In Guinea-Bissau 98 of 114 health centres now offer family planning services and 10 per cent of women use contraception which, while low, is an improvement, said Antonieta Martins, an adviser to the Ministry of Health from UNFPA, the United Nations Population Fund.
UNFPA estimates that giving women access to modern contraception could prevent 40 per cent of maternal deaths worldwide. That could save the lives of many women in Guinea-Bissau, where one in 13 dies in pregnancy or childbirth. The country has one of the highest rates of maternal mortality in the world.
Offering a variety of methods - while stocks last
At San Domingos government hospital 90 kilometres north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.
UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.
Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too soon and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.
They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages.
"Women want family planning here - we meet with very little resistance to our messages," he told IRIN.
But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said.
Dada Saar, 36, mother of five children, spoke to IRIN while waiting to receive her next contraceptive implant at Simao Mendes hospital in Bissau.
"Five [children] is enough," she told IRIN. "We don't have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn't want more."
Next to Saar sat Florence de Silva, 28, who has one daughter and wants another child, but plans to stop at two. "Otherwise I will not be able to educate them...even if I have just two and they are both educated, they will be able to look after me when I am older."
Economic security or better health?
Economics increasingly sways urban families' decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.
"In towns people are more conscious that they want fewer children. They understand life is expensive."
But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. "People have more faith in medicine working, so are starting to think their babies won't necessarily die [when ill]," Alves said.
Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed - a countrywide survey is due out in 2010 - health workers told IRIN maternal and under-five mortality is declining across the country.
While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates, Martins said.
Concerned about the slow progress of international efforts to reduce maternal mortality to meet 2015 Millennium Development Goals, health ministers, government officials, UN and NGO representatives from around the world gathered in Addis Ababa on 27 October to urge governments to make family planning a priority.
Reducing the rate of unintended pregnancies and stopping women from dying in childbirth worldwide would cost $23 billion per year, they said in a communiqué.
However in Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 per cent dependent on donor funding, deciding priorities is difficult, said Alves.
Martins said: "The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems."