Gambia: The right to reproductive health
- Tuesday, 7 March 2017
To commemorate International Women's Day, March 8th, we published a short article on the right to reproductive health in The Gambia, written by master's student Madi Jobarteh, who originates from that country but currently resides in The Netherlands.
Reproductive Health in The Gambia
The Gambia is the smallest country on mainland Africa with a population of 1.8 million people, with a population growth rate of 3.3 percent per annum. Females constitute 50.5 percent and males, 49.5 percent. According to the UNDP, the country is a least developed country ranked at 175th in the world's human development index. Maternal mortality stands at 706 per 100,000 live births which is far below the MDG target of 75, while infant mortality stands as 69 per 1000 live births below the MDG target of 67.
Right to health
The right to health is not guaranteed in the Gambian constitution even though all the other health-related rights are recognized. However the right to health for women and girls has been guaranteed in the Women's Act (amended) 2015. Yet the protection of the right to health for women remains a major challenge mainly because the legal framework is in itself cumbersome and contradictory. In addition to the constitution, the country also has Sharia and customary law as well as common law as part of its legal framework. Thus on matters of marriage, divorce, inheritance and 'wife inheritance' individuals have the option to employ Sharia or customary law within the jurisdiction of the Cadi (Islamic) courts or local tribunals headed by a community chief. These are purely patriarchal institutions where women's rights have little space. Consequently, deep-seated socio-cultural beliefs and practices, which are typically sanctioned by Islam, have served to undermine the right to reproductive health.
Opposition to family planning
Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Sexual and reproductive health implies people having a satisfying and safe sex life, and a right to an informed choice and access to legal family planning and appropriate health-care services. This includes safe pregnancy and child spacing.
In the Gambian context this definition is a major contentious issue because of its socio-cultural and religious dimension. As a society where deep-seated traditions and the Islamic religion play a major part in the life of a person and society, issues of sexuality and procreation are generally interpreted accordingly. There exists series of taboos and rites associated with sexual and reproductive health, which are intertwined with the life of a child and, as he or she progresses into adolescence and adulthood as well as in the institution of marriage and parenthood. Issues of puberty, virginity, sex, pregnancy, breastfeeding and childbirth are all determined by culture and religion. Hence when modern family planning concepts, products and services entered the Gambia, the opposition and resistance was intense.
Culture and religion
Polygyny is a common cultural and Islamic practice widespread in the society. Consequently, the Gambia Demographic and Health Survey 2013 found out that marriage has a high premium especially among women where the average age of marriage is fifteen years. The survey further found out that the desire for having children is higher among men than women, however more women consider at least having four children as ideal.
Because of its male dominated social system or patriarchy, women have limited power in determining the number of children and use of a family planning method. Only nine percent of currently married women are using a method of contraception, with only eight percent using a modern method. The survey has shown that in fact modern contraceptive use has been on the decline from 13 percent in 2010 to nine percent in 2013. It identified the use of traditional methods as responsible for this decline. Furthermore the report highlights that modern contraceptive use is higher in Banjul (15–21%) and its environs than in the semi-urban (11%) and rural areas (1%).
The issue of family planning is a controversial matter among Islamic scholars. While Islam recognizes child spacing, yet many scholars in the Gambia argue there are other methods to use for that purpose than modern ones. These traditional methods include charms or amulets that a woman ties around her waist, or the withdrawal method, which is when a man pulls out during sexual intercourse just before ejaculation. There are also other traditional methods, key among which is when a lactating mother leaves the husband's house to live with her parents or some distant relations for the period of breastfeeding in order to avoid sexual intercourse and pregnancy.
Harmful traditional practices
Religious scholars and traditional leaders have therefore posed the strongest resistance to modern family planning and have constantly clashed with civil society organizations (CSOs) promoting reproductive rights. Furthermore, the continued prevalence of various cultural practices has been noted to be harmful and impede reproductive health. These include female genital mutilation (FGM), early and forced marriage of girls particularly at their teen ages. Culturally it is believed that FGM reduces the desire for sex in women hence prevents promiscuity. While it is generally also considered as an Islamic obligation on every woman, yet thanks to CSO sensitization many imams are now coming out to refute that belief.
CSOs have realized that the promotion of reproductive rights and family planning could not succeed without the involvement of religious and traditional leaders. Consequently several CSOs have now included imams and community chiefs in their campaigns and have been registering success.
Madi Jobarteh is a master's student of International Human Rights Law at the University of Groningen, The Netherlands.
 Key Actions for Further Implementation of the Programme of Action of the International Conference on Population and Development adopted at the 21st special session of the General Assembly New York, 30 June – 2 July 1999
 National Reproductive & Child Health Policy 2010–2015. Ministry of Health and Social Welfare, Banjul