Healthy Women and Families: Faith-Based Approaches to Global Health
Healthy Women and Families: Faith-Based Approaches to Global Health
“All of the major religions of the world are really quite concerned with addressing the needs of the poor and also the disadvantaged,” said Victoria Graham, senior NGO technical advisor at the U.S. Agency for International Development, at the Wilson Center on July 18. “They’re always looking for interventions that address their needs, including health needs. And family planning is probably the most cost-effective way of doing this. Across the continuum – from looking at the economy to the family to saving lives – family planning is an excellent intervention.”Comprehensive family planning allows women to decide the timing and spacing of pregnancies, and can improve the health of both mothers and their children. It can also impede the spread of HIV and facilitate better economic outcomes for women and their families.
There is still a long way to go, however, before women worldwide enjoy universal access to sexual and reproductive healthcare, a target set by Sustainable Development Goal 3. Despite the fact that family planning is an essential pillar of global peace, prosperity, and environmental sustainability, 225 million women worldwide who want to space or prevent pregnancy do not have the means to do so, and therefore face an increased risk of health complications, poverty, and even death. Around the world, faith-based organizations have proven instrumental in addressing this shortfall and connecting underserved women – often in rural or conservative areas where religious leaders wield substantial influence – with maternal healthcare and family planning resources.
Faith-based organizations are “an important infrastructure to be utilized and built on for addressing family planning,” said Graham. “But there’s no systematic approach to working with faith entities. We haven’t really leveraged those large, centralized structures that exist, and to me, this is a huge opportunity that we have to explore in future years. We really need to seize the opportunity.”
Delivering Success and Overcoming Barriers to Family Planning
In developing countries, faith-based organizations are instrumental to the delivery of healthcare, in some cases providing up to 70 percent of all health services – and many have embraced family planning as an essential component of human well-being. “Family planning is probably the most cost-effective, least expensive way to save lives,” said Adrienne Allison, senior technical advisor at World Vision, a Christian humanitarian and development organization.
Christian Health Associations in East Africa, for example, have made remarkable gains in supplying localized family planning services to poor and marginalized populations. According to an article in the latest issue of the Christian Journal of Global Health, between January 2014 and December 2015 faith-based organizations in Rwanda and Uganda who adopted a community-centered approach to reproductive health gave specialized training to 547 medical providers who, in turn, educated close to 400,000 people about family planning. By the end of the program’s implementation, 32,176 patients had adopted a family planning method – a 53 percent increase from 2013.
But significant obstacles to the sustained uptake of family planning in the region still persist. (The rate of contraceptive use in sub-Saharan Africa – where only 25 percent of married women employ a family planning method – is the lowest in the world.) In a 2016 study, researchers at the Uganda Protestant Medical Bureau found that obstacles to family planning had as much to do with tradition and social customs as they did with an insufficient capacity. For example, some residents of eastern Uganda associated family planning with cancer and congenital disease. In addition, inadequate support and threats of violence or divorce from husbands – who tend to want more children, and worry that contraceptives will enable their wives to have extramarital affairs – further discouraged women from utilizing family planning. The cost of contraceptives and a dearth of trained medical personnel also made accessing family planning services difficult.
Incorporating men into community-wide conversations about family planning and addressing their misconceptions is a critical objective. “Women don’t get pregnant alone,” said Pauline Muchina, director of the United Methodist Church’s Healthy Families, Healthy Planet program. “Therefore, we mislead people when we just talk about family planning by engaging women alone and not the men.” The Adventist Development and Relief Agency (ADRA), operated by the Seventh-day Adventist Church, emphasizes male involvement, teaching men and women about the process of labor and potential danger signs all over the world. In Nepal, ADRA’s educational outreach boosted the number of married men who use modern contraception by 12.9 percent, and established 66 community groups that promoted male participation in local-level maternal health and family planning.
“When men take more responsibility for family planning,” said Muchina, “we will see better services, we will see greater investment in family planning services, because it will affect them in a more personal way.”
