Today is International Women’s Day, a day when we celebrate the accomplishments of women and progress toward gender equality, while also reflecting on the challenges that women still face around the world. It’s impossible to think about achieving gender equality without considering the role of family planning. Family planning allows women to choose the number, timing, and spacing of their pregnancies. Access to family planning improves women’s health, empowers them to make decisions about their bodies and their lives, and improves their ability to access education and employment. It is one of the most cost-effective and powerful ways to improve the lives of women.
The story of Monica Otieno illustrates the importance of family planning to women’s progress and achievements and also the work that remains to be done to ensure women everywhere have access to a broad range of contraceptives. Monica grew up in rural western Kenya. As a girl, Monica enjoyed school and performed well; she completed class eight and sat for the national primary school certification exams. She scored well enough to attend good secondary schools in her area, but her family could not afford to pay tuition. Instead, she was married off to a man named Isaiah in her early teens, but she held onto her dream of continuing her education and becoming a nurse.
Monica moved to Isaiah’s village, and they had four children: Moses, Steve, Seth, and Caitlin. Monica and Isaiah worked hard as farmers to provide for their children. In 2006, Monica heard about an opportunity for primary school students in her community to receive scholarships to attend secondary school. She resolved to return to primary school, sit for her primary school exams and win one of the prized secondary school scholarships. Monica shared her dream with Isaiah, who was stunned but supported her. At the age of 31, Monica purchased an adult-sized uniform, a green dress with a white collar, and reported to her village’s primary school along with Moses and Steve, who were in class five and class two. She was placed in class seven. Many in the village laughed at her and others were in disbelief that a grown woman and mother would attend school with her own children, but Monica ignored the gossip and ridicule in pursuit of her dream.
In 2007, shortly after she began class eight, Monica became pregnant with her fifth child. She said at the time, “I was using some pills but I was disappointed and now I’m about to give birth. I don’t know whether that can spoil everything. According to me, I will not give up until I finish my education.” A few months after giving birth to her daughter Olivia, Monica sat for her national primary school exams. She was admitted to a secondary school and awarded a scholarship to attend. Her years in secondary school were very difficult as a mother of five, but in 2011 Monica successfully completed secondary school.
While Monica’s use of family planning enabled her to return to school in pursuit of her dream, at the same time she was frustrated with her family planning options. Contraceptive pills are about 92% effective with typical use, and Monica was among the 8% of women who experience an unintended pregnancy while using the method. She tried other methods, but ultimately resorted to the standard days method, and became pregnant again in 2012.
Monica’s frustration with her family planning options represents a key reason why CHAI entered the family planning space in 2012. CHAI and other organizations recognized that contraceptive implants—which are more than 99% effective and last for up to five years—were a popular method in sub-Saharan Africa and, along with IUDs, were the most effective reversible, hormonal methods. However, implants at the time were prohibitively expensive and therefore not purchased in large quantities, resulting in chronic stock outs and limiting the options available to women.
To address this issue, CHAI worked with the Bill & Melinda Gates Foundation, the governments of Norway, UK, US, and Sweden, and the Children’s Investment Fund Foundation to negotiate a more than 50% reduction in the price of contraceptive implants for the world’s poorest countries. With funding from the Gates Foundation, CHAI then worked with national governments to strengthen the health workforce and supply chain systems required to deliver the implants to women who need them. Since that time, the volume of implants procured by developing countries has increased by 88%, and the number of women accessing implants annually in these countries has increased by 85%. In Kenya, where Monica lives, implant use among family planning users has increased from 2% in 2008 to 10% in 2014 and 27% in 2016.
CHAI is also working in Nigeria and Ethiopia to increase access to IUDs, particularly for postpartum women. IUDs are one of the few methods that breastfeeding women can access immediately following birth, when the unmet need for contraception is often the highest, but placing an IUD following birth requires special clinical skills. CHAI is working with the Nigerian and Ethiopian governments to include training and mentoring for postpartum IUD insertions into a comprehensive maternal and neonatal health approach.
Today Monica is a trained community health worker in her village. Contraceptive implants are now accessible at her local health center. She plans to try an implant, hoping that she will finally find a family planning method that works for her.
To learn more about CHAI’s Family Planning program, please contact Caitlin Glover, Director – Family Planning at the Clinton Health Access Initiative, Inc.
