In 1996, the Kenya Ministry of Health and the International Consortium on Emergency Contraception registered and introduced the dedicated EC pill, Postinor-2.  Although the method proved highly popular in both the public and private sectors, the depletion of public sector EC stocks in 1999 signaled the end of services and relegated Postinor-2 exclusively to private pharmacies. Since its inception, ECafrique has worked to restore public sector access and has supported efforts to ensure the sustainability and acceptability of EC services in its host country.

Support to the Public Sector

In 2004, discussions between ECafrique, the Ministry of Health, and other partners came to fruition with the announcement that UNFPA would procure stocks of Postinor-2 for public sector use.  In April of that year, ECafrique responded to this turn of events by convening, with the Ministry of Health and PATH (a leader in pharmacy-sector provision of EC services), a stakeholder workshop to develop a national strategy for re-introducing public sector EC services.

In January 2005, UNFPA procured 700,000 cycles of Postinor-2 for public sector use. ECafrique took the lead in bringing together partner agencies including the Ministry, UNFPA and PATH to discuss modalities of rolling out EC.  A two-day workshop was conducted (April 21-22, 2005) for senior health planners and policy makers from each of Kenya’s eight provinces.  Together with Ministry officials from Nairobi, the participants discussed and developed an introduction strategy and national roll out plan. Under this scheme, ECafrique has been playing a key role in monitoring EC uptake and consumption levels; documenting the experience of introducing EC into the public sector nationally; developing innovative materials to increase public awareness and demand for EC services; and incorporating EC into the new National Reproductive Health Policy.  On World Health Day 2005, national distribution of EC began in the public sector.

ECafrique has also been an active member of the advisory board responsible for drawing up Kenya’s new National Guidelines for Medical Management of Rape and Sexual Violence and the accompanying Training Manual on Clinical Care of Survivors of Sexual Violence. Published in 2005, the Guidelines incorporated EC as an integral part of standard treatment for rape survivors.

Like Chocolate: A Diagnostic Assessment of Adolescent Emergency Contraception Use in Nairobi

For over a decade, EC has been widely available in Kenya’s private sector.  It has become increasingly popular with adolescents, who value the easy, confidential access provided by pharmacies.  This access, however, has been accused of increasing sexual behavior among young people, and in 2004, the Kenyan media featured a set of reports alleging that an epidemic of EC abuse had emerged among adolescents in Nairobi. Fueling an already heated debate on reproductive rights in Kenya, both a newspaper article and a television news story suggested that easy access to EC encouraged risky sexual behaviors among adolescents.  The features implied that although educated youth have adequate knowledge of the modes of HIV transmission, access to EC has encouraged frequent and risky sexual encounters.  According to the newspaper, young women in Nairobi were so regularly and repeatedly engaging in such risky behavior that they were “using [EC pills] like chocolate.”

Despite the compelling nature of these reports, little empirical evidence exists—either in Kenya or abroad—linking EC access and risky sexual behaviors among adolescents.  To test popular assumptions, while at the same time contributing to a growing understanding of adolescent sexuality, ECafrique undertook a rapid diagnostic assessment of EC use among adolescents in Nairobi.

This rapid assessment was conducted over a two-month period in 2005 using a quantitative survey instrument administered to 300 participants.  To ensure that findings are directly relevant to the current public debate on EC, efforts were made to collect information from the same type of respondents cited in the media reports: namely young women in Nairobi between the ages of 14 and 25.  The survey measured prior contraceptive knowledge, use, and participation in risky sexual behaviors, such as having sex for money and having sex without a condom. Repeat use of EC was also assessed, and participants were asked to rank their own susceptibility to both pregnancy and sexually transmitted infections, including HIV. Data is currently under analysis, and preliminary findings can be seen in an award-winning presentation, delivered at the 2006 Annual Meeting of the Population Association of America.

The Nairobi-based Center for Study of Adolescence responded to the same article by compiling a set of fact sheets on EC, with technical assistance from ECafrique.  These fact sheets were widely distributed nationally to universities, colleges and youth-serving organizations, and are also being used to lobby for the provision of quality and comprehensive reproductive health services for young people