Traditional Beliefs Part of People's Lives

Many couples around the world use rituals, herbal approaches and similar practices to regulate fertility for cultural, economic or personal reasons. While many of these beliefs and practices are completely ineffective as contraceptive approaches, and some are even harmful, certain aspects of these indigenous beliefs can be used to promote better family planning.

Practices that are not harmful -- such as rituals or storytelling -- may offer innovative ways to teach how the body works and about modern contraception, or to encourage correct and consistent use.

Providers who familiarize themselves with cultural beliefs about fertility may communicate more effectively with women and men about their contraceptive options. Programs may reach new groups of clients if their services are considered part of the larger context of a community's historical understanding about fertility.

Grace Delano, executive director of the Association for Reproductive and Family Health in Nigeria, says providers gain credibility by teaching family planning in ways that do not exclude or ridicule traditional beliefs.

"Even before the introduction of modern methods, Africans had methods of fertility regulation," she says. "I consulted with my mother, who is 90, and I worked with traditional healers, to find out about the traditional methods. I figured, if I start from the known, that will make my entry into changing attitudes very easy. Whatever I say from that point forward will be seen as part and parcel of the culture."

Nigerian culture includes many myths, rituals and the use of herbs in attempts to regulate women's fertility. Delano, who has written a book to document popular concepts about fertility regulation in Nigeria, works with local family planning organizations to help them make use of these beliefs in the promotion of good reproductive health care.

She advises providers to discuss with clients their personal beliefs or practices. For example, some customs prohibit pre-marital sex, and others call for a mother's abstinence for up to three years after childbirth, which promotes proper birth spacing. In neighboring Niger, the Committee on Traditional Practices which Affect the Health of Women and Children (CONIPRAT) has identified several cultural practices to be encouraged, including abstinence after childbirth and delayed consummation of marriage until the bride reaches a certain age.1

Delano instructs providers to take advantage of non-harmful rituals to promote the acceptance of modern family planning. An existing Nigerian ritual, placing an object made of red feathers, called a "teso," on the floor, is believed to make it impossible for any man to have sexual intercourse with an adolescent girl until the spell is removed.

Even simply discussing the teso can help women understand that family planning is not new, and that attempts to reduce childbearing have been practiced for millennia in almost every culture.

Many of these beliefs have no harmful effects on a woman's health, and may help assure her of being in control of her own fertility. These include ineffective notions that pregnancy can be prevented when women avoid the sun or moon at certain times or wear charms, including dead spiders, children's teeth, or leopard skin bracelets (since leopards are believed to scare away unwanted pregnancy). Drinking tea made from various harmless roots and weeds and jumping up and down or sneezing after intercourse to dislodge the sperm are other examples.

Counterproductive beliefs

Some customs and practices, however, may be dangerous or counterproductive and should be discouraged. The Nigerian belief that sex during menstruation will turn people into albinos is not harmful, but may increase the risk of pregnancy. Since menses is a time when women are typically infertile, prohibiting sex during menstruation may encourage sex at times when women are more likely to be fertile.

The harmful practice of douching with hot water, salt, vinegar, lemon or potassium after sex is common in African cultures, and should be discouraged. This ineffective technique can introduce infection into a woman's uterus and cause permanent damage, including infertility.

Other potentially harmful pregnancy prevention traditions include: eating arsenic and castor oil seeds; drinking water used to wash dead bodies; and soaking cotton wool in pepper and inserting it into the vagina as a barrier method.2

The 28-bead necklace

In nearly every culture, jewelry has played an important role in sexual relations, including beliefs about fertility. For centuries, amulets and charms have been used to promote romance, as well as to avoid pregnancy.

The Institute for Reproductive Health (IRH) at Georgetown University in Washington, the Population Council in New York and the Center for Research of Maternal and Child Disease (CEMICAMP), a non-profit family planning organization in Brazil, plan to study the use of a 28-bead necklace to help women follow their menstrual cycle and to be aware of when the risk of conception is greatest.

The first bead of the necklace is red to indicate the first day of menses, and the next seven beads are brown, indicating a time of infertility. These are followed by 11 white beads designating the fertile window, with fluorescent beads indicating a woman's peak days of ovulation. A black rubber band marker is moved from bead to bead to follow the cycle. The fluorescent beads for peak days of ovulation glow in the dark, a vivid reminder when the necklace is near a woman's bedside at night.3

"In spite of the negative attitude of most providers toward natural family planning (NFP) methods, every survey in Brazil shows that rhythm is third in prevalence of use, after surgical sterilization and the pill," says Dr. Anםbal Faתndes of the Universidade Estadual de Campinas in Sדo Paulo, who helped initiate the study concept and is a study consultant. "That means there is a demand for the method and that cannot be ignored. Many couples that use it, however, use it incorrectly. Any kind of gadget that can help couples use rhythm more effectively should be used." In Brazil, IRH and CEMICAMP plan to follow 100 couples to see how easily they learn the necklace method, and propose following 2,000 couples eventually to test its contraceptive effectiveness.

Other cultural habits

Just as the bead necklace provides a technique for teaching fertility awareness, a variety of other customs or practices that have no connection with human fertility can be adapted to encourage better family planning.

In order to introduce oral contraception to women in rural villages in the Philippines, Dr. Juan M. Flavier, president of the International Institute of Rural Reconstruction, has used local agricultural practices to explain how the pill works. People in an area where string beans are grown, for example, know that lime juice can be used to prevent bean pods from opening and releasing their seeds. This traditional knowledge offers an excellent way to explain how the pill can prevent a woman's ovary from releasing an egg.

To help women remember to take pills daily, Dr. Flavier encouraged women to devise their own reminders. In one village, five women adapted an old custom of shouting out evening gossip across the village center. The woman who remembered to take the pill first each evening would yell out a reminder: "Let us drink our secret!"4

In Bolivia, IRH is working with Catholic Relief Services to test a "simple rule calendar method" of family planning. The simplified rule would help women recognize their fertile time, without requiring them to chart or monitor physical changes in mucus or body temperature.5

Providers would choose from among four NFP formulas, depending upon the client's cultural background and needs. While the traditional calendar method is available, there would also be a very easy rule, called the "blanket rule," that simply requires abstinence from the ninth day of a woman's cycle until the 19th day. IRH plans to study the effectiveness of teaching the simple rule method.

"There are some populations who want to space children, but do not want to use a modern method, yet the traditional calendar approach can be so intensive," says Virginia Lamprecht of IRH. The modified approach recognizes these cultural preferences and limitations, she says.

-- Sarah Keller

References

1. Proceedings: Regional Conference on Increasing Access and Improving the Quality of Family Planning and Selected Reproductive Health Services in Francophone Sub-Saharan Africa, Ouagadougou, Burkina Faso, March 12-17, 1995. Durham: Family Health International, 1995.
2. Delano G. Guide to Family Planning, New Edition. (Ibadan: Spectrum Books Ltd., 1990) 25.
3. Institute for Reproductive Health, Georgetown University, Center for Research on Maternal and Child Disease. Evaluation of the "Collar" Method of Natural Family Planning. Washington: Georgetown University Medical Center, 1995.
4. Flavier JM. How to bring pills to the villagers. Singapore J Obstet Gynecol 1984; 15(1): 103-8.
5. Lamprecht V, Grummer-Strawn L. Development of a new algorithm to identify the fertile phase of the menstrual cycle. Georgetown University Medical Center, Institute for Reproductive Health. Unpublished paper.