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Kenya

Articles by Kenya

Roe v Wade
24 June 2023

One year post-Roe, Africa finds itself at a critical juncture for reproductive rights

On 24 June 2022, the US Supreme Court overturned Roe V Wade in a landmark ruling that removed the constitutional right to abortion. The repeal means the US joins just three other countries - Poland, Nicaragua and El Salvador - that have removed legal grounds for abortion since 1994. In contrast, 61 other countries have liberalized abortion laws - some of which came in direct response to the repeal of Roe v Wade. While we grapple with providing safe abortion care in these uncertain times, we are reminded that countries like the US, which have historically set the global abortion agenda, are no longer the right or the only leaders. In Africa, we find ourselves at a critical juncture. Amidst these challenges, there have been significant triumphs that inspire hope for a future where reproductive justice is upheld. For example, one month after the US ruling last year, Sierra Leone approved a draft law to decriminalize abortion, in a monumental step towards the repeal of its colonial-era laws. Benin has also enacted one of the most progressive abortion laws in Africa, demonstrating the potential for change even in the face of adversity. In Kenya, the High Court ruled that safe abortion is a fundamental right, and that arbitrary arrests and prosecution for seeking or offering such services are completely illegal.

safe engage foundation
06 February 2023

"I was determined to protect my sisters" - Fighting FGM in Kenya

We had the pleasure of interviewing Christine Alfons, founder and Executive Director of the Safe Engage Foundation, a youth-led organization in Kuria, Kenya, working to end female genital mutilation (FGM) and all forms of gender-based violence through mentorship and empowerment. What prompted you to start the Safe Engage Foundation? I grew up in a community where the practise of cutting was really valued, but my father was actually able to learn quite early on that FGM doesn't have any benefit for girls. And so he protected me and my sisters against the cut. His refusal to allow this practice was seen as a very big taboo, and we believe that it is what led to him being killed. He died for us, and so we do what we can to make our father proud, wherever he is.  After my dad’s death, I was really determined to protect my sisters and others, and it was at that moment I realized that I can help by volunteering. So when I graduated from high school, I started volunteering with local organizations and NGOs. I did this with a group of other people, and in 2016 we decided that we're going to start our own organization. So then that is when the Safe Engage Foundation was born. My main motive is to empower and educate girls on the need to abandon FGM, and to teach them why they should embrace their sisters, both those who are cut and those who are not. What does the Safe Engage Foundation do?  We run youth mentorship programmes, and we have programmes in schools that run weekly and monthly, called the Hold My Hand Initiative and EnlightenUs, respectively. We target both boys and girls to teach them life skill sessions, as well as running SRHR [sexual and reproductive health and rights] sessions.  We teach the youth about their bodily autonomy, and about how young girls can protect themselves against FGM and child marriage, and how to report it if it is happening or might happen to them. We also teach why brothers need to protect their sisters against these things. I have come to realize that there are very many young people who can actually act as role models, to other young girls and boys, to be able to grow in a community where they know that they can protect each other and stand up for each other. We also engage parents at meetings in schools, particularly those who still think FGM is the way to go. We teach them positive parenting issues – why women's and girls rights are human rights and why they need to be upheld, and that FGM is actually a violation of those rights. We work with them until we can see like their attitudes are changing. These issues are also related to economic empowerment. We found that women who are not economically empowered (i.e. don’t have an income) cannot make informed decisions about their own body or households. Many girls drop out of school at 15 to get married, or because of the stigma of not being cut, so they don’t have any employable skills into their 20s or 30s or older. So we train them to use their hands to make some items that they can sell, and also use the income that they have generated to reinvest again and keep making money that way. This income also helps them keep their own children in school, so they can in-turn evade child marriage.  Since we founded the programme, it has been entirely volunteer-run.

Woman with newborn baby receives contraceptive implant form healthcare providers in Kenya.
21 November 2022

Kenya: In the grip of drought, sexual and reproductive health needs soar

The drought situation in Kenya is worsening every day, with an estimated 4.35 million Kenyans currently in need of food aid, according to the National Drought Management Authority (NDMA). The population in the affected areas, some of whom are living in refugee camps, is facing a significant deterioration of already elevated levels of acute food insecurity, which has put lives and livelihoods at risk. The NDMA believes there are at least 134,000 pregnant or lactating women acutely malnourished and in need of treatment.  Sixteen-year-old Maria is among them. Seven months pregnant and living in the camps, Maria had been feeling unwell. She attended the medical camp where news reached her that there was medicine being given out by Reproductive Health Network Kenya, an IPPF Member Association. She had never attended any antenatal clinic before.  “I never knew that a baby can be checked while in the mother’s stomach. The nurse said she could even hear the baby breathing,” she said, smiling. “I am happy if the baby is okay. And I have got some medicine for myself as well.”

