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Reproductive health

Sex education under God

Inadequate mural in Niger / Inadequate Wandmalerei in Niger.

Inadequate mural in Niger / Inadequate Wandmalerei in Niger.

Family planning and the prevention of HIV/AIDS are essential for the development of African societies. However, religious and social taboos often stand in the way of education. Nursing staff in the public health service play an important role in disseminating knowledge. [ Interview with Ursula Schoch ]

From 2002 to 2005 you ran the “Sex education, HIV/AIDS prevention and reproductive health” programme for InWEnt in Niger, Rwanda and Cameroon. While Rwanda is predominantly Catholic, Sunni Muslims dominate in Niger, and Cameroon has 50% Christians, 20% Muslims and 30% followers of traditional religions. Does faith have an impact on how the issue of sex education is dealt with?
First of all, it is obvious that there are reservations against premarital sex in many religions. Normally, the topic itself is taboo. For our work, the views of decision makers are vital. While some are in favour of youth being educated early on, others oppose the very idea, arguing that information might encourage adolescents to become sexually active.

Who says so?
Some Evangelical denominations are very strict. Many Baptists, for example, preach total abstinence before marriage and do not want youth to be informed on sexual education topicsed..

Are you referring to a specific country?
No, Evangelical applicants for our seminars from different countries emphasised time and again that youth need to be shown the right path, the one of sexual abstinence. However, representatives of other faiths with a penchant towards fundamentalist dogmatism share this view, too.

So the religions do not really differ much?
Yes and no. It always matters immensely how rigidly people and their spiritual leaders interpret a religion. Throughout Cameroon, for example, moral standards are quite clear. In the North-West Province, a predominantly Christian region, however, there is a relatively large number of unmarried girls with unwanted pregnancies. It would be ridiculous to attribute this phenomenon to lax moral attitudes. Many young women receive pledges of marriage, which are then not kept. Young men escape the clutches of the girl’s family by moving away. We have been told that, in similar cases, Muslim families in the region will make sure the girl marries in any case – whether the groom is her child’s father or someone else. As a result, no unmarried Muslim women have childredn. That does not mean that they necessarily live by stricter moral standards. It may well be that a similar number of young Muslim women get pregnant before marriage. In any case, it is easier for the families to arrange weddings when necessary. After all, a Muslim man may have several wives. In this respect, Christian families are in greater trouble if the biological father runs away.

So whether someone is Christian or Muslim does not matter much in terms of sexual behaviour?
Oh yes, it does matter, but we must not over-generalise. Even in the big monotheistic religions, there are several branches, and the interpretations of the faith vary. In Niger, for example, there is a minority of Muslim Integrists…

… who have become widely known in the West as fundamentalists…
…and who adhere to a very strict version of Islam. Traditional Islam, on the other hand, is far more tolerant, though not in sexual matters. Nonetheless, I once met an imam from Guinea who handed out condoms. He argued, first, that the Qur’an says nothing about condoms, and second, that it would be irresponsible not to act in view of the fatal consequences of the AIDS pandemic. Of course, his attitude was untypical.

InWEnt cooperatend with eight nursing schools in Rwanda and Niger. What did you do exactly?
We developed teaching units on reproductive health in cooperation with the lecturers. Before 2002, the curriculum of governmental nursing schools neither included the prevention of HIV/AIDS infections and other sexually transmitted diseases, nor family planning. Of course, the staff trained in these schools play vital roles in their country’s health system. Graduates often go on to manage hospital wards or counselling centres on their own. Whichever path they take, they disseminate knowledge and serve as role models.

Are some gaps in HIV/AIDS education and family-planning counselling related to faith?
Those who give advice to others must be adequately prepared for their job. They must have have the appropriate knowledge of how to prevent and diagnose sexually transmissible diseases, and what to do about contraception and family planning. Moreover, it is vital that they know how to deal competently with young people. Taboos and shame hamper communication when it comes to reproductive health. How do you talk with adolescents – particularly girls – who have a problem? And are male counselors available for worried young men? Going to a counselling centre requires an enormous effort by unmarried youth of either sex. The waiting rooms are public, and news of visits spreads fast. Questions are asked in the family and in the neighbourhood. Nonetheless, there are unfortunately instances of nursing staff simply sending people in search of help away because, according to the prevailing moral beliefs, their problem should not exist at all. This occurs in every denomination. Obviously, ignorance and insecurity of nursing staff contribute to keeping matters of sex and reproductive health taboo. That is why better education really helps.

At the International Conference on Population and Development (ICPD) in Cairo in 1994, 179 countries acknowledged that it was necessary to provide young people with easier access to information and services relating to reproductive health. Do you see any progress?
Change only occurs in the long run. It is difficult to overcome taboos. Many devout trainers at nursing schools, for instance, suffer from moral conflicts. While teaching staff agree that the subject is important, they disagree about how to tackle it. Nursing trainers are motivated first and foremost by medical methods. But the question also arises what they should tell future nurses to “expect as normal”. For many, this question has a religious dimension. On the other hand, even those who are basically in favour of sex education struggle to work with illustrations or to speak in public of sex, various kinds of sexual behaviour and the risks related.

But pictures make teaching easier.
Exactly, and that is why we discussed in detail what absolutely must be illustrated and how accurate the pictures have to be. Similar problems arise when explaining contraceptives. Moreover, if you want to reach young people, they must find the way you are dealing with them attractive and convincing. Therefore we tested the manuals we drafted. We consider it a success that the nusrsing schools we cooperated with have acknowledged the problem, modifying their curricula in various ways. In any case, a change of attitudes has set in.

But how substantial are the results?
In 2005, we invited healthcare professionals and affected groups to a workshop in Potsdam. One participant was the head of a Catholic nursing school. Three young women from Cameroon, who had unintentionally become pregnant, gave testimony at told the workshop of their experiences. Afterwards, the head of the nursing school came to me and said I had given him food for thought, the women’s life stories had made him reconsider the issue. It is possible to change thoughts and moral beliefs.

Is that your goal?
Well, InWEnt does take the stand that prevention of HIV/AIDS will not be possible without education. As everyone knows, this disease is a huge problem in Africa. According to UNAIDS, an average of 7.2 % of adults in Africa carry the human immunodeficiency virus in their body. Of course, we do have a sense of mission in light of this situation. Furthermore, all countries affected acknowledged in the Cairo Declaration that youth should have access to information and services for reproductive health. We are doing no more than implement that idea.

What is your advice to people who deal with persons belonging to other religions than they do themselves?
It is always true that one has to becomer familiar with a the belief systems. You must accept those beliefs, even if you do not share them. Otherwise, you will not understand how people think, which you must do, if you want to cooperate constructively with them. In many countries, religion is an important part of life. Praying is a basic need for the people in Niger, for example. So when we organised workshops, we did not only have breaks for meals, but also for prayers.

Questions by Claudia Isabel Rittel.