OnabusydayattheFithMithClinicinasuburbofGuédiawaye,justoutsideofDakar,MamyDiophadjustgivenbirthtoherthirdchild,onlyoneyearandthreemonthsaftertheprevious.Shedidnotknowaboutfamilyplanningbefore,butshedoesnow."IjustdecidedtotakebirthspacingmeasuresandwillasksoonaboutwhichmethodIshoulduse,"shesaid.FamilyPlanningisanemergingandsomewhatcontroversialtopicinSenegalwheremorethan2,000participantsmetinearlyDecemberfortheInternationalConferenceonFamilyPlanning.SenegalesePresidentAbdoulayeWadehighlightedthedilemmahiscountryfaces."Tosurvive,itisgoodtolimitthenumberofchildren,butthisshould,again,beadecisionmadecompletelyvoluntarily,"hesaid."Weareconsequentlybelievers,andwecannotimposecontraceptivemethods,methodswhichpreventprocreation."Butmoreandmore,familiesareseekingcontraceptiontospaceorlimitbirthsdespitetheassociatedtaboosinthecountry,whichismorethan90percentMuslim."SomepeoplesayIslamisagainstfamilyplanning,butlifeisgettingmoreandmoredifficult,"saidMamyDiop.Historically,theonlyacceptableapplicationoffamilyplanninghasbeenbirthspacingforthehealthofthemotherandthechild.ButreligiousleadersincreasinglyareinvokingtheQuran'smessageoffinancialresponsibility."Islamhasdiscussedthis,"saidImamNiasse."Ifresourcesarelimitedandthefamilysizeistoolarge,therewillbeproblemsforthefamily.Wearealreadylivingasituationofscarcityandweshouldtalkopenly.Wehavemanychildrenhere,butwhatkindofchildrendowehave?"ManyMuslimscholarssaythat,barringabortion,thefaithfulcanusemanytypesofbirthcontrol-butonlyifitiscriticalforthesakeofthemotherorthefamily'sfinances.Ifbotharehealthy,theconsensusisthatparentsshouldcontinuetoreproduce.Ifnot,familieshavemanychoices."Thisistheintrauterinedevice,thisthecyclenecklace,theseareinjectables,thisisthefemininecondom,thepills,thereareimplants,plusthemalecondom,"saidnurseMariamaBaye.MariamaBayeistheheadnurseandmidwifeattheFithMithClinic.Shesaysnoneofthosemethodscostmorethan$1permonthanddemandisontherisedespitepersistentsocialobstacles."Withoureffortsanddiscussionsintheneighborhoods,womennowunderstandwhatbirthspacingisandtheywanttocome,"shesaid."Whenwesaybirthlimitation,theydon'tlisten.Sowesaybirthspacing.Withbirthspacing,Ihopethefinalgoalwillbethelimitationofbirths."TheclinicparticipatesinanurbanfamilyplanningprojectfundedbytheBillandMelindaGatesFoundationandcoordinatedbyIntrahealth,aprivateAmericanorganizationthatsupportshealthworkersthroughouttheworld.PapeGayeistheIntrahealth'sCEOandanativeofSenegal."We'veseenwaytoomanypeopleinthestreets,waytoomanypeoplewhoarenotgoingtoschool,waytoomanypoorpeople,whichispartofrefusingtocontrolpopulation,"saidPapeGaye.GayesaysfamilyplanningresultsinSenegaldonotmatchthelargeinvestmentsmadeinthecountry.Hesaysjust12.3percentofthepopulationusecontraception,onlymarginallyhigherthanfiveyearsago.Yet,hehopestherecentconferenceandthepresident'sremarkswillfurtheropendialogueandaccelerateresults.
