Although Mohamed Ekamais from Kalobeyei, just outside Kakuma in Turkana County, may not have seen the inside of a classroom all his life, he is the envy of many men his age in his area.
The 33-year-old has two wives and four children. The four children are from his first wife. His second wife Alice Akiru, 23, has no children. All attempts to conceive have ended in a miscarriage, but this has not stopped the couple from trying to get children. ‘‘It’s only by bearing my children that she will officially become my wife,’’ Ekamais says, laughing mechanically. ‘‘I want at least four children with her.”
Akiru, who has obscure knowledge of modern contraception, cannot wait to ‘‘gift’’ her husband ‘‘as many children as I can conceive’’. This, she says, will ‘‘make me a happy wife’’ and complete their family.
Her husband has heard about contraceptives, but his knowledge is masked in misconceptions. ‘‘My friends say people get sick after using them and that they cause infertility too,’’ he says with a frown, adding with a resigned tone, ‘‘We can’t risk using them before we have children.’’
For an illiterate couple that barely gets by, are they not concerned about providing for a large family? Ekamais says no. ‘‘We’ll just survive,’’ he says in broken Swahili.
At the nearby Loitakoori village, Aleng’oo Lokooyan sits outside her house as her seven children play around her. Lokooyan is 31. While she says she uses contraceptives, there’s little evidence to support this. She has carried a pregnancy every year for the last four years.
Her husband Mark Ekuwam, 43, is a herder and a police reservist. Ekuwam has never wanted his wife to use contraceptives and his knowledge of them is scanty. He even gets slightly irritated at suggestions that it is better to have fewer children.
Besides Lokooyan, he has another wife, 26-year-old Dorcas Lomorkae, who has six children. Lomorkae is heavily expecting her seventh child, even though the sixth has barely left her lap. ‘‘Why are they necessary to use?’’ Ekuwam queries through an interpreter, walking away.
Lomorkae is, however, cooperative. ‘‘I would want to use them, but he does not want this. I am not sure when I can start using them,’’ she says. For now though, Lomorkae, who is also illiterate, has no choice but to continue giving birth.
The story of Ekamais, Ekuwam and their wives mirrors the low uptake of modern contraceptives in the vast county. Women in some areas are reportedly said to use cream from goat milk to control birth. Application of cream as a birth control method, while popular in some remote Turkana villages, is as absurd as it is contentious, with no scientific study whatsoever to prove its efficacy. Joseph Lasuru, senior field coordinator of International Rescue Committee (IRC) in charge of Kakuma Refugee Programme, says his mission serves locals in the surrounding host community.
Those who enquire about contraception, however, account for only 10 per cent of the Turkana community served by IRC’s health programme, Lasuru says.
A 2015 report by the Health ministry titled ‘‘Turkana County: Health at a Glance’’, for instance, indicated that the county’s level of uptake of modern contraceptives stood at a paltry 10 per cent, and even lower in some of its semi-arid regions.
This prevalence was nearly six times lower than the national average of 58 per cent. Turkana had bettered only Garissa (six per cent).
From illiteracy to little reproductive health information, poverty, patriarchy, myths and low distribution of healthcare professionals and facilities, multiple factors are responsible for the low consumption of contraceptives in Turkana.
That said, the scenario in the northern county has been studied several times. Data collected has often ended up in files to gather dust as the soaring birth rate continues.
The ministry’s report showed that distribution of health professionals in the county was low, with an average of 15 nurses, two doctors and 10 clinical nurses for every 100,000 people. This was below the national average of 55 nurses, 10 doctors and 21 clinical nurses. Investment in healthcare remains relatively low.
Experts, however, say the worryingly low uptake of modern contraceptives in the area is largely driven by illiteracy. The 2019 National Population and Housing Census report shows Turkana still has acutely low literacy levels, with the biggest population having never been to school.
Turkana has 851,797 people aged from three years and above. Out of these, 584,977, or 68.7 per cent, have never been to school. Only 3.9 per cent of those who go to school leave after finishing their studies.
Reproductive health expert, Dr Nelly Bosire, argues that illiteracy limits access to information on contraceptives. ‘‘Illiteracy fosters poverty and lack of awareness of sexual and reproductive health and rights. It also promotes gender inequity,’’ says Dr Bosire.
So, how can data-based information be used to enhance consumption of contraceptives?
According to Dr Bosire, attitude, cultural practices and beliefs, religion and level of education all play a crucial role in whether a couple adopts contraception or not.
Both partners must also be involved, she says. ‘‘The struggle is always to ensure that we prevent the escalation of unmet need,’’ Dr Bosire observes. ‘‘The available data goes a long way to aid in planning when finding ways to boost uptake. It helps to map out the population vis-à-vis the healthcare institutions and healthcare workers available,’’ she notes, adding that these insights help in developing a model that helps to address the inequality.
Further, Dr Bosire says belief in large families as a marker of wealth discourages adoption of contraceptives. The situation is not helped either by a high mortality rate of children below five years in the county.
Ultimately, Dr Bosire says, statistical information helps to ‘‘evaluate the extent of the negative predictors and to guide on how to turn around the uptake’’.
To enhance adoption of contraceptives, Lasuru says behaviour change and communication hold the key, especially to debunk the myths around this. ‘‘Occasionally, we conduct health education in the community,’’ he says.