Fahe Kerubo

Pride 2022: Fahe Kerubo in the spotlight

Fahe Kerubo is a 29-year-old Youth Health Advocate & LGBTQIA+ activist, who is currently serving as the Youth Committee Chairperson for Reproductive Health Network Kenya. We interviewed them for Pride Month 2022: How do you celebrate Pride Month and what does it mean to you? Pride Month is a time for me to reflect deeper on what it means to be queer, what it means to be masculine presenting, and what it means to live an authentic life, especially in this era. It is a time for celebration, to re-evaluate, and to remember the lives we have lost and the battles we have to go through for being authentically “us”. What was it like for you growing up in Kenya as part of the LGBTQIA+ community? Growing up in Kenya as a queer, non-binary, masculine-presenting person was a constant battle with the world, for them to see me beyond my sexual orientation and my gender identity. I am misgendered every day and it is expected of me to suck it up, deal with my feelings, and be okay with that.  Here, privilege dictates your sense of dignity, autonomy, and power to decide for yourself. For a queer person from the slums of Kenya – me being one of them – privilege is not something afforded to them. I grew up constantly listening and heeding to voices telling me what to do, how to dress, how and when to speak. So many voices saying “do this and that” – so many voices but my own.  Thanks to education and the humanitarian spaces, I am getting to learn that I can decide for myself whether to be in a relationship or not and with whom. Learning that nobody can decide for me but myself is the greatest gift life has given me, and that alone has given me power to rise above stigma, and most importantly, use my voice in advocating for the prioritization of queer SRHR.   Why is it important to include LGBTQIA+ issues in sexual and reproductive health and rights (SRHR)? The prioritization of queer SRHR issues is very important because the LGBTQIA+ community is not openly spoken about, especially in mainstream discourses, while on the ground these are lives that are constantly at risk and very vulnerable.  The criminalization of our community itself has put us at a risk of acquiring STIs and HIV. Rates of unsafe abortions are also high in the community, and victims of violence are underreported. This is a community with needs that must be addressed. Within the workplace, what steps can be taken to promote a positive and healthy environment for colleagues who identify as LGBTQIA+? 1. Take LGBTQIA+ discrimination seriously – establish a strong anti-discrimination policy to be followed by all staff 2. Foster a gender-neutral environment – such as establishing unisex toilets and using gender-neutral language 3. Provide training, mentoring, and support programs to LGBTQIA+ staff 4. Support LGBTQIA+ events or be part of them 5. Create networks – LGBTQIA+ employee networks can be very powerful ways for colleagues to come together and share experiences  And finally, who or what is your LGBTQIA+ hero and why? Nena Na Binti Hotline offered the LGBTQIA+ community sexual and reproductive health services (including safe abortion care) during the COVID-19 pandemic, and continues to do so. They even offered services to members of the community who didn't have money to pay. I know what it means to want to terminate an unwanted pregnancy and not have money to pay for a safe service. A constant battle we deal with is the high cost of health services, which is one of the reasons we avoid seeking care.  All the queer people I referred to Nena Na Binti Hotline have been served and we live to tell a happy tale. How can they not be my hero this Pride Month? 

The Kenyan flag - black, red and green horizontal stripes with a shield in the middle

Kenyan High Court makes landmark ruling on safe abortion care

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

The Kenynan flag - black, red and green horizontal stripes with a shield in the middle

