Right to contraception in Mali

Hello dear listeners, and welcome to our program. For several years, the government of Mali has been making efforts to provide access to information, adequate services, and the necessary products for contraception. Despite this work, which has been praised by health and human rights actors, the contraceptive prevalence rate remains unsatisfactory according to the seventh and most recent Demographic and Health Survey in Mali (EDSM-VII) conducted by the National Institute of Statistics (INSTAT) in 2024.

 

The report reveals that this low use of contraception is explained by the low level of education among women, particularly rural women, insufficient financial resources to allow technical services to cover the entire national territory, limited male involvement, the weight of traditions and religious beliefs, and the lack of information and awareness sessions. With our interviewees, we will discuss issues related to the use of contraception, the challenges, and the measures needed to guarantee the right to contraception for every Malian woman.

 

To carry out this work, we consulted five interviewees. The first is Fatoumata Djitteye, a young student who will talk to us about the motivation behind her choice to use contraception and the benefits she gains from the practice. Her testimony will be followed by that of her husband, Yacouba Fousseni Coulibaly, a teacher. He will explain why he supported his wife in her decision to use contraception.

Next, we will hear from our expert, Dr. Seydou Z. Dao, a gynecologist at the Reference Health Center of Commune II in the Bamako district, who will discuss the different contraceptive methods, offered at his service. After him, Edouard Keita, Chair of the Board of the Malian Association for the Promotion and Protection of the Family (AMPPF), will speak about the mission of his association and the challenges it faces in implementing its activities.

We will conclude with Dr. Djibril Magassouba, Program Officer for Family Planning at the National Office of Reproductive Health (ONASR), who will explain the policy of the Malian government to ensure the right to contraception for everyone.

RISE OF THE MUSICAL JINGLE, THEN FADE INTO PROGRAM

Hello and welcome, Ms. Fatoumata Djitteye. You are a young married student who uses contraception. Can you tell us how you learned about the existence of contraceptive methods?

 

I learned about contraceptive methods during my training at the health school. But even before that, I had a general idea about the practice through discussions with my friends and some research on the internet. It was during our courses that I received precise information and got answers to all my questions.

 

What gave you the idea to use a contraceptive method?

The course on sexual and reproductive health gave me precise information on the importance of using contraception, especially for a married woman. After having my first child, I decided to use contraception so that I could plan my pregnancies and continue my studies with peace of mind.

 

Which method do you use, and why?

 

I I started with the Lactational Amenorrhea Method (MAMA). It is a natural, simple, and effective method that requires exclusive and frequent breastfeeding. It must begin before the first period after childbirth and be used during the first six (6) months. Its greatest advantage is that it is free and has no side effects.

 

After the six (6) months, I chose the Jadelle implant, which provides protection for five (5) years. It consists of two flexible rods inserted under the skin of the upper arm. Another advantage is that the implant can be removed at any time. It does not require a daily routine, is known for its effectiveness, and is discreet. I have been using the Jadelle implant for two (2) years and plan to keep it for the full five (5) years.

Was your husband in agreement with the idea of using a contraceptive method from the beginning?

My husband is educated and already had a good understanding of the benefits of contraception. When I told him about my desire to use a method, he agreed and supported me throughout the process.

Do you think contraceptive methods are accessible to couples who wish to use them?

 

Unfortunately, I cannot speak for the other methods. However, the Jadelle implant that I use is accessible to couples, even those with limited means. Mine cost five thousand (5,000) CFA francs, which is about 12.29 Canadian dollars, and the product is available at health services.

What changes has this choice brought to your household?

 

Using contraception has given us more freedom and allowed us to have a fulfilling sexual life. It has also given us the time we need to take better care of our child and ourselves. By being able to control the timing of pregnancies, my husband and I have been able to save money and better organize our lives. As for me, I am able to focus more on my studies and carry out my other activities without stress.

Do you face any challenges using this method?

 

I haven’t encountered any difficulties with the method I use, except that having it under my skin was a bit uncomfortable at first. But I’ve gotten used to it, and everything is fine so far.

Tell us about the cost of the method you use.

 

I had my Jadelle implant inserted for five thousand (5,000) CFA francs, including service fees. However, it is important to note that this amount can vary from one facility to another.

How does your family and social circle view your choice to use contraception?

