[Individual articles from the Spring 2019 issue of Intersections will be posted on this blog each week. The full issue can be found on MCC’s website.]
In recent years, Senegal has made significant strides in several development areas, including gender parity and access to family planning services. Maternal and child mortality have decreased significantly since 2005 but remain high compared to global rates. Many of these deaths are from avoidable causes. Improving maternal and child health, notably through family planning, is a priority for Senegal’s government. Although the contraceptive prevalence rate has doubled since 2012, only 27.8 percent of married women are currently using any method of contraception. Another one in five married women wants to use a contraceptive method, but currently cannot do so.
Religious institutions and beliefs shape many aspects of life in Senegal, but systematic approaches to linking these dimensions to development policies and programs have been rare. Despite recognition that faith leaders can play important roles in family planning, some stakeholders have been cautious to engage them out of concern that influential leaders may take firm, anti-family planning positions. At the same time, rumors have circulated about what faith traditions say about family planning, with little clear guidance from faith leaders. In that context, World Faiths Development Dialogue (WFDD) facilitated discussions in 2014 with a group of Senegalese faith leaders to explore issues of maternal and child mortality and family planning. After building consensus on what religious teachings say about family planning, the group formed into the Cadre des Religieux pour la Santé et le Développement (CRSD), an interfaith association that brings together leaders from prominent Sufi orders of Senegal, other major Islamic institutions and the country’s Catholic and Lutheran churches.
As faith leaders with a deep understanding of religious sensitivities, CRSD members have developed strategies that align with religious teachings and are appropriate for the local context in order to encourage broad shifts in attitudes and behaviors related to family planning. Activities include visits to meet with the leaders of Senegal’s principal religious communities; workshops for community groups of religious women; workshops during significant religious events and holy periods, such as Ramadan; and media outreach through radio, television and print. This mix of approaches targets religious leadership at both the national and local levels.
Engaging women through religious networks, both Christian and Muslim, has emerged as a central and particularly successful strategy for family planning efforts. In 2015, CRSD partnered with a midwife to develop workshops that bring technical and religious perspectives into the same conversation. The workshops educate participants on family planning, addressing common myths and rumors and explaining various methods. After piloting the program, CRSD scaled up the work through a training-of-trainers model, directly reaching over 40,000 Senegalese in all 14 regions of the country.
CRSD’s workshop focuses on dispelling misinformation by providing accurate and accessible information on family planning. For example, one commonly held belief is that religion is against family planning, so messaging focuses on the holistic well-being of the family, emphasizing to participants the need to be able to provide for the children they do have. Another common misconception is that family planning is a Western effort to reduce the number of Muslims in the world, with some Sengalese making comments like, “If you look closely, you ask yourself whether Westerners are promoting birth spacing, or if they’re really aiming for birth limitation.” The workshops for Muslim communities, therefore, draw on the Qur’an and the hadith (sayings about the Prophet Muhammad) to show that traditional methods of family planning exist in Islam and that religious teachings promote healthy timing and spacing of births. Discussants draw parallels between the traditional methods found in Islam and the modern methods available today. Some people also believe that women who want to use family planning are promiscuous; by partnering with a midwife to provide accurate medical information to participants, CRSD counters such beliefs and emphasizes that family planning has health benefits for mothers and children.
Although the workshops initially targeted women, men’s engagement has emerged as a priority area. CRSD members have noted that few couples have substantive discussions about family planning. In many cases, men are or perceive themselves to be the principal authority on family planning decisions. Men’s focus groups revealed a range of perspectives on decision making, but many participants echoed this statement from a man who was asked whether or not he had ever discussed birth spacing with his wife: “No, no, no. Regarding birth spacing, well, that’s my decision. If my wife has a kid, it’s me who can let her go five years without giving her a child.” CRSD has worked to convince men to attend workshops with their wives and has included more messaging around joint decision-making. And that effort has paid off—in 2017, 31 percent of participants in CRSD’s workshops were men.
WFDD and CRSD have made considerable progress in dispelling myths about what religious teachings have to say about family planning, but several key challenges persist. Among married women and men in Senegal, the ideal number of children is largely unchanged; society remains staunchly pro-natalist, yet there is a lack of awareness that high fertility rates are linked to maternal and infant mortality. Moving forward, we are continuing to work with CRSD to develop new and innovative approaches that respond to these challenges.
Lauren Herzog is program coordinator and Wilma Mui is program associate at the World Faiths Development Dialogue.
Changing health behaviors, especially our most personal behaviors, is extremely difficult. Trying to do this against the grain of local values, traditions and religious beliefs and without local support is generally ineffective and often counterproductive. Doing effective “behavior change communication” (as it is often called) in the diverse contexts where MCC works requires deep local knowledge, ability to adapt to local realities and creativity in finding ways to engage with local power structures and religious communities in a way that takes cultural beliefs and understandings of gender into account. So-called best practices, however well-intentioned and research-based, can rarely be successfully copy-and-pasted between different cultural contexts.
Providing women’s health education in the highly rural Central Highlands of Afghanistan, for example, is only possible with the full support of local Islamic religious leaders, community elders and men more broadly. Getting such buy-in for the MCC-supported maternal and child health projects in that area has required deep adaptation to and respect for local traditions and beliefs, including allowing male religious leaders to be present during group sessions, supporting male relatives to accompany local female staff in their work and prioritizing approaches that are realistic for women to implement within this context. It is not always comfortable or straightforward to negotiate these dynamics, especially when working across wide cultural and religious divides, but doing so is essential if we care about making progress on women’s health across the varied contexts of MCC’s programs.
The article by Herzog and Mui about WFDD’s family planning work in Senegal shows what this negotiated contextualization of programming can look like when scaled up to a national level and when that contextualization is seen as part of the intervention itself, rather than just one step in project design. MCC has similarly found through its work with partners to improve women’s health that taking local understandings of gender into account when planning, implementing, monitoring and evaluating those women’s health initiatives is vital to their success.
Paul Shetler Fast is MCC’s health coordinator.
Levy, Noam N. “Pope Francis Isn’t the Only Religious Leader to Give a Surprising Boost to Contraception.” Los Angeles Times. February 19, 2019. Available at https://www.latimes.com/world/asia/la-fgcontraception-world-religion-20160219-tory.html.
Herzog, Lauren. “Building Consensus for Family Planning Among Senegal’s Faith Communities.” World Faiths Development Dialogue Briefing. July 2017. Available at https://berkleycenter.georgetown.edu/publications/building-consensus-for-familyplanning-among-senegal-s-faithcommunities.
Impact Staff. “Muslim Leaders in Senegal are Improving Women’s Access to Contraceptives.” Vice Impact. Sept 21, 2017. Available at https://impact.vice.com/en_us/article/43axbp/muslim-leaders-insenegal-are-improving-womensaccess-to-contraceptives.