The European Journal of Contraception and Reproductive Health Care June 2006;11(2):138–145

Effects of reproduction norms on

contraception practice among Muslim
women in Amman, Jordan
S. Sueyoshi, H. O. Al-Khozahe* and R. Ohtsuka**
School of International and Social Studies, Kibi International University, Okayama, Japan; *Department of Social
Work, Al-Balqa’ Applied University, Balqa’, Jordan; **National Institute for Environmental Studies, Japan

...........................................................................................................................................................................................................

ABSTRACT Based on the authors’ interview survey for 275 Muslim women of an ethnically divergent
community in Amman, Jordan, this study examined the psychosocial effects of reproduction
norms on contraception practice, using the normative interpretations of legal provisions in
Islam (hukm). The categorical principal component analysis (CATPCA) reduced the eight
items regarding family planning and contraception use to two factors, i.e. the pressures of
childbearing and acceptability of contraception use, accounting for 55% of the total variance.
Even though the majority of the female subjects were conservative rather than innovative in
terms of reproduction norms and significant interrelations were observed between their
reproduction norms and contraception practice, approximately 70% of the female subjects
who were closely in consonance with the normative interpretations of their religious leader
had used contraception. It is thus indicated that religious leaders may play significant roles in
increase of contraception practice among Muslim women.

KEY WORDS Reproduction norms, Contraception practice, Legal provisions, Islam, Arab population, Jordan
...........................................................................................................................................................................................................

INTRODUCTION

Considering the apparent difference in fertility rate proximate determinant of a decrease in fertility8. As
among the populations of different religions, repre- a result, fertility rate remains high in this region.
sented by especially high level among Muslim Islam has approved contraception use including
populations, the extents to which such sociocultural nonpermanent modern methods. However, changes
factors as religious belief and norm, which psychoso- in religious beliefs on contraception use among
cially influence reproduction behaviors, have become Muslims have often been observed, mostly because
the focus of attention in fertility studies1–4. normative conditions under which Muslims can use
In Arab societies, women’s subordinate position contraception was declared by religious scholars9,10.
and men’s dominance in decision making regarding Moreover, Muslim religious leaders who strongly
childbirth imposed by Islamic tradition give pressure share ways of thinking on life with their congregants
on the women to bear children and to avoid have often misinterpreted the concept of contra-
contraception use5–7, which is the most important ception11. Although there are many positions and titles

Correspondence: H. O. Al-Khozahe, Amman, P.O. Box 962443, Amman 11196, Jordan. E-mail: ohok_90@yahoo.com
MS 400

