Religious Beliefs and Practices: Roles in Decision-Making about Family Welfare in the Sahel
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Religious Beliefs and Practices: Roles in Decision-Making about Family Welfare in the Sahel

– Okay, well good afternoon. I know people will probably
be coming and going and getting food, but
I think since we have a very rich menu and a short time, that we might as well get started. I’m Katherine Marshall. Welcome, delighted to see you here. We’re going to be speaking today about a vital issue, which is essentially about family welfare, as we frame it. But also demography, particularly focused on the Sahel region, which is
an area that we’re working in. So welcome first to the Berkley Center, celebrating, I think, its
eleventh year now at Georgetown. You’re also here with the World
Faiths Development Dialogue, which is an NGO that was
born in the World Bank and we have scheduled, or
we have planned this event because WFDD had its
board meeting yesterday. So we’re particularly honored to have some of our board members here. Rabbi David Saperstein and Tim Lankester are both key board people
and part of the effort to bridge the gulfs between
the worlds of development and the worlds of religion. Where there is often
neglect or preconceptions, but where there is an enormous potential for improving the quality
of development work. I’m not going to speak much longer, except to say the plan
that we have for today. First, John May, who is a
former World Bank staff member, who has also been in the
Population Reference Bureau, but who is now at Georgetown University. But one of the world’s
leading demographers will give us a bit of an introduction, basically answering the
question why this issue is so important and essentially,
some of the key points. We’re then going to hear
from Rachel Robinson, who is at American University and who is doing research,
particularly on this area. Their bios are on the web, so I’m not going to give
detailed bio information. Then Lauren Hertzog and Wilma
Mui, who are the core staff people of the World Faiths
Development Dialogue, which sits here, will speak about the work that we have done and
are doing in Senegal. And there’s a lot of information
on the table about it. To engage religious leaders in what is a nine country partnership,
the Ouagadougou Partnership, to address the issues of family planning in one of the poorest
regions of the world. Which also is the champion
in terms of the large numbers of children that women are
having and the critical issues that that represents for those countries. So they will talk about that. They have also just been,
last week, in Niger, which is, in many respects, the country people are most concerned about on these issues. So sort of the epitome of the
the challenges of religion, security, family welfare, health, population, human development. So they will talk a little bit about … To give you, in a sense, a
aperitif, but also to tempt you. And Lauren VanEnk from the
Institute of Reproductive Health, here at Georgetown,
will set it a little bit in the context of the work
that that institute does. And finally, last but
not least, Tim Lankester will tell us what he thinks
we should be doing next or will give some comments
about how he sees it. He was saying yesterday
that he’s had three careers. One of them was in the World
Bank, both as a staff member, but also on the Board
of Executive Directors. He also ran the British Development Agency and he has a very distinguished career in a number of academic institutions, so he brings some very special attributes. So with that I will turn it over to John. We’d like this to be informal
but we are taping this for people who can’t
be here, and therefore, we have to ask everyone
to speak from the podium. So that’s the element of formality. John. – Thank you Katherine. Good afternoon or good morning. I would like to say a few
words about African demography, why it’s so important and
what we could do about it. First of all, today,
population of Senagal in Africa is about one billion
persons and that’s projected to be more than two billion by 2050. That’s 2.2 billion and
then will be, perhaps, four billion at the end of the century. So the 21st century will be dominated by, to a large extent, what happens, what doesn’t happen in Sub-Saharan Africa. Now the problem is that this will cause and have consequences,
not only for Africa, but also for the rest of the world. When the world population
will have about 35% of the total population of
the world being from Africa. It’s going to be a
totally different paradigm than the one we have now,
where we have about 18% of the world population coming
from Sub-Saharan Africa. Now next, the key issue for African countries is to get jobs. And they need three
things, they need jobs, they need jobs, they need jobs. According to the IMF,
Sub-Saharan Africa needs about 18 million new jobs every year. To give a comparison with India, India needs about 12
million new jobs every year. Africa needs about 1.5
million new jobs every month. So, how to get those jobs? Especially as the world
economy is changing and you will hear from
Davis, where we are entering into the fourth industrial revolution, might be less needs for those jobs. Now the silver lining in all
this, is that Asia, East Asia, has experienced demographic dividends and that’s an economic
surplus, which is caused by the decrease in
fertility and the change in the structure, when you have relatively more active people and provided
these people have a job, they have themselves less dependents, you can really boost the economy. So now, could Africa replicate
the situation of East Asia? That’s a big policy question mark and I just devoted an
edited volume to this, Africa’s population in search of a demographic dividend, Spring of 2017. Now, the key issue to get
demographic dividends, is to change the structure. And to do that, you need very rapid and significant fertility decline. And that’s not happening as
yet in Sub-Saharan Africa. We have a very rapid decline
in infant and child mortality, which is good news and I
hope it will keep going, but fertility decline is
very slow and sometimes countries are experiencing
fertility stalls, where the fertility would
be stuck at some level, let’s say four and a half children for 10, 15, 20 years or so. So, to conclude, I would like to say that the leadership in
Africa has to realize that fertility decline, a
rapid one and a significant one is needed, if they want to, someday, capture demographic dividends. If you look at all the
emerging market economies, all these countries have achieved what we call the contraceptive revolution. Where they have about 75% of couples using modern methods of contraception. In Africa, we are about 1/3 of
that, it’s about 26% of CPR, the contraceptive preference rate, so they still have a very long way to go. But I am afraid and that’s
my work for the time being, that the leadership doesn’t
realize that there is a linkage between rapid and
significant fertility decline. Now, African fertility is at
about five children per woman. The world fertility is about 2.5, so Africa is about twice above. And they need to have this
rapid fertility decline and I’m afraid that the
link is not yet there, in the mind of the leadership in Africa. So with that conclusion,
I would like to say this seminar today is very
important because we need to have all types of allies if we want to really accelerate the
fertility transition in Africa. It’s not just the supply
of contraceptive methods, it’s also the creation of greater demand for smaller family size and
it’s a lot of social change, gender equity, female
education, you name it. And I think the work you are
doing is extremely important. Thank you. – Rachel. – Good morning. Thank you so much to Katherine and the Berkley Center for the invitation. I’m delighted to be here. In fact, a former student of
mine worked here for a while, Crystal, is she still here? But she really brought to my attention all of the wonderful things that you do. So by way of background,
where I’m coming from, I’m an academic, I’m a sociologist and a demographer, like John. And I’m still shamelessly plugging my book that also came out last year. Which is about the relationship between family planning
and HIV interventions. Focusing on Senegal in
Nigeria as well as Malawi, so I’ll speak from that perspective, as well as some other research. I have two main points
that I’ll make today from my experience studying
both family planning and HIV, but also sexuality education
and politicized homophobia in Sub-Saharan Africa
and those two countries. So first, I would argue
that religious objections to social programs have
