Home Lifestyle Trends in contraceptive use among married women

Trends in contraceptive use among married women

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Family planning is part of the entire demographic and population policy of each country and globally.

It has been a priority for the Government of Ghana for many years and is highlighted as a key factor in population management and national development outlined in the GhanaShared Growth and Development Agenda II: 2014-2017 (NDPC 2014).

Important policy documents have been prepared to guide the implementation of the country’s national family planning programmes. These documents include the National Population Policy, the Reproductive Health Service Policy andStandard, the 2000 Adolescent Reproductive Health Policy, the Reproductive Health Commodity SecurityStrategy (2011-2016), the Draft National Condom and Lubricant Strategy and Market Segmentation Analysis for Family Planning, among others (MoH 2011).

Family planning, in its basic meaning, is defined as a number of methods and procedures intended to influence the number of pregnancies and timeframe between them. Family planning, in its broader meaning, is part of the entire demographic and population policy of each country and the planet as a whole. In almost every surrounding, the objectives of family planning commonly highlighted include unwanted pregnancy prevention, extensive population growth reduction, and health improvement of women, children and the population as a whole.

The use of methods for family planning reduces maternal mortality, prevents unwanted and highly risky pregnancies and the need for (un)safe abortions, and provides protection from sexually transmitted diseases. More than 500,000 women die every year due to pregnancy-related problems. According to WHO, approximately 120 million couples in the world do not use contraception and 300 million are not satisfied with the method applied.

There are more than 80 million unwanted pregnancies registered in the world annually and more than half of them end with abortion. There are 78,000 women who die each year due to the consequences of jeopardized abortion. This number may decrease with the use of family planning methods. The lowest reported rate of abortion in Europe is in Germany (8 in 1,000 women), while the highest is in Ukraine (45.4 in 1,000 women). In England, the abortion rate in 2004 was 17.8 in 1,000 women, aged 15-44 (in 1990 the rate was 15), and in the USA the rate was 16 in 2001. Of particular concern is the fact that a great number of abortions occur amongst adolescents, accounting for 11.4 million interrupted adolescent pregnancies per year in the world.

Comprehensive and timely estimates on global trends in family planning are critical for assessing current and future contraceptive demand and setting policy priorities to ensure universal access to sexual and reproductive health and therealization ofreproductive  rights. Contraceptives are used by the majority of married or in-union women in almost all regions of the world

In2015, 64 percent of married or in-union women of reproductive age worldwide were using some form of contraception. However, contraceptive use was much lower in the least developed countries (40percent) and was particularly low in Africa (33percent). Among the other major geographic areas, contraceptive use was much higher, ranging from 59 percent in Oceania to 75 per cent in Northern America. Within these major areas there are large differences by region and across countries (UN, Social and Economic Affairs, 201).

The UnitedNations General Assembly reaffirmed these commitments when it adopted the 2030 Agenda for Sustainable Development (UnitedNations,2015b). The new development agenda includes two targets relevant forfamily planning under broader goalson health andgenderequality and the empowerment of women and girls. Both targets aim to ensure by 2030“…universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes” (Target3.7)and “…universal access to  sexualand  reproductive healthand  reproductiverights  as agreed  in  accordance with the Programme of Action of the International Conferenceon Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences” (Target5.6).

Knowledge of contraception is universal in Ghana. Twenty-seven percent of currently married women use contraception; 22percent use a modern method. The three most popular modern methods used by married women areinjectables (8 percent), implants (5 percent), and the pill (5 percent). Use of modern methods has more than quadrupled in the past 25 years,rising from 5 percent in 1988 to 22 percent in 2014.

The government sector remains the major source of contraceptives inGhana, providing them for 64 percent of current users, an increase from 39percent in 2008. Overall, one in four contraceptive users discontinued using a method within12 months of starting its use. Six percent of episodes of discontinuationoccurred because of side effects or health concerns. Thirty percent of currently married women have an unmet need for familyplanning services, with 17 percent having an unmet need for spacing and13percent having an unmet need for limiting.

