Before advocating the importance of family planning in disadvantaged communities, Peter Yeboah, executive director of the Christian Health Association of Ghana, acknowledged a surprising fact about his background: He grew up with 13 siblings in a Catholic family, and two of his brothers are priests.
“I’m going to confession after this,” Mr. Yeboah said with a laugh, adding that some of his relatives disagree with his views.
The tension in his family represents a broader tension facing groups that promote family planning: Faith-based organizations (FBOs) and churches are effective vehicles for family planning education and resources, but religious convictions often deter such institutions from partnering in the cause.
An event Tuesday at the Woodrow Wilson International Center for Scholars — attended by about 100 people, many representing international charitable organizations — highlighted facets of this tension.
“Faith-based organizations are increasingly supporting family planning, though some avoid it or are opposed to it,” said Victoria Graham, a senior technical advisor at USAID’s Office of Population and Reproductive Health.
FBOs and religious institutions such as churches are key to advancing the cause, Ms. Graham said: religious leaders are respected, and religious institutions have established networks that help facilitate access to family planning.
U.S. organizations that support some methods of family planning in their international ministries include World Vision, Christian Health Associations in Africa, Christian Connections for International Health, and the United Methodist Church. According to its website, Catholic Relief Services promotes only Catholic Church-approved methods of family planning. Samaritan’s Purse declined to comment on its stance toward family planning.
Tonny Tumwesigye, executive director of the Uganda Protestant Medical Bureau, affirmed that when FBOs get involved in family planning services, use of those services increases.
But integrating FBOs into national-level programs, maintaining sensitivity to FBO practices, and dealing with bias against certain family planning methods present challenges, he said.
In some cases, methods make all the difference: only natural family planning methods are officially acceptable in the Catholic Church, but other Christian groups tend to approve contraceptives as long as they don’t prevent the development of an embryo, said Rebecca Oas, associate director of research at the Center for Family and Human Rights. (Ms. Oas was not at the Wilson Center event.)
Abortion, Ms. Graham said, is generally off the table for faith-based organizations, although another panelist — Pauline Muchina, director of Healthy Families, Healthy Planet for the United Methodist Church — said she is pro-choice and believes women should have access to a “comprehensive” range of family planning methods.
To address these differing convictions about family planning, Mr. Yeboah said, CHAG has adopted an integrated approach: it offers artificial family planning methods through faith-based groups that will accept them, but only natural methods through groups that don’t. Catholic groups, he said, comprise 44 percent of those in his organization.
Adrienne Allison, senior technical advisor for World Vision, noted that language can help alleviate biases against family planning, too. Years ago, she suggested that World Vision use “Healthy Timing and Spacing of Pregnancy” instead of “family planning” — and it’s worked, she said.
“HTSP has given it language that doesn’t have any stigma attached to it,” she said. “The word ‘family planning’ … was not successful.”
Whatever terms they chose, all the panelists emphasized that family planning methods are important for helping reduce mortality and poverty in disadvantaged communities, especially in countries outside the United States.
“All of the major religions of the world are concerned with helping the poor,” Ms. Graham said. “Family planning is an excellent intervention and can prevent one in three maternal deaths.”
According to the United Nations Population Fund, granting contraceptives to all women with an “unmet need” would prevent 35 million abortions and 76,000 maternal deaths each year.
Because of this, Ms. Muchina said, FBOs have a moral obligation to support family planning.
“The root problem is that women and children are dying because they don’t have access to family planning services,” she said. “The reason we are doing this is so that we can save lives.”
Not everyone, however, buys into this narrative. Ms. Oas said there’s reason to doubt that family planning is as essential to saving lives and reducing poverty as its advocates claim.
“People are not dying for lack of family planning; they’re dying for lack of healthcare,” she said. “The need for maternal and child health remains, but you can’t contracept your way to maternal and child health.”
The way mortality rates are measured spins the tale, Ms. Oas said. She pointed out a 2014 USAID report that based its calculation of “child lives saved from demographic impact” in part on number of conceptions prevented — thus claiming to save lives that never existed. There’s a difference, Ms. Oas noted, between making childbirth safer and making it rare.
Moreover, Ms. Oas pointed out, the idea of “unmet need” — the number of women who have unwanted pregnancies but don’t use family planning methods — is misconstrued by family planning advocates to make the situation appear more dire.
“The family planning movement’s assumptions are based on the idea that there’s a huge demand for [family planning methods],” she said. “But knowledge and access to family planning methods are near universal.”
According to a 2016 report by the Guttmacher Institute — which advocates family planning — only 11 percent of unmet need for contraceptives in developing countries is accounted for by lack of knowledge, high cost, or lack of access; most women avoid contraceptives because of religious convictions, concerns about side effects and health risks, or other reasons.
Data that emphasizes women needing contraceptives but unable to access them “is designed for advocacy purposes,” Ms. Oas said.
“I appreciate faith-based organizations’ desire to save lives, but they should be a bit cautious in accepting these indicators [from family planning organizations],” she said.
Religious groups should also be wary of the family planning movement, Ms. Oas added, because many major family planning organizations they would have to partner with support abortion. Moreover, she said, family planning organizations tend to promote contraception rather than abstinence — which is essential to natural family planning — as the solution.
“Within the family planning movement, there’s huge advocacy for contraceptives as the solution,” she said. “It’s not all about solving poverty. That’s the difference between family planning organizations and faith-based organizations … one is focused on a very narrow set of means.”
Ms. Muchina said pro-choice advocates need to ask themselves why they tend to oppose natural family planning. The goal, she said, is life, and organizations need to stop condemning others’ methods.
“There is no community that says they don’t want to save lives,” she said. “The question is how they do that.”