Inequities rife in unmet need for contraception

In 2019, Linet Kemunto, resident of Kwa Raila village in Kibra informal settlement in Nairobi was sure she did not want another baby.

She wanted to give her three-year-old first child some time to grow up and be able to cater for him without any obstacles. “To ensure I did not get pregnant, I went to a public facility around our area where I requested for a long-term contraceptive method and various options were given. I opted for Jadelle, a Levonorgestrel-releasing implant, which was to last for five years,” she says.

Kemunto left the health facility a happy woman with no worry of getting pregnant every time she had unprotected sex with her partner.

Contraceptive journey

One month into her contraceptive journey, Kemunto did not receive her menstruation periods, but with the comfort of the implant under her arm, she thought it was normal. “There are so many myths of how contraceptives can make menstruations disappear for some time. So, I thought my situation was normal and did not trigger any fears,” she recalls.

Two months later, and apart from the delayed period, she felt some pregnancy-related symptoms, which prompted her to visit the health facility for a checkup only to met by the shock of her life. “A pregnancy test came out positive. I had so many questions about how I got pregnant yet I was already on a birth control method, and the health workers could not answer me. If it were the pills then I would have thought maybe I had skipped a day, but I was under long-term family planning!” she says.

Mistrust in long-term methods

Kemunto says the discovery threw her into disarray, totally dismantling her plans for the future. “When I told my partner, he accused me of sleeping with another man who got me pregnant. It took him months until I gave birth for him to accept responsibility for the baby,” she recounts.

Although it took time, Kemunto had to reconcile with the fact that she now had two children to take care of, something which took a toll on her, especially during these tough economic times.

Her fears are mirrored on the decision she has had to make after the initial ordeal as her trust on the long-term methods, as well as public facilities was derailed.

Kemunto says she has opted to undertake an injection, whose effectiveness lasts for three months instead of a long-term option. The shots cost Sh250, which might be affordable to others, but expensive to others, such as Kemunto.

Major setbacks in drive

She has further opted to seek the services at a private facility despite the high cost. “I do not want any more disappointments or surprises, and that is why I opted to go to a private facility. It is expensive for me, but I would rather sacrifice that amount rather than get another child,” she notes.

Kemunto’s ordeal did not only have an impact on her, but the entire community, especially women who are now using her case as grounds to refuse to undertake family planning terming contraceptives as unreliable.

Bernard Mutachi, a Community Health Volunteer (CHV) in Kibra, says Kemunto’s case is not unique in the area, but the impact can be felt.

Mutachi, who is also a “victim” of a failed contraceptive, says cases of failed contraceptives have been a major setback in their efforts to champion family planning in their community. “Such failures have made women lose trust in contraceptives, thereby keep off. This is a major setback to our efforts of encouraging adoption of contraceptives,” he says.

And as the world marks the International Contraception Day under the theme Debunking myths and misconceptions on contraceptives Mutachi says effects of failed contraceptives is just a drop in the ocean of the hindrances towards full acceptance of contraceptives, especially in the informal settlements.

Unaffordable services

He says the majority of the nearby facilities have not been consistent with provision of contraceptives forcing women to either seek the services at a private facility or live without. “The services are very expensive for the majority of slum dwellers in the private facility and women have to choose between buying food for their families and getting the contraceptive,” he says.

Mutachi says lack of the commodity and its expensive nature in the alternative facilities is driving a considerable percentage of women in the informal settlement to uncertified herbal methods of family planning.

He says majority of those who choose to use herbal birth control methods do so because they believe they have less effects compared to modern contraceptives, which include male and female sterilisation, male and female condoms, diaphragms, cervical caps, sponges, spermicidal agents, oral hormonal pills, patches, rings, implants, injections, intrauterine devices (IUDs) and emergency contraceptives.

Religion and cultural beliefs have been mentioned as one of the obstacles that prevent women from seeking these crucial reproductive health services.

It is evident that these beliefs trickle down from myths and misconceptions that surround family planning, which include infertility caused by the family planning, gaining or losing of weight, loss of sexual urge, painful menstruation, among others.

Erastus Wangira, a CHV attached to Lang’ata health centre says another challenge is the third-party authorisation where a woman has to seek permission from their partner before getting on a contraceptive.

This locks out hundreds of women who are willing to take contraceptive s, but cannot due to the punitive understanding of their partners.

Addressing the problem

  Mutachi says usage of CHV in the contraceptive campaign has been a game changer as they have been able to make inroads to the most interior parts of the slums while encouraging family planning.

There are close to 22 CHVs who sensitise the Kibra community of the importance of contraceptives in bringing up a good family.

Seven of these CHVs are men who have been tasked with bringing on board their fellow men on the contraceptive information.

This has enabled men in this community to seek contraceptive services without fear of breach of their privacy.

Another way they have been enticing men to encourage their women to undertake family planning is by giving priority to couples seeking health services in their health facilities. “Any woman accompanied by her partner gets services without queuing. This encourages more men to bring their wives for family planning and in the process, educate them on reproductive health,” says Wangira.

Ritah Anindo Obonyo, adolescent and youth project at Reproductive Health Network-Kenya says the answer to most of the challenges is for the government to prioritise the reproductive health of women, especially those in the informal settlements.

She says women issues have been neglected to a point there is no budget set aside to cater for supply of family planning commodities to health facilities in Kenya. “We mostly depend on donors for supply of these products and when donor funding delays, then women, especially those from low income areas suffer the most,” she says.

Doctor Bashir Isaak, the head of the family department in the Ministry of Health says records show that family planning stock levels at facility levels were quite great across the country.

He says it is possible that some facilities may not have the family planning products, but the blame squarely lies on the county health teams. “They are the ones responsible for redistribution of the commodity and alert us in case of a shortage,” he says.

Isaak further says the government is moving away from over-relying on donor funding after signing a commitment with the donors that they will self-finance as from the year 2025/26.