Policy in practice: assessing Senegal's family planning progress using a mixed-methods approach.

Résumé

BACKGROUND: Senegal has made significant progress in family planning (FP), with the modern contraceptive prevalence rate (mCPR) increasing from 12% in 2010 to 26% in 2023, along with a sharp decline in unmet need. Once among West Africa's lowest performers, Senegal now stands out for its advancements in FP access and equity.OBJECTIVES: This study examines the main factors driving Senegal's FP progress-including policy leadership, financing mechanisms and community engagement-while identifying ongoing challenges and lessons for policy and practice.METHODS: We employed a mixed-methods approach, combining trend and decomposition analyses with a review of FP policies, financing and programmes, guided by the WHO's health system building blocks. Qualitative data were collected from interviews and focus groups with policymakers, providers, community leaders and users across various regions.RESULTS: Senegal's early gains in FP were driven by strong political leadership, task-shifting, community-based service delivery and supply chain improvements. Social mobilisation campaigns, including and engagement with religious leaders and men, promoted supportive norms and increased demand. These efforts improved method availability, reduced stockouts and expanded access. Decomposition analysis identified FP knowledge (35%), education (18%) and facility access (16%), particularly among young women, as the main drivers of performance. Broader shifts in gender norms, women's empowerment and male involvement also supported uptake. Since 2017, mCPR has plateaued, with persistent gaps among adolescents, unmarried women and rural populations due to stigma, provider bias, limited youth-friendly services and donor dependence. These findings highlight the need for targeted, equity-focused interventions to sustain and expand Senegal's FP achievements.CONCLUSION: Senegal's FP progress demonstrates how strategic governance, service innovation, and community engagement can increase contraceptive use. To sustain and build on these achievements, renewed investment is necessary in youth-focused services, domestic funding, and equity-centered strategies that are integral to larger health and development plans.