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Jane Safari sits pensively outside the reproductive health section queue at Coast General Teaching and Referral Hospital in Mombasa County waiting for her turn to see a gynaecologist.

Jane is here for a tubal ligation process, an exercise where the fallopian tubes are cut or blocked to disrupt the path normally taken by eggs from the ovaries, to prevent a woman from getting pregnant.
Jane says that she has settled for female sterilisation, a permanent type of birth control after conceiving two babies while using Depo –Provera a contraceptive injection.

“I got pregnant while I was using the three months injection as a family planning method. This time I do not want to go wrong with the kind of family planning I will be using since I am done having children,” she states.

The mother of five narrates that she had settled to undergo the process after pleas to have her 43-year-old husband Bernard Safari undergo vasectomy were futile.

“I wanted my husband to cut his tubes (that supply sperm to the semen), however, he has been hesitant and I am afraid of becoming pregnant again,” she explains.

Fear of the unknown

Bernard, on this day, sits rather pensively at a corner of the hospital bench. Jane says that he is here to witness the exercise and hear for himself of the side effects of permanent sterilisation.

“I am still apprehensive, but since she has insisted, and maintained that unless I undertake the process, she is going for it. Therefore, I am here to listen to what the doctor will say, but I am still afraid of the unknown. I am really against the procedure,” says Benard.

His wife interrupts him and informs him to reserve his comments since they have discussed the issue for the past four months.

“He has insisted that he cannot undertake the procedure and doesn’t want me to undergo the process. He wants me to change my mind upon listening to the doctor. I am ready for the process,” she insists.
Bernard listens to his wife keenly before interrupting again, “It’s a taboo for men to undergo vasectomy,” he says.

According to the Kenya Demographic and Health Survey (KDHS) 2022, the use of modern family planning methods among married women has increased over time from 18 per cent in 1989 to 32 per cent in 2003, and 57 per cent in 2022.

Readily available information

The report further revealed that the use of Intrauterine Device (IUD) commonly known as the coil had increased from one per cent to 19 per cent over the same period.

The report has further revealed that women aged between 15 and 49 years old reported having used the emergency contraception pills in the last 12 months.

The uptake of the emergency contraceptives is the highest among women aged 20- 24 years, reads part of the report
Over the same period use of injectables increased from three per cent in 1989 to 26 per cent in 2014 before declining to 20 per cent in 2022.

Doctor Swabra Swaleh a gynaecologist at Premier Hospital in Nyali, Mombasa attributes the increased uptake of modern family planning to dissemination of family planning information, ownership of health reproductive health by women.

“You will find that unlike before when decisions on family planning were made by couples, the modern woman is more informed about her own reproductive health and will seek for contraceptive services without even involving their partners,” she offers.

Swaleh adds that women from the ages of 15 to 49 were not bowing down to societal expectations that a woman must bear children at a certain age.

“Societial expectations are nolonger considered by women of child-bearing age.Women are now more focused on making better choices,” adds Swahel.

The rising number of women taking up contraceptives, she says, can also be attributed to readily available information where there are forums on contraception methods where women share their experiences and where to access them easily.

Child-bearing age

Collaboration of Women in Development (CWID) a non-governmental organisation that champions for women health reproductive rights through its Executive director Betty Sharon says the rise of modern family planning is due to increased awareness and sensitisation programmes on the importance of career development among young people.

“Due to the increased awareness community-based health workers on accessibility to family planning methods, use and how it affects one’s health has led to the increased uptake,” she added.

The government’s move to introduce community health workers who can easily reach out to women of child-bearing age and administer the modern family planning methods in far to reach areas, she says, has made it easier for women to easily access whatever type of family planning method they are comfortable with,” says Sharon.

In the same breath, Sharon says men are still shying away from using modern contraceptive methods due to lack of awareness and men-friendly health facilities where such processes can be conducted.

“You will find that matters sterilisation among men remains a grey area in Kenya, filled up with myths, such as inability to ejaculate after vasectomy, there is a lot of stereotyping that family planning should only be administered by women,” she says.

The KDHS report revealed that the number of men who have undergone sterilisation still remains low at 0.5 per cent.

However, Swahel says there is hope in Mombasa as more men have been signing up for vasectomy, a factor she attributes to the county being a tourist hub, which attracts many foreignerswho are more informed.

“We have seen an increase in the number of men seeking the services as they take matters into their hands, but the reported numbers are from the white men who live within,” she says.

Unmet needs

She further notes that with increased information, misconceptions are likely to die off. “There is a lot of information now out there. Vasectomy won’t decrease anyone’s libido, cause premature ejucalution, or erectile disfunction. Now even women are supporting their spouse’s knowing that it is the same orange, and it will taste the same, but this time, with no seeds,”she notes.

Swaleh states that despite the increased uptake of contraceptive among married women, the country is yet to achieve 100 per cent use of contraceptive.

“There are still unmet needs in terms of use of contraceptives due to lack of access, misinformation, poverty, lack of decision making among women, unavaibility, cultural beliefs and religious beliefs,” she says.

The data indicates that Embu County is leading in the number of women using any method of family planning at seven per cent while Bomet County recorded the least number of women using any type of contraception at five per cent.

The proportion of women of reproductive age (aged 15 to 49 years) who have their need for family planning satisfied with modern methods is 77.5 per cent globally in 2022, an increase of 10 percentage points since 1990 (67 per cent, accoding to a new survey by the World Health Organisation (WHO).

Reasons for this slow increase include limited choice of methods, limited access to services, particularly among young, poorer and unmarried people, fear or experience of side-effects, cultural or religious opposition, poor quality of available services, users’ and providers’ bias against some methods and gender-based barriers to accessing services.

As these barriers are addressed in some regions there have been increases in demand satisfied with modern methods of contraception.Globally, between 2000 and 2020, the number of women using a modern contraceptive method increased from 663 million to 851 million.