conversations about family planning at home. The training concludes with referrals to local clinics offering family planning services, and trainers facilitate access (e.g. by communicating directly with clinics and accompanying members on visits, as requested). Our evaluation of the pilot finds that savings group-based training is an effective way to overcome some of the socio-cultural barriers Malian women face in accessing information about the family planning. The training increased women’s knowledge about family planning, increased the likelihood that they would use contraceptives, and increased their confidence in having conversations with their partner about family planning.
By disaggregating the data by age, location and living standards, we find that women make different choices about contraceptives. Younger women are more likely to choose injectable birth control, and our fieldwork indicates that is because they can keep this method secret and don't need to visit the clinic as often. Urban women tend to choose the pill. Richer women are most likely to use male condoms; our fieldwork indicates this is because they can negotiate this with their husbands, unlike poorer women. We also find a correlation between confidence in securing access to family planning and socioeconomic status; poorer women are less confident in their ability to access contraception.
We found that family planning training catches on! While the project originally intended to train 7,200 women in 320 SfC groups, and instead we trained 10,593 women in 433 groups. As one trainer explained, “I should supervise 15 groups and I have exceeded the number everywhere, because in some localities there are more groups than expected and it is not possible to choose some and drop others. So I trained them all!” As we move beyond the pilot phase, this signals the need for increased capacity when scaling up.
We also learned that future phases must involve men. During the evaluation, most men refused to be surveyed, stating that they didn’t know enough about family planning or the women’s savings groups. However, men remain a key driver in women’s decision-making: only 17.4% of women feel that they can use family planning if their husband doesn’t agree. An overwhelming majority (90.9%) of women surveyed believe that men must have the last word on healthcare decision-making by members of their family. By contrast, other community members, including elders, female relatives, and religious leaders have little influence on women’s decision-making on family planning.
By Emma Fawcett, Learning, Effectiveness and Accountability Advisor, Oxfam.
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