Talibouya Ka, Muslim leader (imam) of the Omar Kane mosque in the Medina neighbourhood of the Senegalese capital Dakar, encourages his followers to procreate as much as they can. “There are imams who are for family planning, but I am not. I tell worshippers they need to increase the size of the global Muslim family.”
Such attitudes, which used to be prevalent in Senegal, are increasingly rare, particularly in Dakar, midwives and doctors at the Hospital Centre for Health and Hygiene in Medina, told IRIN.
Senegalese families are spacing their children, having fewer, and as a result are increasingly searching for long-term family planning solutions, said Fatou Seck, a midwife at the hospital.
While in 1990 the average woman in Senegal had 6.7 children in her reproductive cycle; in 2009 when the latest statistics were made available, they had 4.8, according to the Health Ministry.
“There is a small revolution going on - husbands and imams who were traditionally against any kind of family planning are slowly starting to accept it,” said Ephie Diouf, 31, a child-minder in Dakar and mother of a five-month-old son.
One reason for contraceptive take-up is the high cost of living, particularly in the capital, said Soda Diagne, 32, a Dakar businesswoman who is married without children. “People are realizing they can’t feed and educate five children at today’s prices.” The price of imported rice - a staple in Senegal - rose sharply in 2007 and 2008 and then again in 2010.
While the average fertility rate across the country is five children per woman, in Dakar it is 3.9, according to NGO Marie Stopes International (MSI).
But the behaviour shift is also due to a push by the government to encourage family planning in state-run hospitals and clinics as part of its maternal mortality reduction strategy, said the UN Population Fund’s (UNFPA) Senegal joint director, Edwige Adekambi.
Many of the poorest performers in maternal mortality are in West Africa; while Senegal is at the high end of the regional scale, the numbers are still significant: 410 women die per 100,000 live births, according to the UN Children’s Fund (UNICEF).
The Health Ministry has doubled the budget for reproductive health, and within that, has doubled the budget for family planning to US$200,000 per year, according to UNFPA.
At parliamentary level, politicians are also starting to take into account the need to balance economic and demographic growth, she added. (In many West African states, the potential gains of economic growth are being erased by soaring populations).
Part of the additional funding will be used to ensure that contraceptives start to be included in the list of essential stocks routinely ordered for government pharmacies and medical centres, as per a ministerial order.
To date, erratic supplies have severely impeded the ability of some women to access contraceptives, said Adekambi, which also means they are subject to paying more than the government-set tariff - 100 CFA (20 US cents) for one month’s supply of the birth control pill.
Diouf backs this up. She pays 1,500 CFA ($3.10) to a private pharmacy for her monthly contraceptive pill because her local clinic is often out of stock. “Many women I know go to private clinics to get their birth control pill, but end up taking bad or old pills and get pregnant anyway,” she said. Availability is even lower in rural areas, where just one in 20 sexually active people use contraception (versus one in five in Dakar).
On 19 September, MSI opened three family planning clinics: two in the capital and one in M’bour, 70km south of Dakar, aiming to give women greater access to affordable family planning services, as well as to give advice and testing on sexual health, and provide basic ante-natal care. Providing these services at an affordable fee could reduce medical expenses linked to reproductive health in Senegal by $20.8 million by 2015, estimates MSI.
The government has been very supportive of the NGO’s work, said Senegal director Maaika Van Min; and the local imam attended the opening ceremony of one of the new clinics.
Agents for change
But while attitudes are changing, there are still pockets where people cling to traditional beliefs, said Adekambi, particularly in rural areas such as Matam in the northeast, which has the lowest contraceptive use rate in the country.
Since 2006 Catholic and Muslim religious leaders have worked together to try and issue updated religious guidelines on family planning, stressing the fact that neither the Koran, nor the Bible are against spacing of births.
Midwife Seck said the imam at her local mosque now preaches to families to space their children by 30 months. “He tells families this is how to keep their wives healthy. Family planning is not banned in Islam… Religion is about well-being, and spacing children is part of that.”
In Matam, UNFPA worked with couples from the community to become agents for change: they went door to door to discuss family planning with household members. Contraceptive use has risen in the region, but Adekambi said nonetheless, UNFPA may take the approach one step further - by opening a “school for husbands” based on a model they organized in Niger, where reproductive sexual health and other gender issues are discussed.
Many husbands or partners are reluctant to embrace family planning at first, said midwife Seck. At consultations “we discuss with them the benefits… that their wife will have more time to look after each child, more time to look after herself, and most importantly, more time to look after him,” she told IRIN.
That tactic often seems to do the trick, she said.