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__________________________________________________________________ “Kapchorwa Gets Very Cold at Night”: Religion, Family Planning, and Development in Eastern Uganda __________________________________________________________________ Sarah Mathys Senior Honors Thesis Department of Anthropology Georgetown University Thesis Adviser: Dr. Gwendolyn Mikell Spring 2019 2 Table of Contents Acknowledgements 3 I. Introduction 4 Background 7 Uganda’s Colonial History 8 Population Growth and Challenges to Sustainability in Uganda 9 Religion in Contemporary Uganda 10 Religion, Family Planning, and Foreign Aid 11 II. The Research Context 14 Controlling Fertility, From the Pre-Colonial Era to the Present 14 African Christianity and its Paradoxes 16 Methodology 19 Sampling 19 Tools 20 III. The Case Study 24 Justiﬁcations for Various Family Planning Methods 27 Religious Opinions of Family Planning 32 Catholicism 33 Church of Uganda 34 Pentecostalism 35 Islam 36 Sources of Knowledge About Family Planning 39 Challenges to Research Design 44 IV. From the Local to the Global 46 The OneAccord Forum and “Holistic Evangelism” 46 V. Conclusion 50 Works Cited 52 Appendix A - Sample Interview Schedule 59 3 Acknowledgements The completion of this thesis would not have been possible without the dedication of Madame Consolate Chemisto, and more generally, the assistance of the Reproductive Health Uganda oﬃce in Kapchorwa. I would also like to thank Darius Salimo, who tirelessly guided me in my ﬁeldwork. Many thanks are also owed to the men and women of Kapchorwa, whose responses and insights are foundational to this research. I am grateful to the faculties of Georgetown University’s Anthropology and African Studies departments, who have always fostered my intellectual curiosity. In particular, I am indebted to Professors Gwendolyn Mikell and Sylvia Önder, who have supported me both in and out of the classroom. These institutions and individuals have helped me to develop my academic interests and to grow as a person, and have made this research possible. Finally, I would like to extend my deepest appreciation for my cohort of fellow students at the School for International Training. Your feedback and encouragement meant the world to me, and were invaluable to this research process. 4 I. Introduction I arrived in Kapchorwa via matatu, the crowded shared minivan responsible for transporting people, foodstuﬀs, and the occasional chicken across East Africa. Kapchorwa is located at the top of a mountainous region in eastern Uganda, near the country’s border with Kenya. The district is spread over several mountain tops, with Kapchorwa Town situated at the highest elevation in the area. My destination was the Reproductive Health Uganda oﬃce, which is perched at the top of a winding road near the center of town; to the east, you can see miles into Kenya, while to the northwest lies the Karamoja Plateau and the mountainous border of South Sudan. It was an eight hour drive from my apartment in Kampala, and I couldn’t tell if my nausea was from car- or home-sickness, or a combination of the two. Most of the matatu’s passengers had disembarked at the bottom of the mountain, and I relished the thirty minutes of relative quiet as the van crawled up the last peak to the town center. Although I had booked a room at Noah’s Ark, the village’s bed and breakfast for tourists exploring nearby Sipi Falls, I decided to meet my contact at Reproductive Health Uganda before checking in. I quickly realized I wasn’t going to make it to the hotel; in the span of ﬁve minutes, Madame Consolate, the director of RHU, had served me milk tea, grabbed my bags, and herded me to her car. Suddenly we were at her house, and I was being attacked by twin four-year-old boys with Biblical names who were fascinated by my glasses and my inability to grasp basic Kupsabiny phrases. I spent the next three weeks living with and learning from her family, which deeply shaped my research experience and opened up new questions for future exploration. I have been interested in the intersections of religion and reproductive health for almost a decade. Growing up in a conservative, rural town in central Texas, I was raised Catholic but was 5 also surrounded by the evangelical and missionary cultures so present in the southern United States. I attended a Jesuit university, and although I no longer consider myself religious, my upbringing instilled a deep curiosity regarding the inﬂuence of religion on all aspects of culture. I chose to study and conduct research in Uganda in order to better understand the intersections between healing and fertility, spirituality, and the fraught relationships between so-called “developing” and “donor” states. Ultimately, my research concludes two things: that religious belief has less of an eﬀect on family planning uptake than existing development literature suggests, and that an understudied gap exists between private and public religious teachings. Additionally, there exists intense mistrust of Western family planning NGOs, whose methods of encouraging birth control uptake are regarded as suspect and even neocolonial. Other anthropologists and social scientists have long theorized on the connections between fertility, religion, and governance; Michel Foucault’s framework of bio-power and governmentality is particularly relevant to this discussion.1 Following in the tradition of Thomas Malthus, population growth has long been problematized in discourse by both theorists and governmental agencies, who see demographic growth as inevitably leading to unsustainable pressures on food supply and resources.2 This trope of “population crisis” was popularized in the mid-twentieth century as the populations of developing countries increased, and was later used to legitimate Cold War-era containment doctrine. In response, development agencies began framing family planning measures as a panacea against the dual spectres of overpopulation and so-called third-world Communism. Foucault argues that such discourse combines political goals with the management of procreation to regulate, and if necessary, discipline, individuals; he calls this new 1 Foucault, Michel. 1978. 2 Edelman, Marc and Angelique Haugerud. 2004. 6 form of power “bio-power.” Bio-power takes life itself as its object of governance, as it “deploys power-knowledge toward the end of securing, insuring, and managing the biological life of the population.”3 In this way, bio-power is one aspect of governmentality, or the rationalities and strategies that those in power employ in order to govern. As the world becomes increasingly globalized, the governing strategies of the world’s most powerful are no longer conﬁned to single or even regional blocs of nation-states; rather, the models of governmentality and bio-power employed by the global North have begun to displace more localized conceptions of governance in the global South in ways that might violate traditional forms of authority.4 Religious groups are often blamed when countries dissent from these international norms regarding family planning. One of the leading theorists of religion and development in Africa is Paul Giﬀord, a professor at the School of Oriental and African Studies in London. His most recent book, Christianity, Development, and Modernity in Africa, theorizes that the “enchanted imagination” of men and women in developing countries, which includes belief in witchcraft, ancestor worship, and other aspects of African Traditional Religion as discussed below, is fundamentally incompatible with development and rational thought. He posits that Western Christianity is essentially diﬀerent from Christianity in Africa, and that because African Christianity maintains some elements of traditional spirituality, its adherents cannot simultaneously participate in Weber’s rational-legal “cognitive strategy,” which Giﬀord believes to be “the correct strategy in any world.”5 My research ﬁnds something very diﬀerent: that rural Ugandans, regardless of religious belief, overwhelmingly accept the scientiﬁc knowledge that Giﬀord claims is incompatible with 3 Poechlauer, Karl. 2011. pg. 17. 