Recently in the Daily Nation in Kenya was an article titles “Expanding Family Planning Access to Poor Women Vital for Kenya’s Future” by Prof. Fred Segor, in the Daily Nation of 7th November 2013.
The article was quite informative on a number of statistical issues. However, a reading of the article also reveals the unfortunate conflation of the terms “family planning” and “contraception.” Contraception is but one aspect of family planning, and the two terms should not be used interchangeably. Lest this view be seen as nitpicking, let us examine the implications of equating family planning with contraception.
Prof. Segor notes that “In Kenya, one in four women don’t want to get pregnant, but lack access to family planning services and information.” International human rights treaties do indeed call on States to provide people with access to family planning information and services. The International Conference on Population and Development (“ICPD”) Programme of Action achieved consensus on “Access to reproductive and sexual health services including family planning”. This includes, amongst others, family-planning counselling, pre-natal care, safe delivery and post-natal care, as well as education, counselling, as appropriate, on human sexuality, reproductive health and responsible parenthood).
Prof. Segor then states, “We know that providing women with better access to a range of contraceptive options is one of the best investments a country can make…” After mentioning the benefits of family planning, which include fewer unintended pregnancies and fewer women and girls dying in childbirth, he then goes on to mention the 2012 London Summit on Family Planning, which “pledged to provide 120 million more women in the world’s poorest countries with voluntary access to contraceptives by 2020.” While the benefits of family planning as stated are not in dispute, the line being taken by most NGOs and UN agencies is that increased access to contraception is the way to help the 220 million women who report a desire to prevent or delay childbirth.
Such a stance immediately raises the issue of informed consent. For consent to a treatment or procedure to be truly informed, it must meet several criteria. In addition to the person making the decision being competent, adequate disclosure, understanding and voluntariness must be present before a decision can be said to be informed. In the context of providing increased access to family planning, adequate disclosure is not achieved, since there is a predetermined method (contraceptive use) being pushed as the main option. It is probably safe to say that many of these women will not be familiar with, say, the FEMM method of family planning, (Fertility Education + Medical Management), which is a natural method of family planning. Granted, it may not be for everybody, but is it even being presented as an option? On understanding as a component of consent, any benefits, as well as side-effects, risks, and long-term implications must be disclosed.
In addition, the language used to inform the potential user must be tailored to that user’s level of understanding, without diluting the facts. In the contraceptive examples of Jadelle and Implanon given by Prof. Segor, statistics reveal that “A five-year clinical trial in seven countries showed that the two most frequent medical reasons, other than bleeding irregularities, leading to removal were headache and weight gain. About 19 per 100 women discontinued use of Jadelle because of bleeding problems. For Implanon, the statistics for common adverse reactions reported in clinical studies show almost a quarter of users discontinuing use because of headaches. Other symptoms include vaginitis and breast and abdominal pain. Is the Ministry and its partners achieving adequate understanding as it promotes these methods of contraception? Lastly, is voluntariness: For voluntariness to be achieved, all available options must be presented (and the preferred method out of these accepted) by the user without coercion. If only contraceptive use is presented as an option, or is highly promoted, can we truly say that voluntariness has been achieved? Is there not a subtle controlling influence present? Where does this leave those women who want to plan their families, but for religious, medical or ethical reasons, do not want to use contraceptives?
Prof. Segor concludes his article with a mention of the International Conference on Family Planning, which is taking place this week in Addis Ababa, Ethiopia. He states that global family planning leaders will “celebrate progress, announce new commitments and call upon donors and governments to do more to expand access to family planning.” My hope is that Kenya will be true to this statement, and faithfully expand information and access to all family planning options as a whole and not just one branch.
By Esther Muiruri, a law advocate in Kenya. Views expressed here are of the author.