When it comes to choosing emergency contraception, young Kenyan women trust their schoolmates. They also trust the chemist, the Internet and their boyfriends.
The only people they don’t trust are their parents
One word explains why a 25-year-old woman we’ll call Jane lowers her face in shame when explaining why she had unprotected sex with a man she had known for only a month.
“I trusted him,” Jane says, averting her eyes and squirming uncomfortably in her seat. The next morning, the enormity of her decision sank in — what if she got pregnant? She was still in college and definitely not equipped to raise a child.
Her new boyfriend came up with the solution — “Just swallow the ‘morning-after pill’ and you will have nothing to worry about,” he advised, even offering to dash to the chemist for her.
For Jane, the suggestion to use emergency contraception proved a “magic bullet” of sorts.
“Since I did not get pregnant that first time, I continued using the E-pill each time I had unprotected sex, which was at least once a week, convinced that I could not get pregnant,” she recalls.
A month later, however, that “magic bullet” took a wrong turn. Jane’s worst fear came to pass — she was pregnant and devastated.
“I just wasn’t ready to handle a pregnancy or worse, become someone’s mother. There was still so much that I wanted to do, so much that I wanted to accomplish…” Jane says, her voice trailing off.
Jane could easily speak for thousands of young women throughout Kenya.
Pick any 10 in the streets of Nairobi, and at least half admit to having unprotected sex — regularly. They will also tell you they don’t ask their partners about their sexual history, and that they use the E-pill far more often than is recommended.
That’s what the Nation found during an interview for this feature with 10 women between the ages of 19 and 27 years. Far from embodying the non-religious, immoral stereotype, these women were either in college or university, or employed in white-collar jobs.
Overwhelmingly, this group is likely to attribute their risky sexual behaviour to trust — the trust they place on boyfriends to shun sexual partners outside their relationship.
In the same breath, they claim strong awareness of the deadly risk posed by sexually transmitted diseases. These women say they’ve investigated various options for preventing pregnancy, yet place absolute trust in the relatively new E-pill as their contraceptive of choice.
In short, it would seem, these women at the peak of their reproductive years would rather face death, or long term complications of E-pill usage, than the condemnation or rejection from family, church leaders, or community resulting from pregnancy.
“My parents would probably kick me out should they find out that I’m sexually active, so I don’t even want to imagine their reaction should I get pregnant today,” says Sheila, a 22-year-old who is about to graduate from college.
This response confirms past Population Council research findings which indicate that fear of pregnancy outweighs fear of contracting the HIV virus among E-pill users — 79 per cent cited pregnancy as their biggest fear, while only 45 per cent thought they were at risk of contracting HIV through unprotected sex.
A 2007 research by Population Services International (PSI) indicates 69 per cent of E-pill users had either college or university-level education, while 59 per cent were employed.
Overall, 64 per cent of users were married, cohabiting or single but in a steady relationship. These findings dispel the notion that adolescents or the promiscuous are the majority of emergency contraception users.
But is death a less tangible concept for these educated, employed young women than pregnancy? The answer, one expert says, may just shock the people most responsible for moulding a young woman’s sense of self.
According to Wanjiku Gikang’a, a family therapist and university lecturer, parents are largely to blame for the shockingly casual approach young women adopt towards unprotected sex.
“Today’s parents think that their duty is done once they provide material support for their children — but they end up neglecting an even more important area — the emotional well-being of their children.”
“Young unmarried women would rather seek an abortion than let their parents know that they’re pregnant,” says Gikang’a.
She cites a case she is privy to, that of a young woman who took the more drastic step of procuring an abortion than confide in her parents that she was pregnant.
“She was suicidal by the time she sought help since the mental torture she experienced after the abortion was just too much to handle.”
Gikang’a says most parents expect, even demand, that young women make wise sexual choices, with little or no guidance.
The result, she explains, is a generation that grows up devoid of self-esteem, even though highly-educated and self-sufficient. It seems logical that they could be persuaded to have unprotected sex with someone whose sexual history is unknown to them. Parents don’t realise that true self-esteem is fuelled by information.
“A young woman who has been raised with self-esteem would think twice before doing anything that will jeopardise her health; she would be empowered to look beyond just getting pregnant,” Gikang’a says.
Dr. Marsden Solomon, the Reproductive Health Regional Medical Advisor for Family Health International, says that for the sexually uninformed young woman, the social, economic, the psychological and moral repercussions of pregnancy seem easier to dodge.
“Unlike a sexually transmitted disease, pregnancy cannot be hidden; it is a visible consequence and demonstration of a sexual act and for the unmarried girl in our society, the shame that accompanies it is heavy,” says Dr Solomon.
