“Until I met the community health worker Penina, I did not know that one can have sex and not get pregnant,” said Wanjiru, a participant of the Tupange Family Planning program. Wanjiru is not different from many women living in the slums of Nairobi. Women in these communities believe that they have no control over whether or not and when to become pregnant.
While attending her second year of secondary school, Wanjiru met Kamau. She fell in love with him and after a few months of courtship, they became sexually active. Within the same month, she became pregnant. This led to her dropping out of school, marrying Kamau and moving into a one room structure with him.
She delivered her first born and within one year, she had had her second child. It was not long before she discovered she was pregnant again with her third child. All this was very frustrating for her. She could not adequately feed her two children as it was, and here was another pregnancy. To add to her sorrows, Kamau disappeared and married a younger woman who did not have children. It was difficult for him to feed a wife and a multitude of children and health care, clothing and all of their other needs were too much for him.
When Penina, a Jhpiego-trained community health volunteer, tasked with promoting family planning, visited Wanjiru, she found her in tears. Wanjiru had been asked to leave her home since she was not able to pay the rent and her children were crying due to hunger. Penina told Wanjiru that it was possible to have sex and not have a pregnancy and that she could space out her pregnancies by using a family planning device like an intrauterine device (IUD). Although Wanjiru liked what Penina was telling her, she was afraid of using a family planning method since she had heard they could have side effects, including contracting cancer. However, after two months of follow-up visits by Penina, Wanjiru was convinced and went to the Kangemi health facility to start using a family planning method of her choice.
When I met Wanjiru in Kangemi last week, she had been using an IUD for two years. After she made her decision, she was very excited about the possibility of planning for a pregnancy on her own terms as well as the other benefits it brought her.
“Since I started using the IUD, I have regained my health,”she told me. “I am able to run my small business in the market where I sell food…Without the burden of pregnancy or babies, I am able to devote a lot of hours to my business. All my children are now in school. And, better still, my husband came back after learning that I now have a way of controlling when to get pregnant. I am enjoying my marriage.”
Today, more than 220 million women in developing countries have an unmet need for family planning—meaning they want to postpone their next birth for two years or more or not have any more children but are not using contraception. In Kenya, the unmet need for family planning stands at 26 percent, with higher rates in informal settlements.
Organizations like APHIA, Tunza and Jhpiego have worked in urban slums communities to help women access quality health care information and services, including family planning. When it comes to Jhpeigo’s work, we know that the use of family planning has increased by 13.4 percent among women in the targeted communities.
For women like Wanjiru who are in doubt and fear using family planning to space their pregnancies, Tupange took the approach of engaging community health volunteers who were well-known in their communities to promote family planning. While trained health service providers are a trusted source of information, women in communities tend to relate better to Community Health Volunteers of whom they feel they can ask intimate questions and have time to discuss details of various family planning methods as opposed to unfamiliar service providers who are usually too busy to engage in long discussions.
With more women having adequate information about family planning, there is hope that many of them will be able to space their pregnancies, engage in income-generating activities to support their families and have stable homes and marriages—just like Wanjiru.