Can a manicure help solve africa's intractable problems? The continent's population is expected to jump from 1.1 billion today to 2.4 billion by 2050, putting inordinate pressure on economic and environmental resources. Of the 22 countries in the world with the highest fertility rates--where women have five or more children on average--all but 2 are in sub-Saharan Africa. The region is also the youngest in the world, with 43 percent of the population under age 15. That ensures "population momentum," in which the number of people is guaranteed to rise even as birth rates drop. 

At the same time, the mortality rate for children under five in sub-Saharan Africa, while declining, remains the highest in the world: 98 deaths for every 1,000 births. (It's 7 for every 1,000 in the United States.) And sub-Saharan Africa continues to be the world's most undernourished region, with 48.5 percent of the population living on less than $1.25 a day. 

Fortunately, there are solutions that are good for the health of women, their communities, and the environment. Health and development experts, international agencies, and nongovernmental organizations agree that empowering women to make educated family- planning choices is the most effective way to solve Africa's population crisis, whether via radio soap operas that present small families as role models, well-digging programs that enable girls to stay in school longer, or a pop-up nail salon where teens feel comfortable asking reproductive-health questions. 

The hurdles are huge: Many in sub-Saharan Africa lack access to contraceptives (and education about how to use them), and gender inequality prevents many women from making their own economic or reproductive decisions. The payoff, however, is far greater than just reining in population growth: Family-planning and reproductive-health programs benefit women, children, and local economies--and also help Africa as a whole become more resilient to climate change. As Kim Lovell, director of the Sierra Club's Global Population and Environment Program, puts it, "Healthy people and a healthy planet go hand in hand." 

Here are a handful of the innovative programs that are helping Africa change course, one woman at a time. 

Door-to-Door

To overcome societal and cultural barriers, the most effective programs are locally based. The nonprofit Population Services International operates ProFam Mali, a "social franchise" composed of 59 privately owned clinics in or near the country's capital city of Bamako--which, with a population of nearly 2 million, is one of West Africa's fastest-growing cities. ProFam Mali clinics receive family-planning training and supplies while agreeing to provide services at an affordable price. Its educators go door-to-door, talking to women about family-planning options, often with mobile video units, or into neighborhoods with projectors and screens for educational movie nights. Family-planning discussions are frequently paired with routine immunization days, reaching large groups of women who are getting their children vaccinated. 

Water Sets You Free 

On a continent where one in nine people lack access to clean water and a child dies from a water-related illness every 20 seconds, a new well can do more than provide uncontaminated water. It can set women free. An African woman can spend eight hours a day fetching and treating water, often enlisting help from her daughters. That makes it nearly impossible for girls to attend school, where they could learn career skills and get information on reproductive-health issues. In fact, education is the single greatest factor determining a woman's eventual family size: If a girl stays in school beyond seventh grade, she is more likely to marry later and have fewer and healthier children and is less likely to die in pregnancy or childbirth.

Groups like Water Access Rwanda install affordable hand-drilled wells in villages that may be miles from a water source. While a single mechanically operated drilled well may cost $12,000, a hand-drilled one costs between $1,000 and $4,000, depending on the local labor market and the availability of supplies. This summer, Christelle Kwizera, a fellow with the Sierra Club's Global Population and Environment Program who works with Water Access Rwanda, helped complete a well in two weeks. "It's really not that hard, but hand-drilling requires a lot of stamina, endurance, and energy," Kwizera says. "No matter how many times one finds water, it's always a celebration, as no well is ever an easy case."

Cliff-hanger Radio

Will Aailyah opt for contraceptive implants? Tune in next week to find out! Multiyear serialized radio programs in Ethiopia, Tanzania, and other African countries have successfully used "entertainment education" strategies that present characters whom listeners can relate to and see as role models. Employing plots and subplots that evolve over months, these programs can address--without lecturing--a wealth of issues: family planning, reproductive health, violence against women, prevention of HIV/AIDS, even deforestation.

