Large Gaps in Knowledge of Family Planning Services

INSIDE

Theme: Kenya Demographic and Health Survey 2003

Kenya’s Population Policies

Evolution of Kenya’s Population Policies

News from Partners

Tips for working with the Media

President Kibaki stars in TV commercial The lack of basic medical equipment is visible here. The KSPA revealed that health workers inappropriately cited contraindications and suggested uneccessary medical examinations before prescribing contraceptives ICPD 10th Annivesary n in-depth analysis of the Kenya Service health sector reform, the study was conducted by the Countdown 2015 Provision Assesment (KSPA) in 1999 Ministry of Health and the NCPD, Ministry of Planning A revealed that health workers inappropriately and National Development, with funding from USAID. District Briefs cited contraindications and suggested medical The KSPA was conceptualized to monitor and evaluate News from DPOs examinations and tests that were not necessary the supply side of service provision that cannot be before prescribing contraceptives. Half the providers captured using the Kenya Demographic Health Survey Children rights incorrectly identified medical diseases and 36 percent (KDHS). The objective of the assessment is to identify Search for Love incorrectly identified breast conditions as reasons they the strengths and weaknesses of health care and would not prescribe the pill. Most providers were provide appropriate recommendations. RH Perspectives inclined to do a test or exam that was not required Plans are underway to conduct the 2004 KSPA to Re-introducing IUCD before prescribing the pill. More than half cited supplement the findings of the KDHS 2003 survey. unnecessary pelvic exams. The study is expected to provide baseline indicators News Briefs “Lack of adequate knowledge on contraindications for evaluating and monitoring the attainment of the and which exams and tests are necessary may Millennium Development Goals (MDGs) and the Gender Mainstreaming activities represent a barrier to contraceptive access,” said Dr. Economic Recovery Strategy goals. The study will also Richard Muga, Director of the National Council for provide baseline indicators for the proposed sector Upcoming Events Population and Development (NCPD). “We need to wide Health Sector Strategic Plan (2005-2010) and Conferences and Training ensure that women are not being excluded from other projects initiated in 2004 and 2005. receiving the family planning method of their choice Other key findings include family planning training Recent Research because of a medical condition that is perceived as a and knowledge, antenatal care services, quality of Results contraindication or because she cannot afford an care, and client satisfaction. inappropriate examination or test.” Male Pill on the Way? Family Planning Training The findings were part of a larger study that Seventy eight percent of family planning service examined factors that affect the use of reproductive providers received family planning as part of their health care services in Kenya. Designed to help guide 1 Cont’d on Pg. 8 Director's Statement

elcome to the inaugural issue of Kenpop News, the population newsletter. As population issues are central to the development agenda, we expect this newsletter to serve as a market place for the exchange of information between Wand among stakeholders in population and development.

The launch of Kenpop News supports the utilisation of NCPD’s goal of strengthening the voice of stakeholders in seeking support for population programmes.

Through Kenpop News, NCPD provides programme implementers, researchers, policy makers, development partners and ordinary Kenyans a platform through which they can address the common challenges that affect Kenya’s general welfare and development. The newsletter aims to strengthen co-ordination, implementation and support a broad range of population activities. In addition, Dr. Richard Muga, Director NCPD it will serve to prioritise and address continuing and emerging issues highlighted by all players across sectors.

NCPD appreciates and recognizes all friends and partners who continue to support this initiative. We look forward to a strengthened partnership and continued collaboration. I trust that together, we will achieve our objectives of providing the needed information and quality services to enable Kenyans to live healthy and productive lives.

YÜÉÅ the Editorial Suite As we mark the 10th anniversary of the ICPD conference, Kenya has made notable progress in its population policies and in addressing problems. Kenpop News has captured these Xw|àÉÜ|tÄ Committee and other views and perspectives from the key stakeholders and also presents views from the grassroots through the eyes Dr. Richard Muga - Director NCPD Chair of the District Population Officers. Human interest angles G.A Kichamu, Head IEC, NCPD Exec. Editor presented by partners add spice and a lighthearted element Emily Nwankwo - APAC Editor to otherwise serious matters. Michael Mbaya - NCPD The KDHS 2003 Highlights form the theme for this first edition. We invite you to enjoy the content as you become Godferey Kariithi - KIMC informed and request your feedback so that we make Kenpop Prof. Emmanuel Wango - IPR News your population magazine that addresses the questions Josiah Mwangi Editorial Intern and concerns, and burning issues wherever you are. David Kinyua - IEC/NCPD Secretary We welcome your feedback through [email protected]

Editors

The NCPD appreciates input from members of the IEC/editorial taskforce in the development of this newsletter. They include: Dr. Lynuss Etyang (FPAK); Judith Karogo (APAC); Martha Warratho (Marie Stopes); Florence Kimata (CAFS); Nester Theuri (FPPS); and Joyce Mwaura (KIMC)

The NCPD and MoH work closely with various donors in support of the Population and Health Sector. These include; USAID, DFID, WHO, UNFPA, UNDP, World Bank, CIDA, EU, GTZ, KFW, DANIDA , PRB and JICA

Design and Production: Apex Communications Ltd. P.O. Box 12313 - 00400 Nairobi, Kenya. Tel: 254 2 2716890 Fax: 254 2 2719478 Email: [email protected]

2 population Policies

Kenya’s Population Policies

decline in population growth rate; increase in life expectancy; increase in contraceptive prevalence; a decline in the ideal family size among married women; and the establishment and implementation of the District Population and Development Programme.

Challenges Throughout the implementation of the population policies, there has been very limited involvement of men in the family planning programme. Other challenges include limited The development of population policies in Kenya encouraged the creation of communication and advocacy funding, duplication of roles by programmes on population and capacity building of health workers to promote the programmes NGOs, inconsistent commitment to family planning by opinion he first population policy in Kenya subsequent population policies are leaders despite political goodwill, and Twas the implicit policy that began in advanced generics of the policy and regional disparities in fertility and the early fifties under the auspices of the they are implemented through a multi- mortality levels and family planning Family Planning Association of Kenya sectoral and multi-dimensional trends as highlighted by the 2003 KDHS. (FPAK). FPAK provided family planning approach through collaboration with Other notable challenges include the services to Europeans, Asians, and a few NGOs, the private sector, donor high level of adolescent fertility, high “informed” black Kenyans. FPAK remains partners, and communities. prevalence of sexually transmitted the largest NGO in the population field diseases including HIV/AIDS, Implementation and Effectiveness of in Kenya to date. diversification of the economy to Kenya’s Population Policies Since independence, Kenya has had accommodate an increasing labour Between 1967 and 1979, Kenya three explicit population policies: the force, and the concern on quality of witnessed a dramatic increase in fertility National Family Planning Programme of reproductive health services including and reduction in infant and child 1967; the Population Policy Guidelines of family planning. mortality. From 1980 to 1989 the country 1984; and the National Population Policy witnessed signs of fertility decline, with Lessons learnt for Sustainable Development (NPPSD) of further decline documented from 1990 Implementation of the population 2000. to 1998. programme has taught policy makers A close examination of the nature, Until the provisional findings of the several things. Policy makers learnt that scope and features of these policies 2003 Kenya Demographics and Health population is more than a medical reveals that they follow the following Survey (KDHS) highlighted that some of concern as had been perceived during sequence of events: The pre-Bucharest the survey indicators, such as fertility and the 1967 to 1980 period and it demands World Population Conference of 1974; mortality, were reversing, Kenya had a multidimensional integrated approach the Mexico Population Conference of already entered a demographic through involvement of the public, 1984; and The Post-International transition. The fertility transition can be commitment of resources, and political Population Conference for Population traced as far back as 1982. The goodwill and commitment to support and Development (ICPD) Cairo demographic transition at this phase the programme. A population policy conference of 1994. (1982) can be attributed to good should be comprehensive and The 1967 population policy laid performance in the implementation of consistent and its implementation should emphasis on family planning to address the country’s population programme. promote development of appropriate population and development issues Policy achievement can be hinged on institutional infrastructure. Another lesson through recognition that the country’s the adoption of the national population is that a population policy should have population growth rate was outstripping policy in 1967 and the subsequent the economic growth rate. The reviews that address emerging issues. precise and realistic expectations from implementation of the policy was Some derivative policies have also been the target publics taking into entrusted to the Ministry of Health but developed addressing selected consideration demographic, social studies showed that its implementation thematic areas such as the youth and economic, political and cultural left a lot to be desired due to poor the elderly. Programme achievements environments. infrastructure at the ministry. The of the population policy are: a notable By Michael Mbayah, Policy Division, NCPD

