Source:The Star In yesterday's Star, we published an interview with Melinda Gates, the co-founder of the Bill & Melinda Gates Foundation, about her family planning projects in Kenya. Today, read about how previously unreached women in the slums are embracing modern family planning methods.
Hundreds of slum women are now flocking health facilities to receive long-acting contraception.
We find Evelyn Irusa in the midst of market women hawking sukuma wiki at a crowded corner of Huruma estate.
They have learnt to ignore a stench wafting from a sewer that forever flows down the hundreds of rusty tin-shacks that together form Mathare, Nairobi's second biggest slum.
"In this city, people must live," she chuckles. "I have four children. She (points to a colleague) has six. My customers also have families that must eat."
She reports to work at 5pm when Huruma and Mathare residents return home. She carefully cuts a pale, flappy leaf of Sukuma Wiki vegetable into hundreds of slices that she then compresses into a small, transparent plastic bag.
"Wasalimie watoto (say hallo to your children)," she pushes it into the hands of a female customer, and receives five shillings.
In the midst of this brisk hawking of food, Irusa has received life-changing 'wisdom' from colleagues about a match-stick sized implant that prevents pregnancy for five years.
"Here we sharpen each other," she points to her colleagues. "Some of our customers have three, four or five children, yet they all buy sukuma wiki worth five shillings. But nowadays we tell them there's a solution. We women talk."
The 37-year-old gave birth to her first child at 15, and now she has three others. "I've been taking injections, that's easy to forget and you get another child."
Her trip the following day for an implant at Mathare Health Centre takes her right through the slum.
Mathare is a big headache to the city's county government. The burgeoning population means the authority cannot provide proper schools or piped water. Electricity here is dangerously stolen from Kenya Power's main poles.
Irusa lived here in 2006 when two rival gangs - Taliban and Mungiki - bloodily fought each other to control illegal taxation of the more than 500,000 dwellers of Mathare.
Former UN-Habitat director Anna Tibaijuka blamed Mathare's woes partly on unplanned population growth. "Population growth rates are the highest in Africa. Their poverty is compounded by many factors such as domestic violence, crime, drugs and alcoholism, to name a few," she said.
Mathare North Health Centre is squeezed between the valley and a sprawling, better developed part of the estate, called Mathare North.
It's a clean facility that offered family planning services to 8,500 women last year. And the number is rising.
"Ninety per cent of our population is urban poor from Huruma, Kariobangi and Mathare," says Dr Moses Owino, the head of health facilities in the larger Kasarani sub-county. We are trying to promote long-acting contraception," he says. The services are entirely free.
The uptake has been impressive. Records from facilities managed by Nairobi County government show most women prefer contraceptive injections, given every three months.
However, the curve is in favour of long-acting methods like implants. The demand for implants in Nairobi rose 54 per cent last year, compared to 2011.
Their popularity partly driven by increased availability after Bayer, the German manufacturer of the popular Jadelle implant, recently cut the price by 50 per cent.
The programme will be supported for six years by the Bill and Melinda Gates Foundation, the Clinton Health Access Initiative, and the United Nations Population Fund among other bodies.
"This means the government can procure more implants, which are then administered for free," Dr Owino says.
The implant now retails at about Sh750 ($8.50) in Kenya and more than 50 other countries globally.
Dr Owino says access to family planning services can save nine of the 21 women in Kenya who die daily during childbirth. In towns, slums like Mathare bear the brunt of these deaths because of high incidence of teen pregnancies and high number of women not using proper contraceptives to space or prevent unplanned pregnancies.
Gates foundation estimates the Jadelle programme will avert more than 30,000 maternal deaths in the participating countries.
Irusa arrives at the health centre at noon and for the first time since she began walking, breathes fresh air. "But I am tired taking injections frequently. Sometimes I forget," she tells Mercy Apopo, a nurse at the family planning unit.
It is a small, beige-walled unit, next to the maternity wing, administered by two nurses.
Every day, the nurses help about 30 women make key decisions in their lives: how to space births and make their families manageable.
The Kenya National Council for Population and Development says such opportunities are important for women's own health.
A sustainable population also helps bodies like the Nairobi City County plan for services like water, sewerage and electricity for estates like Mathare.
The nurses here counsel the women before they receive contraception.
Irusa has been through this before and is more at ease. She answers a range of questions about her family and health.
Her husband, a stone-mason in Huruma, is not aware of her trip this morning. "But he will be ok with my decision when he finds out," she assures.
"So how did you know about implants?" Mercy asks.
"A community health worker told us about them. In fact my colleagues at the market use implants too. I'm tired of coming here, and injections gave me back problems."
Irusa answers another set of questions before Mercy explains how implants work.
"It takes five years and works by stopping ovulation," she explains. "You know pregnancy cannot happen without these eggs? It will also make the mucus in your uterus thick. Kwa hivyo mbegu ya mzee haitaweza kutembea (so the sperm will not go through)."
She continues: "If you want to have children before the five years end, you can always come so we remove it. The 37-year-old does not want any more children. Her first born is 22 and her fourth born is now four years old.
"Na madhara yake (what are the side effects?)?" Irusa asks. The nurse explains she may or may not receive her periods. A few people may have dizziness and nausea, which goes away after a while. Some gain weight. She should immediately return in case of any adverse effects.
Not all women can use implants. Irusa cannot get it if she is pregnant, has a blood clot, liver problem, some certain cancers or abnormal vaginal bleeding.
The insertion takes less than three minutes. Irusa is right-handed so she gets it on her left arm. She first gets a shot of local anaesthesia, which is probably the only painful part. A small incision is then made to insert the rod. The Jadelle implant, the size of a matchstick, is then slowly inserted just beneath the skin of the arm with a special inserter called a trocar. Irusa smiles and says it's painless, as Mercy applies two sets of bandage. And, voila, she is now free until November 7, 2018!
Irusa is one of the 46 per cent of Kenyan women who, according to the 2008 demographic and health survey, use modern family planning methods.
Nurse Mercy smiles and explains there may be some discolouration or swelling at the implant site but that is normal and it will go away.
The outer bandage will be removed after two days while Irusa should visit the clinic after one week for the first bandage to be removed. After that, she does not need to visit the hospital until 2018, unless she experiences any adverse side-effects.
"Thank you! Do I need to pay?" Irusa asks.
"All these services are free," Mercy says.
Irusa trots back to Huruma through the same path. It is now filled with school-age children shouting and trampling in the mud. She looks over bustling Mathare valley and walks even faster. Until November 7, 2018, she has done her part, she says.
