Family planning and maternal health are particularly serious health concerns for women. In the country of Benin, a small republic located in West Africa, families are quite large. Their fertility rate is recorded to be about five children per woman (United Nations Population Division 2015). In addition to the cultural influences that guide this practice, these larger numbers of children per household are tied to low rates of contraceptive use in the country. As of 2012, contraception prevalence for women aged 15-49 years in Benin was at a mere 12.9% (USAID 2012). From a public health standpoint, this underutilization of modern and traditional contraceptives places Beninese women at risk for unplanned pregnancies, as well as the contraction of HIV/AIDs, the spread of STIs and other diseases, and higher rates of maternal mortality (i.e. due to unsafe abortions, birth complications, etc.). Because of contraception’s connection to maternal health and the social determinants that influence the disuse/lack of access to contraceptives, the feminist anthropological perspective is the most appropriate framework for the study of family planning in Benin. Using a feminist lens, this analysis aims to place women at the center of this critical health issue, for the purpose of examining how gender roles and cultural barriers, structural and gender-based violence, education disparities, and gaps in public health care leave both married and unmarried women who do not wish to become pregnant with an unmet need for contraception.
Popularized in the 1970s, feminist anthropology as a historical three-phase theoretical perspective focuses on inequality due specifically to gender, and is characterized by questions such as, “Is someone being treated different because of their gender?”, or, “…is someone being treated in a way that creates economic, political, other social inequalities [tied to gender]?” (Lewin 2006) (Department of Anthropology 2019). Similar to critical medical anthropology, which examines influence/authority structures and economic, political, and social power inequalities, the feminist approach zeros in on the power struggles between ‘men’ and ‘women’; in other words, feminist theory analyzes how individuals benefit or suffer because of their gender or the gender norms and roles within one’s culture (Department of Anthropology 2019). Topics central to this feminist perspective (and present in research about Benin’s family planning crisis) include, but are not limited to, the subordination of women, universal binary opposition, and the domestic power of women (Johnna Dominguez n.d.).
There is a long pattern of gendered ideals and female subordination in the country of Benin. Throughout Beninese history and tradition, men are described as more publicly aggressive, generous, confident, responsible, and showy; their primary role as men has been to acquire wealth and a large household of dependents and supporters (i.e. wives, children, extended family, servants, etc.) (Curnow 1997). Inversely, women were seen as submissive and ruled by emotions like jealousy, represented in folklore and mythology as little more than commodified objects for men (“Against Her Kind: The Phenomenom of Women Against Women in Ovia Cult Worship” 2014). While some of these historical depictions have become rather outdated, expectations of male dominance and female subordination remain intertwined with modern Beninese culture.
Despite the mandate of the new Family Code in August 2004, polygamous and forced marriages still exist, and women in practice still continue to be refused the right to inherit property in certain regions (WILDAF-AO 2016). This subordination of women also creates a space for gender-based violence to run rampant, manifested as sexual assault, rape, abuse (i.e. physical, emotional, mental, sexual, financial), and intimate partner violence. Intimate partner violence (sometimes categorized under the umbrella term ‘domestic violence’) is widespread in Benin, with penalties of up to 3 years in prison for perpetrators; unfortunately, women often do not report such cases of abuse, and authorities are reluctant to intervene in what is usually considered ‘private matters’. Laws that fail to penalize/prosecute perpetrators of gender-based/intimate partner violence, paired with the structural violence of policies that (for example) prohibit legal abortions, restrict women and leave their bodies unprotected from trauma that can have major reproductive and maternal health consequences. Cultural traditions of male dominance and social inequalities based on gender can further complicate family planning, making it taboo to speak about or use contraceptive devices without male consent. In this way, personal autonomy and decision-making power is removed from the hands of Beninese women and placed instead with their husbands, boyfriends, and other forms of sexual partners. Gendered ideals also contribute to the social normalization of the victimization of women in domestic settings, and can have serious health and mental/physical safety impacts for women. In a study that interviewed 21,574 people in Benin with questions relating to violence against women by an intimate partner, the prevalence of acceptance of intimate partner violence was 15.77%. In other terms, one participant out of six considered it justified for a woman to suffer abuse from her husband/partner for at least one of the following reasons: she burned the food, argued with her partner, went out of the house without notifying her partner, neglected the children, or refused to have sex with her partner (Alphonse Kpozehouen 2018). The internalization and female acceptance of gender roles and inferior treatment causes Beninese women to often be unwilling or fearful to push the issue of family planning/contraceptives within their sexual relationships, putting them once again at risk for disease and unplanned pregnancy.