4 Friedman, Jonathan. 2004. 5 Giﬀord, Paul. 2015. pg. 153. 7 their spirituality. It is not modern family planning that they reject, but the discourse of “birth control.” Those I spoke to objected to the exercising of bio-power via Western NGOs, whose authority they did not see as legitimate. As the following pages will show, it is counterproductive to construct development policy around the anxieties of donor states (such as overpopulation) and their proposed techno-ﬁxes (such as increased uptake of birth control), particularly when these “ﬁxes” are devoid of any connection to the cultural or historic contexts of developing states. Instead, eﬀective development should take a bottom-up approach that takes both the priorities and the authority of developing states as foundational to its work. Background With the second-youngest population in the world, Uganda is facing both internal and external challenges to its development policies. Infrastructure and social services are struggling to keep pace with the growing population, but eﬀorts to promote family planning services often face resistance from political, cultural, and religious leaders who are rightfully mistrustful of top-downward health planning and foreign intervention into social policy.6 Uganda’s fragmentation along linguistic, cultural, and ethnic lines has also made it diﬃcult for cohesive development policies to be put into place; there remains serious tension between the Buganda kingdom, which came to power in the late 1800s with the help of colonial forces, and other ethnic and cultural groups across the country.7 Despite these divisions, Ugandans are united by religious belief. As of the 2014 census, 99.8% of the country’s population claimed a religious aﬃliation.8 Although religious leaders have 6 MacCormack, Carol. 1992. pg 428. 7 Roberts, A. D. 1962. 8 Uganda Bureau of Statistics. 2016. 8 frequently opposed widespread contraception use, the mobilization of spiritual communities for family planning advocacy is an under-researched but potentially signiﬁcant avenue for sustainable development work. Uganda’s Colonial History In the eighteenth and nineteenth centuries, the territory that is now Uganda was home to a multitude of kingdoms and ethnic groups, the largest of which were the Buganda and Bunyoro kingdoms. Kabaka Mutesa of Buganda was one of the most powerful kings in East Africa, and his kingdom numbered more than a million citizens. During the 1840s, Mutesa began to prioritize the accumulation of muzzle-loading guns that were being shipped to Zanzibar from Europe, so that he could counter threats from neighboring Bunyoro. By expanding opportunities for trade, Mutesa simultaneously allowed for new points of contact with European missionaries, and convinced both the incoming Catholic and Protestant missionaries that their religion would be favored throughout the kingdom.9 These relationships were constantly in ﬂux, and were primarily used to consolidate regional power, not because Mutesa was particularly interested in converting to a new religion.10 After his death in 1884, Mutesa was succeeded by Kabaka Mwanga, who was signiﬁcantly more suspicious of missionary inﬂuence, particularly among the kingdom’s royal pages. In 1886, Mwanga ordered his pages—young men from wealthy Baganda households, many of whom had been educated in missionary schools—to recant their beliefs, although accounts diﬀer as to why. Most European writings from this time posit that Mwanga had demanded sexual favors from his pages, who, being Christians, refused; other, predominantly 9 Twaddle, Michael. 1974. 10 Brierly, Jean and Thomas Spear. 1988. 9 local, accounts state that Mwanga believed the presence of Christians in his court to be threatening to his sovereignty. Regardless of Mwanga’s motivations, forty-ﬁve pages refused to apostatize and were either beheaded or burnt alive.11 After the killings, Mwanga was deposed and a brief civil war broke out in the kingdom, with Muslim, Catholic, and Protestant armies ﬁghting for dominance. In 1888, the Imperial British East Africa Company received a charter from the British government to “preserve law and order in Buganda” by oﬃcially beginning the “civilizing mission” of colonialism, which lasted until Uganda gained its independence in 1962.12 Despite the execution of the pages, the kingdom of Buganda remained privileged in the colonial system, and Christianity is still the dominant religion in the country today. Population Growth and Challenges to Sustainability in Uganda As of 2014, Uganda had a population of 34.6 million people. Almost half of the population was under 14 years of age.13 Although Uganda has experienced a lessening of poverty over the past decade, the country maintains a fertility rate of 5.8 children per woman; many development organizations, both local and international, are concerned that the recent decrease in the poverty rate is unlikely to have lasting eﬀects if not coupled with a serious push towards widespread family planning.14 Population growth beyond the capacity of state infrastructure will exacerbate problems of water scarcity, poor waste management, widespread malnutrition, poverty, joblessness, and landlessness, and will challenge many other sectors of Uganda’s development. Much of Africa, including Uganda, is expected to ﬁnd itself in a position of “water stress” by 2025, meaning there will be 1,000 cubic meters less water per person per year than 11 Blevins, John. 2011. 12 Hoad, Neville. 2007. 13 Uganda Bureau of Statistics. 2016. 14 Dabelko, Geoﬀrey D. 2011. 10 what is considered adequate.15 This developing water scarcity will also put pressure on food production, which must necessarily increase to meet the demands of a growing population. Because many in Uganda already suﬀer from malnutrition and food insecurity, particularly in the northern and eastern regions, a rapidly growing population will quickly become unsustainable without subsequent decline in the country’s standard of living.16 For these reasons, widespread family planning campaigns have been justiﬁed by international development agencies like USAID as a solution to many of the country’s development challenges. Religion in Contemporary Uganda In 2014, Uganda’s population was over 84% Christian.17 The most widespread denominations were Catholic, at 39.3% of the population, and Anglican, at 32% of the population. Although Uganda is a majority Christian country, other denominations are growing in popularity; 11.1% of the country is Pentecostal, and an additional 13.7% practice Islam. Kapchorwa District, in Eastern Uganda, varies slightly from the country’s religious distribution as a whole; 26% of the population is Catholic, 39.7% is Anglican, 8.6% is Muslim, and 18% is Pentecostal. More broadly, 61% of the world’s Christians and 62% of all Muslims live in the global south, illustrating the enormous inﬂuence that religious doctrine has on the politics of the developing world.18 Most sects of Christianity do not condone the use of contraception, with the notable exception of Anglicanism. Since 1958, Anglicans and the Church of England have encouraged birth choice, or personal responsibility for reproductive decisions, over birth control, which in 15 Ibid. 16 Rwakakamba, Twesigye M. 2009. 17 Uganda Bureau of Statistics. 2016. 18 Pew Research Center. 2011. 