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Published in: BMC Women's Health 1/2019

Open Access 01-12-2019 | Contraception | Research article

How gender and religion impact uptake of family planning: results from a qualitative study in Northwestern Tanzania

Authors: Radhika Sundararajan, Lauren Mica Yoder, Albert Kihunrwa, Christine Aristide, Samuel E. Kalluvya, David J. Downs, Agrey H. Mwakisole, Jennifer A. Downs

Published in: BMC Women's Health | Issue 1/2019

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Abstract

Background

Women in Tanzania report a high unmet need for both information about and access to family planning. Prior studies have demonstrated the complex and variable relationship between religious faith and beliefs about family planning in sub-Saharan Africa. We hypothesized that a major reason for the poor uptake of family planning in Tanzania is that women and their partners are uncertain about whether pregnancy prevention is compatible with their religious beliefs.

Methods

Twenty-four focus group discussions with 206 participants were conducted in Mwanza, Tanzania between 2016 and 2017: six groups were conducted among Christian men, six among Christian women, six among Muslim men, and six among Muslim women. Among Christians, 98% were Protestants. Focus groups were also divided by gender and religion to facilitate discussion about gender-specific and religion-specific factors influencing family planning utilization. Qualitative data were analyzed using a thematic, phenomenological approach.

Results

We identify two important themes regarding the intersections of religion and family planning practices. First, we report that dynamics of family planning are experienced differently based on gender, and that male authority conflicts with female embodied knowledge, leading to negotiation or covert contraceptive use. Second, religious acceptability of family planning methods is of central importance, though participants differed in their interpretations of their religion’s stance on this question. Most who found family planning incompatible with their faith affirmed their responsibility to give birth to as many children as God would give them. Others found family planning to be acceptable given their moral responsibility to care for and protect their children by limiting the family size.

