Women in Kasei Secondary School, Kacheliba constituency, West Pokot County. [DPPS]
West Pokot County has the second-highest fertility rate in Kenya, with an average of seven children per family, way above the two to three for the rest of the country.
West Pokot’s 7.2 per cent fertility rate has been linked with issues related to family planning as the national average stands at 3.4 per cent as per the 2019 Census.
It is also in West Pokot that children suffer the highest stunting rate at 46 per cent, according to the 2014 Kenya Demographic Health Survey (KDHS), which also cites that more than one-quarter of children under five years are malnourished.
Be the county has made significant progress in tackling this issues, as family planning uptake has increased from 13 per cent in 2013 to the current 28 per cent, according to Performance Monitoring for Action Data released by the International Centre for Reproductive Health Kenya (ICRHK).
Struggling to make ends meet
But many women on family planning are doing so in secrecy for fear of repercussions from their husbands, who culturally believe that children are a blessing.
Philomena Cherotich, 33, and mother of three from Ngoleyo in West Pokot, has been using modern contraceptives to prevent pregnancy for the last four years, a fact her husband is not aware of.
If he does, she says, he will ban her from using it. The family of five is struggling to make ends meet, and is a representative sample of thousands of families across the vast county with more children than they can provide for.
As a result of non-spaced births, the risk of children dying before their first birthday is significantly higher in West Pokot compared to Kiambu or Nyeri according to the KDHS 2014.
While there are other factors that contribute to child mortality, no spacing between births is a major contributor. Shorter birth intervals have been demonstrated to be associated with higher mortality, both during and after infancy. Babies born after the shortest birth intervals, less than two years, are nearly twice as likely to die (83 deaths per 1,000 live births) as babies born after three (42 deaths per 1,000 live births) or four or more years (44 deaths per 1,000 live births)
Peter Gichangi, the key investigator for the Performance Monitoring for Action at ICRHK, notes that despite all these hurdles, West Pokot continues to perform impressively well in the uptake of family planning, adding that only 31 percent of pregnancies were unintended in 2020 compared to 39 per cent a year ago.
Prof Gichangi attributes this to increased awareness of the benefits of family planning as well as in the increase of men involved in the family planning decision-making process. Prof Gichangi believes that based on available performance monitoring for action data, the county is poised for a steady increase in the uptake of family planning in the coming years.
Men went home to check
But by 2018, men in West Pokot were vehemently opposed to their wives practicing family planning. Wilson Ngaren, the county’s reproductive health coordinator, recalls cases where men went home to check the upper arms of their wives for any signs of an implant, and then proceeded to raise hell if any was found. So how did that change?
Valentine Cherop, a community health volunteer under ICRHK in West Pokot, says the county organizes weekly barazas to educate men who then pass the information to their fellow men about the benefits of family planning. This has slowly changed the narrative and will hopefully address child mortality and other family planning-related issues in the county.