FREETOWN, September 22 — The journey toward reproductive autonomy for women in Sierra Leone is fraught with challenges, primarily stemming from deep-rooted societal stigma surrounding contraceptive use. Young activist Eunice Dumbuya recalls her own experience of being labeled promiscuous for choosing to get a contraceptive implant a few years ago. Living in a conservative society where sex outside marriage is often viewed as taboo, Eunice took a significant step to protect herself from the risks of unplanned pregnancy.
“I had to go with my aunt to the hospital for contraceptives because my mom was very strict,” Eunice explained. “My aunt was the one who supported me. Using contraceptives boosted my self-confidence.” Despite the personal growth she experienced, she continues to face scrutiny from her community. “Some people, once they see the [contraceptive] implant under your skin, assume you are promiscuous,” she said, adding that for teenagers, the stigma can be even harsher.
In Sierra Leone, family planning is a contentious issue, shaped by cultural norms and religious beliefs. According to the 2019 Sierra Leone Demographic and Health Survey, the contraceptive prevalence rate stands at just 24 percent for all women, with even lower rates for married women at 21 percent, while 53 percent of sexually active unmarried women use contraceptives. Despite slight increases in usage, many women face substantial barriers when attempting to access these critical health resources.
Fayia Foray, Integrated Marketing Officer at Marie Stopes Sierra Leone, an organization dedicated to providing family planning and sexual reproductive health services, identifies cultural stigma, discrimination, and religious opposition as significant hurdles. “It is important that married women use contraceptives to space births, regain their health, and support their families through work,” he emphasized. “Young people use it to delay childbirth, focus on education or skills, and plan for the future. Nationally, it empowers youths to become productive, contributing to the country’s development.”
However, the resistance from some religious leaders complicates the promotion of family planning initiatives. “There are still communities where religious leaders preach against the use of family planning, which severely limits its acceptance and use,” Foray noted. This resistance often extends to families with strict religious views, making it incredibly challenging for young women to seek the contraceptive care they need.
University student Mariatu Sankoh described her struggles in seeking contraception. “I can’t confront my parents to tell them I want to take contraceptives because I know I would receive the beating of my life,” she shared. Instead, she took matters into her own hands, going to the hospital with a friend’s aunt to avoid raising suspicion.
Misinformation about contraceptives further complicates the situation. Some individuals falsely believe that contraceptives cause infertility, while others exaggerate potential side effects. “All medications have side effects, and family planning is no exception,” Foray stated. “Despite the side effects, the benefits of using family planning far outweigh the risks.”
The stigma surrounding contraceptive use in Sierra Leone is intertwined with broader issues of gender-based violence and control over women’s bodies. Reports indicate that about 62 percent of women aged 15 to 49 have experienced physical or sexual violence, with 61 percent of ever-married women suffering abuse from their partners in various forms. Experts assert that the negative perceptions surrounding contraceptives reflect a societal reluctance to accept women’s independence and their right to make choices about their own bodies.
Rebecca Kamara, who has faced similar stigma, shared her perspective: “In our African society, when a young girl uses implants, she is often judged harshly.” She recounted how even partners can be unsupportive, preferring methods that carry greater health risks. “When I started using contraceptives, I was still studying. I didn’t want an unplanned pregnancy to disrupt my education,” she explained.
Isha Sesay, a young unmarried woman, echoed this sentiment, sharing her experiences of being judged by family and neighbors for using contraceptives. “I was looked at in a very demeaning way when I started using implants at an early age,” she recalled. “Some family members and neighbors whispered behind my back that I had multiple partners, that’s why I was using it.”
The stigma also extends to misconceptions held by some men. Francis Kanu expressed a common belief, stating, “If I am the only one you are sleeping with, you can’t stress yourself out to use it. I can’t date a woman who uses contraceptives. They are the ones you should be afraid of as a man.” Similarly, Michael Sahr Kendor, a married man, remarked, “I can understand a teenager using contraceptives, but I don’t see the reason for adult women to use contraceptives.”
Despite these challenges, there are ongoing efforts to improve access to family planning and reproductive health services in Sierra Leone. The nation is part of the FP2030 initiative, a global partnership aimed at ensuring that all women and girls have access to modern contraception by 2030. The United Nations Population Fund has also increased its efforts to provide contraceptives in the public sector. However, the stigma surrounding contraceptive use continues to be a significant barrier.
Adama, a visually impaired woman, shared her experience of discrimination by health workers when attempting to access contraceptives. “At one time, when I went to a pharmacy to purchase an emergency pill, the pharmacist, while handing me the prescription, told me to inform the person who sent me to eat well before taking it,” she recalled, highlighting the assumptions made about her capability to use contraceptives.
Marie Kamara, another woman with a disability, expressed the financial constraints that prevent her from accessing family planning resources. “I have never used family planning. I know I’m not financially strong, so contraceptives are obviously not an option for me. I can barely afford basic needs like feeding, so thinking about contraceptives and how to maintain them isn’t even realistic.”
Eunice, reflecting on the pervasive stigma around contraceptives, emphasized the importance of women taking control of their reproductive choices. “Societal pressure has driven many girls to remove the implant or switch to less visible methods,” she noted. “Even though the stigma affected me, I didn’t remove it because I knew I couldn’t let people’s opinions determine my choices. Sometimes, you just can’t escape the stigmatization.”
The fight for contraceptive access and reproductive rights in Sierra Leone continues, with advocates like Eunice leading the charge against stigma and societal pressure, pushing for a future where women can freely make choices about their own bodies without fear of judgment or retribution.
