Namibia is a nation deeply rooted in cultural traditions and religious beliefs which often influence how individuals navigate their day-to-day lives. Within this context, discussions regarding sexuality and reproductive health bear the profound imprint of culture, tradition and religion, significantly impacting the wellbeing of individuals and communities.
According to Mirjam Josef, a medical doctor specialising in obstetrics and gynaecology, there is a pervasive silence in discourse around sexual and reproductive health rights (SRHR) that hinders access to vital information and services. This silence, she says, is a breeding ground for the sexual taboos and stigmas taught to the youth, and passed on from generation to generation.
These taboos and stigmas cast a shadow on Namibia’s sexual and reproductive health landscape, contributing to the spread of sexually transmitted infections (STIs), unplanned pregnancies and poor family planning, she adds.
Dr Josef took some time to speak to Sister Namibia on the matter, sharing her insights on the intricate web of challenges faced by Namibians when it comes to sexual and reproductive healthcare. Having worked both in Namibia and South Africa, she has witnessed firsthand the stark disparities in the accessibility and quality of sexual and reproductive healthcare services.
Cultural and Religious Taboos as Silent Barriers
Namibia, like many other societies, grapples with deeply ingrained beliefs that cast sex and sexuality into the shadows. Dr. Josef highlights how these taboos extend their influence not only to the people seeking healthcare services but also to the healthcare workers themselves. They create barriers and stifle open conversations about sexual health, rights, and choices.
Dr. Josef explains, “In most cultures, sexual organs – anatomically correct sexual organs – are used or seen as insults, even when they’re not meant to be insulting. So even when the communication does happen, it happens without actually speaking directly. You speak indirectly and therefore there’s not a real conversation about exactly what is supposed to be said.”
She says this reluctance to discuss sexuality in open forums further trickles down – into classrooms, among peers, into the media landscape and also among healthcare workers, where discussions are often skewed by cultural norms, perpetuating shame and misinformation.
Dr. Josef describes it as a silent yet pervasive force that holds back the dissemination of accurate information on contraception, sexual health, and reproductive rights.
Misinformation, Misconceptions and Fear
One of the daunting effects of this culture is the accumulation of misconceptions, for example, the false belief that contraception leads to infertility.
“A lot of women shy away from using contraception because of the fear that it leads to infertility or that it’s associated with promiscuity,” Dr. Josef says.
She adds that these misconceptions instil fear, making it challenging for individuals, particularly young women, to make informed decisions about their reproductive health.
It is a stark reminder that the absence of knowledge and open dialogue can have severe consequences.
Furthermore, Dr. Josef highlights a crucial aspect of this complex issue—the role of healthcare workers as gatekeepers. She says cultural and religious biases, if unchecked, can influence the quality of care provided.
“The healthcare workers are one of the biggest barriers. The healthcare workers don’t have enough information about it, and they often impose their beliefs, whether cultural or religious, on the patients.
“One often sees that the healthcare workers do not even know the sexual and reproductive law on, for example, the age of consent [or] the fact that when a girl is seeking contraceptive treatment they don’t actually need the consent of the parent. They can come and get whatever contraceptive method they want,” she explains.
Drawing upon her extensive experience as a healthcare practitioner, Dr. Josef provides insights into the challenges faced by young women when seeking contraceptives, which often manifest as age-related restrictions, the requirement for parental consent, or the misconception that contraceptive use is only appropriate for those who have already had children.
Dr. Josef says this imposition of beliefs on patients is a direct violation of the principle of autonomy, which states that patients have the right to choose their healthcare options without coercion or judgement. It underscores the urgent need for healthcare worker education and awareness to ensure patients receive unbiased care.
The Thorny Issue of Unwanted Pregnancies
Namibia, like many countries, grapples with the debate around unplanned or unwanted pregnancies, and the legalization of abortion. Dr. Josef points out that this issue is further complicated by cultural and religious beliefs, with little room for a rational, evidence-based discussion. Unsafe abortions are a reality in the shadows, but the stigma surrounding them only exacerbates the problem.
Dr. Josef’s observations emphasise the need to transform the dialogue surrounding abortion into one grounded in healthcare expertise and human rights, rather than exclusively influenced by cultural and religious norms.
She explains, “What we [Namibia] are doing is we are pumping so much into the hospitals – making sure there’s a delivery bed and all of these things. But we could easily just have started from making sure the young women don’t end up with unwanted, unplanned pregnancies.”
Dr. Josef sheds light on a glaring issue: the lack of comprehensive reproductive education among women of various age groups in Namibia, which contributes significantly to the high rates of unintended pregnancies, particularly among young women.
“We have horrible numbers for teenage pregnancies. It’s actually very, very scary how common teenage pregnancies and unwanted pregnancies are in Namibia. […] It’s all the different ages of women. You have a 14-year-old, a 16-year-old, 18-year-olds, a 21-year-old in university, a 25-year-old who just started working, who still does not know what the available contraceptive methods are or which one will suit them,” she says.
This statement highlights the dire need to shift the conversation away from stigmatization and towards comprehensive sexual and reproductive health education and support.
The issues at hand are deeply entrenched, spanning generations and permeating societal norms. Yet, Dr. Josef believes that change is possible through comprehensive education and open dialogue.
“Not talking about it doesn’t make it go away,” she emphasizes.
Education, both for healthcare workers and the general population, is a vital step in dismantling the barriers created by sexual taboos and stigmas.
By providing accurate information, promoting open conversations, and respecting individual autonomy, Namibia can pave the way for a healthier approach to sexual and reproductive healthcare. Dr. Josef says it is a collective effort that requires the unlearning of harmful beliefs.
Arlana is a seasoned journalist dedicated to amplifying underrepresented voices and promoting narratives that drive change. She has tackled a range of topics, from health and environment to social justice, advocacy, education, and politics. She describes her craft as ‘painting with words’. Follow her on Twitter (X): @_pandulana
Image credit: Hildegard Titus