Togo Joins the Family Planning 2020 Movement
By Dr. Gado Agarassi Napo-Koura
Secretary General, Ministry of Health, Togo
As a former medical intern, I witnessed the devastating impact that lack of access to modern family planning had on the lives of women and young girls. I recall admitting a teenager who had an unsafe abortion that was done in secret. Her own mother was what we call an “avorteuse”—a traditional, unqualified practitioner who performs abortions, and she had performed this practice on her own daughter. Unfortunately, it went horribly wrong, and we had to perform a complete hysterectomy on this young girl, who has consequently never been able to dream of motherhood.
Since that experience, I was struck by the importance of family planning. If that young girl had had access to family planning, she would not have had to resort to a clandestine abortion and would not live the rest of her life unable to bear children. Today, in my role as secretary general of the Ministry of Health of Togo, I realize that my commitment at a personal level should be shared at a collective and community level to prevent other young girls who are in college, school, or even working in the fields, from resorting to back alley abortions and using dangerous, outdated methods that result in catastrophe.
In December 2014, Togo became the latest of over 30 countries to make a pledge to Family Planning 2020 (FP2020), the global movement that aims to provide an additional 120 million women and girls in the world’s poorest 69 countries with access to modern methods of contraception by the year 2020. This announcement in Washington DC crystalized Togo’s commitment to repositioning family planning as one of the cornerstones of its development plan. From 2006, Togo has been developing and implementing a family planning repositioning plan, and has passed a number of legislative and regulatory documents in favor of family health, reproductive health, and family planning, such as the Law on Reproductive Health, the Health Code, and others. So, pledging to FP2020 seemed to be a natural progression along the path we had already chosen.
Family planning is crucial to Togo’s and women’s future development. First and foremost, it is very important for the health and welfare of our women because it allows the control and spacing of births, which enables women to manage their families, regain their strength between pregnancies, and continue to engage productively in economic activities—which, of course, is of benefit to their communities and the country as a whole.
Togo’s objective is to increase its modern contraceptive prevalence rate (mCPR) from 13.2% in 2010 to 24.3% by 2017 through interventions that include: disseminating its national plan to reposition family planning services and its reproductive health law, as well as implementing texts by 2015; providing a specific financial grant for the purchase of contraceptive products; scaling up best practice interventions in reproductive health and family planning service delivery; and developing partnerships with the private sector to provide family planning services.
Our plans are already bearing fruit. For example, we have started an informed push model pilot project in two health regions to bring contraceptive supplies to some of the most remote public healthcare facilities, and we have found demand and uptake to be at optimal levels. This avoids stock-outs and allows communities to feel confident when seeking care at these facilities.
We have also deployed community family planning health agents, which also allows us once again to bring modern contraceptive services, including injectables, to beneficiaries in difficult to reach areas, or to those who have been marginalized because of the stigma associated with requests for family planning.
Another innovation in this area has been involving men in family planning promotion. Men who are supportive of modern contraception encourage and educate their peers, and aim to resolve conflicts between spouses pertaining to sexual health. Male resistance to partners’ family planning efforts has always been a persistent barrier for women accessing these services. The other challenges have been financial and geographic accessibility to family planning. Fortunately, today, the innovations that we’re introducing, such as the mobile and outreach strategy, community based distribution, and open door days, are being financed by the Togolese government and by its partners, which makes it possible to offer family planning products to women for free.
We are confident that becoming part of the FP2020 family of pledging nations will be a major asset for the Togolese people. It will allow Togo to share and exchange strategies with other countries that are members of this initiative. And it will enable us to engage with experts, who can provide the technical and financial support to help put our strategies into action, so that our goals can be reached, and our people can thrive.
An earlier version of this essay was published on The BMJ (thebmj.com).