ª 2006 European Society of Contraception

DOI: 10.1080/13625180500539430
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan
for religious personnel in Islam, in this paper, we
separately refer to mufti (interpreter of Islamic law)
and ’ulama (scholar) as religious scholars, and imam
(leader), qad ( judge) and wa’iz (preacher) as religious
leaders.
The normative interpretations of legal provisions in
Islam (hukm), which are defined as the normative
interpretations of legal provisions in Islam governing
the daily life of Muslims, are categorized into five
Arabic terms: wajib (obligatory), mandūb (recom-
mended), mubah (permissible), makrūh (reprehensible)
and haram (forbidden). Because wajib is the constraining
power of Islamic rules for Muslims, they are prohibited
from taking actions. Mandūb refers to a recommended
course of action, but there is no culpability when
Muslims decide not to follow. Mubah refers to
allowable actions for Muslims and the decision to do
or not to do is entrusted on them. Makrūh refers to
actions deserving censure, but there is no accusation
similar to mandūb. Haram refers to actions strictly
forbidden. Because Muslims follow these normative
interpretations based on the exegesis of the school of
law, by which they abide, these five categories play
major roles in understanding reproduction norms
among them.
In Jordan, fertility rate has been decreasing con-
comitantly with the increase in acceptance of
contraceptive methods among women in the past three
decades. For example, the contraceptive prevalence rate
(CPR) has increased from 29% in 1977 to 56% in 2002,
reflecting a high CPR in the urban area, particularly in
Amman, and among highly educated women. In the
same period, total fertility rate decreased from 7.4 to
3.712,13. It is noted, however, that different religious
leaders and congregants have reported different religious
interpretations of the concept of family planning11.
Thus, fully understanding the extent to which the
normative interpretations of religious leaders are shared
by their congregants and to which reproduction norms
affect contraception practice is important to further
promote family planning not only in Jordan but also in
other Arab countries.
Based on the authors’ field research among Muslim
women conducted in Amman, in this study we
examined reproduction norms regarding family plan-
ning and contraception practice among the female
subjects and the effects of a religious leader on them,
to elucidate the psychosocial effects of these norms on
the contraception practice.
The European Journal of Contraception and Reproductive Health Care
Sueyoshi et al.
SUBJECTS AND METHODS
Al-Sharqi, the target community in this study, is
situated in the eastern part of Sweilleh district in
northwest Amman. According to the Department of
Statistics14, approximately 20,000 people inhabited an
area of 1.8 km2 in 2004.
The Community Development Center (CDC),
which was established in 2000 by the University of
Jordan in collaboration with McGill University, Canada,
to improve the social situation of this densely populated
area, recognized that this community was characterized
by the lack of social infrastructures and by ethnical
diversity due to the inflow of migrants from the West
Bank and Gaza Strip in 1949 and 1967. Moreover, the
number of foreign workers, particularly from other Arab
countries, in Jordan has increased in recent years15–17.
The interview survey was conducted over 3 weeks in
August 2004. For the collection of data, seven female
social workers, that were staff of CDC, collaborated as
research assistants after a 2-day workshop on methodol-
ogies and a 1-day pretest were carried out. They
performed door-to-door visits in 20 among 53 blocks in
the study area and interviewed 300 currently married
women, in the reproductive age (15–49 years old).
Of the 300 women, 25 did not complete the
interview. Thus, the remaining 275 women were the
subjects for analyses. For the recruitment of these
subjects, the authors and their research assistants
explained the purpose and interview contents in detail
to each of them and asked her own judgment about
participation in the study.
DATA ANALYSES
The data analyzed were as follows: (1) the birth date
(in months) of each subject, (2) the date (in months) of
her first marriage, (3) her sociocultural background,
that is, birthplace and educational level, (4) juridical
school of law that she abides by, (5) the contraception
methods currently and/or previously used, and (6) re-
production norms regarding the four items on religious
issues and eight items on family planning and contra-
ception use, which were designed on the basis of
information from religious scholars and references18.
Categorical principal component analysis (CATPCA)
was carried out to quantify the categorical variables and to
reduce the eight items regarding family planning and
contraception to a smaller number of interpretable groups
139
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan Sueyoshi et al.

of uncorrelated components. The items were treated as
ordinal data, and the same direction was assigned to all the
categories (obligatory was assigned to the most positive
and innovative norm). In the procedure, the eight items
of the normative interpretations of a religious leader, who
was familiar with the inhabitants in the study community,
were entered in this analysis as dummy variables. After
the distribution of standardized scores for a set of factors
was obtained, the female subjects were divided into the
following three groups for assessing variations in the
norms from ‘conservative’ to ‘innovative’: women whose
scores were lower than the normative score of a religious
leader (group 1), women whose scores were higher than
the normative score of a religious leader (group 3), and
the remaining women (group 2). Finally, bivariate
analyses were conducted to reveal the relationships
between the selected characteristics of the female subjects
by the three groups.
All statistical tests were performed using SPSS
Version 11.5, and a P value of 0.05 was determined
to be the cutoff point for statistical significance.
RESULTS
Table 1 shows the percent distribution of the female
subjects who had used contraception by methods,
separately for three age groups. Intrauterine device
(IUD) was the most commonly used nonpermanent
method (45%), followed by oral contraceptive pill
(27%). The proportion of modern method users (60%)
was higher than that of traditional method users (16%).
The higher the age the higher the prevalence for any
contraceptive method, except withdrawal.
Table 2 shows the percent distribution of interpreta-
tions among the female subjects by specific items
in terms of religious and reproduction issues. Regarding
the items on religious issues, that is, male circumcision,
the use of veil, pilgrimage, and individual reasoning,
more than 80% of the subjects interpreted these issues as
obligatory norms and 70% as forbidden norms. Regard-
ing the items on reproduction issues, namely, family
planning and contraception use, the subjects interpreted
the consent of husband and wife (72%) and danger to the
health of mother (54%) as obligatory norms, the decision
on birthspacing (66%) and good care of children (57%)
as permissible norms, and the decision on the number of
children (75%), the contraception use without the
consent of husband (70%), the desire to have only
daughters (63%) and the desire to have no child due to
fear for health (59%) as forbidden norms. These
proportions showed high consistency with the norma-
tive interpretations of the religious leader, except for
two items, i.e. the decision on the number of children
and contraception use without the husband’s consent.
Table 3 shows the results of CATPCA of the eight
items regarding reproduction issues. The analysis