Conclusions

Both religious tradition and gender dynamics strongly influence the uptake of family planning, with a wide range of interpretations of religious traditions affecting the perceived acceptability of family planning. Regardless of gender or religious affiliation, participants were unified by a desire to live according to religious tradition. Future efforts to improve uptake of family planning are likely to have maximal impact if they are tailored to inform, involve, and empower male heads of households, and to address questions of religious acceptability.
Literature
3.
go back to reference Schummers L, Hutcheon JA, Hernandez-Diaz S, Williams PL, Hacker MR, VanderWeele TJ, et al. Association of Short Interpregnancy Interval with pregnancy outcomes according to maternal age. JAMA Intern Med. 2018;178:1661.CrossRef Schummers L, Hutcheon JA, Hernandez-Diaz S, Williams PL, Hacker MR, VanderWeele TJ, et al. Association of Short Interpregnancy Interval with pregnancy outcomes according to maternal age. JAMA Intern Med. 2018;178:1661.CrossRef
5.
go back to reference Dynes MM, Bernstein E, Morof D, Kelly L, Ruiz A, Mongo W, et al. Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma region, Tanzania: a cross-sectional study, April-July 2016. Reprod Health. 2018;15:152.CrossRef Dynes MM, Bernstein E, Morof D, Kelly L, Ruiz A, Mongo W, et al. Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma region, Tanzania: a cross-sectional study, April-July 2016. Reprod Health. 2018;15:152.CrossRef
6.
go back to reference Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health. 2013;13:523.CrossRef Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health. 2013;13:523.CrossRef
7.
go back to reference Mwageni EA, Ankomah A, Powell RA. Attitudes of men towards family planning in Mbeya region, Tanzania: a rural-urban comparison of qualitative data. J Biosoc Sci. 1998;30:381–92.CrossRef Mwageni EA, Ankomah A, Powell RA. Attitudes of men towards family planning in Mbeya region, Tanzania: a rural-urban comparison of qualitative data. J Biosoc Sci. 1998;30:381–92.CrossRef
8.
go back to reference Msovela J, Tengia-Kessy A. Implementation and acceptability of strategies instituted for engaging men in family planning services in Kibaha district, Tanzania. Reprod Health. 2016;13:138.CrossRef Msovela J, Tengia-Kessy A. Implementation and acceptability of strategies instituted for engaging men in family planning services in Kibaha district, Tanzania. Reprod Health. 2016;13:138.CrossRef
9.
go back to reference Schenker JG. Women's reproductive health: monotheistic religious perspectives. Int J Gynaecol Obstet. 2000;70:77–86.CrossRef Schenker JG. Women's reproductive health: monotheistic religious perspectives. Int J Gynaecol Obstet. 2000;70:77–86.CrossRef
11.
go back to reference Gudorf CE. Contraception and abortion in Roman Catholicism. In: Maguire DC, editor. Sacred rights: the case for contraception and abortion in world religions. Oxford: Oxford Scholarship Online; 2011. p. 55–78.CrossRef Gudorf CE. Contraception and abortion in Roman Catholicism. In: Maguire DC, editor. Sacred rights: the case for contraception and abortion in world religions. Oxford: Oxford Scholarship Online; 2011. p. 55–78.CrossRef
12.
go back to reference Albrecht GH. Contraception and abortion within Protestant Christianity. In: Maguire DC, editor. Sacred rights: the case for contraception and abortion in world religions: Oxford Scholarship Online; 2011. p. 79–104. Albrecht GH. Contraception and abortion within Protestant Christianity. In: Maguire DC, editor. Sacred rights: the case for contraception and abortion in world religions: Oxford Scholarship Online; 2011. p. 79–104.
13.
go back to reference Shaikh S. Family planning, contraception, and abortion in Islam: undertaking Khilafah. In: Maguire DC, editor. Sacred Rights: The Case for Contraception and Abortion in World Religions: Oxford Scholarship Online; 2011. p. 105–28. Shaikh S. Family planning, contraception, and abortion in Islam: undertaking Khilafah. In: Maguire DC, editor. Sacred Rights: The Case for Contraception and Abortion in World Religions: Oxford Scholarship Online; 2011. p. 105–28.
14.
go back to reference Serour GI. Ethical issues in human reproduction: Islamic perspectives. Gynecol Endocrinol. 2013;29:949–52.CrossRef Serour GI. Ethical issues in human reproduction: Islamic perspectives. Gynecol Endocrinol. 2013;29:949–52.CrossRef
15.
go back to reference Dardir AM, Ahmed W. Islam and birth planning: an interview with the grand mufti of Egypt. Popul Sci. 1981:1–5. PMID: 12339475. Dardir AM, Ahmed W. Islam and birth planning: an interview with the grand mufti of Egypt. Popul Sci. 1981:1–5. PMID: 12339475.
16.
go back to reference Varley E. Islamic logics, reproductive rationalities: family planning in northern Pakistan. Anthropol Med. 2012;19:189–206.CrossRef Varley E. Islamic logics, reproductive rationalities: family planning in northern Pakistan. Anthropol Med. 2012;19:189–206.CrossRef
17.
go back to reference Krehbiel Keefe S. “Women do what they want”: Islam and permanent contraception in northern Tanzania. Soc Sci Med. 2006;63:418–29.CrossRef Krehbiel Keefe S. “Women do what they want”: Islam and permanent contraception in northern Tanzania. Soc Sci Med. 2006;63:418–29.CrossRef
18.
go back to reference Mosha IH, Ruben R. Communication, knowledge, social network and family planning utilization among couples in Mwanza, Tanzania. Afr J Reprod Health. 2013;17:57–69.PubMed Mosha IH, Ruben R. Communication, knowledge, social network and family planning utilization among couples in Mwanza, Tanzania. Afr J Reprod Health. 2013;17:57–69.PubMed
19.
