Category Archives: Reproductive Health

Reproductive health, sex education, family planning birth spacing, contraception, HIV, STD, uterine or cervical cancer, fistula, birthing, post natal care, prenatal care, breech birth, fertility, lactation, IUD, implant, injection eclampsia


Contraception: Is it cultural barriers or is it lack of supplies?

It is so often claimed that shortage of supplies is not the real reason for low contraception usage, but here is a case where the shortage is indeed the problem. In 2015, lack of information about family planning may have been the reason, but we have solved that problem with family planning training of a few women and the development of a family planning video in the Maasai language. Consequently, in August, when Marie Stopes showed up with their mobile clinic at a nearby health clinic in the small town of Nainokanoka, 28 women walked 4 miles to get family planning implants.

Now, when more women are showing interest, Marie Stopes has cancelled their mobile clinic, at least until next year. This means that the women who wanted to get a method can’t get one, and that women who were having undesirable side effects from the hormones in the implant can’t easily get it removed and can’t get a new method. It has been shown that women who reject a method that does not work for them are at a large risk of rejecting modern contraception altogether.

We had been hoping that the doctor at the small, woefully inadequate, government health clinic at Nainokanoka could be talked into providing family planning services there. Finally our Maasai team members have become acquainted with the facility and the staff and have convinced the doctor to provide family planning services. This doctor even suggested a mobile clinic to make monthly rounds to serve all the people in the area.

But, gosh, I had really underestimated the sad state of affairs at a government-funded clinic.

This like peeling an onion.

So now I am looking for an NGO who can supply the clinic with the needed contraceptive methods. And then there is all the other equipment needed.

Below is his letter, listing all that is needed.
Dear Karen,
Thank you for your response.
I have impressed on what you have started on Family Planning issues.
I thought that,your plan would be sustainable if we can equip Nainokanoka HC (health clinic) with enough instruments and supplies to facilitate services for the entire population and the nearby.
At our Centre we are providing the following methods of Family Planning:
1.Short term methods-Pills; Combined Oral pills and Progesterone only pills, Male and Female Condom, Calender method.
2.Long term FP methods -Implanon 3 years and Jadedly 5 years.
Permanent FP methods – Bilateral Tubal Ligation(BTL) and Vasectomy meanwhile not practicable as we do not have theatre,.
There are 3 Health Care Workers who trained to provide these services.
It is therefore, they are able to put and remove implants without dought.
Giving them a refresher course will be an advantage.
The following items will facilitate to run Family Planing services at our Centre:
=A supply of Oral Pills and Implants, Lignocane, Surgical blades, Surgical gloves, Iodine solution, Syringes 5cc and 2cc,Cotton wool, Gauze and Antiseptics.
=Instruments needed -Cheatle forceps, Artery forceps, Dissecting forceps, Speculum(cusco), Kidney dishes 5, Gall pots 5 ,Sphygmomanometer (Blood pressure machine), Sterilizer,Examination bed, Examination light and Weighing  scale Adult.
Diesel engine Generator is needed for sterilization of Instruments.
=Mobile outreach clinics to the community will increase the number of Clients but not Family Planning alone in separate, other services like Vaccination to Children, Health education, Antenatal services will be rendered if fuel and Allowance for driver and 4 Staff will be available. 

Family Planning is Happening for Emburbul Women

Marie Stopes came to Naniokanoka in August and 13 women from Emburbul and 10 women from nearby villages walked to town to get family planning.

They all got hormonal implants.

Samwel had talked to other village leaders – those who were not against family planning – and that is how the 10 women from the other villages went for family planning.

This is wonderful news!

Questioning FGC

I am reading a book called However Long the Night. It is about the practice of FGC – Female Genital Cutting.

The first thing I learned from the book is to not call it FGM – Female Genital Mutilation because under this name, it is a “heinous act of cruelty born from gender inequality that girls are forced to endure.” … “But the issue is far more complex than this”, the book continues, “and to consider it from the point of view of the millions of women in twenty-eight nations where the custom is practiced is to understand a far different reality. The truth is, women who adhere to the tradition do not view it as an act of cruelty, but rather as a necessary act of love. Cutting one’s own daughter is critical to her future, ensuring that she will be a respected member of her community and preparing her to find a good husband in cultures where marriage is essential for a girl’s economic security and social acceptance. To not cut one’s own daughter would be unthinkable — setting her up for a lifetime of rejection and social isolation.”