Healthy Timing and Spacing of Pregnancy
Faith-based organizations must also take great care to frame sensitive issues in a way that is compatible with the sensibilities of local religious leaders. “If you meet a bishop and you start with ‘family planning,’ you will just know that they will not hear anything,” said Dr. Tonny Tumwesigye, executive director of the Uganda Protestant Medical Bureau.
Navigating local sociocultural nuances and attitudes is not easy, but it is necessary to deliver much-needed family planning services to communities that lack high-quality healthcare, said Peter Yeboah, executive director of the Christian Health Association of Ghana (CHAG), a network of 300 health facilities run by 25 Christian denominations. “We ensured that our family planning interventions were culturally and religiously acceptable,” he said. “We had to tailor them in such a way that it reflects the interests and sensitivities of all our stakeholders.” In accommodating the religious preferences of Ghana’s various Christian groups, and adjusting training programs and service provision to match their specific needs, CHAG yielded substantial increases in the uptake of family planning. The proportion of adolescents aged 10-19 using family planning rose from 13.7 percent in 2013 to 17.0 percent in 2015, and the number of families who accepted a method of family planning rose from 67,312 to 73,648 over the same period.
“We have to change the name of the game,” said Allison. “If we talk about ‘healthy timing and spacing,’ what the men pick up is the economic advantages they will have if their children are spaced. The fact that they can educate their own children if they’re spaced really resonates with them.”
Healthy Timing and Spacing of Pregnancy (HTSP) is an intervention that allows women and couples to make informed, voluntary choices about the health and desired size of their families. As part of this approach, the World Health Organization and the U.S. Agency for International Development recommend that women give birth between the ages of 18 and 34, and wait at least two years after a live birth before attempting another pregnancy. Following these guidelines can dramatically reduce the likelihood of maternal death, newborn death, and birth-related abnormalities. According to World Vision, if all women had the resources needed to wait three years between birth and another pregnancy, close to two million child deaths could be avoided annually.
“HTSP has given us a language that doesn’t have any stigma attached to it,” said Allison. “And so it is much easier for people who are cautious about family planning to talk about HTSP.”
Meeting the Needs of Young People
Every year, 16 million girls around the world aged 15-19 and 1 million girls under the age of 15 give birth. For these girls – who are often married and unable to access any sexual or reproductive health services – complications from childbirth are the leading cause of death. They are also more likely to contract HIV and drop out of school. As a result, “if the faith community wants to be effective in their family planning programs,” said Muchina, “they definitely have to develop programs to address adolescent pregnancies.”
In sub-Saharan Africa, the dearth of family planning resources for adolescent girls is particularly acute: 67 percent of married adolescent women who want to delay their next pregnancy and 68 percent of sexually active unmarried adolescents in the region are not using any form of modern contraception. To counter this shortfall, the World Young Women’s Christian Association advocates for the construction of safe spaces – safe, private, and locally integrated facilities where girls and young women can come together and develop networks of support; obtain evidence-based information about sexual and reproductive health services; and learn to become leaders, advocates, and active participants in their communities. In recent years, the United Nations Populations Fund in Zambia and Malawi has implemented safe spaces that offer women literacy classes, health education, and refuge from gender-based violence – key resources that help adolescents avoid child marriage and premature pregnancy.
To sustain future family planning efforts, the panelists agreed that faith-based organizations will need to remain committed to culturally attuned healthcare and embrace a holistic approach to reproductive health that effectively balances the interests of national governments, faith groups, development organizations, and, above all, local communities. “It is clear that family planning is a shared responsibility,” said Yeboah. “It needs cooperation, collaboration, and complementarity from other actors and players.”
Sources: Christian Connections for International Health, Christian Journal for Global Health, Georgetown Journal of International Affairs, Global Health: Science and Practice, PLOS One, Population Reference Bureau, United Nations Population Fund, United Nations Sustainable Development Knowledge Platform; U.S. Agency for International Development, World Health Organization, World Vision International, World YWCA
Photo Credit: Wilson Center
Written by Anuj Krishnamurthy, edited by Meaghan Parker
Dr. Tonny Tumwesigye
Environmental Change and Security Program
The Environmental Change and Security Program (ECSP) explores the connections between environmental, health, and population dynamics and their links to conflict, human insecurity, and foreign policy. Read more