So Many Mouths to Feed: Addressing High Fertility in Famine-Stricken Somalia

MOGADISHU, Somalia – In Dabke camp for internally displaced persons in Mogadishu, Muno Abukar shares a tent with her eight children. Fleeing the famine, the family left their home in Lower Shabelle five months ago. Since her husband passed away two years ago, Muno has had no means to support her large family. At the camp, she and her children are provided just one meal a day.

This scene, mothers with several children they are unable to care for, is common in camps for internally displaced persons throughout Mogadishu. Averaging more than six children each, women in Somalia have one of the highest fertility rates in the world. Very few women use, or have access to, modern contraceptives – the prevalence rate is around 15 per cent. Despite conflict and famine, the country’s population has nearly tripled in the past fifty years, even with the high rates of mortality: for every 1,000 live births, about 12 women die and 225 children never reach the age of 5.

Dr. Nimo Abdi Hassan, a gynecologist at Mogadishu’s Madina Hospital, explained that in Somalia, “Giving birth here means that a woman is someone contributing to society...the more [children] you produce the more you save a nation where war has claimed millions of lives.”

Even before the conflict, children represented a form of social and economic capital. Somali society is pastoralist and large families are needed to care for herds. Having a number of surviving children also provides security for parents in old age.

The role of faith in family planning decisions

Dr. Hassan believes the only way to effectively deliver family planning messages is through religion. Nearly all Somalis are Sunni Muslim, and religious leaders are deeply trusted. Some believe that limiting family size goes against the will of God, while others assert that no verse in the Quran identifies contraception as haram, or religiously prohibited.

In light of the varying interpretations of family planning in the Muslim world, partnering with faith-based organizations can alleviate social (including religious) pressures associated with the practice of child spacing. Natural contraceptive methods such as withdrawal and exclusive breastfeeding are more easily accepted in Somali society.

"Family planning programmes that disregard the role of religion in shaping behaviour and attitudes in society, will have their outreach and efficiency hampered, as several studies around faith and family planning dynamics increasingly attest to," said Azza Karam, senior socio-cultural development adviser for UNFPA. "In many instances, a failure to take cultural concerns into account, can lead to misinterpretations about the purpose of family planning and the nature of provision of such services," she added.

Long-term strategies

Throughout the past two decades of conflict in Somalia, international attention has centred on resolving the political crisis and delivering emergency relief. The country has not had a functional central government since 1991, which has led to a breakdown in the delivery of basic social and health services. The Transitional Federal Government, which is located in the capital Mogadishu, has very limited control over the territory of the country.

Under the circumstances, developing the kind of programming and healthcare infrastructure necessary to generate and fulfill a demand for family planning has not been a priority. Most services now are being provided by non-governmental and community based organizations. As part of its mission to deliver a world where every pregnancy is wanted and every childbirth safe, UNFPA delivers essential reproductive health supplies and services through partnerships with both non-governmental and governmental organizations.

In the early stages of the crisis, health interventions to stabilize the malnourished were considered more pressing by the international development community. However, Somalia’s high birth rates have exacerbated the crisis currently facing the country.

“With the worst of the famine now over, there is a much needed opportunity to focus on family planning programming as a way to safeguard the overall well-being of future generations,” said Sherin SaadAllah, Regional Adviser for Arab States at UNFPA. She also noted the added burden of conflict, and volatility on Somali women and the Somali population at large.

“With the international community, in partnership with the UN, refocusing attention on Somalia through the convening of the London Conference (February 2012), and the upcoming Reconstruction Conference for Somalia, hosted by Türkiye (May 2012); UNFPA is making every effort to integrate issues of social development including reproductive and maternal health within the annotated agenda concerns,” she added.

--- Roopa Gogineni for UNFPA