With 13 kids at 26, is she Kenya's most fertile woman?

Selah* sat on her bed, nonchalantly sipping her tea, surrounded by her bundles of joy. She paid us little attention as we stood around her bed listening to our colleague go through her medical and obstetric history in amazement which was quickly turning to shock.

Selah was 26 years old, now a mother of thirteen babies borne of seven pregnancies.

The medical history was not good enough for me. My extremely nosey self was here for the full story. I could not wait for the round to end so that I could come back and get the details. All thirteen babies had been delivered normally and Selah was essentially ready to go home with her babies, who were all healthy and ready for discharge.

However, the senior consultant obstetrician who was running the round that day was having none of that. He is an ardent contraceptive champion and could not understand how this had come to pass. He gave clear direction that Selah would get full contraceptive counselling and where possible, be provided with the same before she went home, to ensure this did not turn out to be another missed opportunity for care.

Your bet is as good as mine; I volunteered for the task, to have a moment to understand Selah’s predicament. She had delivered her first baby at 13 years, leading to the cessation of her education.

She was growing up in the village in Siaya County back then, being raised by her grandmother as one of four grandchildren orphaned because of HIV.

With her elderly grandmother struggling to put food on the table, Selah’s dropping out of school was not even noticed. She joined her grandmother on the farm and in the market, selling the fruit of their toil to make ends meet. At 15, Selah was blessed with her second baby. She pretty much resigned to being a mom and her ambition to return to school was dead and buried.

At 17, Selah got married to a young man from the village across. At 18, her third baby was born, quickly followed by twins at 20. Her husband moved on to another wife and kicked her out. She moved back to her grandmother’s home with five children.

With life getting more difficult, Selah had to find other means of feeding five mouths. She started a small business as a supplier of omena, where she would buy it raw from the fishermen, deep fry it, and ship it to various sellers in Nairobi at a pretty penny. She was making enough to support her grandmother, who would happily take care of the children while she supported them.

With time, Selah found her way to Nairobi and her business expanded. She travelled back and forth and was finally making ends meet. She met someone and they moved in together and at 23, she was pregnant again, delivering healthy triplets. The relationship with the father of her triplets was blowing hot and cold and immediately the triplets got to a year old, she left them with her grandmother and got back to business.

But as they say in Kenyan lingua, whatever goes on between a couple, stay out of it. In a year, Selah was pregnant again, with twins coming through. She was a 24-year-old mother of 10. I have no idea how she was not even looking shaken as she narrated this to me. But suffice it to say, the shock was all mine as here she was, two years later, at 26, with a new bundle of triplets.

What was mind-boggling was how all of Selah’s babies were perfectly healthy; she had delivered all of them vaginally with no complications, and despite being multiple gestations with a high likelihood of premature births, her babies all made it to at least 37 weeks, and they were pretty huge for triplets. They never needed any special care. She was also able to breastfeed them all exclusively.

Selah pretty much came across as never having been any wiser regarding the risks her pregnancy presented. She did not attend antenatal care properly as she was too busy trying to provide for her ever-expanding number of mouths to feed. She had no appreciation of the recurring cycle of poverty created when her grandmother was relegated back to raising infants for the third time in her lifespan.

At the moment, her children could attend school because of the government directive of free primary education but this was not enough.

Having missed out on education herself, Selah had no appreciation of the importance of a quality education either. She had no yardstick to measure her aspirations for her children’s future concerning success.

My last question to Selah was about the multiple births. Selah’s repeat multiple births was a wonder in itself. With limited information regarding her extended family, Selah had no way of knowing if this was a common occurrence in the family. Her grandmother did not sire any multiples and she had no information regarding her mother’s side of the family.

Concerning her fertility desires, Selah was sure she was done having babies. On further enquiry as to why she had not used contraceptives before, Selah simply said she did not know much about them. She was always discharged home to come to the clinic after six weeks for contraceptives but she never got the opportunity to visit the clinic until it was pretty much time to deliver the next baby. As long as her children had received their vaccines, she was done with the health system.

Sellah had a momentary panic attack when I pointed out that while we were having this conversation, her daughter was capable of turning her into a grandmother, should she walk down the same path as Sellah.

After an hour-long session educating Sellah about her contraceptive options, she was clear that she was in for the permanent sterilisation option. She wanted her tubes cut and tied.

She opined that at the rate at which she was going, her next pregnancy might bless her with quadruplets, a theory she was not about to test. However, Selah’s limitation to accessing her method of choice was finances.

She needed to raise Sh6000, a budget she did not have. We had to get creative.

Like many times before, we came together as colleagues and fundraised for her. None of us wanted her back for our services. We were all done here. Early the next morning, Selah was wheeled off to the day surgery theatre and underwent a postpartum tubal ligation. She was back in the ward in time to breastfeed her little ones before they missed her. She went home a content woman.

As we celebrate World Contraceptive Day this week, the bittersweet memory of Selah haunts me. We must continue to ensure that our health systems are responsive enough to guarantee contraceptive access to all!

Dr Bosire is a gynaecologist/ obstetrician