The book is about Molly Melchin, an American student who came to Senegal in 1974 as an exchange student. She eventually formed the NGO Tostan in 1984.

Tostan is a new type of educational program, one that engages communities in the process by working in their own language and using traditional methods of learning, such as dialogue, theater, dance.

The book starts in 1996, in a village where a Tostan facilitator was working with a group of 35 women who were in class three days a week for a three year course. The facilitator, in a departure from her normal topics, starts a conversation about FGC and is met with silence.

“What I’m about to read is a statement from the World Health Organization,” she said. “Female Genital Mutilation is an act of violence toward the young girl that will affect her life as an adult.” … “Would anybody like to share their thoughts about this?”

“We all know that mothers practice this tradition out of love for their daughters, so that they will be respected and accepted members of their society. Why do you think the World Health Organization would make such a statement?”

The women were silent and the facilitator ended the session for the day.

Two days latter, the women returned to class.  “We’ve prepared a theater on the topic,” the facilitator said, asking for volunteers to come to the center of the circle. “It’s based on a story about a girl named Poolel. Who would like to take part?”

The women came alive in their roles. As the story went, the day came for Poolel to undergo the tradition. She was taken to the cutter for her procedure, but afterward something terrible happened. Poolel began to bleed profusely, greatly worrying her mother. When the bleeding worsened, her mother took her to the village health agent. Her efforts to stop the bleeding failed, and it was obvious to her mother that Poolel was in great pain. She was eventually taken to the regional hospital, where the doctors tried to save her life. But it was too late. Poolel died the next day.

At the end of the theater, the facilitator asked. “What consequences befall a girl who is not cut?” She was met with silence. For a long time no one spoke.

Then “Takko the village midwife and a mother of three, hesitantly raised her hand. ‘I know this is an uncomfortable topic for many of us here,’ she began, ‘but all last night I thought very seriously about this. We never talk about the tradition, but maybe it’s time.’”

“Takko went on to describe the problems in childbirth she’d witnessed in her work as a midwife, and how difficult it was for the doctor to sew up scar tissue, therefore requiring more time for a woman to heal. She had long suspected that women who could not have children may have suffered infections following the cutting, causing their infertility. In Senegal, the majority ethnic group—the Wolof—do not practice the tradition, and during her training as a midwife, Takko had assisted in the births of some of these women. She had noticed they were more elastic and therefore had much easier and less painful deliveries. ‘What Ndey (the facilitator) is telling us is true. This is not a healthy practice.”

After awhile her friend Aminata  spoke. “As you know, I’m a Toucouleur,” Aminata said, referring to the predominant ethnic group from the north of Senegal, “and according to my customs I was cut as an infant and sealed shut afterward.” The women knew this was sometimes the type of cutting practiced. After a girl was cut, her legs would be tied together until the wound closed. Aminata’s mother had arranged for her to be married at fifteen.

“On the night before my wedding, my mother explained I would have to be cut open the next morning in order to consummate the marriage. I panicked and tried to refuse all of it,” Aminata said. “Marriage to the man chosen for me, being cut open. But I had no choice. The procedure to open me was agonizing.” Afterward, still in pain, she fled her village. “I’d been told that if I wasn’t penetrated that night,” she timidly told the class, “my wound would again close, but I didn’t care. The pain was so severe I couldn’t imagine having intimate relations with my new husband.” She remained in hiding for a few days until the pain subsided. That man eventually divorced her, and she was married a few years later to another. She ended up having several children, but each time she had great difficulty in childbirth. “My body was so damaged, I could hardly be put back together again,” she told the others. When Aminata finished, another woman stood to speak. And after her, another.

One by one, they cautiously shared their experiences of the tradition.

One woman could not tell her story, it was so painful. Her own daughter almost bleed to death, like Poolel in the story. Eventually she became a champion for ending FGC and said she would not let her second daughter be cut. Then the other women in the class joined in and decided that their daughters would not be cut. Eventually they found allies with other women and ended the practice altogether in their community.