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

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.

Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

“…In instances when side effects presented, these leaders interpreted it as a punishment from God and only discontinuing it would be the way to relief and freedom. Other studies found similar ndings and as discontinuation of any methods were linked to perceived comfort, often times such false narratives were accepted as truth [16,17] Furthermore, the discussions brought light to the fact that spousal miscommunication, unbalanced power and gender roles and non-involvement of male in family planning awareness program hinder the success of family planning interventions. This is underlined by cultural norms in favour of large families and patriarchal society where family planning decisions must be approved by men considered as head of the family but the latter has limited knowledge in the subject matter as family planning is known to be a "women thing".…”

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

“…We sought to use this established methodology to increase uptake of FP. In focus group discussions with Protestant church attenders, many men and women were unsure whether planning their families was compatible with their faith 6. Further, we reported that gender dynamics strongly impact a person’s uptake of FP and that despite misgivings about FP, focus group participants often noted its economic and maternal/child health benefits 6…”

“…Our study had three key goals. First, we further analysed prior data from focus group discussions6 with predominantly Protestant church attenders to construct a theoretical framework for understanding the multidimensional factors impacting the decision to use FP. Second, based on identified interpersonal and intrapersonal barriers to FP, we designed an educational seminar for church leaders.…”

Beyond knowledge acquisition: multilevel factors influencing family planning utilization among women in conservative communities in Rural Burundi.

“…In instances when side effects presented, these leaders interpreted it as a punishment from God and only discontinuing it would be the way to relief and freedom. Other studies found similar findings and as discontinuation of any methods were linked to perceived comfort, often times such false narratives were accepted as truth [16,17] Furthermore, the discussions brought light to the fact that spousal miscommunication and noninvolvement of male in family planning awareness program hinder the success of family planning interventions. This is underlined by cultural norms in favour of large families and patriarchal society where family planning decisions must be approved by men considered as head of the family but the latter has limited knowledge in the subject matter as family planning is known to be a "women thing".…”