Discreetly tucked under the skin of her upper arm, Halima Hassan's matchstick-sized contraceptive implant has given her a newfound sense of autonomy over her reproductive health and future. The 29-year-old mother of three is among the growing number of African women turning to long-acting reversible contraceptives (LARCs) like implants and injectable birth control.
"Before, I would forget to take the pill or my husband would get angry if he knew I was using contraception without his permission," said Hassan, who had the implant administered at a clinic in Nairobi's Kibera slum. "This way, he doesn't need to know. I have control over my own body."
According to the UN's Population Fund (UNFPA), use of LARCs in sub-Saharan Africa has nearly tripled over the past decade from 6.1% in 2010 to 17.7% as of 2022. While still modest overall, that growth is helping empower women across the region with discreet options that can prevent pregnancy for up to 5 years.
"Long-acting contraceptives are giving more women the ability to choose if and when they want to become pregnant," said Dr. Bannet Ndyanabangi, Uganda's Minister of Health. "They're very effective at reducing maternal risks and allowing families to have only children they can properly care for."
Those benefits are critical in areas like Uganda, which has one of the highest fertility rates in the world at 4.8 births per woman as of 2022, according to the UN. Widespread poverty and lack of family planning education have perpetuated the cycle.
However, options like the affordable Depo-Provera injection are growing in availability at rural clinics and helping buck cultural stigmas in conservative communities. According to the UN, contraceptive use among married Ugandan women has risen from 18% in 2006 to 39% in 2022, with nearly half now relying on injections or implants.
"I think women understand more now that managing your family's size can reduce hardships and create opportunities," said Joseline Akia, a family planning counselor at The Adara Group's clinic in a remote Ugandan village. "We're able to distribute contraceptives privately during our community outreach."
While hormonal birth control access expands, obstacles persist. A UNFPA report noted many African health systems remain under-resourced, lacking funding, staff, supplies, and youth-friendly services. Misinformation and spousal coercion also remain barriers in certain cultures.
"There is still a very male-dominated perception that having many kids is a measure of a man's virility," said Dr. Ndyanabangi. "We have more work ahead to keep breaking down those mindsets and social pressures."
For mothers like Hassan in Nairobi who now have a reliable, discreet option, the autonomy is life-changing. Protection from unplanned pregnancy allows her to keep working and giving her children a better future.
"I'm finally in control of when I'll have my next child," she said. "That sense of power over my own body and life is priceless."
As more clinics make long-acting contraceptives available, more African women are seizing the opportunity to take control of their reproductive health on their own terms. While challenges remain, a growing number are deciding for themselves when to become mothers.
