While contraception in Sub-Saharan Africa is still considered taboo in many religious settings and children are viewed as a “gift from God”, some religious leaders are actively promoting the importance of family planning and considering its role in population growth. In this last part of our series on religion, fertility and contraceptive use in Sub-Saharan Africa, we describe religious leaders and denominations that have understood the need to boost the use of modern contraception, and the benefits this can have for communities.
By Nicola Turner and Frank Götmark
Forty-five percent of health services in Sub-Saharan Africa are provided by faith-based organisations. Many religious organisations are against the use of modern contraception and limiting fertility. However, some progressive religious leaders understand that lack of contraceptive uptake, resulting in large families and rapid population growth, undermines people’s health and well-being, exacerbates poverty and degrades the environment.
In Kenya, the National Independent Churches of Africa (NICA) developed a sex and sexuality booklet with references from the Bible and the Quran for use in Sunday schools and madrasas. The lessons are taught by properly trained chaplains provided by the Education cabinet. NICA Archbishop Reverend Stephen Marete is quoted as saying that the aim of developing this curriculum is to “help manage the rising number of teenage pregnancy dropout cases in schools”.
Similarly, the Christian Health Association of Kenya is partnering with religious leaders and Murang’a County’s health department to develop a family planning Costed Implementation Plan (CIP) using the Bible as reference. The message they communicate is that God shows the value of planning: “Suppose one of you wants to build a tower. Won’t you first sit down and estimate the cost to see if you have enough money to complete it? (Luke 14:28).” The message sent is that family planning is crucial to reducing infant and maternal mortality, poverty, and increasing health and well-being, gender equality and environmental sustainability.
In Laisamis, a deeply religious town in northern Kenya where maternal mortality has remained staggeringly high and contraceptive prevalence concerningly low, many Churches brand contraceptives as ungodly and teach that sex is for procreation only. Many locals believe that contraception is used only to prevent diseases among the unfaithful. Geofrey Kristo Lekopir, a pastor for the evangelical Repentance & Holiness Church, along with other church leaders participated in a training program in 2015 with World Vision, a global Christian humanitarian organisation. World Vision reasoned that religious leaders are very much respected and strongly influence people in communities. Leaders were trained to communicate messages about the need for contraceptives to control pregnancies. Prior to 2015, Lekopir believed that discussing contraceptives was not appropriate for the Church. Now, he advises couples to wait 24 months between pregnancies, and adolescents to wait until they are at least 18 years old to become pregnant. However, the increase in contraceptive uptake after the three-year intervention was small, from 5% to 12%. This could be attributed to unchanged views of many of Laisamis’ religious leaders and high religiosity. A similar program was conducted by the African Population and Health Research Centre (APHRC) across western Kenya, where communities are more open to modern contraception. After three years, contraceptive uptake increased by 17%.
In Uganda, the Seventh Day Adventist (SDA) Church Union uses pastoral letters to address societal challenges faced by members and the community. The letters give guidance on what to believe and what actions to take. Five of these letters provide guidance on gender-based violence, teenage pregnancies, maternal health, small family size, and HIV.
In a survey conducted in Tooro, Uganda, 43% of women between the ages of 25 and 34 years and 70% of teenagers reported unwanted pregnancies. Only 48% of the women said they were using family planning, and only 35% were using modern contraceptives. According to Reverend Sarah Kakyo, previously religious leaders would not have supported family planning methods; now, however, some realise the benefits of an age structure with more working adults and fewer children. But while some religious leaders now call upon the public to embrace family planning as a means of reducing unwanted pregnancy, many still remain conservative. Reverend Father Jude Tadeo Basaija, Health Coordinator of the Fort Portal Catholic Diocese, explained that the Catholic Church is not against family planning, but it does not support modern methods, and therefore asks Catholics to embrace traditional method. These methods are often unsafe and ineffective.
In Mityana district, Uganda, senior inter-faith leaders have worked with district leaders to ensure that integrated family planning funds are distributed to intended users. Currently, the district has no clear family planning budget and poor provisions have led to stock outs and decreased uptake of services. Reverend Moses Ssemugooma of Mityana Diocese and Sheikh Abdalla Katongole of the Uganda Muslim Supreme Council raised a concern that 17% of girls in the district are getting pregnant and that cases of abortion are alarming, particularly during the Covid-19 pandemic where teenagers away from school were sexually exploited by men. Katongole added that religious leaders plan to work with the medical personnel in Mityana district to develop messages on the advantages of family planning. The outcome of this work is not yet clear.
The pandemic also raised concerns about unintended pregnancies among Catholic women and religious leaders, as many men lost jobs and became trapped at home for prolonged periods, as was the case with Agnes Muhozi’s husband. While Muhozi received the contraceptive pill, she contemplated whether she was committing a sin, but was also aware that she could not afford more children. At the time, religious leaders from several denominations joined NGOs to embrace the use of contraceptives to avoid pregnancy during the pandemic. But while some religious leaders spoke in favour contraceptive use, this was not supported by the Catholic Church, which reiterated that modern birth control is immoral, unacceptable and against the will of God.
