Parts of West Africa have the world’s highest rates of population growth; sadly, high maternal and infant mortality are tightly linked to similar underlying trends. Several countries, with support from a coalition of partners, have embarked on ambitious programs to support family health by increasing access to family planning and strengthening health services. This involves both government services and a range of civil society action, with changing behaviors and often norms playing essential parts. On both counts the question arises: what roles do religious teachings, faith-linked services, and religious leadership play in shaping norms and approaches? Are religious actors allies or foes specifically on efforts to address family health? Do they support or contradict central messages?
A strategically designed effort in Senegal and Guinea offers important lessons about both opportunities and challenges, many linked to the specific country situations involved but with implications that extend well beyond. The experience offers insights on what is involved in working more effectively with religious actors and on making the ideals of localization of international support tangible and effective.
The origin story
The story has several beginnings. A global summit in London in 2012 launched FP2020, with the goal of enabling 120 million more women and girls to use contraceptives by 2020, focused on 69 of the world’s poorest countries. The main stakeholders have been ministries of health, civil society groups, especially those involving women and youth, and international partners (UNFPA, UNICEF, the Bill and Melinda Gates Foundation, and several bilateral aid agencies prominent among them). While some religious actors were involved during the summit, their roles were frankly marginal. FP2020 has grown and thrived, and now operates as FP2030. In parallel, a coalition focused on health, Christian Connections for International Health (CCIH) had explored both perceptions and operational experience around family planning in Africa. Many consulted during the CCIH process were keenly aware of the tragedies facing unmarried mothers and of botched illegal abortions. Despite fears of a generalized religious opposition to family planning, they found considerable support, especially for approaches that emphasized spacing of pregnancies, and a need for great care in use of language, given tendencies to conflate family planning and abortion. Overall, especially within health circles, pragmatism rules the day, even among Catholics whose official teachings do not support “modern” family planning.
Linked to FP2030, the Ouagadougou Partnership (OP) brings together nine Francophone West African countries with ambitious national programs to address family health issues. It sets specific goals and supports the mobilization of resources and partnerships. The overall goals focus on women’s rights and the proven benefits of their capacity to determine when to have children. The economic benefits of a demographic dividend are central to the case made for action. The ethos of the partnership is quite secular, though over the years there has been a growing awareness that religious actors are one of several constituencies that shape attitudes and support. More deliberately, the Hewlett Foundation (one of the core OP partners) has, since 2014, supported work by the World Faiths Development Dialogue (WFDD), a Washington DC based NGO, to engage religious leaders and communities on family planning. This has led to a decade of experience that highlights both the need to appreciate and understand the complex but essential roles that religious actors play and constructive paths towards engaging them proactively in the broader programs that address family health.
Creation and growth of Senegal’s Religious Family Planning Coalition
Initial efforts focused on Senegal. In a nutshell, an alliance of Senegalese religious leaders came together at first in a loose alliance, which grew into a formal association, and is now a recognized NGO (Cadre des Religieux pour la Santé et le Developpement—CRSD). CRSD has the capacity to engage with both local and international partners and plays significant roles in Senegal’s broader family health programs. CRSD works to broaden understanding of family health challenges and opportunities among its members, who come from all the different religious traditions in Senegal (primarily Muslim but also Christians), and, more broadly, among Senegal’s communities that are marked by strong religious norms as well as structures. CRSD is now an integral part of Senegal’s family planning program. The basic model is being replicated in neighboring Guinea and, hopefully, in Niger.
Briefly, the Senegal experience grew from a lightly defined note in Senegal’s family planning strategy, that faith “champions” would play a role, somehow. But what those champions would do was far from clearly defined. The Hewlett Foundation supported an exploration in 2013 of how to make the overall family planning program work well in Senegal (CIFA led the team). The analysis highlighted that religious alliances must play critical roles if programs were to succeed. WFDD was suggested as a partner because it had long standing relationships with the Sahel region and was preparing a study of Senegal’s religious communities and their work on different development topics. Hewlett agreed to support a modest 18-month exploratory effort. (it was followed by a series of grants supporting the CRSD program). WFDD’s Senegal work benefitted from country “mapping” work undertaken with support from the Henry Luce Foundation, that included an extensive report on Faith and Development in Focus in Senegal.
