When Joseph Mwita made a decision two years ago to have his wives’ fallopian tubes removed, he had no idea there would be a time like this when Kenya has been hit by a contraceptive shortage.
It has turned out to be the best decision he ever made as Covid-19 disrupts the supply of contraceptives, leaving many women exposed to unwanted pregnancies.
In 2018, Mwita, a farmer from Kuria, Migori County, took his two wives for a tubal ligation, which means their tubes were removed to prevent pregnancy.
His two wives had nine children and he feared the family would suffer financial hardships should they have given birth to more. “I lived a very difficult life. I never went to school because we were very many children in our family and my parents could not afford to take care of us. I did not want this kind of life for my children. The little I have is enough to educate and take care of the nine children I already have,” he told HealthyNation, adding that they have never regretted the decision as a family.
The day he decided to have his wives take the procedure, Mwita had taken his farm produce to the market when he heard an announcement asking women to go for a free tubal ligation. He inquired about the details of the procedure and shared the news with his wives.
His wife Angela was the first to agree to the procedure. She had tried all the family planning methods, but, she was reacting to most of them. She felt the four children she already had were enough.
“I had used all the methods, including the long term ones. Whenever I used them, I would bleed. Sometimes I would be admitted to hospital for a blood transfusion. Whenever I stopped using a birth control method, I would conceive,” she said.
Her fourth child had come unexpectedly and she opted for a tubal ligation to avoid another unplanned pregnancy. “Farming is all we have and the little we get is what we use for food and school fees. How was I going to take care of seven children, which I would be having by now if I had not gone for the procedure?” she asked.
“Since I had the procedure, I’m okay. No bleeding, no side effects and I don’t have to go to the hospital to pick drugs,” added the 24-year-old.
HIGH BLOOD PRESSURE
For Christine, Mwita’s second wife, the decision was made because she did not want to continue using any family planning method.
She got sterilised at 30. She also felt the five children she had were enough. When she was pregnant with her fourth child, she developed high blood pressure during delivery. Due to this, the doctor had told her to go slow on getting another child. Unexpectedly, she got her fifth baby, who was delivered through Caesarean section.
With her firstborn now in university, she wants to concentrate on taking care of her children and helping her husband with his business.
In their village, Mwita is now seen as a male family planning champion. He has been urging people to go for tubal ligation to better plan their families.
According to a new report from the Centers for Disease Control and Prevention (CDC), sterilisation is the top contraceptive method, with 18.6 per cent of birth control users opting for it. However, the procedure is most common among older women, with 40 per cent of those in the 40 to 49 years age bracket choosing it. That said, it was still an option among younger groups, with 21.6 per cent of women between the ages of 30 and 39 and four per cent of those between 20 and 29 choosing it.
For Angela and Christine, the family planning shortage will not interrupt their lives. But, for others, the story is different.
For one month now, Elizabeth Akinyi has been moving from one facility to the other looking for her precious contraceptive without success.
The mother of three from Mathare North in Nairobi has been on a three-year implant since 2017. It expired in March and with the disruption in the supply, private hospitals are now charging Sh8,000 for a new one. She had got it for free at a public hospital. Akinyi prefers the long-term method because, unlike pills, it is easy to conceal from her husband, who wants her to “have as many children as possible, but does not offer support”.
At the hospital where she had got it, most contraceptives were out of stock and only emergency pills were available. “I have gone to three health facilities and all of them are out of supply. I just have to get something to keep safe lest I get another child,” said the 34-year-old.
Akinyi either has to look for the Sh8,000 or wait for normal supply to resume, which might take long. She risks an unplanned pregnancy.
Hers is not an isolated case. She represents thousands of women especially in the rural areas struggling to raise many unplanned children. This is due to ignorance, retrogressive cultural practices that shun birth control methods or lack of access to family planning.
As Covid-19 takes up most of the health resources, people with other needs are struggling get care and among the forgotten medical needs are reproductive health services. Due to lockdowns in some countries, there has been a disruption in the importation of contraceptives into the country. As a result, in various health facilities, most of the methods are unavailable, especially the long-term ones.
The lockdown-related disruptions in production in major manufacturing countries, combined with transport and supply chain issues, may have a longer-term effect in the country.
If the pandemic continues, there could be a disastrous effect on women and girls. Experts now warn of an increase in the number of unwanted pregnancies, sexually transmitted infections and perhaps unsafe abortions in the country, where thousands of women die yearly for lack of access to reproductive health care and family planning.
These unplanned pregnancies will rob the girls of their youth and education, undermine opportunities for employment and increase poverty and inequality.
“The shortage will definitely have a ripple effect. Many women will become pregnant, and abortion cases will rise, leading to more complications during childbirth. We need to make the commodities accessible,” Prof Peter Gichangi, the principal investigator for Performance Monitoring Action (PMA) in Kenya, had said earlier this year.
