In the struggle between religious and cultural beliefs versus the social and medical need for contraceptives, our women and girls find themselves caught in the middle.
By Alfred Koroma
At 19, Augusta Stevens attempted to use contraceptives but stopped after a nurse told her she was too young for the medication.
“I was using Depo (,” she recalls. “But one day, I went to get the injection, and the nurse asked if I had given birth. When I said no, she advised me to stop, saying it could harm the fertility of women who haven’t had children.”
“I’ve also heard people say it has after-effects, making it difficult for a woman to conceive. So, I stopped using it,” she adds.
Now 26, Augusta still lives in fear of taking contraceptives. She is not alone. Twenty-two-year-old Lamrana Jalloh, a mother of one, also avoids contraceptives, opting instead for a method passed down by her grandmother.
“I don’t use contraceptives, but after sex, I squat and press my stomach for the sperm to flow out, then use my finger to clean myself,” she says.
Pregnancy is a divine gift
Lamrana, like many others, views pregnancy as a divine gift that should not be prevented. She believes contraceptive pills interfere with God’s plan for procreation.
“I believe pregnancy is God’s will. You conceive when God wants you to,” she explains. “If you keep taking contraceptives, the time you’re ready for a child, God may not grant it.”
Despite progress made, traditional religious beliefs significantly influence attitudes toward contraceptives and family planning in Sierra Leone. According to the Ministry of Health and Sanitation, 1 in 10 women who avoid modern contraceptives do so for religious reasons.
Parental opposition is another barrier for young people seeking pregnancy-prevention options.
“The problem isn’t the children but their parents,” says Nurse Isata Michela Conteh from Bamoi Luma. She recounts how a mother furiously removed a contraceptive band she had given to a 13-year-old girl.
“There are challenges with the parents,” echoes Alusine Mambu, a health worker. “Some believe their culture and religion don’t permit family planning.”
“There are times when a young person visits our centre and takes contraceptives, and the next day she comes back with her parents, saying remove what you implanted in my child,” Mambu explained.
However, some religious leaders are more accepting of family planning.
“When I studied theology, I didn’t see where God forbids planning a family,” said Rev. Joseph Sowa of the Redeem Tabernacle Church.
Pastor J.S. Fofanah of the Wesleyan Church of Sierra Leone agrees. “Family planning improves family well-being. According to scripture, it’s not bad, but sex outside marriage is a sin,” he said, urging parents to support family planning for sexually active youths.
Tug-of-war
The debate over the need for contraceptives is a complex tug-of-war involving the interpretation of religious scriptures, deeply rooted cultural beliefs, advances in modern medicine, and the need for safe sex.
“Family planning rejects Allah’s provision,” argues Sheikh Ibrahim Koroma. “Every child’s sustenance is preordained by the Almighty. Who are we to interfere with His plan?”
Sheikh Ibrahim also criticizes contraceptives for promoting immorality and encouraging premarital sexual activity, which he says violates Islamic principles.
But what are the social, religious and medical consequences of unsafe sex?
Sierra Leone faces alarmingly high rates of teenage pregnancies. According to a 2015 UNICEF report, 40 percent of girls in the country are married before age 18. In addition to teenage pregnancies, unintended pregnancies, unsafe abortions, and maternal mortality remain pressing issues. Despite a nearly 40 percent decrease in the maternal mortality ratio (MMR) from 1,165 per 100,000 live births in 2013 to 717 per 100,000 live births in 2019, Sierra Leone is one of the countries with the highest MMR in the world, according to UNFPA.
Addressing these challenges requires a multi-faceted approach, says Nurse Haja Kamara.
“Education is key,” she emphasizes. “We must work closely with religious and cultural leaders to help them understand the importance of family planning.”
There is a need to bridge the gap between tradition and modern medicine. Sierra Leone can empower its women to make informed decisions about their reproductive health, paving the way for a healthier and more equitable society.
Introducing age-appropriate, culturally sensitive sex education in schools can empower young people with the knowledge to make informed choices about their reproductive health and prevent teenage pregnancies.
There is cultural sensitivity surrounding the provision of affordable or free contraceptives through initiatives such as community health programs aimed at helping more women make informed decisions about family planning, particularly in underserved regions. However, the benefits far outweigh the risks, especially if the country aims to reduce teenage pregnancy and its associated social consequences.
It really comes down to whether we want to empower our girls to have children when they are ready and mature or leave them unsupported, potentially becoming a burden on society. It’s as simple as that,” says Adama Sesay, a Midwife.
