This Wednesday, at the International Conference on Family Planning in Addis Ababa, Pathfinder International presented an interactive session titled “Overcoming Socio-cultural Barriers, Myths and Misconceptions to Scale Up Family Planning Services”. This session discussed innovative approaches for scaling-up family planning services in places where socio-cultural barriers play a significant role in hindering a women’s ability to plan her family.
It can be difficult to convince people, both women and men, to use health services that are not familiar to them or that are different from their traditional approaches to medicine – cultural beliefs or folk methods may trump doctor’s orders. For example, in rural parts of Mexico some women give birth in a cement dome called a temazcal. A temazcal is a heated “sweat lodge” or steam room used for giving birth, healing the sick, and purifying the body. If you were told by a foreign doctor that you were going to give birth in a temazcal, I’m sure you would not be ecstatic to hear the news, and at the very least you would have a lot of questions to ask. The same applies to some Mexican women who are being asked to give birth in a hospital.
Often, individuals go without life saving treatment not only because of a lack of access, but sometimes because of a fear of the unfamiliar. In Mexico, there are some hospitals that have begun combining folk methods and western medicine to ensure the safest birth outcomes and create a familiar atmosphere for the women.
In the case of family planning, the difficult part is not convincing an individual that the service will be beneficial to them – in most communities women want to be able to plan their families. The difficulty lies in changing structures and systems that currently hinder women’s ability to access family planning services, and eliminating social stigma. Cultural beliefs that prevent women from making their own decisions negatively impact the implementation of family planning services. Overcoming these barriers requires innovative approaches that are different from those implemented for other health care services.
Most women I know in the US have a plan regarding their education, career, marriage, and when they hope to start a family. We all want to be prepared to give our families the best we possibly can. In many countries, however, women do not have these choices, and conversely, having children may determine whether or not they can pursue an education or a career. In developing countries, women have increased risk of dying in childbirth, are controlled by their husbands, and their value can be determined by their fertility.
Sabah Salum, a women interviewed in Tanzania about family planning, said:
I think it is good to help mothers plan their family. It is tiresome to have children almost every year.
The following are some examples of socio-cultural barriers to family planning in the Democratic Republic of the Congo. Although each community has its own socio-cultural barriers to family planning, many of the same issues that exist in the DRC are similar in other francophone sub-Saharan African countries.
- Traditionally, having many children symbolized high social status
- Adolescents are not considered adults until they have a child
- Dowry’s suggest that women must bear many children as a way to repay it
- Women become a man’s property after marriage, therefore having little say in family planning
- In impoverished areas, women have few choices other than becoming a mother and wife
- Prior to 1960, the Belgian Congo provided financial incentives for large families
- Christian churches that are well established in Africa oppose the use of contraceptives
Other general cultural barriers to family planning include:
- Social stigma
- Rumors and myths about contraceptives i.e. that condoms are only used to prevent STI transmission
- Lack of male involvement in family planning
- Familial pressure
- Fear of side effects of services
- Early marriage
- Factors associated with poverty or trauma in the population
- Domestic violence
- Decision-making positions being fully or mainly controlled by men within the community
The interactive session held in Addis Ababa on Wednesday focused on how to break through these cultural barriers and get family planning services to those who want and need them. Some potential approaches are:
- Including males in family planning counseling and procedures
- Involving religious leaders
- Providing accurate information to dispel myths
- Including women in positions of power in the local community
Removing cultural barriers is only one part of creating access to family planning services. There are numerous other issues to tackle in order to scale-up services such as providing accessible facilities, adequate staff and supplies, and providing clear information.
Find out what innovative approaches are being discussed at ICFP to scale-up global family planning services by using #ICFPLive and #ICFP2013 hashtags, and following @GirlsGlobe, @FPAddis2013 and @FHI360 on Twitter!