How I ensure I never forget to take my annual pap smear

Sep 22, 2023

By Maryanne W. Waweru

For the last 16 years, Agnes has been taking her annual pap smear on her birthday. It’s easier for her to remember that way, she says. I had a chat with the 43-year-old Interior Design Installation contractor who is based in Nairobi, Kenya, on her decision to do so. A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women.

You’ve been doing a pap smear for the last 16 years without fail. What inspired you to be doing so?

I learned about cervical cancer and how it’s transmitted while in my twenties after hearing about several cases in my extended family. At the time, there was no vaccine and the best solution was early detection.

Take us through the first time you did the pap smear. Was it something you dreaded, and how is it now, years later?

I don’t recall the exact time, but I was around 25 years old. I had had a chat with my roommate back in college, who described it as a painful procedure. So yes, I was dreading it, but I told myself the pain would be the trade off to keeping cancer away. Turns out the ‘pain’ was really just discomfort from the use of a device to open the pelvis to enable the doctor to access the cervix. Different doctors use this device differently and then again –we have different pain thresholds.

With your busy daily schedule, how do you ensure you never miss your annual appointment?

At first, I did it every two years whenever I remembered. But as I got older, to ensure I didn’t forget, I opted to do it on my birthday month, every March. My birthday month is a time for self-reflection, so why not also make it a time to get my annual check-up? A pap smear is one of the tests that women over 30 should get annually to ensure they stay healthy.

Where do you get your pap smear done (public or private hospital) and at what cost? Is it covered by insurance?

I started with a private doctor, but I have since discovered cheaper and more accessible options at LVCTs. Most health insurance covers don’t cover the well-woman checks.

Have you ever had a scare, where your results didn’t come out the way you were expecting?

So far so good. I have never had any test results come back positive for any HPV.

I’d also like to say that as mothers and aunties, we should have this important health discussions with our daughters and nieces and inculcate in them the importance of taking matters about their sexual and reproductive health seriously. We can even offer to take them for their first well-woman check-up.

For instance, having early (teen and pre-teen) unprotected sex exposes the still developing cervical cells to viruses which in future can turn into cancer. Delaying sexual debut to mid-late 20s is best.

We should also teach boys and girls to thinking positively about their health and bodies because how we think about ourselves manifests in actual reality. I also meditate often about my health and wellness.

Your last words?

Annual well-woman check-ups are important for every woman’s general health and well-being. I would advise women to schedule them to coincide with their birthday or the anniversary of an event that will ensure you always remember.

What do you think about this story? Comment down below with your thoughts. Have you ever taken a pap smear test? What was your experience like? If you’d like to share it, you can email me on maryanne@mummytales.com and I’ll get back to you.

Mummy Tales is a platform dedicated to empowering its readers on different aspects of womanhood and motherhood. Read more motherhood experiences of Kenyan moms here. Connect with Mummy Tales on: FACEBOOK l YOU TUBE l INSTAGRAM l TWITTER

Featured image: Iwaria

Why I Left my Marriage after Just Six Months

Maryanne W. Waweru

Sep 14, 2023

Last week, a friend of mine told me about this 31-year-old lady who, after just six months of marriage, walked out of it.

Hers had been a long-distance relationship as she and her boyfriend both worked in different Counties. After dating for slightly under two years, they eventually held their customary wedding ceremony six months ago. After the traditional wedding, she quit her job as an Administrative Assistant and joined her husband, a businessman, in his hometown.

So what happened in those six months, enough for her to walk out, vowing never to return?

Well, she says that immediately after the traditional wedding, she started looking for work as she didn’t want to stay idle. She also wanted to earn her own money. But her husband was hesitant about her getting a job. He, in not so many words, implored her to stay at home. He said that her money would not be necessary because he would adequately provide for her. He asked that she focus on trying to conceive as soon as possible.

Also See: He Slapped me Hard Because I asked him to Serve me Food. I was Still Weak from Childbirth

Though not fully convinced she didn’t protest much because, as a newlywed, she didn’t want to start disagreeing with her husband that early in the marriage. But soon, she began feeling trapped.

Strangely, each time she stepped out of the house – even to the local kiosk, her phone would soon start buzzing. It was her husband, asking her why she was going to the shops yet ‘everything she needed was in the house’. Her husband would always ensure that the house was well-stocked with supplies, so he needed an explanation about what it was she was going to buy.

Also, how he knew each time she stepped out of the house even when he was miles away remained a mystery to her. But he would always know. Seems like someone was watching her. And reporting her. Or maybe he had a hidden camera in the house?

She also began to realize that no matter what she did, it was never enough for her husband. The bed was never spread straight enough, his shoes were not shiny enough, his shirt collar was not well-pressed, the tea leaves were not enough, the bathroom was not clean enough, the salt in the food was too little or too much… basically, everything she did was not enough for him. Since nothing was ever good enough for him, he was always annoyed, and snapping at everything. Whenever she was around him, she felt as though she was walking on eggshells.

Restricted Phone Calls

Every single phone call she received – she had to explain who it was and the nature of their conversation. Including her mother.

In fact, he forbade her from talking to her mother often, and told her that he would only allow her to do so ‘once a week’ and the conversation ‘should not go beyond two minutes’.

He also went though her list of friends (he had written them down in a notebook) and she watched him cross off those she shouldn’t be friends with anymore.

Waiting for a Slap, and More

Another reason she gave is that even though the man hadn’t inflicted any physical abuse on her, her instincts told her that it was just a matter of time before he did so. The hot slap across her face was coming. She could tell. And with all the cases of domestic violence and women being battered to death by their ‘dear husbands’, she wasn’t going to be one of them.

So she fled for her dear life, in her own words.

Too Soon to Leave your Marriage!

Family, relatives and friends were shocked. Most told her that she should have hang on a little bit longer. That it was too soon to leave. Had they even tried counseling? Had they tried to resolve her issues differently? Had they involved the elders? Had she tried prayer and fasting? Had she watched ‘War Room’?

