Transcript Addressing Religion and Family Planning Programming

Addressing Religion and
Family Planning Programming
Katherine E. Beal, MSc
Harvard School of Public Health and
ISSER, University of Ghana
Presentation Outline
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Why Religion and Health?
Conceptual Framework for Unmet Need
Unmet Need and Religion
Our Goals are Similar
Religious Leaders’ Statements
Examples of Success
Lessons Learned and Future Directions
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Why Religion and Health?
• West Africa is most highly religious region in
world:
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99% of people belong to a religious denomination
82% attend religious services regularly
97% give God high importance in their lives
95% believe that there is a personal God or some
sort of spirit or life force
(source: Gallup International Millennium Survey, 2000)
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Why Religion and Health?
• Possible mechanisms by which religious involvement
might have a positive impact on health:
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Regulation of healthy lifestyles & health behaviours
Provision of social resources
Promotion of positive self-perceptions
Provision of specific coping resources
Generation of other positive emotions
Promotion of healthy beliefs
Additional mechanisms, such as existence of a healing
bioenergy (e.g., prayer)
(sources: Levin, 1994; Chatters, 2000; Ellison & Levin, 1998)
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Conceptual Framework
Demographic Variables
Age
Number of living children
Number of marriages
Age at first marriage
Ideal number of children
Socioeconomic Variables
Current place of residence
Migration status
Educational level of women
Religion
Work status
Wife’s versus husband’s education
Exposure to media
Visited by FP worker
Visit of health facility
Proximate Determinants
Knowledge about FP
Women’s approval of FP
Perceived husband’s approval
of contraception
Couple’s discussion about FP
Dependent Variable
Unmet need/met need
(Source: Korra, 2002.)
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Unmet Need and Religion
100.0
90.0
80.0
Percentage unmet need for FP
70.0
60.0
50.0
religious
denomination
40.0
30.0
urban
rural
no education
primary
secondary & higher
Orthodox
Catholic
Protestant
Moslem
traditional
residence
20.0
10.0
education
0.0
Background characteristics
(Percentage of married women with unmet need for contraceptives, by
background characteristics, Ethiopia DHS, 2000; Source: Korra, 2002)
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Unmet Need and Religion
30.0
percentage of unmet need
25.0
20.0
relgious prohibition
fear of side effects
Linear (relgious prohibition)
Linear (fear of side effects)
15.0
10.0
5.0
0.0
1988
1993
1998
2003
year of DHS survey
(Percentage of currently married women with unmet need for contraceptives, by reason for
not intending to use in the future, Ghana DHS, 1988, 1993, 1998, 2003; Source:
Govindasamy and Boadi, 2000)
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Our Goals are Similar
• Goals of a public health
organization:
– Improve the health and
wellbeing of populations
– Education on prevention
of disease
• Goals of a religious
organization:
– Improve wellbeing of
followers
– Moral, ethical education
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Our Goals are Similar
• International Committee of Religious Leaders for
Voluntary FP calls on President Bush to Release $34
million for UNFPA (30 April 2002)
– 136 religious leaders from 31 countries
– Buddhists, Christians, Muslims, Hindus, Jews
– “In the Catholic tradition, caring for the poor and
marginalized is a key social teaching…you can be a Catholic
and support family planning and they know that women’s and
children’s lives are saved when voluntary family planning is
available.” – Frances Kissling, president of Catholics for a
Free Choice
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Religious Leaders’ Statements
• “…family planning is crucial, especially in the
developing world.” – His Holiness the Dalai Lama
• “Planned parenthood is an obligation of those
who are Christians. Our church thinks we
should use scientific methods that assist in
planning families.” – Anglican Bishop Desmund
Tutu
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Religious Leaders’ Statements
• “There is no harm for a man to discharge semen
outside the body of his wife if he desires no
child. But Muslims should bear in mind that this
notwithstanding, Allah creates whomsoever He
intends to create.” – hadith (tradition) of the Prophet
Muhammad
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Examples of Success
• “The imam is charged
with the society’s trust, as
not anyone can be an
imam. At times, people
are ashamed to discuss
their problems in public,
so they come to see me
privately.” – male
participant
Engender Health program, Guinea
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Examples of Success
• Trained imams from 12
mosques in Kaloum
• Messages included in Friday
sermons:
– Marry women over 18 (serious
health risks from births at
young age)
– Practice safe sex (avoid
HIV/AIDS & STIs)
– Use FP (to limit family size and
safeguard health of wives &
children)
Engender Health program, Guinea
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Examples of Success
• Broad reach:
– 300 to 3000 men and women
per imam
– 33,000 of 94,000 received
messages
• Outcomes:
– More health service use
– Repeat STIs decreased by
almost 50% in 6 months
– Male partners visiting clinics
for first time
Engender Health program, Guinea
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Examples of Success
• Recent study examined fertility preferences among male
lineage heads (MLHs) and role of traditional religion in
determining them
• Interviews with MLHs and ancestors through
soothsayers
• Questions on benefits of having many children,
achievement of having desired number of children,
changes in preferences after the fact, male or female
