The International Conference on Population and Development (ICPD) held in Cairo in 1994 called for a global commitment to increasing women's agency and reproductive options by promoting a reproductive health agenda. Voluntary contraceptive use and the quality of reproductive health care have become the predominant emphases in family planning initiatives. Yet, many programs worldwide demonstrate a continued commitment to fertility reduction and slowing population growth. This article explores three arenas of contemporary discourse about reproductive health and family planning. Using Senegal as a case study, it highlights the significant overlaps and disconnects among global reproductive health policy, national priorities and programs, and the biopolitics of gender, marriage, and fertility that shape Senegalese women's reproductive behavior. The article points to the slow decline in national fertility rates to explore how family planning initiatives fail to address reproduction in the context of women's socio-economic challenges and cultural and religious fertility ideals.