Male champions change the conversation about family planning in Nairobi slums
Nairobi, Kenya—Robert Nyaboga is a resident of Block G in the sprawling Dandora slums of Nairobi, Kenya. He works as a waiter in one of the hotels in his neighborhood. On most days, Robert meets his friends after work to chat about politics and sports before heading home. They call the ritual the Bunge la Wananchi—the People’s Parliament. It was here, at the People’s Parliament, that Robert met Peter, a community health volunteer and family planning champion working with Tupange, a five-year initiative led by Jhpiego and supported by the Bill & Melinda Gates Foundation.
Peter had asked the members of the parliament what they thought about the numerous advertisements playing on TV about family planning. A heated debate ensued: some men suspected ulterior motives by the government, others claimed family planning encourages promiscuity, while others advocated for family planning.
The debate left Robert curious. He realized how little he knew about family planning, so he followed Peter out and engaged in a one-on-one discussion on the various options available to him and his wife. Peter explained the benefits of family planning and referred him to a nearby health facility where he could receive accurate information about the health benefits of family planning, high-quality counseling and a full range of methods. Armed with this information, Robert approached his wife about taking up a contraceptive method. The couple chose an IUD.
“I realized that in order for us to comfortably provide for our children we needed to be on contraception,” Robert says.
In the last four years, Tupange has been working in poor urban areas of Nairobi, Kisumu and Mombasa to make family planning a social norm and increase access of quality services to women and families. The initiative, led by Jhpiego and in partnership with the Ministry of Health, includes a variety of local civic and community organizations as well. Since 2010, this innovative program has increased contraceptive uptake from 45 percent to 54 percent, thereby averting close to 75,000 unintended pregnancies. Tupange’s goal is to ensure that every person of reproductive age understands their family planning choices, knows where to access family planning services, and feels empowered and confident to seek out and utilize high-quality services.
Informational campaigns and family planning programs in Kenya have traditionally been directed toward women. Yet, lack of male involvement has greatly hindered the uptake of family planning methods (in addition to a lack of access to modern methods and sharing of myths and misconceptions about their use). Recent studies have shown that when men, who are key household decision-makers, are involved in family planning, uptake of contraception improves.
In response to this finding, Tupange helped form three family planning male champion groups in Nairobi. The groups, which consist of 30 men each, work onimproving spousal communication on issues of sexuality, reproductive health and family planning. Through community forums and meetings, community dialogue days and informal opportunities like the People’s Parliament, over 600 men have been reached with messages on family planning. As a result of these outreach activities, 12 men have taken the lead and undergone a vasectomy and now act as strong advocates of the procedure.
The impact of the program in the Dandora area, where Robert works, shows a 29 percent increase in the average number of family planning clients visiting Tupange-supported clinics.
Catherine Mboche, the District Public Health Nurse for Njiru Sub-County, is convinced that male involvement in health issues contributes greatly to health-seeking behavior. Mboche says that in the past, women seeking family planning would come to the clinic without their husbands’ knowledge. “It’s a different story now since Tupange came,” Mboche says. “Lately we are seeing more men accompanying their wives when they come in for family planning—which is very encouraging.”
The unmet need for contraceptive use in Nairobi has declined from 15.9 percent in 2010, before Tupange began, to 11.4 percent in 2012, according to program data. Among the urban poor, the results are more significant: unmet need dropped from 20.6 percent in 2010 to 6.9 percent in 2012.
In discussing family planning with his wife, Robert learned that she occasionally used pills despite his resistance to them. “It came as a complete shock to me,” Robert says, “I had always told her that the natural method was the best; I never imagined she could be using those things [contraceptives].”
His experience underscores the difficulty many women face in talking with spouses and partners about their desire to plan their families in a safe and healthy manner. But now, through the education and support efforts of Tupange, Robert and his wife are together deciding what’s best for their family. Robert routinely accompanies his wife to health facilities. “It is my duty to ensure that my family is healthy, so I take them for medical check-ups,” he says confidently.