The Table below shows proportions of contraceptive use among currently married women by their educational status. The three main variables involvedare:

  1. Any method used by currently married women which can either be modern or traditional
  2. Any modern method used by currently married women which includes Female sterilization, male sterilization, pills, IUD, injectables, implant, male condom, female, diaphragm, foam/jelly, LAM and other form of modern contraceptive
  3. Any traditional Method used by currently married women which include rhythm, withdrawal and other forms of traditional contraceptive.

Source: myjoyonline

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  150. L’UFCM a constaté depuis quelques mois l’accroissement des tromperies à la « roqya ». Les témoignages de personnes victimes de ces pratiques se multiplient et présentent les mêmes caractéristiques : « Une personne vous appelle et vous propose une séance de « roqya » gratuite. Cette personne vous propose de rappeler un numéro prétendu gratuit, souvent un numéro commençant par 0 800… » Mais, dans les faits, cette prestation est loin d’être gratuite, puisque la conversation est facturée à vos frais et à votre insu. Au-delà de l’aspect juridique qui est traité à ce jour par le pôle juridique de l’UFCM[1], ce procédé soulève la problématique de sa conformité au Coran et à la Sunna. En effet, la « roqya » peut se définir comme une thérapie qui permet de soigner les actes de sorcellerie, de mauvais œil et également de se protéger contre ces derniers. Par conséquent, est-il possible de la pratiquer par téléphone et quelles sont les exigences édictées par le Coran et la Sunna ? Nous présenterons ainsi successivement les conditions liées au soignant (I), les exigences relatives à l’environnement où est réalisée la « roqya » (II). Nous aborderons ensuite la question de la gratuité de la prestation ou de sa contrepartie financière et enfin les conditions dans laquelle elle est réalisée (III). I- Les conditions liées au soignant Souvent la « roqya » est perçue comme une pratique dispensée par un tiers. Or, il est essentiel de rappeler et de souligner un fait important : la meilleure des « roqya » est celle que nous dispensons nous-mêmes à travers le « dhikr » et la récitation du Coran. Ainsi, pour se prémunir des maux liés au mauvais œil ou à la sorcellerie, il convient régulièrement de lire le Coran et faire des invocations notamment celles du matin et du coucher, de réciter régulièrement la sourate « La vache », de renouveler son intention, de placer la certitude dans son cœur, d’effectuer ses prières etc., et surtout de demander à Allah la meilleure des protections. Toutefois, dans certaines conditions, il est nécessaire de recourir à un soignant. C’est à ce stade qu’il convient d’être vigilant. Il ne suffit pas de se rendre auprès d’une personne qui se présente avec la qualité de cheikh ou d’imam pour accepter de lui confier cette pratique. Comme pour tout procédé et encore plus lorsque cela relève de considérations religieuses, il est important de bien choisir son soignant car ce dernier est tenu de posséder des qualités bien affirmées. La maîtrise du Coran et des traditions prophétiques en la matière est une condition sine qua none, mais insuffisante. La personne doit également avoir des notions de psychologie afin de déterminer la part de sorcellerie et celle de troubles psychologiques fréquents chez les patients. La personne doit posséder une bonne hygiène de vie, notamment spirituelle puisqu’il n’est pas inutile de rappeler que le succès de la « roqya » dépend de Dieu. Ces critères sont difficilement évaluables, surtout par une personne qui est affectée par un mal-être, quelle que soit sa source. C’est pourquoi les proches doivent accompagner la personne dans la recherche d’un soignant qualifié et reconnu comme tel par des référents religieux de la localité (imam, responsables associatifs, etc.). De manière générale, le soignant doit posséder des qualités déterminées que nous pouvons synthétiser de la manière suivante. Il doit : être en capacité de lire le Coran, croire avec certitude au Coran, être