3 New ARH&D Policy

he Minister for Planning and The policy demonstrates the progress communication, provision of National Development, Prof. Kenya is making towards the reproductive health services, research, Anyang’ Nyongo’, recently implementation of the 1994 International capacity building, networking among launched a policy document on Conference on Population and partners, and monitoring and evaluation. T Development (ICPD) Plan of Action, Adolescent Reproductive Health and The implementation framework will be Development (ARH&D). This is the which made a paradigm shift towards multisectoral, spearheaded by the product of a lengthy participatory young people and their development. Ministry of Health and the NCPD. process that involved many organisations The policy recognises that gender USAID, through the POLICY Project and people including the adolescents considerations are fundamental to and the Population Council, recently themselves. The policy re-asserts that adolescents and youth health. It highlights funded a workshop for organisations young people form a critical resource for the role adolescents can play in involved in ARH&D so that they could today and the core of our future promoting their own health and make their contributions towards the development, hence their health is a development. It also reaffirms the role implementation of the policy. worthwhile investment for future growth of parents, communities, education and development. institutions, and At the workshop, the director of NCPD, religious Dr. Richard Muga, said that the organisations in government was willing to borrow ideas assisting young from NGO and private sector people to develop programmes so as to successfully positive norms, implement a new National Health Plan. attitudes and values. “NGOs and other partner organisations Successful should step up advocacy campaigns so implementation of that the Ministry of Health can be this policy will be allocated more funds by the government based on strategies and donor agencies for purchase of that include contraceptives,” Dr. Muga added while advocacy noting the low contraceptive practice among the youth as highlighted by the The NCPD Director, Dr. Richard Muga and the Director of Medical programmes, Services, Dr. James Nyikal. Successful implementation of the ARH&D behaviour change 2003 KDHS. By Mr. Karugu Ngatia, Senior Assistant Policy will be spearheaded by the NCPD and the MOH Director, and head of Programmes Division, NCPD

Criteria of Youth Friendly Services

he Ministry of Health (MOH) is working on drug abuse, abortion, Tthe criteria for a youth friendly health facility. pregnancy, female circumcision, Below are some of the key highlights. early marriage, and gender issues. The facility should also The facility should be manned by staff with skills provide youth friendly IEC in Adolescent Reproductive Health (ARH) and materials. The clinic should oriented on ARH. The facility should also aim to establish a referral system for attract young people seeking information by complicated cases needing providing youth friendly services such as videos, specialized attention. Service and recreation facilities. The clinic closing and providers should provide opening times must accommodate the youth. confidentiality for the youth. A The health facility must also be accessible, record of all services provided highly visible and affordable to the youth. The at the facility should be well Youth peer educators from Family Life Promotion Services. Peer provider/patient ratio should be such that it documented for reference. education is an important component of youth friendly services reduces waiting time without rushing through the In order to strengthen the RH education programmes and production of IEC counselling sessions. The facility should also messages and services, the facility should materials. have a feedback process for collecting views establish a peer education programme. Youth from the youth on the facility. In conclusion, the facility should have attributes should be encouraged to form youth groups that attract youth, provide comfortable and Basic reproductive health information themes e.g. establish abstaining clubs. Skill training appropriate setting for them, meet the needs of should be designed to guide the health activities should be encouraged. These include young people and are able to retain youth clientele educators during service provision. The health computer training, areas for income generation for follow up, repeat visits and provide linkages in educators should note the important topics for activities, tailoring, carpentry, outdoor games the community and with specialized services. the youth such as STI/HIV/AIDS, family and tournaments, recording of radio By Dr. Pamela Godia, Dept. of Reproductive planning, sexual abuse, nutrition, alcohol and programmes, puppetry, drama festivals, parent Health, MOH

4 Partners in Population and Development A South-South Initiative

artners in Population and Development (Partners) is Pan inter-governmental alliance of 19 developing countries which are, Bangladesh, Mali, Mexico, Nigeria, Yemen, Indone- sia, Jordan, Pakistan and Thailand. Others are Kenya, Tunisia, China, Colombia, India, Uganda, Egypt, the Gambia and Zimbabwe. The alliance was established during the International Conference on Population and Development (ICPD) held in Cairo in 1994. The main role of Partners is to expand and improve South-South collaboration in the field of Family Partners Country Coordinators from Tunisia, Uganda and Kenya during a partners board Planning and Reproductive Health meeting in Indonesia in 2003 (RH) and also to strengthen institutional capacity to member ments with Egypt and Kenya for programs countries to undertake south- policy level exchange visits and Kenya should also promote and south exchange activities. trading of condoms. The Chinese facilitate South to South Collabora- The key issues addressed by the through the State Family Planning tion as an alternative approach to coalition are: the appropriate of China donated contraceptives sustainable development. It integration of reproductive health and medical equipment to Kenya should also seek to demonstrate programmes into family planning in the spirit of South to South that South to South exchange is initiatives; ensuring adequate collaboration. cost-effective, efficient and sus- allocation of resources for securing Kenya, Uganda and Tanzania tainable. availability of essential RH serv- merged efforts in designing and The South to South collabora- ices and products; addressing implementing Reproductive tion has yielded numerous ben- efits. Lead actors gain invaluable adolescent sexual and reproduc- Health programs since 1997 when skills, knowledge and experience tive health; significantly slashing they established the East African through the systematic transfer of maternal morbidity and mortality Reproductive Health Network their top experts across diverse to ensure safe motherhood; and (EARHN). regions and cultures. Through the effective prevention and treatment Way Forward sharing, countries forego the need of STIs and HIV/AIDS. As a way forward Kenya needs to for the costly process of trial and The partnership has had several identify capacities which must be error. Evidence strongly suggests achievements. South to South strengthened so that it is able to be that South to South collaborations documentation tools and method- effectively involved in South- have yielded gains that far out- ologies have been devised and South collaboration in the area of weigh resources invested into the through these fifteen successful Reproductive Health, Family initiative. This proves the overall outcomes of interventions in RH Planning and HIV/AIDS. One cost-effective nature of this broad in Africa have been documented way to achieve this is to establish collaborative effort. This is despite for sharing experiences. A data- training facilities or training the myriad of challenges such as base of South to South Experts courses for people from other multiple languages, high taxation, (SSEPs) and South to South countries who wish to learn the lack of universal access to technol- Technical Advisory Services relevant skills available within the ogy, co-ordination of experts and (STAS) consultants have been country, documentation and pressure from arduous established and are continually dissemination of best practices, commitments. updated on the Partners website. replication of good practices and In 2003, China signed agree- By Charles Oisebe, Partners Country up-scaling of quality Reproductive Coordinator, Kenya 5 news from Partners

Successful use of Media to Advocate for Behaviour Change

he media is often faulted for were documented. was due to the construction of Enziro its negativity - breach of Jiko’s protected spring water sources, a personal rights - but the fact is In Vihiga district, the number of public health campaign in schools and a T women who gave birth at home but change in people’s behaviour on their that media can be harnessed to help with the assistance of Traditional Birth bring about change in society. sourcing of water and how they process Attendants (TBAs) rose significantly and store their water. The general role of the mass media is to between 1992 and 1998. At the time, inform, entertain, educate the public this was a good indicator. The rise was The project also helped improve the health status, family planning practice and advocate for change in society. attributed to the combined effect of and fertility trends within the Investigative journalism can expose ills capacity building of TBAs through seminars at health centres, micro communities where it was initiated. This in society, and explore options for was possible because all the materials teaching classes for women and behaviour change. produced were based on the results of a empowerment of TBAs through needs assessment carried out in the As a media training institution, the support of their activities. model districts. Kenya Institute of Mass The number of children immunized Communication (KIMC) adopted a Uptake of health services in the model with the BCG and OPVI vaccines multi-media approach to initiate the communities significantly went up due within two weeks after birth increased. Population Education Promotion to improvement in health and family A study done in Enzaro Jiko village Project (PEPP). The project was started planning service delivery, the behaviour found that there was a drop in infant change communication activities carried with technical assistance from the mortality which was attributed to the out through various media and Japanese International Co-operation increase in uptake of immunization promotion of community development. (JICA) and through various media such services. as flannel graphs, folk media festivals, The main lesson from the initiative was video shows and print materials, the Health centre staff in Enzaro Jiko that for the success of such a programme programme advocated for behaviour observed a decrease in intestinal parasite it is important to get cooperation from patients. The same area also had no the community, effectively sell the idea change, and use of health care facilities deaths reported due to cholera in of sacrifice and commitment and in its target areas. February and March 1998, while 58 appreciate that media can play an Several successes attributed to PEPP people died from cholera in the important role to this end. educational activities in the model areas neighbouring Jepkoyai locality. This By Godfrey Kareithi, KIMC Tips for working with the Media

t is rare that media reports or radio talk shows result in the changing of social behaviour of an entire community. They rather stimulate the discussion of issues that will eventually result in the change of Ibehaviour, such as an increase in condom use, or attendance at VCT centres. Kenyan radio programmes, if presented professionally, work tremendously well in spreading health messages, particularly those that relate to sexual health.

There are three important points to remember when producing programmes:

1. You have to broadcast the issues you are addressing on a programme with the right listeners.

Issues about adolescent reproductive health have to be Kenya’s Minister for Information, Hon. Raphael Tuju browses the Web as the broadcast on programmes with adolescent listeners, USAID Country Director Dr. Kier Toh looks on during the opening of the Cont’d on Pg. 7 Internews Media Resource Centre

6 ...... starring President Kibaki!

t was memorable and surprising to many people when the TV advertisement starring President Mwai Kibaki championing the I campaign for behaviour change in regards to HIV/AIDS was first aired on our TV screens. This was the beginning of the Pamoja Tuangamize Ukimwi National HIV/AIDS communication campaign.

