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My maternal burden: I have six children, five to go



Like many women in rural Kenya, Damaris does not use modern family planning methods.

The spirits of six dead relatives live in Damaris Esenye’s little house in Nandi County.

They came to life from her womb.

Damaris has named her children after the departed.

“I have six. Five more to go,” the 30-year-old told the HealthyNation.

There is a good reason for the decision that she and her husband David Ekai made to have children and name them after their relatives: Damaris is an only-child and her husband lost his parents and all his siblings.

Her rented one-room house has a window with no panes, a brown cloth their place. In the room, there is a bed, three stools and a small table.

Looking outside through the door, an unfinished house comes into view. That is Damaris’ kitchen where she uses a three-stone hearth to cook her meals.

There is a subtle but notable smell of raw sewage, maybe of human or animal waste.

Her first and second-born children, aged 13 and 10, are named after her husband’s brothers.

The third and fourth children are named after her mother and father-in-law respectively.

“Huyu wa nne anakaa yeye kabisa. (This fourth-born is a spitting image of my mother-in-law),” she says.

The fifth is named after her sister-in-law.

During the interview, we are regularly interrupted by the soft chuckle of a three-month-old baby, her last child (at the moment), who is named after another brother-in-law.

This naming game is not over. She has to answer five other calls from beyond the grave: Five other relatives are still unnamed.

Damaris is Turkana and her culture considers it bad omen to name any child after dead people, so she also hopes to name the next offspring after her relatives.

Damaris is hesitant to talk about her education background, but her husband says he completed primary school.

The couple moved here from Turkana County in search of greener pastures, but life has not been easy. Yet Damaris has to fulfil her one assignment: To immortalise their relatives, especially her in-laws.

Like many women in rural Kenya, Damaris does not use modern family planning methods.

But there is a direct correlation between the number of children a family has and the quality of life they lead.

The 2014 Kenya Demographic Health Survey indicates that more than half (58 percent) of currently married women are using a contraceptive, with the most popular being injectables (26 percent), implants (10 percent), and the pill (eight percent).

The use of modern family planning has increased from 53 percent in 2008, but there is still 18 per cent of married women in Kenya who have an unmet need for family planning services.

Culture and religious reasons have been blamed for this.

Kenya is also a patriarchal society, where men are considered the sole decision-makers.

Wilson Ngara, a reproductive health co-ordinator in West Pokot, where women also shared their experiences, said that misinformation has hindered access to family planning.

He said, “The fear of side effects, health concerns and opposition to use by a partner or religious prohibition are some of the reasons why women are not using family planning.”

This, Mr Ngara said, births another challenge in the county — abortion.

Damaris got married at 16 and has never used any modern family planning method.

She uses the traditional method of spacing her children.

“I breastfeed for long. I get pregnant immediately after I stop breastfeeding. I want to have what God decides for me. He will decide what is good for me,” she says.

Natural family planning, also known as the fertility awareness method, is a birth control model where a couple (or the woman) monitors her body temperature to know when she is fertile to or not engage in unprotected sex.

Some of Damaris’s children are just a year apart. Research has shown that children born to uneducated women and who are spaced so close have fewer chances of survival.

The Kenya Demographic Health Survey notes that survival of infants and children depends in part on the demographic and biological characteristics of their mothers.

Children born to mothers who are under 18 or too old (over 34) or born in birth intervals of less than 24 months are more likely to die.

Those born to mothers with high parity — birth order four or higher — also face lower chances of survival.

More children are also harder to feed.

During the interview, Damaris excuses herself to fetch sukuma wiki to make for supper with ugali. That is the best she can offer her family of eight.

A decent meal, or a change from this staple to include protein, has been hard to come by. She washes clothes for a living from which she makes Sh200.

Her husband, aged 42, works in the informal sector and is also struggling to make ends meet.

But this couple will not use contraceptives because, they fear for Damaris’s health.

“Tutakuwa tunakosea tukianza kutumia hizo vitu juu hata maisha ya mwanamke inaweza haribika (We will be doing wrong if we start using those things [contraceptives] since they can affect the life of the mother,” says the husband.

In West Pokot County, Regina Lorengi of Sarmach Sub-Location, sails in the same boat as Damaris.

The mother of five, who is in her mid-20s, has never heard of family planning.

“I want to get two more children,” she says.

She sells charcoal for a living, and her earnings that are barely enough to feed her children.

West Pokot, with a high fertility rate (7.2 children per woman of reproductive age), has 46 per cent of children under the age five undernourished, the highest in the country.

SMART Survey, a joint nutrition assessment conducted by county departments of health and Unicef, shows that counties with fewer children per woman have fewer cases of undernutrition.

The survey shows that 24 per cent of children under five in Turkana, which has a fertility rate of 6.9, are undernourished while Samburu with a 6.3 fertility rate, has 30 per cent undernourished children in the same age group.

In a presentation, Dr Alex Awiti from Aga Khan University’s East African Institute, said that central Kenya counties such as Kirinyaga with a 2.3 fertility rate well as Nyeri (2.7), Kiambu (2.7) and two other counties that make up the former Central Province have 18 per cent undernutrition rate.

As a woman becomes more empowered through education, she is more likely to have control not only in the family size that she would want but also on the time that she would want them, mostly through access and use of contraceptives.

Women in West Pokot, Nandi, Bomet and Kericho, who make part of the former Rift Valley Province, have a fertility rate of 4.6 children, and this number is higher in women who are not educated (6.8) than women who have had primary education (4.1) and those with secondary school education (3).

United Nations reproductive health agency, UNFPA, reports that at least 200 million women in the world want to use safe and effective family planning methods, but are unable to do so because they lack access to information and services, or the support of their husbands and communities.

But, even when women are informed, there are logistical challenges. The distance to the hospital as well as stockouts of contraceptives prevent women from accessing family planning.

Performance Monitoring and Accountability 2020 (PAMA2020), under International Centre for Reproductive Health Kenya, uses mobile technology to track trends in contraceptive use and family planning service delivery globally, with data from countries.

According to the site, the use of modern contraception stood at 44 per cent for all women, but there is inequality in counties, where those in arid and semi-arid areas have lower rates of access.

The data shows that women in the four counties are opposed the use of contraceptives, citing health reasons, problems of access, and being unmarried.

Family planning programmes put emphasis on informing users on the methods available and how to use them, but little has gone into understanding the thought process of women in making these decisions that seem harmful to their reproductive health.

Peter Gichangi, principal investigator attached to the PAMA2020, said there is a ray of hope and that women are using contraceptives at early ages.

However, while women in rural areas have an early sex debut, they delay use of contraceptives.

“Despite this progress, many health facilities, particularly private facilities in Kenya, do not offer long-acting modern methods,” Prof Gichangi told the HealthyNation.

“The trend toward increased adoption of these highly effective methods in recent years indicates that expanded access to these methods may lead to an even greater increase in contraceptive use,” he said.

Dr Timothy Abuya’s paper, Decision Making Dynamics on Family Planning Use Among Couples in Kenya, reports that the decision to use family planning is often made by the man.

“Whether or not a woman is exposed to family planning information does not matter if her man does not buy in,” he says.

Dr Abuya is also worried that “most of the funding for family planning is from international organisations” and wonders what would happen if such donors withdrew or decreased their funding. “Would that be the end of family planning programmes in Kenya?” he asks.