In addition to social norms and attitudes regarding gender, culture, public and private safety, education is another important social determinant of health that affects the prevalence of family planning practices in Benin (Office of Disease Prevention and Health Promotion 2019). The African country’s education system contains visible gendered disparities, and educational opportunities for Beninese women and girls are extremely limited. Youth literacy rates (for individuals 15-24 years old) differ between males and females, with 54.9% of males and only 30.8% of females able to read and write. How long children are able to attend school also varies between boys and girls; the stated enrolment ratios for females as a percentage of males for primary schooling is 87.5%, and it decreases to 60.2% for secondary schooling (UNESCO 2000). For many families who are from a lower socioeconomic background or who live in an area where public schools are not accessible, many parents are forced to have their children miss school to help supplement family income. Others must send their children away to be domestic workers in more affluent households in the south (a common practice called vidomegon), where children typically work in exchange for food, clothing, and living quarters that are close to an area with access to public schooling. Vidomegon, however, also disproportionately affects young girls; not only are nearly 90%-95% of cases involving females, but this practice has fallen prey to child trafficking, opening up the door for forced slavery and sexual abuse both inside and outside the home (Africa for Women’s Rights: Benin 2015). Girls, who do not have access to institutionalized education due to these long work hours, gender-based violence, and financial/geographic restrictions, also miss out on sex education. For those fortunate enough to attend, sex education instruction is sparse and incomplete. Students are often not taught about family planning in detail and are not trained in how to use condoms, birth control, etc. Regrettably, this ignorance regarding the safe contraceptive options and how they work follows them into adulthood. Family planning instruction is also lacking for adults seeking these medical resources. In the hopes of increasing the use of various contraceptive methods by women 12.9% to 20% by 2018, the Beninese government began requiring all its public health facilities to provide family planning services as a part of their minimum package of services; however, these services are not readily available in many cases, especially in rural or impoverished areas (S. Chae and Wilson 2015). Where services are available, facilities suffer from shortages of supplies and trained personnel, as well as a limited range of methods for women to choose from. Without guidance and information about contraceptives from clinicians or other trained professionals, many women are left in the dark about their bodies and personal health.
Intersectionality (which is discussed quite frequently in mainstream feminist anthropology theory and is sometimes referred to as ‘intersectional feminism’) and the combination of several different social determinants of health, complicate this health issue for women in Benin further (Lexico 2019). Social conceptions of gender roles and culture, the political structures in place, the geographic location of one’s home, and one’s socioeconomic status/class can create overlapping and interdependent systems of discrimination or disadvantage that can widen that gap between individuals who are seeking health care and family planning resources. For example, a Beninese mother who wants to use contraceptive devices to space out and limit the number of children she has can face many more obstacles preventing her access to family planning information and resources once intersectionality is considered. As a women, she is faced with gendered standards that value a man’s word over hers, meaning she may not be able to use contraceptives (or even discuss the matter with her significant other) if her husband refuses to utilize family planning practices. If this women is from a lower socioeconomic status or lives in a rural area that is far from public health clinics, she might not be able to afford the price of the contraceptive device(s) or perhaps be unable to travel far from home due to her ‘wifely’ duties to take care of the children. This mother may obtain a form of contraception, but, due to a lack of public sex education or a scarcity of trained professionals at neighboring health facilities who are able to advise/instruct her, she may not know how to safely or effectively use it. Once contextualized by a full network of identities and factors that can make it difficult to receive contraceptives, it can seem nearly impossible for some women to properly utilize family planning practices.
In Benin, social determinants of health such as: conceptions of gender and culture, structural and gender-based violence against women, educational inequity, and an imperfect health care system restrict women’s knowledge and access to contraceptives, leaving them vulnerable to a myriad of adverse health effects. By utilizing feminist theory, this health concern can be exposed as an intersectional issue fueled by social, political, and educational disparities between men and women, and can be studied in such a way as to provide insight to the development of targeted approaches that could potentially increase the prevalence of contraceptive use and better safeguard women’s health. While progress is slow and change is often met with resistance, Benin’s government, local activist groups, and other international organizations are working diligently to support Beninese women’s reproductive health and give women back their agency over their own bodies. Hopefully, shifts in rigid gender roles/expectations and power hierarchies, as well as progressive policies eliminating inequity in education, opportunity, and health can holistically and effectively address the topic of family planning and maternal health for women in Benin.
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