Table 1 Percent distribution of female subjects who had used contraception by methods, separately for three age
groups

Age group

Total 15–29 (n ¼ 111) 30–39 (n ¼ 108) 40–49 (n ¼ 56)

Any methods 63.3 46.8 71.3 80.4

Modern methods
IUD 44.7 29.7 50.9 62.5
Pill 26.9 17.1 33.3 33.9
Condom 3.3 1.8 3.7 5.4
Sterilization 2.9 0.0 3.7 7.1
Injectables 2.2 1.8 1.9 3.6
Subtotal 59.6 44.1 65.7 78.6
Traditional methods
Periodic abstinence 6.5 4.5 6.5 10.7
Breastfeeding 6.2 1.8 8.3 10.7
Withdrawal 3.6 1.8 5.6 3.6
Subtotal 15.6 8.1 19.4 23.2

140 The European Journal of Contraception and Reproductive Health Care

 Table 2 Percent distribution of interpretations among female subjects by specific items in terms of religious and reproduction issues, accompanied by normative
interpretations of a religious leader

Category

Issues Obligatory Recommended Permissible Reprehensible Forbidden

Religion
Male circumcision 88.0a 1.8 11.1 0.0 0.0
Veil 86.5a 4.0 9.5 0.0 0.0
Pilgrimage 82.9a 5.8 11.3 0.0 0.0
Individual reasoning 0.0 0.0 10.9 16.4 72.7a

The European Journal of Contraception and Reproductive Health Care

Reproduction (family planning and contraception use)
To use contraception with consent of husband and wife 71.6a 3.6 24.7 0.0 0.0
To use contraception because of danger to health of mother 53.8a 3.3 42.9 0.0 0.0
To decide birthspacing 30.2 2.2 65.8a 1.8 0.0
To use contraception for good care of children 41.5 4.4 54.2a 0.0 0.0
To decide the number of children 0.0 2.2 14.2a 8.4 75.3
To use contraception without consent of husband 0.0 0.0 7.6 22.5a 69.8
To desire to have only daughters 0.0 0.0 4.0 32.7 63.3a
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan

Not to have children due to fear for health 0.0 0.0 15.6 25.1 59.3a
a
Normative interpretations of a religious reader.
Sueyoshi et al.

