Coming Soon in Kenya - A Two-Child Policy
Ann Wafula, 30, patiently waits to see the gynaecologist at Gilead Medical Centre, situated in the upmarket Upper Hill area of Nairobi.
The mother of a three-month-old baby boy, who is also her first born, is here to consult with the doctor on what contraceptives she should use, based on a hormonal test carried at the hospital.
In Hagadera, three hundred kilometres away to the east of Nairobi, 21-year-old Asha Abdalla is a proud mother of twin girls, delivered just a few days ago at a local dispensary. The twins are her second and third born, while her first born is aged barely two years. “I conceived when he was just nine months,” she explains.
Unlike Ann in Nairobi, Asha does not use any contraceptives, partly because of cultural inhibitions and largely because of misinformation and accessibility issues. She knows that there are things called contraceptives and a concept known as family planning, but she does not know how either works.
“All our culture expects of us women is to bear children,” Asha says. “In such a scenario, how dare I suggest family planning to my husband? It’s unheard of... almost impossible.”
Asha is semi-literate while Ann is a business executive in Nairobi. Asha’s biggest role in her community is homemaking and is excluded from making any important decisions that affect her and her family, while Ann, educated and climbing the career ladder, know that any decisions she makes or are made on her behalf will affect the trajectory of her life and children, and thus must carefully examine the possible outcomes of every step she takes.
Such scenarios are common all over Kenya, where the majority of rural and urban-poor know absolutely nothing about the socio-economic implications of their decisions and actions, while a pitiful minority stake a claim to the running of their homes.
This, according to the National Council for Population and Development Director General Boniface K’Oyugi, is a worrying situation.
Dr K’Oyugi is a distressed policy maker; he is among a group of experts who have formulated various family planning measures that only serve as short-term solutions as they explore the idea of a more educated, informed society.
“Statistics have indicated that the more a woman is educated, the less number of children she would bear,” he says. “An educated woman is an informed woman who has the will and access to explore contraceptives and thus plan her family well.”
The United Nations Population Fund (UNFPA) will launch its state of the world population report in a few week’s time, and it is expected that the economic benefits of family planning at individual, household, community and country level will be the highlights of the study.
In Kenya, despite attaining a contraception prevalence rate of 46 per cent, economic planners say the burden a rapidly growing population is putting on the available resources is worrying.
An exploding population growing at the rate of one million people per year and a stagnant economy that does not grow three times as fast as the population is can only spell one thing: disaster.
It is in this light that Parliament early this month passed Sessional Paper No 3 of 2012 on Population for National Development, which, among other things, aims to control the growth of the country’s population, expected to nearly double from the current 42 million to about 80 million in 2030.
If all goes as planned, women will give birth to an average 2.6 children compared to the current 4.6 as part of the government’s move to halve the prevailing fertility rates.
This, experts believe, will lessen the housing, utility, health and education burdens on the economy as well as push the country closer to achieving its development blueprint, the Vision 2030.
Half of Kenya’s population comprises the poor, and that segment, to which Asha at the beginning of this article belongs, is rapidly growing.
To tame the trend, the government plans to first popularise the short-term measure of universal access to family planning, then empower the current and next generations with the right information and education.
“Poor people highly contribute to a drop in economic stability because majority of them have the highest birth rate,” says Dr K’Oyugi, explaining the attention the state is giving this demographic.
“The tragedy is that, as the population grows fast, so does service delivery demand go up. If the taxable base does not correspondingly grow, the economy drops, sometimes rapidly.”
For instance, last year, the economy was expected to grow by 5.6 per cent but ended up growing by a measly 4.5 per cent, the worst percentage growth recorded in the last four years.
This year, the economy is projected to grow at between 3.5 to 4.5 per cent. Contrast this with the expected three per cent growth in population and you begin to see why the increasing number of people to cater for is worrying planners.
Vision 2030’s main aim is to transform Kenya into a newly industrialising, middle-income country providing a high quality of life to all its citizens by the year 2030, all in a clean and secure environment.
But this rapid population growth threatens the achievement of the three key pillars of the Vision, which include economic, social and political stability.
Suspended Kenya National Bureau of Statistics Director General Anthony Kilele has previously argued that, for the current poverty levels, which stand at 46 per cent, to drop, and for Kenya to stabilise, there is need for the economy to grow at thrice its population growth rate.
