Family planning in Togo: religious leaders, key allies for women's development and empowerment

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Extract from the article: Recognising the crucial importance of social norms and the role of religious leaders in achieving the objectives of the Ouagadougou Partnership (OP), the OP Coordination Unit (UCPO) organised a regional OP civil society workshop from 01 to 03 October

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Recognizing the importance of social norms and the role of religious leaders in family planning, the Ouagadougou Partnership Coordination Unit (UCPO) organized a regional workshop from October 1 to 3, 2024. The meeting aimed to highlight the contribution of religious leaders to achieving the PO's objectives. It also served to strengthen collaboration between civil society, young people, and partners.

During these three days, participants took stock of the contribution of religious leaders to achieving the PO's objectives. They also discussed the successes, challenges, and prospects of stakeholders, particularly religious leaders, in achieving the results of the new phase of the PO. The discussions identified promising activities to be imporant out in favor of FP in countries in crisis. In addition, the meeting assessed the impact of religious extremism on the progress of the feminist movement, enabling strategies to be defined to counter discriminatory discourse. Finally, it was an opportunity to renew the regional offices of the Alliance of West African Religious Leaders for Health Promotion and Development (ARAO/SD) and to strengthen ties between the various actors involved in the implementation of the Ouagadougou Partnership.

                                                                               Images from the workshop sessions 

A fundamental role in overcoming cultural barriers

Experience since the launch of the OP in 2011 shows that attitudes and behaviors related to family planning are largely influenced by religious values and cultural practices. Religious leaders are respected figures who are well placed to influence behaviors and overcome cultural barriers. Their role is all the more crucial in Togo, where the majority of the population listens to their advice.

Dr. Abram Amétépé Agossou, Director of Maternal and Child Health at the Togo Ministry of Health, explained that "When it comes to religion, our values and social norms sometimes influence access to family planning services. Some people believe that using contraception is a sin. So we need religious leaders to help us explain what family planning is and find holy words that can be used to convey this message. They help us find passages that make the message easier to understand. We recognize the importance of social norms and the role of religious leaders in achieving the goals of the OP." Their influence and credibility are major assets in changing perceptions.

Progress, demand, and health emergency

Togo has made significant progress in family planning, as recognized by FP2020 and the WHO. The country recorded a Contraceptive Prevalence Rate (CPR) of 24% in 2022, according to the Ministry of Health. This figure is higher than the average of 19% mentioned in the text for West Africa in 2024. The rate was 13.2% in 2010, illustrating a notable increase over the years. Nevertheless, demand for contraceptives remains very high in Togo. Thirty-four percent of demand is unmet, indicating a persistent need to improve access to methods. Togo also has high rates of maternal and infant mortality. There were 399 maternal deaths per 100,000 live births in 2021 and an infant and child mortality rate of 146 children per 1,000 live births. Improving family planning is an essential lever for reducing these tragic indicators.

Actions by religious leaders and adoption of inclusive language

To counter resistance from certain communities, religious leaders have adapted their approach by relying on associations such as the Alliance of West African Religious Leaders (ARAO/SD). Imam Karim Sani Yaya, in Totsi, highlighted this strategy: "Since the Ministry of Health began its awareness campaigns, many of the faithful were reluctant to adopt these contraceptive methods. Because when we talk about family planning, people immediately think of birth control. So we adopted the expression “responsible procreation” to explain that it's not really about stopping the problem, but about spacing out births to allow the mother to recover and the first child to grow up before having a second one.

Religious leaders have a responsibility to raise awareness in places of worship and mosques about adopting methods that enable people to protect themselves. Reverend Pastor Nassoime Jacques of a Protestant church in northern Togo emphasizes : "The Church promotes family planning for spiritual and physical health. We take advantage of departmental meetings to raise awareness among the faithful. We advise couples to space out their pregnancies and to take responsibility so that they can take good care of the children they bring into the world. And to young people, so as not to lead them astray, we propose chastity according to the Bible."

On the traditional side, His Majesty Togbui Essi Akpovi in Nikonakpoè uses an approach based on cultural values. "In tradition, we don't talk about family planning as a science, but as ancestral wisdom. The land only yields good crops if it is left to rest. Similarly, we teach that women's health is sacred because they are the pillars of the family and the clan. We advise young mothers to space out births so that each child can be a source of strength for our community," His Majesty emphasized.

The impact of FP on empowerment and development

Sexual and reproductive health rights are essential for women's empowerment. By enabling women to control their own bodies and lives, FP helps reduce maternal mortality, unwanted pregnancies, and sexual violence. These rights also give young girls the opportunity to continue their education, access employment, and participate fully in social and economic life for the development of the country. Access to contraception and quality care helps prevent early pregnancies and unsafe abortions, which are major problems in Togo. It is estimated that one in five girls worldwide gives birth to her first child before the age of 18. In addition, pregnancy-related complications are one of the leading causes of death among adolescents aged 15 to 19. One of the advantages of family planning is that it allows parents to enjoy a good economic situation. It is essential that religious leaders work alongside health professionals to help convey these messages more effectively, by finding passages in the Bible or the Koran that corroborate the importance of this practice.

Persistent challenges, threats, and inequalities in understanding

Despite efforts, significant challenges remain, particularly in Togo. Access to care remains unequal due to underfunding of the health system, lack of staff and medicines, and discrimination. Factors such as the side effects of contraceptive methods, social influences, low levels of knowledge, and the desire for motherhood contribute to the abandonment of long-acting methods, particularly in rural areas. In addition, the resurgence of fundamentalism and the rise of religious conservatism threaten gains in women's rights. A woman's right to make autonomous decisions about her own body and reproductive functions is central to her fundamental rights to equality, privacy, and physical integrity.

At the doctrinal level, the distinction between methods is a major issue. An opinion leader from the savannah region rejects the use of certain contraceptives outright in his opinion on FP and medical termination of pregnancy (MTP): « We cannot recommend non-abortive methods. But methods that involve removing the embryo, I believe we need to think carefully before committing to them because we are regularly taking lives, and as Christians we cannot encourage Christians in this direction. What we preach is sexual abstinence. »

Amid this lack of understanding, another Islamic leader in the savannah expressed this deep conviction, illustrating the challenge of alignment: « Whether it be vasectomy, tubal ligation, the use of pills, or anything else, family planning would also mean avoiding having children. And Islam forbids that. Abortions and any form of medical termination of pregnancy are considered a sin. Because the Quran states in Sura 6, verse 151: do not kill for fear of poverty. »

These reservations highlight differences in understanding of the message of family planning between healthcare professionals and certain spiritual leaders. For the latter, the theological principles of divine support for life sometimes take precedence over economic and health needs.

 These comments highlight the need for sustained interfaith dialogue, especially since the term “family planning” can be perceived as a limitation imposed on divine will.  Young people in particular should be encouraged to consider marriage as a form of management, even if only within the family, before engaging in intimate relationships, in order to avoid unwanted and irresponsible pregnancies. Religious leaders are at the heart of this struggle and need to be trained and better equipped to address family planning issues more easily.

Togo has made significant progress in access to FP, partly thanks to the commitment of certain religious leaders who use the concepts of “spacing” and “responsible procreation.” These practices are essential for reducing maternal and infant mortality and are a fundamental pillar of women's socio-economic empowerment. To consolidate these gains in the face of fundamentalist threats, it is imperative to integrate coaching programs for religious leaders to ensure a unified and accurate message about contraceptive methods in Togo. Only a common level of understanding between health and doctrine will make it possible to effectively meet the country's high unmet demand.

Esther KOLANI