A disturbing report by the National Council for Population and Development reveals one in five girls aged between 15 and 19 in Kenya is either pregnant or has already given birth.
As at the end of 2019, a total of 379,573 girls, including 10-year-olds, missed their monthly periods, their innocence having been stolen men alike who lure them into sex. More than 20,828 minors driven into parenthood were aged between 10 and 14 years, showed the report.
Data collected by PMA 2020 in 11 counties between November and December last year revealed that the number of unintended pregnancies were highest in younger people (15 to 19 years) at 60 per cent.
It also showed that 50 per cent of young people between 15 to 18 years were sexually active and only about 11 per cent of them were using a family planning method, although they wanted to prevent pregnancy.
“There is a huge disconnect between the desire to use (a family planning method) and availability in terms of access and this puts the women at risk of becoming pregnant,” said Prof Gichangi when releasing the data.
Last week, United Nations Population Fund’s (UNFPA) data showed an estimated seven million unintended pregnancies will be added globally for every six months of lockdown.
Sharing her sentiments during a webinar organised by Columbia University Mailman School of Public Health, UNFPA Executive Director Natalia Kanem said about 50 million other women will lose access to contraceptives in the same period.
Population Reference Bureau (PRB) statistics showed Kenya loses 5,500 mothers yearly to pregnancy- and birth-related complications. The data also shows that one in every 19 children die before their fifth birthday. PRB’s Country Director Kenya and Regional Technical Advisor East and Southern Africa Angeline Siparo said if counties prioritised family planning, they could avert the loss of an additional 2,138 lives by 2020.
Indeed, such grim figures can be avoided if women are free to decide on the number and the spacing of their children.
Marie Stopes Kenya also raised concerns, saying if sanity was not restored and services continued to be disrupted from April to December, the country was likely to witness a worst-case scenario of about 100,000 unintended pregnancies, 65,000 unsafe abortions and 500 maternal deaths.
“We are staring at a deadly situation if nothing is done in the future. We should act and act fast,” said Sophie Hodder, Marie Stopes Kenya country director, adding that the organisation had suspended its outreaches because of the curfew.
A survey done by International Planned Parenthood Federation on its national member countries, Kenya included, revealed 5,633 mobile clinics and community-based care outlets had closed because of the outbreak across 64 countries. Members reported a scale down on contraceptive care services, gender-based services and reduced availability of abortion care.
This is going to bring down the gains the country has made over the years as far as access to modern family planning is concerned. The longer-term effect can be predicted as lockdowns are significantly impacting the production of condoms and other contraceptives in the main manufacturing countries, including India, Indonesia, Malaysia and Thailand.
Kenya is already feeling the immediate effect, with many contraceptives and hormone replacement therapies already out of stock.
DKT International, one of the world’s largest providers of contraception and safe abortion products and services, early this year experienced a shortage of medical abortion pills for its programme in Kenya when thousands of packets got stuck at the New Delhi airport for nearly six weeks due to air cargo delays.
And because most of the active pharmaceutical ingredients come from China, the epicenter of the Covid-19 pandemic at the time, there has been a delay in filling orders and this has resulted in backlogs in supplying key reproductive health medication and commodities to countries around the world.
Some countries, including India, have prohibited manufacturers from exporting products containing progesterone, a critical hormone used in many contraceptives.
Even after the medication is shipped into the country, shortage of staff at the port is hindering the process and regulatory approval of products is taking months, if not weeks.
To mitigate risks and reduce stockouts, the DKT CEO recommended, where possible, programmes should buy extra contraceptives due to the uncertainty brought about by the pandemic. They have reported stock-outs of contraceptives and anticipate a condom shortage as delivery times have doubled from two to four months, said the CEO on Twitter.
Most countries require some kind of regulatory approval for the import of contraceptives and many countries demand that such be renewed on a periodic basis, but with the decision to limit travel to most countries and closed borders to visitors from select countries, the consignment has to be delayed.
HealthyNation sought to find out how much stock the country has. However, calls, emails and text messages to Dr Jonah Mwangi, the Kenya Medical Supplies Authority (Kemsa) CEO, went unanswered.
A Kemsa employee, who did not want to be named as he is not authorised to speak to the press, said the agency was not directly in charge of contraceptives. “We do not procure them directly, we only offer storage,” said the officer, who told us to address our questions to Dr Albert Kaburi, the head of reproductive health at the Ministry of Health.
Asked about the shortage and how the government was planning to fill the gap, Dr Kaburi told HealthyNation he was not allowed to talk to the press unless given a go-ahead by the Cabinet Secretary. “Those are very good questions, but I don’t have the permission to talk to you unless I am allowed to. I can’t give you the details,” he said.