Kenyan High Court makes landmark ruling on safe abortion care

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

Edward Marienga, Executive Director of Family Health Options Kenya
19 May 2020

COVID-19 Impact: What we know so far – Kenya

An interview with Edward Marienga, Executive Director of Family Health Options Kenya (FHOK), on the impact of COVID-19. How has Kenya been affected by COVID-19? The government has enforced measures aimed at stopping the spread of COVID-19, which include a ban on social gatherings, curfews, restrictions on in-country travel, as well as encouraging people to work from home and reinforcing preventive measures. These measures have had adverse economic effects with companies forced to send their staff on unpaid leave or cutting pay. Consequently, many households have lost their source of livelihood.  Cases of gender-based violence are on the rise with many of the survivors trapped with their aggressors, and access to sexual and reproductive health (SRH) information and services is limited. The government ban on all public gatherings has negatively affected FHOK outreach interventions to marginalized and hard to reach populations in rural areas and urban informal settlements denying these populations the right to SRH information and services. The healthcare system has now shifted focus to COVID-19 response, a move that is likely to jeopardize access to SRH services which are not deemed a priority in the face of the COVID-19 crisis. Reproductive health commodity security is an issue of concern with disruption in global supply chain systems. The demand for uninterrupted supply of personal protective equipment (PPE) for health workers on the frontline to curb the spread of the virus has also remained a great challenge. Local companies have started manufacturing PPE following a presidential directive, however the cost is still a key barrier.  What services is FHOK still able to provide during this time? FHOK facilities are open for all walk-in clients in need of SRH information and services including (but not limited to) contraceptives, cervical cancer screening and treatment, maternal health, safe abortion services, gender-based violence, counseling, gynecological services, pediatric services, and sexually transmitted infection screening and treatment.  The organization has taken necessary precautions to reduce exposure to COVID-19 among staff by reducing working hours and number of personnel on duty at any given shift. Outreach activities to the communities and public hospitals have also been suspended while some clinics have been closed. Has FHOK had to adapt the way it delivers SRHR services? Yes, the following measures have been put in place: Extended prescriptions to limit the number of face-to-face consultations to only when necessary Providing rights-based long-term family planning methods and avoiding unnecessary removals before maturity  Use of tele-consulting during which clients are advised what actions to take to avoid unnecessary hospital visits Use of social media including Twitter, Facebook and WhatsApp to share information on guidelines shared by the Ministry of Health/WHO on how to prevent contracting the virus. Online comprehensive sexuality education (CSE) by trained CSE facilitators to young people, and referrals to designated accessible health facilities for SRH services. How are you working with partners during this time to ensure SRHR services are delivered? FHOK is working with relevant stakeholders to gear efforts towards curbing the pandemic. For instance, we're working with the Ministry of Health by following relevant protocols and guidelines like screening all patients at entry points before they enter the facilities, to curb virus spread while accessing SRHR services. The ministry has conducted sensitization and training to service providers on how to handle suspected COVID-19 cases who may present to our facilities. In addition, it has provided FHOK facilities in the respective counties with hotlines for reporting suspected cases and a directory of quarantine facilities in each county. FHOK is also working with local leaders to allow movements of medical emergency cases seeking health services during the curfew. What is FHOK doing to ensure that pregnant women who need services during this time are still able to access them? FHOK is encouraging all pregnant women to attend at least four clinic physical visits while observing the Ministry of Health guidelines on prevention of contracting coronavirus. FHOK clinics are still operating while observing all the safety guidelines. What concerns do you have about women and girls during this time? Do you have any specific information or services targeted at them? Women and girls are at high risk of unplanned pregnancies or exposure to sexual gender-based violence (SGBV) during this period. We encourage them to take long-term contraceptives to reduce the number of hospital visits. Through social media we provide information on how to report SGBV and how to seek SGBV support services. 