as much, or even more to do with concerns about the locusts of institutional authority in society, as they do with the beliefs
of any given religion. So keep that in mind as
an idea to play with. And then second, and relatedly, efforts to build relationships
with religious leaders and broader messaging
about social programs, should address these concerns head on, about the locust of
authority, rather than try to co opt leaders or people
into changing their beliefs. So I’ll address these
points with four examples. The first is positive
contributions by religious leaders to family planning and
HIV prevention in Senegal. The second is challenges
with religious leaders related to family planning in Nigeria. The third is the role of religion in sexuality education in Nigeria. And the fourth is the role of religion in politicized homophobia in Senegal. So first, family and HIV in Senegal. Top line, in short, religious
leaders were important, in a positive way, to
the government’s efforts to provide family planning
and carry out HIV prevention. What made this possible? The intertwined relationship
between religion and politics that has developed in Senegal
through many centuries and that sort of, was
something that could be capitalized upon, both explicitly
and in less direct ways. So in essence, it was
relatively easy for programmers, and I use this term to mean everyone from people within governments,
within civil society, even those working for
development organizations, to reach out to religious leaders to discuss family planning in the 1980s. The barriers were, less high
than in other countries. In the book I talk about
how this experience with family planning
then laid the groundwork for a very similar set of conversations to occur around HIV,
starting in the 1990s. But, there was an important Islamic NGO, by the name of Genre, run
by someone with political and religious connections,
which quickly got involved in HIV programming and helped serve as a very important liaison. So there was a key civil society actor that had both religious
and political ties, that helped make this connection possible. They’ll come back later
on, in my fourth example. So that was example one. Example two, family planning in Nigeria. In short, religious leaders
obstructed government and donor efforts to
provide family planning. Why? Because they interpreted those efforts as taking away their authority. This relates particularly
to what happened, this is somewhat historical. So Nigeria passed a
population policy in 1988, that came to be interpreted
as a four child policy. So again, China has its one child policy, Nigeria’s population
policy was interpreted as a four child policy. Both Christian and Muslim leaders and religious groups strongly
objected to this policy. Christians felt that the
policy was unfair to Christians because it allowed a Muslim man, who could have up to four
wives, to have sixteen children, but a Christian man could only have four. And as I suspect a number
of you are familiar with the politics of
population in Nigeria, constant battles between who is more, Christians versus
Muslims, different states, these types of things. Muslim leaders, although they
sort of won the numbers game in the population policy,
also felt that the policy took away their power, because
it distributed the power about decisions of children to the state and to women, not them. And so, were similarly upset,
though for different reasons. So that’s example two. The third example, religion and sexuality education in Nigeria. In short, religious leaders
have had varying effects on the prioritization and implementation of sexuality education in Nigeria. Why? Because context matters,
it’s not just about religion. So in 2001, Nigeria’s federal government approved a national sexuality
education curriculum, which then meant that
each state was supposed to adopt it and implement it. So Kano, in the very north
of the country, in the Sahel, actually did a very good job with implementing sexuality education, despite what you would expect, in terms of being in a
more conservative state. In large part, because a local
NGO, run by a Muslim woman with great, very high
levels of local legitimacy, worked to support the curriculum. And in particular, she had
gained legitimacy for her NGO, both by being a devout
Muslim and by engaging in a variety of vocational programs, other sorts of programming
that had nothing to do with sex or anything
politically sensitive. Niger State, in central Nigeria,
still the north of Nigeria, but despite being 80% Muslim with Sharia Law practiced in places, it was not that, that
led to a relative failure of implementation of sexuality education, it was bureaucratic bottlenecks
and disorganization. So, straight up problems. They couldn’t decide who was
supposed to be the signatory on the account that was
going to give them the money to implement the programming and things fell apart from there. Then in Lagos, in the more
cosmopolitan, more Christian south of the country, it was parents who were the source of the objection. They framed their objection
to sexuality education, frequently in religious
terms, but I would argue they were deeply concerned
about giving up control over who taught children
about sexuality education. So again, concerns about control and the locusts of institutional control within society, less about religion. I will say as a side note, in an effort to reach compromise across the states in
Nigeria, they were allowed to modify the curriculum
to suit their needs. And this lead to a great
watering down of the curriculum, beyond what its initial
proponents had hoped. So fourth example. Politicized homophobia in Senegal. In short, HIV interventions
made LGBT populations, particularly gay men, much more visible. Political leaders have used homophobia, however, as a means to
gain popular support, thus inhibiting HIV prevention. The fascinating thing is
that the same religious NGO, that was so important to
linking the government and civil society and citizens
more broadly for HIV genre, has become a major obstacle, because of the political ambitions of
its leaders and affiliates. So their effort to gain political control, couched in religious terms, really has negative health ramifications for LGBT populations and
they are contributing to negative discourse about homosexuality. So that’s the fourth example. So I’ll conclude just with a few points. The objections of religious
leaders to family planning, HIV prevention and sexuality
education have more to do with them protecting
their own positions of power than with scriptures or even practices of their individual faiths. A proposition. Those interested in working
with religious leaders must actually work with them, as opposed to seeing them as a mouthpiece to the masses that can be co opted. This has long been … I felt very uncomfortable
with how the average family planning program
treats religious leaders. Oh, yes, yes, we need to talk
to the religious leaders. But they’re seen mainly
as a tool that can benefit the program, as opposed to a
source of genuine dialogue. And then third, and this is not
coming from my own research, but from that of others. Religious leaders do still need
a lot of targeted education about the benefits of family
planning, sexuality education, the importance of HIV prevention
and these various areas of reproductive health
and health more broadly. Thank you. – We’re going to move
next to Lauren and Wilma, but I wanted to give
just a little background on the Ouagadougou Partnership, which not everyone here
might be familiar with. It is an alliance, a program, in the nine francophone
West African countries, that is related to what’s called FP2020, which is the global effort to
revitalize family planning. Rachel was actually speaking about some of the work in the nineties. There was a lot of focus
on family planning issues, particularly around the Cairo
and then the Beijing meeting. But at least our perception is that it went way down in the priority
list for a number of years. And it has been only
recently that there’s been a revitalization of the
interest in family planning and of course, a particular
interest in this part of the world, where, as
I said, there are some of the highest population
growth rates in the world. So the Ouagadougou Partnership involves a number of foundations and
governments, including US aid, the French government is
involved, Canadian, now the Dutch. In other words, there are a
number of bilateral agencies. UNFPA, the UN Family
Planning Agency is involved, as is the World Bank. I don’t think the African
Development Bank, actually, is directly involved,
but they have now a very, sort of Mackenzie-like
