In Kenya, HERproject has been working with global brands to increase use of family planning. Our program employs supply-side strategy, which involves facilitating healthcare linkages from the workplace to external service providers to improve healthcare access for low-income women and men, as well as demand-side strategy, which involves reducing the barriers to access and participation. Our experiences support the widespread view that addressing both demand-side and supply-side barriers concurrently is critical to improving access to modern family planning products for women workers in global supply chains.

According to the most recent Step-Up Kenya report released by the Population Council, UK Aid, and the African Population Health and Resource Center (APHRC), over 40 percent of pregnancies in Kenya are unintended—either mistimed or unwanted. The average Kenyan woman has a fertility rate of 4.6 children; meanwhile, the Kenyan National Bureau of Statistics estimates that if women were to achieve their ideal family size, the rate would drop to 3.4 children per woman. Unplanned pregnancies stem largely from an unmet need for contraceptives: one in four married women in Kenya want to stop or delay childbearing but are not using a family planning product. And control over sexual and reproductive health and rights is a prerequisite for women to reach their full potential.

Family planning initiatives that focus on ensuring access to modern family planning, reducing the distance required to access these products, and educating women and girls on the benefits of family planning can have (and have had) positive impacts. However, addressing social norms that both women and men hold, as well as enhancing men’s awareness and support for their partner’s health, are essential to improving access and use of family planning products.

Access to healthcare is about more than geographic availability: it’s about ensuring that necessary health products and services are available, accessible, affordable, and acceptable to people. In the context of family planning, this means that modern family planning products such as male or female condoms, intra-uterine devices (IUD), or injectables should be in stock, within geographic reach, at a price that people can afford, and socially and culturally acceptable.  

In four agricultural workplaces in Kenya, HERproject asked low-income women workers about their access to modern family planning products. On the supply side of the equation, of the women workers surveyed:

• 97 percent of women reported that family planning products and services were available, with 82 percent reporting that modern family planning products were within walking distance.
• 96 percent of women reported that family planning products were affordable.
• 76 percent of women reported using family planning products.

Yet of those not using modern family planning products, nearly 20 percent said that they would want to use it. So what is holding them back?

We found that the “acceptability” dimension of access is key to understanding women workers’ demand for family planning products. Our data suggest that family planning remains a taboo topic for many Kenyan women. Take the women who are not currently using family planning products. As noted above, 20 percent explicitly said they would want to use it, and 10 percent said they would not want to. Yet nearly 70 percent declined to answer the question, which may well indicate pressure and fear surrounding women’s use of family planning products.

In addition, HERproject seeks to understand the extent to which women have decision-making power and control over use of health products and services. Lack of this decision-making power is likely a barrier for women to use family planning products, even when they wish to delay childbearing.  

In the same four workplaces, we presented workers and managers with the statement: “I think family planning decisions should be made by the man.” Twenty-two percent of women and 19 percent of men—around one in five people surveyed—agreed with this statement.

Together, these data suggest that social norms and attitudes that reinforce inequality can act as a barrier to women accessing family planning products.

HERproject works to improve access and use of modern family planning by addressing stigmas that women and men hold about family planning products during workplace training. We empower women workers to address family planning questions with their partners. We also include male workers in awareness-raising sessions to reinforce the role men can play in promoting the health of their partners and the benefits of this approach for the whole family.

This is an important area that demands comprehensive planning and local expertise to address sensitive topics. We believe that applying a gender lens to access to healthcare and family planning products requires more attention from practitioners, healthcare providers, and employers alike. We invite companies with supply chains in Kenya, as well as healthcare companies, to contact our team to learn more.  

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Photo credit: iStockphoto / debstheleo