Against the grain: Pokot women who have silently undergone tubal ligation

Tens of kilometres away from Kapenguria town, navigating its pristine hills, heading North West, you will come to Kongelai Centre.

A few shops run parallel to the tarmac road - a slice of modernity in a village still steeped in culture. At an open-air market, we find Cheposangiy*, a "mama mboga" (vegetable vendor), as she refers to herself. In her community, she is in the minority in using family planning. In fact, Cheposangiy secretly took up a permanent family planning method.

"Only my doctor knows," she told us, asking that we should protect her identity.

"And your husband?" we prodded.

"That's the point: he is never to know. If he knows he will mistreat me. He will hate me."

Her husband has three wives. Cheposangiy is wife number two. Together, they have borne him 15 children, and counting. Of the 15, Cheposangiy's are five.

To understand just how drastic Cheposangiy's decision was, one only has to look at statistics.

West Pokot is among five counties that recorded the highest fertility rates in the Kenya Demographic Health Survey (KDHS) 2014.

Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014 - 2018, show contraceptive prevalence- the proportion of women using (or whose sexual partner is using) contraception - in the county at 31 per cent.

Compare these to the national numbers: Kenya's contraceptive prevalence as of 2020 was 60 per cent as per the same data. The national total fertility rate (TFR) - the average number of children each woman has during her lifetime - was 3.9 as of 2014, as captured by KDHS.

The latest data, contained in the 2022 World Population Data Sheet (WPDS 2022) by the Population Reference Bureau (PRB), released on the 8th of this month, shows that Kenya's TFR has come down further to 3.3.

In West Pokot, TFR was at 7.2 in 2014 as per KDHS. "Right now it should be about 7.0," Wilson Ngaren, the county Reproductive health coordinator, says.

As the world marked World Contraception Day yesterday, it is becoming clear that Kenya has made tremendous progress.

Dr Anthony Wanjala, an Obstetrician and Gynaecologist at Kapenguria County Referral Hospital, explains the importance of these numbers. "All over the world, a lower TFR usually corresponds to better health indicators like lower infant mortality as well as lower maternal mortality. West Pokot had infant mortality of 80 deaths per 1,000 live births compared to 39 in the nation. Maternal mortality ratio is at 565 maternal deaths per 100,000 live births compared to 362 nationwide," he says.

WPDS 2022, which is released annually, shows that Kenya is ahead of its neighbours when TFR is used as a yardstick. Kenya's TFR is better than Burundi's (5.1), Somalia's (6.3), Mozambique's (4.6), Tanzania's (4.7), Uganda's (4.6), Malawi's (3.9), Rwanda's (3.8), and Zimbabwe's (3.5).

The report further shows that at least 65 per cent of married women and girls in Kenya, ages 15 to 49, are currently using a modern family planning method. However, as already demonstrated, the numbers are far from homogenous. West Pokot County is one of the places lagging behind.

"After marriage, the goal of a Pokot woman - in the eyes of her husband and society - is to give birth," says Cheposangiy, who dropped out of school in Class three.

The concept behind family planning, she says, hasn't gained much acceptance in her community. "Not many women are on contraceptives. And even those using, the majority are doing so secretly - like myself," she says.

Roseanne Kashor, well past menopause, says that the average Pokot man does not entertain the concept of family planning. "A man will beat you to a pulp if he knows that you are on contraceptives. Our society is still patriarchal."

Kashor says she has witnessed many of her peers suffer such beatings. "I know a lady whose husband bumped into a family planning clinic card in the house. He beat her thoroughly."

Why would men hate family planning? We posed the question to a few men in the streets of Kapenguria.

"For what?" one responded.

"Because God said we fill the earth. Why block God's creation from emerging?" another said.

"Those are western ideas: it is not African," another answered.

Dr Wanjala says that medics, as a matter of policy, talk to every woman who attends an antenatal clinic about family planning. "We usually ask the women to tag their husbands along. However, a typical Pokot man wants many children: the majority are against family planning," he says.

Kashor said that the average Pokot man thinks of a woman in family planning as a woman with loose morals. "They believe that the only reason a woman would be on family planning would be to avoid getting pregnant with other men's children," she said. But also, culture - which places value on high fertility - could be to blame, she says.

Leah Chebitwey is the founder of Pokot Women Empowerment Program (POWEO), a community-based organization. She says that Cheposangiy's decision was brave. "We have done a lot of work sensitizing locals on family planning. We have struggled to put the message across: so much that at some point we stopped using the phrase 'family planning' and opted for 'birth spacing'.

"Why would a Pokot woman even think of a permanent method? Such ideas are still very foreign around here," she says.

Often, she says, a Pokot woman's goal is to utilize all her eggs. "It gives such a woman joy to say 'I have utilized all my eggs.' Such a woman can brag and say, 'Otingetaam mouung cho chang soroo!' which loosely translates to 'I have given birth to the point of blessings.'"

Ngaren says the Pokot have a high fertility rate because children are viewed as a resource.

"We [the Pokot] are nomads and pastoralists. We need many children for labour. We need more children so that when some die - as some inevitably do - you still have some left. And we want to have many boys because they give us security and are of great importance in a cattle rustling area like ours," he says.

A Pokot man has status when he has many children. "The more children a man has the manlier he is," Kashor, who herself has given birth to 14 children, says.

Dr Wanjala says: "This is a highly patriarchal society where men make decisions for their wives. It is common to find women in family planning but their husbands do not know of this. That is why the most common contraceptive in West Pokot, among those who use, is the injection: because it leaves no trace. An implant would show on the skin. An IUD has a string that the man will most likely feel. And you can't hide a daily pill for long."

Cheposangiy underwent tubal ligation as she was delivering her lastborn via a Caesarean Section (CS) in October 2020 at Kapenguria District Hospital.

"Five children are more than enough in these tough economic times. I have two sons and three daughters. Why would I need more? I am their primary provider. Their father does not chip in much. I am basically raising them by myself."

Joseph Lopetakuri, a member of the Pokot Council of elders, says the council has warmed up to the idea of family planning "because times have changed: resources are fewer today than they were in the olden days."