empreint de piété, connaître les pièges et les caractéristiques du diable et des djinns, connaître la méthode prophétique de la « roqya », disposer de connaissances de base en psychologie, avoir la conviction que le succès de sa thérapie dépend de Dieu. A l’exception de la première exigence, il semble difficile de vérifier les autres conditions dans le cadre d’un entretien téléphonique avec une personne que nous n’avons jamais rencontrée, même si elle se présente sous le titre de « cheikh » ou d’un imam. Par conséquent, ces conditions soulignent une première limite quant au recours à la « roqya » par téléphone. Par ailleurs, à l’instar de tout médecin, le soignant doit, avant de prodiguer des conseils ou une médication, procéder à une consultation. Ainsi, un environnement adéquat est indispensable pour la réalisation d’une « roqya ». Il est enfin inconcevable qu’un médecin puisse vous affirmer par téléphone connaître votre maladie et attester pouvoir vous guérir. Vous auriez plus que des doutes sur ce prétendu médecin. II- Un environnement propice et la réalisation d’une consultation préalable à la réalisation d’une « roqya » Il est intéressant de noter que, dans son ouvrage « Comment se protéger des djinns & satan », Wahîd ‘Abdussalâm Bâli évoque l’importance du climat pour réaliser une roqya[2]. Ainsi, il expose les points suivants : « 1. Préparer le climat adéquat en faisant par exemple sortir les images et les statues de la pièce où on va soigner le malade, pour permettre aux anges d’y entrer. 2. Débarrasser le sujet de tout ce qu’il peut porter sur lui comme talismans ou amulettes et les brûler. 3. Éteindre tout ce qui peut émettre le son de la musique et des chants. 4. Vider le lieu de tout ce qui comporte une infraction à la shari‘a à savoir, par exemple, la présence d’un homme qui porte de l’or ou une femme qui ne porte pas le voile légal – al-hijab. 5. Donner au malade et à sa famille une leçon de dogme de façon à ce que leurs cœurs ne soient pas attachés à un autre qu’Allah. 6. Leur faire savoir que la façon de soigner est différente de celle des sorciers et des charlatans et que le Coran recèle guérison et miséricorde, comme l’a informé Allah le Puissant et le Majestueux. 7. Diagnostiquer son cas : pour cela poser des questions au malade pour s’assurer de la présence de tous les symptômes (…) ». Or, dans les témoignages communiqués, l’interlocuteur qui se présente comme soignant ne pose aucune question aux personnes. Il débute ainsi la « roqya » directement par une récitation du Coran. En outre, il est intéressant de souligner que dans l’un des témoignages communiqués à l’UFCM, l’interlocuteur demandait à la personne de remplir successivement des verres de lait, d’huile, d’eau etc. et de les poser par la suite sur la table de la salle à manger. Au point que la personne s’est retrouvée avec une multitude de verres posés sur la table. Le comble est que la personne ignorait ce qu’elle devait en faire lorsqu’elle a pris conscience de la tromperie. Nous constatons par conséquent qu’une « roqya » ne peut être réalisée dans un environnement quelconque. En effet, une procédure de diagnostic est essentielle. Nous pouvons à titre d’exemple faire le parallèle avec un rendez-vous chez le médecin ; ce dernier ne peut vous prescrire une ordonnance sans au préalable vous avoir ausculté et interrogé sur les différents symptômes que vous ressentez physiquement. A défaut, au lieu de guérir vous allez aggraver vos maux. Cette attitude vigilante du médecin traitant doit se retrouver lorsque nous envisageons le recours à une « roqya ». Pour illustrer ce propos, nous citerons l’exemple de l’anthropologue, spécialiste de l’islam européen, Farid El Asri, chercheur associé au Centre Jacques Berque, qui nous rapporte une situation alarmante suite à une « roqya » : « Une jeune femme en Belgique (…) est morte suite à une tentative d’exorcisme. Pendant les séances, les fkihs (imams) utilisent normalement de l’eau « coranisée ». Pour cette jeune femme, prétendument stérile, les exorcistes ont carrément plongé son visage dans l’eau et quand elle tentait d’en sortir pour respirer, les guérisseurs