Insights into Family Planning and Religion in Malawi

Publication date: 2015

HEALTH POL ICY P R O J E C T Findings from public opinion surveys in two districts provide important insights that can be used to inform the design and implementation of family planning programs. INSIGHTS INTO FAMILY PLANNING AND RELIGION IN MALAWI September 2015 Over the past two years, the Health Policy Project (HPP) has been working with religious organizations (mother bodies) in Malawi to organize district- wide “Population Weekends.” The purpose of these weekends is for communities to hear about population and development issues, including family planning (FP), in their places of worship. In March and April 2015, HPP worked with the Institute of Public Opinion and Research (IPOR) to conduct public polling in two districts (Salima and Thyolo) to see if any insights could be gleaned to inform future design and implementation of FP programs. The findings below are drawn from a survey of 754 respondents that took place in March 2015 (before implementation of population weekend activities). FP Knowledge and Use Overall, knowledge of FP was high in the two districts (97% in Salima, 96% in Thyolo). Non-married respondents (88%) were relatively less knowledgeable about FP than women (98%) and married respondents (98%). This suggests there may be a need to do more to target these groups with FP information. Youth were also found to be less knowledgeable about FP. Only 87 percent of 18-19 year olds had heard about FP, compared with 96 percent of 20-29 year olds, 99 percent of 30-39 year olds, and 98 percent of those over 40 years of age. Perceived benefits of FP: When asked what they perceived as the benefit of using FP, the most common benefit of FP cited by respondents was its contribution to healthier families, mentioned by almost two thirds (64%) of respondents. The second most common answer was more money for the household (52%). While the government of Malawi and some development partners have been promoting awareness of population and development issues, very few connected national population and development issues with FP, such as Brief Rebecca Mbuya-Brown and Erin McGinn Photo credit: Lindsey Pollaczek 2 November 2015 promoting economic prosperity and development (17%), lessening the burden on resources such as land and water (11%), or slowing population growth (9%). Current FP Use: Nearly two-thirds of sexually active respondents (65% in Salima and 64% in Thyolo) reported using some form of FP. Among those using FP, the injectable was by far the most common method (54%), followed by condoms (16%), and sterilization (13%) (Figure 1). Religion and FP Role of religious leaders: Survey findings found that religious leaders do play a modest role in the dissemination of FP information. Religious leaders were the fifth most-cited source of FP information (11%), after government officials (81%), radio (64%), civil society organizations (31%), and family and friends (27%). A large majority of respondents (86%) reported that the messages from their religious leaders were largely supportive of FP messages (Figure 2). Notably, there may be an opportunity for religious leaders to play more of a role raising the profile of FP and population issues. Nearly three-quarters (72%) of adult residents of the two districts agreed that religious leaders should play a role teaching and guiding their followers on the benefits of FP. Over half (55%) said that what religious leaders say influences their FP choices. However, more than two-thirds (41%) felt religious leaders should not dictate to them how they make decisions about the number and spacing of their children. Religious affiliation and FP knowledge and use: Knowledge of FP was high across all religious groups, with some variation (Figure 3). FP use among most religious groups was comparable to average FP use. FP use was lowest among Pentecostals and members of the Church of Christ, but still notably high—over 50 percent. Method choice: Method choice among religious groups mirrored overall method choice, and was similar across religious groups, although the proportion of respondents using each method varied slightly by religious affiliation (Figure 4). With the exception of Anglicans, a large majority of all groups reported using injectables as their preferred FP method. The pill 1% Condoms 16% IUD 4% Injectable 54% Sterilization 13% Periodic abstinence 2% Traditional 1% Other 8% The pill Condoms IUD Injectable Sterilization Periodic abstinence Traditional Other Figure 1. Current FP Method Use The pill 1% Condoms 16% IUD 4% Injectable 54% Sterilization 13% Periodic abstinence 2% Traditional 1% Other 8% The pill Condoms IUD Injectable Sterilization Periodic abstinence Traditional Other The pill 1% Condoms 16% IUD 4% Injectable 54% Sterilization 13% Periodic abstinence 2% Traditional 1% Other 8% The pill Condoms IUD Injectable Sterilization Periodic abstinence Traditional Other Figure 2. Tone of Religious Leaders’ Messages Toward FP Very Supportive Supportive Against Strongly Against 49% 37% 4% 10% 3 Insights into Family Planning and Religion in Malawi Among Anglicans, the majority reported condoms as their method of choice, followed by an injectables and sterilization. The majority of respondents did not see their religion as a significant factor affecting their access to FP advice and services. Although one third (31%) said that their religion prohibiting use of FP methods is a big problem, more than two-thirds (68%) said that even if their religion prohibits use of all FP methods, they did not consider this to be a problem affecting their ability to access FP advice and services. Spreading the Word IPOR readministered the opinion poll in the two districts in late April 2015 after population weekend events. Survey findings suggest that there is a strong culture of sharing FP information with others. Three-quarters (78%) of respondents who reported receiving FP information from religious leaders during population weekends reported sharing this information with family, close relations, friends, and neighbors. This finding suggests that church/ mosque-based interventions such as population weekends can have substantial follow-on effects that may be difficult to capture. Unfortunately, it seems that this culture does not extend to youth. None of the respondents reported sharing the information they gained with children or grandchildren. This suggests that within Malawi’s sociocultural environment, most parents find it taboo to discuss FP issues with their children. There is a need to more effectively reach youth with FP information, including encouraging intergenerational conversations about FP to reduce the knowledge gap among youth. This is particularly important given that the surveys suggest that youth are being less- effectively reached with FP information. Conclusion The survey findings confirm the importance of using religious leaders to convey FP information to their constituents, particularly given the culture of information sharing that may magnify the impacts of these interventions. However, the findings also suggest that religious affiliation may not constitute a significant barrier to accessing FP information and services, and that many people are making FP choices independent of formal guidance of religious institutions. Finally, the survey reveals the need to do a better job reaching youth with FP information. 0 10 20 30 40 50 60 70 80 90 Catholic CCAP Pentecostal Seventh Day Adventist Other Christian Muslim All Injectable Condom Sterilization IUD 0 10 20 30 40 50 60 70 80 90 Catholic CCAP Pentecostal Seventh Day Adventist Other Christian Muslim All Injectable Condom Sterilization IUD 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FP Knowledge FP Use 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% FP Knowledge FP Use Figure 3. FP Knowledge and Use by Religious Affiliation Figure 4. Current Choice of FP Method by Religious Affiliation 4 The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. HPP is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. Contact Us Health Policy Project 1331 Pennsylvania Ave NW, Suite 600 Washington, DC 20004 www.healthpolicyproject.com policyinfo@futuresgroup.com

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