Reproductive Health

Support for Making Motherhood Safer

Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.   UNFPA programming focuses on three major strategies to prevent maternal mortality and morbidity:  Family planning, Skilled attendance at birth, and Emergency obstetric care (EmOC).    UNFPA’s three-pronged strategy to reducing maternal morbidity includes:   Family planning to ensure that every birth is wanted;  Skilled care by a health professional with midwifery skills for every pregnant woman during pregnancy and childbirth; and Emergency Obstetric Care (EmOC) to ensure timely access to care for women experiencing complications.   In Kenya, UNFPA channels most of its funding for Reproductive Health services including Safe Motherhood through the Ministry of Health’s Division of Reproductive Health (DRH).  Safe Motherhood is one of the components of comprehensive reproductive health care identified under Kenya’s National Reproductive Health Strategy 1997-2010.


Strengthening Reproductive Health Services in Nine Focus Districts

UNFPA supported DRH in Strengthening Integrated Reproductive Health Services at District Level from 2000-2003 under the 5th Country Programme of Assistance. 
The eight project districts were identified during a UNFPA-supported needs assessment in November -December 1998 based on poor RH indicators, including high mortality and morbidity among mothers and children, and low contraceptive prevalence rate (CPR).  The selected districts were: Samburu (Rift Valley Province); Nyandarua (Central); Tharaka Nithi (now Tharaka and Meru South) and Mwingi (Eastern); and Kilifi, Kwale, Taita Taveta and Tana River (Coast).  UNFPA donated several 4WD vehicles and radio-communications equipment to help ensure a functioning emergency referral system in selected districts as part of its interventions.

UNFPA will continue supporting DRH in strengthening reproductive health services in these nine districts under the 6th Country Programme from 2004-2008.  The Reproductive Health in Nine Focus Districts project will concentrate on the provision of integrated reproductive health services including safe motherhood, HIV/AIDS prevention, ARH services, and capacity building of District Health Management Teams (DHMTs) and service providers.  To increase access to improved reproductive health services including HIV/AIDS prevention, UNFPA assistance to DRH will concentrate on: Strengthening the institutional and technical capacities of the MOH DRH to provide a wide range of RH services including FP; Strengthening the referral system for emergency obstetric care; and Strengthening RH commodity security including procurement and distribution, among other strategies. 

Development of Appropriate RH Training Material

The lead activities under the MOH 2004 Annual Work Plan (AWP) include the development of appropriate RH training material and capacity building of service providers through short-term training and refresher courses.  These activities will help improve the quality of health systems and strengthen human resources, especially at district level.  Specifically, UNFPA will provide technical input and financial assistance towards the finalization and dissemination of the life savings skills (LSS) training curriculum, and printing of the National Guide on Obstetric and Pre-natal care.  These activities have also been identified as possible areas of collaboration with UNICEF and WHO, respectively, under the United Nations’ new emphasis on Joint Programming for more efficient use of resources.

UNFPA actively supported the development of the National Guidelines on Management of Post-Rape/Sexual Violence, and the National Guidelines and Standards on Youth-Friendly Service (YFS) Provision.  It is imperative to address the issues of Sexual violence and Adolescent Reproductive Health (ARH) in the effort to help make pregnancy safer.  Lack of access to reproductive health information and services exposes young girls to the risks of unprotected sex, including unintended pregnancies.    Rape is a traumatic event that can have negative consequences for a woman’s sexual and reproductive health, such as unintended pregnancy.  Sexual violence in already pregnant women can lead to adverse pregnancy outcomes. 

Ensuring RH Commodity Security

Meeting the existing demand for family planning services would reduce pregnancies in developing countries by 20 percent and maternal deaths and injuries by a similar degree or more. 4   Expanding access to modern methods of contraception can prevent many unplanned pregnancies, which often lead to sub-optimal pregnancy care and unsafe abortions.  Family planning and ensuring RH commodity security are central to UNFPA programming.  In 2004, UNFPA procured 1,017,000 vials of injectable contraceptives (Depo-Provera) and 700,000 cycles of emergency contraceptive pills (Postinor-2) for DRH.  The 700,000 doses of Postinor-2 represent the first consignment of emergency contraceptive pills (ECPs) into the public sector in Kenya, and Kenya is the first African country attempting to make Postinor-2 available in the public sector.

Emergency contraception (EC) refers to the prevention of pregnancy after unprotected sexual intercourse.5   This form of contraception will target two vulnerable groups in Kenya, namely the adolescents and youth and survivors of sexual violence.  The World Health Organization states that emergency contraceptive pills (ECPs) do not interrupt pregnancy and thus are no form of abortion.6  Emergency contraception is included in the contraceptive method mix in the revised National Family Planning Standards and Guidelines for Service Providers.  Likewise, EC is recommended for pregnancy prevention in the management of post-rape, as stated in the upcoming post-rape care guidelines.

Strengthening Human Resources at the District Level

Improving the availability, accessibility and quality of reproductive health services cannot be achieved without strengthening the human resources in the health sector.  Under the 2004 MOH AWP, UNFPA will provide financial assistance for several training activities including: Training in RH management for District Health Management Teams (DHMTs) and District Health Management Boards (DHMBs); and Training of service providers in Family Planning (FP) updates, Life Saving Skills (LSS), Post Abortion Care (PAC), and Essential Obstetric Care (EOC). 

Youth-Friendly Service Provision

Recognizing that young girls are at greater risk for maternal mortality and morbidity due to the immaturity of their reproductive tracts, UNFPA also works to reduce adolescent pregnancies.  UNFPA realizes that young people need a friendly environment in which to access reproductive health information and services.  Adolescents who receive such information and services are empowered to make important decisions, including delaying sexual activity and avoiding risky sexual behaviour.  For this reason, UNFPA has supported DRH towards the rationalization and standardization of Youth-friendly service (YFS) provision including the development and dissemination of standards and guidelines; and for Training of service providers in youth-friendly Adolescent Reproductive Health services with an emphasis on re-orientation of service providers to influence positive attitude towards young people.

Partnerships

UNFPA is also collaborating with a range of other partners to provide youth-friendly RH information and services, including Voluntary Counselling and Testing (VCT).  These include the Faith-based organizations (FBOs) the Archdiocese of Nairobi (ADN), the Catholic Diocese of Nakuru (CDN), the Council of Imams and Preachers in Kenya (CIPK) and the Mumias Muslim Committee Programme (MUMCOP), and Non-governmental organizations (NGOs) like the Family Planning Association of Kenya (FPAK).  UNFPA-supported programmes use culturally-sensitive approaches to fight harmful traditional practices such as forced early marriage and female genital cutting (FGC) through local organizations like the Tasaru Ntomonok Initiative (TNI) in Narok and the Samburu Aid in Africa (SAIDIA) in Samburu District.  Early marriage means an earlier start to childbearing by a young girl in a physically immature body, with all its attendant risks.  Female genital cutting can lead to maternal morbidity by placing the woman at greater risk for prolonged or obstructed labour.