Back in 7th grade, Mrs. Orr, the PE teacher also taught health in a classroom covered in inspirational posters – pictures of cartoon vegetables, runners striving for excellence, and a big one that said something about self-esteem.
“Something about Self-Esteem” could also be the subtitle for Helen Epstein’s NYTimes Op-Ed “Talking Their Way Out of a Population Crisis,” on improving rates of contraceptive use amongst women of the Kassena-Nankana ethnic group in Ghana. She focuses on a study of contraceptive use and childbearing amongst women who attended evangelical churches:
To their amazement, they found that female Christian converts were three times as likely to use family planning as women who retained their traditional African faith, and had significantly smaller families.
The churches certainly didn’t promote family planning. But, despite their defense of patriarchal family values, many churches were giving women a voice denied them by their own culture.
Exciting, right? Especially given that, according to UNICEF, in the developing world “more than half a million women die as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19.” Family planning services, and access to pre-natal care, are critical to saving the lives of millions of women and children in developing countries – so any program that empowers women to make use of family planning is, as my dear friend would say, “doin’ the Lord’s work.”
And there is something wonderful about the idea that the radically egalitarian message of Christ is being heard, albeit in unexpected ways, to protect women’s lives, and affirm their intrinsic value; that the transformative power of grace really does transform lives. Even coming through the filter of a patriarchal church structure.
When I served as a Peace Corps volunteer in Burkina Faso the youth sexual health education program we used was called Life Skills (pdf) – a program developed by Peace Corps Volunteers in Malawi as part of their HIV/AIDS outreach.The manual focused on teaching the skills necessary for behavior change – of which information about HIV/AIDS comprised only a small part. Youth (and people of all ages) require much more than the grim statistics about mortality rates in order to change sexual behavior – they need access to contraceptives (practically unheard of in some of the small villages I worked in), decision-making skills, communications skills (like assertiveness, for example), not to mention that one from my 7th grade health class wall – self-esteem.
All those skills and more come into play on family planning issues as well as in HIV/AIDS prevention. And successful programs take a holistic approach to behavior change – there is never one solution that will fit every tribe, every ethnic group, every village or every woman. So my initial response to Epstein’s article is a hearty “whatever works!”
Where I get stuck is her causal explanation:
…the Christian women were speaking directly to Jesus about their problems. He was, many of them may have felt, the first man ever to listen. This may have given them a language for speaking to mortal men as well, even about such sensitive matters as contraception.
Notice that shift? “many of them may have felt” [emphasis mine]. It seems awfully curious that at the critical juncture – when Epstein makes the leap to the empowering nature of speaking out in public and organizing – the article relies not on actual quotes or evidence from Ghanian women but an imagined feeling “they may have felt.”
I admit – as a former Peace Corps volunteer – I have my eyes peeled for this sort of thing. Many interventions from well-meaning organizations talk a good game about really listening to the needs, wants and life stories of people in developing countries, and yet miss the critical point of actually listening. Letting them speak in their own voices and understanding how they feel by actually asking them.
In faith, as in public health and behavior change research, listening and asking questions are some of the most important tools we have. Was it Jesus listening to these women that helped them transform their lives? Or was it “forming committees, making speeches and organizing outings, fund-raisers and other activities”? Are the women actually being heard in their communities and their intimate relationships? Or are they choosing family planning tools they don’t have to negotiate with partners, like IUDs or Depo-Provera? Are their increased use of family planning tools also enabling them to protect themselves against HIV?
I do believe – profoundly – in Epstein’s conclusion. I just wish we could hear a few more of the voices of the Ghanaian women who have learned to speak and change their own worlds.