The mosque loudspeaker crackles to life, just as it does five times a day, every day, in this quiet village just outside the Senegalese capital, Dakar.
But instead of the typical melodious call to prayer, the voice booming from the minaret is all business.
“If you are interested in learning about your family-planning options, please come to the health center immediately,” he begins in Wolof, the local language. “The program will begin shortly.”
Religion announces itself loudly in Senegal, which is more than 90 percent Muslim. Paintings of marabouts – leaders of the country’s popular Muslim brotherhoods – stare down from above grocery store tills and dangle from the rear-view mirror of yellow taxis. Cars rapides, the wheezing, colorful mini-buses that serve as public transportation here, are often scrawled with alhamdulillah (“Praise be to God”) – along their sides and on their flaking bumpers. And the word inshallah, or “God willing,” passes as an affirmative answer to almost any question here, from “Will it rain today?” to “Do you have potato chips in stock?”
So when public health officials and international nongovernmental organizations began pushing to expand access to birth control here, it made sense that they would begin at the mosque.
“Any time we come to a town, the first thing we do is go to a religious leader to explain what we are doing, so that they can become our link with the population,” says Michèle Diop Niang, the Senegal program director for Marie Stopes International Senegal, a family planning NGO. “It’s very important because where we work, if people don’t have the support of a religious leader, they won’t use family planning at all.”
In much of the world, including the United States, such an alliance between reproductive health advocates and conservative religious leaders might seem well, unholy.
But in Senegal, it was a natural choice. And advocates say that since imams started getting involved, birth control is beginning to enjoy far wider social acceptance here. Since 2011, the number of married Senegalese women using modern contraceptives has doubled from 12 percent to about 23 percent, according to the Senegalese statistics and demography agency.
“Of course it’s not the only factor, but religious leaders have been an integral part of the strategy, and one that’s showing results,” says Pape Amadou Gaye, a Senegalese public health expert and the president and chief executive of Intrahealth International, a nonprofit that works in Senegal.
Modern means, old message?
About 50 women and a smattering of men have gathered in the courtyard of Beer’s poste de santé, or clinic, whose low-slung buildings are the same color as the sand whipping up all around them. A few minutes later, Médoune Giss, the bespectacled local chief and imam, saunters in wearing an immaculately pressed sky-blue boubou robe, clutching his smartphone, and the program begins.
“Look, our objective is not to tell you ‘Don’t have kids,’ but we want to advise you on how to do it in a way that’s good for your health,” says Coumba Dieng, who leads the informational presentation that begins each one of Marie Stopes’ “mobile clinics,” which travel around the country giving family planning advice and contraceptives to women in remote areas. (Last year, the organization’s 11 mobile teams reached about 67,000 women countrywide, according to the organization’s internal figures).
That idea, Ms. Dieng says, is crucial to winning over the Senegalese, who value big families and often see childbearing as a religious duty. She dangles a condom in front of her audience and explains that contraceptives can can help women space out their children so they can be stronger, less exhausted mothers.
“My dad was an imam and he was the one who taught me about how the Quran tells us to space out our children,” says Dieng, who wears patchwork parachute pants and a tight blue head wrap with her white Marie Stopes T-shirt. “I learned from my father to see work for health as a devotion to God.”
This idea – that modern contraception is an extension of traditional Islamic practices – has been key to winning over both imams and the general population here. It’s based on passages from the Quran that instruct women to breastfeed for at least two years, a natural (if imperfect) form of birth control.
“Family planning is just a new word for what we have always done according to Islam,” says Seyni Cisse, an imam in the southern city of Ziguinchor. “It’s a modern means to do an old thing.”
Making it personal
Of course, not everyone agrees. Rates of contraceptive use in Senegal and other West African countries still rank among the lowest in the world, and only about half the women who want to be using birth control are. Contraceptives remain hard to access, especially in remote areas, and knowledge of how to use them scant. Many religious leaders, meanwhile, remain opposed to contraceptives, and even those who do support them are careful to say Islam only sanctions birth control for married women in monogamous relationships.
But the situations that bring religious leaders around to birth control here are often far more personal than Quranic doctrine, says Aminata Mané, a women’s rights activist in Ziguinchor. For decades, she says, she and other feminist activists here fought to get local women greater access to birth control – often with little success.
“It was hard to talk about in Muslim communities,” she says.
Then, about five years ago, an influential local imam got a call from a local hospital – one of his wives was in labor, and it wasn’t going well. When he reached her side, the midwife on duty gave them an ultimatum – stop having children, or you could die.
“That was a turning point,” Ms. Mané says. “Since then in his preaching he speaks about family planning, and he’s brought many other imams with him.”
Efforts to expand access to family planning in Senegal are bolstered by the Ouagadougou Partnership, an alliance of nine Francophone West African countries and several international aide groups set up in 2011 to rapidly expand access to family planning in the region.
But to really accelerate that process in Senegal, the country now needs to discuss contraception in a broader way, says Mr. Gaye, of Intrahealth.
“I hope in coming years people can be a little more courageous and talk about the non-health benefits too,” he says.
Backat the clinic in Beer, Dieng finishes her presentation and looks up at the crowd. “We’ll start consultations now,” she says. “But first, a prayer.”
Almost in unison, 60 heads drop. Imam Giss stands up.
“You know, the most important thing in your life is your health. You can be a millionaire but if you don’t have your health you have nothing,” he begins. “Marie Stopes, may God bless you for bringing health to us. He will bless you.”
Maguette Gueye contributed reporting from Ziguinchor, and Thomas Faye contributed reporting from Beer. Ryan Lenora Brown’s reporting in Senegal was supported by the International Reporting Project.