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50 years on, the birth control pill has achieved a lot but the fears still linger

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Originally Published: May 30, 2010

Fifty years ago, at the peak of Kenya’s struggle for independence, Kenyan women and girls were perhaps clamouring silently for freedom of another kind.

With birth control a taboo subject in most homes and a high fertility rate, large families kept women out of formal employment, made them dependent on men for everything and put their health at risk.

And girls experimenting with sex at adolescence often found themselves helplessly exposed to unwanted pregnancies, dropped out of school, got forced into early marriages or became social outlaws.

But the accidental discovery of the birth control pill in far-off America in 1960 by a Catholic nurse would help to accelerate the pace of liberation for the Kenyan woman in a manner before then unimaginable.

The Pill, as the tiny tablet is popularly known, is credited with revolutionising sex, love, relationships and the way millions of women around the world conduct their affairs. So small. So powerful. So misunderstood.

In Kenya, where it became central to family planning efforts in the 1970s and 1980s, the dramatic decline in fertility rates from eight children per woman in 1960 to the current 4.6 children per woman is partly attributed to the increasing use of the pill and other methods of contraception.

“It has touched on every aspect of not only the woman’s life, but the whole homestead as well,” says Dr Pauline Giorgio, a pharmacy owner in Nairobi.

Carries stigma

Although it has radically altered the lives of women, it is apparent that its usage still carries some stigma. Dr Giorgio, 53, says she cannot buy the pills from her own chemist due to lack of privacy.

“I would not want my staff to see me pick the pills from my own pharmacy. I prefer going to another chemist to buy them,” she says.

Ever since its discovery, it has courted controversy throughout its five-decade journey. It was the first medicine ever designed to be taken regularly by people who were not sick.

Its main inventor was a conservative Catholic who was looking for a treatment for infertility and accidentally stumbled upon a combination of chemicals that would prevent these “accidents” in 1960.

When the pill finally knocked on Kenyan doors, in the early 1970s and 1980s, it was met with unified opposition from across the religious spectrum.

Protestant, Catholic as well as indigenous African religious opinion shapers united against it.

At that time many regarded sex, even within marriage, as immoral unless it was for the sole purpose of procreation. Fear of pregnancy was a powerful check on promiscuity — and information about contraception was treated as pornography.

“They (church) have always been against contraception. From the outset, they say it is ungodly to plan your family. That only God can decide to give you children. In fact, were it not for the ravage caused by Aids, condoms may still be looked upon as a sin,” says Oliver Waindi, the executive director of Family Health Options Kenya.

In 1962, at the height of calls for a general liberalisation of church teaching, Pope John XXIII convened the Second Vatican Council. Many leaders and clergy anticipated a relaxation of restraints on family planning. But the teaching against contraception stayed in place.

Hundreds of American theologians issued a statement that this was not an infallible teaching and that Catholics could in good conscience dissent.

According to a recent edition of Time magazine, leaked reports of the commission’s findings suggested that nearly all its theologians and a majority of the cardinals favoured changing the church’s teaching on the immorality of contraception. But the following year, Pope Paul VI issued his encyclical Humanae Vitae, in which he sided with the minority.

Humanae Vitae is a letter that re-affirms the traditional teaching of the Catholic church regarding abortion, contraception, and other issues pertaining to human life. The letter prohibited all forms of artificial contraception.

If religion posed a challenge to the acceptance and eventual penetration of the pill as contraception, then tradition was the cryptic puzzle that family planning providers had to solve if they were to claim relevance in uncharted ground.

“How could you tell an African man not to sire children? In his mind, sex was primarily for procreation and also as a sign of fertility. This was their second most important function in the home after protecting their families,” says Ndiritu Njoka of Maendeleo ya Wanaume.

Naturally, the heads of the homesteads were opposed to having fewer children. Bigger families meant prestige.

Data from the Kenya Demographic and Health Survey of 1989 indicate that the average number of children a woman of child-bearing age had in 1984 was 7.7, the highest birthrate on the continent at the time.

“Back then, contraceptive usage was almost equated to murder. Tales were told of wives who were returned to their ancestral homes at the slightest suspicion of having popped a pill or having subscribed to any other form of family planning,” says Dr Louis Machogu of Family Health Options Kenya.
But women still had their way.

“They flocked to government clinics on market days and got their pills or any other form of contraception without the knowledge of their husbands,” says Dr Machogu.

Something had to give if contraception was to become acceptable and make the impact that government planners hoped it would. Reason alone could not appeal to the masses.

The campaigns needed a voice and a face.

“Former President Moi was one of the first prominent people to add voice to family planning. After he gave contraceptive use the green light, acceptance in society gained some ground,” says Walter Odhiambo of Marie Stopes.