11 the context of international aid can be perceived as coercive or neocolonial.19 Catholicism and Islam, however, oﬃcially condemn the use of contraceptive measures for the purpose of preventing conception.20 Some religious leaders, however, are beginning to embrace the possibilities of widespread family planning. Muslim hospitals in religious Indonesia, evangelical Christian aid organizations in the U.S., and even Pope Francis have recently begun to advocate for increased availability of family planning.21 Because religious doctrine has the potential to reach so many people in developing countries, there is a strong potential pathway for involvement of religious leaders in promoting reproductive health awareness in Uganda. Religion, Family Planning, and Foreign Aid The widespread inﬂuence of religion in Uganda is not limited to indigenous practitioners. American faith-based organizations (FBOs) have played an active role in shaping sub-Saharan Africa’s religious and political cultures for the past several decades. The advent of the AIDS epidemic in 1981 opened up new pathways for the participation of religious organizations in spheres previously considered inappropriately worldly or corrupt.22 One of the countries most severely aﬀected by AIDS, Uganda was also recovering from political turmoil and adjusting to the then-new leadership of President Museveni. Funding for AIDS treatment was thus outsourced, ﬁrst to local churches, and ultimately, to international FBOs. This had the eﬀect of institutionalizing the role of spiritual organizations as both necessary caregivers and political actors, reshaping their involvement in the public sphere and their inﬂuence over Uganda’s 19 Harries, Richard. 1996. 20 BBC. 2009. 21 Levey, Noam. 2016. 22 Gusman, Alessandro. 2009. 12 political policies in the process.23 This inﬂuence continues today in arguably problematic ways; one need look no farther than US evangelical support for Uganda’s so-called “gay death penalty” bills for examples of the tangibly harmful eﬀects international religious lobbies can have on the lives of real Ugandans.24 Possibly the single most inﬂuential foreign aid program in Uganda at the beginning of the twenty-ﬁrst century was President Bush’s PEPFAR. The creation of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 paved the way for American involvement in Uganda’s politics in an explicitly conservative, religious context. PEPFAR is best known for its ABC program: “Abstinence, Be faithful, correct and consistent Condom use,” with a particular emphasis on “A” and “B.”25 By mandating that a third of the program’s funding be used for abstinence-only education, “PEPFAR’s ABC programs replicated US legislative deﬁnitions of abstinence and its moralizing, heteronormative deﬁnitions of sex and sexuality. … As a major funder of HIV/AIDS eﬀorts in all focus countries, it continues to wield signiﬁcant inﬂuence over focus countries’ public health policies.”26 A key example of this inﬂuence is President Museveni’s ban on sexual education in public schools.27 Religious leaders, both indigenous and foreign, thus maintain a unique level of inﬂuence over Uganda’s political and social realms, with compelling implications for the future of family planning uptake in the country. Increased access to family planning has promising eﬀects on the development of Uganda and the empowerment of its female citizens, even if one objects to the methods employed by international NGOs to encourage its uptake. By reducing the number of unplanned pregnancies, 23 Prince, Ruth. 2009. 24 Curtis, Heather D. 2018. 25 Cynn, Christine. 2010. 26 Ibid. 27 Okello, Felix. 2012. 13 increased uptake of family planning diminishes poverty levels and makes it easier for families to support the children they already have. Decreasing unwanted pregnancies also correlates with a decrease in unsafe and illegal abortions, in addition to lowering dropout rates for school-aged girls.28 These issues are particularly signiﬁcant in Kapchorwa, where over 50% of girls below the age of 18 drop out of school to get married or care for their children.29 In addition, many women in Kapchorwa continue to face obstacles emblematic of a patriarchal culture, including forced circumcision, domestic and gender-based violence, and lack of decision-making power in the home.30 Improving the availability and usage of family planning methods has shown a capacity for markedly increasing women’s self-perceptions and empowerment, particularly in rural areas such as Kapchorwa.31 Literature on the subject frequently cites the inﬂuence of religious communities in both developing and developed countries as one of the largest barriers to family planning uptake.32 Although this may seem unsurprising, given the oﬃcial positions of most Abrahamic religions, quantitative studies indicate that the correlation between an individual’s faith and their family planning decisions may be smaller than expected.33 It is clear that more research is necessary to accurately understand the eﬀects of religion on family planning usage, particularly in developing countries. 28 Fox, Jared. 2016. 29 New Vision. 2008. 30 Oduut, David. 2017. 31 United Nations Population Fund. 2018. 32 Barrett, Jennifer. 2007. 33 Kelly, William. 1983. 14 II. The Research Context Over the last decade, anthropological research on family planning in Uganda has in large part focused on the response to the AIDS crisis by international actors.34 While PEPFAR and the recent rise of international FBOs has undoubtedly played a major role in shaping the perceptions of Ugandans on family planning, myths and beliefs dating back to the colonial era have a signiﬁcant eﬀect on family planning uptake and opinion. Moving beyond family planning as a preventative against AIDS, it is also important to recognize that Ugandans, as well as many other groups across East Africa, have used alternative methods to control fertility for centuries, although many of these practices were outlawed in the colonial period as authorities exercised bio-power to conﬁne all legitimate medical activity to that provided by the state, thus strengthening the colonial apparatus. This intersection between the biomedical and the spiritual has a signiﬁcant impact on the religious and demographic shape of Uganda today. Controlling Fertility, From the Pre-Colonial Era to the Present High fertility rates were generally considered advantageous in pre-colonial Uganda, which, as an agrarian society with low population density, depended on large numbers of children to help with pastoral and farming work.35 Demographers and anthropologists have also claimed links between large families and religious beliefs, blaming a “cult of the ancestors” for the continuation of high fertility rates into the present day.36 Although children undeniably play an important role in both the household economy and in cementing social relationships and kinship ties, less attention has been paid to the ways in which women across the continent have 34 Boyd, Lydia. 2015. 35 Kokole, Omari H. 1994. 36 Caldwell, John C., and Pat Caldwell. 1987. 15 always regulated their fertility.37 Because abortion was criminalized in most African countries during the colonial period, statistics about the practice are diﬃcult to come by (although some anthropologists and social scientists across disciplines have had limited success in conducting qualitative studies, rather than attempting to rely on oﬃcial statistics). Marc Epprecht emphasizes that East African women have long used “discreet traditional herbal methods of abortion,” but cannot elaborate on the frequency of the practice, while Nancy Rose Hunt ﬁnds that Tanzanian women in recent years have attempted to induce miscarriage by consuming “concoctions of wine, nearly frozen Coca-Cola, and sugar” before resorting to clandestine abortions in undercover clinics.38 39 Although this thesis will not focus on abortion as a form of family planning, a compelling debate about the stigmatization of the practice in the African context can be found in Chiweshe Malvern’s recent research on the subject.40 Given the sensitive nature of abortion throughout East Africa and across the continent, and the premium placed on fertility and child-rearing, most scholarship focuses on the spacing of children through “prolonged breast-feeding, postpartum sexual abstinence, and mechanisms of social dominance” in order to minimize infant mortality and ensure the health of the mother.41 By exclusively breastfeeding their children and enforcing taboos on sexual activity for a period of time ranging from two months to three years following childbirth, women prolong their postpartum amenorrhea, thus decreasing the likelihood of consecutive pregnancies.42 Malvern notes that women across the continent have also “relied on an extensive pharmacopoeia of herbal 37 Newman, James L., and Russell P. Lura. 1983. 