Addressing Religion and Family Planning Programming

1. Addressing Religion and Family Planning Programming Katherine E. Beal, MSc Harvard School of Public Health and ISSER, University of Ghana

2. Presentation Outline • 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

3. Why Religion and Health? • West Africa is most highly religious region in world: • 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)

4. Why Religion and Health? • Possible mechanisms by which religious involvement might have a positive impact on health: • 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)

5. Conceptual Framework Demographic Variables Age Number of living children Number of marriages Age at first marriage Ideal number of children 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 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 (Source: Korra, 2002.)

6. Unmet Need and Religion religious denomination residence education (Percentage of married women with unmet need for contraceptives, by background characteristics, Ethiopia DHS, 2000; Source: Korra, 2002)

7. Unmet Need and Religion (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)

8. 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 Our Goals are Similar

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. More Examples of Success • 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

19. “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.”

20. 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.

21. 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.

22. Resources • 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):23-40. • 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.

23. 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.

24. Special thanks to… • 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