The Contraceptive Mindset Invades the Gambia

As champions of the feminist cause, progressives tirelessly insist that they want to expand the range of choices open to women around the globe. But a new study out of the Gambia in West Africa manifests more than a little progressive discomfort with one kind of female choice: that of bear­ing and rearing a large family. Indeed, this study signals a strong progres­sive commitment to prevent this female choice through a contraceptive reordering of Gambian society.

Conducted by researchers at the University of the Gambia, this new study focuses on “grand multiparity,” the obstetric phenomenon mani­fest when a woman has “carried five or more pregnancies to the age of viability.” The Gambian researchers note that “grand multiparity is still quite common in The Gambia,” where the Total Fertility Rate stands at 5.6 births per woman.

In studying grand multiparity, the researchers are studying a phe­nomenon they regard as a problem, one they definitely wish to make less prevalent by prevailing on more Gambian women to use modern contra­ceptives. “High parity,” the authors of the new study remark, “is… still a common problem in obstetric practice in many developing countries” (emphasis added).

Why do the researchers regard it as a problem that many Gambian women bear five or more children? They note that grand multiparity is “associated with maternal anaemia in pregnancy, antepartum haemor­rhage, abnormal foetal presentation, postpartum haemorrhage as well as medical conditions such as hypertension in pregnancy.” They further remark that, compared with mothers who have given birth to fewer chil­dren, “the grand multiparous woman is also more likely to require a sur­gical obstetric intervention with its attendant risks.” In addition, among the children born to grand multiparous women, medical professionals see a distinct elevation of “perinatal problems including low birth weight, preterm birth and congenital malformations.”

Nonetheless, the researchers acknowledge that “grand multiparity does not necessarily end in adverse pregnancy outcomes.” So why do they not devote themselves to finding ways of dealing with or preventing the medical problems sometimes associated with grand multiparity? After all, the researchers themselves acknowledge that such medical complications “can be minimized by good antenatal care.” Why not focus on providing such care instead of labeling grand multiparity a problem in and of itself?

It would appear that social and cultural attitudes, not simply medi­cal concerns, are at work here. The researchers indeed evince a desire to guide the Gambia toward a future in which it more closely resembles “developed countries,” countries characterized by “high literacy level, availability of modern contraceptive methods, liberal abortion laws and… improved health care services which ensure the survival of almost all children,” countries—such as those in Western Europe and North America—where the incidence of grand multiparity “now ranges from 3 to 4%.”

The authors of this new study believe that Gambian mothers should be “advised to practice effective family planning methods to prevent fur­ther pregnancy,” thus making themselves more like Western European and North American mothers. Indeed, the researchers note that “the Gambian National Reproductive Health Policy [already] provides for the provision of free family planning services in all the health centres in the country.” It is therefore clearly a matter of frustration to the researchers that “despite this huge investment in family planning by the government and international donors, grand multiparity remains a common feature of obstetric practice in The Gambia.”

To better understand the persistence of grand multiparity in their country, the Gambian scholars examine data collected from 514 moth­ers visiting Edward Francis Small Teaching Hospital (the Gambia’s only tertiary health facility) for prenatal care. Of these 514 mothers, 136 (26.5%) were grand multiparous mothers expecting a fifth or subsequent child.

When the researcher asked them why they were pregnant with this child, these grand multiparous mothers most commonly replied that they simply wanted more children. As the researchers report, “The most common reason given for the current pregnancy among the grand mul­tiparous was a desire for more children.” What is more, these mothers are not having large families in ignorance of contraceptive options. The researchers conclude that “97.1% of study participants were aware of the availability of contraception. In fact, 56.6% of these mothers had been counseled regarding availability, accessibility and various options avail­able for contraception in the hospital before discharge in their previous pregnancy. Therefore, inability to use contraception to prevent the occur­rence of pregnancy was not due to lack of contraception or accessibility.”

Perceptive readers will discern the anti-natal bias evinced in the researchers’ reference to grand multiparous mothers’ “inability to use contraception” (emphasis added) to prevent a pregnancy—as though women would somehow want to bear a fifth child only because they lack some essential ability.

To be sure, a significant number of the grand multiparous mothers in this Gambian study did identify their latest pregnancy as a “mistake.” Among these women, the authors of the new study suspect they see “an unmet need for contraception” and therefore call for “additional efforts… to target those with unplanned pregnancies” as potential users of contraceptives.

The Gambian researchers recognize the imprudence of openly impugning the desires of Gambian women who say they wanted their latest pregnancy. But in identifying “high parity” as itself a problem, they unmistakably indicate that these women are also targets in their plans to spread the contraceptive mindset. Even though the number one reason that Gambian women become grand multiparous mothers is simply that they want many children—regardless of the availability of contracep­tives—the Gambian researchers see in the high number of such mothers an indicator “of low literacy, poverty and other forms of injustice and inequity faced by women in the developing world.” No wonder, then, that they envision a nationwide cultural change that will reduce the number of such mothers by sharply increasing contraceptive use. To effect that change in “a religious country” like the Gambia, one of “patriarchal nature,” they believe that advocates of contraception “need to develop family planning messages that specifically target men and religious lead­ers” in order to “get women to practice contraception.”

In their repeated use of the verb target, the authors reveal much about their aggressive cultural intent. Target typically means aligning a weapon for firing against foe or prey—often with lethal effect. The advocates of contraception now target a Gambian society that they find unacceptably different from the contraceptive-friendly, low-fertility societies of Europe and North America. To the degree that these crusaders for contraception do discharge their cultural weapon, Gambian society as it now exists will live no more—and many of the baby Gambians who might have been born will never see the light of day. These crusaders may then congratu­late themselves on having solved the problem of large Gambian families.

(Patrick Idoko, Glenda Nkeng, and Matthew Anyawu, “Reasons for Current Pregnancy amongst Grand Multiparous Gambian Women—A Cross-Sectional Survey,” BMC Pregnancy Childbirth 16 [2016]: 217, Web.)