A Discussion with Dr. Chimère Diaw, Head of Family Planning at Senegal’s Ministry of Health and Social Action

With: Chimère Diaw Berkley Center Profile

November 18, 2014

Background: Dr. Chimère Diaw served as the head of family planning at Senegal’s Ministry of Health and Social Action between 2013 and 2015, where he helped to develop innovative approaches to drive demand for family planning and fostered working relationships with Senegal’s religious leaders. Lauren Herzog and Katherine Zuk of WFDD met with Dr. Diaw in November 2014 in Rabat, Morocco to discuss his work at the Ministry and the importance of his collaboration with religious communities, which he sees as a critical element in government family planning programs and strategies. Dr. Diaw traces his path from treating patients at the district level to promoting family planning at the national level. He addresses the challenges he faces in this work, but he also reflects on the progress that has been made in building government-religious relationships, as well as his vision for continued exchanges and dialogue. This discussion is part of a series of interviews conducted during a visit to Morocco with Senegalese religious leaders, as well a broader effort to map the roles that religious ideas, institutions, and leaders play in development efforts in Senegal..

Where did you grow up? Can you tell me a little more about your education?

I grew up in Saint-Louis, where I went to high school. I did all my university studies, all the way through my doctorate, at Cheikh Anta Diop University, in Dakar. I did a study on vaccinology in Benin, with the University of Paris-Dauphine and the IRSP (Public Health Research Institute). My other areas of specialization are tropical health, medicine in the workplace, public health, health care rights, and vaccinology. I also have training in public finance.

You currently work at the Ministry of Health and Social Action. How did you come to work in the division having to do with family planning?

I was a doctor of public health in a health district. After years of working in districts at the operational level, I was tasked with hosting a mission that involved a strategic family planning project that aimed to reduce maternal mortality. The project really spoke to me. Then, the director of reproductive health called me to see if I was interested in the position in the Health Department and to see if I wanted to work on family planning. I agreed, and it was then that he put me in touch with the Minister of Health. She and I spoke, and then she asked me to manage this family planning program, which is a national priority.

This priority family planning program in Senegal aims to reduce maternal mortality. We identified this as an effective strategy for that reason. For the position, they needed someone who was dynamic, who had a vision, and who showed leadership. This is how I came to hold this position in the field of family planning. I’ve been in this role since 2013. But I had already done quite a bit of research in the area of reproductive health, as it’s a subject that interests me greatly.

As head of the Family Planning Division, what types of activities do you manage?

I have initiated a good number of activities in the area I work in. But in terms of research, I helped introduce Sayana Press (an injectable subcutaneous contraceptive). I participated in putting together the plan to introduce Sayana Press and even the study currently under way on self-injection with Sayana Press. I also played a part in the introduction phase in Senegal of the study on the vaginal progesterone ring. I am currently drafting other proposals in the area of emergency contraception among young people.

Another project has to do with Senegal’s health system. What are the areas for improvement of our healthcare system? We have other projects, such as the engagement of religious leaders. What is the role of religious leaders in the development of the family planning program? We are currently working on this project, but we have yet to finish the study and the proposal we are submitting to certain partners.

How did you come to be part of this working group (on religion and birth spacing)?

I think the idea came from a meeting I had with Ms. Katherine Marshall and Serigne Saliou Mbacké. This all comes from their desire to involve religious leaders in the area of family planning. We talked a lot about the involvement of religious leaders. In Senegal, the Islam that is practiced is one of various orders [Sufi confréries], but the religious leaders are not sufficiently involved in the national family planning program. After Ms. Katherine Marshall and Serigne Saliou did a study, they realized that in Senegal the program had never been brought directly to religious leaders with the goal of discussing with them and seeking their opinions.

What convinced me, on the one hand, to participate in this working group is that the program is already based on an inclusive approach that involves the institution. On the other hand, I myself am quite interested in the relationship between Islam and family planning.

Can you tell us a little more about the relationship between Islam and your family planning program?

To be much more precise, the question should be this one—“What are the family planning positions of the various religious communities, and what aspects of family planning is religion opposed to?” We need a rhetoric that fits with religion. The other aspect has to do with the religious orders here. We have orders in Senegal that are very influential, so it’s important to look at their writings that concern the health of the mother and of the child because scholars have always worked for the well-being of the Senegalese people. They have always wanted to adapt their approaches to our cultures and also to our values. If you really study people’s way of life carefully, you can easily find aspects of that way that align with what we’re doing and what we’d like to do on family planning.

