Fertility Control and Muslim Women

Author(s): Sheela Prasad and Sumati Nair
Date Published: July 17, 2006
Source: (Political Environments #2, Summer 1995)

While studies on the fertility of Third World women are numerous, very few have tried to understand what women themselves feel about fertility control. On the other hand, most studies seem to hold women responsible for their "lack" of fertility control without understanding the reality of women's lives and the compulsions to which they are subjected. Of late there have been some initiatives to determine women's responses to fertility control and our study was conceived against this background. We felt the women's voices needed to be heard. Some of the questions we began with: Is it true that women do not want fertility control? Do women have control over decisions on their fertility? If not, then why are they held responsible? Do women try to negotiate for control over their fertility?

Our research was confined to women in the state of Andhra Pradesh, India, and covered both rural and urban women. In this paper we present some of our findings on fertility control and the perceptions of Muslim women based on a study of Hyderabad, the capital of Andhra Pradesh The city has a sizeable Muslim population concentrated in the Old City and adjacent areas. The women in our sample were drawn randomly, mainly from the Old City and a smaller number from the newer localities of the city. The women ranged from the poor from the slums (who were represented in larger numbers), and the lower middle class including an upwardly mobile lower section (based on remittances from the Gulf) confined to the Old City and surrounding areas, and to a middle and upper class from the newer colonies of the city. Most women we spoke to belonged to the15 to 55 age-group and a large number were living in joint families. We deal with Muslim women in this paper, because the accepted view about them is highly distorted.

Muslim Women and Fertility Control

Most women, rich or poor, know about contraceptive methods and it is only the older women (above 55 years) who said they did not know anything about them. But, while women do now know about contraception, their knowledge is still extremely limited. Most women are only aware of sterilisation. Information about permanent and different spacing methods, their side-effects and health risks are not provided by the doctors and health staff. As a result, many women have many misgivings regarding these methods. Many asked us, "I have heard that women become fat and cannot do hard work after sterilisation, is it true?" In fact, family planning methods have been pushed so vigorously by the State over the years that today, for a large majority, fertility control is associated with the State and does not appear to be a matter of individual choice. This is particularly the case with the poorer women and with regard to permanent methods. Further, the widespread impression that Muslim populations are reluctant to use any fertility control method has made Muslim women extremely vulnerable to coercion by the State health system. The result is that a number of Muslim women avoid using government health facilities as they feel they are ill-treated and are forced to accept sterilisation if they have more than three children. This view we found was shared by not only a number of Muslim women but also other poor women of the city.

We found that sterilization continues to be the most used method by women in the city. Spacing methods were used more by Muslim women due to some religious 'restrictions' on sterilisation among some sections. One young woman also explained, "tubectomy is not advisable for Muslim women because in case of death of her husband or a divorce, she can always get married to another man. Supposing the second husband wants a child from her it becomes difficult then." In spite of this so-called 'taboo' a large number of Muslim women do get sterilised. In fact, we came across women who had got sterilised in the face of opposition from their husbands or in-laws. It seemed from their responses that while women would prefer smaller families, it is the men who prefer having more children. Sometimes, decisions on fertility control were taken by the women without discussion with the husband as the men did not give it much importance and felt it was the responsibility of women.

Some dilemmas the women voiced

• "I wanted to get sterilised after my sixth child and my husband was also keen, but my father-in-law said "no". Now I am again pregnant and my husband is angry with me."

• "After my fourth delivery I went to another private hospital and not to Evita hospital as I knew they do not do sterilizations in Evita and I wanted to get sterilized."

• "I got sterilised even though my husband was against it on religious grounds. He did not sign the papers but I was adamant and my other in-laws and my husband's elder brother supported me. As women have to bear and bring up children, we should decide on sterilisation and men should agree."
• "I went to Suraj Bhan hospital to get sterilised without telling my husband, but my husband and mother-in-law came to know and shouted at me and the hospital doctor and took me away home."

Social Class and Choice of Method

Social class appears to determine the choice of contraceptive methods. The poor Muslim women - like their counterparts in other religions - used no spacing methods, had three to four children and then got sterilised. For the poor of any community fertility control means sterilization as they cannot afford the side-effects of temporary methods. One poor woman argued, "If anything happens to our health after using a spacing method, then what do we do, for us, there is no money for treatment." The family size of poor Muslims shows a decline from the earlier generation and now averages around three children per family.

The lower middle-class Muslim women tend to have larger families. In a few cases we found that the present generation of women in this group had more children than their earlier generation. The reason for this increase seems to be better economic conditions. Most of these families are sustained on remittances from the Gulf, each joint family having at least one member working there. With sudden prosperity the families can afford more children. There also appears to be a social dimension to this pattern. Women with husbands in the Gulf get to meet them for only a few weeks, once or twice a year. This separation may possibly build a sense of insecurity and loneliness in women. A few women said that they welcome pregnancy in such a situation, as having a child brings them closer to their husbands and makes them happy. We heard this explanation for increased fertility among a few women; it may not apply to the majority.

