Dar es Salaam. Researchers at the U.S.-based Weill Cornell Medicine have found that partnering with local religious leaders boosted the adoption of family planning methods in Tanzania.
The experts say that the findings present “a novel strategy” for increasing global awareness and use of contraception in regions where faith leaders are trusted messengers in the community.
The study, published in The Lancet Global Health on November 14, 2024, shows that workshops designed to provide religious leaders with information about family planning promoted discussion in the context of faith and led to a measurable increase in the number of people seeking contraception at community public health facilities.
In that trial, the researchers worked with religious leaders to promote the adoption of male circumcision as an HIV prevention measure. Although the approach was successful, the village women felt left out.
“They kept asking us when we were going to talk to them,” said Dr Downs. When she and her team asked what the women wanted to hear about, their answer was unequivocal: family planning.
“When women have access to family planning, it leads to better health for them and better health for their babies,” says Dr Downs, an associate professor of women’s health and microbiology and immunology in medicine at Weill Cornell Medicine.
Dr Downs and her colleagues began by exploring why women might hesitate to take advantage of free contraceptives available at health facilities in Tanzania.
The team learned that people questioned whether these methods could cause infertility or congenital disabilities. They were also afraid that family planning might go against their faith.
“Both women and men would say things like, ‘Maybe I should just have the number of babies that God wants to give me,’” said Dr Downs, a Center for Global Health member at Weill Cornell Medicine.
Based on their previous study, the researchers realised that local families would be more receptive to information about family planning and referrals to their local health facilities for contraception from religious leaders.
“They are deeply trusted—much more so than doctors,” said Dr Downs. “They’re the ones that people go to with problems, and they’re closely integrated [into] people’s lives.”
In collaboration with Dr Agrey Mwakisole, a pastor and theologian at Mwanza Christian College, the team presented a one-day educational seminar to Christian leaders in rural communities. A parallel course has been developed for Muslim leaders.
In addition to delving into what the Bible says—or doesn’t say—about contraception, the workshop reviewed the risks and benefits of the entire gamut of available family planning methods.
The leaders were then free to share that information within their communities—during services, in private consultation, or by spreading the word via family and friends.
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The researchers then tracked the number of individuals who sought family planning at their local healthcare facility in the 12 communities that received the educational seminar for religious leaders before the end of the study, compared to the 12 communities that received the workshop after the end of the study.
They measured a 19 per cent rise in uptake of contraceptives in communities whose religious leaders attended the seminar.
The researchers speculate that the increase may have been almost double that had it not been for the global COVID-19 pandemic.
“When I did the interim analysis, everything looked good,” said senior study co-author Dr Myung Hee Lee, assistant professor of clinical epidemiology in medicine at Weill Cornell Medicine. “But when I finally got all the data, it was clear something had happened.”
When she plotted the data on a calendar, Dr Lee realised that COVID-19, which struck in the middle of the study, gave people more to worry about than family planning, impacting their results.
COVID-19’s negative influence notwithstanding, Dr Downs said that she and her colleagues were thrilled with the results, explaining: “The approach was highly effective, and we heard stories of people’s lives being transformed.”
A year later, the researchers found people continued to discuss the issues with their pastors, partners, physicians and friends.
Extrapolating from their findings, the researchers estimate that working with Christian and Muslim leaders could advance access to contraception for one million additional women in Tanzania alone.
“Based on the prevalence of religious faith across so much of sub-Saharan Africa,” said Dr Downs, “we think this strategy could prove effective in other countries with an unsatisfied demand for family planning.”