Today, March 8, is International Women’s Day. Click here to learn more.

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The average woman in Kenya has about five kids. In my community, as with many others, children are the greatest wealth one can acquire, the answer to the most fervent prayers, the greatest source of pride. Six is often touted as the ideal. Nonetheless, between such factors as a maternal mortality ratio of about 1 in 38 and staggeringly high unemployment, it’s important for people to have the ability to evaluate their ability to support XYZ number of children and plan their families accordingly.

So while the birth control wars in the US continue to rage more than a century after feminist pioneer Margaret Sanger watched a patient die from septicemia following the termination of a desperately untenable pregnancy, it’s often viewed as slightly less of an issue in Kenya. At least, less of a public one. This is due in part to the fact that such topics are often seen as unseemly for mixed company, and in larger part because while most politicians continue to believe in large families, factors such as the staggering impact of the poverty cycle and extraordinary rise in HIV infections has caused many to become vocal proponents of “family planning.” (Always “family planning,” and never “birth control” – we wouldn’t want to give people the wrong idea, would we? If you’re not married, keep your hands – and all other parts – to yourself.) In theory, all government clinics are required to stock an adequate supply of both hormonal and barrier-method forms of family planning, for distribution at their reasonable discretion. (What this means is, of course, open to interpretation.) Some even go above and beyond, offering quarterly clinics sponsored by international NGOs like the Marie Stopes Foundation, which offer more involved methods from IUDs and Implanon to tubal ligation and vasectomies.

The most common method is far and away the quarterly injection (“Depo”): one doctor’s visit gives you three months of protection, and your husband never has to know. (There are a heartwrenching number of women for which this is a very important factor.) Condoms are available quite cheaply – ten shillings each, or free at HIV testing centres. The Pill, while the most popular choice in the United States, isn’t as widely used (easy to forget, must be taken at the same time each day, some women don’t like swallowing them, etc.) However, unlike in the US, where a doctor’s prescription is required, it’s available over-the-counter at most pharmacies – much like emergency contraception “Plan B” back in the States.

Best of all, even if you can’t make it to a government clinic to get it for free, it’s only 30 shillings for a month’s supply, or about 36 cents US$. In America, even with insurance, the same drug could easily cost you $50 or more per month. (Just for funsies, here’s a calculator to help you figure out how much birth control will cost you over your child-bearing years.) Like several of my fellow lady-PCVs, I confess it’s a constant struggle against temptation to buy it by the cargo container-load, ship it back to America, and drive around in a convertible flinging handfuls of it into the crowd like Mardi Gras beads. WOMEN OF THE WORLD, UNITE! We have nothing to lose but our co-pays. All reputable pharmacies (or “chemists,” as we call them here, borrowing the Britishism) should carry it – or so my colleagues at the clinic told me. “Just walk in and ask. You will have no difficulties.” Coming from women, and medical professionals, I had no reason to doubt them.

But nothing is ever that easy, is it?

I was in Mombasa recently for an appointment and, while wandering around Old Town eating a frozen juice packet (an “icy-icy”), I found myself remembering that conversation with my colleagues. At present, the Peace Corps medical office supplies me with all the medications I could need, free of charge. It’s not an issue. But when I finish, my plan is to be traveling/studying for a month or two before rushing home to begin my graduate school adventures, so it would probably be advisable to stock up on a few necessary items while I’m someplace where I know how to find chemists and can speak/read the language. Mombasa has more/better chemists than my village, and I’m not there often, so why not take care of it that day? I had a few hours to kill before I had to catch a matatu home, so I found myself ducking into the nearest pharmacy.

It was dimly lit, with most of the space taken up by dusty glass cases filled with lung tonics and fever tablets. Unlike familiar neighborhood pharmacies in America, where you serve yourself then present your items at a cashier, in Kenyan shops you tell the pharmacist what you’re looking for and they fetch it for you. I approached the lone person behind the counter, a middle-aged man reading a rugby report. ”Excuse me sir,” I began in polite Swahili, ”Do you sell [birth control pill brand/name]?”

He cocked his head and blinked for a few seconds before disappearing into the back of the store. A few moments later, he re-emerged and handed me an unfamiliar box. I squinted at it. The outside of the box was in German, but the inside instructions revealed that it was medication for some kind of gynecological health problem. We were dealing with the right general body region, but not quite there.

”No,” I said quietly, handing it back to him. I re-iterated the name, then described the packaging. He gazed at me narrowly. “Family planning tablets?” He switched to English. “The Pill?”

“Yes,” I said. ”That exactly. Do you stock it?”

He stared at me for a long moment, his gaze cool. “No.” His tone was low and unwelcoming. He picked up his newsletter and went back to reading, his brow furrowed. I was dismissed.

I stepped back out into the bright sunlight of the street and paused to adjust my scarf. Well, that was odd, I thought to myself. There was another chemist a few streets down. This time, there were several people working – I made a beeline directly to the woman on staff and repeated my inquiry. She thought for a moment, then offered a sad shake of her head and directed me to yet another chemist some distance away. There, I was told they would sometimes stock it, but were currently out. They couldn’t tell me when they might have it again.

I visited half a dozen pharmacies, most of which gave me some variation on that same answer: we don’t have it, we don’t know when/if we’ll ever have it, try someone else. The day was witheringly hot in the way that only blazing, cloudless days near the end of the dry season can be, and I was growing tired. Finally, I found someone I couldn’t imagine not having it: a large chain pharmacy, sharing a plaza with one of Kenya’s handful of large chain box stores. (They haven’t caught on here the way they have in America – at least, not yet.) Inside was all cool white tile and polished mirrors. Two women sat behind a case of sports injury treatments, giggling and joking. I shuffled up, placed my hands on the edge of the counter, and wearily repeated my inquiry.