Other sympathetic ones told her that because the man was already abusing her emotionally, he would eventually have turned out to be physically violent.

She’s now back home to her parents. So those are the reasons why she left her marriage after six short months. Also, she’s just found out she’s pregnant.

What are your thoughts about this woman’s situation? If you’ve ever walked out of a marriage and you would like to share your story, email me on maryanne@mummytales.com

“I’ve lost work opportunities because of period pain” -Veronica Gacheri Makhulo

Maryanne W. Waweru

Sep 4, 2023

Veronica Gacheri Makhulo began her periods as a pre-teen. Today, she is aged 34 years, and openly talks about her period experiences. Veronica’s menses have affected literally almost every aspect of her life. When in school, everybody would know when she was menstruating –from her fellow students to the matron, the teachers and even the headmistress.

At work, the script would be no different as all her colleagues, including bosses, would know when she was on her period. Veronica has even lost some work opportunities because of her menses.

Socially, she has missed friends’ and relatives’ weddings because of her periods. I had a chat with Veronica, where she talked more about her period journey.

Veronica has also authored a book ‘Blossom: From Girl to Woman’ which I loved reading not only because of how well it is written, but also because of the very helpful insights she shared from her experiences with periods. You can reach out to Veronica on +254 715 624 804 for your copy.

Watch my interview with Veronica in the video below.

Do you have a story you’d like to share? Email me on maryanne@mummytales.com

How my life changed after experiencing online gender-based violence

Maryanne W. Waweru

Aug 7, 2023

By Maryanne W. Waweru l @MaryanneWaweru l wawerumw@gmail.com

Twenty-six-year-old Ashley* has always had a passion for modelling. When fresh in high school, her friends encouraged her to join their school’s Miss High School competition.

“They told me I had the body of a model. They said because I was tall and slim, I had the perfect body for any outfit, and that I had a beautiful face that complemented it. Encouraged, I enrolled in the competition and emerged position six, which was a notable achievement for a Form One girl who had never participated in any beauty contest before,” she remembers.

Ashely would continue taking part in the modelling competitions in high school, and when she joined campus, she began modelling for small businesses, showcasing their outfits for sale. She also did shoots with photographers who were building their professional portfolios. Ashely’s ventures not only exposed her to the modelling world, but also earned her an income.

The gorgeous photos

Everything went on well, until the day it didn’t.

“It was 2017, while in the last semester of my final year. I had a photoshoot for a client who was promoting his photography business. My outfit for the shoot was an off-white high-waisted rugged booty short, paired with a red crop-top and white sneakers. I had minimal make-up on with red lipstick. I took the photo in a squatting pose,” she recalls.

Later in the day, the photographer shared the photos and when she saw them, she was blown away.

“He had captured the images perfectly. They literally took my breath away. I was stunned by how gorgeous I looked. I had executed the assignment well.”

So captivated was she by the photos that she decided to upload them to her Facebook page.

Ashely’s Facebook page, with a following of over 12,000 fans was where she showcased her modelling photos, enabling her to get more gigs.

“I uploaded two of the photos on Facebook that night and retired to bed, happy with my achievements for the day. In the morning when I checked, I was encouraged by the comments. Fans were asking me who my photographer was, where they could get such sneakers, where the venue of the photoshoot was and other positive comments.”

Sex machine

That was until Ashley read one comment that wiped the smile off her face.

The comment, from an individual with a male profile read: ‘this is what we call a sex machine’.

“I was horrified!” she remembers.

The comment had attracted about 20 others beneath it, most by individuals with male profiles, and all of them just as bad.

The comments read:

“You look like a prostitute”.

“How much are you selling yourself?”

“You are shameful”.

There were more:

“When I started following you, you were a nice innocent girl, but I cannot believe you are now changing to this –someone who looks like they are soliciting. I followed this page because you were modelling good photos, but it looks like you have since turned to prostitution.”

“Just go sell yourself already!”

Ashely says that with every comment, her heart shattered into pieces. By the time she read the last comment, she was in a dejected trance.

Indecency before my father?

“I felt so humiliated. I had been brought up well and I was shocked that I was now associated with prostitution. Didn’t people understand fashion photography? I’d been comfortable sharing the photos online because my family, including my father, followed me on social media so I would never upload anything indecent. I felt that the comments were vicious and unwarranted. I had planned on uploading more photos that day, but I was now afraid. I switched off my phone and cried myself out.”

When she went to class that day, Ashley was unable to concentrate on her lectures.

“I began thinking that maybe that is how people viewed me in real life. Perhaps my friends and family saw me the same way my online followers had, only that they had never voiced it. Did they all view me as a woman of lose morals because of the clothes I wore for my modelling gigs, or the nature of photos that I took? Were those comments reflective of what everyone around me thought?” she wondered.

Because of this ‘shame’, Ashely disengaged from people –both offline and physically.

“I started looking down on myself as I felt judged. What if these online people identified me on the streets and called me a prostitute to my face? I started avoiding people as I feared everybody had seen the photos. I stopped going out in public. I just wanted to be indoors, alone.”

Selling her Facebook and Twitter pages

The incident affected other parts of Ashley’s life.

“I started wearing oversized, baggy clothes. I didn’t want to show my skin anymore, not even my hands or feet. I changed my wardrobe –the confidence I had about my body, my looks, and my outfits long gone.”

It got worse. Ashley decided to sell her Facebook and Twitter pages.

“I had no desire to be online anymore. The pages no longer served their purposes for me. Thoughts about the hurtful Facebook comments sunk me into a deep, dark hole. My Twitter account had over 40,000 followers while my Facebook page had over 12,000. I sold them since I had come to loathe social media platforms and what they had done to my persona,” she remembers.

But that was not all. The incident affected Ashely’s income.

“I had long stopped depending on my parents for my upkeep as the money I made helped me make ends meet as a campus student. I was also able to save. However, the incident made me stop taking modelling gigs, forcing me to return to my parents for their financial support, which is something I had never wanted to do,” she remembers.

