‘Why aren’t you pregnant?’: How secret contraceptive use sparks violence
A couple argues after a disagreement.
What you need to know:
- A new study reveals how menstrual changes linked to hormonal contraception are fuelling suspicion, coercion and gender-based violence against young women in Kenya, turning private health choices into sources of conflict.
- Girls and young women using family planning, especially without their partners’ knowledge, face heightened risks of emotional, sexual and physical abuse when prolonged or irregular bleeding is misunderstood.
When a young woman in Kenya’s Uasin Gishu County opted for injectable contraception, she did not expect her menstrual cycle to become the centre of conflict in her marriage.
The prolonged bleeding that followed soon drew suspicion from her husband, turning a private health decision into a trigger for coercion and violence.
“You have gone for the injectable, and then your menses start prolonging. He will feel that you are denying him conjugal rights,” recounted the young woman in the 18-19 age bracket. We call her Mary.
Her testimony is among many documented in a study by Population Council-Kenya and the London School of Hygiene and Tropical Medicine, which examines how menstruation, contraceptive use and gender-based violence(GBV) intersect to shape the sexual and reproductive health and autonomy of girls and young women in Kenya.
Drawing on focus group discussions and interviews with girls and young women aged 15–19, as well as family planning service providers, the study found that menstrual changes - often a known side effect of hormonal contraception - are frequently misunderstood and weaponised within intimate relationships.
“At some point, he might even force you into having sex because he cannot be patient with you anymore. Or he will ask you if you want him to start going for other women,” Mary added.
Health workers interviewed for the study reported that changes in menstruation linked to contraceptive use - such as irregular or prolonged bleeding - often heighten tensions in relationships, particularly where rigid gender norms, limited sexual and reproductive health knowledge and unequal power dynamics prevail.
A nurse described a familiar pattern in clinics: “If you bleed every time, when your periods become too irregular, the husband will ask, ‘What’s happening?’ A husband may want sexual activity, and you are bleeding every other time. That is when violence begins. You will tell him, ‘Today I am bleeding,’ and tomorrow you are still bleeding, and he wants the act. So that is where they start fighting.”
For young women using contraception without their partners’ knowledge, the risks were even higher. “Anyway, for me, the man found me already using FP [family planning], and he did not know. He waited for me to get pregnant, but I did not,” said a young woman aged 18–19.
“So, he began to quarrel with me, saying I am consuming his money for nothing. Yet, I cannot get pregnant with his baby,” she added.
The study’s authors argue that improving menstrual hygiene management is integral to strengthening girls’ and women’s sexual and reproductive health and autonomy. They also emphasise the need to challenge stigma and harmful gender norms tied to menstruation and contraception.
Ensuring safe contraceptive use, they add, is critical to preventing and addressing GBV. “In both policy and practice, integrating safety planning into family planning services is essential,” they say. “Providers must address potential risks, such as the consequences of discovering contraceptive use.”