141
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan
Table 3 Results of categorical principal component analysis (CAPCA) of items on reproduction issues
Item
To decide the number of children
Not to have children due to fear for health
Desire to have only daughters
Without consent of husband
For good care of children
Consent of husband and wife
To decide birthspacing
Danger to health of mother
Variance explained (%)
Note: Items with factor loading less than 0.4 are not shown.
yielded two factors in which four items were loaded.
Based on substantive meanings associated with the
factors, factors 1 and 2 were measured as the pressures
of childbearing and acceptability of contraception use,
respectively. These two factors accounted for 55% of
the total variance. Cronbach’s alpha, the internal
consistency (reliability) derived from this analysis of
the eight items, was 0.87.
Table 4 shows the percent distribution of the
female subjects categorized into three groups, based
on the selected characteristics. Thirty-six women
(13%) were categorized into group 1, 152 women
(55%) into group 2, and 87 women (32%) into
group 3. The means of standardized score of
factors 1 and 2 in groups 1, 2 and 3 were 71.53
and 70.76, 70.04 and 70.35, and 0.57 and
0.93, respectively, revealing marked inter-group
differences.
Among the sociodemographic characteristics of the
female subjects, the birthplace, educational level and
school of law were significantly different among the
three groups at 0.05 level, and contraceptive
experience at 0.01 level. Group 1 had higher
proportions of women born in foreign countries
(47%), higher education level (61% intermediate or
higher) and experience of Shafii school (86%) than
group 2 (25, 38, and 65%, respectively) and group 3
(30, 31, and 66%, respectively). Although a high
proportion of contraception users was observed in
group 1 (81%), 69% of the women in group 2 also
used contraception.
142
Sueyoshi et al.
Loading value
Factor 1 Factor 2
0.82
0.78
0.73
0.70
0.74
0.67
0.62
0.48
31.1 23.5
DISCUSSION
The present study revealed that (1) two distinct
factors, i.e. the pressures of childbearing and accept-
ability of contraception use, were obtained from the
analysis of the eight items on reproduction issues, (2)
the majority of the female subjects were conservative
rather than innovative in terms of reproduction
norms, and (3) a significant relationship was observed
between reproduction norms and contraception
practice; the higher the level of innovative norms
the higher the level of contraception use.
Fertility transition in Arab countries occurred when
the use of modern contraceptives was sanctioned by
Islam. Several legal opinions in Islamic jurisprudence
on contraception indicate that Islam has approved
contraception use including the nonpermanent mod-
ern methods (Table 5). However, Islam does not have a
supreme religious and juridical power that is binding
on believers, except for the precepts contained in the
Shar’a (the Muslim code of religious law, i.e. the
Qur’ an, the Islamic sacred book; the Hadth, the col-
lection of traditions relating to Muhammad; and the
Sunna, a portion of Muslim law based on Muhammad’s
words and act), which is the undisputed authority. In
addition, the religious interpretations of new beha-
vioral rules, for example, those on contraception use,
which are not clearly mentioned in the Shar’a, have
been derived from analogical reasoning (qiyas). Thus,
interpretations have often been contradictory among
religious scholars and schools of law, depending on the
The European Journal of Contraception and Reproductive Health Care
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan Sueyoshi et al.

Table 4 Percent distribution of female subjects categorized into three groups, based on the selected characteristics

Group

1 2 3
Characteristic Total (n ¼ 36) (n ¼ 152) (n ¼ 87) w2 value

Age specific (years)

15–29 40.4 27.8 38.8 48.3 3.0
30–39 39.9 50.0 40.8 32.2
40–49 20.4 22.2 20.4 19.5
Birthplace
Jordan 70.5 52.8 75.0 70.1 6.9*
Foreign countriesa 29.5 47.2 25.0 29.9
Educational level
No or basic education 25.1 22.2 22.4 31.0 6.5*
Secondary 36.4 16.7 40.1 37.9
Intermediate 16.7 22.2 19.7 9.2
University or higher 21.8 38.9 17.8 21.8
Age at first marriage (years)
Less than 20 31.6 41.7 31.6 27.6 0.9
20–24 50.2 38.9 50.0 55.2
More than 25 18.2 19.4 18.4 17.2
School of law
Shafii 68.0 86.1 65.1 65.5 6.2*
Othersb 32.0 13.9 34.9 34.5
Experience of contraception
Yes 63.3 80.6 69.1 46.0 18.0**
No 36.7 19.4 30.9 54.0

Note: Kruskal–Wallis test was used for all distributions.

a
Palestine, Iraq, Yemen, Saudi Arabia, Kuwait, Syria, Egypt, Bahrain, and Libya.
b
Hanafi, Hambali and Maliki.
*P 5 0.05, **P 5 0.01.

period9,20,21. Given this situation, a considerable
number of studies have revealed that the religious
belief of Muslims is against contraception use10,22–24.
Previous studies have also explained the contra-
ception practices among Arab women in the context
of Islam. In brief, Arab women tended to avoid
contraception practice unless they decided to have had
a sufficient number of children, particularly for a
certain age and to let God decide on the ideal number
of children. In addition, men play a more significant
role than women in determining childbearing25,26.
These sociocultural norms explain their inconsistent
behaviors (i.e. not wanting more children but not
practicing contraception) and the low effectiveness of
contraception (e.g. short duration and/or high
discontinuation rate of contraception use27–29). The
two distinct factors observed in this study indicate
similar psychosocial situations.
Secularization, in which religion retreats to more
remote spheres of life so that most decisions on
reproduction are no longer based on religious beliefs
or norms, has been progressing in the Third
World30,31. However, such psychosocial changes were
not observed in the present study population, even
though three variables such as educational level,
birthplace and school of law are more likely to
innovate their reproduction norms.
Nevertheless, it is notable that about 70% of the
female subjects, who were closely consonant with the
normative interpretation of the religious leader (group 2),
had used contraception. For the most influential person
when the female subjects decided to do or not to do

