Five children per woman: How Kenya lost family planning battle

In the first three decades of independence, Kenyan families began to have fewer and fewer children as the young country led sub-Saharan Africa in family planning campaigns.

A hugely receptive population, herded to the pill by none other than founding president Jomo Kenyatta himself, saw the country’s fertility rate decline from an estimated eight children per woman in 1963 to around five in the late 1990s.

Jubilant policy planners hoped for more. The trend over the initial 30 years of the nation was encouraging, so they hoped that, in the next decade into the millenium, the number of children per woman would reduce even further.

They were wrong. The last two decades have recorded a stagnated birth rate at around the five children per woman recorded in the 1990s. Yet this is happening at a time when women are becoming more learned, more exposed to medical information, more enlightened and more freed from the demands of their men.

At independence, one out of every six children died before their fifth birthday, but their prospects of living to adulthood have since improved tremendously as a result of the intense family planning programmes of the 1980s and ’90s.

Still, a lot, it seems, needs to be done. If the trajectory carved by the campaign from independence had continued in its path, Kenyan women would today be having between two and three children on average, but they are still stuck at five.

This has planners a bit uneasy because family planning is an essential component of achieving development goals for health, poverty reduction, gender equality, and environmental sustainability.

As the population grows, you have more and more women giving birth, which means that, for sustainability, the number of children these women are having should reduce as the mothers increase.

Other countries have achieved this, but Kenya remains stuck in a rut. The lost decade of family planning is clear when you pit Kenya against global averages; five children in 1963, four in 1976, three in 1992 and two in 2011.

So, why are Kenyans bringing up families that are more than twice the average global size? The answer to that question is found in the most recent edition of the Kenya Demographic Health Survey 2013, which indicates that, today, fewer than half the number of sexually active women in the country use contraceptives.

When you view that shocking piece of information against the backdrop of the nation’s high fertility rate, early marriages (meaning more time within which to have children), unmet family planning needs and low education levels, the signs of the time begin to get a little bit uncomfortable to live with.

Unmet planning needs

Women who have gone to school are four times more likely to plan their families than girls who have no formal education; yet, as Kenya becomes more and more literate, there has been little change in levels of knowledge of contraceptive methods since 2003.

And, according to KDHS 2013, one-quarter of currently married women in Kenya have an unmet need for family planning, which has remained unchanged since 2003. Those unmet needs are evenly split between women who want to wait two or more years before having their next child, and those who want no more children.

Family planning is for both health and wealth. When parents plan their families, they are more likely to realise their education goals and have careers to raise family income. And when countries develop as their fertility rates decline, the proportion of women earning wages rises and their children have greater chances of success.

But in Kenya, the East African territory pejoratively referred to as “the teenage nation” because of the high number of girls giving birth at teenage, the reverse obtains. Here, one out of three women will have given birth at the age of 19, according to KDHS 2013. And such children, unfortunately, are often unplanned.

So many children in the hands of so many underage mothers with so many years to continue their business of unplanned births eventually overwhelms the education and health systems, among many others.
So, what should be done to tame this teenage pregnancy problem? The World Health Organisation believes the answer is quite simple: keep them in school!

Better access to family planning, the organisation advises, is greatly aided by education, and countries that send their children to class and keep them there have seen a rapid decline over the past decade in the percentage of girls reporting birth before age 15, a trend attributed largely to a decrease in early and arranged marriages.

In low- and middle-income countries, over 30 per cent of girls marry before they are 18, and around 14 per cent before they are 15. As a result, more than seven million girls under the age of 18 the world over get pregnant annually, according to a United Nations report released in October last year.

Schooling, therefore, might be all that Kenya needs to promote if it is to recover its lost years in family planning. Girls who have attended secondary school, researchers have found out, start having sex two years later and have their first child three years later than those who have no education.

A girl with no education is likely to have her first child at the age of 19, while one with secondary education will most probably have her first at age 23. Girls with secondary education also tend to plan their families and are four times more likely to use family planning methods, unlike girls without formal education.

Research also shows that only one out of 17 educated girls will not use contraceptives, but she will have discussed the issue with a health care worker.

Education, therefore, is a major protective factor against early pregnancies, but, still, slightly less than half of married women (46 per cent) in Kenya are using a method of family planning, 39 per cent of them are using a modern method and six per cent a traditional one.

World Bank data shows that, in areas where the under-five death rate is high, the fertility rate is also high; but the higher the number of children a woman has, the more likely those children are to die before their fifth birthday.

In Nyanza, for instance, the average number of children per woman is five, with 15 child deaths per 100 births; Western region records an average of six children per woman, with 12 child death per 100 births. Rift Valley also records six children per woman, with six child deaths per 100; Eastern and Central regions report four and three children per woman, respectively, and five child deaths per 100 births. In Nairobi, the average number of children per woman is three, with six child deaths per 100 births.

One third of the Kenyan women who do not use contraceptives name health concerns and fear of side effects as the main reasons for their decisions. Half of women in Kenya do not want more children, yet one out of every three women who need family planning is not receiving it because of the cost or the uneven availability of the services.

This, according to the United Nations Population Fund, is leading to a lot of unsafe abortions. The UNFP reports that at least 200 million women want to use safe and effective family planning methods, but are unable to do so because they lack access to information and services or the support of their husbands and communities. As a result, more than 50 million of the 190 million women who become pregnant globally every year have abortions which are performed under unsafe conditions.

Unsafe abortions

Closer home, according to the Incidence and Complications Report of Unsafe Abortions in Kenya, Kenyan women procured 465,000 unsafe abortions in 2012, contributing to 20 per cent of the total maternal deaths. This is because one out of every six pregnancies in Kenya is unintended.

Rift Valley, Nyanza/Western regions recorded the highest abortion rates of 64 and 63 per 1,000 women of reproductive age, respectively. Eastern had the lowest with 20 abortions per 1,000 women.

The study further indicates that more than 70 per cent of women seeking post-abortion care were not using a method of contraception prior to becoming pregnant, and recommends that in order to prevent unintended pregnancies and the unsafe abortions that follow, contraceptive needs must be met and post-abortion contraceptive counselling and services provided.

Dr Aggrey Otieno Akula, an obstetricist gynaecologist, observes that community attitudes contribute to the alarmingly high numbers of unsafe abortions.

“Lack of knowledge, myths and misconceptions, combined with health provider attitudes, are partly to blame for these high numbers of unsafe abortions,” says Dr Akula, adding that the myths make it hard for uninformed women in rural areas to accept contraceptives.

Some believe that family planning causes infertility, reduces a man’s or woman’s sexual desire, causes birth defects, and affects one’s weight. “If we were to address such fears,” says Dr Akula, “more women and sexually active girls would embrace contraception, hence reduce teenage pregnancies and cases of unsafe abortions.”

Decision making dynamics

A research paper by Dr Timothy Abuya, titled Decision Making Dynamics on Family Planning Use Among Couples in Kenya, argues that incorporating male voices in family planning programming and policy might have positive implications on uptake and fertility related outcomes.

“In many parts of Africa,” says Dr Abuya, “most family planning programmes put emphasis on informing clients on the methods available and how to use them, but there are limited efforts placed on understanding the decision making processes that clients undergo before seeking family planning services.”

That decision, it often turns out, is made by the man, so whether or not a woman is exposed to family planning information does not matter if her man does not buy in.

Dr Abuya is also worried that “most of the funding for family planning is from international organisations” and wonders what would happen if such donors withdrew or decreased their funding. “Would that be the end of family planning programmes in Kenya?” he poses.