Women in Nigeria whose clerics extol the benefits of family planning were significantly more likely to adopt modern contraceptive methods, new research suggests, highlighting the importance of engaging religious leaders to help increase the country's stubbornly low uptake of family planning services.
The findings of the study, led by the Johns Hopkins Center for Communication Programs (CCP), which is based at the Johns Hopkins Bloomberg School of Public Health, and CCP's Nigeria Urban Reproductive Health Initiative (NURHI), underscore the outsized role played by religious leaders in whether modern contraception is considered taboo or acceptable. In Nigeria, 9.8 percent of women of childbearing age use modern contraception. In Rwanda, for example, the figure is 45 percent and, in Malawi, it is 62 percent.
"Religion is an important part of the social and cultural fabric of many communities in Nigeria and elsewhere," says study author Stella Babalola, Ph.D., associate professor in the Bloomberg School's Department of Health, Behavior and Society. "As such, religious leaders have the power to inhibit or facilitate the adoption of modern contraception. Given their high level of influence, interventions that engage clerics as change agents for shaping opinions and influencing behaviors related to family planning are crucial for increasing contraceptive uptake in the country."
The study, published Oct. 3 in the journal Global Health: Science and Impact, evaluated data, collected in 2015 by the Measurement, Learning and Evaluation project, from a randomly selected sample of 9,725 women of reproductive age (15 to 49) in four Nigerian states.
About 40 percent of the women reported being exposed to family planning messages from religious leaders in the previous year, the researchers found, and those women were 70 percent more likely to use modern contraception than those who had not been exposed to a cleric's family planning messages. While 99 percent of the women said they considered themselves to be religious, two-thirds reported that their family planning decisions were influenced by religion.
Contraceptive use among women who consider themselves somewhat religious was higher than those who consider themselves strongly religious, suggesting that strong adherence to religious doctrines and practices, combined with religious leaders who do not incorporate appropriate family planning messages into their communications, likely contributes to low rates of contraceptive use.
The benefits of family planning include improved quality of life, increased well-being of families and communities, improved maternal and newborn health outcomes, reduced poverty and increased female education levels. Religious prohibitions and cultural beliefs have contributed to the limited use of contraception in many places. In some parts of northern Nigeria, for example, contraception is viewed negatively as a ploy to depopulate the Muslim community.
To address this, NURHI developed a strategy of working with religious leaders to increase their knowledge of family benefits and its benefits—and to explain that the primary aim of family planning is not to control population but to save lives. They developed a booklet to help religious leaders—both Muslim and Christian—understand how family planning fits into teachings from the Koran and the Bible and how those texts can be interpreted to stipulate the need for child spacing.
Along with facilitating conversations with clerics, the project developed small advocacy handbooks that included Christian and Islamic sermon notes for family planning. In Kano state, after an advocacy visit, the emir there fully supported the family planning messages and has continued to give inspiring statements in support of family planning at public gatherings and through the media.
"The evidence suggests that in addition to family planning being discussed freely and openly in public places, which was not the case many years ago, many religious women are beginning to see that child spacing and using contraception are not sinful," Babalola says.
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Sunday A. Adedini et al. Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative, Global Health: Science and Practice (2018). DOI: 10.9745/GHSP-D-18-00135