In 2018, E2A and Pathfinder International launched an initiative for young first-time parents in Burkina Faso, with funding from USAID and in collaboration with Burkina Faso’s Ministry of Health. Working in communities and facilities, our project generated valuable evidence about this vulnerable youth population and the best ways to respond to their urgent needs—especially how to advance antenatal care, obstetric and neonatal services, and voluntary family planning. Below, Philomène Bambara, Regional Program Manager at Pathfinder International in Burkina Faso shares a story that illustrates why this work is so tough and important.
During our group session for first-time mothers, a pregnant young woman was nowhere to be found. She was one of our regular members, so I wanted to know why she was missing.
I care a lot about what happens to the young women in my country—and these young first-time mothers in particular. Here, in the Eastern Region of Burkina Faso, many girls are still forced into early marriage. Pulled out of school and away from their families, they are moved into their husbands’ home and pressured to prove their fertility fast.
In Burkina Faso’s Eastern Region—with the highest fertility rate in country—marriage and pregnancy start early for girls
Imagine you are one of these young women—
All of a sudden, you are part of a new family you don’t know very well. You are dropped into a system built on powerful hierarchies, in which women have no right to speak, much less discuss sensitive subjects like sexuality or reproduction. Your health decisions are managed by your husband, your mother-in-law, or your co-wives.
When you become pregnant for the first time, you have to tell your mother-in-law first. You must not tell anyone else you are pregnant. And it is your mother-in-law who tells your husband you are pregnant. Then she informs your other family members about your pregnancy.
Your husband is another important gatekeeper of information. You cannot discuss health issues outside of your home unless you have your husband’s permission. And without your husband’s consent, you cannot use family planning.
To Reach Young First-Time Mothers, We Must Engage Their Influencers
Since 2018, I’ve worked on a project that has addressed the family planning and reproductive, maternal, and child health needs of young first-time mothers across 77 villages in the Eastern and Central North Regions of my country. At the heart of our project are the young women themselves. We recruited and trained 132 first-time mothers to serve as peer leaders, who facilitated group sessions for other first-time mothers on a range of health- and gender-related topics—from recognition of danger signs during pregnancy to contraceptive methods to exclusive breastfeeding.
“My opinion has changed because before I joined the project, I didn’t know what family planning was. Now that I have joined the project, I have been shown. If you choose a planning method that goes well with your body, [you] will be able to carry out your activities without worries. Your child will be healthy, and so will you.” —First-time mother, 19 years old
Understanding that household support is critical for reaching young first-time mothers with knowledge and services to protect their health and the health of their children, our team made a concerted effort to engage their husbands and mothers-in-law.
We trained local community health workers to conduct discussion sessions and household visits involving these key influencers. Our goal was to raise their awareness and build support for young women’s access to much-needed health services, such as antenatal care, safe delivery, and postpartum family planning. Working with husbands and mothers-in-law removed some of the barriers—like a lack of information—and helped young women gain their families’ support for visiting health facilities.
“[The husband session] gave us a chance to get to know the subject better and discuss it with our wives. We’re going to sit down and discuss it. Each one will say how many children they wish to have. Everyone knows that life has become complicated and before making a choice everyone must be aware of this fact. It is therefore necessary to agree.” —Husband of first-time mother, 26 years old
I believe our project is revolutionary in the structure of these talks—bringing together first-time mothers and their influencers to discuss the same life-saving topics. And our collective efforts have paid off.
First-time mothers reported the following changes as a result of the first phase of the project:
✔️ Improved understanding of the benefits of healthy timing and spacing of pregnancy
✔️ Improved knowledge of family planning and attitudes towards its use by both first-time mothers and their male partners
✔️ Improved couple communication about family planning
✔️ Improved knowledge about the health benefits of antenatal care, including the importance of seeking services early in pregnancy
✔️ Increased knowledge related to exclusive breastfeeding and its benefits
Personally, I am encouraged by this progress and proud to report that we have implemented activities in new villages to benefit even more first-time parents. In fact, I think our approach should be expanded to all villages in the region. These young women are really motivated, and we should keep their momentum going.
I’m also aware that overcoming socio-ecological burdens in communities requires long-term substantive work. And a lot of persistance.
This brings me back to our missing young mother—
After noting her absence from the peer group sessions, my team reached out to her to learn more.
It turns out she had been very sick, with a fever that would not go away. She didn’t want to say anything to her mother-in-law, because she thought she had to endure this sickness as part of her pregnancy. In fact, she had malaria. She ended up in the hospital, where she had a miscarriage.
Without her pregnancy, she was ashamed to be among the other first-time parents. She did not want to participate anymore.
So I scheduled a community health worker to visit her in her home—to counsel her on the possible causes of the miscarriage and the importance of waiting six months before becoming pregnant again. We encouraged her to rejoin the discussion groups.
And she did! She participated in all the rest of the talks and chose to delay her next pregnancy to keep herself safe.
Her story really hits home for me. While our project covered many villages and supported many women, her story speaks to the importance of every single first-time mother. She reminds us just how easy it is for a young first-time mother to fall through the cracks. And how—if we work together—we have the power to catch her.
If we act now and increase our support for Burkina Faso’s first-time parents, the rest of their lives will be better. Our investment today can improve not only their health, but also the health of their spouses and their families for years to come.
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