Health officials and women in Liberia say family planning options can empower girls and women to stay in school and concentrate on their businesses. But many fathers and husbands here don’t approve of the introduction of family planning. As a result, many young women are keeping their contraceptive choices secret.
Jackie Wolo seems shy sitting in the busy waiting room at a Planned Parenthood Association of Liberia clinic in Monrovia, Liberia's capital.
"I have come to the clinic because I want to protect myself from unwanted pregnancy," Wolo says.
Wolo sits with the other women, most of them young, waiting for her turn to see the doctor. She says she has been using contraceptives - as they are commonly called in Liberia - as family planning for a couple of years now.
She is not yet married and has not told her boyfriend that she is using contraceptives. Not many women who use family planning discuss the choice with their partners.
Mary Williams, in her late teens, says she also has not told her boyfriend that she is using contraceptives. Williams and Wolo say this is because they fear their partners would not approve.
Williams started using family planning methods only recently.
"It was my mother who introduced me to family planning," she says.
Both Williams and Wolo say the contraceptive they use is the injection method.
Doctors say an increasing number of women in Liberia are using family planning. Girls and women attribute this rise to a desire to stay in school and strengthen their businesses.
But many don't tell their significant others that they are using it, as many men reject the entry of family planning into Liberian culture.
Others worry about side effects. Health authorities have launched awareness campaigns and strategic plans in order to enable and encourage women to access sexual and reproductive health services.
The Family Planning Association of Liberia was established here in 1956 to provide contraceptives to women.
In 2005, it became Planned Parenthood Association of Liberia as it expanded to provide sexual and reproductive health services to women and young people in Liberia. It is part of the International Planned Parenthood Federation.
If certain changes are made, it is possible for Liberia to meet targets to improve maternal health - goal five of the Millennium Development Goals, a U.N. anti-poverty initiative that countries worldwide have pledged to achieve by 2015, according to the MDG Monitor.
Part of this goal is reducing the unmet need for family planning, which in Liberia is about 37 percent, according to the United Nations Population Fund.
The unmet need in Liberia is higher than the regional average, which was about 25 percent in 2010, according to the World Health Organization.
Dr. Florence Kromah, a doctor at the clinic, has been busy all day. Kromah says she has seen more than 10 women so far.
"The number of people who visit the clinic are increasing on a daily basis because of the risk involved in abortion these days," she says.
She says that increased awareness about family planning across Liberia has also contributed to the rise in patients at the clinic.
Most of the clinic's clients are young women, but many married women also come to the clinic to seek advice, Kromah says. The injection method is the most common means of family planning in Liberia because it can be taken once every three months, giving clients time to go about their normal activities.
Another method commonly used in Liberia is the combined oral contraceptive pill.
Kromah says other services the clinic offers have also contributed to the rise in patients.
"Apart from family planning, we provide counseling for HIV/AIDS and other health issues surrounding women, which explains also why we have a rise in the number of clients every day," Kromah says.
Many attribute young women's ability to stay in school to the rise in family planning.
"I am glad that most young women are taking advantage of the facility we have here," Kromah says with a smile. "These days, we don't hear a lot about girls dropping from school."
Williams is one of these girls. She says family planning options have helped her to stay in school.
"I am happy that I am taking family planning," she says. "Most of my friends who did not take it have dropped out of school because they got pregnant. I will be able to get my high school diploma and further my education."
In a cozy office at the top floor of the clinic works Comfort Kollie, a representative of the United Nations Population Fund who is based at the facility.
"The reason we are investing in the clinic is simple," she says. "It will not only save and improve the lives of women and children, but empower them, strengthen health systems and reduce poverty in families in Liberia."
Kollie says family planning saves lives, is cost-effective, and contributes significantly to the economic empowerment of women and their families.
"We at UNFPA believe in the economic empowerment of women," she says. "And one way we can contribute to this is by helping to fund activities at the clinic."
Austin Kamara, who has been married for 20 years, says he sees no problem with his wife and daughters taking family planning.
"I want my girls to stay in school and not get pregnant, so I even advise them sometimes to take family planning," he says.
Kamara says his sister was a family planning counselor when she was alive, and she influenced his opinion on family planning.
But Kamara says many of his friends see family planning as unreligious.
"They don't even like to discuss it," he says.
Moses, who declined to give his last name, says family planning is not natural to Liberian culture.
"My ancestors did not condone family planning, so I will not," he says while shopping at a busy market in Paynesville, a suburb of Monrovia. "This is just the white people way of controlling us again."
At the market is a family planning office where women can go to seek advice. One woman there, who asks to be referred to as Ma Korpu, says that her husband rejects the use of family planning as well.
"He doesn't want me to even tell the children about it," she says.
Korpu says her husband is a member of a culture that forbids the use of family planning. But she says she began to take it anyway after having seven children. She says she wants to focus on her business selling vegetables instead of having more children.
At a family planning office also at the market, other women share the same thoughts as Korpu. They say that family planning can help them to focus on their businesses and enable them to provide more financial support - instead of more children - to their families.
"I wish I had knew about this thing long time ago," Korpu says, looking a bit sad. "If I had known, I wouldn't be suffering with my children as I am doing now."
But other women say they don't use family planning because of the side effects. Alicia Roberts is one of them.
"I learned that when you use family planning, you cannot have a baby at the time you want to," she says.
Local advertisements posted around town say family planning may have side effects, including sexual, hormonal and weight gain problems.
But Kromah says she has a message for people worried about side effects.
"The message is there is no major side effects," she says. "I hear people say that when you take family planning, it's impossible to have a child when you are ready. That is absolutely untrue."
Last year, Liberian President Ellen Johnson Sirleaf launched a five-year plan to reduce maternal and infant mortality. Part of the plan aims to increase coverage of, access to and use of family planning.
But Bendu Tulay, assistant minister of social welfare in the Ministry of Health and Social Welfare, said at a recent press conference that there were still problems getting women to take advantage of the family planning methods available to them.
But Kromah is optimistic that they can resolve these problems.
"We will definitely get there someday," she says.
