The tiny town of Laisamis, in northern Kenya, is already uncomfortably hot by midmorning. The highway running through it is lined with a few dozen shops, behind which are dome-shaped huts called manyattas. A few meters away, along a sandy path, is a corrugated iron structure surrounded by a wooden fence and barbed wire. It is the Repentance & Holiness Church, where Geofrey Kristo Lekopir is a pastor. It’s one of nearly a dozen houses of worship for a population of just a few thousand.
Religion is important in Marsabit County, where Laisamis is located. Marsabit is also Kenya’s least densely populated county, one of the country’s poorest areas, and has one of the country’s highest maternal mortality rates. While maternal deaths around the world were cut in half between 1990 and 2015, Marsabit is one of many places across Africa where they’ve remained stubbornly high. In 2015, sub-Saharan Africa accounted for two-thirds of global maternal deaths.
Maternal mortality around the world has decreased, in part, because contraceptive use has increased. There are still gains to be made — we could avert an additional 76,000 maternal deaths a year if contraceptive needs were fully met. In Africa, only about a third of women use them, half the global rate.
For many Laisamis residents, and Kenyans in general, churches are part of why contraceptive use is so low. Kenya is a deeply religious country, with nearly 85% identifying as Christian (and about 10% as Muslim). Over a third of Kenyans believe contraceptive use is morally unacceptable, a view supported by many church leaders who call contraceptives ungodly. Just last year, an archbishop in western Kenya launched a campaign against contraceptives, claiming they caused harm to women.
Desperate to make a dent in Africa’s dismal maternal deaths, reproductive health experts are looking for an answer in an unexpected place — church. But religious beliefs are powerful, and steeped in centuries of tradition. Even when women’s lives are at stake, is change possible?
Anne Lesenloi, a single mother in Laisamis, has always known that condoms or pills could prevent pregnancy. But she never dared obtain them, even though she’s struggling to support the five children she already has.
Modern contraceptives are issued free of charge in all government health facilities in Kenya, but like many people in her town, Lesenloi thought they were for the unfaithful. “I thought that it was used just to prevent diseases when someone is cheating on her husband,” she says.
For decades, reproductive health programs have focused on teaching women that contraceptives exist, but now that virtually all Kenyan women are aware of them, some experts believe a new strategy is in order.
There are many reasons why people don’t use contraceptives, even if they know about them. “Knowledge is certainly important, but it is only part of the solution,” says Caroline Kabiru, a reproductive health researcher. “Many Christian churches teach that procreation is the main purpose for sex. Contraception is therefore discouraged.”
But until women like Lesenloi feel comfortable using contraceptives, it’s going to be hard to decrease maternal deaths — as well as infant deaths. “Poor spacing affects a mother’s health. If you [have a child] every year, with anemia and poor diet, then you have problems like underweight children,” says Joyce Olenja, a reproductive health scholar and lecturer at the University of Nairobi.
LLekopir had never mentioned contraceptives before in his church, but in 2015, he participated in a training program with World Vision, a global Christian humanitarian organization, that changed his mind. World Vision’s project in Laisamis aimed to measure how contraceptive use changes when faith leaders are trained on family planning and maternal and newborn health.
Lekopir had heard about contraceptives from the Ministry of Health, but he never thought it was a conversation suited for church.
World Vision’s theory was that faith leaders have inordinate influence on people’s behaviors in communities like Laisamis. “Faith leaders are seen as the most powerful, visible, and reachable form of authority, even trusted more than governments or nonprofit organizations,” wrote Moses Alikali in a 2017 study on how faith leaders in Zimbabwe affected contraceptive use in their congregations. “Because of this influence, faith leaders often have an unparalleled opportunity — indeed, a moral obligation — to prioritize conversations about family planning, advocating, and closing the contraception gap.”
Lilian Chebon, a World Vision Program Officer in charge of the project, says that the faith leaders were trained on several messages related to the timing and spacing of pregnancies. One message advised couples to wait at least 24 months before trying to become pregnant again. Another told adolescents to wait until they are at least 18 years old before trying to become pregnant. “We started teaching our people that using these things is not bad,” says Lekopir of contraceptives.
The messages worked for some. Lesenloi, for example, isn’t shy to say that she now gets a contraceptive injection every three months, free of charge, at the Laisamis Sub-County Hospital. “My children are healthy,” she says. “The young one does not fall sick all the time because he had enough time to breastfeed and I do not have another younger one. I also have the energy to work so that I can provide for my family. If I had a young child, I would not work as much as I do now.”
But she is, in some ways, an exception. World Vision’s hypothesis did not prove to be true; most Laisamis residents feel the same way about contraception as they did before the three-year intervention. In February 2018, when the study concluded, there was only a modest increase in usage, from 5 percent to 12 percent.
In places that are deeply steeped in church teachings, like Laisamis, a three-year training may not be enough to change people’s behavior.
The Catholic Church has historically opposed contraceptives. While Protestant Christianity tends to have a more pluralistic view, many religious leaders still oppose it. It was only in 2010 that Pope Benedict XVI said it was acceptable to use an HIV prophylactic if the sole reason was to “reduce the risk of infection.” Since then, the Catholic Church’s only permitted form of birth control is the “rhythm method,” or abstinence during a woman’s fertile period.
It’s a contentious topic in Kenya: just last week, a civil society organization called Catholics For Choice called on the church to drop its opposition to modern contraceptives, blaming the stance on high rates of HIV infection and maternal mortality. While Lekopir’s church is evangelical, Laisamis is the home of the county’s first Catholic mission. (Christianity was initially brought to Kenya in the 1500s by the Portuguese, and was spread widely by missionaries in the twentieth century.)
It may be that Laisamis’ faith leaders need time to absorb the messages. “Demystifying some myths and misconceptions which are intertwined with religious beliefs takes time,” says Chebon. “Thus it may take time before realizing the impact of the approach.”
In other places, where communities are more open to the idea of modern contraceptives, faith leaders have been proven to be more effective messengers. In Kenya’s western region, the African Population and Health Research Center (APHRC) ran a similar program as World Vision. “We trained them and engaged [faith leaders] through continuous value clarifications, and helped repackage their messages into those that are supportive of contraception, including seeking Biblical or Quranic messaging that is appropriate to this subject,” says Michael Mutua, a lead researcher on the study. The faith leaders were paired with community health educators, who could clarify any rumors or myths about contraception, like that it caused cancer or infertility.
After three years, APHRC saw an increase in use of modern contraceptives from 37.8 percent to 51 percent in one county and from 36.2 percent to 56.5 percent in another.
Mutua, however, feels that more needs to be done. “There needs to be an inquiry into the role that religious leaders and religion play in determining contraceptive uptake — and how this influence can be streamlined for better maternal health outcomes,” he says.
Lekopir, on the other hand, feels like he accomplished what he set out to achieve. “It feels good to be part of something that improves the health and well-being of my people,” Lekopir says.
His enthusiasm might be part of the problem. The program in Laisamis teaches us that while engaging faith leaders can be helpful, it’s far from a silver bullet. Religious beliefs are, in many cases, hardwired. While a three-year program may sound long in the international development world, it’s minuscule compared to the history of Christianity.