A family planning program that will work in Senegal is a program that aligns closely with our values and traditions. If we really want to succeed, we have to start from the premise that everything our culture strives for is what we should be looking for and doing in family planning. Otherwise, we always risk being labeled as just taking in imported ideas and concepts, things that have nothing to do with our own culture, and trying to adapt them. The people would simply continue to reject us and reject our program. It is important that our rhetoric aligns with our sociocultural realities so that we can respond to the needs of communities without offending their view of family planning.

Has your participation in this work group changed your opinion on family planning?

I think it has changed a lot of things. I have read a lot and done a lot of research on Islam and family planning. But I guess what has struck me the most is the diversity among the religious orders who come together on the essential points to work together. When you hear them talk about this, you realize that the orders all have the same preoccupations, which are the well-being of women, of children, of families—in short, the well-being of mankind. You can say that all the orders have the same positions, but they have never really sat down together to talk about this in depth before.

Working directly with religious leaders gives me a better sense of their understanding of family planning. How do they understand family planning? What is the content of the words they use? These things are not always clear, as you can have the same objectives without necessarily having the same understanding of the words you’re using.

Do you and the religious leaders feel you understand each other?

The words I use in family planning align with both the program and Islamic teachings. I adapt my way of talking about family planning so that it matches religious rhetoric. In this way, when I discuss with them, they understand better, and I understand them better, too.

Until now, we’ve never had exchanges as regularly as we do now to discuss the program. We realized that we had the same understanding, and that the problem was just that we had never sat down together, that we had never taken a whole week to discuss together and have a dialogue. If we hadn’t had this kind of exchange, they would have believed that I got my information from outside sources and that I was coming to impose it on them.

Thanks to our collaboration, we know each other better now, and they are more likely to see that this guy who is talking about family planning has the same convictions that we do. This is what will create collaboration that will create more ease between the government and them. It can also be an entryway for other programs. This has created a climate of confidence between the state and religious leaders, which is the most important thing. This is the goal we are really seeking.

The other aspect of this group that I have really enjoyed is the fact that we work in a discrete way. If we had started publishing our work, we would have immediately been criticized. I think that at the moment, it’s a bit too early. It is better to wait until we are strong and have enough solid arguments, and that we have done enough visits to other countries.

What is so important about your visits to other countries?

We can finally come back with some documentation that shows we are not in fact more devout than the Moroccans or the Tunisians or anyone else, but that what we really all have in common is Islam. If we are only going to talk about Islam, we must do so in the same voice, with the same vision, and with the same understanding of the hadith and Quranic verses. The exchange visit in Morocco constitutes another argument that allows us to see that Islam is favorable to family well-being.

How will you accomplish this work with religious leaders?

At the beginning of the collaboration, the leaders of the orders and myself would only get together for an hour or two. But now, we can spend a whole day together. We often eat together, which is extremely important. This has created a certain familiarity and confidence among us. Even when eating, they ask questions, questions that have been preoccupying them, but they had never had the chance to sit with me and ask me these questions. This allows them to have this kind of exchange and dialogue with a governmental authority. As for me, this allows me to learn a lot of things about Islam, about their understanding of Islam, but also about family planning.

We don’t talk about limiting births, but rather about spacing them out in order to for people’s well-being and better quality of life. If we want to have a developed country, a flourishing country, we must start very early because it will take awhile to see the fruits of our work. I’m talking about thirty years. If we stay together on this, we can build a whole empire in terms of family planning. But I understand that mass campaigns are sometimes a little much, due to the fact that previous messaging campaigns often led to rejection because they didn’t match socio-cultural realities. If I spend time among religious leaders, they’ll be able to give me the right translation of the word that works best with our culture and which will be the best used and understood. This is a really effective working group.

It has been said that certain religious leaders are against family planning. Why do you think they are against family planning?

In fact, I think that certain religious leaders are against it because of the kinds of behavior we often see among young people who are unmarried but who have access to contraceptives. Islam only recognizes sexuality between a legally married couple. If we talk about this kind of thing broadly and do a wide distribution, there are unmarried young people who will have access to these products and who will take them and do with them whatever they want. To some extent, we will always be seen as encouraging the sexual freedom we already see among unmarried young people. They say that we are giving these young people the opportunity to do whatever they want to, without becoming pregnant.

The other thing they say is that this is a program that aims to limit the number of births. That we aren’t really looking to space births out, but that we just want to limit them. The other problem is their explanation that this is not a purely African policy, but rather a policy imported from the United States who come with their money and impose their policies by saying that we are poor and we shouldn’t be allowed to have so many children. But purely in terms of arguments, there really aren’t any scientific or religious arguments against family planning.

