Urban poor women giving health facilities a wide berth
The urban poor woman is considered to be better off than her rural counterpart due to her proximity to health services, but the reality is that she is still significantly excluded and marginalized.
Experts now say that the “urban advantage” does not exist for the urban poor woman especially when it comes to accessing sexual and reproductive health and rights.
“We prefer traditional birth attendants and we also trust our friends for advice more than a doctor,” says Anastasia Wairimu who works at Mirera Flower Farms in Naivasha.
Mirera is an urban area in Nakuru County but the women who live here face many challenges in relation to accessing sexual and reproductive health services.
Their situation is not unique though. Thousands of women in urban slums across the country face similar challenges even though they are often in close proximity to health facilities.
Statistics from the most recent Kenya Demographic and Health Survey 2014 show that nearly half or 47 percent of Kenyan women will have started childbearing by age 20.
“It is the urban poor woman who is more likely to have started child bearing by age 20. Mainly because they do not access family planning, and when they use family planning it is based on information shared by their friends,” says Dr Gikama Kinyanjui, a gynaecologist and obstetrician in Naivasha. He explains: “As a result, they often do not get the method that best suits them even when that method is available. When they begin to experience side effects, they discontinue the method.”
“The younger a woman is when she starts to have children, the higher are the risks and complications she is likely to encounter during child birth,” explains Kinyanjui.
Young urban poor women are highly vulnerable especially in light of statistics that show that at least 60 percent of maternal deaths occur in women aged 20 to 29 years.
Call for dialogue
Lucien Kouakou, the regional director of the International Planned Parenthood Federation Africa explains: “Access to safe, voluntary family planning is a human right and is central to gender equality, women’s empowerment and poverty reduction.”
Further saying that denying women the power and means “to control the number and spacing of their children is equivalent to denying them their human rights to health, life and equal opportunity”.
However, Wairimu says, the urban woman does not receive the same support and intervention that is given to the rural woman.
“Before I moved to this town, I lived on a farm and Community Health Workers were always looking for us at the farms to give information. It is not the same in towns because they assume we can easily go to the clinics,” Wairimu reveals. She notes: “The same health workers would follow us to our homes in case we failed to attend clinic or go back for family planning service.”
She notes that those who provided services at the health centres in rural areas were also drawn from the community.
“We knew and trusted them. In urban areas the environment is not very welcoming. The nurses can be very rude and queues too long,” Wairimu notes.
Kouakou encourages more dialogue as a way to addressing the primary concerns that are keeping women away from accessing key sexual and reproductive health services including family planning.
Evelyn Samba, Kenya Country Director at Deutsche Stiftung Weltbevölkerung (DSW) says that the benefits of using family planning are many.
“Family planning, helps in cutting unplanned pregnancies, maternal and child deaths, eases the burden of post-abortion care as well as new HIV and STI infections,” Samba expounds.
The national level government statistics show that about 362 women die in every 100,000 live births, among the urban poor, the numbers are higher at over 700 deaths in every 100,000 live births.
Fatal home deliveries
“The urban poor woman will most likely deliver at home and be assisted by a traditional birth attendant. When complications arise, there is no way to get this woman to the hospital fast enough due to lack of infrastructure in the slums,” says Kinyanjui.
Though these women will have attended at least one antenatal clinic visit, Kinyanjui notes, nearly half of them will not make it for the recommended four visits.
Samba explains that in the light of dwindling external resources “county governments need to increase their investment in sexual and reproductive health service provision, especially family planning services”.