Already, the government is running a Sh25 billion deficit and, Dr K’Oyugi warns, if nothing is done to remedy the situation, the economy will remain dependent on foreign investors.
The outlook cannot be gloomier for the architects of Vision 2030, who had hinged the attainment of their goals on, among others, a 10 per cent growth in the GDP by the end of this year.
That target will be missed by more than five percentage points.
But demographers insist that, other than family planning, one of the government’s major investments should go to education in order to tap into the economic and social aspects outlined in the Vision.
“If we do not consider these issues, then we should expect to live in a country with an over 70 million people who are highly depended on foreign investment. If the current global economic outlook is anything to go by, such a scenario is quite a jittery affair,” says Dr K’Oyugi.
“Vision 2030 can only be achieved if we intertwine family planning with higher levels of education, boost the economy and achieve political stability.”
The government’s attention is now on the poor, whom it refers to as “special and vulnerable groups”. The strategy is to offer them vouchers for delivery and reproductive health services that include family planning.
UNFPA country representative Dr Zama Chi notes that citizens need to build their socio-economic being and start being responsible for their actions.
“If you give birth to a child, then you ought to have planned for it and ensure that the child’s livelihood and future is protected and catered for. This way, the government is able to sustain itself without having to shoot itself in the foot,” says Chi.
The government targets 70 per cent of women to be on contraception by the year 2015.
Those on birth control are not disciplined enough
The United States has one of the highest rates of unwanted pregnancies in the developed world — nearly half of pregnancies are unintended, and there has been no improvement in the situation for a decade.
Why? For one thing, women often encounter problems when the birth-control method they had been using no longer works well for them. Many women and their doctors are poorly versed in the wide array of effective choices and how to switch from one method to another without risking pregnancy.
Women choose to switch with surprising frequency. In a national study of contraceptive switching rates, researchers at the Battelle Centers for Public Health Research and Evaluation concluded that “many women are probably dissatisfied with their experiences with particular methods.”
With discontinuation rates as high as 90 per cent for some methods, the researchers found that 40 per cent of married women and 61 per cent of unmarried women in the study had switched methods over two years.
Disturbingly, the researchers also found that “about one in 10 women choose to abandon contraception altogether, even while they are at risk of an unintended pregnancy.”
Most women get their contraceptives from family doctors and health clinics, not from gynaecologists who are presumably well-informed about the choices and able to help women select a method, or two methods, best suited to their circumstances.
Without proper guidance on how to make these changes safely, gaps often occur in contraceptive protection that can result in an unintended pregnancy.
The decision to abandon a birth control method can be a perilous one. William R Grady, who directed the Battelle study, said in an interview:
“Substantial numbers of women change methods within two years, and there’s a high rate — higher than expected — of moving to no method. They may have successfully avoided pregnancy for a year or more and believe, incorrectly, that they have a fairly low risk of conception.”
It happened to one young woman. She was having serious, persistent side effects while on the pill, so the prescribing doctor told her to stop taking it but failed to provide an alternative. She was soon pregnant with her first child, derailing her college plans.
Six years later, unmarried and struggling to be a good mother, to support her child and to attend college part time, she entered a new relationship without contraceptive protection. Having not conceived again for so many years, she thought she was not very fertile, but soon she had a second child.
Another factor that puts some women at risk of an unintended pregnancy is the false belief that one must wait until the beginning of a menstrual cycle to start a new method.
These gaps in protection should never occur, said Lesnewski, who was an author of a report on preventing contraceptive gaps in American Family Physician last year.
“Many women get pregnant when they stop one birth control method before starting another,” she said. For example, a woman who has been on the pill should not wait for the start of her next period before she begins a different pill. Rather, she should switch directly from one pill to another without missing a day.
For other kinds of changes — say, from a pill to a contraceptive patch — a two-day overlap is needed to prevent a decline in hormone levels and assure contraceptive protection.
When switching from a pill, patch or vaginal ring to a progestin IUD or hormonal implant, an overlap of seven days is needed, but no overlap is required if switching to a copper IUD.
On the other hand, if the switch is made in the opposite direction — from a copper IUD to a pill, patch or ring — a woman should use the new method for seven days before the IUD is removed.
Another option is to rely, religiously, on a barrier method of contraception, like a condom or diaphragm with spermicide, to cover any gap in protection. Use of a barrier method for seven days is essential when changing from a copper IUD to a progestin IUD (or for four days when making a switch in the opposite direction) because a woman can become fertile as soon as an IUD is removed.