In the coastal town of Joal, women are facing a deepening crisis as international aid cuts threaten their access to contraception, a lifeline that has allowed them to space pregnancies and avoid life-threatening health risks. The town, heavily reliant on fishing, is seeing its men struggle with dwindling catches due to industrial trawling and increasingly frequent storms, while women bear the brunt of poverty and repeated pregnancies.
For years, the UK-funded Women’s Integrated Sexual Health (Wish 2) programme, run by MSI Reproductive Choices, has provided free contraception to women in Joal every few months. The service offers options such as intrauterine devices (IUDs), colloquially known as ‘appareils’, which give women control over their fertility. However, with aid cuts taking effect, this support is now under threat.
Adama Faye, 29, describes her life as precarious, ‘like I’m holding on to nothing’. Her husband’s fishing income has shrunk, and she relies on family planning to avoid the back-to-back pregnancies that have historically been the norm. Midwife Amy Mbaye, who has worked at the local health post for nearly a decade, says women here typically have nine or ten pregnancies, including miscarriages or stillbirths, leading to severe anaemia and high maternal death rates. Abortion is illegal in Senegal, making unsafe backstreet terminations common.
The health clinic itself is dilapidated, with buckets catching leaks and lacking basic supplies like medical gloves. It serves a population of 28,000, including 7,000 women of reproductive age. Mbaye notes that the town is getting poorer: ‘Everything is linked to the sea. Too often you will call a woman for a checkup and she will say “there’s nothing coming out from the sea, I can’t come”. MSI is the only organisation providing regular contraception here.
Coumba Dieng, 52, a local businesswoman selling meals to fishermen, remembers a time when neighbours shared their catch freely. Now, she must buy fish at high prices. After seven children with gaps as little as nine months, her health suffered from high blood pressure and weakness. Since receiving a copper coil from MSI six years ago, she says the effect has been transformative: ‘It means I can work.’ She took out a £400 bank loan to expand her business, which she has nearly paid off. Without the MSI service, she would have had to pay around £20 – more than her weekly income.
The aid cuts risk taking away the few choices women in Joal have left. As one community worker put it, ‘The women here are warriors.’ But without continued support, their hard-won control over their lives and health hangs in the balance.