Client at FHOK
23 January 2019

The Global Gag Rule and its impact in Kenya

Single mother of five, Mary Mukuhi, is a businesswoman and family planning volunteer in one of Nairobi’s biggest slums, Kibera. Over the last two years she has seen first-hand the impact of the Global Gag Rule (GGR). Since GGR was re-introduced by this US administration on January 23rd 2017, Mary says she has seen a rise in sexually transmitted infections (STI’s), especially syphilis, as well as an increase in unsafe abortions. The GGR denies U.S. funding to organizations like Family Health Options Kenya (FHOK) if they use any money to provide abortion services, counselling or referrals. It means that critical funding is blocked for other sexual and reproductive services like contraception, maternal health, and HIV prevention and treatment.  Healthcare services reduced or forced to close Mary, who has been a volunteer for FHOK’s Family Care Medical Centre in Kibera since 2012, says that one of the consequences of GGR in Kenya was that it had hindered “getting commodities and supplies like condoms, IUDs” and that people had lost their jobs.  With a population at approximately 180,000, Kibera is East Africa’s largest slum, a bustling valley of tin roofs that cover small homes, schools and offices, with inefficient or non-existent sewage systems many people rely on getting access to sexual health services.  Before the Global Gag Rule Before GGR, FHOK was able to provide three or four outreach clinics a month in different parts of Kibera where they distributed supplies, did tests and conducted screenings etc. “Now we go once a month,” she said. It is not just the mobile outreach in Kibera that has been hit by the cuts; other services across the country have been reduced or closed. Before GGR was implemented FHOK reached about 76,000 people annually with its mobile outreach clinics, said Amos Simpano, FHOK’s Director of Clinical Services.  In rural areas, outreach clinics can be even more important because often no other health providers exist. In some places the mobile services offer general care, check-ups, cervical cancer screenings, HIV testing, family planning advice and contraception.  Amos said that when GGR hit, the outreach clinics stopped.  Emergency funding With the help of funding from IPPF’s GGR emergency grant, outreach services were able to start again but only at about half capacity. Today, Amos Simpano estimates about 35,000 people have access to healthcare through outreach programmes.  In total FHOK lost about USD $1.5 million for integrated health projects for the most marginalized communities to prevent and treat HIV. Two clinics closed. Another seven are at risk of closures and are currently operating with reduced services.  GGR has meant 20 staff redundancies and decreased access to consortium funding and partnerships Abdillahi Ali, the clinical officer at the Family Health Options Kenya office in Malindi, a big town in coastal Kilifi county, south east of Nairobi, says the impact of redundancies has been tough for everyone. Before the GGR, Abdillahi recalls, the clinic had a ‘big team’. Once the GGR hit, though, a nurse, a driver, a counsellor and the receptionist were all made redundant. Today everyone left fills in the gaps, “Now you have to work as a nurse and receptionist,” said Abdilllahi of the strain. “At the end of the day, the quality of service is compromised.” Still, the staff carry on, undeterred. Keeping young people engaged Another way that FHOK stayed involved in the community in Malindi was through the youth center which opened in 2013. The center is a place for young people to get information and access to contraception. FHOK spread the word about the center through a Facebook page, word of mouth and peer educators. However, with the GGR, FHOK lost funding for the small stipends they gave to the peer educators. It was a hard time, but now with the mitigation funding, things are getting a little better. Twenty-three-year-old Mahmoud Dzombo, still works as an FHOK peer educator and hosts events for young people. He told us that his last session attracted 30 people who want to learn and talk. “It’s very sensitive, but at the end of the day, we have to,” said Abdillahi of providing information on contraception, including emergency contraception.  “My role is to talk to young people,” Mahmoud explained. He adds that there is a big problem with teenage pregnancy in Kilifi. There’s a high rate of sex work in Maldini, according to Abdillahi, and one of the many reasons the FHOK clinic in town is so valuable is that it will offer family planning and HIV testing without judgment. Indeed, at times the women will bring in the men to get tested as well. He’s glad to be able to continue to provide these unique services even if they are stretched at the seams.  

Leaving no one behind
04 December 2018

Leaving no one behind: Universal health coverage and sexual and reproductive health and rights

Universal health coverage means ensuring every person has access to quality, affordable health services and plays a pivotal role in achieving global development targets. Healthy populations can better contribute socially and economically, while poor health is a major driver of poverty. Universal access to sexual and reproductive health care services is identified in the Sustainable Development Goals as an essential contributor to ensuring healthy lives and promoting well-being for all at all ages. IPPF, together with the London School of Hygiene and Tropical Medicine, undertook a literature review looking at progress to date in and challenges to achieving universal access to sexual and reproductive health and rights. The review, Leaving no one behind, is illustrated with case studies on Afghanistan, Cambodia, Kenya and Sudan. Supported by the Japan Trust Fund.

Teresia

“The split-second decision that saved me” – Teresia’s story

One day, while going about her daily activities in her community in Nakuru, Kenya, 26 year-old Teresia Wangui met a group of people providing medical services. They seemed to be focusing on women, and since she had a few minutes to spare, she made her way to the tent where they were working. This decision would save her life – literally. The Nakuru branch of Family Health Options Kenya (FHOK) was offering mobile cervical cancer screening services at the medical camp. FHOK is the IPPF Member Association in Kenya.  “When I approached the tent, I found out that they were offering free cervical cancer screening services, and I decided to get tested too because I felt that I needed to know my status,” said Teresia. It was a decision that paid off – Teresia was found to have precancerous lesions. To help allay the development of these lesions into cervical cancer, she was referred for cryotherapy treatment for precancerous cells on the cervix.  "I'm glad that I was able to be screened and receive treatment" “Had I not made that split-second decision to pop into the medical camp offered by FHOK, I probably would not be here sharing my story with you today. I'm glad that I was able to be screened and receive treatment. I would advise all ladies to go for cervical cancer screening, even if you are young and have not had children, since it affects everyone who is sexually active. "I would also like to tell my fellow women not to wait for services to be brought to their doorstep. Cervical cancer screening services are also offered in many clinics, so it is your responsibility to undertake regular checks. You are the one responsible for your own health,” said Teresia. FHOK implemented the Cervical Cancer Screening and Preventative Therapy (CCS&PT) initiative in different parts of the country through its static clinics and outreach service delivery points.