38 Epprecht, Marc. 2009. 39 Hunt, Nancy Rose. 2007. 40 Malvern, Chiwesh and Catriona Macleod. 2018. 41 Newman, James L., and Russell P. Lura. 1983. pg. 396. 42 Ibid. pg. 397. 16 abortifacients and contraceptives to regulate fertility,” dating to at least the ﬁfteenth century.43 Scholars note, however, that “this means of fertility control is in no way intended to limit family size; indeed, it is practised in order to increase the number of surviving children.”44 Although this essentializing characterization is debatable, it is clear that women have long used varied methods to regulate their fertility. As artiﬁcial family planning methods have become more widespread across the continent over the last two decades, traditional methods have frequently been discarded or banned outright. The biomedical healthcare system, despite being one among many systems for understanding health and healing, has all but replaced traditional care; in one Nairobi case study, researchers found that traditional care was both more accessible and more easily adaptable to patient needs, but that it was “largely loathed and often curbed from many angles—social, religious, and even politically.”45 The supplanting, rather than supplementing, of traditional care with biomedicine has in many ways undermined the ability of women to make reproductive healthcare choices for themselves, as will be explored later in this thesis. African Christianity and its Paradoxes Before the introduction of Christianity to southern Africa by European missionaries in the late nineteenth century, indigenous religious practices varied widely across the continent. Although diﬀerent regions maintained very diﬀerent practices, literature on the subject emphasizes that commonalities exist across most forms of African traditional religion (ATR), making this categorization a valuable phenomenological approach.46 ATR typically includes 43 Malvern, Chiwesh and Catriona Macleod. 2018. pg. 53. 44 Bertrand, Jane T., W. E. Bertrand and Miatudila Malonga. 1983. 45 Mburu, F. M. 1992. 46 Pobee, John. 1976. 17 aspects of ancestor worship, ritual, spirits, and witch-doctors or other individuals responsible for spiritual guidance.47 Its theology is grounded in the material needs of its believers; ATR has always been deeply connected to African metaphysical understandings of healing, and the two can be understood as a medico-religious system in opposition to today’s biotechnical one.48 Foreign missionaries, many of whom saw African culture as “the enemy of education and progress,” rejected ATR at a fundamental level, seeking instead to convert southern Africans to Christianity and a more “civilized,” European lifestyle.49 Religion was used as a tool of colonial governmentality—by policing the morals of Africans, “managing African behavior, and inculcating modern virtues,” the colonial state was able to produce a new type of citizen that was more easily governable.50 Rather than replacing ATR with a homogenous Christianity, the evangelization process facilitated a cultural encounter in which each set of beliefs shaped the other.51 Missions oﬀered medical care and schooling, thus fulﬁlling the material, as much as the spiritual, needs of their parishioners (although healthcare was often conditional on the successful conversion of the sick to Christianity). Bibles were translated into local vernacular, with the unintended consequence of imbuing Christian doctrine with indigenous meanings. Missionaries, unfamiliar with all of the connotations of particular indigenous phrases, frequently tried to make Christianity—and mission medicine, a core component of the mission’s appeal—more accessible to Africans by bringing in terms from their pre-existing vocabularies. James Pritchett, whose scholarship 47 Ibid. 48 Waite, Gloria. 1992. 49 Knighton, Ben. 2004. 50 Boyd, Lydia. 2015. 51 Ibid. 18 includes work on linguistic changes among the Lunda of Zambia, provides a compelling example: The missionaries came to adopt the Lunda word yitumbu for the English medicine. Yet to Lunda consciousness yitumbu connoted not only curing substances but also incantations, spells, and rituals. Musongo became the accepted gloss for disease. Yet to the Lunda musongo not only meant physical disorders but could also imply bad luck or bewitchment.52 Thus, “mission medicine—and Christianity itself—became saturated with [African] metaphors and meanings, … traditional assumptions, and … metaphysical associations.”53 In turn, southern Africans engaged in a process of “creative recontexualization,” whereby the aspects of Christianity which they found most useful were integrated into their existing cosmologies, creating a hybrid belief system at once Christian and indigenous.54 Interactions between ATR and Christian missionaries are clearly more complex than the essentialized imperialist narrative so commonly propounded by those attempting to compensate for Europe’s problematic history in Africa. Far from glossing over the detrimental legacy of colonialism, however, recognizing the nuances of missionary/African relations serves to highlight the agency which Africans exercised in their fragmentary adoption of Christianity and the mosaic of religious ritual which resulted from their eﬀorts. Recognizing the legacy of foreign actors in local religious and medical contexts can also provide a more realistic context for the successes and failures of subsequent family planning interventions. 52 Pritchett, James. 2011. 53 Ibid. 54 Ibid. 19 Methodology I spent my ﬁrst few days in Kapchorwa observing at Reproductive Health Uganda, a Ugandan NGO dedicated to providing sexual health services like counseling, STD screening, and contraceptive education. I spoke with dozens of young women and men visiting the center for STD treatment and free condoms, but quickly realized that because RHU primarily targets university students and newlyweds, conﬁning my study to institutionally supported participant observation would prevent me from learning from middle-aged families and the elders of the village. For this reason, I worked with Madame Consolate and the rest of the staﬀ at RHU to design a study that would incorporate ethnographic observation with cross-disciplinary social science research methods, ultimately achieving a larger sample size while maintaining deep relationships with those I worked with. Sampling I began by identifying, with Madame Consolate’s help, three areas around Kapchorwa with populations that diﬀered in socioeconomic status, religion, and education. Rather than sampling only from Kapchorwa Town, I traveled around the district via boda boda; although I primarily used convenience sampling, I was able to reach a much more diverse population than I had initially hoped. I then divided my sample into six focus groups, divided by age and gender as shown in Table 1. I did not explicitly sample based on religious aﬃliation, but every participant self-identiﬁed as religious; in total, I surveyed eight Catholics, nineteen members of the Church of Uganda (interchangeably referred to as Anglicans), four Pentecostals, and nine Muslims. Religious aﬃliation was fairly evenly distributed across the six focus groups. 