ISLAMIC TEACHINGS ON REPRODUCTIVE HEALTH AND FERTILITY TRANSITION IN MUSLIM-MAJORITY COUNTRIES

Mehtab S. Karim, Ph.D. Head, Reproductive Health Program Professor of Demography Department of Community Health Sciences Aga Khan University mehtab.karim@aku.edu

As societies transform from a predominantly traditional to a predominantly modem system they tend to experience considerable demographic changes. Ansley Coale (1984) notes that this "transformation is the substitution of slow growth achieved with low fertility and mortality for slow growth maintained with relatively high fertility and mortality rates."

During the 1960s and 70s while trying to explain persistently high fertility in the developing during, most Western Demographers had taken the view that high fertility was generally embedded in cultural and religious factors, which encouraged high fertility in most countries of Latin America, Africa and Asia. In this respect, much more has been written about high fertility among Muslims than about the followers of any other religion.

For example even when no considerable fertility decline was noted in any developing country, Dudley Kirk (1966) in his review of Muslim fertility, observed that: Muslim populations tended to have high fertility, that there was no evidence of decline, and that in a given country, Muslims tended to have higher fertility than adherents of other religions.

Caldwell took a similar view about subSaharan Africa, arguing that high fertility rates in the region , "have much to do with a religious belief system, that operates directly to sustain high fertility.
He further contended that in his study of several developing countries, the commonest factor in explaining high infant mortality was the predominance of Muslim countries. He argued that high infant mortality in these countries was due to lower status assigned to women in theses predominantly Muslim countries, which also leads to higher fertility .

However, taking a broader view, Bongaarts, in his theory of proximate determinants of fertility postulates, that due to socio-biological factors, fertility is likely to be lower than its maximum value as a result of:
delayed female age at marriage, higher use of contraception, high prevalence of induced abortion and, prolonged practice of breastfeeding

In Islamic scriptures, as recorded in the revealed book the Quran and Hadith (sayings of the Prophet), views on each of the four proximate determinants of fertility are available. These issues have also been widely debated in the writings of the early Muslim jurists and scholars.

ISLAMIC TEAHINGS ON FAMILY PLANNING

In Islamic scriptures, as recorded in the revealed book the Quran and Hadith (sayings of the Prophet, PBUH), views on each of the four proximate determinants of fertility are available in the writings of the early Muslim jurists and scholars.

On Marriage
Among His signs is this, that He created for you mates from among yourselves, that you may dwell in tranquillity with them The Quran, Surah 30:21 The Prophet (PBUH) discouraged celibacy and encouraged all Muslim males and females to get married.

One finds general references in the Quran and Hadith regarding marriageable age and the age of sound judgment, without specifying a fixed age. However, some scholars have argued that, if a girl is married at too young age, an element mentioned in the Quran of dwelling in tranquillity could be missing.

Thus, Imam Abu Hanifa suggested an age of marriage of 18 years for boys and 17 for girls.

Subsequently, these were adopted in the Ottoman Family Law before the First World War.

On Lactation
Mothers shall suckle their children for two whole years The Quran, Surah 2:233 Imam Al-Ghazali was of the opinion that since mother must breastfeed the children for two years, therefore, while the mother is lactating, to avoid another pregnancy, couples should practice birth control.

On Contraception
In Hadith, azl (coitus interruptus) is mentioned either as a saying of the Prophet or as his tacit approval. The Prophets (PBUH) companion Jabir relates: We used to have recourse to azl during the days of the Prophet while the Quran was being revealed. He came to know of it but he did not prevent us from doing so.

Throughout the Middle Ages, Muslim physicians instructed people on contraceptive methods. Thus the most well known Muslim physician al-Razi gave illustrations of the different methods of contraception in his book Al-Hawi. He suggested three ways for preventing conception:

withdrawal prevention of ejaculation or apply to the uterus a tampon or a certain spermicide.

In sum, there was a general consensus among early Muslim scholars that contraception is permitted in Islam.
However, most scholars accept that contraception is not acceptable in two situations: if it is used to avoid having female children or if it is used to avoid parental responsibilities

On Abortion
Those who support abortion quote the following verse: We created man from a product of wet earth. Then placed him as a drop (of seed) in a safe lodging. Then fashioned We the drop a clot, then fashioned We the clot a little lump, then fashioned We the little lump with bones, then clothed the bones with flesh, and then produced it as another creation.... The Quran, Surah 23:14

Imam Bokhari quotes a Hadith of the Prophet:

All of us have been kept as a drop of seed which remains in the shape of a drop in the mothers womb for 40 days. Then for another 40 days, it remains in the form of a clot of blood. Then another 40 days it remains in the form of a lump of flesh. Then an angel is sent to the fetus who blows spirit (life) in to it.

The most recent formulation on abortion, given by the grand Mufti of Egypt and Rector of Al-Azhar reads as follows: During the first four months, fetal life is not believed to be human. Thus, juristic consensus exists only to the point that abortion after four months amounts to taking a life, but this limit may be set aside, if the mothers life is at risk.

Opposing Views
Maulana Maududi, a highly respected scholar from the Indian sub-continent makes the following arguments in his book Birth control, first published in 1943:
The

birth control movement is a plot against Islam. To import birth control methods into developing countries would be tantamount to ushering in moral malaise and, Women would feel free to join the labor force and abandon their traditional roles.

