STATISTICS: Covid-19 slows down family planning efforts

The uptake and usage of contraceptives among women aged 15-49 has dropped significantly in recent times.

Data from the Ministry of Health shows that between July 2020 and June 2021, 5,020,335 women of reproductive age accessed the services compared to 5,495,975 in the period of July 2019 to June 2020.
The gap between 44% and 29.6% over the period was attributed to Covid-19.

On Sunday, Kenya marked this year’s World Contraception Day.

Since 2017, the contraceptive prevalence rate (CPR) or the number of women accessing the service has been increasing, with 37 percent (2017), 43.4 percent (2018), and 44 percent recorded in 2019.
The sharp drop of almost 500,000 women in 2020 is a setback for the country’s efforts to tackle the double burden of unwanted pregnancies as well as the spread of sexually transmitted infections (STIs) and HIV.
Experts have attributed this unfortunate trend to the COVID-19 pandemic that kept many young people away from health facilities that provide the vital service
According to Dr Estella Waiguru, who is the Family Planning Lead at the Ministry of Health (MOH)’s Department of Family Health, young people stayed away from the facilities due the restrictions imposed to contain the pandemic.
“We recorded a reduction in the numbers of young people visiting the health facilities for family planning services. This trend was most pronounced among those aged between 15 to 49 years,” she said.
MoH data shows that 38 percent of the women who visited the facility preferred implants, with another 35 percent opting for injectable contraceptives like Depo Provera.
Dr Waiguru said more research was needed to establish why women preferred these options compared to condoms and pills which were required by just 8 and 7 percent respectively. Another 5 percent opted for sterilization while 4 percent preferred the coil or intro-uterine device (IUD).
“More studies are needed to find out why women prefer these discreet methods as opposed to a method like condoms that would require discussion with their partners. In addition to resistance from the men, there could be an element of fear or reservation around the condom as an option,” said the medic.
In an effort to ensure that young people access contraception at any time, the Centre for Adolescent Studies (CAS) carried out a reproductive health service improvement project in Western Kenya in 2020.
The study which was dubbed After The Hours was designed to avail the family planning services beyond the facility’s normal working hours.
“Our aim was to increase the time for the provision of services after the normal working hours that run from 8am to 5 pm, including weekends,” CAS official Dollarman Fafinato said.
CAS trained healthcare workers at the facility to be available for consultation around the clock. The project findings are published on the WHO website.
“We trained the staff to address the young people’s needs on request. The project findings were captured as a successful high-impact reproductive health services and published by the World Health Organization (WHO),” he said.
Mr Fafinato expressed hope that other counties will adopt the model for more efficient family planning services.
“We hope that these practices can be adopted by other counties. Due to the pandemic slowing down the provision of services, teenage pregnancies and other poor outcomes have occurred,” he said.
Mr Fafinato said that the model cannot be effective in all settings, given the country’s diverse religious and cultural landscape.
“County-specific interventions to improve reproductive health services are required to develop solutions suitable for every region,” he said.     
According to the United Nations Population Fund (UNFPA), Kenya’s total fertility rate (TFR) is currently 3.33, which reflects a 1.5 percent decline from the 2020 rate.
Kirinyaga, Meru, Kiambu, Machakos, Tharaka Nithi, Embu, Nyeri, Makueni, Nyamira and Muranga are the 10 best performing counties in terms of uptake of modern contraceptives (mCPR) among married women or those in unions.
This is according to the 2021 national fact sheet published by the National Council on Population Development (NCPD).  
In Kenya, more than half of the women of reproductive age (15-49 years), in Turkana (64 percent), Nyamira (58 percent), and Kiambu (54 percent) have autonomy or freedom to make decisions on whether to use contraceptives or not.
In West Pokot however, an estimated 46 percent of men have the sole decision making power on contraceptive use by their spouse.
Counties where spouses make joint decisions on contraceptive use are Taita Taveta (81 percent), Tana River and Kisumu (78 percent), Tharaka Nithi (75 percent), Makueni (74 percent), Kisii (73 percent), Uasin Gishu (72 percent), and Kilifi (70 percent).
The North Eastern region counties of Mandera, Wajir and Garissa still have the lowest CPR of less than 10 percent each.  
A data sheet published by the Population Reference Bureau (PRB) shows that the population in the Eastern African region continues to grow.
“Regions such as Eastern Africa, where the average woman has a large number of children compared with other places, continue to experience significant population growth,” reads the document.  
The bureau says the number of people in a country will have a significant effect on how it uses available funds for development.
“The size of a country’s population can have important social and economic implications, including how government resources are allocated and whether the country is able to invest in its development goals,” the PRB says.
Eastern Africa’s population is projected to nearly double in size during the next 30 years, from 458 million in 2021 to 861 million by 2050.
