Progress in family planning in Sierra Leone: a mixed-methods case study
Rattachement africain : us, Sierra Leone, bb, pk, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
INTRODUCTION: Expanding access to voluntary family planning is a global health priority, yet progress has been uneven across low-income and middle-income countries. Despite being a fragile state with historically high fertility and limited health resources, Sierra Leone has achieved one of the fastest increases in modern contraceptive prevalence in sub-Saharan Africa. This study explores the drivers of this progress through a mixed-methods case study. METHODS: We analysed national-level data from urban and rural settings, and engaged diverse stakeholders including family planning professionals, healthcare providers, community leaders and service users. Quantitative data were drawn from Demographic and Health Surveys (DHS 2008, 2013 and 2019), and United Nations (UN) Population Division estimates (1990-2022). Qualitative insights were obtained through 33 key informant interviews and 12 focus group discussions. A systematic review of peer-reviewed articles, policies and programme documents was conducted to assess the broader implementation context. RESULTS: Between 2008 and 2019, modern contraceptive prevalence among women aged 15-49 rose from 8.2% to 23.9% (+15.7 percentage points). Among married women, gains were larger in those aged 15-24 years (+12.6) than in women aged 25-49 years (+10.0). Unmarried women maintained substantially higher use, with gains of +19.5 and +16.9 points, respectively. Key drivers included expanded knowledge, higher education, delayed marriage and outreach by fieldworkers. Political commitment-particularly integration into the Free Health Care Initiative (FHCI)-together with women's empowerment policies, donor and non-governmental organisation (NGO) support, media and community engagement improved access, awareness and autonomy. CONCLUSIONS: Sierra Leone's progress demonstrates the importance of holistic approaches combining political commitment, external financing, cross-sector partnerships and community engagement. Government leadership was most evident in integrating family planning into the Free Health Care Initiative, while educational and gender-sensitive strategies proved particularly effective. These drivers consolidated gains and offer lessons for fragile, high-fertility settings.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Progress in family planning in Sierra Leone: a mixed-methods case study
- Date Crossref
- 01/06/2026
- Éditeur
- BMJ
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Michigan pays non établi dans la noticeUniversité ou école supérieure
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Sierra Leone Urban Research Centre Sierra Leone (code pays fourni par la source)Organisation à but non lucratif
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University of Sierra Leone Sierra Leone (code pays fourni par la source)Université ou école supérieure
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Ministry of Health Government of Sierra Leone Freetown, Sierra Leone (pays nommé en fin d’affiliation)Organisme public
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Ministry of Health and Sanitation Sierra Leone (code pays fourni par la source)Organisme public
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Aga Khan University Department of Community Health Sciences pays non établi dans la noticeUniversité ou école supérieure
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Hospital for Sick Children pays non établi dans la noticeÉtablissement de santé
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SickKids Foundation pays non établi dans la noticeOrganisation à but non lucratif
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Center for Community and Public Health Improvement Freetown, Sierra Leone (pays nommé en fin d’affiliation)Institution
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Centre for Community & Public Health Improvement (CPHI) Freetown, Sierra Leone (pays nommé en fin d’affiliation)Institution
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Faculty of Nursing and Midwifery Freetown, Sierra Leone (pays nommé en fin d’affiliation)Université ou école supérieure
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Gates Venture pays non établi dans la noticeInstitution
University of Michigan, Sierra Leone Urban Research Centre (Sierra Leone) et University of Sierra Leone (Sierra Leone), avec 9 autres affiliations. Pays d’affiliation : Sierra Leone.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.