Reproductive health remains a health problem in Sub-Saharan Africa, Kenya included. Unless efforts to reduce maternal and newborn mortality and morbidity, improving access to family planning, and preventing HIV infection are scaled up, the majority of Kenyans remain at risk for poor health outcomes. Women face unsafe abortions, early marriage, and various forms of gender-based violence. They suffer silently from sexually transmitted diseases that make them vulnerable to cervical cancer and infertility, without access to the simple preventive measures like screening and vaccination.
My experience working directly in the community and in health facilities has given me the opportunity to interact with various partners and many disadvantaged young men and women. Listening to their stories of teenage pregnancy, their beliefs in myths related to use of contraception, and experiences with HIV has made me keen to understand and try to address issues related to reproductive health.
I met “Aisha” (not her real name) when her child was enrolled in a study I was working on. She was soon a lost to follow up (LTFU) case and needed a home visit by the Community Liaison Officer. I planned a home visit and luckily I met her. Her daughter was in a group of another five children playing outside. I spent about 30 minutes listening to her reasons for missing follow-up, narrated with humor and honesty. She at one point lamented that “if only I had stepped up to the gate of a school maybe I could also be riding in a big vehicle like you.” Through Aisha’s story, all of the challenges girls and women face became clear.
“My mother died when I was 4 years old and left me with my other two siblings in the hands of our drunkard father who did not bother whether we had food or not, went to school or not. Life became unbearable and we made our way to my grandmother in the village. It was better here because we had at least 1 or 2 meals in a day. As fate may have it my grandmother died and the rest remains history. I got married at the age of 17 and, without realizing it, I was soon pregnant. With the help of a midwife, I delivered my first child; my husband who is a “boda-boda” man struggled to make ends meet. Year after year I became pregnant without realizing. After the fifth pregnancy a community health worker talked to me about family planning and told me that I could visit a health facility where I would get help. Before I could seek that help I conceived the baby who is enrolled in your study, and this time I made an effort to visit health facility and was enlightened on family planning. I found it difficult to decide which method to use and also wanted to take precaution and keep my husband looped in. I did not choose a method, and asked the nurse to give me time to discuss with my husband. The nurse got furious and asked me if I was not embarrassed carrying a small baby and still expectant. I read on her face that I needed to just decide before leaving the room but she did not force me to but her words spoke it all. I already had so many children so this did not make much sense. That evening I discussed with my husband and little did I know this could be the beginning of his concerns and suspicion of how am getting into “western life” and that I would get “big” diseases, start sleeping with other men because I would be protected from HIV. He became so furious and did not want anything to do with health facility and that’s how coming to the health facility became a challenge.”
Aisha’s story left me with a lot more questions on how much more the Government and private sector need to do, and how much there is left to understand of the challenges women face in achieving optimal reproductive health. The Center for Reproductive Health in Kisumu will not serve and benefit Kisumu County, but will also have a far felt impact through research to understand these challenges, and development of programs to address them.