preferences, hut size preferences, approval of FP,
benefits of health and FP service availability
Navrongo Health Research Centre,
Upper East Region, Ghana
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Examples of Success
• Results:
– Both shared strong preference for sons, large compounds, a
growing lineage
– Some ancestral spirits wanted fewer children than
corresponding MLHs
– Traditional religious practices were not a singular negative
force age FP and were flexible and adaptive to change
– Acknowledgement of survival strategies by ancestors
– Methodology suggests usefulness of communicating with
men, soothsayers, spirits about gender issues, reproductive
matters and health
Navrongo Health Research Centre,
Upper East Region, Ghana
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Examples of Success
• Succeeded in getting Catholics to promote
widespread use of (lactational ammenorhea
method (LAM)
• Breastfeeding still accounts for more fertility
regulation in Africa than any other method
• Once a woman began using LAM, she most
often moved to a modern method by month 6
JSI, Inc. project, Madagascar
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More Examples of Success
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Coptic Orthodox Church in Ethiopia
Engender Health program in Pakistan
Seventh Day Adventists, Anglicans, Lutherans
Presbyterian Church of East Africa, Kenya
Tanzania – Adventist Church
Madagascar – JSI project with protestant group FJKM
All Africa Council of Churches – part of Geneva-based World Council of Churches –
organized seminal conference on adolescent health as early as 1975 in Swaziland
Christian Council for International Health
Muslim Women’s Association of Uganda
Catholic nun in Malawi
Madagascar – LAM
Catholics for Free Choice
Planned Parenthood Association of Ghana (PPAG) – religious department
Ghana Social Marketing Foundation (GSMF)
Pathfinder, International in Bangladesh
CEDPA in Ghana – worked with Moslem Family Counseling Center and YMCA
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“My religion says that using condoms is
wrong.”
• Possible response: “It might help to talk with one
of your religious leaders. A lot of people from
different religions use condoms, even though
their religion may be against it. They figure that
preventing infection or unintended pregnancy is
more important than worrying about the
morality of condoms.”
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Lessons Learned and Future
Directions
• It may not be easy, but “nothing ventured, nothing
gained.”
• We may need to learn a whole new “language” and way
of communicating.
• Religion is very important in many people’s lives and it
impacts their health.
• Religious leaders in West Africa have great influence in
people’s lives.
• Accessing the community requires minimal financial
input.
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Lessons Learned and Future
Directions
• We need to get to the heart of the issue.
– Know what the explicitly-stated restrictions are so that you
know what you’re dealing with
– Talk directly with religious leaders, read the texts
– Examine the assumptions (denominations are practiced and
interpreted differently)
• Religion has been a part of people’s lives before FP
programs and will continue to be after many programs
end – this is a key element to sustainability.
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Resources
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Adongo, PB, et al. (1998) “The influence of traditional religion on fertility regulation
among the Kassena-Nankana of Northern Ghana.” Studies in Family Planning, 29(1):2340.
Chatters, LM (2000). “Religion and health: public health research and practice.” Annual
Review of Public Health, 21:335-67.
Ellison, CG and JS Levin (1998). “The religion-health connection: evidence, theory,
and future directions.” Health Education and Behavior, 25(6): 700-720.
Engender Health website, http://www.engenderhealth.org/itf/guinea.html (accessed
2/9/05)
Gallup International Millennium Survey (2000). http://www.gallup-international.org
(accessed 2/10/05).
Govindasamy, P and E Boadi (2000). “A decade of unmet need for contraception in
Ghana: programmatic and policy implications.” Calverton, Maryland: Macro
International, Inc. and National Population Council Secretariat (Ghana).
Korra, A (2002). “Attitudes toward family planning and reasons for nonuse among
women with unmet need for family planning in Ethiopia.” Calverton, Maryland USA:
ORC Macro.
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Resources
• Levin, JS (1994). “Religion and health: is there an association, is it valid and is
it causal?” Social Science and Medicine, 38(11):1475-82.
• Mazrui, AA (1994) “Islamic doctrine and the politics of induced fertility
change: an African perspective.” Population and Development Review, 20(Supp):
121-134.
• Omran, AR (1992) Family Planning in the Legacy of Islam. London: Routledge.
• Ragab, ARA (2004) Muslims’ Perspectives on Key Reproductive and Sexual Health
Issues, Issue in Focus (6), Africa Regional Sexuality Resource Center website,
http://www.arsrc.org/en/resources/newscenter/i_archive/006.htm (accessed
2/7/05).
• Roudi-Fahimi, F. (2004) Islam and Family Planning. PRB, MENA Policy Brief.
• Schenker, JG and V Rabenou (1993). “Family planning: cultural and religious
perspectives.” Human Reproduction, 8(6):969-76.
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Special thanks to…
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Ms. Nancy Harris, JSI, Inc.
Dr. Allan G. Hill, Harvard School of Public Health
Dr. John R. Weeks, San Diego State University
Mr. Joel Lamstein, World Education and JSI, Inc.
Dr. Sam Agyei-Mensah, University of Ghana
Dr. Francis Nii Amoo-Dodoo, Pennsylvania State University
Ms. Lissette Bernal, Engender Health
Ms. Jane Wickstrom, USAID/Ghana
Dr. John Casterline, Pennsylvania State University
Mr. Sahlu Haile, Packard Foundation/Ethiopia
Mr. Alex Banful, Ghana Social Marketing Foundation
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