focus on strategic plans, targets, quantified outcomes, for each of the countries
and they meet once a year. So the meeting that I was
just at was in Conakry, in December, which was
their annual meeting. Where they have, from the beginning, had governments very prominently,
but also civil society, they have a civil society
group, they have women’s groups, they have unions, they have had, basically, a constituency approach, where each one of them
comes to these meetings. What they have not had, traditionally, is religious leader engagement, but that is what is changing. And for the past two years they have had, from each country, one and
this year two religious actors. We have been part of this
now, for the past four years and Lauren and Wilma will be
sort of talking about some of the high points, but
the Hewlett Foundation, Gates and Hewlett are the
big foundation players in this effort, but the Hewlett
Foundation has supported what we call a strategic approach to engaging religious
leaders, starting in Senegal. And by a strategic approach,
we would contrast that with, I think what Rachel was
alluding to, which is, you find an imam or you find a pastor who is interested in these issues, you run a few imam training programs, you might even hint at what they would include in their sermons. But it does not involve
any kind of a broad look at the religious landscape
and power structures, history, within the country. And that is what we have
tried to bring in Senegal, because it has been linked
to a mapping review, where we have basically
studied and written reports about the way in which the religious landscape works in Senegal. So the effort to engage
the religious leaders through a whole set of institutions is the core of the Senegal project. And I will, sort of,
give a spoiler on this by saying that we view
it as somewhat miraculous that this has succeeded as well as it has. Of course, it depends a lot
on the people who are involved on the Senegal side and here,
but it is also a lot of luck, of contacts and the
capacity to deal with it. To me, family planning is on
of the most fascinating issues in development, because it
goes all the way from very, very individual decisions,
which are influenced by many factors, of which religion is one. But your health, your
mother-in-law, your money, your finances, all of those play a role, but it goes from there, at each stage, all the way to the United
Nations, where clearly, family planning is one of the
tensest issues when you look at the issues of religion
and how it’s reflected there. So at every stage. So in Senegal, just as an example, the teaching about reproductive health, not to speak of youth, which I think Lauren
and Wilma will refer to, the government is extremely hesitant because they fear the backlash
from religious leaders. And the Ouagadougou
Partnership very rarely deals with another issue across these countries, which is radicalization. And certainly, in Senegal one of the fears is that there are religious
leaders who are prominent, who equate family planning
with a western plot to limit the size of Muslim population. So you’re dealing with the sort of, hidden issues around radicalization. Some of the issues around migration, at the same time that you’re dealing with the high maternal mortality and the high child mortality still, which are linked to these issues around family welfare and family planning. So over to you. – Okay, thank you Katherine
for giving some of that general context of the Ouagadougou
Partnership and Senegal. So I think a lot of our work starts with what Rachel was talking about with institutional versus
religious authority and taking religious leaders as partners, rather than just slotting them into the family planning plan,
whatever that looks like. Which brings us to the
beginning of our work in 2014. So we have been doing this
for about four years now. The very beginning of this story is Senegal’s family planning action plan or strategy for 2012 to 2016, which of course mentions
the religious leaders and has these ideas of
religious champions. So kind of hand-picking religious leaders who can speak prominently in the media and really champion family
planning in Senegal. However, the ministry of health wasn’t really sure where to go with this. And the religious
leaders don’t really want to be fit into this pre-existing plan. I think in Senegal they’re
pretty aware of the dynamics. They see that the politicians,
a lot of the time, will come to them when they’re looking for support during political campaigns. They don’t want to just be slotted in. They said this family planning strategy has already been created,
we would’ve wanted to be consulted at the
beginning, so that we could help determine what our role would be, rather than just playing
this government role. They very much see it
as instrumentalization. They’re very aware of those dynamics. So that’s the beginning of the story. And at that time, and
even to some extent today, misconceptions still exist around religion and family planning in Senegal, but luckily, to a lesser extent. So as Katherine was saying,
the idea that family planning is this western plot to
reduce the number of Muslims. Also just all sorts of rumors around different family planning
methods and how they could actually be used for
sterilization, things like that. So there were a lot that
revolved around religion and family planning, there was a key role that religious leaders could play here. So at the very beginning, Katherine had made contact
with Sheik Saliou Mbacke. She had known him for years and he happens to be a descendant of Sheikh
Amadou Bamba, who is very, very prominent in Senegal
as the founder of Mouridism. So he became the core, the
key person on the ground in Senegal and helped gather this group of religious leaders for a meeting. A diverse group of religious leaders cutting across the Sufi orders of Senegal. Some of the main Islamic
associations, the Catholic church and the Lutheran church,
all to come together and start discussing what
some of the issues were around maternal and child
mortality, the fact that a lot of maternal and infant
deaths are avoidable and the roles that religious leaders can play, what religious teachings say. And so from there, this has
slowly formed into a core group of religious leaders,
who are now very active and very enthusiastic about
supporting this mission. They were able to get support
from all the different religious communities by
slowly doing what they call visites de courtoisie, or courtesy visits. So going and meeting with the high level religious leadership of each community to discuss what the approach
was, what the mission was, so that each community was
very much aware of the approach that they were taking and the
work that they would be doing. And then each community
designated a representative to take part in the group. So I think that’s been a
really unique component and definitely a strength of the approach, to have the mandate coming
from the highest levels and to have the representation of all the different
religious communities. And I think, in Senegal you always hear about inter-religious
relations, very positive, but a lot of that has been
inter-religious dialogue. There’s been very little
interfaith action, so that’s also been a learning
experience for the group. But they see this being
an interfaith effort as very important. That all the religious
leaders are coming together and that this actually increases the legitimacy of the group. So the group has several core components to their activities. Wilma will address some
of these more in depth. One is reaching out to
women and reaching out to women at the community level. And they’re doing this through a network of religious groups in Senegal, specifically through the Sufi
orders that are called dyras. Another approach has been using targeted messaging in the media. When we first started this work,
the religious leaders said, “We’re not quite ready to go on the radio, “people aren’t ready to
hear us talk about this.” That has evolved. They felt in their communities, that family planning was
becoming less of a taboo. So they started going on
the radio, on call-in shows. They were getting pretty positive feedback from people in their communities and it’s just in the last six months or so that they finally said, “We
think that the Senegalese “population is ready to see us on TV.” So you can see that
they’re feeling things out in their communities and
they’re sensing the change around the discourse on family planning. The next thing is there is
an MNE effort that Wilma will talk about some of the
insights that we’re getting from the ground and how
things are evolving there, attitudes and behaviors
