The journey to Olmekenyu health center in Narok South sub county, Narok County is one bumpy and treacherous, with muddy roads in a mountainous region, bordering the Mau forest. This is one of the high yield public health facilities that the DESIP program is working with.
We arrive with Cheptoo whom we picked along the way, some 20kms from the facility after finding her stuck, on this rainy Thursday morning, carrying her 4-year-old child who has downs syndrome.
The child is attended to, then we get to have the ‘other’ discussion on her reproductive health goals. Langat, a nurse at the facility, takes her through counselling and provision of the method of choice, while observing the PSI quality standards of privacy and confidentiality, patient safety, informed choice and Technical competency, having been trained on Family Planning module 1, by DESIP in November 2019.
Cheptoo shares about her friends and the challenges behind the low uptake of family planning, as we drop her off. On arrival, her delighted children rush to embrace her. The youngest one, who is months old, is visibly hungry and proceeds to breastfeed. The rest congregate around her in anticipation of a meal which, sadly, she has to head off to find as soon as the baby is fed. She is only 34, but her haggard look shows a woman whose youth is long past her. Poor, homeless, illiterate and shouldering the burden of feeding nine children, two of whom have special needs, life couldn’t have dealt her a worse card. That she is married doesn’t make much difference.
She says it was not her wish to have nine children, especially considering that she and her husband can barely feed and clothe them, but because of cultural dictates she ended up with nine girls “trying to get at least one boy”. The community has the majority believing that boys are more valuable in the society and men value wives more when they bear male children.
Most of the families squeeze in the camp, after evictions from the Mau forest. Her eldest daughter, a teenager is also married, after eloping with a casual laborer during the holidays. Her second born daughter is heavily pregnant and lives with them, she is yet to start her ANC visits.
With DESIP program on board, capacity building the health workers on skills and knowledge, issuing of equipment etc., The women now get access to the services at the neighboring health centers of Sogoo and Olmekenyu. They are counselled on family planning and leave with a method of choice. The health workers who hail from the same community, have taken the initiative as a way of empowering their community, help reduce teenage pregnancies and early marriages. Through these initiatives, the reality has made the women here start using family planning and abandoned the “search” for a baby boy.
Majority of women aged between 30 and 40 have nine to 12 children, a whopping 60 per cent above the national average household size of 3.9 children, according to the 2019 census – which was a drop from 4.2 in 2009.
Lack of access to family planning services, lack of consent from their husbands to use modern birth control methods and low literacy levels fuel poverty, and girls are exposed to early marriages to escape the cycle. Hence, they end up with similarly large families, as they start giving birth early. Most of the families here, has had none of their children set foot in secondary school. Some stopped going to school altogether.
With hindsight, Cheptoo wishes she had had information about and access to contraceptives, which she says were rare in Nkoben, where they lived prior to their eviction. Most young mothers agree that birth control is necessary, but the contradiction between belief and practice, they say, is because their husbands deny them permission to access family planning clinics. Hence, the daring ones sneak into health centers and have some procedures done. Others now get to access them when they take their children for immunization or after delivery i.e. post-partum family planning.
Soila, a mother of five, says she was taught about various methods of family planning during the antenatal visits and embraced the implant, which was given after delivery of her fifth child.
“There is a need for a targeted approach on the use of modern methods of contraception by rural women. Some may even have access to the pills but don’t know how to use them effectively” says Langat.
Talking to a village elder at the camp, he says “Childbearing in the past was programmed in a way that a husband would leave the homestead for over a year to allow the wife to raise their newborn.Bottom of Form That was possible because men had alternative homes due to polygamy. Culturally, issues of children were left to the women. Men were not supposed to carry an infant or be involved in the early lives of their children. They left the homestead because they believed a woman was not pure at that stage.”
Deciding how many children to have was never an issue. Children were then seen as a blessing and source of labor in the farms. Nationally, young girls and women below the age of 24 years account for 70 per cent of all pregnancies, most of which are usually unwanted.
According to the Kenya Health Demographic Survey, 50 per cent of married and sexually active unmarried women in the rural areas have an unmet need for family planning.
“Limited access to reproductive health services, gender inequality, stockouts, distance to health points, cultural norms, and lack of skilled service providers are some of the barriers to accessing family planning services in rural areas and have led to them having poor health outcomes,” states the document.
Banking on these figures and the actual situation on the ground, the DESIP program is leveraging on all available opportunities, to ensure that women and girls can safely plan their pregnancies and improve their SRH, particularly the young, rural and marginalized, with impact contributing to reduced maternal mortality, newborn, child mortality and increased mCPR in Kenya.