 

At first, some of my friends were against my choice. They considered it anti-religious, while others feared potential consequences. Most were also influenced by prejudices against contraception. But now, many have changed their minds after seeing its benefits. Let’s say that the view of my social circle is generally positive now.

Do you think women should take a greater interest in contraceptive methods?

 

 

Contraception is essential for women. It allows them to stay healthy, take care of their husband, child, or loved ones, and focus on their personal projects. It also enables them to have a fulfilling sexual life.

 

Thank you very much, Ms. Djitteye, for your responses. Let us now turn to Mr. Yacouba Fousseni Coulibaly, who supported his wife’s choice. Mr. Coulibaly, can you tell us why you agreed to your wife’s decision to use a contraceptive method?

 

I agreed to this idea because I know that after giving birth, a woman can become pregnant very quickly. This makes things difficult for us, especially since we each have our own responsibilities and we have a first child to care for. It is a necessary solution so that my wife and I can have time for ourselves and decide when we want to have our second child.

 

In Mali, the use of contraception is a topic that is rarely discussed. How did you obtain reliable information before making your decision?

 

I am a teacher by profession, so I read a lot and do research. Even before my marriage, I was interested in these topics to learn how to better manage my family. I was able to obtain information on family planning from websites, particularly that of the World Health Organization, which is a reference in this field. In addition, when, by chance, I met a woman passionate about health, it helped me better understand these practices, making the decision much easier.

What changes have you noticed in your household before and after using this method?

 

Before using this method, we were constantly stressed about the possibility of an unplanned pregnancy. My wife has an irregular menstrual cycle, so we had to worry every time we were intimate. These uncertainties led us to rely on other methods, such as condoms or pills. But after using this solution, we no longer worry about an unwanted pregnancy, and we feel free.

 

Are you comfortable discussing your choice with others?

 

 

Sometimes I want to talk about it with friends, but I struggle with shyness. Topics related to sexuality are still taboo for me. However, I hope to overcome this one day and help others make the right choice.

 

How does the community view your choice?

 

As my wife said, the people around us understand the reasoning behind our choice. They see us as a family united in health, stability, and good communication. This contrast with the prejudices has helped many to see things more clearly and change their views on contraception.

What difficulties, if any, can you point out regarding the method you use?

 

The first difficulty is the judgment of people around us. As we mentioned, it took time for this to change. There is also the religious aspect, which can sometimes create moral pressure. Although we haven’t encountered this problem ourselves, the lack of professionalism of some health workers can also expose certain women to health issues.

Thank you, Mr. Coulibaly, for your insightful answers. Let us now welcome our expert, Dr. Seydou Z. Dao, the gynecologist. Dr., having worked in this profession for several years, can you tell us what a contraceptive method is?

According to the policies, norms, and procedures—commonly called PNP in Mali—family planning, which some refer to as contraception, is a method or technique, medical or non-medical, made available to an individual or couple. It allows them to manage their sexual life responsibly, avoid unwanted pregnancies, space births, and have the desired number of children at the right time. It is important to note that Mali has primarily focused on the concept of birth spacing, contrary to what many people think, as some believe that family planning aims to limit the number of births.

Can you tell us about the contraceptive methods available in Mali?

In Mali, most known contraceptive methods are available and can be grouped into several categories

First, there are short-term methods, such as the Lactational Amenorrhea Method (LAM), used by women who have recently given birth, provided certain conditions are met. There is also the rhythm method, based on understanding the menstrual cycle.

Among the modern methods, there are injectable contraceptives, such as Depo-Provera or Sayana Press, as well as birth control pills. Male and female condoms are also available, although female condoms remain rarely used.

For long-term methods, there is the IUD (intrauterine device), also called a coil, and implants, which can be effective for several years.

Finally, there are permanent methods, such as tubal ligation for women and vasectomy for men.

What are the benefits of contraception?

Contraception has a direct impact on the health of the mother, child, and family. Spacing pregnancies helps prevent illnesses, reduces maternal and infant mortality, and avoids complications from pregnancies that are too early, too close together, too numerous, or too late. It also helps prevent unwanted pregnancies and risky abortions, while contributing to the well-being of families and the development of the country.

 

Do any of these methods have medical drawbacks?

 

In medicine, we usually avoid using the term “drawbacks,” especially when it comes to medications, because they go through several stages before being administered to humans and each person’s body reacts differently. Instead, we talk about side effects or complications.

