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Q&A: Teens Wrongly Excluded From Family Planning

Ben Case interviews NAFISSATOU DIOP of the Population Council

UNITED NATIONS, Jul 9 2009 (IPS) - Nafissatou Diop has worked for decades on issues of reproductive health, HIV/AIDS and development in West Africa, including designing and implementing many studies and programmes.

An associate with the Dakar bureau of the Population Council, an international NGO, she holds a Ph.D. in demographics as well as masters degrees in the socioeconomics of development and sociology.

She spoke with IPS correspondent Ben Case about the many obstacles to reproductive health education, and the importance of involving men in issues of contraception and family planning.

IPS: So what are some of the main issues surrounding family planning? NAFISSATOU DIOP: I think that the biggest issue is really to overcome some social cultural barriers and open family planning programmes and services to young people.

In most developing countries we need to recognise that opposition to family planning programmes is higher when it is addressing young people under the age of 20 years because those people are not supposed to have sex, and if they have sex this is within the marriage, and if they are married and have sex, then they should be having children. So they argue there is no reason young people should have family planning.

We need to really push and make sure we say more and more that sexual activity is happening within and without of marriage and those girls – even if they are married – they sometimes don’t want to have children rapidly. Some people find that they’re young and they just don’t want to have the responsibility of having a child.

The other thing is we need to realise is that the circumstance of marriage in a lot of cases in Sub-Saharan Africa is not voluntary, it is some kind of forced marriage. In these cases there is no love or emotional positive engagement. So most of those girls do not want children as soon as they get married.

And there are a lot of young people who are not married and who are sexually active and they need to be protected also.

IPS: Why is education alone not enough? Why do we need family planning? ND: We have to realise that people are having sex. Education is good, but we need to deal with the reality that people need other methods. I think that we need family planning because we do not want unwanted pregnancy.

We want people to have children, great, but we want people to have children when they are ready to have them, and ready means they have to be emotionally mature and economically able to raise a child, which is not always the case when you are young and in school.

We need family planning because we don’t want dropout of girls from school because of pregnancy. We are already fighting to have those girls in school. There are even more inequities here because the girl will stop school if there is a pregnancy but the boy will continue.

We need family planning because many unwanted pregnancies end in self abortion and we don’t want this. This is something very unsafe, particularly in countries where abortion is illegal, so when people do unsafe abortions it we see a lot of trauma and even maternal mortality.

IPS: So you are saying it is less about reducing population growth than it is about health and quality of raising children? ND: Exactly. This is really the argument that we want to use at field level because if you talk about population growth, of course as a demographer there is a real issue of population growth, but for a lot of people this is not really an important issue.

Africa, as you know, went through centuries of slavery. So we believe we lost a lot of our population and people are still thinking that there is some replacement needed in terms of population. So the population argument is one that is not really used even at the policy level because they think that we are missing some of our population who were taken to America.

Then they are given examples like India and China, which are really growing and expanding their economies and they have huge populations. So when you get more into maternal mortality and morbidity, those elements are more important to people and that’s when people start to think they should put in their effort and invest their money.

So at the field level we need to keep this argument really present in the way we are talking about family planning. But that may not be the case for U.S. agencies, who are looking at it from a different perspective.

IPS: How do gender inequities play into this? How do you get men to care and participate in family planning? ND: This is a main issue. Men are very important and so far I have not seen good male involvement programmes. There are small pilots being tested here and there to see how to bring those men in and make them interested in family planning programmes and make them interested in the health of women, but most times it isn’t really working.

The main indicator we can see is the ideal number of children. You can see that men have higher ideal number of children than women. When they want six children, women want four. So we really need to build programmes that increase the participation of men.

But of course the problem then is how. They tend to be very interested in economics. Men are looking for money. And football, they are very interested in football and basketball and sports in general and they don’t want to go to clinics or take classes. So the issue is where you can target them, where you can touch them and talk and communicate with them.

This is where religious leaders can be used. Often, congregations are made of men, either Christian or Muslim, and this is where we are doing a lot of activities to get male involvement, because at least you know how to get them in one place. For the rest of the population you can try to use targeted messages.

IPS: You brought up religion. In parts of sub-Saharan Africa, the church has been pushing for abstention. Has that been an issue? ND: This is a very big issue. Countries where a large percentage of the population is Christian, primarily Catholic, we are really facing a lot of problems. Then of course when you have Protestant or Muslim communities, they tend to be much more open. Islam is even more open to family planning and contraception for the beauty of the woman as well as for her health and this is written in the Qur’an.

The Catholic Church is really where we are getting the problems. In countries like Kenya and Ghana, contraception is taboo and there we are still struggling with churches over this. Recently we had the visit of the pope in Africa and he again made strong statements against condoms. This is really something we are struggling with. We want to work with them but I really don’t think we will get any kind of commitment from them.

What is interesting though is in other parts you can see that Catholic nurses, for example, they are giving pills and everything because they are looking at the situation and they are recognising that this is important. Their first rule is to preserve lives and by giving that pill or that condom they are achieving that. So we do see some Catholics who are facing the reality and helping as opposed to listening to the pope.

IPS: What do you think the best next step would be? ND: I think the next step would be to raise awareness and increase funding for family planning. Over the last 20 years these programmes have become more weak and under-funded.

The second thing is I hope that the marginalised people we have identified (in a recent UNFPA conference) will be more taken into account in our programmes, particularly in UNFPA programmes in the field. We really need to look at the data and find the vulnerable groups and what their needs are and respond to that.