Roe v Wade
24 June 2023

One year post-Roe, Africa finds itself at a critical juncture for reproductive rights

On 24 June 2022, the US Supreme Court overturned Roe V Wade in a landmark ruling that removed the constitutional right to abortion. The repeal means the US joins just three other countries - Poland, Nicaragua and El Salvador - that have removed legal grounds for abortion since 1994. In contrast, 61 other countries have liberalized abortion laws - some of which came in direct response to the repeal of Roe v Wade. While we grapple with providing safe abortion care in these uncertain times, we are reminded that countries like the US, which have historically set the global abortion agenda, are no longer the right or the only leaders. In Africa, we find ourselves at a critical juncture. Amidst these challenges, there have been significant triumphs that inspire hope for a future where reproductive justice is upheld. For example, one month after the US ruling last year, Sierra Leone approved a draft law to decriminalize abortion, in a monumental step towards the repeal of its colonial-era laws. Benin has also enacted one of the most progressive abortion laws in Africa, demonstrating the potential for change even in the face of adversity. In Kenya, the High Court ruled that safe abortion is a fundamental right, and that arbitrary arrests and prosecution for seeking or offering such services are completely illegal.

safe engage foundation
06 February 2023

"I was determined to protect my sisters" - Fighting FGM in Kenya

We had the pleasure of interviewing Christine Alfons, founder and Executive Director of the Safe Engage Foundation, a youth-led organization in Kuria, Kenya, working to end female genital mutilation (FGM) and all forms of gender-based violence through mentorship and empowerment. What prompted you to start the Safe Engage Foundation? I grew up in a community where the practise of cutting was really valued, but my father was actually able to learn quite early on that FGM doesn't have any benefit for girls. And so he protected me and my sisters against the cut. His refusal to allow this practice was seen as a very big taboo, and we believe that it is what led to him being killed. He died for us, and so we do what we can to make our father proud, wherever he is.  After my dad’s death, I was really determined to protect my sisters and others, and it was at that moment I realized that I can help by volunteering. So when I graduated from high school, I started volunteering with local organizations and NGOs. I did this with a group of other people, and in 2016 we decided that we're going to start our own organization. So then that is when the Safe Engage Foundation was born. My main motive is to empower and educate girls on the need to abandon FGM, and to teach them why they should embrace their sisters, both those who are cut and those who are not. What does the Safe Engage Foundation do?  We run youth mentorship programmes, and we have programmes in schools that run weekly and monthly, called the Hold My Hand Initiative and EnlightenUs, respectively. We target both boys and girls to teach them life skill sessions, as well as running SRHR [sexual and reproductive health and rights] sessions.  We teach the youth about their bodily autonomy, and about how young girls can protect themselves against FGM and child marriage, and how to report it if it is happening or might happen to them. We also teach why brothers need to protect their sisters against these things. I have come to realize that there are very many young people who can actually act as role models, to other young girls and boys, to be able to grow in a community where they know that they can protect each other and stand up for each other. We also engage parents at meetings in schools, particularly those who still think FGM is the way to go. We teach them positive parenting issues – why women's and girls rights are human rights and why they need to be upheld, and that FGM is actually a violation of those rights. We work with them until we can see like their attitudes are changing. These issues are also related to economic empowerment. We found that women who are not economically empowered (i.e. don’t have an income) cannot make informed decisions about their own body or households. Many girls drop out of school at 15 to get married, or because of the stigma of not being cut, so they don’t have any employable skills into their 20s or 30s or older. So we train them to use their hands to make some items that they can sell, and also use the income that they have generated to reinvest again and keep making money that way. This income also helps them keep their own children in school, so they can in-turn evade child marriage.  Since we founded the programme, it has been entirely volunteer-run.

Woman with newborn baby receives contraceptive implant form healthcare providers in Kenya.
21 November 2022

Kenya: In the grip of drought, sexual and reproductive health needs soar

The drought situation in Kenya is worsening every day, with an estimated 4.35 million Kenyans currently in need of food aid, according to the National Drought Management Authority (NDMA). The population in the affected areas, some of whom are living in refugee camps, is facing a significant deterioration of already elevated levels of acute food insecurity, which has put lives and livelihoods at risk. The NDMA believes there are at least 134,000 pregnant or lactating women acutely malnourished and in need of treatment.  Sixteen-year-old Maria is among them. Seven months pregnant and living in the camps, Maria had been feeling unwell. She attended the medical camp where news reached her that there was medicine being given out by Reproductive Health Network Kenya, an IPPF Member Association. She had never attended any antenatal clinic before.  “I never knew that a baby can be checked while in the mother’s stomach. The nurse said she could even hear the baby breathing,” she said, smiling. “I am happy if the baby is okay. And I have got some medicine for myself as well.”