estimaient qu’il s’agissait du jinn qui l’habitait et ils replongeaient son visage dans l’eau. Pendant le procès, la famille de la défunte s’est présentée comme musulmane et a accusé ces pratiques d’être extérieures à l’islam quand les guérisseurs estimaient qu’ils avaient simplement fait ce qu’ils pouvaient. Le fait de recourir trop systématiquement au fkih risque également de faire passer une crise d’épilepsie, par exemple, pour une crise de possession. »[3] Nous allons aborder enfin la dernière problématique, celle relative aux honoraires du soignant. III- Les honoraires du soignant Le Prophète, bénédictions et salut sur lui, « a agréé les Compagnons qui ont été payés pour la roqya ». Il est dès lors autorisé de rémunérer un soignant en contrepartie d’une prestation. Toutefois, cette rémunération doit être raisonnable et surtout clairement définie avant le traitement. En outre, nous ne pouvons que souligner et rappeler que, si la roqya est réalisée dans un cadre sérieux, il convient de procéder à toutes les déclarations administratives. Comme pour tout contrat, vous devez exiger un document écrit et le praticien doit préciser quels sont ses engagements exacts afin d’éviter tout litige postérieur. Malheureusement, tous les témoignages transmis à l’UFCM soulignent que l’interlocuteur insiste à plusieurs reprises sur la gratuité de la prestation. Or, dans les faits, cette dernière est payante puisque le coût de la communication est surtaxé. Ainsi, l’une des victimes qui nous a contacté, s’est retrouvée avec une facture téléphonique (hors forfait) de 1800 euros. Par conséquent, nous constatons que ces « roqyas » gratuites sont fondées sur la technique dite du « call-back » qui consiste à amener une personne à rappeler un numéro surtaxé, information qui lui est bien évidemment dissimulée. Une « roqya » peut être payante à condition de respecter un cadre prédéterminé, fondé sur l’information et la transparence des honoraires. En conclusion A la lumière des développements susvisés, l’UFCM appelle d’une part à une régulation du métier de la pratique de la « roqya », d’autre part, à la vigilance de chacun à ne pas céder à la tentation d’une « roqya » qui ne serait pas réalisée dans les conditions requises et qui pourrait produire des effets inverses. Au-delà du cadre spirituel ou juridique, les divers témoignages reçus et étudiés par l’UFCM ne peuvent pas nous laisser indifférents à la question suivante : pourquoi des personnes sont-elles amenées à accepter aussi facilement une « roqya » par téléphone ? Est-ce la gratuité qui a déterminé leur choix ? Certes le mal-être produit par cette société est de plus en plus grand. Nous vivons une époque où les êtres sont de plus en plus coupés des signes de Dieu et vivent un rythme de vie effréné. Ces affaires sont révélatrices des maux les plus profonds qui touchent la communauté musulmane. Par ailleurs, comme l’ensemble des rites islamiques (hajj, halal, pompes funèbres) censés nous rappeler les limites qui déterminent la voie vers Dieu, nous constatons que leur marchandisation trahit de plus en plus leur vocation première. Suffit-il qu’un interlocuteur se présente à nous comme un « cheikh » ou un imam et qu’il nous propose une « roqya » gratuite pour l’accepter aussitôt Ne devrions-nous pas tous nous interroger sur le fait qu’il y ait des musulmanes et des musulmans aussi isolés et aussi ignorants de leur propre religion pour être trompés aussi facilement ? Sommes-nous devenus si dépendants des Hommes que nous en oublions de nous adresser directement à Dieu pour solutionner nos malaises ? Autant de questions que chacun d’entre nous a la responsabilité de se poser. En effet, aucun de nous ou de nos proches ne sont à l’abri d’une telle tromperie. Il convient enfin de rappeler que la « roqya » est un remède précis et qu’elle ne peut se faire que sous certaines conditions et surtout qu’elle demeure l’exception à la règle, qui est de toujours s’adresser directement à Dieu. Avant de recourir à une « roqya », il convient de faire une introspection sur ses propres pratiques cultuelles et de revenir.

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