By Chimaraoke Izugbara, Head of Population Dynamics and Reproductive Health, APHRC via Conversation Africa
Globally, the health community has recognised the importance of contraception in reducing the burden of unplanned pregnancies, encouraging smaller families and empowering women as a move to sustainable development in developing countries.
Research shows there are significantly positive links between contraception and maternal and child survival, household well-being and women reaching their career goals and participating in nation-building.
Contraception also reduces chances of depression and anxiety among family members. And on a personal level, it elevates individual and household happiness levels and ensures higher investment in children.
Despite these vast benefits, the United Nations Population Fund estimates that while over 225 million women globally want to avoid pregnancy, they lack access to safe and effective contraception methods.
In Kenya, 18% of married women and 26% of unmarried women lack access to effective contraception. Nationally representative surveys consistently show that less than 40% of young women and adolescent girls who have had sex have used a contraceptive method. In one survey only 29% of young girls who had sex in the month before the survey had used a contraceptive method.
Currently, just more than half of married women in Kenya use modern contraceptives such as intrauterine devices, also known as IUDs, and contraceptive implants under their skin. But the availability of contraceptives remains lowest among those in greatest need:
There is also a growing need for married teenagers to have access to contraceptives. And there remains critical regional disparities in accessing contraceptives. In some regions only 3% of women use contraceptives. In Kenya, 59% of women live in rural areas.
The benefits of contraception
Contraception is more than fertility control. It empowers couples and women to take charge of their fertility and to decide and schedule the number of children they have.
This not only has far-reaching benefits for individuals and couples, it also impacts on their households, communities and the society at large.
A review of the socio-economic benefits of contraception also shows it benefits men. It gives them more disposable income, allows better health outcomes for their households, mothers, wives and colleagues. It also results in more satisfying and longer-lasting relationships with their partners.
The Kenyan crisis
In the 1960s Kenya was a regional leader in providing contraceptive and family planning services. It launched the first official national family planning programme in sub-Saharan Africa.
Policy analyst Maura Graff from the Population Reference Bureau noted that the increased use of contraceptives in Kenya led to a decline in the total fertility rate. It decreased from an average of 8.1 children for each woman in 1978 to 4.7 in 1998. With rapid increases in planned childbearing, family incomes began to rise and the proportion of women earning wages also increased.
But from the mid 1980s, support and funding for family planning in Kenya waned massively. This resulted in major reversals in strategic gains. Contraceptive and family planning services in Kenya have yet to fully recover from this hiatus.
Kenya’s poor contraceptive service system has telling implications. In 2012, half a million induced abortions occurred in the country. In the same year, 70% of the women who were treated for complications after unsafe abortions were not on contraceptives.
Unintended births continue to contribute substantially to population growth in the country. Annually, thousands of Kenyan schoolgirls drop out of school because of unintended pregnancy. Research also shows rising risk of repeat abortion and its dangerous sequel among girls and women in the country.
There are several factors at the heart of Kenya’s contraceptive crisis, including poor political support.
There has also been little commitment to scale up successful family planning and contraceptive provision programmes and interventions. Research shows contraception is one of the least frequently taught topics in Kenyan public and private schools. Consistent national communication remains weak. Several political leaders continue to publicly antagonise family planning and contraception.
Few Kenyan women who undergo treatment for unsafe abortion complications receive a contraceptive. This is partly because of the frequent stock-outs of critical contraceptive products which health facilities in Kenya experience.
A recent study showed very few providers in Kenyan public health facilities knew how to perform a vasectomy or administer long-acting reversible contraceptives, such as an IUD or a contraceptive implant under the skin.
Poverty and longstanding regional inequities also perpetuate the exclusion of many people from accessing effective contraception.
There are several myths and misconceptions that circulate about contraception in Kenya. These include fears that some modern contraceptives cause cancer, infertility, and hurt people during sex. There are also widely-held beliefs that contraception facilitates promiscuity and sexual waywardness.
Opposition to contraception by the country’s religious right remains fierce. Efforts to directly reach young people with contraceptives are resisted by different interest groups.
Fixing the problem
At least two of the new poverty alleviating sustainable development goals underscore the importance of contraception. Planned births, smaller families and access to effective contraception is key to achieving gender equality, women empowerment and a healthy life for all.
We need to raise awareness about contraception and improve public education about sexual and reproductive health. Every pregnancy should be wanted and families should have the number of children they can take care of. Unsafe abortions should be eliminated and girls should not drop out of school due to an unintended pregnancy.
Serving Kenyans who do not have access to contraception would prevent millions of unintended pregnancies, unplanned births, unsafe abortions, miscarriages and maternal and infant deaths. And this is very doable.
Bolstering contraceptive and family planning services in Kenya would require conscientious action from various sectors. This includes politicians, thought leaders, researchers, the media, health providers, educators, activists and development agencies, among others.
The task ahead of Kenya is attainable – but it demands that everybody, not just a section of the country, act.