on family planning. And then, as Katherine mentioned, there’s the regional dynamic within the Ouagadougou Partnership. One of the components of this
work has been for this group of religious leaders, now called CRSD, Cadre des Religieux pour la
Sante et le Developpement, to visit other countries in
the Ouagadougou Partnership to discuss approaches, challenges, exchange on best practices. Senegal has been seeing
some success with this. Their contraceptive prevalence rate has nearly doubled in the past few years. We can’t say that all of that is due to religious engagement, but I think that the religious engagement
is changing the discourse, is making this less of
a taboo and starting to, kind of, move the ball on family planning. So they have visited
Mauritania, Guinea and Niger. I think, Guinea we really saw a lot of will to make things happen. I remember we were in a
meeting, I believe with the, maybe, Islamic Association of Guinea and the Senegalese religious
leaders were talking about how many deaths are avoidable,
if you space out births. And we just remember seeing
some of the imams in the room, their faces, and they said,
“We didn’t know any of this.” And so I think we saw a lot of buy-in from Guinea’s Ministry of Health, from some of the civil
society organizations and also from the religious communities
to move things forward. So starting this year, we’ll be working with the Senegalese religious leaders to help pilot some activities in Guinea, to see if those same discussions
and the same approach that worked in Senegal, can maybe help to start moving things in Guinea. And as Katherine said, we were just in Niger earlier this month
with the same approach. So to have those conversations between … We were with a group of eight
Senegalese religious leaders from CRSD and also a representative of Senegal’s Ministry of Health. So you can see that there
is a growing relationship between Senegal’s Ministry
of Health, which now says that they realized how
important it was to go to the religious leaders, so that’s why they went to them from the beginning. So the story is changing
a little bit on that side, but I think that shows how
enthusiastic Senegal’s Ministry is and that there is this
growing partnership there. So we met with several
different government entities in Niger, civil society organizations, religious institutions –
both Muslim and Christian, to start having some of these discussions. And I think people were largely positive, because CRSD members all
promote family planning within religious teachings, within what’s accepted
within religious teachings. And so people seem to be very on board, especially with the idea of birth spacing within the Muslim communities
for health reasons. That being said, one of the
things we found interesting was that nearly every
organization, government entity that we met with said,
“Of course, we’re engaging “with the religious leaders,
we had this meeting.” So in my mind, that comes
to one of two things: either people seem to be
largely overstating the level of religious engagement that there is or religious factors don’t
play that much of a role. Which I don’t think is the case. When we were at Pathfinder in Niger, they gave us the results of a study that they had recently done
and in that study it said, “68.7% of girls” and
this was married girls, “Agreed with the statement that “I cannot use family planning
because of my religion.” So I think we can’t say that religion doesn’t play a role here. So I think there’s some denial in terms of how much religious
engagement is going on. That being said, I think
one of the strengths of CRSD’s approach has been
to have a diverse group of religious leaders engaged and I don’t yet see that in Niger. I see one key player,
who is trying to organize the family planning movement and serve as the religious, kind
of, contact on the ground. And I think to have success
and move things forward there, there needs to be broader
religious engagement and greater representation of the various religious communities. On that note, I’m gonna
turn it over to Wilma. – Alright. So I’m gonna take us back to Senegal and talk a little bit
about our work there. So Lauren mentioned that we
work with women’s groups. So that really started off
as a very small movement, where we had this amazing
midwife in Senegal who bought into this religious engagement. And so it started off, simply
with her and members of CRSD going to a dyra and then speaking
about the religious aspect of family planning and then she would go into the technical aspect. So having the dual approach of
the religious leader speaking about family planning and what is allowed within religious teachings, it followed up by the technical presentation
was very successful. So in our first year, she did
20 of these trainings of these workshops and we reached a
little under a thousand people. In year two, she decided
that she was one person, she runs a clinic, she couldn’t
do all of these workshops, so she trained different
trainers in the regions to do the same thing. And in year two, we
reached over 14,000 people. And in year three, over 16,000. So, as you can see, our
approach has definitely grown. And another aspect that we
noted was, in the beginning, we had men attend these workshops as well. It was targeted at women, but men were more than welcome to come. So in our first year, we
started off with about 13% of participants being men
and then in our second year, that grew to 24%, and in our
third year, it grew to 33%. So a third of our participants
ended up being men. And as you can see, men are
often times decision makers in the household, so engaging men and having them hear
the religious argument, as well as the technical
side, was very important. And then, as Lauren mentioned,
we also have the MNE program. And so we had a baseline two years ago, we did a midline last year and
our consultants on the ground are about to launch an end-line/baseline for the next phase of our project. We’re rolling in to want to save funds. So the first inert baseline, we went to six different regions
and we used mixed methods. So we conducted over 400
surveys of married men and women and we conducted
focus groups as well. And we also did interviews
with religious leaders. And from that, we found some
really interesting data. So of those people that we
surveyed, about 98% were Muslim and about 25% of those participants were in polygamist marriages. And we wanted to know where
they received their information on religion and family
planning and we found that 82% of participants said that they listen to religious television shows. And 51% listen to
religious radio programs. So as Lauren mentioned, our
religious leaders decided about six months ago that
they are ready for television and as you can see from these numbers, they can reach a very large audience. We did have some challenges
with our baseline. In our program design, we
wanted a random sample. In reality, it was not so random. So we found that, in our baseline survey, 64% of participants said that they, as a couple, use family planning methods. That is about three times the
numbers from other surveys and so as we dug in deeper,
we found that our consultants and our surveyors had reached
out to health centers in certain regions and that,
potentially, skewed our numbers. So we found a lot of
interesting information from our focus groups and our interviews. And examining those, we found a lot of misconceptions about family planning. We heard a lot of the family
planning is a western plot. We heard rumors and
misconceptions about condom use. We heard a lot of people talk about the perceived side effects
of family planning, that, in reality, when were are
studying them, they don’t exist. So that really built into CRSD’s work, so they took that information and they directly addressed some
of those misconceptions. In certain areas, there’s,
for example in one region, there was a very low
contraceptive prevalence rate and in that region we found
a lot of people were talking about the misconceptions of
the family planning methods and how they caused infertility. So CRSD was able to take that information and to address that specifically. And yeah, so our consultants
are on the ground, starting at the end of this month. So we will, hopefully, have
some information to compare to our baseline and to see
how our program has impacted the family planning
perceptions and attitudes and hopefully, we’ll have
a publication on that soon. Oh, sure. So when CRSD is doing their work, they very much target
married men and women. And so they, as religious
leaders are not able to directly address unmarried
youth and sexuality. They are very hesitant to talk