Fahe Kerubo

Pride 2022: Fahe Kerubo in the spotlight

Fahe Kerubo is a 29-year-old Youth Health Advocate & LGBTQIA+ activist, who is currently serving as the Youth Committee Chairperson for Reproductive Health Network Kenya. We interviewed them for Pride Month 2022: How do you celebrate Pride Month and what does it mean to you? Pride Month is a time for me to reflect deeper on what it means to be queer, what it means to be masculine presenting, and what it means to live an authentic life, especially in this era. It is a time for celebration, to re-evaluate, and to remember the lives we have lost and the battles we have to go through for being authentically “us”. What was it like for you growing up in Kenya as part of the LGBTQIA+ community? Growing up in Kenya as a queer, non-binary, masculine-presenting person was a constant battle with the world, for them to see me beyond my sexual orientation and my gender identity. I am misgendered every day and it is expected of me to suck it up, deal with my feelings, and be okay with that.  Here, privilege dictates your sense of dignity, autonomy, and power to decide for yourself. For a queer person from the slums of Kenya – me being one of them – privilege is not something afforded to them. I grew up constantly listening and heeding to voices telling me what to do, how to dress, how and when to speak. So many voices saying “do this and that” – so many voices but my own.  Thanks to education and the humanitarian spaces, I am getting to learn that I can decide for myself whether to be in a relationship or not and with whom. Learning that nobody can decide for me but myself is the greatest gift life has given me, and that alone has given me power to rise above stigma, and most importantly, use my voice in advocating for the prioritization of queer SRHR.   Why is it important to include LGBTQIA+ issues in sexual and reproductive health and rights (SRHR)? The prioritization of queer SRHR issues is very important because the LGBTQIA+ community is not openly spoken about, especially in mainstream discourses, while on the ground these are lives that are constantly at risk and very vulnerable.  The criminalization of our community itself has put us at a risk of acquiring STIs and HIV. Rates of unsafe abortions are also high in the community, and victims of violence are underreported. This is a community with needs that must be addressed. Within the workplace, what steps can be taken to promote a positive and healthy environment for colleagues who identify as LGBTQIA+? 1. Take LGBTQIA+ discrimination seriously – establish a strong anti-discrimination policy to be followed by all staff 2. Foster a gender-neutral environment – such as establishing unisex toilets and using gender-neutral language 3. Provide training, mentoring, and support programs to LGBTQIA+ staff 4. Support LGBTQIA+ events or be part of them 5. Create networks – LGBTQIA+ employee networks can be very powerful ways for colleagues to come together and share experiences  And finally, who or what is your LGBTQIA+ hero and why? Nena Na Binti Hotline offered the LGBTQIA+ community sexual and reproductive health services (including safe abortion care) during the COVID-19 pandemic, and continues to do so. They even offered services to members of the community who didn't have money to pay. I know what it means to want to terminate an unwanted pregnancy and not have money to pay for a safe service. A constant battle we deal with is the high cost of health services, which is one of the reasons we avoid seeking care.  All the queer people I referred to Nena Na Binti Hotline have been served and we live to tell a happy tale. How can they not be my hero this Pride Month? 

The Kenyan flag - black, red and green horizontal stripes with a shield in the middle

Kenyan High Court makes landmark ruling on safe abortion care

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

The Kenynan flag - black, red and green horizontal stripes with a shield in the middle

