Bill & Melinda Gates Foundation

Can Kenya Break New Family Planning Ground?

June 25, 2012

It's not an overstatement to say that women's health care including care during pregnancy and childbirth, and family planning, has been neglected in Kenya. For all but the wealthiest in this nation, access to quality maternity care, family planning, and on-going women's reproductive care including HIV prevention and treatment, is limited. In 2010, Kenya enacted a new constitution which makes Rosemary Mugando, Deputy Country Director for the Kenya program of the global health organization PATH “optimistic” that change will happen. The constitution declares reproductive health care the right of all citizens. As well, the Department of Reproductive Health is working with partners and practitioners to integrate family planning services into other health care services like vaccine delivery for babies and children.


Marura Dispensary is a women's health clinic dispensing family planning, prenatal care, and other women's health services to poor women in Kenya.

Kenyan native and experienced health journalist Sam Siringi is traveling with the International Reporting Project delegation this week. He tells me that the goal is to increase the rate of women who use contraception in Kenya from 46 percent to 56 percent by 2015.

Despite a new constitution, there's a lot that needs to be done to meet the goal.

There are currently two Ministries of Health: The Ministry of Medical Health and The Ministry of Public Health. It's an inefficient system which allows for a lot of overlap and very little coordination; in the coming year the government will merge the two, hopefully with improved benefits. But, still, the government must commit more funding if the number of women who have access to family planning and quality maternal health care is to increase considerably. It seems hard to understand how that will happen in this country where the poorest women, from the urban slum areas to the rural expanses, often don't have enough food to eat, access to clean water, or education after primary school. 

 
"Women tell me they are tired. They don't want to have more children because they have no money to educate them or even to feed them. They want contraception, is what they say to me, "says Yunis.

As we walk through the halls of Pumwani Maternity Hospital, the evidence of a lack of investment in women's health becomes clear. It’s where the poorest pregnant women, new mothers, and their babies, in Nairobi, come for a range of services from immunizations to childbirth care to family planning.

We are invited into a room with peeling paint, by a nurse in a long white-coat. Sitting down is a tiny young woman, dressed in a long blue-skirt, a colorful green print head wrap, her hands curled underneath her small round stomach. She keeps her head bowed, somewhat embarrassed it seems. The nurse tells us the young woman gave birth six weeks ago.

“Why is she here now?” one of us asks.

The nurse says she’s back to get contraception “of course.” Posters providing information on the female condom and birth control pills cover the walls. A crowded room filled with pregnant women, and new mothers and their babies, wait outside. The handful of pregnant women I've spoken with tell me they all plan on using contraception after the birth, and plan on coming back here to access it, if they can afford it. In another room, the mother of a malnourished nine-month old baby is given information on proper nutrition as well as nutritional supplements for her daughter. But for many of the poorest women here, having babies is a way to ensure a big family; when the fear of their children dying from undernutrition or lack of access to quality health care is very real.

Women waiting to access family planning or breastfeeding support at Marura Village Health Clinic.

Between 60-100 women give birth everyday at Pumwani; a maternity hospital which has been enmeshed in scandal over the years. But for many women it's the only access to skilled providers during pregnancy, childbirth and beyond, they have. Though the hospital still receives very little funding, the clinic offers the family planning services these women say they desperately want. It's clear women here need the international community to act.

As the Family Planning Summit nears, where developing countries, donors, the private sector, and civil society will come together to pledge to provide an additional 120 million women in the world’s poorest countries with lifesaving contraceptives, information, and services by 2020, these are the women and children sitting before us who will directly benefit.

In a two-room health clinic outside of Ol Pejeta Conservancy (which provided the seed money for this clinic), in the Laikipia region of Kenya, women line the walls, many of whom are breastfeeding. Yunis, the coordinator of the clinic, comes out of the "Family Planning room" to greet our delegation of bloggers who have come to visit on this International Reporting Project trip.

Yunis explains that the women who come here, from the region around the Ol Pejeta Conservancy, are seeking family planning information and services, immunizations for their babies, breastfeeding information and support, and prenatal care as well. The clinic also offers HIV testing services. Many of the women (most) do not tell their husbands they come here for family planning, when they do.

Today, the breastfeeding support group gathered in the room, on splintered, green benches. There is informal contraceptive information-sharing that goes on.  The women come from different tribes with differing beliefs related to family planning but when they come here for breastfeeding support or to bring their babies for vaccinations, they talk about contraception with each other. Those who use contraceptives tell others that family planning helps: life is easier when they have fewer children, their children's health improves when they are able to provide health care access for the children, and it benefits the husbands by allowing them to work less, when they have less people to support. 

"Women tell me they are tired. They don't want to have more children because they have no money to educate them or even to feed them. They want contraception, is what they say to me, "says Yunis.

Yunis and the volunteer community health workers educate the women on their options. Many opt for injectable contraception, IUDs, the pill, and natural family planning as well. All of these options cost 30 shillings (the equivalent of approximately .35 cents). The clinic is no longer funded by Ol Pejeta but instead by the government of Kenya. But clearly it's not nearly enough.

There's much more to be done. In addition to a host of commitments from many different sectors, the summit will also call upon developing country governments to invest sufficiently in family planning, eliminate “stock outs”, and to work with civil society and women, men, and young people to make sure their voices are heard.

Beatrice is a volunteer community health worker for the Marura Health Clinic.

Why young people? Because as you look around Kenya, young women are particularly hard hit. One out of every four girls in this country, by the time she reaches 15 years old, will get pregnant. When girls get pregnant they must drop out of school. Even if a girl remains in school, some tribes in the outlying areas force young girls into early marriages, or pull girls out of school to care for younger siblings. It's critical that girls are given the opportunity for empowerment through access to information and tools for family planning, as well.

The groundbreaking summit offers hope. If successful, the summit will halve the number of girls and women who want access to contraception but don't have it, especially throughout Africa. With this in mind, Kenya’s climb towards broad contraceptive coverage, and with that the hope for increased empowerment for women and girls and an improved economic situation for all, seems steep but scalable.

 
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