about it and so everything that they do is within
the married context. – And I would just quickly add that one of the challenges for
them, as religious leaders, is that there’s a lot of pressure from different family
planning actors in Senegal, to address the youth question. As religious leaders, they don’t feel like they can
really address it that much. That it would undermine their legitimacy to address it very much. What they say is they can
have an implicit approach where if unmarried youth
come to the events, they’re happy to have them
there, because they see it as preparing them to be
successful as future husbands, wives, mothers and fathers. But I think this shows
that there’s still great misunderstanding of how to
work with religious leaders and I think their efforts need
to be seen as complimentary to other family planning
efforts, rather than thinking that religious leaders can
be all things for all people. – Alright, that was a great presentation and built on a lot of what
I’m going to be talking about. So my name is Lauren VanEnk and I’m with the Institute
for Reproductive Health. This is a research institute that’s part of Georgetown University,
but we’re located off campus, over in DuPont Circle. So we make it our mission
to address global challenges related to family planning
and unintended pregnancy and just expanding access to women who are seeking to use family planning. And we really want to
make sure that every woman has the child that she
wants, when she wants it. But, unfortunately, as
many of you probably know, every day approximately 800 women die from pregnancy related complications, 99% of them in the developing world. And mortality rates are
also higher for infants born to very young mothers
and infants born too quickly after the birth of the previous child. Studies have shown that
allowing women and couples to delay their first birth and space subsequent pregnancies
three to five years apart, has dramatic effects on
the health of the children and the mother, thereby
improving the health of the family and the
well-being of the community. One could argue that it could even affect population
concerns at a macro level, like food security, pandemics and even the stability of nations. And I emphasize those health
issues because those are the very things that are compelling when working with religious communities. Many women in fact,
want to avoid pregnancy, but are not using a modern method of family planning to do so. And collectively we are
striving to help find ways to kind of bridge this
disconnect, you know, a desire to delay pregnancy
but not using a method. And we are finding that in
countries where there have been a lot of large gains, that
progress is stalling as of recent and it’s much less about
geographic access to family planning and much more
about attitudinal resistance. So as part of the demographic
and health surveys, which are some of the
most robust data we have on population health, women who
say they want to delay their next pregnancy, but are not
using a method, are asked why. And three key reasons emerge. The first one is a
misunderstanding of pregnancy risk. So this might be a woman who
has just given birth and is breastfeeding and doesn’t feel
she is at risk of pregnancy. Or it could be a woman who just
doesn’t understand her body and the way her menstrual cycle works, to know which days during
her cycle she is fertile. The second reason is cultural, religious or social barriers
to modern method use. And finally, as Lauren
and Wilma just described, it is a fear of side effects. So this is both the real side effects that family planning
methods do, in fact, have, but it also is so much about
the myths and misconceptions and the rumors that happen
around those methods. So tackling barriers related
to attitudinal resistance can be difficult, it’s
non-linear and it’s slow. And it requires an approach that’s focused on local norms and beliefs. All communities are guided by social norms and gender norms, even our own. But some of these norms
can have harmful effects. Favoring values like aggression or unilateral decision
making, especially among men. Which can result in conflict
and poor health outcomes. And as most of you probably
know, since you’re here, gender equality measures across the Sahel are some of the lowest in the world. One of our projects at IRH is
called the Passages Project and it aims to address these
social norms, at scale, and build evidence around
normative interventions for family planning. So to change a social norm, it’s essential to change individual perceptions about what others believe and do,
but no one might dare to question those shared rules,
for fear of negative sanctions. So where does that leave us? This is where social influencers like, for example, religious
leaders, could play a role. You’ve heard maybe, of this
concept of disruptive solutions. Well, religious leaders can be part of that positive
disruption in a community. And many see and truthfully recognize that religion can perpetuate
harmful social norms, it can also be part of the solution. Faith communities build
individual and collective values like human dignity,
forgiveness, respect for people as image bearers of God. And these values affect relationships from the most intimate
to the most distant. In the Democratic Republic of Congo, we’re working with Tearfund,
which is an international FBO, to promote gender equality
and positive masculinities within faith communities. Through workshops and structured
small group discussions the intervention draws
out spiritual reflections and scriptural reflections
on gender equality, gender based violence and family planning. This approach is currently being done with Christian communities
but it’s being adapted for the Islamic context as well. So at IRH we’ve seen
across our decades of work engaging FBOs and religious
leaders, that when they see and understand the benefits
of family planning, they do become more supportive. Indeed, some have relatively
conservative views, related to family planning, but working with religious
leaders where they are, working with them as partners
in ways that are consistent with the community’s
needs and their values, really can open up new
avenues for further dialogue. For example, one thing at IRH that we do, is we often open that conversation with a discussion around
fertility awareness methods. These are natural, modern effective methods of family planning. And this opens a door where a door may not have been open before. And if you can open that door
and begin to build the trust, you can build things and continue the conversation from there. World Vision speaks eloquently
about how they did this in northeastern Kenya with a
majorly Islamic population. So while some of the approaches in the family planning community
certainly exacerbate the divide between that
community and faith communities, we know that from our experience, common ground areas do exist
and progress is possible. So I’m just really encouraged
by your willingness to both look at the challenges around
religion, but also think aspirationally about how they
play a part of the solution. Thanks. – Tim. – Well thank you very much Katherine. I’m not a West Africa expert
or family planning expert, but I’m interested in this
topic very much today. Professor May, of course
rightly told us about the importance of both the supply
side and the demand side. And the necessity of getting both right. I’ll just start with a little story about my one direct experience with
family planning projects. That was in India in the early 1970s. I was the junior World Bank
staff member on the very first World Bank family planning
project, which was in India. And the 1960s and 70s was the period of what one might call high modernism in development studies
and development policy. And high modernism is the idea
that the world can be changed through science and technology
and through direct planning. And this was epitomized
in the Soviet Union, but was also epitomized by Robert McNamara and by other planners on
this side of the world. This idea that if you
understood technology, if you could throw money at things, you could achieve the change. And this was the basis of the World Bank’s approach to family planning in India. So we had a distinguished
medical man on the team, we had a demographer, Paul DeMain, we had a couple of economists,
I was a junior economist. And what did we do? I collected the numbers, I
went around six districts of Uttar Pradesh, very poor districts, largely Muslim districts. And we worked out … We knew we discovered what
the fertility rate was, we did our sums and we asked ourselves how many condoms would
have to be supplied, how many tubectomies,
