By Anna Louie Sussman
Tuesday, March 13, 2007
Yemen has scored enormous success in reducing maternal mortality rates and increasing contraception use. Advocates turned to religious leaders to help get out the message. Third in a series on women changing religious institutions and practices.
SANA'A, Yemen (WOMENSENEWS)--No matter what she heard to the contrary, Jamila Ghalib Al-Sharie was sure that her religion did not intend women to have more babies than were good for their own health or the overall well-being of their families.
"When we first began talking about contraception, women would tell us 'No, it is haram (forbidden). We cannot use these things; it is not allowed,'" says Al-Sharie. "It was a challenge to let people know what is correct in the Quran and the Sunnah," she adds, referring to the Muslim holy book and religious practice established by the Prophet Muhammad.
Using religious belief and the power of Islamic religious leaders, Al-Sharie and other advocates have succeeded in a dramatic change in the demographics of Yemen and the health of mothers.
In 1990, when Al-Sharie joined the Yemen Family Care Association, national health surveys showed that Yemen's fertility rate and maternal mortality rate were among the highest in the world. On average, a woman would have more than eight childbirths over a lifetime, while women died in childbirth at the rate of 1,400 per 100,000 live births, according to United Nations data.
Political leaders also recognized that the spiraling population--expected to more than triple to 38.8 million by 2025 from 12 million in 1990--would exert unsustainable pressure on the country's economy and knew they needed to act.
Al-Sharie, currently an advisor on community mobilization for a basic health services project for the U.S. Agency for International Development and other reproductive health providers, found that discussing contraceptives with women went nowhere fast, due to what she believed were misconceptions about religious prohibitions on their usage.
Fighting fire with fire, she began using her knowledge of the Quran, which she studies privately and also studied through her work at the family care association, to demonstrate that Islam encourages family planning.
Traveling throughout Yemen, she met with rural women, as well as male political and religious leaders, to spread the word about the Prophet Muhammad's take on family planning.
Working in conjunction with the Ministry of Religious Affairs, the National Population Council and the U.N. Population Fund, Al-Sharie and her colleagues aimed their programs high and low. They trained some of the country's most powerful sheikhs and imams to spread the message.
They also worked at the grassroots level, recruiting men from afternoon qat-chewing, a daily Yemeni ritual where men usually spend hours chewing a mildly narcotic leaf and talking in someone's home. Under Al-Sharie's influence, some of these groups started meeting in a spare room at a ministry or, in the rural areas, in the home of the local sheikh to discuss reproductive health and its importance in Islam.
"Men are the decision-makers in the family so we need to target them so they know to send their wives to clinics for care," says Al-Sharie.
The Yemen Family Care Association handed over the training sessions to the U.N. Population Fund in 1999.
Since then, the U.N. has trained hundreds of sheikhs from around the country to speak about issues of reproductive health, from the importance of family planning to HIV-AIDS prevention. While they themselves are not medically trained, they are given accurate information about the means of prevention and transmission, immunization campaigns, patient's rights and instructions to send their constituencies to clinics and to allow health workers into their homes.
The religious leaders later return to their mosques and deliver these messages in well-attended Friday sermons.
The basis for the workshops are manuals and materials prepared by Yemeni ministries, nongovernmental organizations and external consultants such as the International Planned Parenthood Federation, and compilations of rulings and opinions from such religious institutions as Al-Azhar in Cairo, widely regarded as an authority on Sunni Muslim theology.
"There are concepts of birth spacing in the Quran," says Al-Sharie. "For example, it says to breastfeed for at least two years because it is good for the health of the woman and the child. So for this she needs at least three years between children. It also says that parents are responsible for their children and they must provide a good life for them. So it is better to have less and to take good care of them than to have too many, because if you do not give them a good life, you will be held accountable before God."
The family planning message caught on.
Since 1990, the fertility rate has declined to 6.2 births from 8.3 live births per lifetime, according to statistics from the U.N. Population Fund and the Washington-based Population Reference Bureau. Maternal mortality has been more than halved, down to 366 deaths per 100,000 live births in 2003, from 1,400 deaths per 100,000 live births in 1990, according to a 2003 national demographic survey and World Health Organization data.
The key, says Sawsan Al-Refai, gender program officer for the population fund in Yemen, was to frame the message in a religious way, one that was acceptable to Yemen's deeply religious and conservative society, where most women wear the full veil and niqab, a face covering that reveals only the eyes, and often gloves as well.
"We are trying to transform society using its strengths instead of imposing ideas from outside," says Al-Refai.
Al-Refai says that because extra-marital relationships are not allowed in Quranic text, and are not culturally acceptable, unmarried people refrain from demanding family planning services.
"It's not on the agenda, because it's not accepted by the community, or by tradition, or religion. It's not an issue people would want addressed, because no one would want the community to know that they were having a sexual life outside marriage," she says.
Many religious leaders have cooperated in the pro-contraception push. Some have even appeared on TV and radio public service ads aimed at raising awareness of reproductive health issues and destigmatizing AIDS, which is estimated at between 10,000 to 11,000 cases in the population of 22 million, according to Al-Refai.
Rashida Ali Al-Nassiri, now the general manager of the General Directorate for Women and Children in the Ministry of Social Affairs and Labor, remembers one instance when she was working at a family planning center in the district of Sayoun.
The local cleric came in asking, "Who are you? What are you doing?" After she explained herself and described the problems that village women were facing, he became happy to help. He opened the mosque yard for her to give family planning lectures to local women, and sent his wife to her to get birth control pills.
Al-Sharie says people were well aware of the financial price they were paying for having such large families in a country where 45 percent of the people live on less than $2 a day, according to 2006 statistics from the Population Reference Bureau.
"You have to give people the background on the health situation, so they know what the problem is," she says. "But you don't have to tell them the economic reasons. They know this from life!"
Dr. Fowzia Jaffar, a long-time advocate for women's health who has worked for Marie Stopes International, the World Bank and now the Ministry of Public Health and Population, agrees. "Most people just can't support three or four children."
Anna Sussman is a freelance writer based in Cairo, Egypt.
This series is supported by The Sister Fund.
United Nations Population Fund, Yemen:
"24 Percent of Yemeni Women Experience Genital Mutiliation":
"YFCA Midwives Graduate to Tackle Maternal Mortality in Remote Areas":