As the world marked the World Contraception Day last week, over 200 million women still do not have access to any form of family planning. In order to bridge this gap, Community Based Distributors of Family Planning are moving from home to home, defying norms to ensure that women and men have adequate knowledge on matters child spacing.
Emily Lochikuk is a 27-year-old mother of three. When she gave birth to her last-born child, she learnt of child spacing from a community health worker in her village. “I visited the Tamkal Health Centre for more information,” she says. On the day we meet Emily, she had brought her five-month-old baby for post natal check-up at the health facility.
Gladys Chebiatich’s delivered her son six years ago at Tamkal Health Centre. “I was quite young. I was only 16 years and did not want to have another child until I was ready,” she says. Fortunately, the then teenage mother sought the services of a community health worker who introduced her to various forms of family planning. For the past years, Gladys says she has had adequate time to take care of her child. “I have tried different forms of family planning and I am now happy. I have had adequate time to recover from childbirth. In addition, I have been able to focus on my farming venture,” she adds.
According to the World Health Organisation, 270 million women of reproductive age globally have an unmet need for contraception. The WHO records that in 2017, 214 million women in developing countries did not have access to any form of contraception. The agency attributes this unmet need to fear or experience of side effects of contraceptives, cultural or religious opposition, limited choice of methods and gender based barriers among other reasons.
Julia Sipoti, a nurse and the West Pokot County Health Promotion Unit coordinator says cultural barriers are still a huge challenge to the uptake of family planning commodities in the area. For some time, messaging on family planning has been viewed as a taboo topic. But using radio programmes across the county, Sipoti says that last two years have seen positive strides in the adoption of family planning. “We have also witnessed general improvement in reproductive health indicators,” added Sipoti.
According to Sipoti, however, cultural practices such as polygamy, a still a challenge to family planning. “Co-wives compete to have many children so that they increase their chances of inheritance. You see, in our culture, the more children a woman has, the more the share of inheritance she is entitled to,” Sipoti explained.
In order to ensure that many people in access information and family planning commodities, Delivering Sustainable and Equitable Increases in Family Planning (DESIP) Programme commissioned a number of community based distributors for family planning commodities in 19 counties, including Elgeyo Marakwet and West Pokot Counties. Paul Yaporeng is one such CBD, who also serves as a community health worker.
The programme seeks to reduce maternal, newborn and child health mortality while increasing the access and use of modern contraceptives.
Yaporeng, a 31-year-old Community Health Worker also serving as a Community Based Distributor for family planning commodities. “I have to plan my week and be strategic in order to attain maximum results,” he says, adding that while doing their work on sensitising the community on family planning, it is important to understand some of the reservations that the community members have. “Such knowledge helps us know the best way to approach this sensitive topic of family planning,” he says.
Yaporeng, who serves over 200 household in Weiwei ward in West Pokot targets chief’s barazas and nyumba kumi meetings to pass information on family planning. Although there is an improvement in the uptake of family planning commodities and adoption of child spacing among locals, he says CBDs face a challenge of transport, especially during rainy seasons.
Despite the efforts by the CBDs, however, health workers decry poor road infrastructure that hinders distribution of family planning commodities alongside other drugs. “Whenever we experience floods like a few weeks ago, women cannot access the health centre due to impassable roads,” said Jackson Pilat, the Clinical Officer at the Tamkal Health Centre. According to him, most of their clients missed their recommended deadlines for having their contraceptives.
Daniel Wanjala, the Sigor Sub County Reproductive Health Coordinator blames the low uptake of contraceptives in the area on low literacy levels. “Although women are more receptive to information on contraceptives, in some cases, men show open defiance. Rarely do you see a man accompanying his wife to the health facility for family planning services. This is a challenge,” he says.
Despite the cultural barriers, most CBDs have put their best foot forward in matters family planning. In the neighboring Elgeyo Marakwet County, Gladys Kipserem, a community based distributor has learnt the hard way, to do her work while respecting the cultural values of the people she serves. It is, however, not an easy task.
Kipserem, 46, who also serves as a community health worker in Kapsikoria community unit says hers is a calling. “I have done this for 10 years and nothing is going to stop me,” she says. She makes house to house visits, sensitizing women on the need for family planning. Family planning, she opines, does not mean stopping giving birth but rather giving a woman adequate time to heal while planning for the next baby.
“Many women accepted but men still remain a challenge. As CHVs advocating for family planning, we have actually been barred from some homes.” Some women do not have bus fare to go to the health facility to access family planning commodities. At such moments, Gladys has to step in to assist the women. “I have to find them some means of transport to the facility. Where possible, we are forced to use other reasons in order to allow the women access the commodities,” she says.
The support from her husband, she says, has made her work easier. “I have put a suggestion box and condom dispensers at the hospital. When clients come home, I refer them to the hospital to collect the condoms. For the adolescents, I hold friendly dialogues with them,” says Kipserem.