Understanding the Role of Culture in Sexual and Reproductive Health in Mozambique


It is increasingly being recognized that development approaches in the areas of health, specifically Sexual and Reproductive Health (SRH) in the case of Sub-Saharan Africa, are not having the desired effects. HIV rates remain high, despite the substantial financial and human resources invested from governments and donors and the level of effort made in awareness raising campaigns. A new approach which takes into account the lifestyles, attitudes, beliefs and traditional practices that form the basis of a community´s perception of health and illness, life and death, and sexuality has come to be recognized as a potentially more effective way to intervene in matters related to SRH. Aruia Issufo, a ‘Halifa’ (religious leader and performer of initiation rites) in Nampula province, Mozambique stated “…we are concerned with the health of our children, and it is in culture and tradition where this will be resolved.” In the context of the MDG-F Joint Programme for Strengthening Cultural and Creative Industries and Inclusive Policies in Mozambique, UNESCO and the United Nations Fund for Population Activities (UNFPA) are working to promote greater integration of a culture, gender and human rights based perspective in national development plans, processes and programmes on SRH.

In March 2010 the consulting firm KULA undertook research on socio-cultural practices in SRH on behalf of the Joint Programme. The field work resulted in a study on ‘Cultural and Community Practices in Promotion of Sexual and Reproductive Health in Nampula, Sofala and Inhambane’. At the community level, recognizing the socio cultural aspect means being aware of the norms, beliefs and practices of any one community and the role that religious and traditional leaders, traditional health practitioners, family members, schools and health units all play in transferring and disseminating knowledge, in this case on SRH. Describing the key actors and identifying how the different spheres of knowledge interact with each other was one of the main aims of the study, because if progress is to be made in the area of SRH and HIV and AIDS in particular, the connections between all these systems will have to be recognized and an open dialogue encouraged, with the view to strengthen collaboration.

The results of the study were recently shared at the provincial level in Nampula and Inhambane, and a pilot exercise was initiated at the district level in Mossuril and Zavala with representatives from the communities. The goal of the pilot exercise is to apply the socio cultural approach to find local solutions for the issues under discussion and develop a concrete, locally driven roadmap for change. Some of the main issues identified were: lack of knowledge on the origin of HIV and AIDS, prevention of sexual diseases, and family planning; resistance to family planning by male members of households and some religions; prohibition of condom use by some religions; the impact of multiple/concurrent partners and polygamy in the area of SRH and HIV and AIDS; the belief that more children represent increased potential for wealth and income for the family; and early traditional marriage. Each of these issues was discussed and priority areas for further action established.

Sahara Usufo, a traditional healer and resident of Retane, Mossuril commented that for her, the most valuable aspect of this initiative was “…to find out how my community can raise awareness amongst young people to take care, prevent and mitigate the problems associated with SRH” adding “When it comes to SRH, taking into account the socio-cultural aspect is important because talking about sex and reproduction are areas that have to do with culture, customs and habits”. For Ivan Negócio, a traditional leader from Mossuril, the value of this approach was in helping people to understand the causes of various illnesses and reconciling traditional and modern knowledge: “Through this [pilot] we will be able to interpret scientific aspects in relation to traditional ones”. Florentine de Jesus, a teacher from Chipole in Zavala, spoke about the increasingly dangerous attitudes towards HIV and AIDS that predominate in her community and society in general: “Sometimes we look at things without understanding the risks they bring…we think of things as normal because they happen often, for example now the problem of HIV and AIDS kills many people, but as we are all so used to hearing about it, the disease has become something normal to us. We need to go back to thinking that HIV and AIDS is not normal or inevitable and we need to know how to protect ourselves from it.”

Because of the variations in core messages being transmitted, there often exists a weak relationship between the main actors responsible for the dissemination of SRH, in particular the formal health system, the school and the community. At the community level, the teachings center on initiation rites, religion, taboos and traditional medicine, while in schools and health units the approach encourages preventative measures such as family planning, condom use, gender equality and sexual and reproductive rights. One example of the conflicting messages between traditional and formal education is the fact that in the community, girls are considered ready to get married and have children after the first menstruation while conversely, schools and health units advocate delaying sexual activity. Lurdes José, a traditional healer from Mavila, Zavala stated that one of the biggest problems in her community is early pregnancy. Through the workshop she has learnt the value of being more open about certain topics: “In my area we didn’t used to talk about sensitive subjects with children and young people, but now I have learnt that you have to talk about these things, like telling them to study until they reach their goals, using protection and getting tested.”

In most of the districts surveyed, there exists a marked intergenerational conflict between youth and their parents, due in part to tension between cultural tradition and a rapidly changing society. The elder generation believe that modernity is negatively influencing the behavior of young people, and the young think older people are failing to keep up with changes in society. “For me, a big problem is that the parents don’t want to submit themselves to modern life” stated Ms Issufo, “parents should be sensitized to meet the needs of young people”. The overwhelming objective amongst participants was to find ways to work together to improve life and health in communities and help and protect the younger generation. According to population statistics, there are 20 million people in Mozambique, 78% of which are 35 years of age and under, with 34.4% between the ages of 15 and 35. With young people being the majority of the population, SRH and its associated issues therefore affect most of the population.

Most development initiatives have a greater chance of success if key individuals in communities are actively engaged from the outset, acting as advocates for change at the grass-roots level, and using their cultural foundation to form more appropriate plans. In this way, knowledge-sharing partnerships can be developed and common objectives and approaches established. Currently, community leaders are designing operational plans of the pilot interventions to develop more appropriate communication strategies and collaboration between the formal education and health systems and the complementary traditional systems. It is strongly hoped that this pilot initiative will have a positive impact on all future interventions in the area of Sexual and Reproductive Health in Mozambique, including the
prevention, mitigation and care of HIV and AIDS.

For more information contact Moira Welch (m [dot] welch [at] unesco [dot] org), Advocacy and Communications Senior Assistant, MDG-F Joint Programme for Strengthening Cultural and Creative Industries and Inclusive Policies in Mozambique.

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