Cyber-bullying

This experience, which took a heavy toll on Ashely’s health and wellbeing, is within the realm of cyber-bullying. According to UNICEF, cyber-bullying is bullying with the use of digital technologies and can happen on social media, messaging platforms, gaming platforms and mobile phones. Examples of cyber-bullying include spreading lies about or posting embarrassing photos or videos of someone on social media, as well as sending hurtful, abusive or threatening messages via social media. Online bullying ‘can feel as if you’re being attacked everywhere, even inside your own home and can seem like there is no escape.’ Cyber-bullying can affect the victim’s physical, mental, psychological, and social health. Emotionally, they may lose interest in the things they once loved.

Women are more vulnerable

While cyber-bullying, a form of online violence affects millions of people worldwide, girls and women are particularly vulnerable.

A global study by the Economist Intelligence Unit found the overall prevalence of online violence against women globally is 85%, with younger women being more likely to have personally experienced online violence. While alarming across the globe, the prevalence of online violence against women was 90% in Africa. The most common forms of online violence included misinformation and defamation (67%) cyber harassment (66%), hate speech (65%). Hacking and stalking (63%), video and image-based abuse (57%) and violent threats (52%). The study found that nearly three-quarters of women surveyed expressed concern about online abuse escalating to offline threats.

The need to end gender-based violence against women and girls is a matter of global concern. It has been elaborated in numerous international and regional instruments such as the Declaration on the Elimination of Violence against Women (DEVAW), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the African Charter on Human and Peoples’ Rights and its Protocol on the Rights of Women in Africa (the Maputo Protocol). Locally, the Sexual Offences Act (2006) captures the issue of gender-based violence, though it does not explicitly tackle online gender-based violence.

Social media users in Kenya

In Kenya, there are about 17.86 million internet users in Kenya, according to 2023 data by research firm DataReportal. The report notes that there are 10.55 million social media users, equating to 19.3% of the total population. Further, 44.3% of Kenya’s social media users are female, while 55.7% are male. An already vulnerable population, the emergence and growth of the internet has increased women and girl’s vulnerability to its negative effects, including online gender-based violence.

Data from a survey conducted by Badili Africa in 2020 showed that 99% of young women in universities were not aware of their digital rights. The survey revealed that Facebook and Instagram were the leading platforms for the young women to likely experience a security breach in the form of pornographic content, explicit messages, trolling or cyber stalking. Some victims end up taking long breaks from these platforms or quitting altogether.

Legal frameworks

To address online violence, Kenya’s government has initiated various cybersecurity policy and legal initiatives and frameworks including: The Kenya Information and Communications Act (1998), the National Cybersecurity Strategy (2014), and the Computer Misuse and Cybercrimes Act (CMCA) (2018).

Through the 2014 Strategy, Kenya established the Kenya Computer Incident Response Team and coordination Centre (KE-CIRT/CC) and the National Digital Forensics Laboratory at the National Police Service under Directorate of Criminal Investigations (DCI).

Combating online violence

If one needs to report cases of cyber-crime, including online violence, the Directorate of Criminal Investigations (DCI) is one of the channels through which they can do so through its toll-free number 0800 722 203, as well as the DCI Twitter and Facebook pages. Individuals are also encouraged to report these incidents at police stations.

To complement government efforts, various civil society organisations have been working to combat online gender-based violence, including Badili Africa, which builds the capacity of young women in universities- as digital advocates to effectively navigate digital platforms to influence change as well as increase their inclusion in key decision-making processes.

Similarly, UNFPA is spearheading the BodyRight campaign, which aims to create awareness about digital violence and push lawmakers, digital companies, and social media platforms to take abusive use of human bodies seriously. The campaign seeks to empower women and young people to take ownership of their bodies online and make the digital world a safer space for everyone.

Eveminet is similarly addressing digital security by creating awareness among digital users on how to identify red flags, how to act and where to get help.

However, a lot more needs to be done to address online gender-based violence. Evelyne Kasina, Eveminet’s Chief Executive Officer (CEO) has a few recommendations.

“Though the Computer Misuse and Cybercrimes Act, 2018 is a good start, it needs to be strengthened to better address the specific challenges of online violence. This could include expanding the definition of online violence to include more types of abuse, increasing the penalties for perpetrators, and making it easier for victims to report abuse,” she says.

Ms. Kasina also advocates for the need for more research on online violence as this will help to broaden all stakeholder’s scope of the problem and subsequently develop effective interventions.

On supporting survivors of violence, Ms. Kasina notes that they need to be provided with more accessible and affordable support services, such as counselling, legal aid, and financial assistance.

“The government should provide funding for these services and ensure that they are accessible to all survivors.”

Where is Ashley today?

It is now six years since the incident that deeply affected Ashely. She graduated from campus and now works in Advocacy and Communications, consulting with different NGOs.

How has life changed for her, and what would she do differently now if a similar incident were to happen?

“Back then, I didn’t know that what had happened to me had a name. Now I know it is cyber-bullying, or online gender-based violence. Furthermore, since it had happened on Facebook, I now know that I can report it to Meta, who can act against the perpetrators,” she says.

Today, many online platforms have policy guidelines that regulate users’ conduct and allow for reporting of offences. Facebook states that ‘if you manage a Facebook Page, you may use the profanity filter to hide comments with profanity from your Page. Facebook determines what to hide by using the most reported words and phrases marked offensive by the community. Hidden comments with these words remain visible to the people who wrote them and their friends. They won’t be visible to everyone else.’

Similarly, TikTok has a dedicated team of moderators who are trained to identify and remove content that violates its policies against online gender-based violence. The platform also has several tools and features that users can use to protect themselves from abuse, such as the ability to block users and report content.

I wouldn’t have sold

There is something else that Ashley would have done differently regarding her social media accounts.

“I would not have sold my Facebook and Twitter accounts, just because someone made mean, untruthful comments about me. That is not who I was, and their comments should not have intimidated me. The abuser altered my life in way that I allowed him to, which shouldn’t have happened.”