The launch marked a turn in the history of behaviour change communication campaigns in Kenya. The unique design and utilisation of key opinion leaders in a social marketing campaign opened a new frontier for influencing behaviour in a simple but convincing manner. A comprehensive planning period in which communication needs, information gaps, and communication channels were identified preceded the campaign.

This was the first phase of the national campaign. It lasted ten weeks on the main media while communication resources continue to be distributed in the country to support community activities in the war against HIV and AIDS.

A phase two campaign will be developed after the National AIDS Control Council (NACC) evaluates the impact of the phase one campaign. The phase two campaign is expected to set the programme agenda for more targeted interventions and will aim to strengthen existing partnership between NACC and organisations implementing behaviour change communication interventions.

Working with the Media from Pg. 6 who will be interested in listening to such issues. For not understood by journalists or adolescents. If you talk instance: If you would like to broadcast or sponsor a in such terms, your story will not have an impact. programme on condom use for adolescents, you would 3. You have to understand what journalism training and have to choose a youth station for this. organising press conferences involve. You would also have to choose an appropriate time for Training workshops: NGO workshops that provide your programme to be broadcast and do a lot of research journalists with information on desired issues, RARELY before you decide on a programme. For instance: WORK. In Kenya, the journalists’ biggest problem is that You would have to choose a time that teenagers could they do not have the skills to use this information. They listen to the radio. Choosing a time between 8am and need journalistic skills that equip them to use the 3pm, when they’re at school would defy your purpose. information you have shared with them. The information alone does not help. They need scriptwriting and 2. You have to understand what format works for a interviewing skills. specific programme. Press Conferences: It is important that NGO’s The content and format of a programme are directly understand what is newsworthy and what is not. NGO’s related to its impact. Merely having had all the issues that often get upset because journalists don’t attend media you believe are important to mention on air does not conferences or that their stories don’t get broadcast or mean that your programme will have ANY impact. You published. Mostly, this is as a result of a poor have to make sure that those facts are presented in such understanding of newsworthiness. Many NGO’s think a way that an adolescent will understand them. For the opening of an office, a workshop, or the launch of a example: If you talk about ways to prevent HIV infection, new project is in itself newsworthy. IT’S NOT! You have you have to have an appropriate person to demonstrate to find a news angle that will attract journalists. If your this. Only having an expert in the studio, will not work. project or workshop is for instance about OVC issues, You’ll need an HIV-positive teenager as well. The find an angle such as the discrimination against HIV- teenager’s experience is what adolescents will relate to. positive children in school to present to journalists.

An expert must be aware that technical language and Mia Malan is the Resident Advisor of Internews Network. Internews is funded by USAID and trains and supports Kenyan radio journalist in HIV/AIDS NGO terms such as sero-conversion, ARV or OVC are reporting. [email protected]

7 Knowledge of FP Services contd from pg. 1 basic medical training, while only 55 years leading to drop-out by users. In Availability and quality of service percent received in-service training. In a addition, funding initially targeting family Basic essential obstetric care (BEOC) sign of dramatic improvement over the planning programmes may have been should be available at all health facilities last decade, nearly all of the health care diverted to fighting HIV/AIDS. It is that provide delivery services. Of the workers (96 percent) who graduated from therefore important to look at the cost, sampled maternal health facilities basic training in 1995 or later, covered availability, and the system for delivery of providing delivery services, over half (55 family planning as part of the training, family planning services. The KSPA percent) did not provide all the elements compared to only 62 percent in 1990. survey is expected to shed more light on of basic obstetric care services. While this scenario. delivery sets (equipment) were available Family planning knowledge in 80 percent of these facilities, only 62 On average, health workers providing Antenatal Care (ANC) services percent of the delivery sets were family planning services asked four out of Use of antenatal care is high, but not complete. 11 standard questions considered timely or frequent. Ninety two percent of essential for a new family planning client. the women used ANC services at least Client Satisfaction Over half of providers failed to inform the once during pregnancy. However, More than half of ANC service clients interviewed (57 percent) expressed a client about multiple methods, one-third according to the MOH guidelines, women high level of satisfaction in general. did not explain how to use the contracep- should visit ANC clinics in the first However, only 24 percent believed that tive prescribed and 28 percent did not trimester of pregnancy, and thereafter – they were treated “very well.” Women mention the side effects. four or more times. Early and timely visits who were older, over 25 years of age, In the 2003 Kenya Demographic and promote essential screening of high-risk more educated, and from a high social Health Survey (KDHS), the Contraceptive mothers and emergency preparedness. economic status were more likely to have Prevalence Rate (CPR) remained The study revealed that only 14 percent a high client satisfaction with services. constant at 39 percent of married women of women visit in the first trimester and Lower levels of client satisfaction were who were using any method of family only six in ten women attend ANC found in the Coast Province, 42 percent; planning. This plateau is in sharp contrast services four or more times as is Eastern Province at 38 percent, and with previous trends since the early 1980s recommended. Nyanza, 19 percent. Ninety four percent when a steady increase in family planning Women receiving antenatal care from of clients responded positively that the use among married women had been a health professional rose from 78 health workers were easy to understand, documented (see highlights of KDHS percent in 1989 to 95 percent in 1993, about 80 percent felt the information 2003 pp. ii-iii). then dropped to 90 percent in 2003. would be kept confidential, and about In his presentation of the KDHS 2003 In addition, the proportion of women three-quarters were satisfied that the findings, the Minister for Planning Hon. who seek medical assistance during waiting time was reasonable. Prof. Anyang’ Nyongo’ said that the delivery declined from 50 percent in 1993 stagnating CPR could be attributed to to 42 percent in 2003. By Dr. Paul Kizito, Senior Assistant Director Policy Division, NCPD and Mr. George Kichamu, contraceptive stock-outs in the previous Senior Assistant Director, IEC Division NCPD

in Central Province at 60 years for males and 68 years for females while Kenya’s Statistics Nyanza province recorded the lowest at 42 years for males and 48 years for Kenya’s Population. Has almost tripled in the last three decades, from 4.8 females. million in 1948 to 8.6 million in 1962, 16.1 million in 1979, 21.4 million in 1989 Adolescent childbearing. Is rampant yet the risk of dying at this age is four and 28.7million in 1999. times higher than women older than 20 years. Adolescents account for 12% Growth rate. Increased from 3.3 % in the 1948 - 1962 period to 3.9% in the of births In Kenya. Across the provinces; Nyanza recorded the highest of 1966 -1979 and declined to 2.8% during the 1989 - 1999 period. 15% while North Eastern had the lowest of 8% adolescent births. The primary school enrolment ratio for Kenya is 103 males to 99.8 females. Rural / Urban Distribution. In the 1999 census, 23,300,100 people reported The difference in ratios is more pronounced in Nyanza province with 121 to be residing in rural Kenya and 5,361,000 in urban areas with Nairobi having a population of over two million. The Rift Valley had the highest population of males to 115 females. 6,982,000 while North Eastern had the lowest of 962,000. Population living below poverty line. Increased due to poor economic performance from 52% in 1997 to 56% in 2002 with the proportion of the Most densely populated Province. Is Western Province with 456 persons economically productive population being only 28% and dependency ratio of per sq. kilometre while the least densely populated province is North Eastern 113 per 1000 in the year 2000. with eight persons per sq. kilometre. The Working woman. Sixty one percent (61%) of the total women who work Life expectancy at birth. Has declined from 58 years to 54 years for males are not paid compared to 39% of their male counterparts. This trend is recorded during the years preceding 1999 period and 61 years to 57 years for females in all the provinces. during the same period. The highest life expectancy at birth was recorded By Vane Lumumba, Research Division, NCPD

