HIGHLIGHTS

• Despite progress in meeting women’s reproductive needs, unintended pregnancies remain common in Senegal.
• Supported by the Gates Foundation, the Pathways Project examines social, cultural, and environmental risk factors affecting reproductive, maternal, newborn, and child health and nutrition.
• ideas42 is applying behavioral science expertise and leading qualitative research development and analysis as part of the Pathways Project.

The Challenge

Despite significant progress in meeting women’s reproductive needs in Senegal, 31% of pregnancies are still unintended. One-size-fits-all approaches have not been shown to reach or address the needs of more vulnerable groups who tend to experience worse health outcomes across health areas. 

For several years, the Gates Foundation has supported the Pathways Project—a design-driven, interdisciplinary approach to explore the social, cultural, and environmental risk factors impacting reproductive, maternal, newborn, and child health and nutrition. This approach combines quantitative data, in the form of measurable factors, with qualitative data that describes people’s lived experiences, to segment the population and understand the programmatic implications of these differences.

Our Approach

ideas42 is supporting the application of the Pathways methodology in Senegal. The work of Pathways in Senegal, focused on contraceptive use among married women, seeks to inform the work of the Department of Maternal and Child Health of the Ministry of Health and Social Action of Senegal. Apart from contributing behavioral science expertise to the broader project, ideas42 is also leading the development and interpretation of qualitative research to complement the quantitative segmentation data.

Once this research is complete, we will work collaboratively with other partners to support the Ministry of Health and Social Action in Senegal and its implementing partners to leverage these findings in their family planning strategies and programming.

Results

A few key insights from the qualitative research were:

• “Good” women were considered to be courageous and strong in giving birth to many children, and obedient to their husbands and in-laws.
• While many women have an explicit preference for the number of children they desire, this is generally viewed as ideally in the hands of God, barring health or economic challenges.
• Children are generally viewed as an investment in the future in terms of providing support with household responsibilities and contributing financially either by having a job or laboring in the fields.
• Segments with higher vulnerability have low engagement with the health system, low media exposure, and a less rich social network, therefore missing out on potential family planning information and support at those touch points.
• Women across segments frequently noted concerns that the use of contraceptives would affect one’s ability to conceive in the future, leaving women to “prove their fertility” before considering contraceptives. 
• Women are more likely to exercise their autonomy in family planning decisions without consulting their husbands in particularly difficult situations like financial distress, absent partners, overwhelming childcare responsibilities, or fatigue or illness due to close pregnancies.
• Cost was not noted as a major barrier for any segments, most likely because particularly vulnerable and low-income segments only use family planning in situations of significant distress, rendering the relative cost of family planning irrelevant.

Takeaway

The application of the Pathways approach in Senegal has generated rich and nuanced insights into the social, cultural, and environmental factors shaping women’s reproductive health choices. We are now focused on how to make these insights and data relevant and actionable for government stakeholders. Learn more here. 

Interested in our work applying behavioral science to global health? Email health@ideas42.org or reach out to us on LinkedIn to join the conversation.