Women’s & Girls Health, Reproductive Choice

Patriarchal Traditions

Girls and women are married off in exchange for cows. In such a patriarchal arrangement as this, they seldom have a choice about going to school and how many children they are going to have.

Underage Marriages

Girls who marry under the age of 18 have more problems with pregnancy and childbirth because their bodies are not mature enough. Some of them die and others suffer fistulas. An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged contractions that push the baby’s head against the mother’s pelvic bone.

 

Nine Emburbul women attending FAME training on reproductive health and nutrition

Nine Emburbul women attending FAME training in Karatu (70km away) on reproductive health/ birth spacing and nutrition. Grace (with the hoodie), Mapena and Samwel (in front) are the Emburbul home team.

Birth Spacing

Men may come to support birth spacing when they understand the health benefits.

A spacing of two or three years is suggested between pregnancies.

A pregnancy within 12 months of giving birth is associated with an increased risk of:

  • The placenta partially or completely peeling away from the inner wall of the uterus before delivery (placental abruption)
  • A pregnancy within 18 months of giving birth is associated with an increased risk of:
    • Low birth weight
    • Preterm birth
    • Infant death
    • A large-scale African study shows that babies born less than two years before a “preceding sibling are twice as likely to die as those born after an interval of 2 years
  •  Pregnancy and breast-feeding can deplete a woman’s stores of essential nutrients, such as iron and folate. If she become pregnant before replacing those stores, it could affect her health or her baby’s health. Inflammation of the genital tract that develops during pregnancy and doesn’t completely heal before the next pregnancy could also play a role.
  • In some cases of short birth spacings, the older sibling died after the mother turned her breast to the newborn sibling.

Three ‘natural’ forms of family planning can be used to help space births:

  • Breast feeding. Breast feeding is one of the best things a woman can do to maintain the health of her child. Breast feeding also, in many cases, delays a woman’s fertility. This is a natural human defense against draining the mother’s reserves beyond what she needs to sustain her children.
  • Abstinence during ‘fertile’ periods (use of ‘fertility’ or ‘cycle’ beads to determine times of fertility and infertility).
  • Withdrawal (pulling out). Contrary to popular belief, this method can actually work pretty well if used correctly and consistently. This method can be used during fertile times (see above), but is not very effective.
  • It is the author’s opinion that men will support these three methods of family planning if they decide to become more responsible about their wife’s and baby’s health and future.
  • These three methods are much less effective than modern methods of family planning, but they are better than nothing.
  • One barrier method that can be used by men: condom. Not as effective but still better than nothing.

Holdups:

  • Masai babies in Emburbul are weaned at the early age of 3 months. We think this is due to malnutrition or short birth spacing but we are not sure.
  • Masai women are known to starve themselves during pregnancy to have an easier birth.
  • Masai women likely have been cut, which can have unhealthy consequences during childbirth.

Family Planning

A growing body of research and scenario-building points to the critical role of family planning as one of the most cost-effective, high-yield interventions to improve mothers’ and children’s health and survival.

The modern methods of family planning all require a visit to a health professional for at least the first time the method is given.

The IUD – Inserted in the uterus. It can be inserted by a health care worker and then left in until the mother wants to get pregnant. Then she needs a health care worker to remove it. Lasts 10 years. Both copper and hormonal IUDs are convenient, safe, and effective—and both kinds of IUD can be inserted at any time and, optimally, immediately after delivery. When an IUD is placed immediately after delivery, the risk of expulsion may be slightly higher than if the woman waits several weeks, but the convenience of not having to schedule a time to go back to a health care provider may be worth it.

The Implant — It is inserted in the arm and lasts for 3 years. It is very easy and completely safe to get the birth control implant immediately after delivery. The implant can be inserted any time prior to discharge from the hospital.

The shot — The shot lasts 12 weeks. It can be done at any time, and optimally, following childbirth. In most hospitals it’s easy to get the shot prior to discharge, so it can be a great option for temporary or longer-term postpartum birth control. The effects of the birth control shot last for 12 weeks.

Sterilization — For those who are done having children, it is a permanent procedure that cannot be reversed. Surgical sterilization can be performed at anytime, but optimally  immediately after delivery. Sterilization procedures are usually performed at the time of cesarean birth or within the first two days of vaginal delivery.

The pill — must be taken every day and must be replenished every month.

 

Family Planning  – the wrong approach

No woman should be pressured or shamed into using family planning. Women must make their own decision to use it or not use it. Women are very capable of making the right decision for themselves and their own family. Each woman should make the decisions concerning her own body, her life, and her children.

 

Benefits of Family Planning

1. Birth spacing.

Infants who are spaced too close together may be premature, have low birth weights, fail to thrive, and may compete with each other for the mother’s milk. Mothers body does not fully recover between births. Three years between births are recommended for the health of mothers and babies.

2. Delaying child bearing for girls.

Until a girl’s body matures, her birth canal will be too small to deliver a baby; she may suffer damage to her insides, including fistula and incontinence, even death. The baby may die in the birthing process. Girls who are able to delay child bearing will be able to go to school longer and perhaps get a job like Grace has, or be successful in a small business. Girls under age 16 are far more likely to die in childbirth than older women.

3. Prevents pregnancy when a pregnancy or childbirth is dangerous for the mother.

4. Can limit the family size if there are not enough resources to feed everyone, or if the mother is tired from childbirth.

5. Contraception has less harmful side effects than pregnancy and child birth.

 

Barriers to Family Planning

  • Supplies are too far away.

– We should try to get family planning methods at the Nainokonoka clinic
– Advise women that they can get family planning when they go to Karatu for giving birth or for the health of their child.

  • Girls are expected to have babies when their bodies are too young.

– We should try to educate more girls

  • Men see many babies as a sign of wealth

– We should educate men on the value of healthy mothers and infants by birth spacing. And men should responsible about spacing babies and saving their wives from the risks of having too many babies.

School

Girls who go to school tend to have fewer children than girls who don’t.

We are looking into sending some girls to school.

If we can get a female school teacher, girls will be inspired to stay in school.

If we can send young girls to school before they are marriage age, they will have 2-3 fewer children (at least) on average, because they will delay their childbearing until a time when they choose to have children. Girls who get married at age 12 tend to have 2-3 children before they reach age 18 – if they and all their babies survive. Delaying marriage is the fastest way to lower population growth.

What We Are Doing:

  • Sending girls to school
  • Sponsoring family planning/ health trainings at FAME hospital/health clinic
  • Trying to make family planning available in nearby Nainokonka
  • Strategizing on involving men and helping them to take responsibility
  •  Trying to help women to join a ladies bead coop so that women have a reason to be out and about in Nainokanoka as well as make some income (perhaps to pay for health services).
  • Incorporating into the Masai Harmonial (Emburbul) organization constitution: health, women’s rights, and approaches to starting a conversation about cutting. Also youth groups and opening the door to conversations about sexual health for young people.