With the global population reaching 7 billion this year, doctors and health officials are advocating better family planning methods. Senegal, where some 2,000 international delegates gathered in early December to tackle the issues.
On a busy day at the Fith Mith Clinic in a suburb of Guédiawaye, just outside of Dakar, Mamy Diop had just given birth to her third child, only one year and three months after the previous. She did not know about family planning before, but she does now.
"I just decided to take birth spacing measures and will ask soon about which method I should use," she said.
Family Planning is an emerging and somewhat controversial topic in Senegal where more than 2,000 participants met in early December for the International Conference on Family Planning. Senegalese President Abdoulaye Wade highlighted the dilemma his country faces.
"To survive, it is good to limit the number of children, but this should, again, be a decision made completely voluntarily," he said. "We are consequently believers, and we cannot impose contraceptive methods, methods which prevent procreation.”
But more and more, families are seeking contraception to space or limit births despite the associated taboos in the country, which is more than 90 percent Muslim.
"Some people say Islam is against family planning, but life is getting more and more difficult," said Mamy Diop.
Historically, the only acceptable application of family planning has been birth spacing for the health of the mother and the child. But religious leaders increasingly are invoking the Quran's message of financial responsibility.
"Islam has discussed this," said Imam Niasse. "If resources are limited and the family size is too large, there will be problems for the family. We are already living a situation of scarcity and we should talk openly. We have many children here, but what kind of children do we have?"
Many Muslim scholars say that, barring abortion, the faithful can use many types of birth control - but only if it is critical for the sake of the mother or the family's finances. If both are healthy, the consensus is that parents should continue to reproduce. If not, families have many choices.
"This is the intrauterine device, this the cycle necklace, these are injectables, this is the feminine condom, the pills, there are implants, plus the male condom," said nurse Mariama Baye.
Mariama Baye is the head nurse and midwife at the Fith Mith Clinic. She says none of those methods cost more than $1 per month and demand is on the rise despite persistent social obstacles.
"With our efforts and discussions in the neighborhoods, women now understand what birth spacing is and they want to come," she said. "When we say birth limitation, they don't listen. So we say birth spacing. With birth spacing, I hope the final goal will be the limitation of births.”
The clinic participates in an urban family planning project funded by the Bill and Melinda Gates Foundation and coordinated by Intrahealth, a private American organization that supports health workers throughout the world. Pape Gaye is the Intrahealth's CEO and a native of Senegal.
"We've seen way too many people in the streets, way too many people who are not going to school, way too many poor people, which is part of refusing to control population," said Pape Gaye.
Gaye says family planning results in Senegal do not match the large investments made in the country. He says just 12.3 percent of the population use contraception, only marginally higher than five years ago. Yet, he hopes the recent conference and the president's remarks will further open dialogue and accelerate results.