Many women are living with expired, undesired, or injurious coils and implants as they cannot afford to have them removed.
Women with expired devices, suffering intolerable side effects, or want a child, have to beg, plead, cajole or bribe health workers to remove them. “You either bribe or stay with the device until you can raise some money,” groups of women recently told researchers in Western Kenya.
The women from Kisumu, Kisii, Busia, and Bungoma said while insertion was free and most were even begged to take up the methods, many health workers turned nasty when requested to remove them before the expiry date.
“I used to bleed so much and when I went there (clinic), they used to tell me to open my mouth and they check my tongue and say that I am lying and told to carry on,” said a participant.
The PMA2020, a Ministry of Health contraceptives use data collection tool, shows that last year about 10 per cent of women who wanted the devices removed were unsuccessful. Most were pressured by care providers to use them for full duration, regardless of side effects or desire for pregnancy, and “providers refused to remove for women both with and without agreement of male partners,” they told researchers.
The study published in March in the journal Contraception by researchers from Kisumu County Department of Health, the USA, Belgium, Argentina, and The Netherlands says removal problems saw many women drop the use of the two long-lasting birth control methods.
The implants and intrauterine devices (IUDs), the latter also called the coil, are the second and third most used forms of long-acting contraceptives in Kenya after the injection respectively.
For placement or removal, the two methods require a trained health provider, with most of this happening in public hospitals, which have the requisite personnel “but removing the thing in a public hospital is not easy. You must bribe the providers,” said another participant.
The unofficial fees demanded ranged from Sh200 to Sh3,000. And “if you don’t have the cash, then that device will not be removed, even if it is due for removal,” said a woman who has since stopped using contraceptives due to frustrations.
Most of the women did not think it appropriate that insertions were free but removals were costly. Most health workers, however, argued that implant removal is tedious hence can’t be free. Others pegged bribery solicitation to low and delayed salaries and “if the big fish are doing it then why not me down here?”
An earlier report from Kenyan Federation of Women Lawyers noted that women who are unable to pay unofficial fees for family planning methods were often made to wait longer in hospital queues, or even ignored completely.
Nairobi and Kisumu counties are the worst hit, a culture that accounts for unwanted pregnancies for those without Sh50 bribe and “by the time she comes back, that unwanted pregnancy has happened, and now she has to deal with a burden which could have been prevented,” said a nursing officer at a public hospital.
In the study led by Prof Katherine Tumlinson of the University of North Carolina US, health workers said solicitation of informal fees was common with most charging Sh500 for long-acting methods and Sh50 for injection. The researchers suggested that health insurance covers contraceptive removals or reimbursements as the cases maybe.