However, Ashely does not believe the pain would be any less now, than it was then.

“I’d still be deeply hurt if anyone said such words to me. Back then I was only 20 years old and naïve, but even now when I’m more mature and more exposed, I can’t say I’m at the point where I have a tough skin to deal with online attacks. I still feel fragile.”

Return to social media and being blacklisted

Ashley’s work sometimes requires her to access different online platforms.

I’m very cautious on social media. I have ‘ghost’ Facebook and Twitter accounts, which I only use when I need to access my client’s pages. I am however on LinkedIn with my full profile because I feel it is a professional platform where users are unlikely to be abusive,” she says.

Ashely has since resumed modelling, but she’s very particular about the jobs she takes.

“I am now in control of the photos of me that are published. I don’t take photos in clothes that I’m not comfortable in. I do not wear short or revealing clothes. I’m also very keen on the photographers I work with because a photographer’s shot can portray you in a way that you wouldn’t want depicted. As a matter of principle, I refuse to pose in certain ways they ask of me if I feel uncomfortable.”

Because of this, Ashley has lost some jobs, as she has been labelled a ‘kichwa ngumu’ (difficult model to work with).

“They prefer working with girls who agree to everything they ask. I have even been blacklisted by some modelling agencies, and I’m okay with that,” she states firmly.

*I used this pseudonym to protect Ashley’s identity. She is still healing and emotionally recovering from the incident.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

Featured image courtesy: Iwaria

The day I helped a mother who had given birth by the roadside –Judith Shitabule

Maryanne W. Waweru

May 26, 2023

Judith Shitabule, 44, is a community health volunteer (CHV) based in the Lindi area of Kibera, Nairobi County. She is well known in her locality, such that people freely approach her when in need, especially regarding their health. You can read more about Judith in this article that I wrote about her.

As a CHV, Judith often comes across incidents that are lifechanging; sometimes a matter of life and death. She narrated to me one such incident that happened recently, where she assisted a mother and her newborn.

Read: Judith Shitabule: Champion of Maternal and Newborn Health in Nairobi

“Last month, I handled a roadside delivery in the dead of the night. While I have handled emergencies before, this one was unique (and scary) because I could see that the mother had a complication and I wasn’t sure how I would handle it. This is what transpired:

Frantic knocks on my door

I live by the roadside, with my house being familiar to residents since my work as a CHV is well known. Because of this, people know they can call on me for help anytime, even in an emergency.

On this particular day, I remember the security guards shouting, calling out my name as they frantically knocked on my door. I dressed hurriedly and when I came out, I found a mother lying down on the dirt road. She had just delivered her baby, who also lay on the dusty ground. Mother and baby had not been separated yet. It was a few minutes after midnight.

The woman’s husband was desperately asking the security guards to help him out. I noted the sigh of relief on all their faces when I arrived.

Cutting the umbilical cord

After assessing the situation, I quickly ran back to my house for a pair of gloves. I also took out a new, unused razor blade which I used to cut the umbilical cord.

After doing so, I realized something odd with the mother. Even though her placenta was out, something else was protruding from her vagina, which I didn’t think was normal. She was also bleeding. Thankfully, she was conscious and talking. I knew we had to rush to hospital as something didn’t seem right with her. I also needed to get the baby checked by a medic, to ensure all was well.

Also read: How health workers in Kibera are assessing sick children using a new digital health tool

Ambulance unavailable

I called for an ambulance but they told me that while the vehicle was available, it didn’t have fuel. It was a county government ambulance. I felt bad because it was an emergency. We didn’t have money to hire a private ambulance. What to do next?

Thankfully, the tuktuks parked next to my house became the lifesaver. The security guards agreed that they would use it to rush the mother and baby to hospital, and would later explain to the owner what had informed this decision.

One of the security guards took the wheel as we wrapped both mother and baby up with some lesso’s from my house, and off we went. Our destination was the Kibera Community Health Center (AMREF). By the time we arrived, the mother looked pale and weak, as she drifted in and out of consciousness. I quickly handed her over to the medical team. We kept vigil at the reception area, nervous, but hopeful for good news.

Childbirth complication

Finally, the doctor came out and shook my hand saying “thank you for saving this mother’s life”. The doctor informed us that the mother had experienced a complication and thankfully, we had brought her to the hospital in the nick of time. The protrusion that I had seen, which seemed unusual to me, was her uterus, in what the doctor informed was referred to as a uterine prolapse.

Mother and baby stayed at the hospital and were released the following day. I often see them when I make my household rounds in the community – they are both healthy and doing well. Even though it has its challenges, I find my work as a CHV quite fulfilling.”

Also Read: Sodomy: a Kenyan Mother Recounts her Son’s Path to Justice

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

Champion of Maternal and Newborn Health: Judith Shitabule, Community Health Volunteer in Nairobi

Maryanne W. Waweru

May 25, 2023

Judith Shitabule, 44, is a Community Health Volunteer (CHV) and reproductive health advocate based in Kibera, Nairobi. Judith monitors 100 households in her allocated area; Lindi. On average, each household has about eight people, including children. In a month, she must visit at least 34 households. At the end of each quarter, she visits all 100 households at least once.

Pregnant women

As a CHV, Judith pays particular attention to pregnant women. She identifies them and ensures she visits each one of them at least once a month. Judith offers pregnant women health education, emphasizing on their need to make at least four antenatal care (ANC) visits to the hospital, as recommended by health experts. ANC visits are important for screening and diagnosis as well as injury and disease prevention. The visits are also important in pre-birth and post-birth preparedness.

Delayed first ANC visit

While it is recommended that a woman make her first antenatal visit before 10 weeks into her pregnancy, Judith notes that many pregnant women in Kibera delay their first ANC visit until the third trimester.

“They say the queues at the clinic are too long, hence wasting their time. The clinic run can take up to four hours, time they say will prevent them from performing their domestic chores, running their small businesses, or caring for their other children. Most delay ANC visits until the seventh or eighth month of pregnancy “when they are ready to give birth,” says Judith.

