One day, a woman visited Dr. Bocar Mamadou Daff’s health clinic in rural Senegal. She was in tears.
At an earlier visit, the woman complained of feeling run-down. Daff noted that she was having a child every 18 months and recommended that she “rest awhile” between births by using family planning to space her children. Her health and her children’s health were at stake, he told her.
The woman shook her head and said her husband would never agree. Their family and cultural traditions expected them to have many children.
Now she was back in Daff’s office. Her husband had left her, she said—she was an exhausted single mother struggling to feed her family and raise four young children.
Many years later, the details of that story remain crystal clear in the mind of Daff, now director of the Reproductive Health and Child Survival Unit for Senegal’s Ministry of Health and Social Action.
Daff is a driving force behind Senegal’s bold goal to more than double the percentage of women using contraception by 2020. He sees Sayana® Press, the all-in-one injectable contraceptive created and championed by PATH and our partners, as a critical step forward—for the health of women and children and for the very future of Senegal itself.
Daff’s nearly 30-year career in medicine is defined by a simple principle: Access to health information, health care, and essential medicines is a basic human right. It’s a belief that took root following a health scare involving his sister, with whom Daff was especially close when they were growing up in rural Senegal.
His sister fell ill, and her skin turned yellow. The family tried every traditional remedy, but over the next two weeks, her condition worsened. People said it was the work of the devil. In desperation, Daff asked his teacher for advice. The teacher correctly identified the symptoms of malaria and anemia and urged him to get his sister to a health post.
That conversation saved her life—and changed Daff’s. He went on to get his doctorate in medicine in 1989 and additional degrees in public health, health economics, and international development.
“I became a believer in modern medicine. . . .It is an obligation to me now, a moral obligation, to help others,” he says. “Every night, I ask myself if what I am doing is good. Is my work helping the poorest populations?”
Today, Daff’s desk in Dakar is a tangle of colored folders, government reports, and journal articles. His calendar is a solid block of back-to-back appointments interrupted by calls from the Minister of Health and other senior government leaders.
He has become a vocal advocate for evidence-based decision-making on health service delivery and access to family planning supplies to improve health and save lives. An estimated one-third of maternal deaths worldwide could be averted by delaying motherhood, spacing births, preventing unintended pregnancy, and avoiding unsafely performed abortions. He was also instrumental in developing an innovative distribution strategy for contraceptive supplies called the “informed push” model that has reduced stockouts in pharmacies and clinics to near zero.
In 2013, Daff’s leadership earned him the Excel Award for family planning leadership from the Bill & Melinda Gates Institute for Population and Reproductive Health.
When you talk to women and health care providers in Senegal about why they like Sayana Press, the same idea comes up again and again: Sayana Press puts women in charge.
If women are empowered to control their own reproductive health, it is “a kind of revolution for them,” Daff says. Women can make their own informed choices about when and whether to have a child and have the freedom to work and be independent.
Adama, who lives in a suburb of Dakar, is a case in point. She switched to Sayana Press about a year ago after her husband found her birth control pills and asked about them. She received her first injections through her health care provider, then enrolled in self-injection research studies being conducted by PATH and the Ministry of Health.
If it was up to her husband, Adama says, the couple would have a child each year. “If he found out I am using family planning, we would fight, and he would think I don’t love him anymore.”
Now she carefully hides Sayana Press in the single room she shares with her husband and three children. She appreciates the fact that one injection lasts three months, and she doesn’t have to remember to take a daily pill.
“The three children I have—I am praying to God for them to grow up healthy,” she says. “As women, we have to think first about the children.”
Daff also believes Sayana Press is an investment in Senegal’s future and an opportunity to capitalize on the country’s “demographic dividend”—the economic boost that can result from changes in a country’s population age structure.
Family planning gives Senegal “the means to create our own development.”
Today, Senegal's total fertility rate is about 5 children per woman. The government's goal is to reduce that by half.
Reducing average family sizes “will allow us to. . .have the means to create our own development,” he says. “It will enable us to educate our children, to have the means to invest in development, in infrastructure, in water quality, in energy, in security, in employment.”
“You cannot have more people working when they are not healthy. You cannot have more people working if we cannot afford to invest in jobs,” he says.
PATH’s longtime partnerships with the governments of Senegal and other African countries paved the way for the country-led pilot introductions of Sayana Press over the past two years.
We worked with a consortium of donors, partners, and the governments of Burkina Faso, Niger, Senegal, and Uganda to develop introduction strategies. And we helped ministries and other partners collect data, navigate complex procurement funding and logistics, and support training for health care providers that emphasizes women’s informed choice about a range of family planning methods.
Because Sayana Press is so easy to use, it is also uniquely suited for women who want to inject themselves. PATH is working with the Ministries in Senegal and Uganda to conduct research on the feasibility, acceptability, and potential impact of self-injection. Hundreds of women like Adama have had the opportunity to try self-injection through these studies.
We are now working to ensure that results from the introductions and the research on self-injection open the doors to Sayana Press becoming available in additional countries. For example, we are developing new, evidence-based advocacy materials to help local champions advocate for policy action on access to Sayana Press.
When PATH first discussed the possibility of a country-led pilot introduction of Sayana Press with Senegal’s Ministry of Health, Daff was one of the biggest champions of the idea.
With Daff’s leadership and support from PATH, Senegal introduced Sayana Press in 2015 in 31 health districts across four of the country’s most populous regions.
By the end of the pilot introduction in June 2016, more than 115,000 doses of Sayana Press had been administered in the pilot regions through public and private health care providers and at every level of the health system, from urban health centers to rural health posts.
Even before the pilot introduction ended, Senegal’s leaders had decided to make Sayana Press available nationwide through health care providers. While the self-injection research is still ongoing, the Ministry is also strongly considering how self-injection could accelerate women’s access to contraception.
“I think it will happen fast because they are so committed,” said Dr. Marguerite Ndour, PATH’s coordinator for Sayana Press in Senegal. “I’m very confident in the future there will be a revolution in family planning…and our young will be the engine of our transition.”
—Written by Jolayne Houtz