Cultural conceptions of health and family planning

My family planning research is moving forward and always taking unexpected turns.
During my first weeks in Mali, I had been developing the questionnaires with midwifes and doctors who work in the field of family planning in Bamako. I wanted to make sure the questions were written in a culturally sensitive way and that these would provide answers to the questions I had, but also to the questions the community health centers where I would be carrying my research had. I realized that my initial 62-question interview was too long. Many women stop by the community health center on their way to the market, and they have to hurry or their husband will wonder where they went. Many women hide to seek family planning counseling, therefore, having such a long questionnaire is a risk for them.

Imams, marabouts and women’s perspective
I initially got interested in the topic of family planning because I wanted to understand cultural conceptions of family planning, fertility and birthing, but I also wanted to know whether Islamic leaders are a major influence in the women’s decision-making process. I wanted to know if women chose to use family planning or not according to what local Imams say. However, I progressively understood one thing: there are many kinds of religious leaders here in Mali.

The Imams, the “official” religious leaders tell me that they support family planning. These are the Imams who are responsible for Islamic organizations and speak at Friday prayers. However, almost 90% of the women I interviewed so far tell me they heard Imams say that family planning is ‘against the will of God’. They explained to me that at the mosque, Islamic leaders said that using contraception is intervening in God`s plan, they sermon: “He wants you to have a child, you should not go against his will”. This means that either the Imams tell me what I want to hear as a western woman to avoid confrontation, or that I am not interviewing the popular Imams, the ones that the women in the neighborhoods listen to. But in fact, it does not matter where the confusion comes from, because even the women who knew local Imams say Islam is opposed to family planning came for family planning counseling. So, these Imams don’t influence women. The women explained to me that what the Imams say influence their husbands and their husbands are the ones who give the money for the purchase of family planning methods. So, yes these sermons have an impact on their capacity to seek family planning counseling, but it does not influence their own opinion. In general, even if the Imams say that family planning is bad, women still believe they should be allowed to control their fertility.

Traditional medecine, magic, and talibés
The kind of religious leaders who do have influence on women are the marabouts. According to my interviews, most women first seek health advice at the marabout`s home. Marabouts are the ones who provide the traditional medicine, and they also claim some kind of Islamic leadership. Normally they can read Qu’ran and have pupils, the talibés, who live with them to learn Qu’ran. The Marabouts also can do magic, white and black. Women seem to trust them much more then the official Imams, modern doctors and western medicine. Using traditional medicine and magic is part the local culture, and it has been part of African traditions forever, but they are some problems with the practices of the marabouts. First of all, it is quite difficult to discern the real marabouts from the charlatans. Also, some marabouts use their talibés as slaves. They don’t feed them, and use them for daily chores, and the talibés, with their red containers, beg at the big intersections in Bamako. Also, some marabouts are very greedy, and if they cannot help a patient, they won’t refer him to the local clinic, and they would rather have the patient pay for more treatments and put many patients’ life at risk.

Interview with the most famous marabout in Bamako
I met two days ago with a very powerful marabout in Mali, he told me that modern family planning was a problem because some methods such as the injections cause the menstruation to stop (amenorrhea). In fact, he believes menstruating is necessarily in the life cycle of a woman. He says a woman needs to be dirty to be pure again after the menstruation, and interrupting this cycle causes problems. He also told me that if the menstruation stop, everything will stay clogged in the uterus. In fact, most of his comments proved that he had very limited medical knowledge. I found him to be disrespectful of women. Calling a woman ‘dirty’ and ‘impure’ because she is menstruating is patriarchal and condescending. Menstruation is part of a woman’s daily life, and this natural biological phenomenon is nothing to be ashamed off. Traditionally, this period of a woman’s month have been used to exclude her and make her feel lesser of a human being, but men need to understand that this is something that should in fact be honored and respected, because it reminds us that women have the power to create life, and bring children in this world. However, his comments also demonstrated something powerful: the body, the environment, and the cycle of nature are fundamental and closely related in the Malian society. Interrupting something like women’s menstruation disturbs the rhythm of life, and confuses tradition. My meeting with him and the answers of the women at the health center made it clear: marabouts are key players in women’s decision-making process, and they often determine whether women will choose or not modern methods of contraception.

Tagged as: bamako, contraception, family planning, health, MALI, marabout, women