Progress in family planning in Sierra Leone: a mixed-methods case study

Area of Science:

• Global Health
• Reproductive Health
• Demography

Background:

• Voluntary family planning access is a global health priority with uneven progress in low- and middle-income countries.
• Sierra Leone, a fragile state with high fertility, has seen rapid increases in modern contraceptive prevalence.
• This study investigates the factors driving Sierra Leone's family planning success.

Purpose of the Study:

• To explore the drivers behind Sierra Leone's significant increase in modern contraceptive prevalence.
• To identify key factors contributing to improved family planning access and uptake in a fragile state context.

Main Methods:

• Mixed-methods case study analyzing national data (Demographic and Health Surveys, UN estimates) from 1990-2022.
• Included 33 key informant interviews and 12 focus group discussions with diverse stakeholders.
• Systematic review of peer-reviewed articles, policies, and program documents to understand the implementation context.

Main Results:

• Modern contraceptive prevalence rose from 8.2% to 23.9% between 2008 and 2019.
• Key drivers included increased knowledge, education, delayed marriage, fieldworker outreach, political commitment (Free Health Care Initiative), women's empowerment, and community engagement.
• Substantial gains were observed across different age groups and marital statuses, particularly among unmarried women.

Conclusions:

• Sierra Leone's success highlights the importance of holistic strategies combining political commitment, external funding, cross-sector partnerships, and community engagement.
• Government leadership, particularly integrating family planning into the Free Health Care Initiative, was crucial.
• Educational and gender-sensitive approaches were effective, offering lessons for other fragile, high-fertility settings.