In Ethiopia, family planning increasingly an article of faith

Religious figures have been preaching the gospel of family planning here in Africa's second most populous nation. The result: a whittling of the fertility rate, and a leap in contraceptive use.

In Ethiopia, where the population is devout and widely scattered, local religious figures exercise far more authority than government officials or the young female health workers they send out across the country.

The poverty and high mortality rates in many communities have led to an unusual level of support for contraception among Ethiopia’s religious leaders. Pastors, priests, and imams are paving the way for the birth control that the government is making available for pennies. 

It is a pragmatism born of problems with poverty that don’t exist in many Western countries. Religious leaders are now seen as one of the most powerful tools in development workers’ hands across sub-Saharan Africa, from Kenya to the Ivory Coast to the Democratic Republic of the Congo. 

“A pastor who is living in a certain community – he observes the problems of the community. He sees a pregnant woman who is suffering because she has many children and there is nothing to eat," says Tilahun Seifu, a development worker with Ethiopia’s Lutheran church. "He observes also a woman who is dying from delivery. Daily they observe this … The problem itself tells you the need of using contraception.”

Several years ago, men like Mr. Tilahun and Abeya Wakwoya – who also works for the Lutheran church, known here as the Ethiopian Evangelical Church Mekane Yesus – set out for rural parts of Ethiopia to speak with religious leaders.

Their goal was not to directly distribute contraceptives but to create a receptive audience for the government health workers who followed them into the community with subsidized or free pills, implants, injections, and intrauterine devices (IUDs).

Sitting down with both Christians and Muslims, Tilahun and Mr. Abeya pointed to the problems of hunger and unsafe childbirth brought on by families that were too large. They asked these local faith leaders if they saw the benefits of modern birth control amid such conditions.

Their message appears to be catching on. Contraception use is up, from 8 percent of married women in 2000 to 29 percent in 2011, according to Ethiopia’s last Demographic and Health Survey in 2011. The fertility rate is down to 4.8 children per family from 5.9 in 2000, according to the survey, although still well above the three children most women say they want.

In a sprawling mostly rural country it is not possible to pinpoint how many families were convinced by religious leaders. But in more than a dozen interviews, Ethiopian men and women said they had felt initial qualms about contraception – but that messages from faith leaders helped change their minds.

'Accepting the goodness'

“It was hard to swallow in the first place. [Muslims] were disagreeing, arguing why they had to use contraception,” says Habib Mustafa, a religious Muslim from the town of Mareko, a couple hours south of Addis Ababa. “It took gradual, continuous interviews with the health workers for the Muslims to accept the goodness of it.”

Contraception helps ensure families only have as many children as they can feed. That makes for healthier conditions for all concerned, he says.

Sometimes women did the pro-contraception persuading. Mebrate Tenangne, a young Orthodox woman from the village of Mosebo pregnant with her second child says she used birth control for several years after having her first child.

The girl, now seven, sits quiet but alert on the stoop, her back erect as she listens to the conversation.

Ms. Mebrate’s husband, a local clergyman was not happy about the contraception, she says. But when she pointed to their small plot of land and the aging sewing machines they use for their tailoring work – and asked how they could care for a second child -- she convinced him.

Today, even in far-flung areas where few men or women get more than a year or two of high school education, their comments on contraception are peppered with clinical terms like “spacing” – putting a few years between each birth. When asked what convinced them, they rattle off answers that sound as if they came straight from the health workers’ reading material.

The promotion of the term “spacing” was very deliberate, says Josiane Yaguibou, the family planning policy advisor for southern and eastern Africa with the United Nations Population Fund. The UN found that “spacing” evoked far less anger than “family planning” among religious and traditional leaders.

Reading between the lines in the Quran

For work in Kenya’s predominantly Muslim northeast, the UN delved into the Quran to find verses that could be interpreted as supportive of family planning. “The mothers may breast feed their children for two complete years, for whoever desires to complete the nursing period,” one such verse reads.

“The Quran does not prohibit couples from spacing pregnancies. The silence of Quran on the issue of contraception is not a matter of omission by Allah,” the UN guide explains. “The two years spacing is seen by scholars as an endorsement for child spacing.”

Today, Ms. Yaguibou says, groups like USAID and Save the Children find it easy to “penetrate” previously hard to reach communities.

Dr. Addis Tamire, chief of staff to Ethiopia’s minister of health, says that ending opposition to contraception among some faiths is a very high hurdle. To overcome the Muslim community’s particularly staunch resistance, the ministry brought Muslim leaders to Bangladesh to show them how their counterparts there had joined the government’s family planning efforts. When the Ethiopian leaders came home, they were converted.

“If nobody is resisting you, neither supporting you directly nor resisting you, it’s OK,” Dr. Tamire says. ”What we need at the end of the day is women having the choice. {Religious leaders] may not openly talk about it, they may not go out and say it’s possible to use the [injections], but they don’t object, they don’t oppose it, and that’s very important.”

Ariel Zirulnick reported from Ethiopia with the International Reporting Project.