The country has been rocked by massive stock-outs of some critical contraceptive methods in recent years. Health officers say because of the shortages in public facilities, many women cannot afford to purchase the birth control commodities which are expensive from private drug stores and therefore end up getting pregnant.

"Most clients come asking for Implanon (a contraceptive inserted under the skin of a woman’s upper arm) but they cannot get what they are asking for," Mohammed Salat Dagane, a provincial nursing officer in Kenya's North Eastern Province told IPS, "What will stop them from becoming pregnant? The pregnancy rate in this region is high."


Karen Owuor, his counterpart in the western province of Nyanza had the same story. "Majority of our clients prefer injectable or surgical contraceptives but these are not accessible in most of our facilities. Even though they are available in the market, not many people can afford them so they either have to wait until they are supplied to the hospitals or get pregnant," she said.


Kenya's last Demographic Health Survey (KDHS) in 2003 found that 24 percent of women who do not want another child within the next two years are not using contraception due to unavailability. The lack of access to family planning commodities, particularly surgical and injectable contraceptives, is a major contributor to the figure, coupled with a lack of awareness on methods available.


According to Josephine Kibaru, head of the Family Health Department within the ministry of health, the stock-outs have been largely due to insufficient funds to purchase the commodities. Bureaucratic obstacles between different ministries - specifically enormous difficulties and delays in securing the release of funds to the health ministry by the treasury - have been criticised.


The government drug supply body, the Kenya Medical Supplies Agency (KEMSA), has also been faulted for failing to deliver promptly contraceptives to government health facilities.


"If a woman comes and misses contraceptives of their choice at our hospitals, even if they are brought later, it will not make a difference. The next time she comes it will be when a traditional birth attendant sends her to us dying from complications of an unplanned pregnancy," Kibaru said.


The KDHS puts the maternal mortality rate (MMR) at 414 deaths per 100,000 live births, far in excess of the U.N. target of 147 deaths per every 100,000 live births by the year 2015. Two-thirds of these due to birth-related complications and the remainder to unsafe abortions.


The National Contraceptive Commodities Security Strategy 2007-2012, published by the health ministry, puts the government on the spot for its low budgetary allocation for family planning.


Even though the past three years have seen authorities allocate about 6.7 million dollars for procurement of family planning commodities, an estimated 20 million dollars needed annually to ensure adequate supply.


Family planning in Kenya was previously supported exclusively by donors - who are expected to finance the deficit this year. The donor community has also been partly blamed for the stock-outs.


"We need partners to deliver their pledges on time. There is no need of them giving us funds two months after the stock-outs. We need to ensure uninterrupted supply of contraceptives to all people that need them whenever and wherever they need them," Kigen Bartilol, deputy head of the Division of Reproductive Health in the health ministry told IPS.


Increased funds have to go hand in hand with prompt delivery of services. Health experts at the launch of the national plan on Apr. 16 called on KEMSA to include contraceptives in its essential drug kits when delivering medicines to health facilities across the country.


"Family planning commodities are as important as medicines for other diseases. We want KEMSA to include in the kits contraceptives that are equivalent to the specific needs of every region. By this we will not be working on assumption but on actual requirements and figures, ensuring that everyone is catered for on time," Kibaru said.


But the lack of qualified personnel to administer the commodities still remains a challenge. "For example surgical contraceptives must be managed by skilled health care providers, and these are lacking especially in low level institutions like dispensaries and health centres which are closer to communities," Monica Agutu, head of Kisumu Medical and Education Trust, a community organisation, said in an interview with IPS from Kisumu, western Kenya.


She added, "A woman will think twice before travelling miles away to a provincial or district hospital where she may be able to access these services. Before she knows it, she will be pregnant. If it is unplanned, no one will stop her from procuring an abortion; if it goes sour, another death."


(END/2009)

NAIROBI, 6 May 2008 (PlusNews) - Marie*, 25, comes from France but works for an international non-governmental organisation that often requires her to travel around Asia and Africa. While on one such trip she made a decision that could change her life forever.

"I met a colleague from one of our other offices; he seemed really nice and almost as soon as we met we began to flirt outrageously with each other. At the time I didn't think anything would really happen beyond flirtation - after all, he was my colleague.

"One night, after a long day's work, we went out to dinner and then went clubbing. We both got really drunk and became even more flirtatious. One thing led to another and we ended up in bed together.

"We used a condom, at least I had seen him put it on, but when I got up in the morning, I realized I had what looked like semen on my body. I wondered if the condom had broken and went to look at it. I found it intact but with no semen in it - he had obviously removed it while we were having sex.

"By then he'd returned to his own hotel room so I ran to his room to confront him. At first he denied it, but eventually I got him to admit that he had removed the condom before we'd finished having sex. I was so worried, I asked him when he'd last been tested but he just kept saying he was okay, he was sure he was HIV-negative.

"After that I kept replaying in my mind the things he'd told me before we slept together - things like how many women he'd been with; he made himself out to be some kind of man-about-town. I was dead scared.

"By the time I thought about post-exposure prophylaxis [a short, preventative course of antiretrovirals] it was too late. I'm not worried about pregnancy because I'm on contraceptives. I'd told him that earlier, so maybe that's why he felt like he could do it without a condom - he knew I wouldn't get pregnant.

"Now I have to wait six weeks [the window period before HIV can be detected] before I can have an HIV test. I think the chances are slim, and I'll be able to deal with it if I am HIV-positive, but I am so angry with him - and I still have to see him whenever I'm in our [other] office!

"I still can't believe a silly one-night stand could change my life forever."


*Name has been changed