A lot needs to change if we are to make contraceptive choice a reality for every woman. Public sector social franchising has the potential to unlock real change in Mali and in low income countries around the world. The term sounds complicated, but the principle is simple: leverage the country’s existing network of health facilities to maximize the contraceptive choices available to women. Mali currently has a contraceptive prevalence of nearly 10%, with long-acting and reversible and permanent methods of contraception accounting for just 0.2% of the method mix. When more family planning (FP) options are available, more individuals can meet their reproductive intention to delay, space, or limit future births.
To expand access to a broader range of FP methods for women and couples, MSI/Mali and the Ministry of Health brought together 102 health clinics under the social franchise BlueStar brand. Many of these clinics already offer short-acting contraceptive options. However, when health clinics join the BlueStar social franchise network, MSI provides support to increase the range of FP methods available to include intrauterine devices (IUDs) and implants. MSI trains doctors, nurses, and midwives to provide these additional options. We also support the management of supply chains to prevent commodity stock-outs, as well as assist health facilities to raise awareness of available FP choices.
Our results speak volumes. This public sector social franchise network provided over 50,000 women with the contraceptive of their choice in 2013, with over 21,000 of these choosing long-term reversible contraception which would not previously have been available to them. This is contributing to a broader shift in Mali’s contraceptive method mix; preliminary 2013 DHS results show that almost one third of women using contraception are now choosing long acting reversible and permanent methods. By reaching more women with the FP methods that best meet their needs, MSI is fulfilling its aim to support a woman’s right to choose whether, when, and how often to have children, and what contraceptive method to use, whilst also contributing to the long-term financial autonomy of community health facilities.
Challenges remain, of course, but the untapped potential of the public sector to increase women’s contraceptive choices is extraordinary; and I, for one, am glad that Mali is taking a stand and seeing this innovation through.
 Ross, J., Hardee, K., Mumford, E., and Eid, S. 2002. Contraceptive method choice in developing countries. International Family Planning Perspectives Vol. 28(1).