Attitudes to contraception: Tradition and Religion
Berna Dilbaz
Turkey
Worldwide there are around 123 million women, mostly in developing countries who are not using any contraceptive method despite their desire for birth spacing or limiting the number of births. Furthermore as a result of this unmet desire, an estimated 38% of all pregnancies occur all aorund the world each year. Women's lack of effective birth spacing and fertility control puts their life and health under risk. Pregnancies which are too early or too late in a woman's reproductive life or too closely spaced or unwanted carry higher health risks. Sexual abstinence is a very successful way to avoid unwanted pregnany but is not feasable therefore contraception is the key to avoid unplanned, unwanted pregnancies.
In order to use contraception people must be aware of the family planning methods, regard their use as beneficial and be able to obtain the method of choice. Therefore besides awareness and availability of contraceptive methods, women's and even societies' perception and attitudes about fertility and family planning methods play a major role in approval of family planning and accepting to use a contraceptive method. Age at first marriage, desired family size, son preference, premarital sex, women's education and autonomy are factors resposable for differences in fertility among various group of women. All these factors are influenced by social, economic and cultural factors. Religion and tradition has an undeniable impact on social and cultural structure of the society.
Family planning behavior is under the influence of environmental and individual factors. Social influences on fertility behaviour show the importance of tradition. In some cultures there is a tradition of early marriage and immediate childbirth and no birth spacing. Any contraception is perceived as individual coercion and deviation form ancestral tradition. Traditions, like unacceptance of premarital sex is a barrier against acceptance of teenage sexual activity that might well lead to unprotected intercourse due to inadequate information on family planning and sexually transmitted infections. The strength of religious opposition to contraception is a major obstacle in individual's choice of fertility regulation. It is important to learn different religious attitudes related to reproductive health problems when handling the health problems and needs of a woman. Health-workers should be able to adress religious and traditional barriers. National family planning programmes and policies should also take the cultural differences into account in order to reach the clients and increase the acceptance of health policies. Policy makers and service providers need to evaluate the cultural structure of their society and consider the differences in traditional and religous beliefs of different groups. Service providers should be sensitive to cultural norms that affect the behaviour of different ethnic groups.
The efforts to control fertility have been a common practice even in primitive, preliterate societies in history. Inscriptions from ancient Egyptians indicate that monogamous marriage was the norm, and various methods of contraception existed. In the 4th century B.C. Plato and Aristotle advocated a single-childed family.Aristotle advocated covering the cervix and vagina with cedar oil as a contraceptive technique. In the 5th century B.C., Saint Augustine condemned contraception even among married couples. The Kakun Papyrus dating from about 1850 BC has references in the text showing whether a woman is fertile and describes some contraceptive measures. The Hippocratic writers recommended semen to be removed from the vagina and recommended gaining weight as an anticonception measure. Primitive forms of contraceptive devices were described and used by Greek and Islamic physicians. Contraceptive technology improved dramatically with the beginning of 20th century and was accepted by many societies.
Scientific advances and their use to improve quality of human life do not always harmonise with the desire to follow faith, religious sayings and tradition. Religion is a cultured phenomenon. Different religions have different sayings about sexual behaviour and fertility. Religiosity or acceptance of the teachings of a particular religion is a stronger determinant of sexual behaviour than a specific religion per se
Many aspects of religiosity is found to be associated with general sexual behaviour. Card et al. analysed six main categories of determinants for and individual's decision to use or not to use an effective contraceptive method by reviewing 259 articles, monographs, and books: demographic, sociopsychological, experiential or behaviorial, infromational, including knowledge, husband and wife interaction, environmental. The groups with relatively high fertility and low contraceptive use are people from a low socioeconomic status, adolescents, people aged 40 and older, Catholics and highly reliogous, unemployed women with many siblings or working women who do not attach great importance to their careers and ethnic minorities.. The evidence linking values and attitudes to fertility-related behavior is stronger than personality traits.
Individual's perceived importance of religion is important in choosing a birth control method. Attitudes of 240 female Hispanic teenagers towards the importance of birth control were examined and 4 predictors: primary language, mother's education, importance of religion and friends' perceived birth control use were found to be associated with attitude toward the importance of birth control. Perceived importance of religion was significanly related to lower scores of birth planning and little importance was related to high scores.
The practice might divert from the religious teachings in some settings. In a study aimed to analyze the relationship between religiosity and contraceptive method choice among users of contraception in the Jewish population of Israel, contraceptive choices of religious women were found to be determined largely by considerations unrelated to religious doctrine such as peer influences, cultural effects and acceptance of a particular religious theology.
Although the Catholic Curch favours natural family planning and has obstructed modern birth control programmes and practices in various part of the world it came out that 91% of the Catholics were using illicit contraceptive methods by 1971.
Religion is not a sole nominator in choosing a contraceptive method and people from the same religion living in different settings can practice contraception differently. Malian migrants in France continue to be strongly pronatalist; men tend to oppose contraception, citing Islamic doctrine while women increasingly justify contraceptive use in response to health policies. More Islamic countires are establishing national family planning policies. Secular Islamic countries; Turkey and Tunusia have liberal family planning laws.
Cultural setting and tradition like son preference, fatalism exert an important influence on reproductive behaviour, independent of economic development. The concept of male dominance and superiority that is a part of cultural heritage in some countries leads to early marriage, over-population and a variety of health problem in both sexes (STD, unsafe abortion etc..). The norms and traditions that are against limitation of the family size influence the fertility decision-making process and lead to low contraceptive use. Cultural traditions have strong influences on the acceptability of pregnancy at an early age. In some cultures women's autonomy like the possibility of women using contraception without husband's knowledge is regarded as a threat to tradition. Children in some settings are seen as an asset as they are a task force while young and care giver to parents when they are old.
Developments in science and technology raise new religous questions that do not always have clear answers. Claims by women to autonomous reproductive choices is an ongoing debate. Improvement in education and social status of the women in the family and in the society are major forces that can overcome the negative impact of tradition and other sociocultural factors.