Family planning program in Senegal drawn into conflict with religious leaders

Washington Post

IN MERETO, SENEGAL — From the corner of his family’s bustling courtyard, El Hadji Fally Diallo looked out approvingly at his large extended family. Several women with babies on their hips prepared the massive midday meal, and children studying the Koran mumbled verses to themselves.

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“It’s like we expanded from one family to three,” Diallo, a 76-year-old village leader, said of his own three wives and expansive brood. “With 30 children, some can go to the field, some can deal with the cattle, some can go abroad. It’s a lot of money you can have with this size family, so that is a lot of power.”

The Diallos have a time-tested definition of success in which a large family plays a central role. But that model is clashing with a government program to increase contraceptive use and reduce family sizes. Largely financed by international donors, the program is part of a global campaign that aims to give 120 million more women around the world access to contraception by 2020.

For supporters of the program, the benefits of contraception are clear: better health for women and children, economic benefits and smaller families.

This last justification, smaller families — and so smaller populations — has drawn the women’s health program into conflict with religious leaders and rekindled suspicions about the motivations for international aid.

For Diallo and his son Ibrahima Diallo, who is an imam, their large family is not only an economic boon, it is also a moral imperative.

“If Europeans say the population is too large so we need to limit births, Islam can’t agree with that because God says, ‘You are my people, multiply,’ and it is the duty of God to take care of the family,” the younger man said. “It’s not for Europeans to bring family planning and say, ‘You have a large population, you will have consequences.’ ”

Senegal, a country of 13 million, is 94 percent Muslim, and the views of imams such as Diallo are deeply respected.

West Africa has one of the lowest rates of contraceptive use in the world. And while some local activists have been pushing for family planning for decades, much of the current programming is funded by international donors.

A Senegalese women’s rights network called Siggil Jigeen has been advocating family planning for nearly two decades, and program director Fatou Ndiaye Turpin is frustrated with its dismal progress. The biggest hindrances, she said, are Islam and rumors about side effects of contraception.

“If religion allowed it, there would be no problem,” she said.

Siggil Jigeen regularly works with imams to find ways to promote theological justifications for family planning, such as highlighting sections of the Koran that emphasize preserving women’s health and spacing children. “It’s always men who come and say this is forbidden by Islam,” she said. “Women don’t know what’s in the Koran.”

Turpin said she has been criticized for promoting what many here see as an international agenda that goes against Senegalese values. “Some people understand our mission, but some think this is an invasion that came from outside the country because they give us money,” she said.

At a global conference on family planning in Addis Ababa, Ethiopia, in November, numerous sessions focused on explosive population growth. West Africa and the Sahel region were highlighted as particularly vulnerable. By 2050, the region’s population could triple to 300 million, worsening an already palpable food crisis.

The United Nations projects Senegal’s population to reach 58 million by 2100, largely because of the high birth rate. Women here have an average of five children; in rural areas such as Mereto, the average is 6.3.

At the Ministry of Health, Bocar Daff, the director of reproductive health, said that his role is to “improve the health of the population.” A lower fertility rate would “affect the development, security, school, electricity, it’s clear,” he said, “but if we go to the population, I don’t think that’s the strategic way” to present the issue.

But at the financial ministry, Lanfia Diané, who works in the population and development planning division, was more direct.

“The population should be at the heart of all development,” he said, “Five children per woman? No country in the world has developed themselves with this rate.”

In the Diallo courtyard, such macro-level analyses are discounted as culturally inapplicable. “In Senegal, we have solidarity; you can take your child to . . . your brother’s house for help,” Imam Diallo said. “We can have even a bigger and bigger population, but with solidarity we won’t have problems.”

Family planning activists often point to the economic strain of a population with fewer workers than dependents. But religious leaders worry that the focus on family size ties contraceptive programs with population control, something most imams see as un-Islamic.

“Family planning is not reproductive health, is not space between babies; it’s not health of women, it’s to limit births,” said Imam Ahmed Ndiaye, an outspoken critic of family planning programs and a frequent guest on television programs in the capital, Dakar.

But little by little, Senegalese women are turning to family planning themselves as they learn about contraception from each other, community health workers and government radio announcements.

In Koumpentoum, the district where the Diallos live, only 4.7 percent of women used family planning methods in 2013, according to the health center. And midwives say the tiny minority who use contraceptives often hide them from their husbands.

Yassin Diouf, 40, who lives across the village from the Diallo family, has had 10 children, though only six survived. She has used contraception in the past and plans to use it again.

“No more, this is enough, thank you, thank you, God. God help me to stop here,” she said, cooing to her suckling 4-month-old baby. “Maybe it’s forbidden by Islam, but women are so tired of giving birth.”

Allyn Gaestel reported from Senegal with support from the International Reporting