Once Opposed To Maternal Health, Islamic Scholars Become Champions

Aminu Gamawa wants to change the way Islamic scholars think about health care.

He's a Harvard-trained lawyer who lives in Nigeria, where maternal and child health are major concerns. According to UNICEF, 1 in 13 Nigerian women die while pregnant or while giving birth. In addition, 2,300 children under age five die each day. Many of those deaths, says UNICEF, could be prevented with appropriate medical care.

Nigerians like Gamawa want to bring those numbers down. But these advocates face a challenge: religion.

Particularly in the country's Muslim North, many Islamic scholars have used verses from Islam's holy texts to oppose maternal care, family planning and child vaccines because they believe it's haram — or forbidden in Islam. Gamawa, who is Muslim, says these scholars wield significant influence not only over Muslim health workers but over Muslim patients as well.

But Gamawa thinks their influence can actually be used to improve maternal and infant health. In association with the Development Research and Projects Centre (DRPC), a Nigerian organization that trains community leaders on issues like education and health, he's founded a program to turn Islamic scholars who oppose these forms of medical care into champions.

"In societies where culture and religion are critical, people who are traditional leaders should not be viewed as obstacles," says Gamawa. "They should be viewed as allies who can make things better."

To change the way Islamic scholars think about health care, Gamawa sought out community and religious leaders — male and female — who were suspicious of maternal care.

The initiative received two $250,000 grants, one in 2011 and one in 2014 from Saving Lives at Birth, a program funded by partners like USAID and the Bill & Melinda Gates Foundation (which is a funder of NPR and this blog). With this money, Gamawa and colleagues at DRPC arranged for 15 leaders to travel to Egypt in 2012 to be trained by scholars specializing in Islamic teachings and maternal health.

Egypt is a good fit, says Karlee Silver, the vice president of programs for Grand Challenges Canada, one of the sponsors of Saving Lives at Birth, because the country predominantly practices Sunni Islam, the sect most common in northern Nigeria, and has well-respected experts in maternal health. Several institutions, including the Egyptian Family Planning Association and Al-Azhar University, participated.

The sessions, which lasted two weeks, showed scholars how Islam can be reconciled with maternal and child care.

For example, some Nigerian scholars and community leaders were worried about leaving women alone with male doctors, which they thought was haram. But the trainers argued that in the Prophet Muhammed's time, it was not considered improper for a member of one sex who had medical expertise to examine a patient of the opposite sex. The trainings suggested a tweak to put uneasy husbands at ease, says Ballama Mustafa, a program officer with DRPC: Let husbands accompany their wives during doctor visits.

The curriculum also covers family planning. For those who believe the Quran forbids it, the Egyptian trainers point to a passage in the Hadith — a collection of sayings from the Prophet Muhammed — that acknowledges the pullout method, withdrawing the penis before ejaculation. It shows there seems to be no blanket prohibition against contraception.

Some Nigerian Muslims are also suspicious of vaccines for children. Some believed they were actually a means of sterilizing Muslim children, says Kathryn Coughlin, director of Harvard's Prince Alwaleed bin Talal Islamic Studies Program.

But Gamawa says when he showed many Islamic leaders mortality rates for women and children, the leaders were open to reconsidering. The training emphasizes that safeguarding the body is a Muslim duty. Since then, the scholars have begun urging members of the community to attend vaccination drives, according to Silver.

So far, more than 150 health care students in Katsina and Kano, two northern Nigerian states with large Muslim populations, have received this training, as well as more than 140 practicing health workers in the area. Based on the average number of patients the health workers see, the group estimates it has improved the care of tens of thousands of patients.

Slowly but surely, perceptions around maternal health are shifting, says Dr. Abdulazeez Mashi, one of the scholars who went through the training. A professor of Islamic studies at Umaru Musa Yar'adua University in Katsina, he brought what he's learned from his training to his students. He can already see that it's made an impact.

"The opinion of the people around us is changing now," he says, adding that maternal care is increasing.

Silver of Grand Challenges Canada says the initiative is particularly impressive because it focuses on changing behavior by people who know the cultural practices well enough to change them. "They completely understand the context and why people act the way they do," she says of Gamawa and his colleagues.

Gamawa's ultimate hope is to scale his project to reach other states in the region — and break the link between childbirth and death.

"I refuse to believe that pregnancy is a disease," he says. "No woman should die in childbirth."