Wondering how on this earth Covid 19 is strangling access to contraceptives? And this is not just a sidewalk declaration. Picture this, between July 2020 and June 2021, Ministry of Health (MoH) data indicates that 5,020,335 women of reproductive age accessed the services compared to 5,495,975 in the period of July 2019 to June 2020.
Since 2017, the contraceptive prevalence rate (CPR) or the number of women accessing the service had been increasing, by 37 per cent (2017), 43.4 per cent (2018), and 44 per cent recorded in 2019.
Now, almost 500,000 women are not accessing the service. This is a setback for a country that has made strides to tackle the double burden of unwanted pregnancies as well as the spread of sexually transmitted infections (STIs) and HIV.
Who Is The Culprit?
Covid of course. It has kept many young people away from health facilities that provide the vital service
According to Dr Estella Waiguru, who is the Family Planning Lead at the MOH Department of Family Health, young people stayed away from the facilities due to the restrictions imposed to contain the pandemic.
“We recorded a reduction in the numbers of young people visiting the health facilities for family planning services. This trend was most pronounced among those aged between 15 to 49 years,” she said.
MoH data shows that 38 per cent of the women who visited the facility preferred implants, with another 35 per cent opting for injectable contraceptives like Depo Provera.
Dr Waiguru said more research was needed to establish why women preferred these options compared to condoms and pills which were required by just 8 and 7 per cent respectively. Another 5 per cent opted for sterilization while 4 per cent preferred the coil or intro-uterine device (IUD).
“More studies are needed to find out why women prefer these discreet methods as opposed to a method like condoms that would require discussion with their partners. In addition to resistance from the men, there could be an element of fear or reservation around the condom as an option,” said the medic.
The Centre for Adolescent Studies (CAS) carried out a reproductive health service improvement project in Western Kenya in 2020.
The study was dubbed ‘After The Hours”.
“Our aim was to increase the time for the provision of services after the normal working hours that run from 8 am to 5 pm, including weekends,” Dollarman Fafinato, an official at the Center for Adolescent Studies said.
“We trained the staff to address the young people’s needs on request. The project findings were captured as successful high-impact reproductive health services and published by the World Health Organization (WHO),” he said.
Mr Fafinato said that the model cannot be effective in all settings, given the country’s diverse religious and cultural landscape.
Mr Fafinato said that the model cannot be effective in all settings, given the diverse religious and cultural makeup of the country.
“County-specific interventions to improve reproductive health services are required to develop solutions suitable for every region,” he said.
According to the United Nations Population Fund (UNFPA), Kenya’s total fertility rate (TFR) is currently 3.33, which reflects a 1.5 per cent decline from the 2020 rate.
Kirinyaga, Meru, Kiambu, Machakos, Tharaka Nithi, Embu, Nyeri, Makueni, Nyamira and Muranga are the 10 best performing counties in terms of uptake of modern contraceptives (mCPR) among married women or those in unions.
This is according to the 2021 national fact sheet published by the National Council on Population Development (NCPD).
In Kenya, more than half of the women of reproductive age (15-49 years), in Turkana (64 per cent), Nyamira (58 per cent), and Kiambu (54 per cent) have autonomy or freedom to make decisions on whether to use contraceptives or not.
In West Pokot however, an estimated 46 per cent of men have the sole decision making power on contraceptive use by their spouse.
Counties, where spouses make joint decisions on contraceptive use, are Taita Taveta (81 per cent), Tana River and Kisumu (78 per cent), Tharaka Nithi (75 per cent), Makueni (74 per cent), Kisii (73 per cent), Uasin Gishu (72 per cent), and Kilifi (70 per cent).
The North-Eastern region counties of Mandera, Wajir and Garissa still have the lowest CPR of less than 10 per cent each.
Hey, Do I Really Need To Use Contraceptives
Dr Waiguru says there is a need to dispel mistaken notions among Kenyans on the intentions of the contraception services offered by the government and partner organizations.
“What we are avoiding through the use of contraceptives is the adverse effects of their absence. These include the situations that compel young women to go for unsafe abortions, which are usually harmful to the health of the woman,” she says.
In 2016, a study on abortion by the African Population and Health Research Centre (APHRC)’s showed that nearly half a million induced abortions occurred in Kenya in 2012.
This works out to an induced abortion ratio of 30 abortions per 100 live births, and a rate of 48 abortions per 1000 women of reproductive age.
The study, which was acknowledged by the Ministry of Health, found that 77 per cent of women who visited Kenyan health facilities for post-abortion care (PAC) were treated for moderately severe and severe complications, such as sepsis, shock, or organ failure.
Dr Waiguru reminded Kenyans that the shocking statistics on illegal abortions in addition to the death and misery they caused were more than just numbers.
“Abortion is illegal in the country. These abortion figures are not just statistics but intimate and important details about our mothers, sisters, aunts, neighbours and friends,” she says.
Dr Waiguru said increased family planning uptake is justified because it will lead to reduced loss of life by pregnant women that may resort to abortion. She added that it was the perfect tool to allow women to manage their fertility for a better quality of life.
“One of the main goals of family planning is to prevent unintended pregnancies. In providing the service, we look forward to a future scenario where all pregnancies are planned, and where every child will not only be planned for but expected and welcomed,” said the medic.
According to Dr Joseph Okore of the United Nations Population Fund, the reduction in the contraception prevalence rate (CPR) was not entirely a disaster since the period also witnessed a decrease in teenage pregnancies.
“During the period of restriction, the number of road traffic accidents reduced because fewer people were travelling. Teenage pregnancies also reduced, meaning that there was reduced sexual activity between the young people that would require contraception,” said the medic.
According to Dr Joseph Okore of the United Nations Population Fund, family planning is a human right that has long suffered from wrong perceptions and labels.
“Family planning is a human right that should not be coerced. No one should be forced to get the services,” he said.
The medic takes the view that family planning should be called child spacing. This, he says, is appropriate because it has been in use for a long time in traditional African societies.
“In culturally or religious sensitive settings, the ideal label for family planning is child spacing. This is because, in traditional African society, we had the idea that once a child is able to run errands, then it is time for another one to be conceived. The spacing in between allowed the mothers time to rest and regain their strength for the next child,” he said.
Finances
According to the UNFPA official, the government contributes between 40 to 60 per cent of the country’s contraceptive commodity needs. In 2020, UNFPA procured commodities worth Sh938.4m or 8.5 million USD.
This year, the UN body has so far bought commodities worth Sh386.4m or 3.5 million USD.
“The government contributes to the procurement of 40 to 60 per cent of the country’s commodity needs. The balance or remaining gap is filled by development partners including the UNFPA depending on the long or short term needs,” he says.
Dr Okore pointed out that the country needed to scale up funding for the family planning program and fully cater to local needs.
“At the ICPD Summit in 2019, President Uhuru Kenyatta committed himself to increase the country’s allocation for the health budget to 15 per cent. This would enable the country to buy 100 per cent of the contraceptives. Kenya will not rely on donors and development partners for support in the purchase of commodities much longer,” he said.