Embedded in the initial proposal was exploration of attitudes of Senegal’s religious communities towards family planning and of potential partners who might be engaged. Cheikh Saliou Mbacké, who had long interfaith experience, agreed to join the exploration and emerged as the leader of the effort and creator of CRSD. The exploratory phase included building relationships with government and partners, ensuring that women were part of the effort from a conceptual phase, and a series of visits both within Senegal and other countries (notably Morocco) that broadened horizons of the teams involved. WFDD’s contributions included setting the effort in a broader country context, advocating for early focus on monitoring and evaluation, and broad capacity building support. An important feature of the CRSD approach was “visites de courtoisies”, courtesy visits to leading religious figures that in practice were critical to the effort to build a solid common understanding of how religious actors could be involved in the national family planning effort. Another critical element was a theological exploration of Qur’anic teachings about family health and specifically family planning. The resulting “argumentaire” published early in the process is a continuing focus of community outreach that has focused both on core religious teachings and on the practical and material support to families that are seen as an essential part of religious roles.
The decade of CRSD/WFDD experience in Senegal has taken place during a complex, often tumultuous period in the Sahel. The West African Ebola crisis affected Senegal but far more Guinea. The engagement of the religious alliance in supporting government programs that responded to broader health policies lent credibility to the broader family health approaches. Then the COVID-19 emergencies presented still wider challenges with shutdowns, circulation of misinformation that undermined trust, and disruptions of all operations. Again, positive outreach and a capacity for adaptation helped to build stronger relationships with governments and international partners. Political turbulence in Guinea, Mali, Burkina Faso, and Niger present continuing challenges for the Ouagadougou Partnership overall. Religious engagement in these matters is in flux but it is likely that with the eventual benefit of hindsight it will be seen as significant.
The period from 2014 to 2024 has witnessed the steady expansion of CRSD’s capacity and programs, and a widening circle of relationships. Many positive outcomes have developed from years of relationship building and persistence, including formal MOUs with other NGOs working in the family planning space and a strong working partnership with Senegal’s Ministry of Health. The year 2023 saw the expansion of many activities and networks for CRSD. Decision making on planning and implementation has progressively shifted from WFDD to CRSD. Among techniques developed is a practical monitoring system that relies primarily on qualitative information, notably focus groups that represent a rich trove of information that reflects the diversity of attitudes and experience even within small communities.
CRSD has met notable success in engaging women, in significant part through the leadership of a midwife, Rokhaya Thiam, who has pioneered local training approaches that engage both religious actors and women and men. Engaging youth has been a central challenge and has seen the emergence of a constructive approach to the difficult balancing act between religious leaders remaining true to their core teachings while remaining open to dialogue with new generations. Early experience with public “confrontations” with religious leaders and forthright youth groups highlighted pitfalls and CRSD has since developed an argumentaire focused on youth that is driven by continuing dialogue. The argumentaire focuses on nine themes and outlines definitions, citing of consequences, and includes religious perspectives. It was designed to support active discussions of issues that youth may face, including reproductive health education. Sex education within school systems has been approached carefully but with positive forward steps. The Population Reference Bureau (PRB) produced a video that argued for positive religious engagement on family planning. Activities solely focused on the youth argumentaire reached almost 300 participants during 2023, including 150 religious leaders. Broader CRSD activities include continuing birth spacing workshops (15,000+ individuals reached), parenting classes for young married couples, and training new relais (local facilitators) who conducted 700 workshops. Information and communication play important roles, with a focus on religious media and outreach by CRSD leaders.
The Ouagadougou Partnership links nine countries that, with French a central language, share history and cultural features but differ markedly in approaches to development and outcomes. A common thread is high birth rates and low use of modern contraceptive methods (the average in the nine Ouagadougou Partnership countries is 18.2%). However, the situation varies significantly by country. Related challenges include early and common child marriage and long traditions of female genital cutting (FGC). CRSD and WFDD have from the outset explored regional dimensions, building on strong transnational religious linkages (for example the Sufi confréries or orders and the Catholic and Protestant communities). Efforts have advanced furthest in Guinea, where a solid program is underway, building on Guinea’s related but quite distinct religious landscape. This was shaped by the socialist ethos of the Sekou Touré era which brought substantial engagement with religious institutions. A striking feature there is the large role that women play in religious leadership. In Niger, political turmoil colors a promising start to exploring religious engagement in what stands today as the country with the world’s highest natural rate of population increase.