how many vasectomies. We did simulations and
we worked it all out, what would be the cost effectiveness. And we recommended certain amounts of money that would go to
each of these districts. But we barely asked ourselves
whether and how the men and women in these areas
would actually respond and whether they would respond. There was no engagement,
whatever, with civil society. We talked to governments in Lucknow and they were very resistant
but they said okay, throw some money and resources and do it. But we had no engagement with
the religious communities. The World Bank in those
days and including myself, I have to say we regarded
religion and religious organizations as either things
to be ignored or despised. We had no interest in really understanding what was going on in society. There were no anthropologists
in the World Bank, there were no sociologists. So this was a classic
supply side approach. Technically, quite competent, no doubt. And there was an element of marketing, I think there was some money thrown in it. There was no television
in UP at that time, but there was gonna be
money for Hindi newspapers, which would advertise the
benefits of family planning. And no surprise, it wasn’t a success. Indeed, it was a bit of a disaster, because within four years
such was the disappointment in the bank, but the bank didn’t
really do anything about it. But the real disappointment
was in the federal government in New Delhi and this was
a period when Mrs. Gandhi was kind of becoming a bit autocratic and her eldest son Sanjay
Gandhi was the serious autocrat. And he decided that he would
offer small amounts of money to males, if they would
agree to vasectomies. And this was interpreted,
because of the way it was encouraged as policy,
as forced sterilization. And so the family
planning program in India was not back a number of years. I lost touch with exactly what happened, but it really went into
reverse in the late 70s. And this was attributable, I think, I mean you couldn’t do this
in a democratic society. India, for all its political difficulties, was basically democratic,
this was not China. So there was this reversal and the lessons took many years for these to be learned. And so I think moving on 40 years, it is extraordinary
encouraging to know that here, but I think in eight agencies
generally and certainly the case at DFID, which
I headed in the nineties. Anthropology and an
understanding of institutions and society became
integral to development. No doubt, it came rather slowly. But I think what we’ve heard today is incredibly encouraging. The fact that there’s an
attempt to really understand and work with the demand side,
if I might put it that way. It’s slightly technocratic by putting it, but I’m an economist, you’ll
have to forgive me for that. You know, there was an
economist, Albert Hirschman, who I admired, but in the
academy in Britain and in America at that time, he was regarded
as a bit of an oddball. Incredibly impressive
German-American economist, who wrote a book called The
Strategy of Development. But we didn’t … We sort of read it, but we
sort of put it on one side because the models of Rasselstein, Rodan and all these other characters
the Soviet economists seemed much easier to understand. And it’s only now in
the last decade or so, that Hirschman’s insights,
his view that you had to understand institutions and people if development was going to work. He wasn’t popular in the World Bank, he did some work for the World Bank and they told him to go away. So coming back to Senegal, I
think what our young colleagues are achieving there is quite remarkable. I think they’ve had a bit of luck, because they’re working in
a country where there is this extremely favorable
political institutional situation. But you’ve used that situation
and worked with these various conferees and you’ve found
some people there to work with. And the way you’ve worked with medical and religious leaders and with education. Educating the religious leaders
or getting somebody else to interpret the Quran and
educating the women’s groups has achieved extraordinary results. And I think the challenge now is to see whether that can be
replicated in other countries. You’re working in Niger, which appears to be a much
more difficult situation. Not only is the population challenged with sudden fertility is it? I mean it’s pretty bad news really. But the institutions aren’t
as favorable and I think the lesson of what you’re doing in Senegal is you have to dig deep and
understand the institutions and work with people who
are going to be helpful and persuade people and
avoid what Sanjay Gandhi did, what the World Bank did
back in those early days. And really focus on the demand side. Of course there are
supply side issues too. Getting the methods out
there, the World Bank made a big mistake on the supply
side and put a lot of emphasis on tubectomies and I’m
not a medical person, but I think if you’re going
to emphasize tubectomies, there has to be, women have
to have access to medical and if you have to travel
50 miles on an ox cart, you’ve had a tubectomy
and you’ve got infection, it’s bad news. And again, misunderstanding, you have to, the people were right, the
women didn’t want tubectomies because they feared, they had fear. You had these men, we’re all men, sort of putting out on one
side, you know, it’ll be okay. So I think it’s … I won’t go on congratulating
you because the fact is you’re doing a great job and
if you can move on to other countries or work with
other practitioners, combining analysis with good practice and develop a program in other countries, I think this would be incredibly useful for Africa and the world. Thank you. – Well thank you Tim and thank you to this really remarkable group of people. At one point, by the way,
we thought we were going to have a womanel, which
is a women only panel. But happily, we achieved
much more diversity. A couple of, we’re gonna
open it up for a discussion. How much time do we have now? – [Wilma] 20 minutes. – About 20 minutes, so get ready. And do we have a mic or is
that what we’re gonna do? Just a couple of comments. One of them, when we first
started working in Senegal, we asked about women religious leaders, because when you’re dealing
with family planning, you need to engage women, obviously. And the first-level answer was, no there are no women religious leaders and there are no women’s
religious networks. But we discovered,
basically, that’s not true. There were quite remarkable
informal women’s networks, which is what has been developed. The midwife that both Lauren and Wilma referred to
is called Rokaya Tium. And we have a remarkable
interview with her on our website. She actually started as a communist. She experienced domestic violence herself. She overcame many obstacles. So her life story is fascinating. But the way in which she engages with the religious actors
is quite fascinating. The other comment I would make is that if we had had a choice in Senegal of the issue to start engaging
with religious leaders, family planning would
not have been the issue. It was the fact of the
Ouagadougou Partnership in the interest of the Hewlett
Foundation specifically, that took us to family planning. But our hope and expectation was that the focus on family welfare, in other words the whole
welfare of the family, of which family planning is a part, would take us into other issues. And in many ways, the most
obvious one has been child marriage, which is a major
issue in this region. And it was one that the
religious leader group was initially quite uncomfortable with. Their basic view was that child marriage is probably a pretty good thing. We also had some members of
the group who thought that female genital mutilation
was also a pretty good thing. So the discussions that have
taken place have really changed a lot of those discussions
and we think, the views. The other factor, which I
think Tim in the World Bank, we knew this and John, is that there is this element of
competition among countries, that sometimes does play a role. And it’s been interesting to see that in the Ouagadougou Partnership where they are very aggressive about … This year, the countries, I
think it was Burkina Faso that did the highest numbers of
increase in family planning. But it has a surprising effect, the competition among countries. More positively and something
that we’ve worked on is taking examples of
what’s happened elsewhere, these exchange visits. In fact the first visit was to Morocco. And that had a tremendous effect on the religious leader
group, because Morocco, in many ways, was way
ahead of the Sahel region, in terms of their family
planning, but also in the ways in which the religious actors
