Nary has a day gone without Josephine Akinyi, a mother of five in Nairobi's Kibera slums, worrying about tomorrow. Two of her children are in primary school. The third is about to clear nursery while the last two are next in line.
"It is overwhelming providing for all of us," she says. For a family like Akinyi's, the cost of life is dreadful. She and her husband (who prefers not being named) struggle to bring food to the table by doing manual work. And when the economy bites, they, like many parents with children beyond their capability to care for, bear the brunt of it. The family's house has shrank over the years. It can barely accommodate seven heads. When the couple married in 2007, family planning was a distant thought. The children were streaming in fast and furious until they opted to curtail the run-away fertility wars.
"When we decided that I will be taking pills, it didn't dawn on us that at times we would be forced to choose between buying food and buying the tablets. In-between the slips, we ended up having our last born," Akinyi's husband says. It is stories of despair such as Akinyi's that took center stage at a reproductive health conference in Turku, Finland.
"Accessing reproductive health is a right for every woman," Dr Kai Haldre, an obstetrician working for a reproductive medicine and sexual health association in Estonia said. Statistics clearly show a huge gap in as far as women's need to control reproduction is concerned. Worldwide, more than half of all women of reproductive age in developing countries, approximately 867 million, want to avoid pregnancy.
Unfortunately, about 222 million have unmet need for medically approved means of contraception. The result is an estimated 33 million cases of unintended pregnancies – either due to contraceptive failure or incorrect use. Kai says unintended pregnancies are game changers in many women's lives. For instance, there are unmitigated factors on cost of health and cost of social services, as well as significant emotional distress to not just the woman but to the rest of the family as well.
"It is healthy that every woman is able to access the type of family planning suitable for them," offered Kai. The setbacks in fostering reproductive healthcare for many families have been caused by what many professionals term as ignorance. These would include misconceptions that have been played upon minds to look as truth, says Lieven Hentschel, the head of Therapeutics and Women's healthcare for Bayer, the pharmaceutical company, in Europe and Canada.
"There is ignorance, based on taboos and cultures. But there is also lack of education; so that many women end up rejecting contraception on the basis of unfounded fears. Those would include notions such as contraception causes infertility," he pointed out.
Beyond families, Hentschel notes that research has proven that family planning saves state economies significantly. For developing countries, an investment strategy that includes fully meeting needs for family planning as well as maternal and newborn health services would not only save many lives but also cost over Sh150 billion less compared to maternal and newborn health services alone.
The experiences Emmah Kariuki, a midwife with Jhpiego Kenya, has had interacting with clients within the country indicate that many women still need to be educated about contraception.
"Majority of our population still lives in abject poverty. That has made it difficult for some to access contraceptives. The cost, for some, spells a barrier. At the end of the day, buying household essentials outweighs the need to pay for contraceptives. In reality though, contraceptives may help a family plan for its future needs," says Emmah.
To many women, Emmah has discovered, there is a lot of myth on family planning that remains confounding. She says: "Many fear they may get sick using contraception. Others think that it is correlated to promiscuity. There are also those who think that emerging non communicable diseases like cancer can be pegged on contraception."
The cancer claim is one that Kai vehemently refutes, saying that there is no science based evidence that cancers are caused by contraception.
"In fact, some forms of contraception have helped cut down on cancer cases. Like the use of condoms – which arrests spread of the HPV virus, known to cause cervical cancer," says Kai.
This year, on September 26, as the world celebrated contraception day, the amount of unplanned pregnancies was holding fort at 41 per cent. The painful thing about it, however, was that nearly half of such pregnancies end in abortion – whether legal or performed in the backstreets.
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It has also emerged that 33 million unintended pregnancies are as a result of contraceptive failure or incorrect use.
There are methods which have been found to be less effective. Use of fertility calendar, like in use of condoms, cervical cups and spermicides, has been found to be 82 per cent effective. This is significantly lower compared to 94 per cent for pills, patches, vaginal rings and three-month injections. The use of implants, intrauterine devices and systems, as well as sterilisation methods have shown 99 per cent effectiveness.
Stories such as Akinyi's are replicated in many places in Kenya. It is even worse in marginalised areas such as Samburu, Turkana and Mandera, where the term family planning is yet to be heard.
What experts believe though is that if the unmet need of contraception was fully satisfied, 53 million additional unplanned pregnancies could be prevented every year.
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