20 After running each focus group, which I will describe below, I asked group members to select one participant to join me for a longer in-depth interview. These interviews were self-selecting as many of the men and women I worked with had already taken valuable time away from their ﬁelds or had traveled across town to meet with me. Asking group members to choose an interviewee amongst themselves was not particularly random, but it prevented my study from being more of a time commitment than anyone could easily spare. Individual interviews were conducted according to the sample question schedule in Appendix A, and typically lasted no longer than 30 minutes. Although I had initially planned to survey more participants using a questionnaire format, in-depth interviews were ultimately a better ﬁt for this study because they oﬀer the chance to ask follow-up questions, clarify misunderstandings, and better understand the individual voices of respondents. Table 1. Participant Index Focus Gender of Age Range of Number of Location of Focus Group # Participants Participants Participants Group 1 22-28 7 Siron Village 2 Female 30-50 8 Sipi Subcounty 3 56-62 6 Siron Village 4 18-25 6 Kapteret Parish 5 Male 30-45 7 Sipi Subcounty 6 50-88 6 Kapteret Parish I also conducted interviews with key informants both in Kapchorwa and in Kampala. These key informant interviews were held with religious leaders, local council members, 21 reproductive health workers, nurses, and a municipal development oﬃcer. On my last day in Kapchorwa, I was also invited to a meeting of Kapchorwa Secondary School’s Gender-Based Violence Club, where I worked with the student members and the adult club leader. This was not part of my initial study design, but it provided me with fascinating insight into myths and misconceptions regarding family planning, which I will describe further below. Tools Keeping in mind the extractive nature of classical anthropology, I wanted to prioritize reciprocal learning in each of my focus groups. I thus elected to guide my focus groups with a pictorial survey (Figure 1) in the tradition of participatory rural appraisal (PRA). This method is meaningful because it provides a feedback-centered approach to qualitative research, one in which a study is done with, rather than on, the population of interest.55 Although the use of PRA has been a controversial subject among anthropologists, with some viewing the methodology as a “hasty, superﬁcial approach” or as “‘short-cut’ social science,” I believe that PRA can be an essential element of applied anthropology if it is used to break down artiﬁcial barriers between “expert” anthropologists and passively-studied populations.56 By allowing communities to take part in representing and analyzing their own situations, and prioritizing the involvement of these communities in anthropological discussion, PRA can be an important complement to the tradition of long-term ethnographic research. For these reasons, I worked with RHU to design a handout that illustrates six diﬀerent methods of family planning, both natural and artiﬁcial. I asked participants to describe their experiences with each method, explain what they knew about how each method worked, list any 55 Mosse, David. 1994. 56 Cornwall, Andrea and Sue Fleming. 1995. 22 side eﬀects they had experienced or heard about, and evaluate the general eﬀectiveness and quality of each method. Each participant was asked to share their own experiences and to build oﬀ of the responses of other group members. Throughout the discussion, I actively encouraged participants to ask questions about the diﬀerent methods being discussed; indeed, I struggled at ﬁrst to balance both asking and answering questions about the diﬀerent family planning methods. Figure 1. PRA Focus Group Handout 23 After concluding data collection, I transcribed my interviews and hand-coded them, extracting important themes and writing follow-up questions to share with Madame Consolate via email. The entire ﬁeldwork process took approximately four and a half weeks, but I spent the following year conducting a more thorough review of the literature and reﬂecting on my experiences. Like all ﬁeldwork, the data I collected helped to answer my initial research question while raising dozens more potential projects. I hope to return to Uganda in the coming years to further explore these themes in new ways, and to maintain the close relationships I formed while conducting my research. 24 III. The Case Study The boda rumbled to a stop just as a clap of thunder shook overhead. Tiny pinpricks of rain began to fall and I regretted not bringing an extra sweater. My friends in Kampala had warned me that Kapchorwa was freezing, but they also tended to wear giant puﬀer jackets when the temperature dipped below 70 degrees, so I had mistakenly ignored their advice. I thanked the boda driver, tipped him a few hundred shillings, and set oﬀ into the woods to ﬁnd Madame Betty’s house, where I had been told two groups of women were waiting for me. After wandering for a mile in what I later learned was exactly the wrong direction, I was found by my translator, Darius, and led to a small compound surrounded by freshly-tilled plots of beans, manioc, and mangos. Several profuse apologies later, I sat down among the trees with my ﬁrst focus group: seven young women, each with a child or two pulling on their arms and screaming. Armed with sweets for the children and biscuits for the mothers, I launched into the most awkward hour of my life, as my tape recorder malfunctioned, Darius became irritated, and my ﬁeldnotes got soaked by what had quickly become a downpour. Despite these diﬃculties, the women I interviewed gradually began to construct a narrative about family planning that took me by surprise. As my further focus groups would conﬁrm, the vast majority of men and women I surveyed had experience with at least one form of family planning (see Figure 2). Anglican participants had the lowest uptake rates of family planning possibly because this religious aﬃliation skewed slightly older and decidedly female, a demographic which the literature states is the least likely to use family planning because of 25 historical barriers to access during their childbearing years.57 Nevertheless, almost three quarters of Anglican respondents indicated familiarity with at least one form of family planning. Figure 2. Proportion of Religious Groups Using Family Planning Participants diﬀered on the type of family planning they used most frequently, although this variation did not correlate strongly with religious aﬃliation. Among artiﬁcial methods, almost half of all participants had used injectables, and 67.5% had used either condoms or the pill. Only one woman stated that she had used an IUD in the past, which ﬁts into trends established by the literature on IUD knowledge and accessibility in developing countries. Figure 3, below, illustrates this data. Cutting across religious groups, four participants stated that they regularly used the rhythm method, either separately from or in conjunction with condom use.58 In fact, almost half of all respondents claimed to have used more than one type of family planning, 57 Godfrey, Emily. 2011. 58 Many respondents were not familiar with the rhythm method, but recognized the terms “moon beads” or “counting days.” “IUD” was also more frequently recognized as a “coil,” highlighting the need for local assistance in compiling research terms. 