Kenya: Increasing Access to Family Planning in Informal Settlements

12 July 2013

Kenya's infant mortality shows the fastest rate of decline among the 20 countries in sub-Sahara Africa, according to the World Bank. Among the possible reasons for this decline are the efforts of public health workers like Aspen Institute's 2013 New Voices Fellow Jane Otai, and targeted new public health projects such as the Tupange initiative, an urban reproductive health project focused on improving the health of women and families in the urban slums of Kenya. "Tupange" means "let's plan" in Kiswahili. Otai's work with the Tupange initiative can be added to 20 years of her work in Kenya's slums, providing women access to family planning, prenatal care, HIV counseling and testing, screening for cervical cancer and sexual abuse, immunizations and sanitation. Growing up in a poor community in Nairobi, Otai’s memories of the difficult environment and lack of access to family planning techniques have helped shape her work. Otai spoke with allAfrica’s Bradley Parks about her work in family planning with women across Kenya.

Tell me a bit about where you grew up. How have your experiences brought you into this work?

I grew up in a very poor community in Nairobi. The church helped me to go to school and I was able to acquire my primary and secondary school education and I succeeded to go to university. But it was a struggle with no school fees sometimes, no food sometimes. Clothing was a problem - all those things that a girl would need in life, it wasn’t a given that I was going to get them. But through all the years I think the church stood with me and I was able to go through school and acquire my university education and came back to work in the informal settlement.

How would you describe the successes and the challenges of the Tupange initiative to this point?

We are covering five cities in Kenya. The program has so far been very successful with more women and girls having access to family planning, becoming aware of the benefits of timing and spacing pregnancies. We have seen an 11-percent increase in family planning participation in the last three years that the program has been running. We feel this is very, very successful because more and more people are taking on family planning. But, of course, it comes with challenges. Last week I was in Kisumu and there was a shortage of contraceptives. Women were coming to the facility and were not able to access commodities because they're out of stock. Security of family planning materials is still a challenge, but we are working with the government and medical supply stores to provide contraceptives to women within the country.

How does the Aspen Institute Fellowship help you advance the goals of the Tupange initiative?

We have five objectives as a program. We ensure the quality of family planning services within the health facilities we support by training the service providers. We also have the issue of demand creation. Because you can have all the family planning contraceptives and you can have the services available, but if people do not demand family planning services then it will just be a good facility with good stuff, but people are not demanding. So we are also creating demand for the people to go to the health facilities to seek treatment. To advance our goals, we work with chiefs, ministers, leaders within the community to promote family planning. And apart from just working with government, we also work with the private sector so that health facilities that are privately owned also promote family planning and they offer family planning services.

What are some things you would like to see happen with the Tupange initiative through partnership with the Aspen Institute?

One thing that I want to see is advocacy for more family planning because the Tupange program - a five-year project - comes to an end next year. But I feel that we have not been able to reach all the women that we need to reach because we are only working in five cities, but mainly in three. I wish we would consider covering the whole country with this program so that many more women have access. The rural women are not able to access the kind of information we are giving to women in the cities. So I’m hoping that when I am at the Aspen New Voices Fellowship, I will learn how to advocate for increased funding to have family planning for the whole country.

What’s one of the most important things you have learned about the people you serve through working with the Tupange initiative?

I am a mother. I have three children. And I think every woman, after they start having children, they stop living and they start living for their children. These women want their children to live a better life than they have lived. And if there are ways to let women know that for their children to succeed in life, they need healthy spacing of pregnancies then all women would be willing to go for it. Women make the mistake of having too many children just because somebody has not opened their minds to the benefits of family planning; somebody has not spoken to them about healthy timing of their pregnancies, and they continue to have all these misconceptions about family planning. But when they have an opportunity to use family planning, they are able to space their pregnancies and give their children the best.

Is there any personal story that happened while working on this project that told you that you were on the right track?

One story that I can easily relate to is how women who are satisfied with family planning are able to promote the message to their friends. There is this one woman who works in a salon, and we talked to her about family planning and she accepted to take one of the [contraceptive] implants, so we referred her to the facility. She was given an implant, which lasted for three years. When she got that implant, she was able to go back to her business and continued working. She was very, very happy with the implant. Every woman who comes into her salon for hairdressing, she tells them about family planning and, when they accept, she actually takes them to the facility to find out what method of family planning works for them. So because she was a satisfied user, there is a whole number of women who have found out about family planning when they came to her salon.

I think when you have women who are really empowered and they are very happy with the message, they themselves can actually sustain family planning by talking about it and making sure more women get the message. I think women really feel for their fellow women and they are able to help out other women who they think need a particular service.

Is there anything you would like to add?

The big thing that we have been talking about is family planning, but we need to remember that women have many more needs in reproductive health than family planning. Before I started working on the Tupange program, there is another program that I worked on, which was gender-based violence and rape within informal settlements. This was a program that, having lived this life, I really understand what girls go through and women go through in the informal settlement. So I started a program on sexual violence because the women themselves say, ‘You know, for us to get pregnant, it’s not so much that we engaged in unprotected sex. It’s because we are raped. Don’t talk about spacing of children or spacing of pregnancies, let’s talk about rape within our community.’ So I started working on a program about rape in the community.

We trained the women to be paralegals, so they are able to follow up on cases of rape. We trained service providers in our health facilities on the management of rape cases. We trained the police on how to apprehend people who are the perpetrators of rape and how to record and take the issue to court. We trained lawyers. All these people we trained, the various stakeholders within the community, and they started working together. People who were within the health facilities were able to manage people who had been raped by giving them emergency contraception, post-exposure prophylaxis, and they were able to write up the report so that the report can be part of the evidence in court. This program was very, very successful. When we talk about pregnancy, I think we are concentrating on just one area, but I wish we could take care of the whole area of reproductive health.

Does the rape program you’re working on address the immigrant Somali community in Kenya?

There is a community that is of Somali origin in one of the informal settlements of Korogocho. So many times they are so detached from the other people. They try to keep alone, maybe because of their status in the country. I’ve worked with them on the family planning program. I’ve worked with them on the HIV program, but not so much on the rape program.

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