While statistical analyses of data can paint a picture of contraception and fertility trends in Sub-Saharan Africa, much can also be learned from speaking directly with citizens. In Part 5 of our series, we examine focus group discussions and in-depth interviews conducted by researchers with local groups across Sub-Saharan Africa. From such work, one gains a broader understanding of how religion influences fertility and the uptake of contraceptives.
By Nicola Turner
In Part 2, Part 3 and Part 4 of this blog series, we looked at influences of religious affiliation on fertility and contraception, often from Demographic and Health Surveys (DHS). Qualitative studies, so called focus group discussions (FGD) and in-depth interviews (IDI), complement other studies by examining actual quotes of respondents’ opinions on fertility and contraceptive use. Here we explore such studies, taken from the literature review1 that inspired this blog series. Some views presented below were not identified in the quantitative studies, thus providing a broader understanding of the extent to which religious affiliation and other factors influence fertility and contraceptive use.
The studies, from 2010-2020, included men and women of reproductive ages in eight countries: Ethiopia2,3, Kenya4, Malawi5, Nigeria6-10, Somalia11, South Africa12, Tanzania13-16 and Uganda17. All participants were affiliated with either Christianity or Islam. No participants were affiliated with African Indigenous Religions.
Across the studies, many Christian and Muslim respondents stated that contraceptive use contradicted their religious beliefs, that their religion encourages them to have as many children as possible (e.g. to use up all the eggs that God gave them) and that children are a gift from God and should not be declined. Therefore, many respondents, particularly women, say that they do not feel empowered to make contraceptive decisions. This view was particularly strong in predominantly Muslim Northern Nigeria and Somalia where religiosity is reportedly high despite a high level of awareness and knowledge of family planning. In contrast, in Kenya religious leaders accept that family planning is supported by Islam within the context of marriage, and that the Quran or Sunnah do not prohibit its use.
Despite a widespread perception that family planning contradicts Islamic beliefs, Muslim respondents in Kenya, Somalia and Nigeria agree that use of family planning is acceptable for birth spacing, but only when used in compliance with Islamic beliefs. Breastfeeding is the most accepted form of birth spacing and the Quran recommends that mothers breastfeed their children for two years to restore their physical and psychological health before continuing with another pregnancy, up until menopause18. However, there is still a 5% risk of a woman becoming pregnant within the first six months after birth of a child, and the risk increases after six months19. Respondents also mentioned the withdrawal method as another acceptable form of family planning; however, condoms are prohibited as religious leaders state that it would likely promote sexual activity outside of marriage. Permanent and non-reversible contraceptive methods are also not permissible. Although oral contraceptives are prohibited in Islam, religious leaders in Somalia agree they are permissible for birth spacing.
Economic Constraints vs. Religion
Despite the perception that Islam does not support the use of contraception, especially for limiting births, many respondents in Kenya justify their use of contraception as a result of economic constraints (smaller family size improves quality of life). In a study by Davidson and colleagues6 of Eritrean and Somali refugees in Ethiopia, Somalis cited Islamic religion as a deterrent for use of contraceptives, inducing its followers to have many children. Many Somali respondents desired large family sizes of up to 15 to 20 children, despite their refugee status. Somalis felt that religious beliefs outweighed economic concerns as they believed Allah would provide them with protection. This sentiment was echoed by Somali refugees living in Djibouti21 and Finland22. Eritreans who were followers of Christianity preferred to limit their family size to 3 to 5 children, due to economic constraints and refugee status.
In Tanzania, some Christian respondents believe that using family planning was a moral responsibility and limiting the number of children was in line with religious texts, such as caring for children and living within one’s means. Using contraceptives was consistent with these moral standards. Other respondents supported the view that family planning is against their religion; however, they were also in support of the use of family planning given hardships in life, including economic problems and the spread of diseases.
Women in the Shanisha community, in Sudan’s Blue Nile State, speak about reproductive health services with United Nations Population Fund representatives. Source: UNFPA Sudan/Sufian Abdul-Mouty
Polygyny, Faith and the Role of Churches
In Malawi, Nigeria and Uganda, polygyny was mentioned as an influence for both increasing and limiting fertility. Polygyny is common in Islam where men are allowed to have up to four wives, but it also occurs among Christians. Across the countries, women who have competing co-wives acknowledge that they have many children to get more attention (women perceived men to view them as more beautiful if they had more children) and to get more wealth from husbands. According to the Islamic inheritance system, in polygynous marriages, women with more children obtain a higher share of the husband’s daily earnings and of inheritance at a husband’s death. Furthermore, women wish to give birth to more children to prevent husbands from taking on more wives. More children mean greater financial responsibility for the husband.
Similar practices were also reported from Muslim-dominated Senegal, where high fertility was a micro-tactic for economic survival for women where few opportunities exist for female autonomy. High fertility is also a strategy to deal with the threat of divorce, especially when Muslim men have reached their allowed limit of four wives. In Northern Nigeria, divorced women do not leave with their children, but rather, the children are left with the husbands. Therefore, having many children will put husbands off from divorce.
Contrastingly, some women in Malawi stated that having fewer children helped them remain attractive to their husbands thereby preventing them taking on a younger second wife. In Nigeria, some older women felt that if they spaced their children, the effect of repeated deliveries would have less of an effect on their bodies and they would look more attractive, healthier and youthful to their husbands. Therefore, these women were more inclined to use contraceptives.