In Nigeria, Family Planning 2020 (FP 2020, now FP 2030) is an initiative to increase uptake of family planning and contraceptives through collaborations with local and international NGOs, civil society organisations, faith-based organisations, traditional and religious leaders, and government ministries. The initiative aims to address socio-cultural barriers and limitations, while promoting the benefits of family planning and health information in schools. A 2015 study by Adedini and colleagues in Federal Capital Territory, Kaduna, Kwara, and Oyo States revealed that Christian and Muslim women with exposure to family planning messages from religious leaders were considerably more likely to take up contraceptives compared to women with no exposure. Interventions that engage religious leaders in shaping norms and informing about family planning seem crucial for increasing contraceptive uptake.
In Ogun State, Nigeria, Islamic and Christian religious leaders under the aegis of Interfaith Association on Family Planning and Childbirth Spacing have incorporated family planning and sex education messages into religious teachings through references to the Quran and Bible. They argue that teenage pregnancies, high maternal mortality and abortions need to be reduced. They also aim to remove the stigma that contraception is associated with promiscuity, saying that many unfaithful partners don’t use contraception. While the outcome of this initiative has not been reported, the government is aware of their activities and are in support.
In rural Bauchi State of Nigeria, just 2.4% of women or couples used contraception. In Sokoto State, it was fewer than 1%. In 2016, HC3, a USAid-funded program at the Johns Hopkins Center for Communication Programs, contacted a group of Islamic religious leaders about the benefits of birth spacing, before expanding to other denominational and government leaders. When the religious leaders were educated, they counselled through radio and in their communities for birth spacing and its benefits, before considering modern contraceptives. After mid-2017, the communities engaged through HC3 in Sokoto, Bauchi and Ebonyi States have seen sharp increases in visits to family planning clinics (on average, 75% more people) and rising adoption of modern family planning each month.
Other Nations in SSA
The Evangelical Association of Malawi sends family planning messages with supportive scriptures from the Bible to change the misconception that family planning disrupts procreation. In Zimbabwe, the GRACE Foundation, a faith-based organisation, teaches family planning on the streets. In Ethiopia, while access to sexual and reproductive health services is perfectly legal, there is still a cultural stigma attached to such services, particularly among young, unmarried people. The Ethiopian Graduate School of Theology trains religious leaders on gender, health, and maternal and child health, including theology issues, and aims to change attitudes so that such leaders can spread messages about family planning to communities. In Ghana, the Muslim Family Counselling Society (MFCS) pushed for the inclusion of clinical family planning methods in the National Health Insurance Scheme, which led women in six districts to access family planning for free. MFCS director Mohammed Bun Bida states that the organisation trains and empowers Imams and Chiefs to encourage people to take up family planning services.
Yet in many countries in Sub-Saharan Africa, churches still resist the efforts of government and aid organisations to increase contraceptive use. In Burkina Faso, where the fertility rate is 5 children per woman and only 22% of women of reproductive age were using family planning in 2015, weeks after the government urged its citizens to take up contraceptives to reduce the size of families, the Catholic Church renewed a campaign against family planning. It argued that children are a blessing and gift from God, and stated that “prevention of life” is murder. While the government has threatened to end state subsidies to Catholic hospitals if they continue to oppose the use of modern contraceptives, the Church is adamant that it will not be influenced by subsidies. Cardinal Philippe Ouédraogo of Ouagadougou quotes, “We should reject policies that degrade human life and return to our traditional values that respect and promote life.”
Convincing religious leaders to speak about family planning during worship and in contacts with community members may require some – or much – persuasion, but the outcome in several examples above shows that it can be effective. While religious leaders and organisations alone are not enough to increase contraceptive uptake sufficiently, we suggest they can be a strong contributing factor, particularly in rural areas where explaining the benefits of birth control is difficult due to attachment to religious beliefs.
We would like to ask if any of our readers are aware of other religious leaders / organisation that speak about family planning / contraception. If so, we would be grateful if you could reach out to us with information.
This blog series is based on the following thesis:
Read the rest of the series on religion and fertility in Sub-Saharan Africa:
- How Africa’s Religious Leaders are Changing Sexual Health Narrative
- Church Leaders Helping to Boost Family Planning
- What Happens when Pastors Preach about Condoms?
- Religious Leaders Advocate for Family Planning in Tooro
- Mityana Inter-Faith Leaders Push for Allocation of Family Planning Funds
- During Pandemic, Some Ugandan Catholic Women Consider Using Birth Control
- Nigeria Needs $5bn Annually to Meet Contraceptives, Maternal Healthcare
- Adedini, S. A., Babalola, S., Ibeawuchi, C., Omotoso, O., Akiode, A. & Odeku, M. Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence from the Nigerian Urban Reproductive Health Initiative. Global Health: Science and Practice 6(3), 500-514 (2018). doi:10.9745/GHSP-D-18-00135
- Why Religious Leaders Must Preach about Family Planning and Sex Education
- Making Family Planning Inroads in Nigeria, One Religious Leader at a Time
- Church at Odds with Burkina Faso Campaign for Women to Use Contraceptives