Poor financing, culture put women in need of contraceptives at risk

Irene Chunja, a mother of 10, says her husband believes women who use contraceptives lose their sex drive and always warns her against trying contraceptives.

“When I go to the clinic, I am asked if I need any contraceptive, but I am afraid of trying because my husband made it known from when we got married that he would not tolerate it,” she says.

And hers is not a lone voice. Cultural beliefs have been flagged as a hindrance to the uptake of contraceptives. Most contraceptive users admit that they never go to a health facility but get recommendations from friends.

Today, as the World Contraception Day is marked, the family planning programme has been complicated by the battle to contain Covid-19 pandemic. Access to routine medical care, including contraceptives, has been disrupted.

It is a day to improve awareness of all contraceptive methods available and enable young people make informed choices on their sexual and reproductive health.

Recent United Nations Population Fund (UNFPA) research projected that 47 million women in low- and middle-income countries may not be able to access modern contraceptives during the Covid-19 pandemic. The agency predicted that this could result in seven million unintended pregnancies.

In Kenya, contraceptive use is only talked about in social media groups and among friends who are too shy to publicly talk about family planning methods. Incidents of young people fidgeting around chemist shops when they want to buy emergency contraceptive are common.

“The transaction when buying contraceptives looks like a drug deal. There is whispering and sliding of concealed pills because nobody wants to be known to be using a contraceptive,” says Titus Mburu who operates a chemist shop in Nairobi’s Roysambu estate.

The journey to finding an effective contraceptive has been long but now there are methods that can protect against pregnancies for several years without one having to make regular hospital visits.

Even with advancement in technology, contraception has been a subject rarely talked about. In 2014, a Reproductive Health Bill was presented for a parliamentary vote. The Bill sought to provide guidance on protecting reproductive rights, including right to access family planning in public facilities.

“The National and County Governments shall make available contraception and family planning services, including contraceptive options, counseling, information and education,” reads the Bill that never got to pass.

The process of passing the Bill has been dogged by controversies and resistance from cultural and religious leaders who have continually cited that it might open up misuse of contraception among teenagers.

“The Bill speaks of Sexual and Reproductive Health and Rights, when in fact it simply wishes to introduce in Kenya unhealthy practices,” reads a letter by Kenya Conference of Catholic Bishops (KCCB) in June to protest the passing of the Bill that had been presented by Nakuru Senator Susan Kihika.

Dr Maureen Owiti, a consultant obstetrician and gynaecologist in Nairobi, says visiting a healthcare facility is important, as it identifies several health factors that could interfere with the efficacy of the contraception. “Diseases like osteoporosis and diabetes should be checked before taking up contraception that has estrogen,” she says.

Medics are also advising that contraceptives should be prioritised post-birth to decrease infant mortality. “Spacing pregnancies at least two years apart after a live birth not only prevents unintended pregnancies, but also lowers newborn, infant and child mortality in subsequent pregnancies,” reads a World Health Organisation (WHO) report.

Vasectomy as a male contraception method is available in Kenya, but medics say most of the men only opt for it when they have underlying health issues. Reports from the Kenya Obstetrical and Gynaecological Society indicate that only one per cent of men have undergone vasectomy despite several campaigns, including offers of free services.

Some of the challenges that family planning projects in Kenya have faced include defunding by major donors, including the US government. There is also a glaring disparity in counties when it comes to contraceptive use, with counties like Wajir having a contraceptive prevalence rate (CPR) of as low as 2 per cent, while Kirinyaga’s CPR is close to 80 per cent.

During last year’s World Contraceptive Day, Ministry of Health acknowledged the importance of investing in contraception facilities. “Evidence informs us that every $1 invested in contraceptive services will save $2.20 in maternal and newborn healthcare as a result of a decline in unplanned pregnancies,” said former Health Cabinet Secretary Sicily Kariuki.