Updated: November 13, 2018 12:05:43 am
Talking family planning can never be easy in a mixed religious, conservative population, where it is normal for a woman to have up to six children. But in this sprawling health facility in the eastern corner of tiny Rwanda, health workers, faced with local Catholic priests’ resistance, have turned the Bible into an ally to talk about family planning.
The law in Rwanda requires written consent from husbands before wives can opt for any permanent contraceptive method. But the unwillingness of faith-based health centres to stock contraceptive items and the resistance of local clerics, especially the Catholic ones, became an increasingly difficult barrier to surmount. That is when the health establishment responded with their own interpretation of the Bible.
Esther Imaniragena, a nurse and a community worker mentor at the health centre that caters to a population of over 51,000, talks about how the lines in the First Timothy Chapter 5 Verse 8 were re-interpreted. “The lines roughly are ‘If anyone does not provide for his own, and especially his own household, he has denied the faith and is worse than an unbeliever’. We tell people that the Bible asks you to educate and feed your children well, how can you deny them that by having too many babies. Bible makes it obligatory for you to give them a decent living. It works,” Esther says with a triumphant smile.
But, normally, she says, it is the education levels of the men that determine their willingness to talk contraception rather than their religion. There have not been such receptivity issues, she clarifies, with the local Imams, who have participated more willingly in the government’s initiatives to involve faith leaders in family planning messaging.
The experiences of Esther and many others like her in Rwanda and around the world will be the focus over the next three days at the International Conference on Family Planning in Kigali. In the run up to the conference, an annual report on family was released. The report for the first time compiles spending by countries and shows that with a total expenditure of $249,000,000 in 2016, India spent the most on family planning. The country also has one of the oldest family planning programmes dating back to 1951, but according to a recent UN report, is set to surpass China in population by 2024.
Esther, meanwhile, says that the most challenging part of her job is to get the men to participate in family planning initiatives, that between January and September 2018, 50 per cent of all family planning related products dispensed/administered were intra-uterine contraceptive devices and injectable contraceptives — both of which require the husband’s written consent — shows that the strategy of counselling, not setting targets for family planning and having the binomes (community health workers who work voluntarily) on the ground has worked. In fact, says Philbert Muhive, manager of the health centre, sterilisation, both male and female, forms a minuscule percentage of contraceptive measures administered.
At four children, Nyirangabira Chantal, who is waiting at the centre for her next contraceptive shot, has touched the average fertility mark of Rwandan women. She has been on the shots for eight years, she says, and it was not at all difficult to get her husband’s consent, Chantal says, speaking through an interpreter.
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