"With more than 91 million people in Ethiopia, you have to deal with issues on a countrywide scale," says Robert Walker, president of the Population Institute in Washington, D.C. The 257 episodes of Looking Over One's Daily Life, which ran from 2002 to 2004, reached half the country's population. "People would sit around the village's radio and debate," Walker says. "Twelve years ago, only 5 to 6 percent of Ethiopian women used contraception. Now that rate is as high as 29 percent." In Tanzania in the late 1990s, a serial drama broadcast by Radio Tanzania reached 58 percent of the population between the ages of 15 and 45 and is credited with increasing the number of people who understood their vulnerability to HIV, approved of family planning, and understood that individuals, rather than deities or simply fate, determine how many children they have. "It's about changing attitudes and behaviors, not just providing knowledge," Walker says.

Maxi-Impact

In Rwanda, sanitary pads can cost a day's wages every month. Women who are already struggling to buy food and clothes turn to rags, bark, newspaper, even dried mud--ineffective, unhealthy, and undignified solutions that contribute to African women missing as many as 50 days of school or work each year. Sustainable Health Enterprises (SHE), a New York-based nonprofit, calculates that, over a lifetime, this adds up to five years of lost learning or earning. In Rwanda, where the average worker earns 65 cents an hour, a woman loses an average of $215 in annual income because of workdays missed during menstruation. 

SHE's solution, based on talks with 500 women in Rwanda and with the assistance of engineers from MIT and North Carolina State University: menstrual pads made from absorbent banana fibers, a waste product of Rwanda's second-largest agricultural crop. SHE helps local women's groups purchase inexpensive machines on which women can manufacture the pads, which sell for 30 percent less than imported commercial products. The organization isn't alone in tackling the rarely discussed issue: In Kenya, social business Makit distributes low-cost silicone menstrual cups called Ruby Cups and provides peer-to-peer menstruation education. In Uganda, Afripads distributes washable, reusable sanitary pads manufactured by women's collectives. "What I didn't anticipate was what would happen when we got people talking about this subject," SHE founder Elizabeth Scharpf told SIR.tv (which stands for "social innovation rockstar"). "A whole dialogue around taboo subjects, around health and family, has risen up around us."

What Girls Want

Any parent knows that finding ways to comfortably talk with teens about contraception and reproductive health is more art than science. To hone its programs in Zambia, London-based family-planning nonprofit Marie Stopes International collaborated with Ideo.org, the philanthropic arm of innovative global design firm Ideo. After trying to reach teens at dances, the Ideo.org team hit on the idea of a pop-up nail salon. Renting a space in the Kamwala street market in Lusaka, Zambia's capital city, they offered free manicures intertwined with girl talk. "The girls were comfortable sharing their experiences, had hundreds of questions, and were eager to take referral cards and more information back to their friends," writes Ideo.org fellow and product designer Mariana Prieto on the group's blog. "There is something special about looking down at your nails, not having any eye contact and throwing in a hard question wrapped inside superfluous comments. 'Is this the shade of red you wanted?' 'Oh, so the injection made you gain weight?' 'Do you also want white tips or just glitter?'" 

#FamilyPlanning

If you think the cellphone has changed your life, consider what it can do in a region where telephone landline infrastructure is dismal. In fact, a decade ago Africa became the first continent with more mobile phone users than fixed-line subscribers, and today the continent has more mobile phone users than the United States or the European Union. 

Across Africa, countries are using mobile technology to deliver maternal and family-planning services, particularly in rural areas. To reduce maternal and infant mortality in Tanzania, a free text-messaging service called Parents Love Me sends out instructional messages timed to a specific week of a woman's pregnancy or the age of her newborn baby. In the Democratic Republic of the Congo, Population Services International's Ligne Verte toll-free hotline provides confidential family-planning information and refers callers to clinics and pharmacies. In its first three years, the service received more than 80,000 calls, 80 percent from men. In Kenya, the C-Word, a comprehensive online sexual- and reproductive-health service sponsored by Population Services International, can be accessed using an array of digital and online devices. And in several African countries, "mobile money" technology reimburses family-planning service providers and sends vouchers that pregnant women can use at the clinic of their choice.n