Family Planning in Bamako, Mali

This study discerns why contraceptive prevalence remained low despite the presence of quality and accessible family planning services in Bamako Mali.

Abstract

Researchers conducted a infant and child mortality survey which followed 6902 mothers who gave birth in Bamako Mali in 1982 and 1983 for 2 years. They also spoke in-depth with 78 women who lived near the city center or in an outlying squatter area of Bamako. They did this study to discern why contraceptive prevalence remained low despite the presence of quality and accessible family planning services. 31 women had used a traditional family planning method in the past and 8 currently did. The researchers interpreted this high use as a demand for natural methods rather than modern methods to space births. A cotton belt with knots tied around the waist and a combination of certain amulets and charms were some of the most common traditional methods used. 11 women knew the rhythm method and 5 actually used it but they tended to not accurately understand the menstrual cycle. Sexual abstinence was allowed for 2-3 months postpartum. Some women even tended to refuse sex on demand after the postpartum period. After delivery 10% of the women in the large survey knew a modern contraceptive and 3% knew at least 1 traditional method. Further only 3.4% ever used a modern method. Yet in the small sample 90% knew at least 1 method after prompting. In fact they tended to name all the methods available (oral contraceptives injectables and IUDs). But only 6 women currently used a modern method and 9 had used such a method in the past. Husbands and wives did not communicate well about family planning. Moreover many women held fatalistic beliefs and did not take charge in making childbearing decisions. Yet they did realize the importance of birth spacing. But they tended to consider contraceptives to be an unacceptable means to space births. Nevertheless some women questioned mens motives and considered a large family as a burden.