But young woman might be more willing to gamble on hiding symptoms of HIV or STD’s for years. After all, even people who contract HIV can live for decades with ARV’s, proper nutrition and counselling.
Besides trust, the young women interviewed for this feature also cited pressure from their boyfriends to engage in unprotected sex.
“Most men question your faithfulness and love for them if you insist on using a condom, so we end up giving in to unprotected sex to prove that we’re not seeing anyone else,” said Mary, a 21-year-old student at a city college. She has been using the E-pill to prevent pregnancy at least twice a month for the past one year.
“Men also argue that the relationship isn’t close enough when we insist on using protection,” said Christine, a 25-year-old accountant who started having unprotected sex with her current boyfriend three months after they started dating. They have been together for six months but are yet to visit a VCT centre to have their status checked. She, too regularly pops the E-pill to prevent pregnancy.
Only two of the women assembled by the Nation had done more than cursory Internet research into the emergency contraception pill. What’s most startling is that those who haven’t had a “failure” — a pregnancy — don’t believe they are abusing the E-pill. They think it is easier to use and safer than other methods of birth control.
But the Ministry of Health’s Family Planning Guidelines for Service Providers, as well as the World Health Organisation, emphasise that emergency contraception should only be used as a backup method in emergencies and not as a regular method of family planning because it is not as reliable. In fact, using the E-pill on a monthly basis points to misuse and heightens the risk of pregnancy.
The E-pill has a pregnancy prevention rate of 88 per cent when taken within 120 hours after unprotected sex, compared to the 99.78 per cent protection that other hormonal methods offer. What’s more, the E-pill’s ability to prevent pregnancy diminishes with regular use because it contains a much higher dose of hormones than regular contraceptive methods.
So far, there are no documented health risks from frequent E-pill usage. But the ripple effects are far-reaching. As Dr. Solomon points out, you might succeed in preventing an unwanted pregnancy for a while, but might repeatedly expose yourself to the HIV virus and STD’s such as gonorrhoea and Chlamydia, which have a devastating effect on a woman’s reproductive organs.
“These two STD’s damage the fallopian tubes where conception takes place, leading to infertility,” Dr. Solomon explains.
In a conservative society like Kenya’s, childlessness attracts harsh social and cultural judgment. Young women should also consider the increased possibility of seeking an unsafe abortion, which could result in long-term complications or death.
Despite these sobering facts, many young women still don’t embrace common family planning contraception methods, due to myriad myths and misinformation.
For instance, a 2008 study by Population Council found that 57 per cent of the women who used the E-pill believed that it was not possible to become pregnant after using the emergency contraceptive.
This group also believes that regular family planning methods, such as the combined oral contraceptive pill, injectables and implants, are for married people who do not want any more children.
“A friend told me that they (implants and injectables) cause infertility and permanent varicose veins when used over a long period,” said 23-year-old Faith, an actress with a local theatre group.
For most of the youngest E-pill users, informal networks (friends and relatives) appear to be the main source of information on emergency contraception. But it’s almost guaranteed that no one in that network is a responsible, informed adult. Ironically, young people themselves are clamouring for change in that regard.
A recent study by the Centre for the Study of Adolescence revealed that, nearly 65 per cent want to receive sex education in school. They also want their parents involved in forums where sexual heath is discussed.
“Our parents know that we’re having sex, but they don’t talk to us about it. Yet when we get pregnant or when a friend does, they are embarrassed and angry and blame us for not-knowing better,” says Beatrice, a 22-year-old who was 16 when she first heard about the E-pill.
And 26-year-old Angela, who became pregnant in her second year in college, wished that parents could open up and talk to them about sex candidly, instead of cautioning them about “playing with boys” or flatly condemning sex.
“Right from our homes, to learning institutions as well as the church, sex is a taboo subject, and when young people talk about it, they’re branded immoral,” echoes 21-year-old Sylvia.
In short, the women who spoke to the Nation painted a clear picture of why it’s frighteningly easy to trust a man you met a month ago, who advises you to take a pill you really don’t know much about, to prevent a situation that will force a painful conversation with the very people who should have your best interest at heart.
And there is only one remedy, family therapist Gikang’a says. Accurate, thorough information — from the very first people we trust in life.
“Sex is still taboo in our society, yet the irony is that we cannot divorce it from our daily lives — the fact is that our children are having it. Let’s empower them to make the right choices by talking to them about it and let’s let them know that they can confide in us about anything because we’ll support them — this is what unconditional love is all about.”