Natural family planning has emerged as a preferred method for women in the country even as the uptake of modern contraceptives among married women increases by five per cent.
According to the Reproductive and Maternal Service Unit of the Health ministry, under the family planning methods, about 63,785 women (10 per cent) were by August using natural methods, which include abstinence or monitoring safe days.
Among those using modern methods, a majority of women (760, 800) were using the injection method, followed by male condoms 251,712, combined oral contraceptive pill (COC) had 219,138 users, 153, 541 women were using implants (two rods), while the progestogen-only contraceptive pill method had 87,133 users.
The usage of short-term acting methods increased from 23 per cent in 2019 to 27 per cent in 2020 while that of the long-term methods reduced from 20 to 19 per cent.
The demand satisfied by modern methods increased from 74 to 76 per cent. This means that out of 10 women that needed modern family planning in 2020, eight were able to get the methods.
The report also indicated that married women use modern contraceptives more than their unmarried counterparts at 58 per cent in 2019 and 62 per cent in 2020, as compared to 56 and 61 per cent, respectively.
However, with the increase in the number of women using modern methods, stock-outs of commodities remain a problem in public and private health facilities, with many of the commodities yet to be delivered as of last month.
From the data, only about four methods were in stock and not enough for the whole country. The only available method that would last the country for the next 34 months is COC. There is less than two months of stock of intrauterine devices. The rest of the methods – implants, emergency contraceptive pills, injections, cycle beads and progestogen-only pills – are out of stock.
Could this be the reason why more women are now choosing to go the natural way?
Mildred Atieno, who missed the method that she really wanted, opted to try natural family planning, and for three years now, she has never used a modern method, though she conceived her third-born at a time when she was not ready.
“I made trips to public hospitals and every time my preferred method, the non-hormonal copper coil, was always out of stock, the hormonal ones would make me bleed, this is why I started using the withdrawal and cycle beads methods,” she said. At some point, she lost count of her safe days and fell pregnant.
“This is method is only good when you have a regular cycle and are smart at counting the days, otherwise, if you are forgetful, you might end up conceiving when you are not ready,” she said.
Prof Peter Gichangi, the principal investigator at Performance Monitoring for Action (PMA) Kenya, said the traditional methods were equally important since there are individuals who still benefit from them.
“This is usually an individual choice. If couples agree to use either safe periods or the withdrawal method, then it is okay,” said Prof Gichangi, who is also a lead researcher at the International Centre for Reproductive Health Kenya.
Natural methods have no side effects. They include the lactational amenorrhoea method, coitus interruptus (withdrawal), calendar method or rhythm method, cervical mucus method and abstinence.
“Women may choose to use these methods because they have a religious objection to contraception or because they prefer to use a hormone-free method. However, these methods are less effective than modern contraception,” Dr Gichangi said.
Given that more women are aware of modern methods and the uptake is increasing, from 40 to 46 per cent in all women, a few of those who are opting for natural methods may be doing so out of fear of side effects.
The Centres for Disease Control (CDC) confirms Prof Gichangi’s assertion that traditional methods are not as effective as other methods of birth control. It states that the failure rate is 24 per cent, which means that about two in 10 women who use natural family planning will get pregnant.
“You need to be careful, be diligent, and have plenty of self-control to practise natural family planning. You have to follow instructions completely to be successful. If you do not have regular periods, then it is not advisable to practise this method of family planning,” states CDC.
Dr Gilchrist Lokoel, the director of medical services in Turkana County, added that in some parts of the world, culture has made it difficult for some women to use modern family planning.
“Traditional methods are accepted though they are not as effective as modern ones and they cannot be used by everyone. You need to study your body carefully. To avoid unintended pregnancies, it is advisable to decide on one method that is most convenient for you,” said Dr Lokoel.
With the Covid-19 pandemic, access to family planning services dipped by 4 per cent in 2020, the Health ministry revealed. Some of the services that were interrupted include information sharing, family planning commodities distribution and counselling and assessment.
The Ministry has however not established why there was a decline in access to these services.
Head of Family Health at the Health ministry Dr Estella Waiguru said that it could be because of Covid-19 and fear of the unknown.
“Women may not have reached out to get these services because of fear of contracting Covid-19. They might have kept off the hospitals, but that is just speculation. We are yet to investigate why this drop happened. When research is conducted, then we can learn what exactly caused the dip,” she told Sunday Nation.
This year’s theme for the World Contraception Day, which is being celebrated today, is Leaving No One Behind, and the government says it plans to reach out to the vulnerable and marginalised populations to enable them to access family planning services.
“Some people living with disabilities may be missing out on the services, so we want to include them and make sure that the access is equal to all,” said Dr Waiguru.
“Even while we plan to reach the marginalised areas such as the north-eastern parts of Kenya where the uptake is quite low, we will ensure that family planning remains a voluntary service. We will not coerce anyone into taking a commodity that they are not willing to,” she added.
However, some stakeholders feel that men are being left behind in the conversation on family planning.
Dan Otieno who works with the Network for Adolescent and Youth of Africa, said that including men will be in tandem with this year’s theme.
“Men are left out of the contraceptives topic. We want this year onward to have gender-inclusive family planning,” he said. “This way, we will avert unwanted pregnancies because, at the end of the day, girls bear the brunt of such occurrences. It may lead to abortion, and because our laws dos not provide for abortion unless it is on special medical grounds, the unsafe abortions may lead to permanent damage of the girl child.”
While commemorating the day at the Sarova Panafric Hotel in Nairobi on Friday, Dr Dan Okore of the United Nations Populations Fund said that plans are underway to ensure that family planning services are accessed even beyond the usual hours.
“It is quite unfair that family planning services are limited to certain periods. We are piloting a programme in Western Kenya to ensure that people get 24-hour service,” Dr Okore said.
He also noted that up-scaling and training human resources on health can be useful in ensuring that people get the essential family planning services.