8 o o ECCFof KDHS

he Department of Reproductive Health (DRH) of the For the first time the KDHS covered the Northern frontier Districts. Ministry of Health provides most of the reproductive What policies will the Government develop to ensure that people T health services in Kenya. Dr. Josephine Kibaru, head in these regions have equal access to health services? of DRH, gives some useful insights on implications of the The northern frontier receives the same budgetary allocation as any KDHS findings in Kenya. other districts or provinces in Kenya. But due to the nomadic lifestyle of people in that part of the country, static health points do not work. The only way to meet their health needs is through use of outreach services. Q. What should be our main source The Government could support the outreach services currently provided of concern from the KDHS 2003 by NGOs in the region so as to meet this challenge. findings? A. Most of the indices have fallen. There So as to deliver services to the region effectively, the MOH also needs is a rise in the Total Fertility Rate to build on community partnerships. The residents are very conservative (TFR) and mothers are not using the hence there is a need to find out what is acceptable to them before delivery services that are in place. embarking on projects in the area. Many mothers and babies die during Many resources have been used delivery due to the use of Traditional Birth Attendants (TBAs) and when over the years to provide these an emergency occurs, mothers cannot be taken to the health centre on services but we still have these time because it is far away and transport is also a hassle. negative indices. There is need to go to the communities and find out Adolescents form an important component of the population. How Dr. Josephine Kibaru, Head of why mothers are not using these do you propose to serve their special needs? Division of Reproductive facilities. The DRH is also working on developing guidelines for youth friendly Health (DRH) services and together with the NCPD and partners in reproductive health What is the MOH/DRH doing to ensure contraceptive availability look forward to implementing activities in ARH&D soon. and minimise stock outs? The main reason for stock outs is donor dependability. Donors procure most of the contraceptives used by Kenyans. The government is trying Key indicators from KDHS 2003 to improve donor co-ordination in many ways, one of which was the development of the ‘Contraceptive Commodities Procurement Plan Condom use in Kenya is still low. Men are more likely (17%) than women 2003-2006’ to help the Government plan in advance to meet this (5%) to use a condom during sexual encounters. challenge. HIV/AIDS prevalence in Kenya is 6.7%. Women were more likely (9%) than men (5%) to be HIV positive. The MOH is lobbying the Government for increased funding for contraceptive procurement. If the MOH has the funds, it can procure Level of education proved to be a factor in uptake of health services. the contraceptives locally in case of a stock out. The MOH would like Mosquito net use is low in the general population (14%). the District Health Management Team (DHMT) to give contraceptive distribution the same priority they give to vaccines and essential Under five mortality increased from 96 per 1000 (1993), 65 per 1000 medicines. (1998) to 114 per 1000 (2003) live births. This implies that one in every nine children in Kenya died before their fifth birthday. Has the government identified sources of increased budgetary allocation to meet the rising need for family planning services? Vaccination coverage declined from 79% (1993), 65% (1998) to 52% The Abuja Declaration recommended that government should allocate (2003) KDHS. 15 percent of its total revenue to the MOH. Currently, the government Female Circumcision. Thirty four percent of women in Kenya are gives around 9 percent. The MOH is thus lobbying for increased circumcised (Somali 97%, Kisii 96% and Maasai 94%). budgetary allocation. Total Fertility Rate (TFR), number of children per woman, went up slightly What kind of support would you hope for from donors and NGOs from 4.7 in 1998 to 4.9 in 2003. to meet the health needs of our country? Gender Violence data was collected for the first time. Forty four percent of Donors need to invest in personnel training as part of helping us meet married/divorced or separated women aged 15 to 49 had been either Kenya’s health needs. Donors also need to support NGO projects physically or sexually abused by their partner. through the country’s health budget so that the effect of the projects can be felt countrywide or can easily be accessed for national up scaling HIV Status is not known by many Kenyans. Only 13% of Kenyan women in future. NGO funding should be through the budget so that they can and 14% men know their HIV status. respond to the country’s health priorities and they can help support the Medically assisted delivery has fallen from 50% births in 1989 to 42% in Government strategies. 2003 KDHS.

HIGHLIGHTS Key Findings ...... ii - iii Government Responds ...... iv Three Point Turn ...... iv 9 Key Findings of the KDHS 2003 Survey By George Kichamu

he Central Bureau of Statistics (CBS) together of Reproductive Health and Family Planning services likely to use a condom during sex than rural women with other stakeholders carried out the 2003 in Kenya. The DHS surveys are continually improved (4 percent). T Kenya Demographic and Health Survey to address questions policy makers and programme (KDHS) from mid-April to mid-September 2003 using managers ask and offer important guidance for future Fertility a national representative sample of almost 9,000 provision and access to health care. In this article, we Fertility data was collected by asking every woman in households. All women aged between 15-49 years examine the preliminary findings of the 2003 KDHS, the survey for a history of her births. In the period and all men 15-54 years in a sub-sample of one-half the final report of the findings will be ready for 1989 to 1998** Kenya experienced a 30 percent of the households were eligible to be individually dissemination and distribution by June 2004. decline in total fertility rate (TFR) from 6.7 children interviewed. per woman in 1989 to 4.7 children per woman in HIV/AIDS 1998**. However, the 2003 KDHS showed a slight “The KDHS findings HIV/AIDS is one of the most serious public health increase in TFR to 4.9 children per woman. The call for urgent review challenges facing Kenya today. The 2003 KDHS for apparent increase may be attributed to the constant of relevant population, the first time included a survey on knowledge and proportion of women using contraceptives in the health and socio- prevalence of HIV/AIDS. Awareness of HIV/AIDS was period 1998 to 2003**. The TFR in rural areas (5.6 economic policies in high with 86 percent of women and 92 percent of births) is higher than in urban areas (3.3 births). order to set new men surveyed believing that there is a way to avoid targets against which the virus causing HIV/AIDS. Nairobi province had the Family Planning interventions will be highest awareness that HIV/AIDS can be prevented at Female respondents were asked to mention methods based,” Hon. Anyang’ 94 percent, while North Eastern province had the of family planning by which a couple can delay Nyongo’, the Minister lowest with only 30 percent of women and 44 for Planning, said Hon. Anyang’ Nyongo’ the percent of men believing that AIDS can be Minister for Planning during its launch. Contraceptive Use Among Currently Married avoided. “Most of the indicators in the health sector have Women, Kenya 1978-2003 (excluding northern districts) continued to deteriorate implying that all stakeholders HIV/AIDS Prevalence in Kenya is now estimated 45 39 39 in the sector should re-evaluate their programmes.” at 6.7 percent among men and women aged 15 40 to 49 years. The survey found that 4.5 percent 35 33 The KDHS survey provides up to date data on child of the men tested were HIV positive compared 30 27 survival, contraceptive use, maternal care, child to 8.7 percent of the women tested. The 25 mortality and other key health topics. HIV/AIDS and proportion of HIV positive persons was found 20 17 gender violence were new components in the 2003 to be lowest in the 15 to 19 age groups at 2 15 KDHS that also covered North Eastern Province for percent and highest in the 35 to 39 years age 10 7

the first time. method any using currently Percent group at 10 percent for both sexes. 5 The KDHS findings provide useful insight for policy 0 The survey found that only 13 percent of the makers and programme managers as the survey 1978 1984 1989 1993 1998 2003 respondents has ever been tested and know their evaluates programmes, measures their effects and HIV status. Thirteen percent of women and 14 percent improves the design of health programmes. It assists of men are presumed to know their HIV status or at pregnancy and whether the lady had ever used it. The policy makers develop strategies for efficient provision least knew it at a certain point. Contraceptive Prevalence Rate (CPR) plateaued at 39 percent of married women who were using any method HIV prevelance by Province Men and Women aged 15-49 years Condom Use of family planning. The plateau is in sharp contrast with previous trends since the early 1980s when a 14 Men were 17 percent likely to use a 14 steady increase in family planning use among married condom during any sexual encounter women had been documented. Modern methods (31 12 while women were 5 percent likely. percent) are more commonly used than traditional 9.1 Both men and women are less likely 10 methods (8 percent). to use a condom during sexual 8 intercourse with a cohabiting partner 6 Urban women (47 percent) are more likely than rural Percent 5.9 6 5.2 5 (3 percent and 2 percent respectively) women (36 percent) to use contraceptives. 4.1 than with a non-cohabiting partner (46 4 Contraceptive use also increases dramatically with the percent and 23 percent respectively). level of education. More than three quarters of women 2 The reported level of women using a 0 with higher education are more likely to use any 0 condom during any sexual encounter Nairobi Central Coast Eastern Nyanza R/Valley Western N/Eastern method compared to just over half of the women with rises sharply with education level while Province incomplete secondary education and only 12 percent urban women (10 percent) are more of those who never attended school. Married women 10 ii A drop in most of the indices is linked to the rise in poverty

in Central province have the highest contraceptive primary education and 99 percent of women with of women have ever been physically or sexually prevalence rate (67 percent), followed by Nairobi (52 higher education. violated by their husbands or partners, while 29 percent). The lowest level of family planning use is in percent of women indicated that they were victims of North Eastern province with less than one percent. Antenatal care from a health professional rose between physical and sexual violence one year preceding the 1989 (78 percent) and 1993** (95 percent) KDHS survey. Rural women were more likely to be victims Fertility Preferences and then experienced a decline thereafter (92 percent of violence than their urban counterparts. In addition, in 1998 and 90 percent in 2003**). In addition, the Women were asked questions about whether and when women from Western (67 percent) and Nyanza (56 proportion of women who seek medical assistance they would like to have another child. Twenty nine percent) provinces appear to have a higher risk of during delivery declined from 50 percent in 1993 to percent of all the currently married women would like violence than women in other provinces. 42 percent in 2003**. More mothers and babies are to wait for two or more years before the next birth at risk of dying during childbirth due to this drop in while 48 percent do not want to have another child or Female Circumcision use of medical assistance during delivery. are sterilised. The vast majority of currently married “There is need to have more programmes and policies women without a child (79 percent) would like to have that would reduce the incidence of domestic violence a child soon. Women show greater interest in Child Health and Nutrition and female genital cutting (FGC) in the society.” Hon. controlling their births once they have a child. The In the last decade, infant mortality rate has risen by Anyang’ Nyongo’ proportion of women wanting no more children or 26 percent from 62 per 1000 live births in 1993 to 78 are sterilised rises from 9 percent among women with in 2003**. Under five mortality rose by 19 percent The data shows that 34 percent of women in Kenya one living child to 79 percent of women with six or from 96 per 1000 live births in 1993 to 114 per 1000 are circumcised, which is a decline from 38 percent more living children. in 2003**. in the 1998 KDHS**. The percentage of women circumcised varies with age. Older women and those The increase in childhood mortality rates Total Fertility Rates, Kenya 1975-2003 in rural areas are more likely to be circumcised than (excluding northern districts) depicts deterioration in quality of life in the younger women and those living in urban areas. 9 8.1 last decade. It may also be due to declining 8 immunization rates of children under five years. Genital cutting is highest in North Eastern province 7 6.7 The 2003 KDHS indicated that only 52 percent (99 percent) and least in Western province (5 percent). 6 5.4 of children aged 12 to 23 months are fully The Somali (97 percent), Kisii (96 percent) and Maasai 5 4.7 4.9 immunized. This is a significant decline from (94 percent) ethnic groups reported the highest rate 4 65 percent in 1998 and 79 percent in 1993**. of female circumcision while the Luo (0.7 percent) 3