The survival of Islam also motivated high fertility among Muslim women in Northern Nigeria. Respondents cited that it guarantees the survival of religion, and helps it flourish. However, the women interviewed did not support unregulated childbearing as they were aware of the consequences of poverty, lower quality of life, ill-health and reduced opportunities for their children. The awareness of the dangers of unlimited childbearing seems widespread among women in Northern Nigeria.
In South Africa, where 95% of participants said religion plays an important role in their everyday life, the Catholic Church officially prohibits modern contraceptives as well as premarital sex. Respondents12 felt conflicted and uncertain about how their religious beliefs might impact sex and condom use. Some felt that they did not need condom protection, as God protects them. The sexual act itself is stigmatised by the Church, and carrying a condom implies the act was planned. Several female participants felt embarrassed when buying condoms. Some participants reported that they were able to disassociate their religious beliefs from sex and condom use. South Africa has a much lower fertility rate (TFR 2.2 children) compared with many other countries in Sub-Saharan Africa, which may be attributed to history, stronger family planning programs23-24, education23 and relatively high wealth20. Fertility generally is negatively associated with levels of education and GDP per capita24.
In Tanzania, the view that limiting the number of children goes against God’s plan was particularly strong in rural areas for Christians and Muslims. Tanzania is a deeply religious country with 93% of its population rating religion as very important25. Women who regularly attend religious services were reported to be less likely to receive family planning information from health care facilities26. Some Christian respondents were unsure whether their faith allowed them to control the number of children due to vague statements and interpretations regarding fertility in the Bible, and lack of talk on the subject from religious leaders. Although some participants questioned if family planning could be discussed in a religious setting, others were open to it. In cases where Church leaders were educated about family planning, and conveyed it to their congregation, Church attenders became eager to learn more27-30, demonstrating strong influence of religious leaders in their community, and the potential impact on contraceptive behaviour. However, interventions with Muslim leaders must be structured differently to that of Christian Church leaders, due to the generally stronger Islamic teachings on sex and family size13.
Ethiopia: A Special Case
In studies by Mjaaland and colleagues3 in Ethiopia, Orthodox Christians formed the largest group (44%)32, highly religious with 78% attending Church on a weekly basis, while only 6% of Orthodox Christians in Russia say they do this32. Muslims and Protestants made up 34% and 19% of the population, respectively31. Although the Orthodox Church was once against the use of contraceptives, it has since downplayed this rhetoric33. While a third of the respondents in one study2 specified not wanting to use family planning because they believed the Orthodox Church did not allow it, there was a 57% higher contraceptive use reported among Orthodox Christians than among Muslims and Protestants. Another third interpreted the Orthodox Church’s silence on the issue to mean they were allowed to use family planning. The final third believed the Church was still against contraceptive use, but they still decided to use it anyway as they felt it was necessary. Although women were much more religious than men (as in most other countries worldwide34), many Orthodox women ignored religious disapproval of contraceptive use. Participants from both rural and suburban areas stated that if they could not afford children, then they should not have any, indicating a relatively high level of female empowerment of Orthodox women in Ethiopia.
Moreover, in a study by Gurmu and Mace35 from Addis Ababa, where fertility is below replacement level (1.9 children), the view that women should have as many children as God lets them have is no longer believed among the residents of the city. Women with low or no levels of education, and who have access to less than a dollar per day, had longer birth intervals than women who were better-off, suggesting that they have a wide understanding of the advantages of having smaller families and educating children. However, it is possible that when children become more educated and the economic situation improves, fertility increases again. This causality is applicable when economic considerations are central to family size2.
Other Influences on Fertility and Contraceptive Uptake
The focus above has been on the influence of religion on fertility and contraception. The participants in the qualitative studies also specified social status as a reason for increased fertility, but financial constraints and quality of life led to limiting fertility. Regarding contraception, lower contraceptive uptake was associated with gender attitudes, where husbands were often the main decision-makers (this included decisions over contraceptive use); misconceptions that contraceptives could reduce sexual desire and performance, and cause body deformations, infertility and cancer; and general attitudes such as the view of family planning as taboo. Women who used contraception could also be viewed as promiscuous, and men who let their wives use contraception were considered weak and powerless. Higher contraceptive uptake was associated with birth spacing, increased knowledge of family planning, and financial opportunities.
These qualitative studies strongly suggest that religious affiliation and degree of religiosity can increase fertility, but also demonstrate mixed views on the influence of religion on fertility and contraceptive use, and local and regional variation across Sub-Saharan Africa. While some respondents strongly believe family planning and limiting fertility is forbidden by their religion, some felt it did not influence their decision, while others felt conflicted on the issue. Stronger religiosity, judged subjectively here, is associated with less contraceptive uptake or hesitation. A religion’s stance on fertility and family planning plays an influential role. Among Muslims, family planning is acceptable for spacing births, but not for limiting family size. Economic constraints also influenced contraceptive uptake, regardless of religion. Ultimately, religious leaders can strongly influence a community and spread messages on family planning that impact fertility and contraceptive behaviour.
I wish to thank Frank Götmark for advice and cooperation in my work on this review.
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