Pandemic takes a bite of contraceptives use in Kenya
Dr Estelle Waiguru, Family Planning Lead at the Ministry of Health’s Department of Family Health, speaks during the World Contraception Day at Sarova Panafric Hotel on September 24, 2021. She said the country’s contraceptive prevalence rate (CPR) had dropped from 44 per cent in 2019 to to 29 per cent in 2021.
By AGGREY OMBOKI
As Kenya marks this year’s World Contraception Day, the uptake and usage of contraceptives among women aged 15-49 has dropped from 44 to 29 per cent.
Between July 2020 and June 2021, 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 has been increasing, with 37 per cent (2017), 43.4 per cent (2018), and 44 per cent recorded in 2019.
The sharp drop of almost 500,000 women in 2020 is a setback for the country’s efforts to tackle the double burden of unwanted pregnancies as well as the spread of sexually transmitted infections (STIs) and HIV.
Experts have attributed this unfortunate trend to the COVID-19 pandemic that kept many young people away from health facilities.
According to Dr Estella Waiguru, the Lead at the Ministry of Health (MOH)’s Department of Family Health, young people avoided the facilities due 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 29 years,” she said.
MoH data shows that 38 per cent of the women who visited facilities preferred implants, with 35 per cent opting for injectable contraceptives like Depo Provera.
Dr Waiguru said more research was needed to establish why women preferred these options 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.
Reaching the youth
To ensure that young people access contraception, 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 was designed to avail the family planning services beyond facilities’ normal working hours.
“Our aim was to increase the time for the provision of services after the normal working hours that run from 8am to 5 pm, including weekends,” CAS official Dollarman Fafinato said.
CAS trained healthcare workers at the facilities on the need to be available for consultation around the clock. The project findings are published on the WHO website as a high impact reproductive health service delivery intervention.
“We hope that these practices can be adopted by other counties. Due to the pandemic slowing down the provision of services, teenage pregnancies and other poor outcomes have occurred,” Mr Fafinato said.
One of the challenges identified under this model was the diverse religious and cultural setting, hence the need to look for alternative ways in such specific scenarios.
According to the United Nations Population Fund (UNFPA), Kenya’s total fertility rate (TFR) is 3.33 per cent, which reflects a 1.5 per cent decline from 2020.
Data
Ms. Angeline Siparo, Senior Country Director and Regional Advisor, Population Reference Bureau (PRB). Photo: Courtesy.
A data sheet published by the Population Reference Bureau (PRB) shows that the population in Eastern African- where the average woman has many children than other places continues to grow.
The bureau says the number of people in a country impacts development.
“The size of a country’s population can have important social and economic implications, including how government resources are allocated and whether the country is able to invest in its development goals,” the PRB says.
Eastern Africa’s population is projected to nearly double from 458 million in 2021 to 861 million by 2050.
Experts have projected a twofold increase in the population in Burundi, Madagascar, Mozambique, Somalia, Tanzania, Uganda, and Zambia by 2050.
Ethiopia, which is the region’s most populous country, is projected to nearly double, from 117.8 million in 2020 to 208.3 million in 2050.
Kenya’s population is projected to increase from 54.7 million in 2020 to 89.6 million in 2050.
Dangers of unsafe abortions
Dr Waiguru said there was need to dispel misinformation 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. This includes situations that compel young women to go for unsafe abortions, which are usually harmful,” she says.
In 2016, a study on abortion by the African Population and Health Research Centre (APHRC) showed that nearly half a million induced abortions occurred in Kenya in 2012.
The induced abortion ratio is 30 abortions per 100 live births and a rate of 48 abortions per 1000 women of reproductive age.
The study, which was endorsed by MOH, found that 77 per cent of women who visited Kenyan health facilities for post-abortion care (PAC) were treated for moderately-severe to severe complications, such as sepsis, shock, or organ failure.
“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 of pregnant women who may resort to abortion. It is a tool for women to manage their fertility.
“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 less people were travelling. Teenage pregnancies also reduced, due to reduced sexual activity between the young people that would require contraception,” said the medic.
He added: “Family planning is a human right that should not be coerced. No one should be forced to get the services,” he said.
The medic opined 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 be sent, then it is time for another one to be conceived. The spacing allowed for the mothers time to rest and regain their strength for the next child,” he said.
Dr Jospeh Okore of the United Nations Population Fund (UNFPA) official speaks at the World Contraception Day in Nairobi. He said the UN body has so far spent Sh386 million on procuring family planning commodities for use in Kenyan health facilities.
Dr Okore says the practice of conventional family planning uses modern methods to achieve this noble but ancient objective.
Government need to increase funding
According to the UNFPA official, the government contributes between 40 to 60 per cent of the country’s contraceptive commodity needs. The balance or remaining gap is filled by development partners including the UNFPA depending on the long or short-term needs. In 2020, UNFPA procured commodities worth Sh938.4 million.
This year, the UN body has bought commodities worth Sh386.4 million.
“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 forever,” he said.
Involve youth in policy
Mr Alvin Mwangi of the Sexual and Reproductive Health Alliance asked policymakers to ensure that they involve the youth in policy formulation and decision making on family planning for inclusion of their needs.
“The government should actively seek out the voice of the youth in its efforts to implement a youth-friendly reproductive health programme. This is the only way to design and implement a programme they will easily accept and participate in,” said Mr Mwangi.
The SRHR Alliance is coalition of 17 civil society organizations working to promote the sexual and reproductive health rights of young people and women in East Africa.