Lessons?
The CRSD experience offers many insights on the challenges specific to engagement of religious communities on development issues. Three merit reflection in the context of efforts to work towards a more strategic, i.e. systematic and evidence driven approach. The CRSD program has required a continuing balance between a global framework and approach (FP2030) and challenges that are very locally specific. Second, issues of how to make monitoring and evaluation practical and operationally useful have proved a recurring theme. And third, navigating some specific concerns and preconceptions around religious roles were challenges from the outset that demand thoughtful and nuanced approaches.
The global focus on the central role of demographic trends and efforts to advance gender equality and women’s rights are central to the work of FP2030 and the Ouagadougou Partnership, and communicating those goals and the evidence that underlies the global push are central. Yet distinctive local circumstances determine whether the programs succeed or fail. Many social, political, and economic realities of the Sahel region and the Ouagadougou Partnership countries reflect religious beliefs and institutional structures. The links are far from simple, with culture, historic upheavals, quality of governance, and economic performance shaping complex relationships, but ignoring religious factors is foolhardy. The religious backdrop has particular importance in West Africa where the measures we have of religiosity (how important is religion to you?) are especially high, as is relative trust in religious leaders compared to other categories of leaders. The CRSD experience has highlighted the significant insights and benefits that can come from a systematic engagement with religious actors. There was always a potential downside in ignoring religious factors or in handling relationships poorly—that communities might actively oppose family planning programs. But the positive aspects were not always seen as integral to the overall program. The CRSD experience as well as work in Guinea “make the case” for active and strategic religious engagement from the outset as an integral part of any program that involves social norms and changes in attitudes and behaviors.
Designing meaningful and useful monitoring systems, with communities that initially tended to approach the topic with considerable skepticism, was a challenge from the outset. Attributing specific changes, especially at a national level, to specific interventions or communities was acknowledged by both funders and intermediaries as problematic despite the understandable appetite for robust quantitative measures of impact. Therefore approaches to monitoring and to reporting from the outset looked to innovative approaches that relied less on quantitative measures of direct impact than on tools that reflected the diverse communities and factors involved. The reality of complex decision-making involved in family planning, colored by a host of factors, was appreciated and taken into account. Culture, family circumstances (including gender norms, marital status), economics, social milieu and pressures, religious beliefs, and perceptions of health risks are tightly intertwined, Decisions that matter about family planning (for example, to use contraceptives, which ones, to
abstain from sex, to seek another child, to ignore the topic and let "nature" take its course) are intimate choices made by couples and individuals. They reflect the individuals’ expectations, values, hopes, and fears; these can be shaped largely or in different degrees by one or the other of a couple (a woman basically decides, or the man has more power and influence) or by the two together. Rarely is a single factor involved. But monitoring and continuing assessment was and remains vital. Among the mixed method tools used, results from focus group discussions have offered the most valuable insights. Among these was wide variation in attitudes even within restricted communities and varied understandings both by religious leaders about family health and by individuals. How, for example, do women (who rarely attend mosque prayers) gain information (radio a critical factor as well as community exchanges)? Links between “pastoral” religious leader roles and their de facto political alignments are significant and nuanced phenomena that need to be better understood.
Perhaps the largest and most complex questions and therefore emerging lessons involve how to engage with religious communities on broad matters of public policy and specifically development. This involves the mechanisms that exist on relationships with religious communities among governments (both overall and by sector). It also involves less formal attitudes and preconceptions around religious roles that involve governments and their international partners. In Senegal, the “starting point” was an absence of formal coordination mechanisms that engage both specific religious communities and interreligious platforms and mechanisms, especially interesting given well appreciated understandings of vital political roles of religious actors. The process of mutual learning and dialogue linked to the family planning program has benefitted from the specific challenges and links to concrete programs, as CRSD has demonstrated its openness to engagement with the range of partners and the practical implications of its engagement through dialogue and active engagement at the community level. Communications at the national level through different forms of media have also contributed to a growing appreciation that religious engagement is both necessary and feasible.