Experts have projected a twofold increase in the population of Burundi, Madagascar, Mozambique, Somalia, Tanzania, Uganda, and Zambia by 2050.
Ethiopia, which is the region’s most populous country, is projected to nearly double, from 117.8 million in 2020 to 208.3 million in 2050.
Kenya’s population is projected to increase from 54.7 million in 2020 to 89.6 million in 2050.
Dr Waiguru said there was need to dispel mistaken notions among Kenyans on the intentions of the contraception services offered by the government and partner organizations.
“What we are avoiding through the use of contraceptives is the adverse effects of their absence. These include the situations that compel young women to go for unsafe abortions, which are usually harmful to the health of the woman,” she says.
In 2016, a study on abortion by the African Population and Health Research Centre (APHRC)’s showed that nearly half a million induced abortions occurred in Kenya in 2012.
This works out to an induced abortion ratio of 30 abortions per 100 live births, and a rate of 48 abortions per 1000 women of reproductive age.
The study, which was acknowledged by the Ministry of Health, found that 77 percent of women who visited Kenyan health facilities for post-abortion care (PAC) were treated for moderately-severe and severe complications, such as sepsis, shock, or organ failure.
Dr Waiguru reminded Kenyans that the shocking statistics on illegal abortions were more than just numbers. The data, she said, stood for the death, pain and misery they caused.
“Abortion is illegal in the country. These abortion figures are not just statistics but intimate and important details about our mothers, sisters, aunts, neighbours and friends,” she says.
Dr Waiguru said increased family planning uptake is justified because it will lead to reduced loss of life by pregnant women that may resort to abortion. She added that it was the perfect tool to allow women to manage their fertility for a better quality of life.
“One of the main goals of family planning is to prevent unintended pregnancies. In providing the service, we look forward to a future scenario where all pregnancies are planned, and where every child will not only be planned for, but expected and welcomed,” said the medic.
According to Dr Joseph Okore of the United Nations Population Fund, family planning is a human right that has long suffered from wrong perceptions and labels.
“Family planning is a human right that should not be coerced. No one should be forced to get the services,” he said.
The medic takes the view that family planning should be called child spacing. This, he says, is appropriate because it has been in use for a long time in traditional African societies.
“In culturally or religious or culturally sensitive settings, the ideal label for family planning is child spacing. This is because in traditional African society, we had the idea that once a child is able to be sent, then it is time for another one to be conceived. The spacing in between allowed the mothers time to rest and regain their strength for the next child,” he said.
Dr Okore says the practice of conventional family planning uses modern methods to achieve this noble but time-honoured objective.
“Modern methods of contraception are designed to help families plan for the children,” he said.
He said it was important to find a way to ensure that women in marginalized areas also accessed contraception.
“It is important to note that the northeastern region has recorded the lowest mCPR, in addition to high rates of maternal and child mortality. More efforts should be made to scale up contraceptive uptake in such areas, in line with the national objective of leaving no one behind,” he said.
Dr Okore said UNFPA is also involved in the effort to make contraceptives available to vulnerable and marginalized populations.
“We are working with partners to increase access to contraceptives among people living with disabilities as well as key populations like commercial sex workers and men who have sex with men,” he said.
According to the UNFPA official, the government contributes between 40 to 60 percent of the country’s contraceptive commodity needs. In 2020, UNFPA procured commodities worth Sh938.4m or 8.5 million USD.
This year, the UN body has so far bought commodities worth Sh386.4m or 3.5 million USD.  
“The government contributes to the procurement of 40 to 60 percent of the country’s commodity needs. The balance or remaining gap is filled by development partners including the UNFPA depending on the long or short term needs,” he says.
Dr Okore pointed out that the country needed to scale up funding for the family planning program and fully cater to local needs.
“At the ICPD Summit in 2019, President Uhuru Kenyatta committed himself to increase the country’s allocation for the health budget to 15 percent. This would enable the country to buy 100 percent of the contraceptives. Kenya will not rely on donors and development partners for support in the purchase of commodities much longer,” he said.
Mr Alvin Mwangi of the Sexual and Reproductive Health Alliance asked policymakers to ensure that they involve the youth in decision making on family planning.
The SRHR Alliance is coalition of 17 civil society organizations working to promote the sexual and reproductive health rights of young people and women in East Africa.
Mr Mwangi said the involvement of the youth in reproductive health policy formulation would enable the programme to be designed with their needs and views in mind.

“The government should actively seek out the voice of the youth in its efforts to implement a youth-friendly reproductive health programme. This is the only way to design and implement a programme they will easily accept and participate in,” said Mr Mwangi.

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