University of Michigan professor, graduate work together to empower Sudanese women

May 9, 2018, University of Michigan

South Sudanese women have among the highest fertility rates and maternal death rates in the world, yet cultural norms still frown upon contraceptives—even to make pregnancy and birth safer for women.

In light of this paradox, University of Michigan researchers wanted to better understand these Sudanese 's ideas about contraceptives and in order to address the challenges to providing contraceptives and better child and maternal care.

Between 2013 and 2017, researchers from the U-M School of Nursing conducted six Home-Based Life Saving Skills workshops with 68 Sudanese women—one group in South Sudan, and five in Northern Uganda refugee camps, where many Sudanese women were driven during the war, said Ruth Zielinski, U-M associate professor of nursing.

The researchers found, overwhelmingly, that use of modern family planning methods wasn't acceptable in the community, but that despite that, women still wanted to learn about it.

Zielinski became interested in this population of Sudanese women about five years ago, when she was contacted by U-M graduate John Musick. Musick and his wife, Rev. Denise Scheer, had been doing nonprofit mission work in developing countries since 1994, and in 2003 they decided to broaden this to include villages in the Sudan.

Their group, the South Sudanese Leadership and Community Development Group, uses grass-roots community development to teach marginalized Dinka women in Northern Uganda refugee camps basic skills for self-sufficiency.

Musick said that while learning about the population and prioritizing the community's needs, maternal and child care topped the list.

"One of the first things we heard when we talked to the community was, 'We're dying in childbirth,'" he said.

So, Musick contacted Zielinski, a nurse midwife, to help him develop and implement the family planning and maternal and child health component of SSLCD's mission.

"As a nurse midwife I had been very interested in global women's health," Zielinski said. "Once I started going there, it was hard not to go back. They are so smart and so interested in learning."

She said family planning must be approached much differently there than it is here—where for the most part, birth control is not taboo. Also, many of the women can't read, so this is a picture-based program that focuses on identifying and preventing problems during pregnancy and birth.

"Family planning must be incorporated in with the bigger picture, which is education around pregnancy and birth and infant care," Zielinski said. "You can't just go in there and start talking about family planning and contraceptives."

For instance, very few of the women in the study even knew about modern methods of contraception, and while some had heard of condoms, most didn't know how to use them. There were also firmly held cultural taboos regarding contraceptives—that only "loose women" used birth control and that contraceptives would decrease the population.

Despite this, women were still interested in learning about family planning, and even wanted to share the information with others, Zielinski said. They acknowledged that times were changing and that their children would learn about family planning, which motivated them to learn as well. However, they didn't believe it was acceptable for their daughters to use contraceptives or have sex outside of marriage.

The primary method of planning for the women was abstaining from sex while breastfeeding, to space children apart. This cultural norm is slowly being abandoned, which will negatively result in more pregnancies that are closer together, Zielinski said.

The women believed that having children too young, too old or too close together wasn't good, but they felt that having lots of children was beneficial because that insured at least some would survive despite the high mortality rate.

Zielinski said that a critical component to reducing unplanned pregnancies is to empower Sudanese women in the community, a sentiment Musick echoes. This is a highly patriarchal society where women are expected to submit to their husbands, and many women—especially younger women and adolescents—feel they can't refuse a marriage proposal, and adolescents have more complications during pregnancy.

Women in the study suggested that men also take the HBLSS workshops, and Zielinski said researchers are developing a pilot project for men that will be presented in the fall.

Explore further: Pregnant women are at increased risk of domestic violence in all cultural groups

Related Stories

Pregnant women are at increased risk of domestic violence in all cultural groups

April 26, 2018
Domestic violence occurs across all age groups and life stages. Rather than reducing during pregnancy, expecting a child is a key risk factor for domestic violence beginning or escalating.

Treating refugees from Western perspective leaves providers, patients lost in translation

December 20, 2017
For years, research has shown that female Somali Bantu refugees may be hesitant to use hormonal birth control and other methods of family planning.

A lack of knowledge may explain low contraceptive use in Nigeria

July 27, 2017
The importance of family planning in addressing a range of challenges in developing countries is now widely accepted. Family planning is a key factor in achieving the Sustainable Development Goals. And getting it right can ...

Contraception could save world $5.7 bn, says UN report

November 14, 2012
The world economy would be boosted by billions of dollars if all women had access to contraception, the United Nations said on Wednesday in its annual State of World Population report.

Women's contraceptive use influenced by contraception education and moral attitudes

May 28, 2014
Nearly half of all pregnancies in the United States are unintended, and unplanned pregnancies are associated with poorer health and lower rates of educational and economic achievement for women and their children, according ...

Sub-Saharan women using modern contraceptives more likely to be HIV tested

April 26, 2016
Women in sub-Saharan Africa who use modern contraceptives are more likely to be tested for HIV than those who do not, according to a study published April 25, 2016 in the open-access journal PLOS ONE by Katherine Center from ...

Recommended for you

A co-worker's rudeness can affect your sleep—and your partner's, study finds

December 14, 2018
Rudeness. Sarcastic comments. Demeaning language. Interrupting or talking over someone in a meeting. Workplace incivilities such as these are becoming increasingly common, and a new study from Portland State University and ...

A holiday gift to primary care doctors: Proof of their time crunch

December 14, 2018
The average primary care doctor needs to work six more hours a day than they already do, in order to make sure their patients get all the preventive and early-detection care they want and deserve, a new study finds.

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

Large restaurant portions a global problem, study finds

December 12, 2018
A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of ...

Receiving genetic information can change risk

December 11, 2018
Millions of people in the United States alone have submitted their DNA for analysis and received information that not only predicts their risk for disease but, it turns out, in some cases might also have influenced that risk, ...

Yes please to yoghurt and cheese: The new improved Mediterranean diet

December 11, 2018
Thousands of Australians can take heart as new research from the University of South Australia shows a dairy-enhanced Mediterranean diet will significantly increase health outcomes for those at risk of cardiovascular disease ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.