Like any medication, some contraceptive methods can have side effects. For example, these may include menstrual cycle changes, absence of periods (amenorrhea), light bleeding, or headaches. Intrauterine devices (IUDs) can cause cramps or heavy bleeding during the first three months after insertion. Each method has its own specific side effects.

What is the most commonly used method in Mali today?

 

The methods used vary from one area to another. However, we have data from national sources, notably the seventh Demographic and Health Survey conducted in 2023 and 2024. According to this survey, the most commonly used method is implants (11%), followed by injectables (5%).

 

Which method is the most effective?

 

In contraception, no method is 100% effective. Every method has a record of failures. However, the most effective methods are permanent methods: tubal ligation, after which a woman can no longer have children, and vasectomy, which reaches its maximum effectiveness after three months in men. Long-acting methods are also very effective.

 

What categories of people use contraception in your service?

All women of reproductive age use contraception. At our Reference Health Center, other services refer women to us who are at risk. So, we receive all categories of women.

What about the availability of contraceptive products?

 

All contraceptive methods are currently available in Mali. There may occasionally be supply challenges methods, but these are usually resolved quickly. Many NGOs are involved in family planning, and annual family planning campaigns are held for at least one month. During these campaigns, information is shared through the media, and meetings are organized with community and religious leaders to explain the benefits of family planning. Contraceptive methods are provided free of charge during this period, and the government also donates supplies to health facilities.

 

Are the prices of these products affordable for the average citizen?

 

Contraceptive methods are generally not expensive in Mali. Costs vary depending on the facility and the method chosen. According to the latest National Budgeted Action Plan for Family Planning (PANB) for 2019–2023, prices range from 100 CFA francs (0.25 Canadian dollars) for oral products like pills, up to 10,000 CFA francs (24.69 Canadian dollars) or more for methods such as female sterilization. We can say that these methods are more or less accessible to the population.

 

What advice can you give to people who wish to use a contraceptive method?

 

Before using a contraceptive method, it is recommended to consult a health worker who can explain the different methods and help the person make a choice. Therefore, contraceptive medications should not be purchased without consulting a health professional, as there may be contraindications if the person already has health issues.

 

Thank you very much, Dr. Dao, for your insightful answers. Let us now turn to Mr. Edouard Keita, who is also a specialist on these issues and the Chair of the Board of the Malian Association for the Promotion and Protection of the Family (AMPPF). Mr. Keita, can you tell us what the right to contraception is?

 

The right to contraception is an integral part of sexual and reproductive rights. It is the right of every woman, every man, and every couple to freely and responsibly decide whether to have children, when, and how many, without pressure or discrimination. This right also includes access to complete information, quality services, and safe, effective, and affordable contraceptive methods. It is a fundamental right recognized by numerous international instruments and by national health policies in Mal

Is this right respected in Mali?

 

Significant progress has been made in recent years, notably through the National Reproductive Health Policy and the efforts of the government via the National Office of Reproductive Health (ONASR) and its partners, such as the AMPPF. However, full respect for this right still varies across regions, urban and rural areas, and social groups. Some women, particularly adolescents and those living in rural areas, continue to face obstacles related to culture, religion, or a lack of awareness of their rights.

What is the level of knowledge among the Malian population regarding the use of these contraceptive methods?

Overall, the level of knowledge is fairly good, especially in urban areas, thanks to information campaigns led by the AMPPF, ONASR, and other partners. However, many misconceptions persist. Many women know the word “contraception” without fully understanding the available methods, their benefits, or where to access them safely.

Can you tell us about your mission in support of contraception?

For over 53 years, the AMPPF has been promoting sexual and reproductive health rights in Mali. Our goal is to enable everyone, especially women and vulnerable youth, to access complete information, quality health services, and safe, affordable contraceptives through our centers, clinics, volunteers, and awareness programs.

What challenges do you face in pursuing your mission?

 

We face several challenges: sociocultural and religious resistance, which maintain taboos around contraception; lack of financial resources to cover the entire country; occasional stock shortages of contraceptive products; and sometimes, limited involvement of men, even though they play a key role in family decisions.

 

How would you assess the interest of the Malian population in contraceptive methods?

 

Interest is clearly growing, especially among young people and educated women. There is a positive shift in attitudes, but many couples still need guidance and support to make informed choices. The demand is real, but it is often held back by fear of judgment or social prejudices.

