Addressing Family Planning Gaps in Narok County – The Women of Mau: A Case Study
The journey to Olmekenyu Health Center in Narok South Sub County is far from easy. Winding, muddy roads in a mountainous region bordering the Mau Forest set the stage for the daily challenges faced by women seeking healthcare. This center, one of the high-yield public health facilities partnered with DESIP, is a lifeline for many in the community.
On a rainy Thursday morning, we met Cheptoo—picked up 20 kilometers along the way when she got stuck. Cheptoo, a 34-year-old mother, was on her way to the center with her 4-year-old child, who has Down syndrome. Once her child was attended to, Cheptoo sat down with a nurse named Langat for a conversation about her reproductive health goals. Langat carefully counseled her and provided her with her method of choice, ensuring privacy, patient safety, informed choice, and technical competency—all in line with PSI quality standards and DESIP’s training from November 2019.
As we dropped Cheptoo off, she shared the challenges that have long hindered family planning in her community. Her story is not uncommon in Mau. At home, her delighted children greeted her with open arms—though the youngest, just a few months old, was hungry and promptly began breastfeeding. Cheptoo’s tired face told the story of a woman whose youth was already slipping away under the weight of poverty, homelessness, and illiteracy. She shoulders the burden of feeding nine children, two of whom have special needs. Despite being married, she explains, her situation has been largely shaped by cultural expectations: “It was never my wish to have nine children, but in our culture, there’s a strong belief that you must try for a boy. My husband and I struggled, but we had no choice.”
Many families like Cheptoo’s live in temporary camps after being evicted from the Mau Forest. Her eldest daughter, a teenager, is already married after eloping with a casual laborer, and her second-born daughter is heavily pregnant and yet to start antenatal care.
With DESIP’s support, women in these communities now have access to family planning services at neighboring health centers such as Sogoo and Olmekenyu. Here, they receive counseling and leave with a method that suits their needs. The health workers, many of whom hail from the same community, have taken the initiative to empower women, reduce teenage pregnancies, and discourage early marriages. These efforts are gradually replacing the traditional “search” for a baby boy with informed family planning choices.
In Mau, it’s common for women aged 30 to 40 to have between nine and 12 children—a staggering 60% above the national average household size of 3.9 children (as per the 2019 census). Limited access to family planning services, lack of spousal consent for modern birth control, and low literacy levels perpetuate cycles of poverty. Girls often face early marriages in a bid to escape these cycles, and many never progress beyond primary school.
Reflecting on her past, Cheptoo wishes she had known about and had access to contraceptives when they were scarce in Nkoben, where her family lived before eviction. Many young mothers agree that birth control is necessary, yet the contradiction between belief and practice remains—largely because husbands often deny permission for their wives to access these services. As a result, some daring women sneak into health centers to receive care, while others access family planning during immunization visits or through post-partum services.
Soila, a mother of five, shared how she was taught about various family planning methods during antenatal visits and chose to embrace the implant after delivering her fifth child. “There is a need for a targeted approach to modern contraception for rural women. Some may have pills but don’t know how to use them effectively,” explains Langat, the nurse.
A village elder at the camp reminisced, “Childbearing used to be planned in a way that a husband would leave the homestead for over a year so his wife could care for the newborn. That was possible because of polygamy—men had alternative homes. Back then, issues of child-rearing were left solely to the women, and men were not expected to be involved.”
Today, nationally, young girls and women below 24 account for 70% of all pregnancies—most of which are unwanted. According to the Kenya Health Demographic Survey, 50% of married and sexually active unmarried women in rural areas have an unmet need for family planning. Limited access to reproductive health services, gender inequality, stockouts, distance to health facilities, cultural norms, and a lack of skilled providers all contribute to these challenges.
Drawing on these insights and the reality on the ground, the DESIP program is seizing every opportunity to ensure that women and girls can safely plan their pregnancies and improve their sexual and reproductive health. The ultimate goal is to reduce maternal, newborn, and child mortality while increasing the modern contraceptive prevalence rate (mCPR) across Kenya.
