The situation of reproductive
health in Kenya
At the last national census in
1999, Kenya had a population of 28.7 million people. In 2004,
the population was estimated at 32.8 million. An annual birth
rate of 34 births per 1000 and a death rate of 14 deaths per 1000
have contributed to the population’s growth at 2% per annum.
Life expectancy is only 49 years for women and 47 years for men.
The total fertility rate as measured in the 2003 Kenya
Demographic and Health Survey (KDHS) was 4.9 children per
woman, and the infant mortality rate was 77.2 deaths per 1,000
live births. The use of family planning is moderate, with 39%
of married women using some form of contraception. However, at
the same time, unplanned pregnancies are still common, and 24.5%
women of reproductive age were found by the KDHS to have unmet
need for family planning.
Kenya’s adult HIV infection
has dropped from 15 percent in 2001, to 6.7% percent in 2003 (KDHS).
The numbers of people living with HIV include 1.1 million adults
between 15 and 49 years, another 60,000 aged 50 years and over
and approximately 100,000 children.
Reproductive health services are
delivered through an extensive system comprising facilities operated
by the government, non- governmental organisations (NGOs) and
the private sector. The main strategies in the delivery of health
services address fertility, mortality, family planning, reproductive
health and reproductive rights, gender perspectives and HIV/AIDS.
The role of the Division of Reproductive
Health
The DRH works to promote the reproductive health
of all Kenyans by responding comprehensively and effectively to
their needs for information and services. Working with a broad
range of local and international partners, the division focuses
its efforts on the following programmatic areas:
Safe Motherhood
Complications during pregnancy and childbirth are
among the leading causes of death of women of reproductive age
in developing countries. In Kenya, the threats that affect the
pregnant mother and the newborn child are maternal infections,
anaemia, malaria, complicated and unsupervised delivery, nutritional
deficiencies, hypertension, and postpartum haemorrhage. The goal
of the safe motherhood and child survival programmes is to reduce
the deaths of mother and baby, through efficient and accessible
preventive and promotive health services, which include family
planning, antenatal care, clean and safe delivery and obstetric
care.
Gender and Reproductive
Health Issues
Many reproductive health issues centre on the ability
of women to make decisions affecting their lives, such as the
ability to choose whether and when to have a child, and ability
to protect themselves from sexually transmitted infections. However,
there are gender-based issues that threaten the health of women,
including gender-based violence and harmful traditional practices,
among them female genital mutilation, early marriages, nutritional
practices and wife inheritance. As a result of widespread gender
inequality and cultural bias, most women do not have opportunity
and ability to determine when and with whom to have sex, and neither
do they have the right to own and inherit property.
In most communities men’s behaviour and attitudes
have significant impact on the health of women and children. Yet
few reproductive health programmes have sought to involve men
more. In addition, most reproductive health services have traditionally
been provided in settings that are predominantly women-oriented,
such as family planning clinics. The DRH aims to empower men and
women to make informed decisions and act on reproductive health
issues that affect them.
Adolescent Reproductive
Health
Adolescents and youth are generally defined as persons
in the age-groups 10-19 and 10-24 years, respectively. Youth in
the age-group 20-24 are often referred to as young adults. In
Kenya, the Children Act, 2001, defines a child as a person under
the age of 18 years; adolescents therefore fall within the protection
of the Children’s Act.
According to the 1999 Population and Housing Census,
adolescents and youth constituted 26 and 36 percent of Kenya’s
population respectively. This large proportion of young people
has major demographic, social and economic implications. In particular,
adolescent fertility has remained high despite declines experienced
among other age groups.
The government addresses adolescent sexual and reproductive
health issues in health and development through activities initiated
by DRH and its partners. The Adolescent
Reproductive Health and Development Policy (2003) has identified
the following as priority strategic concerns in promoting the
health of young people in Kenya: adolescent sexual and reproductive
health and rights; drug and substance abuse; socio-economic factors;
and adolescents and youth with disabilities. These priorities
are being addressed through the implementation of the Adolescent
Reproductive Health and Development Plan of Action (2005).
Family Planning, Infertility,
STI’s and HIV/AIDS
The 2003
Kenyan Demographic Health Survey (KDHS) indicates a significant
and worrying trend in the rise of fertility levels from 4.7 percent
in 1998 to 5 percent in 2003. However, there is an apparent shift
towards HIV/AIDS initiatives at all levels.
The high incidence of HIV/AIDS in Kenya requires
the government to address health and socio-economic implications
of limited access to family planning and other reproductive health
services within the context of the HIV/AIDS pandemic.
Infertility has multiple causes and consequences
depending on the gender, sexual history, lifestyle, society, and
cultural background of the people it affects. Infertility is the
failure to conceive a pregnancy after attempting for at least
one full year. In primary infertility, pregnancy has never occurred.
In secondary infertility, one or both members of the couple have
previously conceived, but are unable to conceive again after a
full year of attempting.
In collaboration with Family Health International
(FHI), DRH is working to increase access to and provision of the
intrauterine contraceptive device (IUCD) in Kenya as a way of
expanding women's contraceptive choices. Six IUCD method briefs
that the Ministry of Health, FHI and project partners developed
in 2003 detail the latest research on the copper
T IUCD and the contraceptive method's reintroduction in Kenya.
DRH is also working with FHI and other partners to
test a national strategy for integrating family planning and voluntary
counseling and testing (VCT) services. A recent study exploring
the acceptability and feasibility of incorporating family planning
services into HIV/VCT services found that few VCT providers in
the study referred clients for family planning services. All VCT
providers and most clients in the study, however, supported some
level of family planning service provision within VCT clinics.
Community Reproductive
Health
The unmet need for family planning and other
reproductive health services in Kenya is huge. Less than half
of the population live in urban areas and have access to health
facilities. Currently, Kenya boasts of approximately 4,020 health
facilities, but not all of them offer comprehensive reproductive
health care. Moreover, the 4,020 health facilities designated
as service delivery points (SDPs) for family planning provision
are not equitably distributed throughout the country.
Communities are at the foundation of affordable,
equitable and effective health care and are the core of the Kenya
Essential Package for Health (KEPH) proposed in the second National
Health Sector Strategic Plan 2005-2010 (NHSSP II). The community-based
approach is the mechanism through which households and communities
take an active role in health and health-related development issues.
The overall goal of the community strategy is to enhance community
access to health care to improve productivity and thus reduce
poverty, hunger, child and maternal deaths, as well as performance
across all stages of the life cycle.
Monitoring and Evaluation
Monitoring and evaluation (M&E) is essential
for assessing and improving how policies and programmes are designed
and conducted. Implementation of M&E should start from as
early as project planning and design (Rossi and Freeman 1993).
The two functions though related are distinct.
The DRH seeks to ensure that all priority RH areas
utilize M&E tools and that data are maintained at all stages
of implementation. The DRH has used a participatory and collaborative
approach to harness resources and expertise of Collaborating Agencies,
donors, and other agencies to build its capacity for monitoring
and evaluation. The DRH is being strengthened to collect and utilize
data for decision-making at the national, provincial, and district
levels through: developing a training module on utilization of
data for decision-making and conducting training using the module;
creating a national RH M&E framework with key national indicators
identified; and revising current data collection tools for the
above indicators.
*For full report of the 2003 Kenya
Demographic Health Survey (KDHS), please visit: http://www.measuredhs.com/pubs/pub_details.cfm?ID=462#dfiles