Births per woman This implies that more children are at risk of and the Luhyia (0.9 percent) had the lowest. The survey

2 dying from preventable diseases like measles, also revealed that the majority of Muslim women (54

1 polio, and tuberculosis. percent) are circumcised compared to about one-third

0 or more of the non-Muslim women. 1975-78 1984-88 1990-92 1995-97 2000-02

Ownership and use of Proportion of Women Circumcised Maternity Care Insecticide Treated 120 Mothers who had given birth in the five years preceding Mosquito Nets 100 99 the survey were asked a number of questions about Data was collected on the ownership and use maternity and child health care. Mothers were asked of mosquito nets per household. Questions 80 whether they received antenatal care during pregnancy, were also asked on the treatment of the

Percent 60 and whether they received tetanus toxoid injections nets with insecticides. More than 20 45 41 and/or iron supplements while pregnant. percent of the households reported at least 40 34.2 36 33.7 one mosquito net but only 6 percent of 21.6 Almost nine in ten mothers reported seeing a health these households have an insecticide 20 19.4 professional at least once for antenatal care for their treated net. Ownership and use of mosquito 5.5 0 most recent birth. Coverage is slightly higher in urban nets is highest in malaria endemic areas Nairobi Central Coast Eastern Nyanza R/Valley Western North Kenya Eastern areas than rural areas (93 percent and 87 percent of Nairobi (37 percent), Coast (33 percent), Province respectively) and the proportion is lower in North Nyanza (31 percent) and Western provinces Eastern province (25 percent) compared with a range (19 percent). **So as to make the data comparable, the of 87 to 95 percent in all the other provinces. Data percentage in most instances excludes data for showed that 67 percent of women with no education Domestic Violence the northern districts, which were surveyed for received antenatal care from a health professional For the first time, the 2003 KDHS surveyed the extent the first time in the 2003 KDHS. compared to 88 percent of women with incomplete of gender violence. The results showed that 44 percent

11 iii Govt. A Three Point Turn by David Kinyua Responds to Findings he Kenya Demographic and Health reproductive health directly affect the imple- Survey (KDHS 2003) confirmed fears mentation of the Government’s Economic within the population and reproductive Recovery Strategy for Wealth and Employment David S. Nalo T PS, Ministry of Planning health community that most of the key indica- Creation and ultimately poverty alleviation. tors had actually reversed. For a country that “HIV/AIDS continues to be a national disaster. The Poverty itself is not a new agenda in the country. had earned international praise for achieving a KDHS information will assist in formulating evidence What is new is the worrying trend it is taking. low total fertility rate (TFR) of 4.7 percent in based programmes and verify/supplement the 1999 from a high of 8 percent a decade earlier More than half of Kenyans live below the poverty information from sentinel sites. More concerted efforts to record a TFR of 5.0 percent is a reason for line on Sh.80 a day and total fertility rate (TFR) should be directed at reducing further the prevalence much concern. Fortunately, these concerns are in Kenya is highest among the poor. This leads us rates.” Hon. Anyang’ Nyongo’. being addressed. to the second turn – Advocacy. Adolescent Reproductive Health. The NCPD, with Kenya was the first sub-Saharan African country Advocacy will promote and support increased support from various partners, is in the process of to adopt an official national family planning awareness, knowledge, understanding and developing an action plan for the implementation of policy. The main objective of the policy was to commitment to the national population and the country’s Adolescent Reproductive Health and Development Policy (ARH&D) to deal with the high level of adolescent fertility.

Unmet demand for Family Planning. Implementation of a National Population Advocacy and IEC Strategy for Sustainable Development, will among other things address the high unmet demand for family planning. Provision of quality information and services in appropriate audiences will be undertaken for positive behaviour change.

The development of the Contraceptive Commodities Procurement Plan (2003-2006) by the MOH also aims to promote contraceptive security and expand contraceptive choice to meet both FP and other RH needs in Kenya. The plan will assist the government with information for forward planning for timely procurement of contraceptive commodities.

Regional and rural-urban disparities in fertility A community awareness day conducted by Marie Stopes to encourage behaviour change and mortality levels. To address these disparities and trends in family planning levels, District Specific health programme. For instance, we can reduce the population growth rate, which was Strategic Plans of Action (DSSPA) have been advocate for increased contraceptive uptake considered to be too high for the achievement of developed and are being finalized. the country’s development objectives. Substan- using participatory methods while providing tial achievements were made in policy and factual information. We shall inform families, The increasing infant mortality as noted will be programme implementation over the years, educate schools, and ask peers to educate each addressed through implementation of appropriate programmes targeting each segment in society. “A especially in the campaigns to encourage other and enlist religious organizations in our more focused strategy on immunization coverage Kenyans to adhere to a small family norm. This campaigns. We could train youth, men and should be developed since coverage continues to explains the decline in family size, TFR and women on life skills and, when possible, provide decline in spite of the programmes developed by the subsequently reduction in birth rate. Now that friendly reproductive health services. government and donors.” Hon. Anyang’ Nyongo’. this trend is reversing, there is need for urgent For the third turn – Communication - we will action. Is a three-point-turn in our strategies examine the cumulative, rather than discrete The Ministry of Health is in the process of possible? effects of communication. We shall be asking, implementing Health Sector Reforms and a National for example; “If you are not aware, why don’t Social Health Insurance Scheme to address the The first point is to ask ourselves how we treat you know; and if you know, why don’t you act on unmet need for healthcare in Kenya population dynamics in development planning? the basis of that knowledge?” A full understand- Resources. The Government is lobbying for We have merely been breaking down the ing of the underlying determinants of behaviour, resources both locally and internationally to support population structure with little effort to highlight is the basis of relevant messages and pro- the implementation of the National Plan of Action and address the challenges of population on the grammes aimed at influencing change. (NPA) to implement the population policy. overall development in the country. Our first Free primary school education programme turn then will be to advocate for our planners to Let us get started now! launched by the Government in 2003 has raised the appreciate that changes in population and school attendance ratio in the country. iv 12 ICPD 10th Annivesary: Global Roundtable

t the International Conference on A coalition of international Population and sexual and reproductive Development (ICPD) held health and rights inA Cairo in 1994, Kenya was organisations is preparing among 179 countries that for an NGO led programme committed to advance of activities focusing on reproductive health ICPD and the halfway point and provision of sexual and United Nations Population services and women’s for the PoA. The reproductive health Fund (UNPFA) together rights and to make basic programme, ‘Countdown services. with governments have reproductive health 2015: Sexual Reproductive conducted a survey of services available to all by Health for All’ was initiated The review also revealed achievements made so far 2015. In 1999, Kenya was by Family Care that much greater action towards achieving this again among countries that International (FCI), was still needed in certain goals. Several activities are ratified the Millennium International Planned areas and by consensus it planned for 2004 to review Development Goals (MDGs) Parenthood Federation was adopted by the general implementation of the that committed the (IPPF), and Population assembly. The Key Actions ICPD PoA. international community to validated the Action International (PAI) an ambitious goal that comprehensive approach UNFPA has conducted a and now involves a wide would see the world reduce to population and field inquiry on national range of NGOs. the number of persons development articulated in experiences among all Countdown 2015 activities living in absolute poverty the Programme of Action, countries and a report will include an International by half by 2015. To do this, affirmed the ICPD goals, be released during the Round Table to be held in world leaders set specific and provided a set of annual session of the London, from 31 August to targets for life expectancy, benchmarks for achieving UNDP/UNFPA executive 2 September 2004. The education, housing, gender them. board on June 21 2004. The Round Table will be equality, openness of trade, preceded and followed by a and environmental series of activities protection. including six regional The five-year review of the meetings to be organised implementation of the by IPPF in partnership with ICPD Programme of Action other NGOs and networks. (PoA) in 1999 showed that The African Region progress was being made. Meeting will be held on Policies had been 23rd to 25th June 2004 in developed in most Nairobi. countries to address At the Global Round Table, highlighted issues and the coalition will launch a governments were pushing report card and the RH agenda. There is supplementary materials now a critical shift in focus aimed at assessing country in population policies and The ICPD Programme of Action calls for increased access to healthcare performance and ICPD programmes from a for women commitments. The Round primary concern towards Table programme will have achieving a country’s emphasis is on lessons a strong emphasis on demographic targets It is now ten years since learnt and on exchange of assessing the progress through family planning ICPD 1994 and four and a experiences at the regional made toward achievement programmes to an half years since the MDGs level. Countries can identify of ICPD and to help emphasis in improving the were set. To review how they can assist each determine what action is quality of life through achievements towards other in a south-south co- needed to realize the goals promotion of human rights attaining these goals, the operative spirit. by 2015.