were engaged on these issues. So that was a real eye opener
for them and one of the reports there has some graphs,
the blue report at the end, of different countries, Muslim countries. And sort of looking at these graphs and seeing how poorly Senegal was doing, clearly was a wake up
call to them and the same is now true as Senegal
looks at other countries. So we have 20 minutes,
so who’d like to start? Any of the panel want to … Oh yes, okay great. – [Panel Member] Perhaps
you’re aware that in China they had the one child
policy per family for years and finally, it was abandoned. Their population is perhaps
the greatest in the world but it hasn’t been growing as
fiercely as other countries and they figure there’s more room to increase the population at this point. India of course, has gained on them tremendously past one billion people. I wondered, is there any
way to approach the people in say, Senegal, or any African nation, and ask about a two child
policy or some limitation so that the population
won’t get out of control and beyond the means of the
nation to support the populous as far as food, jobs,
whatever it might be. – I think John, you might be
the best place to answer that. There was a big ruckus this
summer, by the way, when ECOWAS, the West African Regional Organization, came out with a comment
which basically suggested that there should be a limit, basically, of three child per family. And we all know that talking about population control is a no, no. We don’t talk about that anymore. John do you wanna? – Yeah, Katherine, I
think that since Cairo, September 1994, the world has changed. We are getting away from
targets, from goals, from quantitative goals and we are moving into reproductive health,
reproductive rights. So the world has totally
changed, we cannot come back and to say now you should
have only three children or you should have two children. It’s not going to go down very well. And I think, in a sense,
it’s better that way, because we should predicate our efforts on the individual freedoms on
the decision of the couples to have as many children as they want. Also, another thing I would like to say, if you bring things into
a global perspective, the high fertility countries
now it’s the end of a process. We are talking about 12,
13% of the world population, where there are more than
4 children per woman. And so that has also caused, I believe, the fact that the
population issue as such, has been kind of pushed to
the background and has not received enough attention
in the last decades. So we have to appreciate
that the world has changed, we have the post-Cairo era and
we have to work this way now. If we do the supply side,
and that’s the effort of the Family Planning 20/20,
remember Melinda Gates, she had the London Summit in
2012 and they were going to help 120,000 women to have
access to modern contraception. 69 priority countries,
2/3 of them in Africa. And when you look at what happened since and there was another summit
in London, I think in 2017, on World Population Day, July 11, things are going slow slow. The supply side is very
important, is necessary, but we have an increase in
contraceptive prevalence rate in the high fertility countries. Which, in Africa it’s about a bit more than half a percentage point per year, we would need 1.5 percentage point per year to really move faster. So we have to work and I think
that’s what Tim was saying, we have to work more on the
demand side and so I plug in what Rachel said we have to
think about the power structure and the power game and
it’s not only the powers in the institution, but
I think also the power between men and women, which
is another huge dimension. So I think the time has come to move away from the top down approach,
the target approach and you mention the India disaster, the emergency, 75, 77 if I remember well. And all that’s now it’s history has given a bad name
sometimes, to family planning. Like if you read the
book by Matthew Connelly, Fatal Misconception I think. But now with this work here in Senegal, we are moving to a new world,
which is kind of promising and I think there are some avenues that we should explore even better. It’s the empowerment of women,
if we can have African women to take their destiny in their
own hands and to really be, to have the power, I think
we are going to see changes and probably, the African region will not have four billion people
at the end of the century. It could have only 3.2 or
three, which would be probably better for the environment, et cetera. So I think that’s where we have to work, that’s the battle line of tomorrow. Thank you. – Tim. And then Lauren. – It sort of struck me that
the demographic dividend argument can be a bit
confusing to policy makers. It strikes me that there’s very rarely a dividend for human
flourishing, for individuals. There might be a dividend for the state, because a larger population for a country enables a country to develop
military power or whatever. But I think it’s quite hard to see how a larger population can actually
improve living standards. I think the espousal of this view, particularly in India
in the last 10 years, has actually resulted in people taking family planning less seriously. And I was a bit concerned
when you mentioned well there could be a transition to a
demographic dividend in Africa. I couldn’t really understand that. Perhaps you could comment. – Yeah, the demographic
dividend is a theory which was based on the analogies of
what happened in East Asia. And so they David Bloom,
David Kenning and all those designed the concept of demographic bonus or demographic dividend,
which is actually based on the change in the age structure, it’s not just the number of people, it’s the age structure which is changing. So you have relatively more active people, less young dependents and
before the old dependents would start to kick in, you
have a window opportunity, which is about 40 to 50 years. Now whether that can
be replicated to Africa is a big question, I think it’s a bit of a pie in the sky for the time being. Especially for different reasons. One, the fertility decline is very slow. To cite Jack Caldwell from
Australia National University, there is a very slow erosion
of high fertility levels, so it’s going so slow, like
a lot of things in Africa. And also the requirements for labor are totally different than
what happened in East Asia. We outsourced, we made China
the factory of the world. Is Ethiopia going to be the
factory of the world tomorrow? I’m not totally convinced. So I think the demographic dividend is, I think it has been oversold
to African leadership, but it’s the flavor of the
month, so what can I say? Everybody is taken with
the demographic dividend and it might not happen
or it might happen, but in a number of decades, not right now in most African countries. – Lauren. – To come back to the question about can these countries put into
place, some sort of policy that limits children and
how would that be received. I think one of the issues in
Senegal and many of the other Sahel countries is that
people were equating the term family planning
with birth limitation. And so I think people
were resistant to any sort of family planning because they
saw it as birth limitation. I think moving the conversation to clarify what family planning means and
what family planning can be, in terms of things like birth spacing, so spacing out children
for health reasons, has actually increased the
use of family planning. I think to have any sort of
limitation policy in place would be detrimental and
I think in that context, there would actually be a
backslide in the number of users. If we look at Senegal, the
Muslim religious leaders in Senegal agree to birth
spacing for health reasons. So space out your children, put a couple years
between the pregnancies. Birth limitation is not
something that they accept. So I think if there was any
sort of limitation policy, there would be a lot of backlash from the religious communities. – One comment on this
is that for a long time you had the arguments
that population control was what was important for
the survival of the world. And that really created backlashes and has gone out of style. We are hearing more questions like that and comments like that, with
the climate change debates and the environmental issues
that people are again worried about the carrying capacity
of the world and so forth. So we find, I cringe now when
I hear population control, because we know that it’s first of all, it’s against human rights, it’s denigrating the
rights of the individual, but it also generates
very negative reactions. So finding ways to have that discussion as climate change becomes a more