The upper-middle class and the rich, the more educated Muslim women of Hyderabad, practise spacing methods. Their family size has also reduced to an average of two children per family. Though there are some in this group who get sterilised, a larger number depend on spacing methods to delay the first pregnancy. The most common spacing method used is the IUD, and there were a large number of women who had an IUD for three years and then got it replaced with another one. Condoms and the pill are not popular - the first because most men are reluctant to use the condom, and the second because most women are now aware of the side effects of pills. One woman confided, "I myself did not like it when my husband used the condom." Another complained, "With pills I had weight gain, weakness and a sense of not feeling fresh in the mornings."

Attitudes to Abortion

Unquestionably, Muslim women desire fertility control and they practice it. Besides the modern methods of contraception, we came across the use of natural methods like withdrawal and rhythm, with the former used more by Muslims. It also became apparent that abortion is increasingly seen as a contraceptive method though women do not admit it. Many women spoke of having miscarriages, and it is not clear to us if they were reluctant to admit having an abortion because of the social stigma it carries. We make this point because most of the doctors we spoke to in the Old City, and elsewhere, reported a sharp rise in abortions by women, including unmarried girls. This is an option that is not available to the poor as they prefer to continue the pregnancy rather than bear the costs, both economic and physical, of an abortion. For women of the other classes, abortion is seen as a choice for control of their fertility. One woman told us, "I read about the Marie Stopes abortion clinic in the newspaper and went all the way there to get an abortion done."

In the control of fertility, information sharing and experiences of close relatives play a determining role. This is especially true in joint families, where, if one woman has a favourable experience with the use of a particular contraceptive method, other women in the family will use it. But the reverse also holds true. This tendency is exemplified by many sterilisations that are followed by complications. Many women spoke of the fear of sterilisation as they knew of someone whose health had suffered after being sterilised.

Our study suggests that fertility control decisions rest not only with the woman, but to a large extent with the husband and mother-in-law. However, we also found women have taken decisions to control their fertility in the face of family resistance by not confiding in their parents-in-law. Instead, these women were seeking and getting support from their mothers and sisters. There are instances of such women going in for abortions, using the pill or even getting an IUD to avoid another pregnancy. One 20-year-old woman, the mother of two small children who sought an abortion, had this to say. "I want an abortion. I told my mother-in-law and my husband that I had my periods but have actually missed them. I only told my sister about it and no one else knows in the family and I have come with my sister to get it done." Another woman admitted, "I had an abortion when my second child was only six months and I conceived due to failure of the withdrawal method. My husband and I decided to get an abortion done and we did not tell my in-laws as they would have objected. I have never felt guilty about getting the abortion done."

It is important to point out that women would like to control their fertility and limit their pregnancies. They may not protest and may appear to be passive sufferers, but they do attempt to control their fertility in subtle ways. The fear of repeated pregnancies is very real for many women. Some admitted how much they enjoyed sex after sterilisation or use of an IUD. A few practised abstinence for fear of getting pregnant again. One woman who has very painful periods said, "I get a lot of pain during the first two days of my menses. But in case my periods are delayed by a few days I start to get very tense and welcome my menses - the pain does not matter then."

The Importance of Motherhood

In any understanding of fertility control therefore, one needs to be sensitive to the socio-economic reality that women live in that determines and limits their choices for contraception. The social pressures on a woman to prove her fertility immediately after marriage can be traumatic for her. Women fear that they are infertile if they do not conceive in the first few months of marriage. One woman admitted, "I was frightened when I did not conceive in the first three months of my marriage, as I thought that my husband would leave me and marry another woman." (We would like to mention here that we did not come across any case of polygamy in our samples and this is another popular misconception about Muslims that needs to be corrected.) Most women would therefore use no contraceptives until they have proved their fertility. Motherhood seemed to be more important to women than their health. A large number of women told us, "A woman is complete only if she has children."

Women do want fertility control. They object to coercion, the lack of information and the quality of services offered. Wherever quality of services are good, women have used contraceptives. Most women we spoke to did not perceive childbirth as having affected their health. Instead quite a few were of the view that the use of contraceptive methods, both temporary and permanent, had adversely affected their health.

We would like to end this paper with the fertility control experience of a young woman of 29 years in her own words. "After my first child was born I used the pill but found that I put on weight and felt weak but continued to use it. I forgot to take the. pill once and conceived. As my child was only two months old I went in for an abortion with my husband's consent. I then asked my husband to use the condom and he tried but did not like it. He suggested I use a copper-T and I got one inserted for two years even though it did not suit me too well as I had pain in the back and lower abdomen. I had my second child and now we practise the withdrawal method which was suggested by a friend. I do not want any more children."

Sheela Prasad is a Reader in Regional Studies at the University of Hyderabad. A native of Hyderabad, Sumati Nair lives in Amsterdam, where she edits the newsletter of the Women's Global Network for Reproductive Rights.