26 whether simultaneously, as with those who supplemented the rhythm method with condom use, or subsequently, due to dissatisfaction with a particular method. Figure 3. Utilization of Family Planning Methods Of the “other” methods discussed, one woman claimed to have had success with lactational amenorrhea, although the literature suggests that many women seek to space their children in this manner without considering themselves as practicing family planning. Other common responses included tubal ligation, the progestin IUD/implant, and the withdrawal method. Additionally, one young woman in my ﬁrst focus group described a method her mother used before she “got educated and opened her eyes to real family planning”: You have a baby and you cut the cord. Dry the cord and put it in a box, like an empty matchbox. Place it among the stones in the hearth. Then you light a ﬁre 27 like normal. You won’t have a baby until you remove the box from the stones—one year, ﬁve years, whatever you want. That’s what my mom did. Participants of the focus group laughed when the young woman ﬁnished telling her story, but many of them agreed that they had heard of similar practices, whether or not they believed in their eﬀectiveness. The next section will expand upon the role of traditional family planning methods, while also describing the advantages and disadvantages of modern family planning most frequently mentioned by participants. Justiﬁcations for Various Family Planning Methods Almost every focus group participant, regardless of religious aﬃliation, agreed that family planning had had a positive eﬀect on their lives, or more broadly on the development of Uganda. “You can buy land, build a business, and care for your husband if you don’t have too many children,” said one middle-aged woman in Focus Group #2, emphasizing the holistic beneﬁts that family planning can have on women’s lives. Women and men alike focused on the economic beneﬁts of spacing and limiting children, citing the rising costs of school fees and Kapchorwa’s worsening land shortages. Many older respondents reﬂected on positive changes in family planning perceptions and usage over time, including an older man from Focus Group #6: People used to have many children because there was a lot of land. Seven or eight children was good, because they could be soldiers for their tribe. Ugandan culture meant having many kids, in case some of them died or turned out to be thieves or bad kids. Now, school is expensive and land is little. We need to have smaller families—maybe two [children] are enough. … When I was young, women used traditional methods, but they were very dangerous and ruined women’s wombs. 28 They encouraged witchcraft, so as I grew older they died out and were replaced with more modern methods. Though some still used traditional practices, many women agreed that modern family planning, whether natural or artiﬁcial, was more eﬀective and less dangerous than the herbs or other methods previously employed. Although most participants agreed that modern family planning was beneﬁcial, opinions diﬀered as to when speciﬁc methods were most appropriate. Each of the three male focus groups explained that condoms could only be used outside of the context of marriage. Over half of the men surveyed claimed that condom use was synonymous with cheating; condoms were good to use with extramarital partners, because they “prevent[ed] disease from entering the home,” but conversely, if their wives insisted on condom use, they would assume that they also had other partners. Interestingly, this also did not correlate to a speciﬁc religion, implying that extramarital aﬀairs are common across religious aﬃliation. Women focused on the negative health eﬀects of using family planning with men other than one’s husband, claiming that “sleeping outside of the marriage with a coil [IUD] causes cancer” and “if your husband is cheating and you use family planning, it will cause you to get syphilis.” Although some of these misconceptions could be corrected with increased sexual education programs (as discussed in a later section), they are also indicative of broader cultural ideas concerning promiscuity and family planning, which some claim have been exacerbated by President Museveni’s abstinence-only education policies.59 Many participants were eager to describe the beneﬁts and drawbacks to each method they had sampled. Condoms and the rhythm method proved to be the most polarizing, with many 59 Cynn, Christine. 2010. 29 respondents advocating for both their advantages and disadvantages. Both men and women claimed that their spouses got no pleasure from sex when condoms were used, stating alternately that “men don’t like to use condoms,” “women aren’t satisﬁed with a barrier,” and “there is no sweetness between partners if a condom is used.” Men in particular, however, claimed that condoms were the best method of family planning, because they prevent both sexually transmitted infections (STIs) and unintended pregnancies. Men primarily cited the rhythm method as having major drawbacks, particularly for the self-control necessary for its implementation. Many men claimed that they did not like having to abstain during a woman’s fertile time, and stated that it was sometimes diﬃcult to keep track of “safe days” and “danger days.” Women seemed satisﬁed with the rhythm method, however, and praised it for being natural, rather than “like taking drugs.” Because most respondents had experience with multiple types of family planning, almost all were able to identify a favorite method that ﬁt best with their lifestyle. Figure 4. Side Eﬀects of Family Planning 30 The majority of participants who had never used family planning, or who had utilized a method in the past but discontinued use, cited negative side eﬀects as the biggest disadvantage of family planning as a whole. 85% of respondents claimed to have directly experienced at least one serious side eﬀect of modern family planning, while several others said that the stories of their friends prevented them from wanting to try family planning for themselves. The most common side eﬀects mentioned, as shown in Figure 4 above, were over-bleeding (25%), weight gain (17.5%), not menstruating (15%), and general susceptibility to illness (15%). Another side eﬀect, mentioned only in male focus groups, was that hormonal family planning methods “weaken women.” Over a quarter of all men surveyed claimed that the side eﬀects of modern family planning prevent women from doing work around the house, saying that “it makes our wives weak and sickly … even to the point where it would be better just to have more children, so at least they will want to work.” The implications of this statement are important, as studies have shown that the involvement of men in family planning promotion is essential to its acceptance and continuation.60 If men believe that using family planning will require them to hire additional house help to make up for the lost working capacity of their wives, they may be more likely to discourage its use, limiting the options available to women. Other reasons for not using family planning were both cultural and practical. A catechist at St. Paul’s Catholic Church in Kapchorwa recognized the positive eﬀects that smaller families could have on development, but still had questions about family planning: Why should we emphasize family planning when there are so many deaths in the world? Road accidents, malaria, cancer, all ﬁnishing us—who will replace those 60 Vouking, Marius. 2014. 31 who are dying? Another older man from Focus Group #6 had similar reservations, stating: It is not Sabine culture to use family planning—why would we want to? We are very few in number, so we should be trying to increase. We need to produce so many more Sabine to maintain our culture. Do you not think the same things in America? This focus on large families in order to preserve culture is supported by the literature, and by historical population trends.61 A darker side to this conversation also occurred with disturbing regularity, as both men and women frequently asked me if Americans hated Africans and thus wanted to limit their population. One middle-aged man expressed shock at the idea that Americans also died from AIDS, and explained that he assumed “Americans had all the healing drugs and weren’t giving them to us, because you wanted us to die.” These beliefs reﬂect colonial-era concerns about European doctors as organ-harvesters or vampires intent on proﬁting from the deaths of Africans. With the frequent weaponization of missionary medicine and the conditionalities imposed on health aid today, these impressions must be taken seriously by development practitioners.62 Although almost every participant surveyed supported family planning for married couples, providing access to contraception for school-aged girls was a much more divisive subject. The male focus groups in particular were highly divided, with some encouraging their daughters to practice safe sex, and others convinced that the side eﬀects of hormonal birth 61 Pernia, E. M. 1982. 