The European Journal of Contraception and Reproductive Health Care 143

Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan
Table 5 Several legal opinions in Islamic jurisprudence (Fatwa) and conferences against contraception in the twentieth
century
Year Fatwa (religious scholar) or conference
1937 Fatwa (Sheik* Abdul-Majid Saleem,
Mufti of Egypt)
1964 Fatwa (Sheik Abdullah Al-Qalqili, Mufti
of Jordan)
1965 The academy (high council) of Islamic
research in Cairo, Egypt
1971 The ‘‘Islam and family planning’’
conference in Rabat, Morocco
1979, 1980 Fatwa (Sheik Jadel Haq, Mufti of Egypt)
1988 Fatwa (Sheik Sayyid Tantawi, Mufti
of Egypt)
References: Omran (1992)19.
*An Arabic honorific title to express one’s respects.
something important in their life, the most significant
result was that more than 80% of them answered
‘religious scholars or leaders’. As pointed out by
Underwood11, religious leaders have played important
roles in the process of fertility decline in Jordan,
indicating that there is a high possibility of increasing
the acceptance of contraception in the context of Islam.
The high population growth due to the influx of
immigrants has continued in Amman. The population
problems have to be urgently resolved in such a
situation. For this purpose, the importance of under-
standing the reproduction norms of the local people in
cooperation with not only women themselves but also
the religious leaders is suggested.
REFERENCES
1. Zafar MI, Ford N, Ankomah A. Significance of beliefs
and values in predicting fertility and contraceptive
behaviour in Pakistan. J Biosoc Sci 1995;27:301–18.
2. Khan HT, Raeside R. Factors affecting the most recent
fertility rates in urban-rural Bangladesh. Soc Sci Med
1997;44:279–89.
3. Knodel J, Gray RS, Sriwatcharin P, Peracca S. Religion
and reproduction: Muslims in Buddhist Thailand. Popul
Stud 1999;53:149–64.
144
Sueyoshi et al.
Major commentary
The use of family planning through al-azl (coitus
interruptus) and new contraceptive methods is
sanctioned.
There is clear indication in Sharia that contraception is
definitely allowed.
Couples are free to practice family planning according to
individual conscience and sense of religion.
The Islamic law gives the Muslim family the right to deal
with sterility and to plan suitably spaced pregnancies
using safe and lawful contraceptive methods.
The contraception is not antagonistic to the truth of God,
neither is it a contradiction of the will of God.
Family planning is sanctioned liberally for economic,
cultural or health reasons.
ACKNOWLEDGEMENTS
The authors are grateful to Dr Izziddeen Al-Khateeb Al-
Tameemi, Supreme Judge, the King for Islamic Affairs;
Dr Ahmmad Al-Awaisheh, Director, Islamic Cultural
Center, University of Jordan; Dr Hamdi Murad,
Dr Mohammad Abu Jreeban and Dr Abdel Rahman
Abu Melhim, Assistant Professor, Al-Balqa’ Applied
University; Sheik Bassam Mohammad Qawasmmi,
Senior Imam, Ministry of Islamic Affaire; Mr Talal Al-
Qdah, Instructor, University of Jordan, for their support
in the preparation of items in the questionnaire. The
authors thank research assistants and local inhabitants for
cooperation in the field investigation.
4. Dharmalingam A, Morgan SP. Pervasive Muslim-Hindu
fertility differences in India. Demography 2004;41:529–45.
5. Nagi MH. Trends and differentials in Moslem fertility.
J Biosoc Sci 1984;16:189–204.
6. Riley NE. Gender, power, and population change. Popul
Bull 1997;52:1–48.
7. Greene ME, Biddlecom AE. Absent and problematic
men: Demographic accounts of male reproductive roles.