13 district Briefs

he District Population Office was established to help the NCPD headquarters co-ordinate population and reproductive health activities at the district level. A District Population Officer (DPO) represents the NCPD at T district meetings and contributes to issues related to population and reproductive health. The DPO also reports on ongoing activities and accomplishments to the headquarters.

An important task DPOs undertake is the dissemination of information on population and reproductive health to district stakeholders. The DPO is also a member of the District Development Committee (DDC) and makes contributions and recommendations during the preparation of district development and other strategic plans for the district. As feedback from DPO’s provides important evidence-based information for the NCPD policy and monitoring and evaluation process, Kenpop News will be highlighting population issues from the DPO’s.

Kisii and Gucha with Stephen Ndili Kakamega with Peter Nyakwara yanza province as a whole has a major problem with malaria. Several malaria control activities have been undertaken to everal organisations are currently implementing deal with this. In Kisii and Gucha districts, Merlin, a local youth sexual reproductive health activities in NGO, has been supporting malaria control activities since 1999. Kakamega district and western province as a N Merlin has helped in capacity building of health workers and health whole. The most notable are PATH-Kenya, the MOH/ S centres in the district to deal with malaria more effectively and has GTZ reproductive health programme, Uzima Foundation, also helped the Ministry of Health, Ministry of Education and NCPD Family Planning Association of Kenya (FPAK), World of in training shopkeepers, teachers and pupils on malaria. Through youth and children, and the Kabras jua kali association cost sharing, Merlin has managed to make the project self among others. With the formulation of the ARH&D policy, sustaining. many more organisations are likely to initiate programmes targeting young people and those undertaking youth related activities will refocus their Kisumu with Alex Juma activities in line with the policy and emerging issues. reliminary results of the Kenya Demographic and Health Survey 2003 rank Nyanza province as one of the leading Provinces in incidences of violence against women. Against this scenario, a Kirinyaga with Peter Reriani Pnumber of programmes have been launched with the ultimate goal of he poor performance of the coffee sector reducing or eliminating all forms of violence in the community. Some of in recent years is one of the major these include the dissemination of the Children’s Act and Gender reasons for the rise in poverty in Sensitisation at all levels and sectors. Kirinyaga district. Poverty is visible in the lack of T Fida Kenya, with support from the 5th UNFPA Country Programme, has land for farming, poor housing, unemployment, launched an in-school programme to deal with this practice. The lack of money to pay school fees and medical bills objectives of the programme are to promote gender sensitisation in and, lastly, most people cannot afford a daily schools; identify traditional practices that affect child development; and meal. to develop an Action Plan to deal with these harmful practices. Domestic conflicts and drunkenness are the major The programme has helped increase the enrolment and school retention social problems brought about by poverty. Land is rate of the girl child in the district and has also led to the improvement in the main bone of contention. In coffee farming education performance of the girl child in National examinations. Peer areas, the issue of progressive sub-division has reduced land size to uneconomical small sizes. In education has also been introduced in some secondary schools while the marginal area of Mwea division, farmers at the guidance and counselling has successfully been integrated in many extensive rice scheme believe they can make schools to deal with cases of indiscipline, thus replacing corporal better use of their land if they were allocated title punishment. deeds for the land they occupy.

Marketing of produce is a problem for both coffee and rice farmers. Coffee farmers blame their Siaya and Bondo Districts with Samo Otieno poverty on non-payment for their produce. Rice chool attendance in Siaya and Bondo Districts is very low. farmers have large stocks of unsold rice, while the The school drop out rate in both primary and secondary government allows for importation of rice. schools is very high. Poverty is the main reason for drop out Sfrom secondary schools since most students are not able to raise money for school fees and many girls drop out of school due to pregnancy. This has led to a high illiteracy level, which is visible in the reduced lateral development, increased insecurity, and a reduced participation in population development activities.

14 Nairobi with Mrs. Beatrice Aosa Nyeri with Peter Reriani ural urban migration has led to he Nyeri District Population and Family Planning (DPFP) committee met in inadequate housing and the March 2004 to discuss the implications of the KDHS findings and pinpoint overburdening of education areas that could be remedied. The District Development Committee (DDC) Rand health facilities in Nairobi. Another Talso deliberated on the findings. The DPFP Committee felt that it was necessary for the major challenge is the presence of findings to be analysed down to the divisional level where most of the development multicultural communities in the province activities are implemented. living in diverse circumstances. The The committee appreciated the fact that Nyeri district reported one of the highest DPO is challenged to understand the percentages in uptake of family planning methods in the country (67 percent); however, different myths and beliefs each they also noted that there was a need to enhance condom use, which was particularly community holds on health issues so as low in the district. to adequately deal with the overall needs of the population. Another cause for concern was the decline in uptake of immunisation services in Central province as a whole and Nyeri district. The number of fully immunised children declined from 92 percent in 1993 to 74 percent in 2003 in Central Province.

Nakuru with Samuel Aloo Ogola Migori with Emmanuel Adienge he youth have been targeted all over the country in he Luo cultural norms contribute to the HIV/AIDS activities. In Nakuru, the Catholic Diocese high rate of HIV/AIDS in Migori. initiated behaviour change, peer counselling and reproductive Traditional attitudes and values have health education for the youth through a programme tittled ‘an enlightened T affected men’s sexual behaviour. Having multiple youth is a responsible citizen’. The programme uses a Christian belief T sexual partners among men is seen to be model that states that behaviour is a function of belief and as such one ‘macho’, hence, promiscuity is rampant. Wife should be motivated to act according to faith. Among the unique aspects of inheritance and polygamy complicate matters the peer counselling programme is the ‘virginity club’ started by the youth further. themselves that encourages the youth to declare their virginity and their willingness to abstain at all cost.

children’s Rights

Three Young Girls Search for Love By Catherine Ndii, DPO Mombasa he heart rending true story of three sisters, Lena, Sarah, and Shauri surrounded by domestic and sexual violence and are denied education. The (not their real names) who were brought up in love and respect comes few who manage to go to school beg for basic necessities from well-wishers. T to mind when I think of the suffering children encounter at the hands This has led the children to engage in drug peddling and commercial sex of adults. These three girls knew no violence until their parents died of HIV/ work. Those in school don’t have much to look forward to and most of them AIDS. eventually drop out.

Lena, sixteen years old, went to live with an uncle in an urban area. He raped Children’s rescue institutions are expected to offer respite to these children. her and she ran away. Her whereabouts are unknown. Sarah, fourteen years The reality is that most children are confronted with the same agony in these old, went to live with another uncle in a rural area. Her cousins raped her institutions and continue to encounter physical, psychological and sexual abuse. The lucky few who end up in caring institutions reform. A good example repeatedly and she too ran away. She is still on the run. Twelve year old is the WEMA care Shauri lives with another uncle who has denied her education and she is institution that has become currently the housemaid in his house. This is not news to most Kenyans since a home for over 200 girls it is the appalling injustice directed at children by society today. These sufferings in Mombasa. bring into sharp focus the rights of children, which are blatantly violated with no evident recourse for the child. There is need for information education and Mombasa Island is a case in point. According to the District Children’s Officer, communication activities there are about 1,500 orphans on the streets in the Island Division alone. to increase awareness in Most of them are AIDS orphans who seek refuge on the streets after being the communities on child disinherited or abused by relatives. There are about 3,000 street children on welfare issues. There is Mombasa Island today. This number includes orphans and children who also need to enforce the migrate from Nairobi and who cross the border from Tanzania in search of rights of the child. Kenya’s free primary education. Others are driven from home by violence or poverty. population development The poverty level in Coast province is 58%. Mombasa district has a poverty agenda should place child incidence of 44%. It ranks high in the country’s poverty scale. welfare issues on high priority so as to Life on the street is no bed of roses. Boys are sodomised, some girls are complement existing raped while others end up in commercial sex work. Sexually transmitted programmes that try to diseases and HIV/AIDS are common due to the heightened sexual activity. Street boys sniffing glue: Child abuse drives many children to the streets deal with child Some of the orphaned children who are taken in by their relatives grow up exploitation.

15 rh Perspectives

The various advocacy and consensus building activities are to Re-introducing the cultivate ownership among the various groups who include programme managers, professional associations, service providers, researchers, trainers, funding agencies and clients of the project. A IUCD in Kenya task force was established from this group to develop a strategy for the IUCD reintroduction. lthough the contraceptive prevalence rate has tripled since Through the MoH AMKENI Project, a USAID-supported service 1984, the number of women using the Intra Uterine delivery project, the initiative will build the capacity for IUCD use and A Contraceptive Device (IUCD) has decreased from 31 per distribution. The MoH’s Decentralised Reproductive Health Training cent in 1984 to 8 per cent in 2003. Despite its proven safety, and Supervision teams are implementing this objective. The effectiveness, acceptability and low cost it has become invisible programme will utilise the AMKENI Project’s behaviour change among the available method mix for family planning over the past 15 communication strategy to generate demand for the IUCD through years. various media tools and channels.