go back to reference Hallfors DD, Iritani BJ, Zhang L, Hartman S, Luseno WK, Mpofu E, et al. “I thought if I marry the prophet I would not die”: the significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe. SAHARA J. 2016;13:178–87 1st ed. Taylor & Francis.CrossRef Hallfors DD, Iritani BJ, Zhang L, Hartman S, Luseno WK, Mpofu E, et al. “I thought if I marry the prophet I would not die”: the significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe. SAHARA J. 2016;13:178–87 1st ed. Taylor & Francis.CrossRef
20.
go back to reference Yeatman SE, Trinitapoli J. Beyond denomination: the relationship between religion and family planning in rural Malawi. Demogr Res. 2008;19:1851–82.CrossRef Yeatman SE, Trinitapoli J. Beyond denomination: the relationship between religion and family planning in rural Malawi. Demogr Res. 2008;19:1851–82.CrossRef
22.
go back to reference Downs JA, Mwakisole AH, Chandika AB, Lugoba S, Kassim R, Laizer E, et al. Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial. Lancet. 2017;389:1124–32.CrossRef Downs JA, Mwakisole AH, Chandika AB, Lugoba S, Kassim R, Laizer E, et al. Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial. Lancet. 2017;389:1124–32.CrossRef
23.
go back to reference Sandelowski M, Barroso J. Classifying the findings in qualitative studies. Qual Health Res. 2003;13:905–23 SAGE Publications.CrossRef Sandelowski M, Barroso J. Classifying the findings in qualitative studies. Qual Health Res. 2003;13:905–23 SAGE Publications.CrossRef
24.
go back to reference Smith J, Osborn M. Interpretive phenomenological analysis. In: Smith JA, editor. Qualitative psychology: a practical guide to research methods. SAGE publications. 3rd ed; 2015. p. 53–80. Smith J, Osborn M. Interpretive phenomenological analysis. In: Smith JA, editor. Qualitative psychology: a practical guide to research methods. SAGE publications. 3rd ed; 2015. p. 53–80.
25.
go back to reference Davidson AS, Fabiyi C, Demissie S, Getachew H, Gilliam ML. Is LARC for everyone? A qualitative study of sociocultural perceptions of family planning and contraception among refugees in Ethiopia. Matern Child Health J. 2017;21:1699–705.CrossRef Davidson AS, Fabiyi C, Demissie S, Getachew H, Gilliam ML. Is LARC for everyone? A qualitative study of sociocultural perceptions of family planning and contraception among refugees in Ethiopia. Matern Child Health J. 2017;21:1699–705.CrossRef
26.
go back to reference Farmer DB, Berman L, Ryan G, Habumugisha L, Basinga P, Nutt C, et al. Motivations and constraints to family planning: a qualitative study in Rwanda's southern Kayonza District. Glob Health Sci Pract. 2015;3:242–54.CrossRef Farmer DB, Berman L, Ryan G, Habumugisha L, Basinga P, Nutt C, et al. Motivations and constraints to family planning: a qualitative study in Rwanda's southern Kayonza District. Glob Health Sci Pract. 2015;3:242–54.CrossRef
27.
go back to reference Harrington EK, Dworkin S, Withers M, Onono M, Kwena Z, Newmann SJ. Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya. Cult Health Sex. 2016;18:453–69.CrossRef Harrington EK, Dworkin S, Withers M, Onono M, Kwena Z, Newmann SJ. Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya. Cult Health Sex. 2016;18:453–69.CrossRef
28.
go back to reference Gasca NC, Becker S. Using Couples’ discordant reports to estimate female covert use of modern contraception in sub-Saharan Africa. J Biosoc Sci. 2018;50:326–46.CrossRef Gasca NC, Becker S. Using Couples’ discordant reports to estimate female covert use of modern contraception in sub-Saharan Africa. J Biosoc Sci. 2018;50:326–46.CrossRef
29.
go back to reference Fleming PJ, Silverman J, Ghule M, Ritter J, Battala M, Velhal G, et al. Can a gender equity and family planning intervention for men change their gender ideology? Results from the CHARM intervention in rural India. Stud Fam Plan. 2018;49:41–56.CrossRef Fleming PJ, Silverman J, Ghule M, Ritter J, Battala M, Velhal G, et al. Can a gender equity and family planning intervention for men change their gender ideology? Results from the CHARM intervention in rural India. Stud Fam Plan. 2018;49:41–56.CrossRef
30.
go back to reference Thummalachetty N, Mathur S, Mullinax M, DeCosta K, Nakyanjo N, Lutalo T, et al. Contraceptive knowledge, perceptions, and concerns among men in Uganda. BMC Public Health. 2017;17:792.CrossRef Thummalachetty N, Mathur S, Mullinax M, DeCosta K, Nakyanjo N, Lutalo T, et al. Contraceptive knowledge, perceptions, and concerns among men in Uganda. BMC Public Health. 2017;17:792.CrossRef
31.
go back to reference Lutalo T, Gray R, Santelli J, Guwatudde D, Brahmbhatt H, Mathur S, et al. Unfulfilled need for contraception among women with unmet need but with the intention to use contraception in Rakai, Uganda: a longitudinal study. BMC Womens Health. 2018;18:60.CrossRef Lutalo T, Gray R, Santelli J, Guwatudde D, Brahmbhatt H, Mathur S, et al. Unfulfilled need for contraception among women with unmet need but with the intention to use contraception in Rakai, Uganda: a longitudinal study. BMC Womens Health. 2018;18:60.CrossRef
32.
go back to reference Downs JA, Fuunay LD, Fuunay M, Mbago M, Mwakisole A, Peck RN, et al. “The body we leave behind”: a qualitative study of obstacles and opportunities for increasing uptake of male circumcision among Tanzanian Christians. BMJ Open. 2013;3:e002802.CrossRef Downs JA, Fuunay LD, Fuunay M, Mbago M, Mwakisole A, Peck RN, et al. “The body we leave behind”: a qualitative study of obstacles and opportunities for increasing uptake of male circumcision among Tanzanian Christians. BMJ Open. 2013;3:e002802.CrossRef
Metadata
Title
How gender and religion impact uptake of family planning: results from a qualitative study in Northwestern Tanzania
Authors
Radhika Sundararajan
Lauren Mica Yoder
Albert Kihunrwa
Christine Aristide
Samuel E. Kalluvya
David J. Downs
Agrey H. Mwakisole
Jennifer A. Downs
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Contraception
Published in
BMC Women's Health / Issue 1/2019
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-019-0802-6

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