I can't buy condoms, it’s shameful! A slum girl’s dilemma

Twenty one-year-old Emily lives with her parents in Lindi area of Kibra slums in Nairobi County.

She has been in a sexual relationship with her current boyfriend who also hails from Kibra since she was 17, and for all the years, she has never been to a pharmacy to buy contraceptives.

"It is my boyfriend's responsibility to buy condoms," she says.

I ask her why it is not a shared responsibility to buy the condoms.

She responds: "I can't imagine going to a chemist to buy condoms. It is too shameful, especially if you are buying from a chemist near your home. That man or woman selling at the chemist might tell your mother and then what happens? How do you even face your parents when they look at you and in their heads they are wondering 'when did this one start having sex?"

Emily is a Second Year business management student at a city campus. She prefers consulting the internet on contraceptive use. She has come to understand that an emergency pill is the other option of a contraceptive in case a condom bursts. Nevertheless, she is too concerned of the likelihood that she may use it.

"From what I gathered from the internet, consistent use of the P2 can alter the normal functioning of the womb. I don't want that. My boyfriend and I often have an open discussion about the emergency pill and I have made it clear to him that I am not comfortable using it, so he must be careful on how he uses the condom," she says.

She says if she were to go to hospital for contraceptives, she would be more comfortable being attended to by a youthful health worker than an elderly one.

Birth control pills

Essy, 28, is a mother of one.

She lives in Olympic area of Kibra and works with a local-based SRHR focused- organisation as a programs officer.

Essy started using birth control pills at the age of 23. At the time, her partner was uncomfortable with her using the pills as he wanted a child while she was not ready. Having joined the organisation, she knew the importance of contraceptives.

But then in 2018, she travelled abroad for work, forgetting her pills behind. Again, she failed to resume immediately upon her return.

On the same week, she met her partner and they didn't use any protection. A proposal to use a condom was an inconceivable idea at the time owing to his objection on taking regular birth control pills.

"I ended up pregnant, by accident, but I chose to embrace the pregnancy," she says.

Now, she is using an intrauterine device implanted in October last year, at a public hospital at no cost.

On whether girls in her area of operation are aware of contraceptive services in health facilities, Essy says there is a lot of stigma around contraceptive use among girls.

First, the pharmacies are along the road or pathways, and the people who run them in most cases know the girls' parents. So they prefer to keep off to avoid trouble.

Others fear being mocked that they "are exploring and know more than what they should at their age," she says.

Youth-friendly health facilities

While others shudder at the thought of visiting either a private or public health centre as they will be sent back to bring either a parent or a guardian.

She says, although there are privately run youth-friendly health facilities, the fact that they are known by the community of the services they offer, is a deterrence.

There are two of such facilities in the slum, one located in Olympic and another in Gatwekera.

"But the girls are afraid of being noticed walking in and out," she says.

She observes that consistent sensitisation drives could end "stigmatisation of girls for being responsible."

"It is unfair to limit girls from accessing information on use of contraceptives. We must be alive to the fact that there are those who can abstain and there are those who cannot. Let them have appropriate information and decide on their own. Do we let girls get pregnant and die while attempting to procure an abortion?" she wonders.

Twenty five-year-old Lily, a resident of Gatwekera too, started using emergency pills while a teenager. It is from her peers that the mother of one knew where to buy, and how to use them.

When she completed high school at the age of 21, her aunt secured her a waitress job at a wines and spirits joint in Bondo, Siaya County.

A client who was a friend to the business owner demanded for a sexual encounter with her.

I was pregnant

"I couldn't refuse since I wanted to keep my job. I suggested we use a condom but he refused claiming that it caused him an irritation. I didn't want to annoy him, so I accepted," she says.

Later, she bought a P2 but kept it for two days with the assumption that it could still work if taken before elapse of 72 hours.

"Actually here (Kibra), that is the belief. That the P2 will still work when you take it on the third day," she says.

"In my previous encounters, I could take it late and it worked but this time, it simply failed and I was shocked to learn that I was pregnant," she adds.

Now, she is using a three-month birth control injection.

To avoid another pregnancy mishap, she ensures her boyfriend with whom she has an on and off relationship, uses a condom.

"I no longer tolerate excuses. I know the injection does not protect me from diseases and so we agree on using a condom. If he refuses, then that is it. No sexual relations. In fact, I carry my own condoms to avoid unacceptable excuses of 'Oh I forgot or I didn't buy,'" says Lily who is now a grassroots pro-contraceptive campaigner.

She adds: "I have my younger sisters and they frequently engage in sexual relations. I know they are already addicted and I can't tell them to stop because that's an impossibility. All I advise them to do is to use a condom every time they have sex. I also refer them to a youth-friendly clinic in Gatwekera for more guidance."

SRHR information

The three women reflect the challenges girls growing into adulthood in the slums face in accessing appropriate SRHR information even though the reality of early exposure to sex is clear from their interviews.

Kenya has a 14 million population of women and girls of reproductive age, an increase by three million in a span of eight years.

According to Family Planning 2020 (FP2020) report, there were 11 million women and girls aged 15-49 in 2012 against the 14 million in 2020.

Last year, only 5.97 million women and girls of the reproductive age were using contraceptives, which is nevertheless an increase from 5.82 million in 2019.

Ms Jane Anyango, founder of Polycom Development Project, a grassroots organisation sensitising girls and young women in the slums on sexual and reproductive health services and rights, says girls are aware of contraceptives but the information they have on use is wrong.

"When we started in 2014, discussions on contraceptives were hard but later we adopted a method of listening more to what they know, then later we share the right information," says Ms Anyango who trains the 18-24 year-old women on SRHR to mentor, on the same, those in nine to 17 age bracket.

She says P2s are the most talked about contraceptives among the girls and the most abused.

"Girls share information among themselves and reorganise and repackage it in their own way," she says.

But even as girls become more aware of their sexual and reproductive rights, communities are still conservative of the realities they are sexually active before they hit 18 years.

What about condoms

"Here girls are even shy of buying pads, yet having periods is a biological process. What about condoms, considering that they are in a society where they are not even supposed to have sex," she poses.

Chief Administrative Secretary in the Ministry of Health Dr Mercy Mwangangi says they are in the process of implementing recommendations brought forth by the youth including deploying youthful healthcare workers to clinics where they can get information on contraceptives.

Although she didn't indicate the number of designated youth-friendly health centres in the country, Dr Mwangangi notes that they have trained healthcare workers to offer youth-friendly health services in the roughly 12,000 health facilities, including more than 8,000 that are public and the rest private and faith-based.

She observes that contraception is available for women above 18 years of age, in exception of those sexually abused, noting that early exposure to contraception is harmful and that is why parental consent is important.

The Health ministry, she says, is working on introducing age appropriate sexuality education in the education curriculum.

"So that the young people can understand their bodies and grow to live a productive adulthood life.”

*Names changed to protect the privacy of the women

[email protected]