The Ministry of Health, with assistance from Family Health Partners in the project are already collecting data to help in International (FHI), has launched an initiative aimed at popularising monitoring and evaluating the progress. The information collected will IUCD use. Through a well-planned process the MoH has undertaken help in refining and improving the programmes implementation consensus-building activities among partner organisations working in strategy. RH that are aimed at generating support for the re-introduction of the For more information contact FHI’s Research and Practice initiative IUCD in the country. at [email protected] or FHI Nairobi at [email protected] Saving Womens’ LIVES he National Council for significantly reduce the number of neonates by increasing equitable access, Population Development (NCPD) unsafe, illegal abortions. However in the use, quality and safety of health services T embraces the population policy in recent past, the NCPD is concerned that for mothers and neonates through Kenya. It draws its mandate from the women could not access contraceptives concerted action at the policy, service Session Paper No. 1 of 2000, which due to shortages. and community level, with special incorporated principles from the According to the latest Kenya attention to reaching the poor and most Programme of Action that was adopted at Demographic and Health Survey of 2003, vulnerable. the Cairo International Conference on there is a large number of women who The ongoing national debate on Population and Development (ICPD) in want to space or limit the number of abortion provides a platform to highlight 1994. The policy emphasizes that children, but are not practising family issues that affect the health and lives of “abortion will not be used as a method of planning. Moreover, the survey shows mothers. family planning in Kenya and every that the number of family planning users To terminate a pregnancy, Kenyan law attempt will be made to eliminate the has stagnated over the last five years at requires that two registered Medical need for abortion through reliable 39 percent, with only a small increase practitioners (Doctors) be in agreement information, counselling and services. over the last decade. During the same that the life of the mother is in danger. Women who have had an abortion will period, the number of children per The Council is aware that there are many have access to quality services for woman has increased from 4.7 to 5.0. places where there are no doctors and management of complications arising This is in stark contrast to the dramatic there is a need to review this provision to from abortion. Post abortion counselling, successes in family planning that Kenya allow other registered health providers education and family planning services experienced in the 1980s and early like Nurses and Clinical Officers who are will also be offered.” 1990s. The NCPD is currently involved available in rural areas to be able to The NCPD advocates the view that in promoting dialogue to increase access advise and refer mothers to facilities one way of preventing mistimed or to contraceptives and to reinforce family where safe abortion can be carried out if unwanted pregnancy is to promote family planning programmes. the life of the mother is in danger. planning services, including counselling The NCPD embraces and promotes As the world approaches the 10th on natural methods and access to a full the WHO strategy on safe motherhood, anniversary of the ICPD, Kenya faces a range of modern contraceptives. This will the ‘Making Pregnancy Safer’ initiative. continued challenge to respond to the enable women to avoid resorting to The WHO strategy is designed to reproductive health needs of women and abortion as the only option. strengthen the capacity of health systems reduce unnecessary deaths due to Family planning saves lives and can to improve the health of mothers and unsafe abortions. 16 Marie Stopes Kenya

Marie Stopes Kenya is an NGO that pro- vides reproductive health care to all peo- ple of reproductive age across Kenya. Es- tablished in 1986, Marie Stopes Kenya is affiliated to Marie Stopes International and runs 15 clinics and four maternity nursing homes across the country.

The nursing homes are located in four prov- inces - Coast, Nairobi, Nyanza and Central Provinces. Further to these clinics and nurs- ing homes, Marie Stopes provides commu- nity outreach services in all provinces ex- cept North Eastern.

The organisation with assistance from part- ners offers affordable healthcare helping mothers deliver their babies and providing contraception advice and options to fami- Community awareness outside the Marie Stopes Eastleigh Clinic lies across the country. The organisation plays an important role in the provision of reproductive health services in Kenya. Titbits POEM Baba Ndure’s experience used to pass through Eastleigh First OnePOEM of the poems presented to the youths duringPOEM the celebrations Avenue every morning while going to work. to mark 2001 world Population Day in Kisumu District. I On the street, I used to see a board boldly written Marie Stopes as I passed by. I never bothered to find out what Marie Stopes was. “BANANA” One day, I was seated at home when my Do you want to taste “Kanini do not eat the banana” wife started experiencing labour pains. She was A fruit that is so great “But why daddy - each of my school eight months pregnant, it was late at night, and Fleshy and full of meat mates eat the I did not know what to do. At that point a Somali They say it is so sweet banana - they say its so sweet neighbour entered my house. With all that was Sweeter than honey And to avoid indigestion and going on I almost ignored him but as we talked I More valuable than money constipation explained my predicament to him. They take it with a special Nylon” “How could you be suffering and a clean Banana Banana Banana Slap! I do not want to hear that topic Fruit inaayopendeza health facility is right next to your house?” he Akilini hukupumbaza Mtoto ukimslapu asked me unbelievingly. I told him I did not Moyoni hukuliwaza Jua hujamhelpu know what he was talking about. He pointed at It’s true Nakueleza Maisha ataflopu the Marie Stopes Clinic and I told him I thought Ukiila huteleza Kwani atakosahopu it was just a normal business opened up by And when its in your throat Mtoto mueleze dhahiri shahiri another entrepreneur. You happily shout Auuuuch…… Kwani banana sio siri I took my wife to the clinic and we were very Although banana ni tamu well received. After a month, she delivered a People are crazy about Banana Though hukutia hamu beautiful baby girl and I named her ‘Bahati’. I For it Masupuu hipigana Mwishowe huwa ni sumu was so thankful since the hospital was very Mama zetu hupigana For your stomach will swell clean, the health providers were kind and they Our grandma’s hurogana You will think it s hell all knew their work. Should I have a patient, I Banana Banana And that will be the market tale They take each to churches would not hesitate to refer him or her to Marie to take vows Abstain is not in vain Stopes. “ A swear I shall not share my Abstain escape the pain By Margaret Warratho, Marie Stopes But do they keep their promises. Abstain its full of gain.

17 news Briefs Gender Mainstreaming Activities

n the past decade, the Government has been active in organisations that promote gender issues. The government mainstreaming gender issues into the national agenda. provides this kind of institutional support through the Ministry of Gender services and also through the enactment of TheI Ministry of Gender, Sports, Culture and Social Services in the National Commission on Gender and Development in collaboration with various organisations, has initiated a 2003. The Government has also established Units of Gender gender equity, equality and women’s empowerment Issues (UGIs) in all key government ministries and programme that focuses on mainstreaming gender issues department, NGOs, the District Women Development nationally so as to enable the implementation of the Committees and the National Facilitation Initiative for the Governments Economic Recovery Programme for implementation of the Beijing Platform for Action and the Employment and Wealth Creation from a gender perspective. Women Groups.

Through this approach the Ministry of Gender will promote The recent enactment of the National Commission on gender equality and the political, social and economic Gender and Development Act in 2003 will facilitate the setting advancement of women. up of the commission which will be autonomously mandated The Government is a signatory of several international to coordinate all gender mainstreaming activities and advice conventions and treaties on gender equality. These include the the government on all aspects of gender and development.

Convention on the Elimination of all Forms of Discrimination The Gender Division through the UGIs and District Against Women (CEDAW), the Convention on the Rights of Gender Focal Points will ensure gender mainstreaming in all the Child (CRC) and the African Charter on Human and sectors at all levels. Gender mainstreaming is also secured and People’s Rights among others. Kenya also participated in the monitored through gender training and support to all project negotiation of the Vienna Declaration on Human Rights and staff. the Beijing Declaration and Platform for Action in 1995. By Julliet Kola, Women’s Bureau, Ministry of Gender, Sports, Institutional support is essential to strengthening Culture and Social Services Kenya to Receive US$9.5m for FPAK incorporates Population and Health Programmes maternity services and he Government of Kenya and the United Nations Population Fund ARVs into its programmes T(UNFPA) have signed an agreement to support population and health ecently, the Family Planning Association of programmes as contained in the Country Programme Action Plan RKenya (FPAK) integrated maternity and (CPAP) document 2004-2008. This country programme will be the sixth outpatient services into its reproductive health (6CP) by the UNFPA to Kenya. services in all twelve of its clinics across the The goal of the 6CP is to contribute to the improvement of the country. quality of life of the people of Kenya by supporting population and Maternity services are available at Nairobi West health policies and programmes. The country programme is to adopt a and Eldoret Family Care Centres and will later on rights-based approach programme in order to empower males, females be expanded to other facilities. and adolescents, particularly girls to exercise their sexual and reproductive FPAK pioneered the family planning and rights. population movement in Kenya in 1962, before Programme partners identified to work with UNFPA in the the Government embraced the idea. implementation of the CPAP (2004-2008) will include a variety of FPAK currently implements four HIV/AIDS stakeholders. These will include UN agencies, Government Ministries, interventions in different parts of the country. FPAK NGOs, CBOs, faith-based organisations, national specialised training trains service providers on use of antiretrovirals and research organisations and bilateral/multilateral development (ARVs) and on the management of opportunistic partners. The partnership will largely be at programme intervention level infections. Four doctors, five nurses and two except for NGOs, CBOs and Government Departments, which will also clinical officers have already been trained in this receive direct financial support from UNFPA. The programme will be area. nationally executed under the overall co-ordination of the Ministry of The Association started targeting youth with RH Planning and National Development information and services as early as 1977. Today, In addition to the US$9.5M committed for the 6CP UNFPA will FPAK has five youth centres in Mombasa, Nairobi, seek to mobilise an additional US$2.5 Million from other sources, Nakuru, Eldoret and Kisumu. Using the peer subject to donor interest to meet financial requirements for the realisation educator approach, the youth centres design of the CPAP. UNFPA and the Government of Kenya will conduct annual programme review meetings, which will help determine continuation of and implement initiatives in adolescent sexual the partnerships on the basis of satisfactory delivery of results. health and reproductive health services and information including VCT. FPAK is affiliated to the By Karugu Ngatia (Senior Assistant Director), Head of Programmes Division, NCPD and Samwel Ogola, District Population Officer, Baringo and Nakuru International Planned Parenthood Federation (IPPF). 18 upcoming Events