That is why Judith pays particular attention to pregnant women because she knows the value of antenatal clinics, and fears that women who don’t attend them remain vulnerable to negative pregnancy outcomes.

“I tell them that pregnancy is a critical time in their life, and it is therefore important for them to have their health and progress monitored in a hospital. I alert them it also helps detect any problems with the pregnancy, such as if they have anaemia, rhesus factor, low weight etc.,” she says.

Mother and child booklet

Judith makes certain that each pregnant woman has her own copy of the Mother and Child Health handbook/booklet that is available in public health facilities. This booklet contains a wealth of information about pregnancy, childbirth and after childbirth until the child is five years old.

“I stress to them the need to carefully read the contents of the booklet as it contains lifesaving information, such as the danger signs in pregnancy and how to identify them,” she says.

Pregnancy danger signs

Danger signs in pregnancy include severe headache, fever, swelling of face, hands and legs, vaginal bleeding, severe abdominal pain, convulsions/fits, and reduced or no movement of the unborn baby.

Judith also educates them on healthy eating during and after pregnancy.

“I tell them that a nutritious diet shouldn’t be expensive. There are many nutritious options within their reach, such as eggs, green leafy vegetables, fish, beans and fruits –all affordable and accessible within Kibera.”

They don’t read

While all this information is contained in the mother child booklet, Judith notes that unfortunately, most of the pregnant women she hands the book to don’t read it.

“I even give them homework, telling them that when I return for my next visit, they will share with me snippets of what they read. For those who cannot read, I tell them to look at the pictures and try and understand the message. I tell them to take note of any concerns or questions they may have, which I answer in my next visit,” she says.

However, when Judith visits them again, she is often disappointed.

“I find they did not even open a single page. They say they prefer waiting for my next visit so that I can educate them; that it is easier for them to hear from me than to read or look at pictures, because it is less complicated.”

Also read: How health workers in Kibera are assessing sick children using a new digital health tool

Community advocate

Judith has been a CHV for the last 20 years. She has been trained by both the government and stakeholders in the private sector, including NGOs, in different issues surrounding community health. She also works closely with local leaders such as Members of County Assembly and the Nairobi woman representative to advocate for various issues, such as the availability of ambulances, better referral systems, improved road networks and staffing of nurses and doctors in health facilities that are accessible to the Kibera population.

In this next article, Judith recounts an incident where she was woken up in the middle of the night to assist a woman who had delivered by the roadside and was experiencing a birth complication. Read it here.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

Also watch: Challenges faced by married Somali women refugees as they seek family planning services in Nairobi

The story of the small white card that is Nasra’s lifeline

Maryanne W. Waweru

Apr 26, 2023

By Maryanne W. Waweru l wawerumw@gmail.com l @MaryanneWaweru

There is something that Nasra*, 36, cannot forget to do every three months.

She would rather forget to eat, brush her teeth, take a bath or apply her favorite lotion on her smooth, silky skin, but she cannot forget the date on the small white card she keeps in a purse safely tucked away in a corner of the single-roomed house that she shares with her husband and five children.

The date, renewed every three months, is what helps her ‘live without much stress’ as she puts it.

The date on the card indicates her next appointment at the family planning clinic where she gets her contraceptive injection.

The reason Nasra cannot forget that date is because of the experiences she had in her first years of motherhood, which she describes as being ‘extremely stressful’.

After giving birth to her first child at the age of 21 years, she found herself pregnant again just a few months later. Shortly after delivering her second child, she fell pregnant again. By 24, she had three children –all under three years.

A life of loneliness and struggle in Nairobi

As a newlywed, Nasra had left her hometown of Moyale to join her husband in Kamukunji, a sub-county in Nairobi, Kenya’s capital city. Moyale is a town located at the border of Kenya and Ethiopia.

Distanced from her relatives, the only person she knew in Nairobi was her husband, a casual laborer who would be out at work all day long.

“In between breastfeeding, caring for the babies, cooking, cleaning, fetching water, washing clothes and undertaking all domestic chores all by myself, I was always exhausted,” she remembers.

Surviving on a cup of tea

Things would get worse as sometimes, her husband would go for weeks without a job.

“I remember the times I was pregnant while also breastfeeding, yet we had no food. I would make do with just a cup of strong tea all day long. I felt like I would die. I would rebuke my husband as I felt he was not working hard enough to provide for us. I blamed him for having brought me to Nairobi to suffer. I was always very angry at him,” she remembers.

A new revelation at the well-baby clinic

One day, when Nasra took one of the children for his routine immunization at a government clinic, a conversation with the nurse got her thinking.

“I had gone to the well-baby clinic with my three children. Even though it was only one child who was being vaccinated, I had carried the others along since I had no one to leave them with at home. The children were quite fussy, and I struggled to control them. The nurse, who noted how overwhelmed I was, asked me if I was ready to have another child and if not, what I was doing to avoid getting pregnant again.”

Nasra didn’t know how she could delay or avoid pregnancy. She asked the nurse for more details.

Seeking husband’s permission

When her husband returned home that day, Nasra narrated her experience at the immunization clinic. She told him that she wasn’t ready for another pregnancy and wanted to use family planning. Her husband did not object and gave her 50 shillings to open a file at the clinic.

“The nurse explained the different family planning options and I settled for the injection as I thought it was the most convenient for me. She also told me that once I stopped the injection, I would be able to get pregnant again.”

For the next few years, Nasra would engrave in her memory the date that the nurse wrote on her small clinic card every three months. She would keep the card safely tucked away in a purse in the corner of their single-room house. She never forgot the date of each appointment and when she felt she was ready to have another child, she did not renew the injection.

A better-planned pregnancy

“When I got pregnant again, my last child was three years old. My husband had also found a better job by then, so things were better financially. I felt ready to get another child,” she remembers.

After delivering her fourth child, she resumed her regular dose of the family planning injection, only stopping when she felt she was ready for another child.

Her lastborn child was delivered four years after the previous birth.

