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Why women, girls are not accessing family planning services

Reproductive Health
 A 14-year-old girl with her baby at their home in Ndhiwa village Homa Bay County. [Collins Oduor, Standard]

At the tender age of 13, Betty (not her real name) got pregnant.

The Standard Six pupil from Migori County gave birth and when she went back to hospital for family planning services, she was turned away.

The girl decided to visit another hospital where she had implants inserted in her arm.  

Betty went back to school but was surprised when the deputy head teacher ordered her to remove the implants, failure to which she would be expelled. She does not know how the teacher found out.

Fearing her education would be discontinued, Betty had the implants removed. Yet this turned out to be a big mistake as she conceived again, just three months later. 

It took a nurse at the hospital, where Betty had been attended to, to explain to the teacher why it was important for her to be on family planning. 

“Because I was sexually active, my friends advised me to go for family planning. However, the medical staff at the hospital were harsh. They said I was too young to take up family planning. They even said I was too young to engage in sex or get pregnant,” Betty told Health & Science.

“Now I have two children whom I am unable to provide for. I do not have a job and their father cares less.”

Another teenager, Sarah (not her real name) said she was stigmatised by health workers at a Migori hospital for seeking family planning services. 

“The medics told me to abstain from sex instead of seeking family planning services,” said the 15-year-old.

A month later, the girl conceived. To add salt to injury, the teenager had also contracted HIV reportedly from a relative who had defiled her. 

“I met a nurse who was very rude. She said I would become reckless if she offered me family planning services. She sent me away,” said Sarah, adding; “I wish the nurse listened to me; I would probably not be having a baby I cannot provide for.”

The two are among the rising number of teenagers and women struggling with unwanted pregnancies because of lack of comprehensive information on family planning and other reproductive health services.

A report by Centre for Reproductive Rights and Trust for Indigenous Culture Health (TICAH) blames increased cases of unintended pregnancies among girls and women to lack of information on reproductive health. The report found that girls aged 15 and above had less knowledge on how to prevent pregnancy.

Meanwhile, women aged between 21 and 30 were found to be most knowledgeable as far as prevention of unintended pregnancies is concerned. The study also found that most women in this age group (80 per cent) use contraception while the rest have opted for abstinence.

Most girls under 15 that reported to have abstained were either single or in school, the report said. Most of those using contraceptives and are above 15 years were either married or had steady partners.

“Majority of women and girls, irrespective of age, are uninformed. They even lack information on their constitutional rights as far as reproductive health, including abortion, is concerned. Many are unaware that the law permits abortion in some circumstances. All they know is termination of pregnancy is illegal in Kenya,” the report reads.

Reproductive health

Learning institutions, the report found, also offer limited or no education on sexual and reproductive health. This was despite the fact that girls preferred receiving such information from their schools, according to the report.

The study was conducted in Bungoma, Kericho, Homa Bay, Kilifi and Nairobi where health professionals said most girls don’t feel free to seek information on reproductive health or family planning. This was despite the fact many girls, some as young as 10, are actively engaging in sex with many of them getting pregnant. 

The study linked failure by girls to seek information on reproductive health to fear of being judged that often leads to stigma due to social, cultural and religious beliefs.

“Young girls fear seeking information on their reproductive health and family planning services because of negative attitudes directed at them by some health workers and some personnel in schools who believe such services should only be given to those who are married or to adolescents whose parents have given consent,” the report says.

Health professionals said they don’t share the information for fear of being arrested for giving such information to underage girls. 

The researchers noted that there are many barriers to access to reproductive health education, pushing women and girls into unsafe abortion.

In August 2020, Chidzuga (not her real name) from Musuro village in Baringo, walked 15 kilometres to Marigat Hospital hoping to procure abortion.

The 15-year-old, who was in Form Three then, said she pleaded with the medics to terminate her pregnancy but they declined. Instead, they took her through counselling and placed her on antenatal clinic.

The girl was not satisfied. She badly wanted to get rid of the six-week pregnancy for fear it would interrupt her education. She also feared being married off early.

“She tried so many things. At one point, she took an assortment of herbs, mixed them with juice and drank it in the hope it will end her pregnancy. This was after the staff at Marigat Hospital declined to help her end it,” a health volunteer, who requested anonymity, told Health & Science.

The Kenya Demographic Health Survey (KDHS) 2014 showed that 35 per cent of maternal deaths in Kenya were caused by unsafe abortions. On the other hand, a survey by the Ministry of Health and African Population and Health Research Centre in 2012 showed at least 464,000 abortions were procured that year.

Another report, dubbed The Costs of Treating Unsafe Abortion Complications in Public Health Facilities in Kenya, released by the Ministry of Health in 2018, showed treatment of complications resulting from unsafe abortions was costing the public health system heavily.

A doctor takes about 7.4 hours to treat a person with complications from unsafe abortion, depending on the intensity of the complication, the report said. On average, it costs between Sh3,264 to Sh9,133 to treat a patient who develops complications after unsafe abortion.

And lack of the information has also contributed heavily to increased cases of sexually transmitted infections, including HIV, findings of the TICAH study showed.

A 23-year-old woman, who did not wish to be named, said she was denied information on family planning at Pumwani Hospital because she is lesbian. 

“The hospital’s staff developed an attitude towards me after I told them I was a lesbian. They discriminated against me and did not offer me the services I had sought,” she says.

Betty Odallo, advocacy adviser with Centre for Reproductive Rights, an organisation that seeks to advance reproductive health rights, wants the government to ensure girls and women access comprehensive, accurate and timely information on reproductive health services.

“The government should provide information on services such as contraception, maternal health and protection from harmful practices, sexual violence and safe abortion,” said Odallo.

She added: “The government should also educate men and boys on the importance of reproductive health so they can support and facilitate women’s access to such information.”

TICAH Executive Director Jade Maina said: “The government must remain committed to Sustainable Development Goals and involve everyone in designing sexual and reproductive health programmes.”

In some cases, because of the unfriendly hospital staff and for fear of stigmatisation, some underage girls are secretly procuring family planning services. For instance, some private clinics and chemists in Kaptembwo slums, Nakuru Town West, are secretly selling contraceptives to teenage girls, according to investigations by Health & Science.

Most of the school-going girls aged between 14 and 17 are mainly introduced to contraceptives by their peers. Some are using three-month injections and five-year implants to control pregnancy. 

Christine (not her real name) is among those who got an implant on August 19, 2020. It will be removed on August 19, 2025.

She said family planning helps her engage in safe sex without the fear of getting pregnant. “Having sex with my boyfriends earns me some money. I need the cash to support my younger siblings. What our mother makes from casual jobs is too little,” she said.

Declined to comment

Owners of some of the clinics said to be providing girls with implants declined to comment on the reports.

Adelaide Baraza, an obstetrician at the Rift Valley Provincial General Hospital, said anyone who desires to prevent pregnancy has a right to contraceptives.

“If parents agree to have their teenage girls put on family planning, nobody should stop them. But teenagers cannot decide on their own, consent is needed,” said Dr Baraza.

While implants are safe, Baraza said, they may delay fertility for up to six months. Three-month injections delay fertility for 18 months. “Health professionals should explain to clients the side effects of contraceptives to enable them to make informed choices,” she said.

Implants and Intrauterine Devices (IUDs) are among the commonly used methods of family planning in Kenya. According to the Ministry of Health, about 6.1 million women use a modern method of contraception, an increase from four million in 2012.  

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