When Fardosa Osman received an invitation to attend a family planning event at the Bomas of Kenya in Nairobi, she did not give it much weight at first.
Fardosa, the wife of former Garissa governor, says she wondered what she had to do with a family planning event.
The use of contraceptives was very low then because of religious beliefs that God wants big families and contraceptives were forbidden.
In Garissa, family planning was never a priority and was not given much attention by most policymakers.
“I was not sure what I would meet, hear and see but I had to drag myself and go to Bomas,” she says.
It was while at the event that Fardosa's perspective changed after seeing what her fellow governors' wives were doing in their counties. This gave her the zeal to drive the family planning agenda in her own county.
By the time she left Bomas, she had made up her mind to replicate in her own county what she had seen and heard.
But the problem was how to go about it. Fardosa had to come up with strategies that would ensure the message was well received without the messenger getting stoned by her community.
“Because of the cultural belief associated with FP, and it is perceived that you are limiting people to have one or two children, so it actually got me thinking to be very strategic,” she says.
“Family planning is not a word that you can mention in the county, so my first strategy was to change the name from family planning to child spacing.”
The concept was well received as it speaks within the Quran and is thus acceptable to the people in her county.
In her quest to ensure the FP agenda bears fruit, Fardosa knew the plan’s success also depended heavily on involvement of men.
Male involvement was important as the majority of them in the county did not accept family planning yet they were the gatekeepers.
Fardosa had to involve them in her advocacy and make sure they were on the forefront in her campaigns and were supporting the women in the community.
Despite the deeply entrenched patriarchal nature of the society, the county has witnessed a commendable 25 per cent surge in male involvement in postpartum family planning.
Before the implementation of this strategy, data showed that 47 per cent of husbands and partners were uninformed about contraception.
“The other strategy I used for my project to be successful in amplifying women voices in Garissa was also through the sheikhs, the imams, and the chiefs. We call them the community gatekeepers and the chiefs who are very strongly listened to by the community,” she said.
“In Garissa, we had low male involvement. It was extremely low so it has helped me amplify FP services in Garissa county.”
Through her Fountain of Hope Initiatives, family planning uptake in the county has more than doubled, climbing from six per cent (KDHS 2014) to 11 per cent (KDHS 2022).
According to the Kenya Demographic and Health Survey 2022, Garissa’s total fertility rate (number of children per woman) stands at 5.3 per cent against the national rate of 3.4 per cent.
Data shows that use of modern method of FP among married women aged 15 to 49 stands at 11 per cent while the unmet need for FP among married women within the same age bracket is 10 per cent.
The demand for FP satisfied by modern methods within the same age bracket is estimated to be at 50 per cent.
A circular that directs all facility heads and medical superintendents to enhance the provision of postpartum family planning services promptly has been endorsed.
This is a boost to the integration of postpartum family planning services into routine maternal and child healthcare, ensuring that family planning options are discussed and made available during post-natal check-ups and subsequent care visits.
But Fardosa is not done yet. Her plan is to move the uptake from the current 11 to more than 20 per cent.
She wants to move her advocacy beyond talking on behalf of women in Garissa to all women in all the counties in Northeastern.
She feels that political leaders, too, should be brought to the table as they sometimes pose as a challenge in family planning agenda.
During the elections season, some of them tell their constituents to have more children, which Fardosa says is an impediment to the family planning advocacy agenda.
“I speak on behalf of Garissa but I want to speak on behalf of the northern counties. I want to challenge myself and make sure I have made a difference. I am there and I am ready to work,” she says.
A healthcare worker at Garissa County Referral Hospital says a huge percentage of men do not accept FP.
In the county, women's roles are limited to childbearing and taking care of their children at home.
“A woman found using FP against the husband's wish is punished, threatened with divorce and the husband may end up marrying another wife,” he says.
As a result, women are forced to device other means of concealing their family planning pills.
“Women who use any FP method do it secretly without the husband's knowledge. Some narrate that they even bury pills in the soil where the husband can't know or reach,” he says.
National Council for Population and Development director general Mohamed Sheikh says family planning uptake in the country varies from county to county.
Counties in Northeastern are yet to fully embrace family planning due to religious factors and traditional beliefs.
The uptake is also low in Samburu, West Pokot and Kwale counties.
He recommends that women who have given birth take a spacing of at least two years before getting pregnant again for the sake of their health and that of their child.
“Family planning is not about controlling the number of children but about spacing. We would like to advice women that they should use any method either traditional or modern to space their children,” Sheikh says.
Head of the Maternal and Reproductive Health Division at the Ministry of Health Edward Serem says the Constitution guarantees that every woman has a right to get the best attainable standards of health, including reproductive health.
This means both men and women should have access to several family planning options.
Serem encourages women to use longer working methods such as the implant and coil, which are effective for at least three years compared to three months injections, which is expensive.
“Three months injection is expensive. Men should go for vasectomy if they feel they have had enough children,” Serem says.