LILONGWE, Malawi — When the United State Embassy in Malawi began considering how to expand family planning services in this southern African country, one major need was work in Muslim-dominated areas with high birth rates.
U.S. President Barack Obama's Global Health Initiative is working to improve health in Malawi, especially for women and children, and family planning is part of that.
An estimated 3 million Muslims live in Malawi, according to Muslim associations, accounting for nearly one quarter of the population. But many Muslim leaders here had opposed any form of family planning due to cultural considerations and perceived guidance from the Koran.
The U.S. Embassy asked one of its contractors, the Cambridge-based Management Sciences for Health (MSH), to organize a conference for Muslim leaders on family planning and the Koran, which was held in 2009.
“We knew that in areas with large Muslim populations there was a big issue with family planning — use was very low,” said Rudi Thetard, MSH’s country director. “So we wanted to bring together the Muslim leaders so that they could talk about what the issues were and how to resolve them.”
Alison Liawanda, general secretary of the Quadria Muslim Association of Malawi, one of the two main Muslim groups in the country, said that a group of about 30 leaders came together in 2009 for three days of intensive talking.
They narrowed the issue to two passages in the Koran. One said that Allah’s message to families was not to fear poverty because he would provide for them. Another said that a mother should breastfeed her children for two years after birth.
Liawanda, who also is a development outreach and communications specialist at the U.S. Agency for International Development (USAID) in Malawi and a family planning supporter, said the second passage became key to the discussions.
“That made us see very clearly that Islam does not prohibit family planning,” he said. “To protect the health of the mother, and to protect the health of the child, the Koran says that the mother should breastfeed her child. And so the spacing between births should be at least two years.”
He added: “It really should be three years — or more.”
In 2010, the Muslim leaders began putting the family planning message out to communities. But in February 2011, concerned about the lack of follow-through in some areas, the group came together a second time and agreed to more aggressively pass the message to community members.
“Our major challenge is that you have high illiteracy rates in some areas, and when you have that situation you a lot of trouble in getting people to understand these issues,” Liawanda said. “A Muslim man is permitted to marry up to four women, and it’s not unusual to see that one man can have eight to 10 children. So this effort will take a long time. We have to be careful. It’s a sensitive issue.”
For instance, he said, if a local Muslim leader tells his community that having fewer children will reduce the expenses for a family — an argument used in many parts of the world — Muslim couples could reject it because the Koran says that Allah will provide for them.
Another critical part of the effort, he said, was to dispel myths in poorly educated communities about proper family planning methods.
“We’ve found that when we ask some people what type of family planning method they use, some say, ‘After sex, the lady is turned upside down, and she will not get pregnant,’” Liawanda said.
In addition, he said that when girls drop out of school, families often arrange marriages for them at ages as young as 12 years old. “We have a lot of problems that arise from that — the delivery of the first child becomes a problem, especially if the girl is so young.
“So as a community, we have to make a decision: How do we protect these girls? We know we should be educating them, keeping them in school,” said Liawanda, who has six siblings, but has just two children of his own. “When MSH came in, it was a relief. On our own, we could not do it. We needed an outside group to help organize us. Now, I think we are on the right track. Our plan to increase family planning will save a lot of lives.”
He said that his organization and the other Muslim group, the Muslim Association of Malawi, had no issues with the U.S. government supporting family planning. “In some places, there may be concern that the U.S. government has political reasons to reduce the Muslim population, but we didn’t have that issue here,” Liawanda said. “I think it was because the Muslim groups led the process and made its own decisions.”
Funding for this project is provided by the Henry J. Kaiser Family Foundation as part of its U.S. Global Health Policy program.