 

Is there any resistance among the population to these contraceptive methods?

 

 

Yes, it still exists, particularly in some communities where contraception is seen as contrary to religion or tradition. However, this resistance is gradually decreasing thanks to community awareness campaigns, dialogue with religious and traditional leaders, and the involvement of peer educators among young people.

 

Do we have statistics on contraceptive use in Mali?

 

 

According to the latest Demographic and Health Surveys (DHS), the modern contraceptive prevalence rate in Mali is around 17–21 %. This is progress compared with previous years, but it is still below the national target of 30 % by 2030.

 

How would you assess the government’s policy on contraception?

 

The government’s policy is generally supportive and encouraging. Mali has committed to strengthening family planning through the FP 2030 roadmap. However, effective implementation, intersectoral coordination, and sustainable national funding need to be strengthened to ensure equitable access for all social groups.

 

How can contraceptive use be improved?

 

It is necessary to strengthen comprehensive sex education from a young age, involve religious leaders, men, and youth, ensure continuous availability of contraceptives in all areas, and boost awareness campaigns to break taboos and fear of judgment.

 

What categories of people use contraception?

 

We mostly serve married women aged twenty-five (25) to forty (40), but there is increasing demand among youth and adolescents. Men are also becoming more involved, particularly through couples’ programs.

 

Does Mali have laws that guarantee the right to contraception?

 

Mali has a Reproductive Health Law, Law No. 044 of 2002, one of the first in West Africa. However, it is now considered outdated, and a revision is underway. According to an ONASR assessment, it no longer meets current needs, especially for youth and patients with chronic illnesses, making an update essential to ensure equitable and affordable access to care.

 

Thank you, Mr. Keita, for all this information. We conclude with Dr. Djibril Magassouba, a specialist in family and community medicine and the Family Planning Program Officer at the National Office of Reproductive Health (ONASR). Dr. Magassouba, what is the Malian government’s policy regarding the right to contraception?

 

The Government of Mali drafted a law in 2002 regulating reproductive health. Article 4 of this law states that all men, women, adolescents, and youth have the right to freely and responsibly receive information and use the contraceptive method of their choice, provided they respect the current standards.

 

What measures has the government put in place to support this policy?

 

After adopting this law, the government shared its provisions with the population, health providers, and partner NGOs. It also established the National Office of Reproductive Health (ONASR), which coordinates all reproductive health matters. Internationally, Mali has committed to making contraception a key pillar for achieving the demographic dividend.

 

What challenges does the government face in implementing its policy?

 

For fifteen (15) years, Mali has been experiencing a multidimensional crisis—security, political, and social—which impacts the implementation of family planning. Health funding decreases every year, limiting resources for contraceptives, provider training, and national coverage. Despite this, the government continues to make efforts to meet these needs.

 

What solutions are being considered to address these challenges?

 

 

Under the leadership of the Ministry of Health, ONASR is exploring innovative solutions to strengthen family planning. We mobilize domestic resources, advocate with local authorities and the private sector, and use digital tools to raise awareness widely. Managing demographics is essential for development, and we are working to make contraception free. The road is still long, but the momentum has begun.

 

What objectives has the Malian government set for the coming years?

 

Mali has a national document called the National Budgeted Action Plan (PANB), a five-year plan whose third generation was developed this year for 2025–2029. It sets very clear objectives. The main goal is to increase the modern contraceptive prevalence rate from 21 % to 30 % by 2029, with actions already outlined to achieve this. Of course, the challenges are significant. Without security, it is very difficult to ensure full coverage. If solutions to these difficulties are found, Mali could be recognized by 2030 as a leading example in family planning, positively impacting the country’s sustainable development.

 

Thank you very much, Dr. Djibril Magassouba, and thank you, dear listeners, for your interest in today’s program on contraception in Mali, which is now coming to a close.

This right has been guaranteed by law in Mali for several years, yet the country is still far from achieving its targets due to numerous factors, such as traditional norms and insufficient human, material, and financial resources.

Thanks to the support of partners combined with the initiatives of the Malian government, efforts are beginning to show results, as reflected in the official figures. According to senior officials, new strategies, such as mobilizing domestic resources, should help achieve the overall goal of reaching a modern contraceptive prevalence rate of 30 % by 2030.

 

This concludes today’s program. Thank you for your attention, thanks to our guests for their availability, and we look forward to welcoming you again for our next episode.