Kenyan Women Go on the Pill—Behind their Husbands’ Backs

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In the three weeks I spent traveling the rural villages around the Kenyan port city of Mombasa last month, I interviewed more than 100 women and 25 medical professionals about contraception use and maternal health. I’d assumed that women were skittish about using birth control in male-dominated Kenya, where they are often seen as little more than baby-making instruments, and rape and female circumcision are commonplace. But I found instead that more of Kenya’s women are clandestinely opting to use contraception behind their husbands’ backs. Without the notice of their government, these women are risking public shaming and violence to stop the unwanted pregnancies that tether them. In this sense, they’re like American women of a half-century ago—taking birth control pills in secret to take control over their lives.

Birth control is legal in Kenya, and for the past 20 years, oral contraceptives have been available, free or heavily subsidized, at government clinics and hospitals. I saw signs that women are finally starting to take advantage of this. I met 18-year-old K. Suleman when she was visiting a dispensary in Mnyenzeni village with her first child, 3-week-old daughter Amira. A dispensary attendant weighed Amira as Suleman spoke in hushed tones to a female clerk, who was overseeing the dispensary because it had no trained doctor and nurse. Suleman described her daughter’s harrowing birth, which took place while her husband was away. “When Amira was born I was delivering in my home,” she said. “I bled so much when she came out I was about to die. My husband’s sisters put me in a wheelbarrow and wheeled me 30 kilometers to a hospital while I carried my tiny baby.”

Since giving birth, Suleman has experienced crippling anxiety attacks every time her husband approaches her for sex. The fear is real: According to UNICEF, one out of every 39 Kenyan women die in childbirth over the course of their lives. But Suleman’s husband, a day laborer who hasn’t worked in nearly a year, is anxious for Suleman to become pregnant again right away, because his brother already has three children and their father was favoring him. Suleman’s husband has made it clear the decision to have more babies is up to him—I could see the evidence of his determination in dark swelling around her mouth.

So with Amira giggling on a makeshift scale made out of a sling, Suleman received Depo-Provera contraceptive injections that she could easily hide from her husband. She left the clinic calmer, though nervous about the secret she now carried in her bloodstream. The typical Kenyan woman will deliver six babies in her lifetime, and under tribal rules a husband is allowed to take a second wife if his first wife is unable to give him the children he wants. Suleman was risking more violence, as well as being displaced in her own home. Still, she said, “I would rather be kicked out on the streets and die hungry than go through [another birth].”

Dr. Stephen Mwange of the Kinango District Hospital works as OB-GYN, general practitioner, oncologist, and pediatrician in the understaffed medical center outside of Mombasa. He says that in the past year, the number of women who have come to him to ask about contraception, without their husband’s knowledge, has increased from around 100 a year to 100 a month. In the past, he said, a wife was afraid to use contraception unless her mwenye, or husband, agreed. But now “what they are starting to realize is that what the mwenye doesn’t know cannot hurt him,” Dr. Mwange explained.

The birth control pills that Mwange gives to women are called Chaguo Langu, Swahili for “My Choice.” They come in a green box that features a comely husband and wife with two children of clearly different ages. “That is what I wish my family looked like,” one 35-year-old woman whispered to me as she accepted the pills from her nurse. She quietly slipped them into her skirt as the nurse told me that the patient had 10 children. From the creases on her face, I had guessed she was nearly 60.