Plans to have more children

Nasra says that while she still hopes to have ‘two or three more children’, she is at least doing so at her own terms –when she is ready to, thanks to the date on the small card hidden in the purse in a corner of the single-room she shares with her husband and five children.

Family planning for positive maternal health outcomes

Nasra is one of the women enjoying the benefits of family planning. The Sustainable Development Goals (SDGs) have focused on contraception as one of the priority areas to boost maternal and child health outcomes.

Within the married Somali refugee women community living in Nairobi County, to which Nasra belongs, an approximate one in every four of them use family planning. This is according to a recent study by Dr. Eliphas Gitonga Makunyi, a population and sexual reproductive health expert and lecturer at Kenyatta University.

In his study, Dr. Gitonga sought to examine the utilization of family planning among blended married Somali refugee women aged 15-39 years in Nairobi, Kenya. The blend included Somali women from neighbouring countries (refugees) and natives from Nairobi and the northern region of Kenya. Somali refugees in Kenya originate from Somalia, Ethiopia, and Djibouti. The native Somali women are from Nairobi and the northern region of Kenya.

The study established the prevalence of modern family planning among Somali refugee women as 24%, compared to that of 43.5% among native Somali women.

Among the Somali refugee women using modern family planning, the preferred methods are injectable (19%), pill (9%), Implant (31%), Intra uterine device (10%), male condom (27%) and others (4%).

Among the native Somali women using family planning, the preferred methods are injectable (40%), pill (21%), Implant (26%), Intra uterine device (6%), male condom (3.5%) and others (3.5%).

Male engagement in family planning

The study also established the link between family planning utilization and spousal support among Somali women. Participants in the study indicated that women need permission from their husbands for almost every decision they make for their lives, including their health.

The proportion of Somali women using modern family planning is highest among women who are accompanied by their husbands for family planning services, are given financial support for family planning services, have partner approval to use, are asked about family planning progress by their partners, and those with high constructive male engagement.

Owing to this, one of the key recommendations by Dr. Gitonga is the need to increase the level of constructive male engagement among refugees in Nairobi. He also recommends the need for policymakers at county and national levels to formulate urban refugee targeted family planning policies.

Learn more about the study here.

I was denied my family planning method of choice at the clinic

Secrets in marriage: I use family planning but my husband doesn’t know

Why I decided not to give birth again after delivering my 10th child

The story of Sadiya and Mama Kevo of 7th Street

*Name changed to protect her identity.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

I was denied my family planning method of choice at the clinic

Maryanne W. Waweru

Feb 16, 2023

What happens when a young woman seeking family planning services settles on her preferred method, but the service provider disagrees with her choice? Is she compelled to go with the service provider’s recommendation? Does the service provider give her sufficient information about why she shouldn’t use her preferred method? Does she leave the clinic feeling satisfied about the service offered? Do service providers understand the dynamics around the contraceptive choices of their clients?

This is the story of *Fawzia, a young married Somali refugee woman in Nairobi, Kenya, whose experience sheds more light on the interaction between service providers and young family planning clients.

By Maryanne W. Waweru l wawerumw@gmail.com l @MaryanneWaweru

When 22-year-old Fawzia’s son was two months old, she and her husband were undergoing serious marital problems; their future together uncertain. One thing she was however sure of is that she did not want to get pregnant with her second child soon –until she had clear direction about her troubled marriage.

To avoid getting pregnant again, Fawzia went to the family planning clinic at a public health facility near her home in Kamukunji, where she requested for the five-year implant. Her friends had told her about different contraceptive methods and she had settled on the implant. She believed it was the surest way to prevent an unplanned pregnancy.

Denied family planning method of choice

However, things didn’t go as expected at the family planning clinic.

“The nurse told me that I was too young to get the implant, saying that it was mostly given to older women who had already bore enough children. At that time, I was 20 years old with only one child. She said it would not be good for me to have a long-term hormonal contraceptive at my age. The nurse advised me to take the daily pill instead. She wrote me the prescription and directed me to the pharmacy where I would get the pills.”

But Fawzia did not go to the pharmacy. She went home instead, disappointed.

Threw away the prescription

“Even as the nurse was writing the prescription for the pills, I knew she was wasting her time as I was not going to take them. This is because my friends who had used the pill before had told me how after they started taking the pill, their breastmilk had dried up. At that time, my son was only two months old, and I didn’t want the same thing to happen to me. Once outside the gate of the health facility, I threw the prescription away as not only was it unhelpful, but I didn’t want my husband to know that I had been to the clinic.”

Breastfeeding to prevent pregnancy

Having been denied her choice of family planning method at the clinic, Fawzia opted to diligently breastfeed her son to avoid getting pregnant. She would nurse him every three hours without fail. Traditionally, Somali women are encouraged to use breastfeeding as a means of contraception, though it is not always reliable.

Fawzia and her husband have since separated. She is however hopeful about getting married again and having more children.

Also read other stories from Somali women refugees and their personal experiences with family planning:

Secrets in marriage: I use family planning but my husband doesn’t know

Why I decided not to give birth again after delivering my 10th child

The story of Sadiya and Mama Kevo of 7th Street

Fawzia is among the three in four urban married Somali refugee women in Nairobi who do not use any modern family planning method. This is according to a recent study undertaken by Dr. Eliphas Gitonga Makunyi, a population and sexual reproductive health expert and lecturer at Kenyatta University.

Dr. Gitonga’s study sought to examine the utilization of family planning among blended married Somali refugee women aged 15-39 years in Nairobi County. The study area was specifically Kamukunji, Embakasi, and Ruaraka sub-counties, where the highest portion of the Somali community lives. The blend included Somali women from neighbouring countries (refugees) and natives from Nairobi and the northern region of Kenya. This is the first detailed study specifically focusing on Somali refugees (who make up the highest percentage of the refugee population in Kenya and in Nairobi County).

The study established that the level of utilization of modern family planning among married Somali refugee women was 24%. This, compared to 43.5% among native Somali women. Among the users, injectable, pills and implants are the main methods and are sourced from public facilities. This utilization is much lower than the national average, which is 53%, and the Nairobi County average which is 58%.