Kenyan High Court makes landmark ruling on safe abortion care

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

Edward Marienga, Executive Director of Family Health Options Kenya
19 May 2020

COVID-19 Impact: What we know so far – Kenya

An interview with Edward Marienga, Executive Director of Family Health Options Kenya (FHOK), on the impact of COVID-19. How has Kenya been affected by COVID-19? The government has enforced measures aimed at stopping the spread of COVID-19, which include a ban on social gatherings, curfews, restrictions on in-country travel, as well as encouraging people to work from home and reinforcing preventive measures. These measures have had adverse economic effects with companies forced to send their staff on unpaid leave or cutting pay. Consequently, many households have lost their source of livelihood.  Cases of gender-based violence are on the rise with many of the survivors trapped with their aggressors, and access to sexual and reproductive health (SRH) information and services is limited. The government ban on all public gatherings has negatively affected FHOK outreach interventions to marginalized and hard to reach populations in rural areas and urban informal settlements denying these populations the right to SRH information and services. The healthcare system has now shifted focus to COVID-19 response, a move that is likely to jeopardize access to SRH services which are not deemed a priority in the face of the COVID-19 crisis. Reproductive health commodity security is an issue of concern with disruption in global supply chain systems. The demand for uninterrupted supply of personal protective equipment (PPE) for health workers on the frontline to curb the spread of the virus has also remained a great challenge. Local companies have started manufacturing PPE following a presidential directive, however the cost is still a key barrier.  What services is FHOK still able to provide during this time? FHOK facilities are open for all walk-in clients in need of SRH information and services including (but not limited to) contraceptives, cervical cancer screening and treatment, maternal health, safe abortion services, gender-based violence, counseling, gynecological services, pediatric services, and sexually transmitted infection screening and treatment.  The organization has taken necessary precautions to reduce exposure to COVID-19 among staff by reducing working hours and number of personnel on duty at any given shift. Outreach activities to the communities and public hospitals have also been suspended while some clinics have been closed. Has FHOK had to adapt the way it delivers SRHR services? Yes, the following measures have been put in place: Extended prescriptions to limit the number of face-to-face consultations to only when necessary Providing rights-based long-term family planning methods and avoiding unnecessary removals before maturity  Use of tele-consulting during which clients are advised what actions to take to avoid unnecessary hospital visits Use of social media including Twitter, Facebook and WhatsApp to share information on guidelines shared by the Ministry of Health/WHO on how to prevent contracting the virus. Online comprehensive sexuality education (CSE) by trained CSE facilitators to young people, and referrals to designated accessible health facilities for SRH services. How are you working with partners during this time to ensure SRHR services are delivered? FHOK is working with relevant stakeholders to gear efforts towards curbing the pandemic. For instance, we're working with the Ministry of Health by following relevant protocols and guidelines like screening all patients at entry points before they enter the facilities, to curb virus spread while accessing SRHR services. The ministry has conducted sensitization and training to service providers on how to handle suspected COVID-19 cases who may present to our facilities. In addition, it has provided FHOK facilities in the respective counties with hotlines for reporting suspected cases and a directory of quarantine facilities in each county. FHOK is also working with local leaders to allow movements of medical emergency cases seeking health services during the curfew. What is FHOK doing to ensure that pregnant women who need services during this time are still able to access them? FHOK is encouraging all pregnant women to attend at least four clinic physical visits while observing the Ministry of Health guidelines on prevention of contracting coronavirus. FHOK clinics are still operating while observing all the safety guidelines. What concerns do you have about women and girls during this time? Do you have any specific information or services targeted at them? Women and girls are at high risk of unplanned pregnancies or exposure to sexual gender-based violence (SGBV) during this period. We encourage them to take long-term contraceptives to reduce the number of hospital visits. Through social media we provide information on how to report SGBV and how to seek SGBV support services. 

