Nairobi, Kenya—During a visit to Jhpiego-supported programs in a slum outside Nairobi, Melinda Gates heard the same message from dozens of residents—women want to plan their families so they can provide for their children and give them opportunities they never had.
“I talked to more than 50 women about family planning when I was in Kenya, and all but one told me how desperately they wanted to plan their families and space their children…,” said Gates, whose family foundation recently chose Jhpiego, the Baltimore-based international health non-profit and Johns Hopkins affiliate, to lead its $23 million urban reproductive health program in Kenya called Tupange.
“The women I met talked a lot about how important it was to make sure their daughters learned about family planning. One woman said she had six children before she knew anything about family planning, and she told me she must not let the same thing happen to her daughter. Her direct quote: ‘My daughter will be more informed about family planning than I was. I will teach her everything.’”
Whether speaking through a Swahili translator or finding their voice in English, the women who met Gates recognized that spacing their children in a healthy manner would enable them to better care for their families so all would thrive.
“I asked a group of women why they wanted to practice family planning. One woman summed it all up when she said, ‘I want to bring every good thing to one before I have another,’” said Gates. “It just reinforced what I always come away from these conversations realizing—that mothers everywhere want the same things for their children, that we all want to set our children up for a successful future.”
Jhpiego, whose urban health program has been recognized for its innovative strategies to increase access to quality health care and services for Kenyans, hosted Gates during a day-long visit that included meeting with women from a Nairobi area slum. The organization’s work in Korogocho and Viwandani slums led to a significant increase in family planning use by women.
As Gates walked through the communities and talked with Kenyan wives and mothers, women shared the challenges they faced in getting adequate family planning services that include disapproving husbands, physical infirmities and inadequately supplied health clinics.
“One woman had been trying to plan her family for years, but her husband wouldn’t hear of it. Then, because she had so many children in the same room where she was cooking their food, there was an accident and her child got burned. They had to go to Kenyatta Hospital, and the dad finally understood the importance of child spacing. The woman was at the clinic to finally start the process of planning her family.”
But Gates also learned about new family planning methods that were being offered to Kenyan women living in these crowded, impoverished areas of the city.
“I visited a health clinic in Kariobangi, and I happened to be there on the day they set aside for long-term family planning, including tubal ligation, IUCDs and implants,” recalled Gates. “The women I talked to were really excited about the implants. They called them batteries, because they work for four years. I got to see a woman having the procedure done, and it was just amazing to me how easy, quick and relatively painless the procedure is.
“It’s such a cost-effective and effective way to give women the ability to plan. I thought to myself, that little procedure can make such a huge difference in the lives of women, their families and their communities. That’s why there was a line out the door and a four-hour wait to have the procedure done.”
Throughout her visit, Gates was heartened by women’s concerns for one another and the network of support that had developed among many to access family planning services.
“The sad truth is they don’t get much support from the men, but they make sacrifices for one another. At the health clinic, two women told me they’d already gotten implants, but they had come because they wanted to encourage other women who were scared or uncertain,” said Gates. “Seeing that there were women who had come to give advice and another who had come seeking advice made me realize that tools and technology are only part of the equation.”
Gates recalled her meeting with a courageous, determined volunteer health worker named Maureen.
“She was an HIV-positive mother, and one of her five children also had HIV,” said Gates. “Now, she is running a program where HIV-positive mothers counsel pregnant women with HIV about preventing mother-to-child transmission. The most important thing, she said, was helping the women realize that others just like them had overcome the same obstacles. In her words this was ‘Living Positively.’ Maureen told me that in her program, they haven’t had a baby born with HIV since August—and that’s more than 30 healthy children!”
Access to family planning services can have a profound impact on the lives of women and their families. A woman named Mary told Gates about a savings club—called a “merry-go-round”—in which members contribute to a pool from which they can get loans to start a small, home business.
“Mary took a loan to buy a sewing machine, and she had a thriving business selling backpacks out of denim. She sold them at the local market for 50 shillings apiece, and she was supporting her family and paying back her loan,” said Gates. “When I visited Mary’s workshop, she was caring for her youngest child while the other two were off at school. I just kept thinking that the futures of those children were so much brighter because their mother had been able to plan her family and band together with other women in the community to grow a business.”