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Families, Planning, and Faith

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Balandou, five years ago. A small village in Guinea, 14 hours by bush taxi from the capital. My daughter was serving as a Peace Corps teacher and I was a fascinated visitor. We emerged from her hut early one morning to see groups of women, dressed in white, walking by. They were going, we heard, to bury two women who had died overnight. Why did they die? The cause? No answer, but death in childbirth seemed the most likely explanation. Muslim tradition calls for swift burial. In a village like Balandou the community mourns a young woman's death, but has little time and fewer means to question the event. Such deaths are simply and sadly a part of life in many poor communities.

One of the greatest tragedies of our time is that so many women still die in childbirth. It was a normal, sad event in our family memories, but today in America a woman dying in childbirth is rare and shocking. Yet in poor countries it is still a common reality. We do not even know with certainty how often women die and why. Statistics on women who die from causes linked to pregnancy are frankly quite rough estimates: 350,000 a year? 500,000? Among the Millennium Development Goals, the one lagging most seriously is Goal 5A: to reduce by three quarters maternal mortality. The goal should be achievable: making childbirth safe can be done, and quite quickly. But frankly it is just not getting the needed focus and priority in many parts of the world. And it almost certainly will not be achieved by 2015, the deadline set by leaders of all the world's nations.

Surely this is the most natural cause in the world for religious leaders and institutions to adopt. Faced with the dual realities of avoidable deaths of mothers and our capacity to do something about it, you would expect this group before all others to throw their passions, mobilizing skills, and moral authority behind campaigns to save women's lives. Motherhood is precious, esteemed in most faith traditions, and the family is always a focus. We see such leadership in spots, but not the cries of outrage from churches, synagogues, temples, and mosques that might make a real difference in the sad global picture.

The "whys" here are complicated but there are two main obstacles and they are linked. Both are especially though not exclusively pertinent for religious communities and leaders. First, there's the whole set of assumptions, ranging from crude to very subtle, that women's lives are worth less then men's, that women are dispensable. Women's voices are muffled or silent. So when priority choices are on the table, say at budget time, actions that specifically help women rarely rise to the top. A new ambulance so that women in labor can reach the clinic? Equipment for the clinic? Training programs? Maybe next year. And within families and congregations a similar process reflects this cruel fact of lower priority.

So reducing maternal mortality is tightly linked to women's status, in people's hearts and minds as well as in their budget choices. In many religious circles, talking about women's rights is uncomfortable: "surely it's about families and human dignity", is a common reaction. Obviously the doubters have important points but their hesitations too often mask questionable commitment to the fundamental premise that each person's life has equal value. The nagging doubts undermine a sense of urgency in saving lives as women give birth. We need to confront such doubts about the meaning of equality and rights, whether it is in a congregation in the U.S. or in a village like Balandou.

The second obstacle centers on reproductive health, family planning, and women's sexuality and we are seeing it played out in our American budget wars. Shockingly our statistical landscape is largely intelligent guesstimates, but it shows the magnitude of the problem: an estimated 150,000 women die each year because they do not have access to family planning. From many surveys (notably the important demographic and health - DHS - surveys), we know that in the poorest communities unmet desire for family planning is huge, especially knowledge and contraceptives. Worldwide, about 40 - 50 percent of unintended pregnancies are aborted, around 95 percent illegally because women, and men too, are desperate and their choices are few. Both unwanted pregnancies and illegal abortions carry a high risk of death and of lifelong injuries, to the mother and her children. Thus there is a powerful case that "family planning saves lives." Family planning was a leading development topic some years ago but with tensions especially around abortion mounting, its priority, nationally and internationally, has slipped.

The irony is that many if not most religious communities support the essential goal of helping families to "responsible parenthood". This is well documented in several recent studies, notably one by Christian Connections for International Health and a forthcoming report by the Georgetown University Institute for Reproductive Health. That generally means spacing childbirth and not having children until the woman is old enough, hopefully after she has finished her schooling. It means contesting child marriage and embracing the need for information, including for young people, so they can make informed choices.

Because tensions around family planning have a religious DNA, several recent studies are delving into the attitudes and issues that make the topic so explosive. At a stocktaking meeting last week in Nairobi, a group including Christian, Muslim, and secular organizations thrashed out a consensus statement. This statement and the surveys resoundingly affirm a common commitment to making family planning accessible to all. There are many sensitivities, with language landmines and nuances in what is and is not acceptable and real differences in both theology and practice. The Catholic Church hierarchy's categorical opposition to both contraception and abortion poses significant issues, but "natural" family planning is part of their agenda, as is "responsible parenthood". The huge Catholic medical community is known for its pragmatism and compassion. Some of the leading family planning programs in poor communities have Muslim leaders and institutions behind them.

The central outrage against poor women dying needlessly can thus be a theme that unites leaders, institutions, and faith communities across wide divides.

The bottom line here is that family planning belongs front and center in policy discussions and fear of religious reactions need not be the obstacle many have thought it was. It does call for a real testing and self criticism about attitudes that still see women as second class citizens. It also calls for sensitivity and dialogue to find out where the sore spots truly lie so they can be respectfully and creatively addressed. It calls for much better facts; surely in our technological age we can do better than rough guesstimates about how many women die because they are pregnant, why, and what is needed to change the situation. Every life counts and when pregnancy is concerned, at least two lives are at stake. It's a sacred agenda.