Patriarchy in the Somali community

According to Dr. Gitonga, this could be associated with the population of study who are refugees and face multiple challenges in accessing family planning. Being of Somali origin is also a key factor because of cultural and religious beliefs and norms that discourage women from using family planning.

The Somali community is a patriarchal system, where most decisions are made by men. According to the study, the husband’s or partner’s disapproval of family planning reduced the likelihood of utilization. The study established that constructive male engagement in family planning increased the likelihood of utilization among Somali refugee women. The study also showed that a belief that a woman’s community culture is unsupportive of family planning reduced the likelihood of utilization.

Male involvement in family planning

Some of the study’s key recommendations is for family planning programs to take religion and culture into account to reach urban Somali women. It also recommends the need to increase male engagement in reproductive health programs targeting refugees in Nairobi. The study also urges Policymakers at county and national levels to formulate urban refugee targeted family planning policies.

Learn more about the study here.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

*Name changed to protect her identity.

Secrets in marriage: I use family planning but my husband doesn’t know

Maryanne W. Waweru

Feb 14, 2023

Why do some women who use family planning do so without their husbands’ knowledge or against their husbands wishes? Seynab is one woman who uses contraceptives without her husband’s knowledge. I spoke to her, and she shares more information about what transpired that led her to keeping this secret from her husband.

By Maryanne W. Waweru l wawerumw@gmail.com l @MaryanneWaweru

31-year-old *Seynab is a mother of eight. She had her first child when she was just 13 years. After she had her fourth child at the age of 20, she felt she needed a break from ‘constantly being pregnant and breastfeeding’.

After confiding in some of her friends in her Eastleigh neighbourhood, they advised her to go on family planning until her last child was at least three years old. The idea seemed good to her, and she immediately shared this information with her husband. She also sought his permission to visit a family planning clinic.

Husband’s refusal

Unfortunately, her husband disapproved, saying that children come from God at His own timing. He warned her against interfering with God’s will. Additionally, he said it was not in accordance with their Somali culture for her to use modern family planning.

“Despite my attempts to get him to understand my point of view, he didn’t budge and cautioned me against visiting the family planning clinic. When I shared the news with my friends, they advised me to visit the clinic anyway. They told me my husband didn’t need to know.”

Secret agenda

Seynab heeded their advice and visited the family planning clinic without her husband’s knowledge. She was put on a five-year contraceptive implant. The nurse assured her that she wouldn’t get pregnant until her last child was in nursery school.

However, her husband soon discovered her secret.

“It didn’t take long for him to see the strange stick under the skin on the inside of my upper arm. Of course, he was infuriated and demanded that I take it out immediately. I tried to protest but he threatened to leave me if I stayed with it,” Seynab remembers.

Complying with husband’s wishes

Eventually, afraid of losing her marriage, Seynab went back to the clinic and had the implant removed. She conceived not too long after. While she had desired to have a five-year gap between her fourth and fifth child, pressure from her husband to take out the implant saw the gap reduce to just two years.

After giving birth to her fifth child at just 22 years, Seynab figured that she needed a better strategy to delay her next pregnancy.

As she was busy thinking about this strategy, she found herself pregnant again!

Her sixth child was born just eighteen months after the previous one.

A more serious secret strategy

Seynab knew she couldn’t deal with another pregnancy soon, and decided to be more serious.

“I went to the family planning clinic again without my husband knowing and explained my predicament to the nurse. I told her that while I wanted a family planning method that would delay my pregnancy for about three or four years, I didn’t want my husband to find out. Having an implant again was out of the question because he would discover it just like the last time. The nurse helped me to settle on the three-month injection.”

Counting on a good neighbour to keep my secret

To ensure success, Seynab made an interesting arrangement with her good friend Christine, whom she fondly refers to as Tina. She asked Tina to safely keep her family planning clinic card in her house, and to always remind her when the date for the next injection was due.

Every three months, Seynab would leave home to go to the ‘market’, pass by Tina’s house, get her card, go to the clinic, receive the injection and then pass by Tina’s house again to drop the card before heading home. It is a strategy that worked because for three years, and only when she felt she was ready for another child did she stop the injection appointments.

She then got her seventh child at the age of 27 years.

Careful not to arouse husband’s suspicion

Seynab’s arrangement with Tina continued well, where she would receive the injection secretly while keeping the card at her friend’s place. She was however careful to keep the birth spacing of her two last children to three years, lest her husband and her in-laws became suspicious about why she was taking long to conceive.

Last year, at the age of 30, Seynab gave birth to her eighth child.

Seynab says that she will wait for her current lastborn to turn four years before having another child.

“My aim is to have 10 children in total, so I have two more to go. But at least I’m having them at my own time, and without pressure from my husband and my in-laws,” she says.

Family planning among refugee Somali women in Nairobi

Seynab’s experience is not unique among the urban married Somali refugee women residing in Nairobi County. According to research undertaken by Dr. Eliphas Gitonga Makunyi, a population and sexual reproductive health expert and lecturer at Kenyatta University.

The study sought to examine the utilization of family planning among blended married Somali refugee women aged 15-39 years in Nairobi, Kenya. The blend included Somali women from neighbouring countries (refugees) and natives from Nairobi and the northern region of Kenya.

The study established that when Somali women want to use family planning, they will use it irrespective of the opinion of their partner. This they do because of the pressure of life, empowerment, and health effects.

“If a woman wants to use family planning, she will use all available means to do so. Most will use injectables that cannot be detected. They can even use pills which they hide in charcoal stores, or within maize flour, or even sometimes within the pillowcase without the partner noticing. Some even have a neighbor keep the contraceptives for them,” Dr. Gitonga says of the study findings.