There is a hadith stating that it was the Prophet who recommended that people multiply because on Judgment Day he will rejoice in the number of the faithful. This is just to show that, among all Muslim people, there are arguments against family planning. But there are more arguments in favor than against, and I think that this is important.

The other day, we were talking about the dilemma that can exist between your profession and your religious convictions. Can you tell us a little more about this?

As a health professional and doctor in Senegal, you take the Hippocratic Oath, which says that you must care for everyone who comes to see you for a consultation, regardless of their beliefs or religious convictions. There is a passage that says, “I will care for those who are destitute, and I will never ask for a salary that goes beyond my work.” We don’t take religious arguments into consideration when we are standing before a patient. We don’t check to see if that person is a Muslim or a Christian or if that person is married or not. This person has come because of a health problem and must be cared for.

There is another religious conviction that tells you that you must never judge any of the patients you see. You must talk to them about their health problems, and if you can resolve their health problems, you resolve them. Otherwise, you refer them to another health structure that can help them.

What is your vision for this working group?

I think that in terms of this working group, we can help other programs to progress. I know that this has already created a certain link between religious families, and this link already existed. But they were never really engaged before on health problems, and they had never been involved in development problems. By involving them, they realize that they don’t just have a social role, but that they can also have a role in economic development.

It is very important that we be able to bring them all together, which offers opportunities because they can work better with international organizations like WFDD. Incidentally, there are other religious leaders who have formed their own groups, but we have never had a working group formed by religious families themselves. This represents something really unique. Later, this could lead, as it has in Morocco, to the creation of a high council in charge of religion, formed by general khalifas. I think that this is an ultimate goal.

How would this group be formed?

The president would have to say that the various khalifas are very influential and that he would create a space for them to have exchanges. The president must see them as direct advisors. He can help them write fatwas, or even just with an approach. For instance, when an important question regarding family planning comes up, they must state their position with complete unanimity. All the khalifas and the Cardinal must get together around a table and put out something that shows their position very clearly. This would enable the state to know the position of religion and to push the legislative and regulatory changes that respond to these needs.

This is an excellent idea that deserves to be deepened, but we would do better simply to work to strengthen collaboration with the government because in everything we do, we hope to support the Ministry and the government. This is how we will create that link.

What is the goal of this collaboration between the government and religious leaders?

Creating this kind of frameworks engenders a climate of confidence. If we haven’t always succeeded, it’s because there has never been this climate of confidence. A better mutual understanding encourages better progress. There is an old saying that says that everything you do without me is really something you are doing against me. We need to move forward together within the framework of family planning because this is a national project. Religious leaders need to know where we are hoping to go with this project. If we better understand the risks, together we can develop arguments to manage these risks.

You have said that the Ministry of Health had the idea to work with religious leaders. Could you explain their idea?

I won’t speak on behalf of the state, just on behalf of the family planning division that I direct. And I will say that we will work better together around conclusions, procedures, fears and risks. We have the opportunity to benefit from this because our strong point is that, at least, we have been able to put in place a group that takes into several religious families into account.

The other aspect has to do with the Ministry of Health. This will allow us to immediately create strategic plans with them and to see how to develop them in the future. Every religious family has millions of talibés [disciples]. If the talibés see that religious leaders are interested in this question, those talibés will have more confidence and will become more interested in what we are doing.

I am very interested in the study that you’d like to do on scholars and writings on family planning. This is extremely important because in Senegal, whenever people are discussing, they want to know what scholars have said or written about the subject, and I think that this can change a lot of things.

How are you going to attract and ensure the participation of religious leaders?

The content of our discussions must be of high quality so that people feel the necessity to come and to remain in our working groups. Otherwise, if they don’t feel this interest around the questions, they will leave. The other thing is the opportunities they have. Maybe they have a lot of knowledge, but there are certain among them that have never been outside Senegal and who therefore don’t have a very good idea of what’s going on abroad. Now, they have the possibility of traveling with the group and can benefit from the experience of other countries. This can also be a strong motivation for them to be more interested in participating in these groups.

In your view, what role can religious leaders play?

I think that religion is there to improve people’s live, both socially and economically. There is a strong link between religion and development—one must understand this to be able to create any change. Religious leaders can be hard to convince sometimes, but once you are able to convince them, you realize that sometimes they move even faster than you do. They have very open minds. These are intellectuals who read a lot and who understand very quickly. I remain convinced that there are a lot of things that we can do together and change together, as this is, after all, our objective.

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