Botswana has had a stable democratic government and good governance since
independence in 1966. It has experienced a record sustained high average economic
growth of about 9 percent, fueled by the diamond mining industry, and is the only
country in Africa listed among the 13 ‘economic miracles’ of the world during the
period 1960-2005.
The total fertility rate (TFR) remains high in sub-Saharan Africa, with 25 countries
showing a TFR greater than 5.0. In contrast, Botswana has experienced the greatest
fertility decline in the region (during 1980-2006) with a remarkable decrease in TFR
from 7.1 in 1981 to 3.2 in 2006. The Botswana national family planning program, which
was adjudged as the strongest in Africa, contributed to the remarkable decline. In
addition to the family planning program, other factors that contributed to the fertility
decline were
• increased age at first birth
• prolonged breastfeeding
• increased female education
• women’s participation in the labor force, and
• improved survival of children.
The government showed strong commitment to meeting the family planning needs of
Batswana by integrating maternal and child health/family planning (MCH/FP) and
sexually transmitted infection (STI) services right from the outset in 1973. Thus, when
women visit health facilities for MCH services (antenatal care, postnatal care,
immunizations, and STI), they are also offered FP services. With the advent of the HIV
epidemic in the 1990s, HIV/AIDS services were also integrated in MCH/FP. These
integrated services offered daily in a vast network of primary health care facilities in
both rural and urban areas made FP services widely available in the country. This was
complemented with outreach services at mobile stops and home visits to reach out to
those who do not utilize the static services. The free MCH/FP services and the
availability of health services (every Motswana is within 8 to 15 kilometers‘ radius of
the nearest health facility) facilitated access to family planning services.
Other components that strengthened the family planning program were: pre-service
and in-service training of service providers; a condom social marketing program (a
multimedia campaign); information, education and communication (IEC) that focused
on the training of service providers and the development of IEC materials; training of
nongovernmental organizations (NGOs) to improve outreach services to the youth and
collaboration with private providers of family planning; improvement of the
contraceptive logistics system; and strengthening of the monitoring and evaluation
system.
vii
Knowledge of at least one family planning method increased between 1984 and 1996,
from 75 percent to 97 percent. Additionally, use of modern contraceptives increased
steadily among all women ages 15 to 49, from 16 percent in 1984 to 29 percent in 1988 to
40 percent in 1996 and finally to 42 percent in 2000. The pill was the most popular
contraceptive during the 1984-1996 period but the use of male condoms increased
dramatically from 1 percent in 1984 to 15 percent in 2000. The prevalence of injectables
also increased, rising from 1.1 percent in 1984 to 8.1 percent in 2000. Data on
contraceptives supplied by the central medical stores to the health facilities (1993 to
2005) and family planning attendance records show that the more widespread use of
male condoms is attributable to the effective multimedia HIV campaign for dual
protection.
Some of the lessons learned might be applicable to high-fertility countries, including
these six lessons:
• Integrate MCH, FP, and HIV/AIDS services at all levels of the health care
delivery system.
• Generate demand for family planning services.
• Strengthen program management through regular supervision and
monitoring.
• Promote and invest in the education of girls.
• Promote policies that favor female participation in the labor force.
• Promote prolonged breastfeeding