62 Ranger, Terence O. 1992. 32 control were worse for their children than pregnancy. One man in Focus Group #5, participating in an animated debate between group members about the proper time for beginning family planning, made a well-received point, stating “You can’t keep girls from having sex, so at least let them be protected.” After hearing this, the men continued to argue, but ultimately agreed that it was acceptable for girls to use condoms and perhaps the pill while still in school. This exchange emphasizes the importance of community dialogue; although I had done my best to convince the men that their fears about birth control in young women were unfounded, my positionality as an outsider made me acutely afraid of overstepping my bounds. Ultimately, it was the reassurance of a respected community member that changed the men’s minds. Although most participants used family planning, individual experiences were mixed, particularly because side eﬀects were so varied and, in several cases, so debilitating. Participants explained the cultural justiﬁcations for using certain methods and not others, depending on the situation. Most participants agreed on the signiﬁcance of particular methods, and believed that predominantly married couples should have access to family planning. The next section investigates the role of religious culture in shaping these beliefs. Religious Opinions of Family Planning In most of my focus groups, participants spoke brieﬂy about their religious beliefs, but presented them as mostly unimportant to their decisions about family planning. This conﬂicts with the inﬂuential development literature of Professor Paul Giﬀord, who posits that an “enchanted imagination” present in pan-African society prevents men and women from making rational decisions and permits religious doctrine to control every aspect of their lives.63 While 63 Giﬀord, Paul. 2015. 33 Giﬀord has occasionally been criticized for his claim that African spirituality is incompatible with development, his books have also been considered “essential reading” for scholars of religion and development in Africa.64 Although his essentializing claims and emphasis on rational-legal authority struck me as suspect, I expanded my initial six focus groups in order to further explore the relationship between religious doctrine and family planning decisions. The following section is broken into the four major religious belief systems present in Uganda. Although logistical issues prevented me from speaking with an Anglican pastor, I was able to speak with almost a dozen Catholic leaders, in addition to a Pentecostal pastor and a Muslim imam. My conversations with these men contradict Giﬀord’s claims, problematize the idea of a religious-rational dichotomy, and point to a signiﬁcant gap in public and private religious teachings. Catholicism Catholic leadership in Kapchorwa publicly reﬂected the oﬃcial positions of the Vatican on most aspects of family planning. Father Oyengo Joseph at St. Paul’s Catholic Church explained: “We encourage smaller families and the education of children as responsible parenthood, because it’s easy to give birth but hard to care for a family.” His catechists reiterated the importance of only having as many children as you can care for, but warned against: … using drugs that interfere with nature and God’s blessings of procreation. Some people have too many children. That is true. But God has a plan for them all and will provide. Just carry on, because every child who comes is God’s gift. 64 Storer, Liz. 2015. 34 Father Joseph emphasized the discipline required for eﬀective use of the rhythm method, claiming that “using moon beads requires respect of and for both partners. … Men have to learn self-control.” He conceded that condoms were sometimes appropriate, however, particularly if one partner in a marriage was HIV positive while the other was negative. Generally, though, artiﬁcial family planning was not considered acceptable for Catholics in the ranks of the Church. Focus group participants agreed with some of these points, but many Catholics stated that the Church was much more lenient than the leadership had suggested. Although most of the female participants believed that Catholics did not accept artiﬁcial family planning, men across all age groups claimed that the Church actively promoted injectables and condom use because “with the problems of today, what are their other options?” It did not seem to matter, however, if participants believed that their religion supported or forbade modern methods—even among those who believed that the Catholic Church said family planning was a sin, 100% of Catholic participants reported using a form of birth control in the past. Church of Uganda Anglican participants used family planning at the lowest rate of any religious group surveyed, although many participants believed that their church leadership was supportive of modern methods. Responses were highly varied, however; one woman attends a church that promotes “living a natural life” without family planning or vaccinations, while another stated that her pastor frequently tells his congregation that “family planning is the only way to prevent the next generation from becoming squished by the high population.” Several Anglican participants 35 argued that “the Church of Uganda is focused on societal problems, so it is up to you to decide about your family,” which aligns with the oﬃcial position of the Anglican church.65 All participants whose pastors spoke positively about family planning reported that they felt secure in their decision to use these methods, but claimed that they would continue to use artiﬁcial family planning even if their religion were to condemn it. Of the ﬁve Anglican women who did not use family planning, two were newly married and actively trying to have children, one was postmenopausal and said that she did not have access to family planning during her child-bearing years, and two said that their churches promoted natural lifestyles that did not even allow for the rhythm method. Of the women using family planning, only one stated that she exclusively used the rhythm method, primarily for religious reasons. All other women had used artiﬁcial methods at some point in their lives. Pentecostalism Pentecostalism as a belief system is incredibly varied, and as my study included just four Pentecostal participants, it is diﬃcult to make meaningful claims about family planning perceptions among Pentecostals as a whole in Kapchorwa. With that acknowledged, valuable insights can still be gleaned from my work with key informants, and the openness of the Pentecostal focus group participants. I worked primarily with members of Pastor Henry Arapahi’s Christ Alive Glorious Church in Kapchorwa Town, and interviewed the pastor at length about his church’s opinion of family planning. At well over six feet tall, with a booming voice to match, Pastor Henry is one of the most imposing men I have ever met. Minutes after ushering me and Darius into his dimly-lit sitting 65 Harries, Richard. 1996. 