The former president, who has eight children, became a vocal supporter of family planning.

The effect of contraceptive use was felt in the early 1990s. The Kenya Demographic Health Survey of 1989 indicated a drop in fertility rates from 7.7 in 1983 to 6.7 in 1989. And all trends at that time pointed to the rates going lower.

But sceptics were not fully convinced of the marvels of the pill and its fore-runners like the coil, the intra-uterine devices and injections. Lack of information among the public could only serve to fuel the rumour mill.

“Every woman had her own method of preventing pregnancy. The thought of a chemical substance in their systems made many women uncomfortable,” says Dr Giorgio. Dr Giorgio uses the safe days method and resorts to the pill only when she suspects failure in her system.

Other traditional methods included prolonged breastfeeding, withdrawal method and abstinence.

Ancient Egyptians are said to have made a paste out of crocodile dung and formed it into a vaginal insert.

The condom is often credited to one Dr Condom, who was said to have invented a sheath made out of sheep intestines for England’s King Charles II to help limit the number of bastards he sired in the mid 1700s.

From suspicions of causing cancer to milder side effects such as hot flushes, all one needed was pick a side effect and use it as an excuse to abandon “modern” methods of pregnancy prevention.

In these claims, experts say, lie truths, half-truths and untruths.

Contraceptives have a direct relationship with one of the biggest fears of its users – cancer. Some may accelerate it while others may slow down its progress.

“Growth of cancerous cells is accelerated by the presence of high amounts of oestrogen. At first, most contraceptives had high amounts of oestrogen. Thus, women already predisposed to the disease were at greater risk,” says gynaecologist Eric Sagwa.

But he says evolution in the medical world has resulted in the creation of “smarter” contraceptives with little amounts of oestrogen and more amounts of progestin.

“The cancerous cells cannot thrive as well in an environment with little oestrogen. So the cells grow at normal speeds. Such contraceptives are not considered as trigger factors to abnormal growth of body cells,” Dr Sagwa says.

Other side effects such as weight gain, or flushes depend on the individual using the contraception.

“These are chemical substances aimed at mimicking the body hormones. Since each woman has a different hormonal balance the methods react in various ways. That is why it is advisable to seek professional help when deciding your preferred contraceptive method,” says Mr Odhiambo.

But on the business side, it has become a hot sell.

“It is selling more than ever. We have marked a more than 100 per cent increase in sales since our last consignment,” says Dr Giorgio.

In the late 1980s, family planning initiatives received more than Sh80 billion in donor aid. By 2000, the amount of money coming in had reduced by more than 60 per cent to less than Sh32 billion.

“Aids happened and many donors diverted funding to HIV/Aids-related programmes. A cut meant stockouts at government facilities fuelling a black market for fakes and quacks,” says Mr Odhiambo.

It was then thought that a tangible solution to this would be to increase government funding in the Department of Reproductive Health and make some contraceptives, such as the emergency pill an over-the-counter drug.

Stockouts persisted as government funding fell short of the intended projections and the problem of fakes continued to fester. But yet another problem arose from these stop-gap measures.

“The ease of accessing the emergency pill led to a rise in its abuse. Some women used it not in emergency situations, but as their choice contraceptive resulting in health complications,” says Dr Machogu.

Bit by bit, the gains in family planning that had been made over the last 15 years dating from 1990 slowly began reversing.

In 1984, a survey found that just 18 per cent of married women used some form of contraception. The Kenya Demographic and Health Survey 2008 indicates contraceptive use among married women stands at 46 per cent.

Half a century after its discovery, the pill cannot be said to have been radically successful in its aim of curbing population growth.

Sharing a birthday with your child may be considered special by many parents. But for Rose Naliaka, the coinciding dates of her 28th birthday and her fifth born’s 3rd birthday is a reminder of a failed family planning programme.

Naliaka grew up in rural Bungoma.

“Not once did I ever hear of the pill. The only sure family planning method I knew of was abstaining from sex,” she says.

Older women from her village are now telling her to watch the size of her family.

“They say one day my husband may run away and leave me with all these children. I once told him of a visit to the dispensary. He left and came back after two days,” she says.

As a result, Naliaka has fallen back to her old method of abstinence on the days she feels “unsafe”.

There cannot be a definitive answer on whether the pill as a precursor to other contraceptives has failed or succeeded.

The only certainty is that women and men, for centuries to come, will still be talking about the exploits of Margaret Sanger, the devout Catholic nurse who stumbled upon a hormonal combination that helped women avoid unplanned and unwelcome pregnancies.

“We have a whole generation of women who grew up while the pill was making inroads in the country. Many of them still have five or more kids. It still has a long way to go,” says Monica Wanjiru of Population Council of Kenya.

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