By Kieran Guilbert
LOUGA, Senegal, Oct 17 (Thomson Reuters Foundation) - Watching as dozens of children don robes and belts for a karate class at a youth centre in western Senegal, Aissatou and her peers are gearing up for a different kind of fight.
Armed only with leaflets, posters and advice, these young volunteers are taking on a deeply entrenched taboo in the mainly Muslim nation: the use of contraception among girls and women.
"Girls are scared of seeing relatives at a health centre, or being judged by staff," said Aissatou, one of 50 volunteers in the Louga region who advise young people about family planning and encourage them to seek health services at the youth centre.
"We offer a safe space to discuss sex, contraception and pregnancy," the 22-year-old told the Thomson Reuters Foundation.
West and Central Africa has one of the world's lowest rates of contraceptive use among women and teenage girls, who often lack knowledge about their options, struggle to access health centres, and face objections from their husbands and families.
However in Senegal, a drive to raise awareness, increase stocks of contraceptives, and provide youth-friendly sexual and reproductive health services has led to a rapid rise in the number of women and girls on birth control, health experts say.
"In recent years, the family planning community has pointed to Senegal as a beacon of hope for a region that has lagged behind on virtually all health indicators," said Perri Sutton, senior programme officer at the Bill & Melinda Gates Foundation.
In Senegal, about one in four married women and girls aged 15 to 49 use modern contraception - up from 12 percent in 2011 - according to the country's latest national health survey.
The Senegalese government aims to lift that figure to 45 percent by 2020, and increase the number of youth who use sexual and reproductive health services to 70 percent from 10 percent.
But only 7 percent of married teen girls use birth control in a country where one in three are wed before 18 - leaving many likely to fall pregnant, and at risk of dying during childbirth.
Complications during pregnancy and childbirth - such as fistula - are the leading cause of death among teenage girls worldwide, according to the World Health Organization (WHO).
Reducing teenage pregnancies not only saves lives, but can also improve gender equality in education and in the workforce, thus boosting economies in developing countries, according to an annual flagship report by the U.N. Population Fund (UNFPA).
Investing in family planning and narrowing inequality is therefore crucial if the world is to meet the U.N. Sustainable Development Goals (SDGs) - a global plan to end poverty, hunger, advance equality, and protect the planet by 2030 - UNFPA said.
"In Senegal, we are honing in on teenage girls ... this is the first generation to have access to information and these services," said Andrea Wojnar-Diagne, head of UNFPA in Senegal.
"The real impact will be seen in 20 or even 40 years ... but more still needs to be done to change attitudes in rural areas."
About one in three married girls and women in Senegal's cities use birth control, compared with less than a fifth in rural areas - where men are often in charge of such decisions and many people consider family planning to be 'un-Islamic'.
In Louga, 180 km (110 miles) from the capital Dakar, Aissatou and her fellow volunteers visit homes, talk on radio shows, and work with imams to challenge stigma surrounding contraceptives.
"We make it clear that we don't encourage sex, or just give out condoms ... and that family planning is not about stopping births, but spacing them, and preserving health," she said.
In the nearby town of Dahra, midwife Fatim Fall said more girls and women were coming to discuss family planning with the blessing of their husbands. Yet many others, particularly teens, tended to visit at odd hours, without anyone knowing, she added.
One night, a woman came with her 14-year-old daughter. The girl had been forced into a marriage her mother had opposed.
"The mother was powerless to stop the wedding," Fall said. "But she realised she could preserve her daughter's childhood and protect her by secretly bringing her to get contraceptives."
Among those waiting to see the midwife, 30-year-old Aminata said she started taking the pill after her first marriage ended in divorce, and discreetly continued to do so after remarrying.
"I feared the marriage wouldn't last, and it didn't," she said, smiling wryly. "I feel at ease about using birth control, my family and friends know I do so and they don't say anything ... people are much more open to it than before."
From pills to implants and injections, modern contraceptives are increasingly available for Senegalese women in the health system, even in rural regions, and tend to cost less than 500 CFA francs ($1), mainly due to funds from international donors.
Yet the United States, one of UNFPA's top donors, said in April it would stop funding the agency as it supports "coercive abortion or involuntary sterilization" - a charge UNFPA denies.
It follows the reinstation by U.S. President Donald Trump in January of a policy known by critics as the "global gag rule" which withholds U.S. funding for international organizations that perform abortions or provide information about abortion.
While other nations have vowed to help fill the funding gap, the decision puts pressure on developing countries such as Senegal to invest more in family planning, health activists say.
Senegal says it will almost double spending on provision of contraception to 500 million francs ($900,000) by 2020 as part of the Family Planning 2020 (FP2020) initiative - which aims to give 120 million more women worldwide access to birth control.
In the meantime, volunteers like Aissatou and midwives such as Fall are determined to get more women and girls in Senegal talking about sex, contraception, and family planning - and taking control of all decisions concerning their bodies.
"Sometimes I hear about teenage girls - some as young as 13 - and their newborns both dying," Aissatou said. "It is so sad ... such a waste of life," she added. "It makes no sense."
(Reporting By Kieran Guilbert, Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)
Travel for this story was supported with a UNFPA grant.
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