Contraceptive talk: Creating safe spaces

As she was turning 16, Felista Mumo got pregnant with a young man who was 22 at the time. The pregnancy was unplanned and a shocker to her, the boyfriend and the family.

Besides, she was just clearing high school and now with her future interrupted, life had to take a trajectory.

At first, her parents did not want to hear anything about it. Feeling dejected in a world so unfamiliar, she contemplated suicide as her parents threatened to press charges against her boyfriend whose actions and friendship she defended.

He was in university then and as survival options got limited, they moved in together more so to avert her parents’ wrath; the possibility of getting her boyfriend imprisoned and the thought of taking her own life.

The two got twins, and two years on got a third baby. Felista is 21 now, a single mother of three and living separately from the father of her children.

“I do not regret having children but I regret my actions, getting pregnant at such an early age. I wish I knew better. I should have taken control of my life seeing that I now have compromised so much and somewhat derailed,” says Felista, who works at her father’s retail business as a shopkeeper.

“After giving birth to the twins, I suggested to my boyfriend that if we were to remain sexually active then I needed to use contraceptives. However, he was not for the idea and said that contraceptives have a promiscuity notion. That I could cheat on him. He was opposed to any form of family planning and reproductive health,” she says.

Felista is not alone. According to statistics, stigma and discrimination are great hindrances when it comes to the delivery of sexual and reproductive healthcare.

Mostly, this is linked to factors such as age, disability, religion, culture, marital status and gender. Other barriers include restrictive policies, limited accessibility to services, financial constraints, periodic stock shortages, and inadequacies in healthcare provider training.

Even though statistics indicate a steady decrease in the unintended pregnancy rate in Kenya between 1990–1994 and 2015–2019, paired, the proportion of unintended pregnancies ending up in abortions surged from 24 per cent to 38 per cent during this period. This emphasises the need to address unmet family planning needs comprehensively.

The Kenya Demographic and Health Survey (KDHS) 2022 data signifies a reduction in teenage pregnancy rates from 18 per cent in 2014 to 15 per cent in 2022, although stark disparities exist among counties, with some areas reporting substantially higher rates.

Over time, there has been an increase in the percentage of married women using modern contraceptives, moving from 32 per cent in 2003 to 57 per cent in 2022. The unmet need for family planning has decreased from 27 per cent to 14 per cent during this period.

“While these statistics indicate progress, they also highlight persistent gaps in access to and utilisation of family planning services, necessitating intensified efforts to achieve the envisioned. Sexual and reproductive health and rights in Kenya have received good support when it comes to policy issues. However, the implementation has been slow,” says Nelly Munyasia, the Executive Director, of Reproductive Health Network, Kenya.

“We face the triple threat which comprises of family planning, maternal health, access to safe abortion and prevention of sexually transmitted infections. The fact is that adolescent girls as young as 11 are getting pregnant while others are contracting HIV-Aids. That is why we have introduced the Chaguo Mkononi Campaign to reshape access to family planning and contraception services throughout Kenya,” she says.

The campaign is grounded in a profound understanding of the interconnectedness between reproductive health autonomy, individual empowerment, and societal advancement. It embodies the fundamental importance of self-care in revolutionising the availability of crucial family planning and contraception information and services,” Nelly says.  

Nelly says the campaign’s momentum stems from the pressing need to address persistent challenges related to unmet demands in family planning and contraception, which significantly impact reproductive health outcomes, socio-economic development, and individual empowerment.

Through a strategic blend of advocacy, education, and community engagement, she says this initiative seeks to dismantle barriers and provide comprehensive access to family planning and contraception services.

There has also been the introduction of Nena na Binti Call Centre, a toll-free lifeline offering a haven for women and girls seeking comprehensive sexual and reproductive health and rights (SRHR) information and services in Kenya.

“This initiative provides a secure space for women and girls to access essential SRHR resources. It will serve as a dedicated resource hub, fostering unrestricted access to life-saving information, including family planning information and support, free of stigma and discrimination,” says Beverlyne Pollet, a health care provider based in Kakamega.

According to Beverlyne, the core of the Nena na Binti call centre is its commitment to ensuring uninterrupted access to comprehensive sexual and reproductive health and rights (SRHR) information and services for adolescent girls, young women, and all individuals seeking support and guidance.

“Here, individuals can access information on family planning, referrals for contraception services, as well as legal and psychosocial support. Beyond the call centre offering mere information dissemination, it also serves as a sanctuary where individuals can freely seek guidance, gain knowledge, and receive the necessary support to make informed decisions about their sexual and reproductive health,” she says.

“By offering a secure and non-judgmental platform, the call centre strives to empower girls and women, enabling them to navigate their reproductive health journey with confidence and autonomy.” 

Nelly says innovations in providing this digital intervention play a significant role in facilitating accessibility to crucial information and creating awareness of family planning and contraception.

“While there has been a reduction in the unmet need for family planning among Kenyan women and teenage girls in recent years, it remains relatively high due to various factors. Prevailing social norms, limited knowledge about available services, and the costs associated with acquiring services and commodities contribute to this persistent unmet need,” she says.

Published by the Ministry of Health in 2022, the Reproductive Health Policy 2022–2023 spells out family planning as a premier investment in reducing reproductive health morbidity and mortality.

A couple that has achieved their desired family size is not only more likely to be a stable family unit but is also likely to be a better empowered socio-economic pillar for the nation. According to the report, family planning is a national security issue.

In the urban setting where most women are more enlightened and better empowered, the receptiveness towards contraceptive use has been on the rise. More so, a younger generation that is more liberal when it comes to shedding off cultural hindrances associated with the use of contraceptives is tilting perceptions on sex and family planning.

“It is true that more women are using oral contraceptive pills, implants and also injectables as common means of contraception and family planning. The thing is that women are more considerate when it comes to family planning application methods as opposed to their male counterparts, who could even be their husbands.

Not so many men would care about carrying vasectomy and even worrying enough, some will not accept the application of the simple option of a condom,” says Lillian Muthami, a gynaecologist.

“I know society has a way of judging women who are sexually active and who opt for contraceptives such as pills. But which is better, having a preventive measure against unplanned pregnancy or ending up getting pregnant and having an abortion?” says Gloria*, 24 who confesses that she uses prescribed contraceptives.

Kenya has made significant progress in increasing access to family planning services in recent years, with the modern contraceptive prevalence rate increasing from 39 per cent in 2014 to 58 per cent in 2021.

“Access to comprehensive sexuality education is crucial for adolescents to realise their sexual reproductive health rights. There is a need to have a vibrant adolescents and youth programme with professionally trained peer providers who provide youth-centric interventions, referrals and services. This is part of what we provide,” says Nelly.