One woman – let’s call her A – whipped her head around to face me and gave me a sharp look. “Are you married?” She stared me down, as if to say, I’ll know if you’re lying.

“I’m not.” I wasn’t wearing any rings and was too tired to care anyway.

A turned to her colleague, who we’ll call B, and said in rapid Swahili, ”You sell it to her.” She then folded her arms across her chest and stared pointedly down into the case.

B was nothing but polite and obliging. She walked over to a large, colorful dispensing box on a high shelf and drew out a pack. Next to the box was a poster extolling the virtues of the Pill – ”Family planning for modern women” it informed me in looping, fuchsia script. “Actually, can I have two? So I can save myself a trip back here?” B nodded and pulled out a second packet, while A drew in a sharp, gasping snort. Her stool scraped loudly across the tile as she rose and stomped into the back room. B didn’t respond to this, merely rang me up at the cash register with a smile. As she carefully wrapped the packets in brown paper, birthday-gift style, we made casual small talk about the weather, the recent holidays, and the unique necklace she had worn that day. She waved as I walked out.

To say the sum total of my experiences are due solely to misogyny or scathing moral judgments would no doubt be an unfair misattribution. In all likelihood, at least some small part of the difficulty owes to the fact that The Pill isn’t quite as common a method here as it is in the States, as I mentioned earlier. (One woman pharmacist, after informing me they didn’t have it, gently offered to give me the Depo shot for the same price if I could offer proof I wasn’t already pregnant.) But in at least two of those cases, we have demonstrable proof that birth control access WAS a touchy issue, for any number of reasons, contrary both to what I had been told and to the popular awareness of Kenya’s government-subsidized population control plans. Moral perceptions were certainly a factor, even if it was one I was ultimately able to overcome.

If pharmacist B hadn’t been there, what would I have done then? If I were a Kenyan woman who didn’t have the time to run to 7 different pharmacies, how would this story have ended? If I were married, and had only enough time to slip into one while my husband was off haggling for goods in the markets? What if I were a young woman, even a student, already shaky in my resolve, nervous about judgment, frightened of being shamed? Would my courage have lasted long enough to get to the seventh pharmacy? Or would the unspoken rebuke of the first chemist been enough to shatter my determination?

I don’t mean to imply that Kenyan women or African women or young women in general are delicate little flowers who can’t shoulder a bit of adversity. Far from it. And God knows I’ve spoken to American college students who could barely overcome their own issues to walk down the hall to their RA’s door and snatch a couple of condoms from the “FREE USE” basket. There are plenty of women, even here in Sub-Saharan Africa, who are brave and outspoken on the issue, from whom their peers can draw inner strength. But convenience and ease of access MUST be taken into account, for all the scenarios I’ve outlined, and more. As long as a disconnect exists between the recognition of the need for means women can use to prevent unplanned pregnancy (to say nothing of preventing disease) and the ability of women to obtain those means, for WHATEVER reason, we have a problem. A big one.

Yesterday, I took this story back to my coworker who had originally assured me I’d have no trouble. Her response was minimalist. She pursed her lips and shrugged, then, after a beat, added “Karibu Kenya, dadangu.” Welcome to Kenya, dear. She then mentioned off-handedly that numerous government health clinics had been having shortages of the Depo shot, too, and most who claimed to stock the elusive female condom had never even seen them. Who was the blame? Almost definitely the government, she said. They tend to promise more than they have any intention of delivering, especially in election years. (In this, Kenya is certainly not alone.)

The relationship this nation has with the issue of birth control family planning is probably no less complex than in many other countries – the conflict of necessity and access, the economics spending to save or tightening our belts, the perpetual tug-of-war between those who view it as private tool and those who view it as a public governmental thumbs-up to extra-marital non-procreative uber-immorality. (Although I’d like to point out, in the immortal words of human rights journalist and author Nicholas Kristof, birth control access is no more a cause of sex than carrying an umbrella causes rain.) To translate it into current generational slang, if Kenya and birth control had a facebook relationship status, it would be: it’s complicated.

Birth control access is a human rights issue. Anywhere. Everywhere. For one, it’s used to address any number of legitimate medical concerns, from controlling Polycystic Ovarian Syndrome and protecting fertility to increasing quality of life among women who experience severe menstrual symptoms. 58% of American women who are on the pill use it for reasons other than to prevent pregnancy. More than that, it’s a vital tool for allowing women to make appropriate social and financial choices – if and when to have children, and how many to have. It’s the single most important factor in preventing abortions, and regardless of where you fall on the political spectrum, we can all agree that bringing this number down is a good thing.

In Kenya, the right of a woman to say NO is still a controversial topic – sexual assault is a hidden epidemic, often not taken seriously by authority figures and average citizens alike. (I will never forget the feeling of white-hot rage pooling behind my eyes when, at a seminar addressing gender-based violence, one participant – a late-middle-aged man – cavalierly interrupted the female presenter to glibly inform us all that woman can no more accuse her husband of rape than a fruit vendor could accuse a man of being a thief for eating a mango he’s already paid for. It’s a ridiculous idea, and Not How We Do Things Here.) However, the discussion of sexual agency is not complete without also acknowledging a woman’s right to say YES. Yes to planning her family according to what she can support physically, emotionally, and financially. Yes to enjoying the company of and giving reciprocal pleasure to her husband. Yes, even, to saying, “Sexual expression is part of the human experience, and *I* will decide when and with whom it is right for me to participate – not the politicians, not powerful church lobbies, not the judicial system. Me.”

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