Silent struggle as women shift from traditional to modern family planning

Florence Nakhumicha is a traditional birth attendant and herbalist. [File, Standard] Long before the coming of contraceptive pills, injections, and intrauterine devices, African communities were not strangers to family planning. In Bungoma County, traditional practices such as the placenta ritual played a crucial role in birth control long before the emergence of modern contraceptives. That historical knowledge is yet to fade away, even as scientific methods dominate reproductive health care. The quiet tension between cultural continuity and medical innovation is shaping reproductive decisions for thousands of women and herbalists like Florence Nakhumicha. At 78, Nakhumicha is a revered traditional birth attendant and herbalist. For over five decades, she has helped women give birth including family planning. "In those days, we didn't have injections or pills," Nakhumicha recalls. "We had the placenta ritual." In this deeply rooted custom, the placenta and umbilical cord were buried inside the home, mixed with specific herbs, to symbolically and spiritually signal a woman's desire to stop giving birth. "By doing so, the new mother would not conceive again until the ritual is reversed; this helped women in the traditional society to space their children," said Nakhumicha. To reverse the ritual, women would return to the herbalist, who would administer specific herbs believed to restore fertility. Despite her strong traditional foundation, Nakhumicha recognises the relevance of modern family planning. "I support modern methods," she says cautiously. "But couples should still have at least four children; you never know what life brings." Though she no longer assists in deliveries due to Ministry of Health regulations, Nakhumicha remains highly sought after for prenatal "pampering" services. Each morning, up to 15 women, including some from neighbouring Uganda, visit her home for massage techniques aimed at easing pregnancy discomfort and determining foetal positioning, an ability she attributes to divine guidance. Nakhumicha says the emergence of modern pills is quickly replacing the traditional birth control, as her clients now prefer pills and injections, which are safe and convenient. "I have lost most of my clients, and they are now adopting the modern way," she says. Dr Isaac Misiko, a herbal medicine researcher, says traditional birth control extended beyond the placenta ritual. He cites placing post-coital fluids under a water pot to render a man sexually inactive or using dietary restrictions to influence libido and fertility. "Traditional methods were symbolic, herbal, and deeply spiritual," Misiko explains. "But they weren't permanent-they could be reversed." Yet, he remains skeptical of modern contraceptives, citing concerns like side effects, including heavy menstrual bleeding. His sentiments are echoed by others in the community who fear the long-term effects of medical interventions. In rural areas of Bungoma, injectables and implants are the most common birth control methods. But this change has not come easily. "Initially, communities resisted modern contraceptives," says Diviniza Ochwila, a senior nursing officer and reproductive health specialist at Bungoma County Referral Hospital. "Cultural and religious beliefs shaped their views on reproduction," she says. Organisations like Marie Stopes helped bridge the gap by training healthcare workers and launching community awareness campaigns. Their goal is to show that family planning is not a moral or religious judgement; it's a health decision. In Bungoma, the reproductive health expert reports that most residents have embraced long-term family planning methods. "In the past year we have witnessed spouses coming in for either vasectomy for the men or tubal ligation for women," Ochwila says. She explains that for a vasectomy the vas deferens, which connect the testicles to the plumbing downstream, are cut and sealed. "After vasectomy, sperm production continues in the testicles, but the sperms are reabsorbed into the body instead of being ejaculated," Ochwila says. Tubal ligation refers to a medical procedure where the fallopian tubes are cut or tied, preventing the ovum from passing out and sperm from entering in; hence, no fertilisation can occur. Ochwila argues that a woman who embraces family planning would be able to have enough children that she can comfortably cater for. "When it comes to family planning, we focus on spacing pregnancies. When a mother uses a method and waits before conceiving again, her body has time to heal and regain strength. By the time she gets pregnant, the previous child is likely around two or three years old, allowing the mother to concentrate better on the new pregnancy," she explains. She reveals that during childbirth women lose a lot of blood, hence the need for them to take time for the womb to heal before conceiving again. Ochwila warns against mixing herbal detox remedies with modern methods. "These herbs can reduce the potency of modern contraceptives, increasing the risk of unplanned pregnancies," she says. She cites a case of where a woman who was on the intrauterine device (IUD) for 3 years got pregnant. She attributes contraceptive failure to lack of proper pregnancy screening by healthcare providers before administering the family planning method. "Despite the fact that the method failures have been minimal to zero in the recent past, we can't ignore the fact that in the past we have witnessed failures, especially in one case of a lady who got pregnant while on an IUD. In such cases we advise them to keep the pregnancy without removing the IUD, which is expelled during childbirth," she says. Ochwila, however, advises health practitioners to include teenagers in family planning education to curb early teenage pregnancies. "For us to fight the high numbers of teenage pregnancies in our communities, teenage boys and girls should be included in active conversations in regard to contraception," she says. Today, traditionalists like Nakhumicha possess rich traditional wisdom, while clinicians like Ochwila push for medically safe, evidence-based practices. The question isn't whether one side will replace the other, rather, it is how both can coexist and complement each other while safeguarding women's autonomy and well-being because, in the end, whether through herbs or hospital visits, the goal remains the same: to give women the power to choose.

Silent struggle as women shift from traditional to modern family planning

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