Bitter pill for Muslim women 

Written by Mariam Mokhtar    
Friday, 18 June 2010 
Slow progress for Muslim women despite the 50th anniversary of The Pill

In May, "The Pill" celebrated its 50th anniversary and counted up enormous 
accomplishments in terms of improved women's health, falling birth mortality 
and improved professional and personal status for women, not to mention sexual 

But in the 50 years since it was approved by the US Food and Drug 
Administration in the United States and swept much of the planet, the lack of 
birth control methods in the Muslim world - and a misconception that birth 
control is forbidden by Islam -- have prevented many women from controlling 
their family size.

Although Islam has endorsed conception for 1,400 years, many Muslim countries 
across the planet have the lowest rates of birth control, according to the 
United Nations Population Fund, despite the fact that Muslim women want fewer 
children and know about contraception. There is an apparent discrepancy between 
Islamic theological opinion and the real lives of Muslim women. 

It is the marginal status of women in Muslim countries, not Islamic law, that 
prevents women from obtaining contraception, according to Khadijah Knight of 
Amana, a London-based Islamic education organization: "Birth control is often 
presented as a religious question, as a way of subjugating women." 

Islamic family planning is quite rudimentary. Theoretically premarital 
relations are forbidden. Sex before and outside of marriage are viewed harshly. 
Sexual relations between a wife and husband form the ideal expression of love, 
not just procreation. 

Nonetheless, either with the pill or without it, many Muslim countries have 
slashed their fertility rates dramatically, Indonesia and Pakistan among them. 
Pakistan has reduced its fertility rate from six or seven children per woman to 
2.48 per woman. And ddespite the problems that Muslim women face in many other 
countries, Indonesia, the world's fourth most populous nation, has been making 
considerable gains in family planning. 

Some 88 percent of Indonesia's 320 million population are Muslim. The country's 
National Family Planning Coordinating Board coordinates all of its family 
planning needs under the Ministry of Health. 

Indonesia's contraceptive usage tripled in 27 years (1976, 19 percent; 2003, 
60.3 percent). Total fertility decreased by more than 50 percent in 35 years 
(1968, 5.6 births per woman; 2003, 2.4). In 2003, 60.3 percent of married women 
used contraception and 13.2 percent were on the pill. In 2007, the NFPCB 
drafted a handbook for the ulemas to further disseminate its family planning 
program. In a Family Health International (FHI) study conducted in Indonesia, 
women with only one or two children reported feeling greater satisfaction than 
those with more than two children. They also felt more attractive, with more 
free time to devote to family, work or other interests. 

Malaysia ironically had a strong family planning program in the 1960s, with the 
main method of contraception being the pill. By 1967, the Family Planning Board 
had reached 90 percent of its target. One of the pioneers instrumental in 
driving the family planning message was Dr. Siti Hasmah, the wife of former 
Prime Minister Mahathir Mohamad, also a physician.

But in the Second Malaysia Plan of 1971-1975, the New Economic Policy was 
introduced to tackle the problem of Malay poverty. Efforts to promote family 
planning were hampered by government neglect and inadequate facilities and 
personnel. The government considered family planning a "sensitive topic" and so 
ignored it.

Then in 1984, Mahathir reversed the National Population Policy completely, 
setting a target of 70 million Malaysians by 2100 at a time when the country's 
population stood 12.6 million. His aim, to make Malaysia a fully industrialized 
and developed nation by 2020, required Malaysians to contribute to the economy 
by increasing both their production and their reproduction, an economic theory 
that most planners found to be irrational.

The result was that the birth-rate among the rural and poorer Malay women 
increased, while their Contraceptive Prevalence Rate dropped sharply, according 
to the Malaysian Population and Family Survey of 1984-85. Today, birth control 
is hit-and-miss, carried out largely and often surreptitiously by women who do 
not want any more children. Abortion pills like RU486 are widely available, 
known colloquially in Malaysia as pil cuci benih.