Date Event Contact Person

June 2004 Dissemination of the results on Maternal User Fee Study. POLICY Project Tel: 020 - 2723951/2 June/July 2004 Dissemination of results of the Family Planning Access Study. To be released by the Division of Reproductive Health and the POLICY Project POLICY Project Tel: 020 - 2723951/2 June/July 2004 Dissemination of Safe Motherhood Unit Costing Study by the Division of Reproductive Health and POLICY Project POLICY Project Tel: 020 - 2723951/2 15-17 June 2004 Workshop on “Traditional Medicine, Research and Sustainable Develop- ment” at the School of Monetary Studies, Nairobi Vane Lumumba, NCPD on Tel: 2711600/1 16-18 June 2004 First National Conference on Peer Education, HIV and AIDS; theme will be National organisation of Peer Educators (NOPE) “Lets question our Relationships”, at Kenya College of Communication and Tel: 020 - 4451201/2 or email: [email protected] Technology (KCCT), Nairobi 26-28 June 2004 Regional Meeting on ICPD POA, Nairobi, Kenya 20-30 June 2004 Ad Hoc Committee on Population and Development Puerto Rico http://www.eclac@org/celade/ 6-9 July 2004 Workshop on the 13th International Union against Sexually Transmitted Infection (IUSTI), Asia Pacific Congress, Chiang Mai, Thailand 11 July 2004 World Population Day 11-16 July 2004 The XV International AIDS Conference. The first of its kind to be held in Conference being organised by the Intenational AIDS Southeast Asia, Bankok, Thailand Society in partnership with the Thai Ministry of Public Health and in collaboration with UNAIDS July/August 2004 A national conference for the National Empowerment Network of People Inviolata Mmbwavi, National Coordinator, Living With HIV/AIDS in Kenya (NEPHAK) will be held in and will aim to Tel: 020 - 2725455/2730952, email: [email protected] promote meaningful involvement of PLWHA in the fight against HIV/AIDS and is being organised by NEPHAK, NACC and development partners 31 August - Global Roundtable (RT) on ICPD+10 For more information: 2 September 2004 www.icpd.eastwestcentre.org/roundtable.asp 6-9 September 2004 International Forum on Population and Development - Implementation of ICPD/POA and MDG and Ninth Annual Board Meeting of Partners in Population and Development China

Training

The Centre for African Family Studies (CAFS) will be offering the 2. “Advocacy for Reproductive Health”, 5-16 July 2004 following four regional courses in Nairobi, Kenya: 3. “Advances in Behaviour Change Communication for HIV/ AIDS”, 19 July - 6 August 2004 1. “Management of Community Based Services in Reproductive 4. “Managing Reproductive Health Programmes”, 2-27 August Health Programmes”, 7-25 June 2004 2004

Short course on hospital management, budgeting and priority-setting

hrough an initiative of the Ministry of Health, and with financial officers, and laboratory technologists, medical officers of health, Tassistance from USAID through the POLICY Project, the above medical superintendents and health board members. As the course course will be launched at the United States International University gets rooted, those in similar ranks from the civil society, including - Africa (USIU-A) on 7th June 2004 and will run for two months up to private sector will also be considered to attend. August 6th 2004. The short course is going to be institutionalized at the USIU-A and The focus of the course is to assist hospital managers to develop is designed to: an understanding of the importance of linking planning and Be an interactive 8-week course conducted twice a year at the budgeting; learning how to identify the required resources in University; preparing a budget; how to estimate the cost of services; developing tools and techniques for preparing a budget and Promote a modular structure and format to allow participants to appreciating government planning and financial policies and integrate their learning with realities of work environments; and procedures. The goal of the course is to strengthen the participants’ Strengthen managerial skills of senior personnel in the Ministry of knowledge and leadership skills necessary for effective Health. management of health care delivery in the country. For more details about the course, contact: The POLICY Project, Health Care The course targets hospital management teams which are made Finance and Policy Division at [email protected] OR the Ministry of Health up of the chair persons, the nursing officers in charge, hospital - the Department of Policy Planning and Development and Division of administrators, pharmacists, and medical records officers, supplies Health Care Financing (Afya House, Nairobi) 19 research Results Male Pill on the way?

he prospect of a male contraceptive pill is on the horizon according to immunocontraceptive could be developed scientists at the Institute of Primate Research (IPR) in Nairobi who are and taken orally as a pill and its dosage and T at an advanced stage of its development. administration could also be varied. Scientists have cited the fact that the Dr. Pius Adoyo, is the head of reproductive He took some components from the top injection could be given once every three health at IPR, and has been conducting of the human sperm and similar months as an advantage instead of taking components from baboon sperm. He research on the male pill in Japan over the the pill everyday. past ten months, has identified sperm injected three rabbits with baboon sperm Designing an immunocontraceptive has protein components that are instrumental to components, three rabbits with human proved to be difficult mainly because unlike this breakthrough. His study is one sperm components and three rabbits with disease prevention vaccines whose effects alongside others by immunologists in water as a control to his study. He observed aim at long-term (mostly lifelong) Australia and in two United States the rabbits for three months and noted immunization, immunocontraceptives aim universities, seeking to develop a new male interesting new developments. for a highly effective immunization against immunocontraceptive. “I discovered that some baboon sperm human cells or molecules which should be components were similar to human sperm reversible after a specified period of time. What is an immunocontraceptive? components which meant they could have been Other noted disadvantages are the delay Immunocontraception is the use of the evolutionarily conserved,” Adoyo says, “ I also between administration and attainment of body’s immune defence mechanisms to identified three sperm proteins that have not effective immunity and the individual provide protection against unplanned been identified or documented by any scientist variation in immune responses and therefore in the world before. The three proteins pregnancy. There are different research in the level and duration of effectiveness. It immobilise sperm when interfered with and studies worldwide being carried out on is also noteworthy that an immuno- are potential molecules for immunocont- immunocontraceptives, some focusing on contraceptive cannot act as a barrier to raceptive vaccine development.” the sperm and others on the female egg. sexually transmitted infections. Another significant discovery was the Developing an immunocontraceptive Several research issues have yet to be fact that rabbits injected with baboon sperm requires insertion of a gene for a specific conclusively addressed. No progress has components were able to build immune protein in the genome of the desired been made toward final product response to the target antigen in three days molecule in a way that results in the development and before they can be while it took rabbits injected with the production of the correct protein and universally sanctioned, their safety has to be human sperm antigen around a week to do sufficient accumulation of foreign protein so. The immunity levels generated by the ascertained. for stimulation of immune response. IPR is baboon sperm samples were also much There is an ongoing socio-political working on developing a male higher than those generated by human debate on the subject. Opponents to immunocontraceptive that attacks a part of sperm samples. He is in the process of immunocontraceptive research have noted the sperm-production process. publishing his findings. the unknown health risks of the method. The IPR is currently looking for funding Judith Richter and Susan Sexton in an Breakthrough to further this research as the institute feels article ‘the politics of contraceptive research’ say: Last year, Dr. Adoyo, through support from the study has made a major stride in the “Apart from potential auto immune the Japanese government, was able to right direction. diseases induced by cross reactions, an further his research using Recombinant immunocontraceptive might also cause allergies DNA technology (molecular biology). Advantages and limitations or immune complex diseases that might Although he transported some baboon “Because men do not experience menstrual interfere with or exerceberate existing immune sperm components to Japan to carry out periods, they would not experience menstrual disturbances, a risk of any vaccination.” further tests on his findings, for the first problems associated with the birth control pill In global surveys on the male time he had access to human sperm for the in women,” he says. contraceptive pill, women have expressed research. His research work in Kenya is Since vaccines are not necessarily apprehension on trusting a man to take the restricted to use of apes, mice and rabbits. administered through injections, the pill everyday.

Kenpop News is a publication of the National Council for Population and Development (NCPD), edited and produced by NCPD in collaboration with its strategic partners. This publication has been BRIDGE supported with USAID funding through the POLICY Project and the Bridge Project. 20