Client at FHOK
23 January 2019

The Global Gag Rule and its impact in Kenya

Single mother of five, Mary Mukuhi, is a businesswoman and family planning volunteer in one of Nairobi’s biggest slums, Kibera. Over the last two years she has seen first-hand the impact of the Global Gag Rule (GGR). Since GGR was re-introduced by this US administration on January 23rd 2017, Mary says she has seen a rise in sexually transmitted infections (STI’s), especially syphilis, as well as an increase in unsafe abortions. The GGR denies U.S. funding to organizations like Family Health Options Kenya (FHOK) if they use any money to provide abortion services, counselling or referrals. It means that critical funding is blocked for other sexual and reproductive services like contraception, maternal health, and HIV prevention and treatment.  Healthcare services reduced or forced to close Mary, who has been a volunteer for FHOK’s Family Care Medical Centre in Kibera since 2012, says that one of the consequences of GGR in Kenya was that it had hindered “getting commodities and supplies like condoms, IUDs” and that people had lost their jobs.  With a population at approximately 180,000, Kibera is East Africa’s largest slum, a bustling valley of tin roofs that cover small homes, schools and offices, with inefficient or non-existent sewage systems many people rely on getting access to sexual health services.  Before the Global Gag Rule Before GGR, FHOK was able to provide three or four outreach clinics a month in different parts of Kibera where they distributed supplies, did tests and conducted screenings etc. “Now we go once a month,” she said. It is not just the mobile outreach in Kibera that has been hit by the cuts; other services across the country have been reduced or closed. Before GGR was implemented FHOK reached about 76,000 people annually with its mobile outreach clinics, said Amos Simpano, FHOK’s Director of Clinical Services.  In rural areas, outreach clinics can be even more important because often no other health providers exist. In some places the mobile services offer general care, check-ups, cervical cancer screenings, HIV testing, family planning advice and contraception.  Amos said that when GGR hit, the outreach clinics stopped.  Emergency funding With the help of funding from IPPF’s GGR emergency grant, outreach services were able to start again but only at about half capacity. Today, Amos Simpano estimates about 35,000 people have access to healthcare through outreach programmes.  In total FHOK lost about USD $1.5 million for integrated health projects for the most marginalized communities to prevent and treat HIV. Two clinics closed. Another seven are at risk of closures and are currently operating with reduced services.  GGR has meant 20 staff redundancies and decreased access to consortium funding and partnerships Abdillahi Ali, the clinical officer at the Family Health Options Kenya office in Malindi, a big town in coastal Kilifi county, south east of Nairobi, says the impact of redundancies has been tough for everyone. Before the GGR, Abdillahi recalls, the clinic had a ‘big team’. Once the GGR hit, though, a nurse, a driver, a counsellor and the receptionist were all made redundant. Today everyone left fills in the gaps, “Now you have to work as a nurse and receptionist,” said Abdilllahi of the strain. “At the end of the day, the quality of service is compromised.” Still, the staff carry on, undeterred. Keeping young people engaged Another way that FHOK stayed involved in the community in Malindi was through the youth center which opened in 2013. The center is a place for young people to get information and access to contraception. FHOK spread the word about the center through a Facebook page, word of mouth and peer educators. However, with the GGR, FHOK lost funding for the small stipends they gave to the peer educators. It was a hard time, but now with the mitigation funding, things are getting a little better. Twenty-three-year-old Mahmoud Dzombo, still works as an FHOK peer educator and hosts events for young people. He told us that his last session attracted 30 people who want to learn and talk. “It’s very sensitive, but at the end of the day, we have to,” said Abdillahi of providing information on contraception, including emergency contraception.  “My role is to talk to young people,” Mahmoud explained. He adds that there is a big problem with teenage pregnancy in Kilifi. There’s a high rate of sex work in Maldini, according to Abdillahi, and one of the many reasons the FHOK clinic in town is so valuable is that it will offer family planning and HIV testing without judgment. Indeed, at times the women will bring in the men to get tested as well. He’s glad to be able to continue to provide these unique services even if they are stretched at the seams.  

Leaving no one behind
04 December 2018

Leaving no one behind: Universal health coverage and sexual and reproductive health and rights

Universal health coverage means ensuring every person has access to quality, affordable health services and plays a pivotal role in achieving global development targets. Healthy populations can better contribute socially and economically, while poor health is a major driver of poverty. Universal access to sexual and reproductive health care services is identified in the Sustainable Development Goals as an essential contributor to ensuring healthy lives and promoting well-being for all at all ages. IPPF, together with the London School of Hygiene and Tropical Medicine, undertook a literature review looking at progress to date in and challenges to achieving universal access to sexual and reproductive health and rights. The review, Leaving no one behind, is illustrated with case studies on Afghanistan, Cambodia, Kenya and Sudan. Supported by the Japan Trust Fund.

Teresia

“The split-second decision that saved me” – Teresia’s story

One day, while going about her daily activities in her community in Nakuru, Kenya, 26 year-old Teresia Wangui met a group of people providing medical services. They seemed to be focusing on women, and since she had a few minutes to spare, she made her way to the tent where they were working. This decision would save her life – literally. The Nakuru branch of Family Health Options Kenya (FHOK) was offering mobile cervical cancer screening services at the medical camp. FHOK is the IPPF Member Association in Kenya.  “When I approached the tent, I found out that they were offering free cervical cancer screening services, and I decided to get tested too because I felt that I needed to know my status,” said Teresia. It was a decision that paid off – Teresia was found to have precancerous lesions. To help allay the development of these lesions into cervical cancer, she was referred for cryotherapy treatment for precancerous cells on the cervix.  "I'm glad that I was able to be screened and receive treatment" “Had I not made that split-second decision to pop into the medical camp offered by FHOK, I probably would not be here sharing my story with you today. I'm glad that I was able to be screened and receive treatment. I would advise all ladies to go for cervical cancer screening, even if you are young and have not had children, since it affects everyone who is sexually active. "I would also like to tell my fellow women not to wait for services to be brought to their doorstep. Cervical cancer screening services are also offered in many clinics, so it is your responsibility to undertake regular checks. You are the one responsible for your own health,” said Teresia. FHOK implemented the Cervical Cancer Screening and Preventative Therapy (CCS&PT) initiative in different parts of the country through its static clinics and outreach service delivery points.