Mary*, a 35-year-old mother of four who is a farmer in Kakamega County, prefers not to have any more children.
If circumstances were good, she would not mind a bigger family. But as things stand, she and her husband are struggling to provide for their four children.
That she almost died from post-partum haemorrhage (heavy bleeding after giving birth) in her last pregnancy further stokes her apprehension.
“He would kill me if he found out,” Mary responds when asked whether her husband is aware she is on a family planning method. It’s for this reason too that she sought anonymity.
She has been on an injectable family planning method for the past year. It was administered at her local public health centre.
Initially, she had been hesitant as she had heard that there is a risk of infertility. Following her last delivery, she received more information from the nurses at the health centre and took up an option that would ensure that her husband would not “notice a change” — at least not in any way that matters to him.
Ms Grace Asami, a nurse at the health centre who has over three decades of experience in reproductive health services, explains she has handled multiple such cases in her career.
“The women mostly fear their husbands’ reactions and doubt if their husbands can accept their choice to use a family planning method,” says the medic.
Her job, therefore, requires a high level of psychological insight.
“As a health professional, you must read the mood in the room. If, say, a woman has come with her spouse, then you must find a session where you can speak privately,” she explains.
The nurse notes some women have started discreetly seeking her out in local community groups, especially those who have eight or even more children.
“It can be complicated as some of these women have to make up an excuse as to why they must visit the health centre every so often. This is particularly so for those using injectables that require quarterly visits, and which happens to be the preferred method as it is discreet and no over-reliance on memory is necessary as in the case of contraceptive pills. Therefore, you better have the stock when the woman comes in because she might not be able to pay you another visit any time soon,” says Ms Asami.
In some parts of the country, it used to take more than a month to get the family planning products restocked in public health facilities.
This is because of the delays in the procurement system from the public health centre through the county government to the Kenya Medical Supplies Authority (Kemsa).
Reasons for the delays were varied. However, recent developments give hope that distribution bottlenecks are being addressed, which will be good news to the “underground” family planning practitioners.
Kemsa has developed an integrated Logistics Management Information System (Ilmis) that allows for end-to-end visibility during the delivery of family planning commodities.
The system has received an award at the Global Health Supply Chain Summit and it is to be showcased as the go-to-standard for the best supply chain practices using big data at the 20th Reproductive Health Supply Coalition General Membership Meeting in Accra, Ghana.
Beyond it being a local digital innovation, the three-in-one solution addresses different components in the procurement and logistics process.
The first component, the commodity early warning and alert system, allows for notification of a commodity running low in a certain facility to initiate an order request.
The second is the allocation system, which utilises artificial intelligence to determine the volume a facility requires based on their usage, which eliminates wastage.
The third is the Electronic Proof of Delivery, a mobile application that is utilised by public health officials upon receiving their shipment, with immediate notification to all parties once the commodities are received at a health facility.
“The system has revolutionised Kemsa’s operations with our stakeholders and instilled confidence in our development partners who have continuously invested to create transparency and accountability in our systems,” said Kemsa acting CEO Andrew Mulwa. “Our donors are able to track real-time the key performance indicators which define various programmes.”
