Advanced Maternal Age and High-Parity Pregnancy – The Role of Culture and Community Support in Family Planning in Togo and Niger

“Having many children is a prevalent, if not expected, reproductive norm in Niger and Togo, but socio-cultural norms around large families vary slightly according to context. In urban Togo, for example, a transition to lower fertility desires has begun.”

This brief presents qualitative research findings around the role cultural and community norms play in women’s and couple’s family planning (FP) decisions, specifically as it relates to advanced maternal age (AMA) and high parity (HP). The brief is one of a series of three briefs that emerged out of research conducted by the Health Communication Capacity Collaborative (HC3) to better understand the knowledge, attitudes, practices, and socio-cultural factors in Togo and Niger that lead women to continue having children later in life and after they have already had many births. The findings outlined in the briefs are based on an analysis of Togo and Niger Demographic and Health Survey data, as well as other research. HC3 also conducted qualitative research in Niger and Togo with women, male partners, healthcare providers, and community leaders.

The following are a selection of findings in relatiion to culture and social norms:

• In both Niger and Togo, social norms, religion, and other cultural values directly contribute to and perpetuate AMA and HP pregnancy in rural and urban communities by encouraging large families and constraining modern FP method use. However, using FP methods to have smaller families was more accepted in urban Togo than any of the other sites, and was least common in Niger, where the concept of limiting remains “forbidden” or taboo.
• A fatalistic attitude and a refusal to interfere with God’s plans by limiting pregnancies was a prevalent theme. This default to religious beliefs was more common in Niger than Togo, and more tied to Islam than Christianity or other beliefs. In Niger, perceived religious constraints were experienced by participants regardless of education level.
• Normative factors – such as gender roles around FP decision-making, polygamy, and desired family size – facilitated or hindered the use of FP. For example, in terms of polygamy the research found that having children was often a strategy to 1) prevent the husband from taking another wife, or 2) compete with co-wives for her husband’s attention, resources or inheritance. In this way, polygamy resulted in a race to have more children, regardless of the risks each pregnancy carried. A large family size was also perceived to enhance people social status in several ways, for example, by being positively perceived in the community, or being seen as blessed by God.  These factors were slightly less influential in urban areas, particularly in urban Togo, where norms have begun to move toward smaller families and acceptance of limiting births.  Nonetheless, participants in both countries reported they would be more likely to accept contraceptive use if they believed it had become a norm in their community and was accepted by other women.

The brief recommends a strong strategic communication strategy that aligns closely held cultural values, FP use, and preventing AMA and HP pregnancies at the national, district and, community levels in both Togo and Niger.  It outlines the following considerations for strategy development:

• Use evidence-based communication strategies to shift harmful maternal health and FP norms - is important to work with local organisations and structures to develop holistic, community-centered programmes that address harmful norms – specifically those encouraging large families, mistrust of FP methods and services, competition between co-wives in polygamous relationships, and male-dominated decision making – to reduce AMA and HP pregnancy prevalence. Advocating for national attention to age-and parity-related pregnancy risks, corresponding communication strategies, and supportive policies (e.g., those facilitating FP use by couples and a woman’s right to adopt her chosen FP method without the permission of her husband) would further strengthen this effort.
• Capitalise on community leaders’ willingness to support initiatives. Prevention efforts should take advantage of community and religious leaders’ insights in designing and disseminating AMA and HP pregnancy prevention and management messages. These leaders can be key sources of information and encourage community members to use FP, accept or plan smaller family sizes, communicate with their partner about FP and promote women’s agency in making FP decisions.