Buchanan, Liberia—When Marwo Weagai opens for business at the local market here, she sells bags of salt, bottles of palm oil and dried spices—and also offers free family planning (FP) advice and supplies to interested shoppers. Marwo is among 22 market vendors participating in an innovative program in three counties in Liberia to increase women’s access to FP counseling and services.
Many of the market vendors know from personal experience the challenges faced by Liberian women who want a safe and reliable method to plan their families. For example, long lines at health facilities are a deterrent to accessing services for women who are busy caring for and trying to support their growing families. In Liberia, the average number of children per family is five. And, according to the latest Liberia Demographic and Health Survey (LDHS 2007), the unmet need for contraceptives is 36 percent. Moreover, the maternal mortality ratio is 994 per 100,000 live births—one of the highest in the world.
To address these issues, Jhpiego—through the support of the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP)—partnered with the Ministry of Health and Social Welfare and developed an innovative program to train women who work in the markets to be FP peer counselors and providers. Their market stalls are now posted with signs that say “Free Family Planning Services.”
In Grand Bassa, the volunteer counselors promote healthy behaviors and provide counseling, condoms and refills for contraceptive pills; they refer first-time users to a health facility.
“I like and enjoy this program, because it has increased my knowledge on family planning,” says Marwo, who also talks with family and neighbors outside the market about their FP options and encourages them to visit her stall in the market. “Every morning, when I come and put my market wares on the table, I go around talking to my peers about FP; those who are interested and are continuous users come for refills, and new clients, I encourage them to go to any government health facility of their choice for FP services.”
MCHIP has been working to increase FP services in Liberia since 2010. In addition to strengthening the skills of FP providers and integrating FP and immunization services at selected health facilities, MCHIP is identifying effective approaches to increase FP services and awareness through community-based distribution. To date, the market contraceptive program has served more than 1,500 clients in markets in the three targeted counties of Grand Bassa, Margibi and Montserrado.
Reaching out to adolescent girls has been a priority for the program. The statistics are telling: in Liberia, 48 percent of girls have begun bearing children by the time they are 18 (LDHS 2007); Grand Bassa County has a teenage pregnancy rate of more than 68 percent (UN 2008 Common Country Survey); and among all women of childbearing age, 25 percent of deaths are associated with maternal complications. Consistent access to FP services can save lives.
Marwo recognizes the impact she is having because knowledge can save lives too. “This [program] makes me feel very good, because I am helping my country to reduce teenage pregnancy and to prevent women from dying because of childbirth since many women and girls are having children too soon and too close,” she says. “Because of the program, I have counseled all my younger sisters and they have accepted a FP method.”
Other market FP peer providers have also noted that the program is helping women to prevent unwanted pregnancy and unsafe abortions.
As part of this program, MCHIP has trained both market peer providers and Ministry of Health and Social Welfare health facility providers. In addition, MCHIP has supplied ongoing supportive supervision and data collection for routine monitoring.
During a visit at the Monrovia Junction market in Buchanan, an MCHIP staffer had the opportunity to speak with clients of the market contraceptive program; one woman reported that: “We are grateful, because this program is really good for us. It helps us to space our children and it also makes it easier for us to get our refill,” without spending a lot of time waiting in long lines at a busy clinic.