As originally seen at Global Post.

Joy Phumaphi began public service in Botswana as a local government auditor. From 1994 to 2003, she went on to serve in Parliament and then became Minister for Health in the midst of the country’s AIDS crisis. She later became the Assistant Director General for Family and Community Health Department at the World Health Organization and the Vice President of the Human Development Network at the World Bank. She currently is on Aspen Global Health and Development’s Global Leaders Council for Reproductive Health. Phumaphi spoke to writer John Donnelly about the key role of community health workers in introducing family planning and saving lives and the far-reaching impact of a letter from a seven-year-old boy named Kenneth.

How did you get started on issues of women’s reproductive health?

It started at the beginning. I was born in a rural village. Households in Botswana had three homes. There’s a home in the village, a home in a place where they plowed the land, and a third place where they look after their cattle. Botswana is the size of Texas and at the time when I was born it was a population of 1 million. Now we have 1.8 million. I was not born in a medical facility. I was born in the place where we did our farming. It was in October, and my grandmother was the midwife.

In 1990, the average Senegalese woman had 6.7 children during her reproductive years. By 2009, that number had significantly dropped. According to the Ministry of Health and Prevention, Senegalese women are now, on average, having 4.8 children during their reproductive years. This reduction, taking place over a span of almost 20 years, has been a long time coming as the Senegalese government has been encouraging family planning utilization across the country in state-run hospitals and clinics. In fact, the Ministry of Health and Prevention has doubled its budget for reproductive health. And within the reproductive health budget, UNFPA reports that the proportion donated to family planning has also been doubled.

Attitudes around family planning use are changing across Senegal, IRIN news reports. “There is a small revolution going on - husbands and imams who were traditionally against any kind of family planning are slowly starting to accept it,” said Ephie Diouf, 31, a child-minder in Dakar. Not only have some religious leaders’ individual attitudes changed, but their outreach to the community regarding family planning is also evolving. Catholic and Muslim leaders are educating people that spacing births by using contraceptives is not against the Bible or the Koran. A midwife from Senegal reported that her local imam now tells families that, “Family planning is not banned in Islam… Religion is about well-being, and spacing children is part of that.”