Also read: Why I decided not to give birth again after delivering my 10th child

Also read: The story of Sadiya and Mama Kevo of 7th Street

Seynab is one of the 26% Somali refugee women in Nairobi who use modern family planning, according to the study. The main methods of family planning are injectable (33.1%), pills (24.4%), and implants (23.8%). All three methods are hormonal based. Despite the level of uptake being low, the high prevalence of the injectable is consistent with other studies, including demographic health surveys (26%), that find it higher among other modern family planning methods. This is mostly due to the discrete nature of the method in the context of a non-supportive male partner for family planning.

The study showed that a refugee who had lived in Nairobi for 21–30 years had a higher likelihood of utilizing family planning. Migration is associated with attitude change due to the norms of the host community.

Dr. Gitonga’s study also established that a husband’s or partner’s disapproval of family planning reduced the likelihood of family planning utilization among Somali refugee women. Towards this, one of the key recommendations of the study is to increase the level of constructive male engagement among Somali refugees in Nairobi County.

“Future family planning programs should take religion and culture into account to reach urban Somali women. Policymakers at county and national levels should formulate urban refugee targeted family planning policies,” says Dr. Gitonga.

Learn more about the study here.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

“Why I decided not to give birth again after delivering my 10th child” – family planning among married Somali women in Nairobi

Maryanne W. Waweru

Feb 6, 2023

Modern family planning among refugee and native married Somali refugee women

What happens when the birth of your child nearly kills you? Farhiya lived through that experience and in this post, she talks about how a near-death experience during childbirth made her resolve not to give birth again. So what exactly happened?

By Maryanne W. Waweru l wawerumw@gmail.com l @MaryanneWaweru

When 35-year-old Farhiya felt the pangs of labor, she knew what would happen next. It being her 10^th child, she had been through the routine many times before. Farhiya slowly walked to the public health facility within her neighbourhood in Eastleigh Third Avenue, where she had delivered all her other babies.

While Farhiya remembers delivering her baby safely, she cannot recall how she ended up in an unfamiliar environment. All she remembers is waking up confused, a team of medics hovering around her, worried looks on their faces. The unfamiliar environment Farhiya found herself in was at Pumwani Maternity Hospital.

But how did she get there?

The missing baby

“I had no idea how I had gotten to Pumwani or what I was doing there. I remembered delivering my baby well, but when I stretched out my hand on the bed in a bid to find her, she wasn’t there. I panicked. What had happened to my baby? What had happened to me?” Farhiya wondered.

It turns out that after delivery, Farhiya had suffered a retained placenta, whose complications had led to post-partum haemorrhage (PPH) –severe vaginal bleeding after childbirth. The excessive blood loss had rendered her unconscious, and it was during that time that she had been transferred –via ambulance –to the larger and better equipped Pumwani Maternity Hospital, the largest obstetric and maternal referral hospital in Kenya.

Post-partum haemorrhage is the leading cause of maternal mortality in Kenya. One of the risk factors for PPH is having many births –the risk going up the more times a woman gives birth.

My worried husband

“When I spoke with my husband, he told me that I had nearly died from the bleeding. I had never suffered any complications with my previous nine births. He described to me the emergency situation the haemorrhage had caused, saying that it had greatly frightened him. It frightened me too!” remembers Farhiya, who remained admitted at Pumwani Maternity Hospital for two weeks.

Farhiya’s children’s years of birth are: 2004, 2006, 2007, 2009, 2011, 2013, 2015, 2017, 2019 and 2022.

Having nearly lost her life with her lastborn, she decided she would not give birth again.

“I had a discussion with my husband, and I told him I was afraid of getting pregnant again as I would surely die during the next childbirth. He was in agreement and said that the 10 we already had were good enough.”

Breastfeeding to prevent another pregnancy

Farhiya’s lasborn is now six months old. Since she does not want more children, what is she doing to avoid another pregnancy?

“For now, I’m breastfeeding my daughter as I believe it is an effective method of preventing pregnancy. Every time I have breastfed my other children, I do not see my period but as soon as I stop, I see it again and I get pregnant. So for as long I’m still breastfeeding my daughter now, I’m not worried about getting pregnant,” she says.

Visiting a family planning clinic

In the meantime, Farhiya says she has been thinking about going to the family planning clinic.

“I might need to get on a contraceptive as soon as I stop breastfeeding, so I need to think about the different options available,” she says.

“I’ll start with the pills as I think they are the safest. I will not take the injection because I have a friend who started bleeding heavily after she started using it. I also don’t want the implant as I don’t want something foreign in my body,” she says.

Also read: The story of Sadiya and Mama Kevo of Eastleigh’s 7th Street

Farhiya is one of the 76% of urban Somali refugee women in Nairobi who do not use any modern family planning method. This is according to a recent study undertaken by Dr. Eliphas Gitonga Makunyi, a population and sexual reproductive health expert and lecturer at Kenyatta University.

The blend included Somali women from neighbouring countries (refugees) and natives from Nairobi and the northern region of Kenya. This is the first detailed study specifically focusing on Somali refugees (who make up the highest percentage of the refugee population in Kenya and in Nairobi County).

Modern family planning among Somali refugee women

The study established the prevalence of modern family planning among Somali refugee women as 24%, compared to that of 43.5% among native Somali women.

Among the Somali refugee women using family planning, the preferred methods are Implant (31%), male condom (27%), injectable (19%), Intra uterine device (10%), pill (9%) and others (4%).

Among the native Somali women using family planning, the preferred methods are injectable (40%), Implant (26%), pill (21%), Intra uterine device (6%), male condom (3.5%) and others (3.5%).

Involving Somali men in family planning

Dr. Gitonga’s findings indicate that the factors associated with modern family planning utilization include: place of residence, age group, religious beliefs, community beliefs, perception of being a community misfit, information on family planning, husband approval, peer approval, constructive male involvement, and duration within the city as a refugee.

The Somali community is a heavily patriarchal one. With this regard, one of the study’s key recommendations is for urban reproductive health and refugee policymakers to devise interventions to engage men in family planning conversations, for better maternal health outcomes.

Learn more about the study here.

Do you have feedback on this article? Comment down below or email me at wawerumw@gmail.com

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