Maulana Maududi, however, allowed the practice of birth control if a couple so desires for personal reason but not as a concern for population growth

Do Muslim countries have a typical demographic pattern?

In The Demography of Islamic Nations, Weeks (1988) found noticeable regional and temporal diversity in fertility among Muslim countries. He argued that,
The single most remarkable demographic aspect of Islamic societies is the nearly universal high level of fertility.

Samuel P. Huntington in his well publicized book, The Clash of Civilizations states:
The Resurgence of Islam has been fueled by equally spectacular rates of population growth Population growth in Muslim countries, provides recruits for fundamentalism, terrorism, insurgency, and migration. [thus] demographic growth threatens Muslim governments and nonMuslim societies alike [and] Each of these challenges is having and will continue to have into the 21st century a highly destabilizing impact on global politics

In a monograph on Reproductive Behaviour in Muslim Countries (1997), which I prepared for UNFPA in 1997, based on the analyses of DHS data from 12 Muslim countries, I had had taken the view that: while poor socioeconomic conditions might have played an important role in maintaining high fertility in Muslim countries, more recently effective family planning programs coupled with high female literacy seem to have become major factors in achieving fertility transition in these countries.

Post 9/11 there has been considerable interest in Muslim population living around the World. For example, the Economist of London came out with a special issue on 13th September, 2003, with an estimated population of 1.5 billion and the following regional distribution:

Distribution of Muslim Population by Region

East Asia Europe and North America Central Asia South Asia

South East Asia

Middle East and North Africa Subsaharan Africa

I am of the view that:

Demographic transition begun in most of the Muslim-majority countries at some time over the past two decades, and in some, it has moved very rapidly. Elsewhere, there is only little evidence of the onset of fertility decline.

I support my view with the following data and illustrations:

AN OVERVIEW OF DEMOGRAPHIC TRANSITION IN MUSLIM MAJORITY COUNTRIES: 1970-2000

# of countries with CBR of 1970 2000
45+ 40-44 35-39 30-34 25-29 20-24 <20 28 4 8 2 1 0 0 6 8 4 3 7 8 7

# of countries with CDR of 1970 2000

25+ 20-24 15-19 10-15 5-9 <5 10 6 12 10 5 0 0 4 7 6 18 8

Total

43

43

Total

43

43

Trends in Fertility Decline: 1960-2000

Till the early 1960s, fertility rates in almost all Muslim countries were fairly high. During the past 40 years many countries have experienced substantial declines. The most dramatic regional declines occurred in North Africa, where Egypt began with the greatest early decline, quickly joined by Tunisia, Morocco, and Algeria. All three South-East Asian countries experienced similar declines.

Thus, in a majority of countries in the Muslim world, there is considerable evidence of demographic transition, particularly in fertility, during the past 25 years.
Muslim countries in East and West Africa saw only modest declines in fertility, while in Asia, Pakistan, Afghanistan, Yemen and Oman were the exceptions. The most remarkable recent declines on the other hand, were experienced by Bangladesh and Iran. Regional trends in fertility declines are

Fertility Decline in North and NorthEast African Countries

8 7 6 5 4 3 2 1 0

TFR

ia ge r Al

yp t Li by M a or oc co Su da Tu n ni C si a om or os D jib ou So ti m al ia
Year 1960-65 Year 1970-75 Year 2000-05

Eg

Fertility Decline in West African Countries

9 8 7 6 5 4 TFR 3 2 1 0
M au ri t an ia am bi a G ui ne a Fa so M al i Se ne Si ga er l ra Le on e C N ig er ha d

in a

Bu rk

Year 1960-65

Year 1975-80

Year 2000-05

Fertility Decline in West Asian

Countries

Fertility Decline in South-Central Asian

Countries
8 6 4

TFR 2
0
yz Ist an M al div es Pa k is ta n Ta ji k Tu i st an rk m en ist an Uz ba ki s ta n Af gh an is t Ba an ng lad es h Ira n

Year 1960-65

Ki rg

Year 1975-80

Year 2000-05

Fertility Decline in South-East Asian Countries

8 6.7 6.7 5.4 4.7

6 4.4 2.5

4.2 2.9

TFR

2.4

Indonesia

Malaysia

Daressalam

Brunie

1960-65 1975-80

2000-05

Similarly, currently married women using contraception show no significant differences between Muslim and nonMuslim Countries- 2003
90 80
83 74 72 64 60 41 28 14 14 10 9 8 5 64 57 54 56 56 49 48

Percent

70 60 50 40 30 20 10 0

Chima Iran UK Turkey Italy Bulgaria

Country

Algeria Egypt South Africa Cote d'lvoire Niger Sudan Senegal Ethiopia Mozambique

Indonesia Bangladesh Phillipines India Pakistan

There appears to be no typical pattern of reproductive behavior which could be described as Islamic. Islam as such seems to be neither a hindrance nor a stimulating factor in fertility decline. It seems that governments in most Muslim countries, due to a pragmatic thinking have adopted a positive approach to birth control. However, with a few exceptions, contraceptive use rate is low and consequently fertility is high in some Muslim countries, similar to other countries in the same region.

IN CONCLUSION

Recently Prof. Mehtab Karim coedited a book with Prof. Gavin Jones on Islam, the State and Population. Hearst & Co. London. 2005