36 room, he asked me about my own religious beliefs and began aggressively attempting to convert me to Pentecostalism. As Susan Friend Harding notes in her seminal study of fundamentalist rhetoric, language is the primary tool by which born-again believers come to understand themselves as Christians and their relationships with the secular world.66 Nevertheless, I was taken aback by Pastor Henry’s tactics, which involved inviting his son to marry me in an attempt to make me a “good Pentecostal mother.” Despite being disappointed by my failure to convert, Pastor Henry was very open to my questions and our conversation was lively. He agreed that family planning was a positive development in many people’s lives, because “due to modern economic demands, it can be too diﬃcult to have even two or ﬁve children.” In a similar vein as many other religious leaders surveyed, the pastor primarily advocated for natural family planning methods, but admitted that his wife used injectables for several years and that they worked well for her “until [they] found out she was four months pregnant—because God had willed it.” Members of Pastor Henry’s church and other Pentecostal churches in the area made similar points about the “proper” Pentecostal view of family planning. A young woman in Focus Group #1 claimed that “the Bible says to be fruitful and multiply … so, God doesn’t like family planning.” An older woman in Focus Group #2 stated that “when you use family planning, it’s like you’re a murderer, because you’ve prevented sperm from reaching the egg.” This led to an intense debate among the women, who ultimately concluded that “sometimes, what we learn in Church is diﬀerent from what we have to do for our families.” This statement was surprising, but the idea of separate spiritual and practical realities recurred frequently throughout the study. Indeed, although all four Pentecostal focus group members claimed that their churches did not 66 Harding, Susan Friend. 2001. 37 support family planning, or only advocated for the rhythm method, three members reported that they primarily used artiﬁcial methods regardless. Islam In literature on family planning, Muslims are regularly cited as having one of the lowest uptake rates of any religious group.67 It was surprising, then, that all of Muslim men and women surveyed claimed to regularly use family planning. Kasmart Ismail, an imam in the district, discussed his own use of family planning while balancing his one-year-old son on his knee: I want eight children, but I can’t aﬀord to educate them. I have three now and it is already diﬃcult. In the past, there was a focus on big families, but now I believe that women should not get married before the age of 25—they need to be educated and know how to manage the home. … The Quran allows for family planning if the spouses agree, if the man allows the wife. Family planning is not so bad, but it depends on the method. This interpretation of family planning permissibility in the Quran seems very progressive, but is perhaps growing more common. All Muslim participants stated that their mosques oﬃcially do not allow for family planning, but that they themselves, and many of their friends, utilize artiﬁcial methods. Focus Group #4 consisted primarily of young Muslim men, all of whom claimed to regularly use condoms, and who were familiar with other methods. A young mother in Focus Group #2 explained her choice to use injectables: I use family planning even though the imam says it is wrong. We want to space our children, to have good children who we can care for well. My husband is not 67 Barcelona, Delia. 1985. 38 ﬁnancially stable—we can’t care for ten children, we have to modernize our family. At the end of the day, if you’ve produced them, you must take good care of them. Focus group members cited increasing community sensitization and involvement of clinics and hospitals as the driving force behind rising family planning uptake. 80% of Muslim members stated that even if their mosques were to expressly forbid the use of artiﬁcial family planning methods, they would still incorporate them into their lives. One issue that came up consistently in both focus groups and key informant interviews was the dichotomy between the public and the private teachings of religious leaders. Many participants reported hearing strongly negative information about artiﬁcial family planning methods in religious services, but being counseled diﬀerently when meeting with spiritual leaders individually. Even in my own interviews, religious leaders stated that they understood “the situation in families is maybe diﬀerent from what the Bible says.” Father Joseph at St. Paul’s Catholic Church explained that although he promotes the rhythm method among his congregation, “Kapchorwa gets very cold at night” and self-control can be diﬃcult. A catechist at the same church claimed that “if people are using artiﬁcial methods secretly, we don’t discourage it.” Similar responses among other religious leaders make for a compelling argument: as many focus group participants claimed, the positions of religious institutions may be much less black-and-white than their oﬃcial doctrine suggests. My ﬁnal interview was conducted with Madame Tegulwa Nageeba Hassan, the National Coordinator for Women’s Aﬀairs on Uganda’s Muslim Supreme Council. Madame Hassan discussed with me the challenges she continues to face in promoting family planning among 39 religious communities. She described a meeting with a prominent imam, who had privately complimented her advocacy and conﬁrmed its necessity, but who refused to speak to his mosque about the issues. After much cajoling, she convinced him to advocate for limited family planning—only natural methods and condoms, and only for married couples—at a conference of religious leaders from across Uganda. The imam was the ﬁnal leader to speak on a panel about family planning, in which all previous participants had spoken negatively about the use of contraception. The imam kept his promise and publicly supported family planning in certain situations, citing the potential advances for Uganda’s development as well as beneﬁts for individual families. He received a standing ovation from the other panelists for his speech, which “publicly stated realities that many other religious leaders recognized but could not say.” This story encapsulates key cultural challenges, as the perceived cost of speaking contrary to oﬃcial doctrine can be too high for religious leaders to risk lending vital support to family planning advocacy. By working to dissolve the boundaries between public and private teachings, religious leaders could more adequately meet the needs of their congregants by destigmatizing family planning decisions. Sources of Knowledge About Family Planning A common problem cited in family planning literature is the lack of quality sources of information in rural communities.68 For this reason, I also asked each participant to list their primary source of knowledge about family planning. This information is displayed in Figure 5. A plurality of participants (37.5%) claimed that they learned the most about family planning from their friends, which is consistent with previous studies about the spread of misconceptions about 68 Oye-Adeniran, Boniface. 2006. 40 contraception in developing communities.69 A quarter of participants prioritized knowledge gained from community outreach, which is promising given the increased funding that these outreach programs are receiving, but still not at the level that many community organizers would wish. A ﬁfth of participants referenced school as their primary source of information, which is concerning given the acknowledged issues with the abstinence-only policies promoted by President Museveni. Only 10% of participants said that they got the most information from their churches or places of worship, which could have implications for the role of religion in determining family planning usage. Other sources of information included family members and local council leaders. Figure 5. Sources of Knowledge About Family Planning 69 Gueye, A. 2015.