In the heart of Kibera, Kenya's largest urban informal settlement, Shega Fatuma, a mother of two, balances her family responsibilities. While her husband works as a casual labourer at a nearby market, Fatuma manages the household with care. To plan her family's future, she relies on the convenient family planning services offered at the nearby Mbagathi District Hospital, a government-run hospital in Nairobi, the capital city of Kenya.
"I was married at 18 years, and for the past 10 years, I have accessed most reproductive health services free of charge," she says. Fatuma's husband opposes her use of contraceptives, but the availability of free services proves to be a lifesaver for her. "I secretly go for free services offered at the government hospital because if I were to ask him for money, he wouldn't yield." She added.
In 2023, a proposed Nairobi City Finance Act by the Nairobi City County government almost turned the tide for women's reproductive health in the wrong direction. The new legislation recommended increased fees for sexual and reproductive health (SRH) services, including contraception and family planning, across all health facilities within the country. According to the proposed law, a Depo-Provera injection, a contraceptive containing progestin, would be priced at KSh150 (USD 1.2), which is the same cost as two kilograms of maize flour, a staple food that can sustain a family of five for a week.
For many women like Fatuma, being required to pay for SRH services would have presented an impossible dilemma, forcing them to make a hard choice between prioritising necessities such as food and affording these essential services. "Had it not been for [free] family planning, maybe today I would be a mother of five and this would have been a huge burden on me," Fatuma said.
However, the proposed legislation did not go unnoticed. Deborah Monari, a government nurse, upon learning of the bill, quickly assembled a coalition of health colleagues to take action. Wasting no time, they launched an online petition to halt the adoption of the proposed law, hoping to rally public support and prevent what they perceived as a major setback for sexual and reproductive health and rights (SRHR) in Kenya. "Charging for essential health care services is harmful and would have hampered progress in the fight against unplanned pregnancies, HIV, and unsafe abortions," Monari shared.
Monari's online petition.
Deborah Monari's petition quickly gained traction and garnered widespread support from various social and civil rights groups, including the National Taxpayers Association, who underscored the dire consequences the proposed law could have on the reproductive health of women from disadvantaged backgrounds. The online petition, which stirred up discourse across both digital and physical spaces, ultimately proved to be pivotal, compelling the county government to reverse its earlier decision.
Monari, who describes herself as an advocate for medical and social justice, says that the proposed law would have made contraception and other family planning services unaffordable to women of reproductive age, had it been passed. "The charges that had been proposed were too high and would have denied a lot of women reproductive health services which should be affordable if not free," Monari added.
Mary Shakala, 45, has been a health advocate in Mukuru Kwa Njenga -a slum located in the east of Nairobi -- where she has spent time advocating for better SRHR. For years, she has witnessed hundreds of young girls dropping out of school due to early pregnancies. "Majority of these girls end up with unwanted pregnancies due to lack of access to reproductive health services. Increasing charges and making the services hard to access would only worsen the situation," Shakala explained.
According to Monari, her online petition was all about securing women's right to exercise their sexual and reproductive health and rights and their freedom to make decisions about their bodies.
What limited access to SRHR means for women.
in 2022, the Kenya Demographic Health Survey delivered a report revealing that Nairobi City County experienced the highest number of teenage pregnancies that year, with 452 pregnancies being recorded among girls between the ages of 15 and 19.
This statistic, coupled with the National Syndemic Diseases Control Council (NSDCC) report in 2023, estimated that approximately 696 adolescent girls across Kenya became pregnant each day. This painted a grim picture of the state of teenage pregnancy in the country, emphasising the urgent need for more robust reproductive health interventions.
The chairman of the National Taxpayers Association, Peter Kubebea, believes that the filing of the online petition was a crucial step in mitigating the potential rise in abortion-related deaths among young women in Nairobi.
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Brenda Wanjira, a reproductive health nurse at Mutuini Hospital, has witnessed firsthand the positive impact of free contraception services in public hospitals. "With free contraceptives, we are seeing an increase in the number of girls seeking these services, and this goes a long way in promoting safe sexual practices and reducing the risk of teenage pregnancies and sexually transmitted infections," Wanjira said.
All three levels of health facilities now provide SRHR services at no cost.
Patients' rights
Deborah Monari's crusade for healthcare reform is a deeply personal one, fuelled by her own experience with medical malpractice and negligence. Empowered by her conviction, she has launched yet another online petition, advocating for the establishment of Patient Rights Committees in Kenyan health institutions to curb medical negligence and malpractice in public hospitals.
Monari's advocacy has once again captured the attention of the Kenyan health sector, particularly the Minister of Health, who has invited her to discuss her proposal for Patient Rights Committees with the Ministry team. Monari views this as a promising development, with the potential for her ideas to improve the healthcare system.