"Norma," a 29 year-old housewife who lives in a Kuala Lumpur suburb with her 
husband and their four children, is a product of this change in policy. She is 
of slight build and looks old for her age. Her husband works as a bus-driver 
and she is aware that if she doesn't budget carefully, she would have to pawn 
more of her jewelry to feed her children. 

When she discovered she was pregnant, she feared telling her husband and 
confided in her friend that she didn't want any more children. She was told to 
go to the gynecologist and say that she missed her period. She would be given 
pil cuci-benih, which cost a few ringgit and are cheap, compared with an 
illegal abortion, which costs RM870 (US$267). 

Norma says, "I have no choice. I am forced to do this. I'd rather not have an 
abortion or take these anti-abortion pills, but we cannot afford another 
child." She regrets that her husband's refusal to share the responsibility 
means that she now uses abortion as a form of family planning. 

In a 2008 Malaysian Population and Family Survey, 24 percent of married women 
who said they didn't want any more children were not using any kind of 
contraception. Despite Malaysia's economic growth and an increase in women's 
education, it has a low contraceptive prevalence rate compared with Asian 
countries with a lower socio-economic status like Thailand, Vietnam or China. 
In Malaysia only 32 percent of women use a modern method in 2004 compared with 
30 percent in 1994 and 34 percent in 1998. In 2004, the rate was lowest in 
Kelantan (16 percent) and the highest was Negri Sembilan (63 percent).

Part of the problem relates to Islamic beliefs, compounded by a rise in 
fundamentalism, which has led to lower levels of contraceptive use. 
Birth-control is perceived to be infanticide, and family planning programs are 
considered a western conspiracy to reduce the number of Muslims, and thus 
diminish their power. 

Women allow their daughters to take the pill to regulate their periods when on 
a religious holiday but strongly oppose its use for contraception. "It is 
permitted when we are on the haj or umrah because a menstruating woman cannot 
pray or enter the mosque," said one mother."But she cannot take the pill 
ordinarily, unless she marries. It will lead to free sex."

Even married women do not find the same liberating experience with the pill as 
their western counterparts. There is no separation of sexual pleasure from 
child-bearing. In Islam, sexual relations between a wife and husband are mainly 
for procreation. Having children is encouraged because children will bring 
rezeki (gifts or blessing from God). The pressure to bear children is enormous, 
as is the pressure to have boys.

However, among Malaysian youth, there is desire to increase sexual awareness 
with 59 percent saying they would like to consult someone in confidence, 57 
percent wanting better sex education in school, and 50 percent needing access 
to more educational literature. A secondary schoolgirl, Sita, said in an 
interview, "When Whisper (a sanitary-towel company), came to the school to talk 
about condoms and sex, that was the first time we learnt about our bodies. Even 
our teachers are embarrassed to talk about human sexual organs, during biology 

Mala, a marketing executive in a multi-national company and who is in her early 
thirties said, "I learned all that I needed to know about sex from the 
internet." She comes from a typically modern Malay family, but even her mother 
considers sex a taboo subject. Mala was briefly on the pill until she found 
that it made her put on weight; 10 kilograms in two months. "The pill gave me a 
better complexion, but my friends said that I would have thrombosis and other 
health problems, so I stopped. If it had not made me fatter, I might have 

Two elderly women said that in the 60s, they took the pill. One who lived in 
the kampong (village) said that in those days, she had easy access to a bidan 
or midwife. Just as today, husbands left the choice of contraception to the 
wives, but they did participate. According to the other 77 year-old: "After 
dinner, my husband and I would sit down in front of the television, have coffee 
and I would take my pill. It was the same ritual every night." 

Today, Family Planning clinics charge minimal fees and provide a good, 
confidential service. Unmarried girls are encouraged to visit and may qualify 
for free contraceptive services. 

Without easy access, women cannot enjoy the benefits of family planning. If 
money is scarce, a woman's priorities are her family, food and schooling. Not 
on transport to clinics, even if the Pill is cheap or free.  

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