Craig White's Literature Courses

Critical Sources

"Talking Cure"* for
Family Planning

*In Psychiatry & Psychology, the "Talking Cure" refers generally to "talk therapies," where articulating conditions alleviates them.


women of Presbyterian Evangelical Church, Ghana

Domestic Violence workshop for women
at Ghanaian evangelical church


Talking Their Way Out of a Population Crisis

New York Times 22 October 2011

Helen Epstein is the author of “The Invisible Cure: Africa, the West and the Fight Against AIDS.”

THE world’s seven billionth person is about to be born, according to the United Nations Population Division. Before this century ends, there could well be 10 billion of us, a billion more than previously expected. Nearly all of these extra billion people will be born in Africa, where women in some countries bear seven children each on average, and only 1 in 10 uses contraception. With mortality rates from disease falling, the population of some countries could increase eightfold in the next century. [cf. Demographic Transition]

Africa’s future matters to all of us. Globalization, to say nothing of shared interest in scarce resources, connects our fates. In many parts of Africa, people already scramble to obtain food, land and water, and discontent provides fertile ground for extremism. So it is important to think carefully about the response to Africa’s exploding population.

Early next year, researchers will publish findings that provide good, if surprising, news: relaxed, trusting and frank conversations between men and women may be the most effective contraceptive of all.

We know this from Western history. In Europe and the United States, birthrates plummeted between the late 18th and early 20th centuries. A research team led by Ansley J. Coale of Princeton University discovered in the 1980s that this had nothing to do with modern contraceptives, which had not yet been invented, or with government policies. Noting that great shifts in family size seemed to spread like a germ from one Western country to another starting more than two centuries ago, the Australian demographer John Caldwell speculated that the germ was cultural — it was the very idea that childbearing was something couples could discuss openly and decide for themselves.

Since then, many researchers have found that spousal communication is a powerful predictor of both contraceptive use and smaller family size. The converse is also true: wherever such discussions are silenced by churches, governments, patriarchy or puritanism, birthrates remain high.

Could a “contraceptive talking cure” work in Africa in our own century? It just might, and the evidence comes from somewhere almost no one has thought to look: Africa’s evangelical churches, long seen as the bane of family planning programs everywhere.

A Columbia University demographer, James F. Phillips, stumbled upon this curious finding about 10 years ago. He and a group of Ghanaian colleagues had spent a decade trying to encourage contraceptive use in the Kassena-Nankana district of northern Ghana, with little success. When they began their work in 1990, the Kassena-Nankana people were among the poorest in the world and losing one child in four to disease and malnutrition. They saw large families as an asset, and the entire culture of these rugged people was devoted to reproduction.

Family planning was not even open to discussion. Women who refused to have sex with their husbands, or who tried to use contraception secretly, were beaten. “If the man’s penis is up,” explained one, “unless it enters into the vagina, it won’t lie down. So allow him to have his sex and only then can you be free. Is it not better to have the sex than to have the beating?” When asked about family planning, another woman said, “If you talk about such issues, you are a fool.”

A team of doctors from the Ghana Health Service created a program to send nurses from hut to hut on motorized scooters treating sick children and pregnant women and offering contraceptive pills and injections. Ten years later, child mortality had fallen by 70 percent. But most women were still afraid to even discuss family planning.

Dr. Phillips and his Ghanaian colleagues knew that for family planning programs to succeed, they would also have to empower women to use contraception. But how?

At first, they organized special “durbars*” — all-male political gatherings presided over by the village chief — to help explain to men that family planning would make their women and children healthier and stronger. These efforts weren’t very successful. [*durbar = Indo-British colonial term for ceremonial gathering]

Then the team noticed two things: Their data clearly showed that large numbers of women were having fewer children, whether or not they lived near the experimental family planning programs. And large numbers of evangelical preachers were establishing churches in the Ghanaian hinterlands to which, every Sunday, Kassena-Nankana women dressed in Western-style finery headed in droves.

Dr. Phillips assigned a student to see what effect the churches were having on contraceptive behavior. 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.

TRADITIONALLY, Kassena-Nankana women are not involved in everyday decision making, even about household matters. But the born-again women were forming committees, making speeches and organizing outings, fund-raisers and other activities. Tradition in Kassena-Nankana also forbids women to communicate with ancestors and other spiritual beings; only men can do that. But 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.

Dr. Phillips and his colleagues began wondering how to give the Kassena-Nankana women a voice in their own traditional culture. A decade ago, they urged elders there to admit women to the traditionally male-only health and family planning durbars.

At one of the first events, a woman spoke of the burden placed on women by men who demanded that they produce so many children. The official translator refused to interpret her words for the researchers, but the local women in the crowd went wild with enthusiasm.

Dr. Phillips’s team also recruited male scouts to keep an ear to the ground for gossip about men who beat their wives, and to then visit them and urge them to stop. According to the forthcoming journal article, since the start of the program wife beating has declined and the fertility rate has fallen to 3.5 children per woman, a drop of more than one birth.

These powerful findings hint at a deeper phenomenon. Being able to express oneself and exchange ideas without fear of reprisal may be the very essence of empowerment, and potentially more important to lowering birthrates than money or access to health services, or even education. The individual human voice, a tool available even to the poorest people, may be the key not just to population control, but to Africa’s broader political and economic development as well.