prominent issue is important. – Lado. – Thank you. Well thank you very
much for all your input. Which is very, very
interesting in terms of, I mean what I want to touch on is actually local ideological debate about
these issues of … (mumbles) All the policy dimensional data. My impression is that
actually at the local level, obviously reaching out
to religious leaders is a good way to push it. But I guess … (mumbles) You also find intellectual
circles where people are more and more distrustful
of interventionist approaches, especially when John was
talking about this linkage between population decline
and property development. Especially when it comes from
outside and if you put it in historical perspective, people
haven’t experienced policies like structural adjustment
and the affiliates. I’m very much distrustful
of some of these blueprints approaches to what works
and what doesn’t work. And idea that what has worked elsewhere will work for Africa. Even in the intellectual circles, it is very much debated today
and I don’t know how that is factored in when there’s dialogue between western intellectuals
or policy makers and African intellectuals
and policy makers. I mean besides religious leaders,
that would be my question. Probably mainly to John. – Yeah, thank you. I don’t think we are talking
about population decline. Whatever we do, population
is going to double and it’s going to triple in Africa. What we are talking about is
the change in the structure, which is the fundamental issue and that’s the fundamental
goal, if we want to, in principle, get to
demographic dividends. There must be a change
in the age structure, the active adult versus
the young dependents. – I was just going to add on
that last important point. I think from my own work, this is what really speaks
to the deep involvement of local organizations
in all conversations. It has been striking to me,
in terms of family planning, HIV, sexuality education, in a number of Sub-Saharan African contexts. Local organizations, led
by charismatic people, funded by external donors almost always, but led by people who
have great, legitimacy in the context in which
they’re working, are crucial. For buy in, for making connections, but also for channeling
resources in productive ways. One of the things I sort of
begun saying is if you care about this issue, you have to
support local organizations. And donors don’t actually like doing that, it’s not very sustainable, right, to give money to organizations so that they can keep the lights
on and do things like that. But I actually think it can contribute to many broader goals. Just two other comments on this very interesting conversation. One about the demographic dividend. Of course, after fertility declines, governments have to invest and they have to invest in human capital. And the good thing about that, is I think in some regards,
it is an easy sell. I think many African leaders
like the idea of a more educated population that
can be more productive, but it does take a lot of resources and you have to have people saving. And so thinking about setting that up. I share John’s skepticism about what the demographic dividend, if that can be reproduced in Africa. But those are things that have to happen. And then the final comment
about population control, 2/3 of African countries
have population policies designed to limit population growth. None of them have targets,
actually Nigeria’s old one is one of the ones that has a
sort of more explicit target. But it turns out that these programs, even in China, are not hugely effective. So demographers are debating the extent to which the one child
policy for Chinese fertility to decline could be
attributed to that policy. So things that work, the example
from Matlab in Bangladesh showed that door-to-door
community health workers providing contraception, as well as
oral re-hydration salts to save children’s lives, as well as basic health information. That has had a lasting
impact decades later. The regions that were part of that intervention have lower fertility. Now coming out of FB20/20, real efforts at providing family planning
in the post-partum period. So capturing women
immediately after delivery and giving them a family
planning method then, to make sure that they’re
essentially not lost to follow up. Our techniques again for I think for what Lauren really spoke to, making sure at least
before the women who want to be not having children, soon
have the techniques to do it before even trying to
convince somebody else who did want to be having
children, to change their ideals. – Well in the discussions
that we’ve been part of, the area that in a sense, is the most difficult
is the issue of youth. And of course, we’re
dealing with populations that are by large majorities, very young and so the fertility
issues really are often, they involve directly, child marriage, or they involve pregnancy
among unmarried mothers. Now just as an illustration of that issue, we don’t know the numbers,
but we’re hearing a lot about infanticide in Senegal, which
is not part of the tradition. But women in prison are often
there because of infanticide, which to me speaks to
the level of desperation of young people who don’t have access to family planning but
who are sexually active. So this issue of dealing
with youth, I don’t know of many religious traditions
that are comfortable about talking about sexuality
outside of marriage. But I know, for example, Saliou
Mbacke was at this meeting in Conakry in December,
was very uncomfortable with the way that the
Ouagadougou Partnership and the Gates Foundation and so forth, were basically dealing
with the youth issue. Which was very much a we have
a right to contraception, a lot of very modern
discourse, you could call it. And clearly, there’s a need for a dialogue between the religious leaders
and the religious communities and the young people and having
this be a subject of tension is not conducive to reaching
solutions to things that include child marriage and this
awful issue of infanticide. Yes? – I was wondering Rachel,
whether it’s going to be more difficult to
replicate what Lauren and Wilma are doing in Christian
and Animist countries. I’m thinking that maybe in the Sahel, where it’s predominantly Muslim, more of a unified ideology, et
cetera, whether it’s easier. Whereas in a place like Zambia, you’ve got numerous Christian
communities Animism, how do you actually get into that? It seems it might be more difficult. – So I think that’s an extraordinarily important question and I think two things. First of all, just totally depends. So early on in the 2000s when I was first looking at HIV in Africa, I was in Namibia and there
it was the Catholic bishops who had come out and said
yes, condoms are okay. I mean so they had just totally gone against their broader faith community. So anything is possible
is the first thing. But what I do think is that,
which I think you elude to, religious divisions can be
particularly challenging. So homogeneity, Senegal’s
homogeneity is an asset. But homogeneity comes in different forms and I think Nigeria’s diversity, although it can be an
asset, is one of the things that greatly complicates these matters. And so sometimes it’s not a question of which particular faith
or which particular group, but how the power structures are laid out across religious, ethnic,
regional differences. – This is the last comment
because we have to … – [Lauren V.] I’ll make it quick. Just to say that IRH is actually working in a majority Christian context of Uganda doing something very similar
and I just want to recommend or just emphasize this idea of
having both the medical lens, as well as the religious lens. So right now we’re working with the Christian Health
Associations in Uganda, which provide a large proportion of health services to the people. So having that legitimacy
of being that medical lens and also having the service
availability, but working with all of the religious
leaders in that context. So you have a facility where
the services are active, but then you also say okay, who are the influential churches here? Is it a Seventh Day
Adventist, is it Protestant, is it Anglican, is it a
New Evangelical megachurch that doesn’t have really any
denominational connections and you invite those
people in for the dialogue and to be able to have that back and forth about what is family
planning, what are the myths and misconceptions and that’s
worked incredibly well for us. – Well we’ve come to the end of our time, so let me thank all of
you warmly for being here, for your wonderful questions
and wonderful presentations. And let’s continue the dialogue. (audience applauds)

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