Kenya’s Climb to the Contraceptive Summit

Kenya 2012

June 20, 2012

Also published at Impatient Optimists

Kenya is far more than the sum of its health statistics, of course. I've been here only a few days but have experienced amazing hospitality and kindness, vibrant cities, gorgeous lush countryside, and certainly a feeling that while life is unbelievably difficult for many in the country, there's tremendous potential for change. Still, you can't ignore the realities of daily life for those who are extremely poor whether in the rural or urban areas. In one large region of the country 1 of every 30 women die from complications during pregnancy, childbirth, or immediately after childbirth; 15 percent of people are infected with HIV; and 75 percent of women who want contraception, do not have access.

Kibera stories of HIV, contraception

I thought she was closer to 45 when I pulled back the curtain that served as a front door, and entered the almost pitch black room where 29 year-old Marion lives with her husband, Albert. My eyes adjusted somewhat to the dark as I sat down on a small wooden stool in the tiny room the couple calls home, in the Kibera slum in Kenya. Albert is 43 years old and HIV positive. Marion is not.

Albert and Marion live on less than $1 per day and yet they came to Kibera (a slum in Nairobi in which depending upon whom you ask hundreds of thousands of people live) to make a better life for themselves. The plan, when they arrived three years ago from "up country" in an effort to escape a hopeless economic situation, was to find work, make some money, and return to their home village. Marion tells me they left their four young children, all girls, with her father back home.

Albert tells us that he contracted HIV from his first wife, who has since died. Marion says she gets tested for free at the nearest public health center, every three months. They use condoms which Albert receives when he goes to the government hospital, outside of Kibera, for his medication. For now Marion is HIV negative, they use condoms, and they are doing all they can to provide for their children "back home."

Albert and Marion struggle; and without Marion to do whatever work she can find washing clothes, Albert would have no one. For many households in Kibera, in the heart of Kenya's largest city, Nairobi, women end up on their own caring for their own children, or their grandchildren, with no male partner to help them. And in a country where over 50 percent of the population over 17 years old is female, this is significant especially as it relates to contraceptive access.

Ann is 17 years old. When we come to her home, only a few twists and turns through the trash-filled dirt roads from Albert and Marion, Ann is breastfeeding her own two-year old son, William, who was born inches from where we sat, while her younger sister, Fanis, stands quietly next to them. Her mother had been taken to the hospital the evening prior because, Ann told us, she was bleeding. Ann has heard nothing since then.

Ann is now the sole caretaker of her child and her younger sibling. The young man who got Ann pregnant is not a part of her or her son's life; and her father is deceased. Though Ann is not in school, because she needs to care for William, she told us she is not planning on having any more children, is using an injectable contraception, and says she has regular access to the method as well.

Is it better or worse than we think?

Admittedly, I was surprised and uplifted somewhat by the availability of contraception for the women I met in Kibera.

Forty-six percent of the women in Kenya use contraception currently which, while larger than some sub-Saharan African countries including Senegal and Nigeria, still means too few women who want access to family planning actually have that access.

However, that number skyrockets in the Nyanza region where a full 75 percent of women who want access to contraception do not have it. While some women in Kibera may have information about contraceptives, and even access, for most women in Kenya (especially poor women) birth control is often “stocked out” or women don’t use the contraception regularly making overall contraceptive use is still a problem.

Eighteen percent of young women between 15 and 19 years old are mothers in this country. And not necessarily because they wish to be. As well, according to Dr. Bashir Issak, an obstetrician in Kenya, a focus over the last eight years on HIV/AIDS funding has meant a shift away from family planning funding. Fifty percent of Kenya’s health budget goes to HIV/AIDS and malaria focused prevention and treatment; mostly from donors. For family planning services? A much smaller 14 percent. 

This imbalance in funding has a devastating impact on girls’ and womens’ lives in the country; especially those who are poor. Without contraception, young girls get pregnant and are forced to leave school. Only 10 percent of girls return to school after the baby is born, notes Rosemary Mugando Deputy Country Director of the Kenya’s office of PATH, because who will look after him or her? When women are not able to control when or if they get pregnant, their health and lives suffer and the health and lives of their children suffer.

Mugando also says that while the Kenyan government needs to do more to prioritize women’s health; in particular family planning, she sees signs of change on the horizon.

If we increase access to contraception over the next eight years, the hopeful outcome of the Family Planning Summit being hosted by the Gates Foundation and the UK government on July 11 of this year, 200,000 fewer women and girls will die during pregnancy and childbirth and nearly 3 million fewer infants will die during their first year of life.

When women have the means to avoid unintended or unwanted pregnancies, they avoid the risks from pregnancy and childbirth which come with having very little access to safe, reliable health care. They have the means to space out their pregnancies, if they chose. This ensures that newborns are born healthier, and are given a much greater chance of surviving – and thriving. In turn, the fewer children a woman has, the better able she is to provide greater opportunities for her children including basic health care and education.

And when you're sitting across from a woman at a maternity hospital in this rural Kenyan region of Nyanza, who is HIV positive, lives in poverty down the long, bumpy, sometimes impassable roads where picking up contraception and other medical supplies are anything but easy, and has just had her fifth child, it's not just about the statistics. It's about empowering her with the tools to be the healthiest woman she can to provide a better life for her children.

Pregnant women and new mothers in the waiting area of a maternity hospital in Nairobi, Kenya.

Amie Newman is the editor of Impatient Optimists, the blog of the Bill & Melinda Gates Foundation. She traveled to Kenya on a 2012 IRP trip that focused on reproductive health.

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