Beyond Donor Support: Safe Motherhood in Kenya

Editor's Note: Today we welcome Florence Machio, a journalist writing from Kenya. She has experience in reproductive health, global health and human rights and will be reporting on reproductive health in Africa.

2007 is the halfway mark to achieving the Millennium Development Goals, one of which focuses on reduction of maternal mortality by 2015. It also marks nine years since the World Health Organization's 1998 statement declared safe motherhood a human right, yet contraception is far from being available in many parts of the world.

Editor's Note: Today we welcome Florence Machio, a journalist writing from Kenya. She has experience in reproductive health, global health and human rights and will be reporting on reproductive health in Africa.

2007 is the halfway mark to achieving the Millennium Development Goals, one of which focuses on reduction of maternal mortality by 2015. It also marks nine years since the World Health Organization's 1998 statement declared safe motherhood a human right, yet contraception is far from being available in many parts of the world.

At least one-third of women in the developing countries need contraceptive services. Yet some women do not know much about safe-guarding themselves from unwanted pregnancies, are unable to get contraceptives or afford them or simply distrust the methods available. Others cannot get the method they want and others live with a partner who does not approve of contraception.

The challenge of meeting the Millennium Development Goals is great—including the goal to reduce child mortality by three-quarters. Experts agree that unless unprecedented levels of financial support and policy reform and programme coordination among donors, government and civil society, it is unlikely that these targets will be met.

With the risk of dying during pregnancy and after childbirth high in Africa, it is imperative to nip the problem in the bud by starting with providing contraception.

Fardhosa Ali Mohamed runs a clinic in Eastleigh to the east of Kenya's capital, Nairobi. Most women who come to her clinic prefer injectable contraception. Mohammed says: "That's the only way they can control how many to have without their husbands interfering."

Her clients are generally poor. Most of them are refugees from Kenya's neighbor to the east, Somalia, and have no source of income. "They prefer buying drugs at local pharmacies and come to my clinic to be injected," she says. They have been complaining lately that they are unable to get the drugs and are wondering why.

What they do not know is that there has been a shortage of contraception and donors started phasing out Kenya in this area. According to Sam Orero a Nairobi gynecologist, the risks to women are great since lack of contraception is synonymous with unwanted pregnancies and unsafe abortions.

Women here depend on Family Health Options (formerly Family Planning Association of Kenya) and Marie Stopes International for their reproductive health needs, which in turn rely on donors for funding. The two organizations enjoy a wide geographic presence, national reputation, depth of clinical services and expertise to deliver quality reproductive health care. But since the gag rule was enforced by the Bush administration, these organizations have closed 35 clinics in rural and poor areas.

This has created a void in the unmet need. Most developing nations, including Kenya received advance warning in 2001 to start investing in contraceptives during the world conference on contraceptive commodities held in Istanbul, Turkey. In essence they were told to stop relying on donor funding. Kenya was among the countries placed under the eight-year phasing out period. Five years have gone by and women are beginning to feel the pinch.

Although the government has started investing in family planning services, it's still not enough to cover the unmet need. Dr. Sam Thenya of the Nairobi Women's hospital says "Within the budgets we have in the health sector, we can manage to provide quality health care."

Peter Odongo, a member of the Kenya Medical Association gives several insights as to why it has taken the government this long to invest in family planning. "The government does not have a lot of resources to put into primary health care. At the moment, family planning is treated as a luxury. This presupposes that families have a choice of having children or not and the government does not want to infringe on this. Over the years the government has concentrated more on treatment rather than prevention. When a woman needs contraception, she is not sick and therefore, her situation is not an emergency."

Odongo adds that contraception prevalence is quite low at the moment and is not affordable to many Kenyans—cause enough for alarm. "What we are asking is that the government invests in family planning, even if it is on a small-scale. This will reduce the number of women who have to seek abortion. What we are asking is that the health care budget should include subsidized contraception so that all women can access their first shot at safe motherhood."

WHO declares health a human right. Women want this right entrenched in health care systems. It doesn't take an expert to determine that more women's lives are lost without contraception and education. Without these, the Millennium Development Goals are unachievable.