"Contraception and Women's Health in the Maghreb," the fourth meeting in the Islam, Gender, and Reproductive Health series sponsored by The Middle East Program and Environmental Change and Security Project and supported by USAID's Office of Population and Reproductive Health and the Interagency Gender Working Group, featured anthropologist Dr. Lilia Labidi of the University of Tunis and Dr. Karen Hardee, director of research at the Futures Group International in Washington.
While the countries of the Maghreb (Tunisia, Morocco, and Algeria) have taken different paths in developing family planning programs, former Wilson Center Fellow Labidi said they "all show a similar and significant reduction in birth rates." Current estimates place fertility rates at 2.5 children per woman in Morocco, 2.3 in Algeria, and 2.0 in Tunisia, down from rates well above 6 children per women in the 1970s. This reduction is quite impressive: the Maghreb "accomplished in 25 years what took almost 200 years in France," Labidi observed.
Although Tunisian women gained certain rights in the 1950s and 1960s, such as the right to vote and obtain judicial divorce, the government chose to promote contraceptive methods that "took the initiative away from women"—specifically, IUDs and sterilization (sometimes coerced). However, Algeria and Morocco, where women's rights were less advanced, chose to promote the contraceptive pill, which gave women more control over their fertility. Labidi examined this apparent contradiction, tracing the impetus for Tunisia's sometimes coercive methods to the growing "secularization" of the state. She hypothesized that the technocrats in charge of Tunisia's program feared the unchecked growth of a rural population beset by tribal conflicts:
The specter of population growth, seen as "aimed against the state," led to the fear that the theocratic state would emerge and constitute a barrier to modernization and centralization. Decrees, laws, and technology were put into place to counter the "sexual disorder of the rural areas" and encourage the modernization of the state, and protect urban areas and Islam by putting an end to tribal conflicts.
Asked about the future of family planning, Labidi said that the return of a pro-natalist government in Tunisia was not possible: "Women are not ready to go back. Women will not do it….Too many changes have happened in the country. Tunisia is very proud of its development."
Turning to Indonesia, Hardee described the results of four studies carried out by Family Health International on family planning and women's empowerment in Indonesia. Home to the world's largest Muslim population, Indonesia's strong, highly institutionalized family planning program has reduced the fertility rate from 5.9 children per woman to 2.6 over the past 30 years, employing educational campaigns and slogans like "two is enough." Although it faced initial resistance in the 1960s, the government engaged religious leaders in the policy dialogue to reach consensus and ease concerns about certain methods, like the IUD. Because of this engagement, "religion does not play a big role in the decision to use family planning," said Hardee, and Islamic leaders support family planning for the benefits it offers families.
The four studies, based on surveys and in-depth interviews, found that family planning did not have a strong influence on women's work habits, since the contraceptive use rate was already high (about 60 percent). While the number of children did not appear to affect whether a woman worked for income, women with fewer children were more likely to report higher family incomes. Family planning was associated with some aspects of women's empowerment within the family, such as communicating with their husbands about family planning and economic decision-making. However, regardless of family planning use, the division of household duties remained strictly gender-based, with women responsible for domestic chores and daily expenditures.
In general, women reported positive attitudes about family planning, as it relieved their workload and financial burdens. They reported negative experiences with side effects from some contraceptives, leading some to switch methods. To improve services, Hardee recommended that the clinics offer more information about choices, recruit female service providers, spend more time with patients, set longer hours, and offer less expensive methods.
Drafted by Meaghan Parker.