Pregnancy prevention and fertility enhancement in rural Tanzania: An ethnography of young people's beliefs and practices

Historically, fertility has been highly valued in Africa, supported by early marriage and low contraception, although fertility has declined in recent decades, particularly in urban areas. Little research has examined current fertility-related beliefs and practices in rural African settings. This study involved 158 weeks of participant observation in nine Tanzanian villages from 1999-2002. Reproduction was a source of pride, accomplishment, and future security. Some believed pregnancy desirable in any circumstance. However, pre-marital pregnancy could reduce a woman's brideprice, create financial or legal burdens for her sexual partner, and limit either partner's choice of spouse. Many youths thus wanted to prevent pregnancies, especially school girls, who were expelled if pregnant. Most young women reported traditional pregnancy prevention, e.g. wearing charms or drinking herbal or ash solutions. A small minority used modern contraceptives, but very few girls did because of limited access and confidentiality. Deprovera injections were the most popular modern method, as they were infrequent and easily hidden from partners. There were widespread beliefs that oral contraceptives caused infertility and condoms reduced male pleasure. Infertility and miscarriage were attributed to God's will, bewitchment, punishment by ancestral spirits, and/or STIs and other physical conditions, particularly some involving painful menstruation. If a pregnant woman had sexual partners other than her baby's father, it was believed her delivery would be difficult and the child harmed. She was reportedly cured by taking traditional medicine while naming her partners. There is great need for improved reproductive health education and services in rural areas, particularly modern contraception for sexually active young people.