Popul Dev Rev 2000;26:81–115.
The European Journal of Contraception and Reproductive Health Care
Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan
8. Horne AD. Fertility-inhibiting indices in the Arab
world. Popul Bull ESCWA 1992;40:5–35.
9. Atighetchi D. The position of Islamic tradition on
contraception. Med Law 1994;13(7–8):717–25.
10. Ghazal-Aswad S, Rizk DE, Al-Khoori SM, Shaheen H,
Thomas L. Knowledge and practice of contraception in
United Arab Emirates women. J Fam Plann Reprod Health
Care 2001;27:212–6.
11. Underwood C. Islamic precepts and family planning: the
perceptions of Jordanian religious leaders and their con-
stituents. Int Fam Plan Perspect 2000;26:110–7.
12. Department of Statistics, Macro International Inc. Jordan
Fertility Survey 1976. Calverton, MD: Ministry of Statis-
tics and Macro International Inc., 1979.
13. Department of Statistics, ORC Macro. Population and
Family Health Survey 2002. Calverton, MD: Ministry of
Statistics and ORC Macro, 2002.
14. Department of Statistics. Statistical Year Book in Amman
District. Amman, Department of statistics, 2004 (in
Arabic).
15. Share MA. Wage differentials in Jordan: effects on
integrated labour market. Popul Bull ESCWA 1987;
30:51–68.
16. Samha M. The impact of migratory flows on population
changes in Jordan: a Middle Eastern case study. Int Migr
1990;28:215–28.
17. Van Hear N. The impact of this involuntary mass ‘return’
to Jordan in the wake of the Gulf crisis. Int Migr Rev 1995;
29:352–74.
18. Al-Tameemi IK. Islam & contemporary issues. Monthly
Book Series 75. Amman: Ministry of Culture, 2003.
19. Omran AR. Family Planning in the Legacy of Islam.
London: Routledge, 1992.
20. Musallam BF. Why Islam permitted birth control. Arab
Stud Q 1981;3:181–97.
The European Journal of Contraception and Reproductive Health Care
Sueyoshi et al.
21. Schenker JG, Rabenou V. Family planning: cultural and
religious perspectives. Hum Reprod 1993;8:969–76.
22. Warren CW, Hiyari F, Wingo PA, Abdel-Aziz AM,
Morris L. Fertility and family planning in Jordan: results
from the 1985 Jordan Husbands’ Fertility Survey. Stud
Fam Plann 1990;21:33–9.
23. Libbus K, Kridli S. Contraceptive decision making in a
sample of Jordanian Muslim women: delineating salient
beliefs. Health Care Women Int 1997;18:85–94.
24. Petro-Nustas W, Al-Qutob R. Jordanian men’s attitudes
and views of birth-spacing and contraceptive use (a
qualitative approach). Health Care Women Int 2002;23
(6–7):516–29.
25. Oheneba-Sakyi Y, Takyi BK. Effects of couples’
characteristics on contraceptive use in Sub-Saharan Africa:
the Ghanaian example. J Biosoc Sci 1997;29:33–49.
26. Petro-Nustas W. Men’s knowledge of and attitudes
toward birthspacing and contraceptive use in Jordan. Int
Fam Plann Perspect 1999;25:181–5.
27. Al-Najjar LM. Fertility preference and fertility regulation
behaviour in Jordan (1976). In Studies in African and Asian
Demography. CDC Annual Seminar. Cairo: Cairo Demo-
graphic Centre, 1990,1991:413–51.
28. Sueyoshi S, Ohtsuka R. Effects of polygyny and consan-
guinity on high fertility in the rural Arab population in
South Jordan. J Biosoc Sci 2003:35; 513–26.
29. Sueyoshi S, Ohtsuka R. Ineffective contraceptive use and
its causes in a natural fertility population in southern
Jordan. Hum Biol 2004;73:711–22.
30. Caldwell JC, Caldwell P. The cultural context of high
fertility in sub-Saharan Africa. Popul Dev Rev 1987;13:
409–37.
31. Courbage Y. Economic and political issues of fertility
transition in the Arab world-answers and open questions.
Popul Environ 1999;20:353–80.
145