Cake, Contraceptives, and Kiambu County

Today marks the end of my second day of the Ipas Maguire Fellowship at the Ipas Africa Alliance in Kenya and I am still STOKED. Monday was spent meeting many new and friendly faces and getting acclimated with the support of the Alliance’s amazing HR staff. Today, I celebrated my birthday with the most delicious surprise birthday cake, something I was not at all expecting, being so new to this office. I was pretty moved. I mean, who does that for someone they barely know? Apparently the Alliance Office does ❤.

In the afternoon, I traveled to Kiambu County to shadow Choice for Change (C4C) Program staff. C4C is an Alliance program that promotes uptake of long-acting reversible contraceptives (LARC) among adolescents and young people by 1) Improving service delivery at health facilities through provider training in values clarification, youth-friendly services and LARC placement (basically, how to provide LARC to youth and be nice about it!), 2) Activating community groups to mobilize them in favor of promoting and/or referring for the use of contraception, with a focus on LARCs and safer sex via condom use, among the young people in their county, and 3) Working with county health officials and other stakeholders to advocate for the inclusion of reproductive health funding in county budgets.

The program ‘s slogan is Maisha Poa, Future Poa, Chaguo Langu– Swahili for “Good life, Good future, My Choice”. I love that it embraces reproductive autonomy, a pillar of sexual and reproductive health and rights. The program aims to reach girls with information about contraceptives, especially the benefits of LARC, from age 10 up through age 24- taking into account the realities of the young people they aim to reach and the need to inform girls of the options available to them well before they are sexually active. While many adults may be loath to admit that someone as young as 14 may need LARC, there is undoubtedly a need to equip very young women with more discreet options and less user-dependent methods of preventing pregnancy, especially given the reality of early sexual activity and power imbalances in too many sexual relationships. While the program doesn’t address gender inequality directly, it’s beyond argument that programs like these help facilitate women’s and girls’ access to opportunities toward self-fulfillment by delaying childbearing.

Kiambu County is in the Nairobi Metropolitan Region, and hosts beautiful stretches of green farmland. 14% of girls aged 15-19 years have given birth in this county, which is lower than the national level of 18% (Kenya National Bureau of Statistics, 2010). This rate is still pretty high, and county health officials are eager to see it come down. Side note: I think one of the things that felt incredibly ironic today, was the fact that many Kenyan health leaders seem to want everyone in their country to have a basic level of access to medical care, whereas my leaders largely seek to strip it away from anyone they see as undeserving. I’m over-simplifying here, but I think the overall point is still valid and shameful in a country with a GDP as high as that of the U.S.

Anyhow, on this visit, the Alliance’s Youth Program Advisor, Moses Kidi, gave an overview of the program to Kiambu County Community Health Workers (CHWs). Peppering his explanation of the program’s comprehensive Community Referral Strategy with anecdotes about the unfair burden carried by too many young girls, particularly those born into poverty, who have been denied access to information and reproductive healthcare, Moses makes a compelling argument for working to improve the life chances of women and girls. He described the story of a girl who was forced to sleep with her uncle as he paid school fees for her and her siblings. If there wasn’t a way to remove her from that situation immediately, LARC might be her only option for delaying pregnancy, but adult judgement at her request for contraception would likely shut-down her down and squander the one chance to help her from within the healthcare system. He also made a strong economic argument for the program, highlighting the negative impact overpopulation can have on a country’s economic growth. The CHWs seemed to identify strongly with his arguments, and shared some of their own.

I could see that promoters seemed genuinely interested and committed to this work, and a visit later in the day to a sub-county hospital (mid-level hospital) and dispensary (primary care clinic) provided evidence that their work is paying off. At the first facility, the number of patients seeking family planning services has nearly doubled since it became an official intervention site just about six months ago. The provider there shared with me that Implanon is most popular among young women, and that having LARC prevents young girls from having to return to the facility regularly, which is important as her community may speak poorly of her, assuming that her frequent visits are for contraception. While the program doesn’t address abortion directly, any person who appreciates real (not alternative) scientific research, can agree that this program prevents unwanted pregnancies, abortions and, given that safe, legal abortion is still out of reach for the vast majority of Kenyan women, girls and people with female reproductive organs, I have no doubt that it’s saving lives. One would think that anti-choice folk would be gaga over a program like this… but that’s another post!

Some of the gorgeous scenery in Kiambu County, Kenya

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