Knowledge about birth spacing changes a Kenyan mother and her family's life

Rose Aoko Aloo barely clears five feet, but this petite Kenyan mother of seven children is a powerful presence. Determined to move her family out of poverty, she credits learning about healthy timing and spacing of pregnancies from a World Vision-trained neighbour as a turning point in her family’s life.

Two years ago, Rose delivered her seventh baby. Anxiety consumed her joy as she worried about how to feed her newborn girl, along with five older daughters and a son.

“My husband, John, was unemployed, and we struggled to care for our children,” recalls Rose, 35. “Everything fell to me—finding money for food, clothing and school fees for them. They were sick and hungry often.”

Juggling child care and chores, Rose says she only left the house to go to the nearby market. “I could never attend the monthly baraza—the community meeting in our village, where important news and information is shared. My husband went without me.”

Isolated and overworked, Rose prayed constantly not to get pregnant again. The couple fought frequently about money and sex. Rose says John opposed all forms of family planning as being against his Christian faith. His views about contraceptives are not uncommon in Siaya county, western Kenya, which has one of the country’s highest birth rates. Until recently only 40 per cent of women of childbearing age used modern contraceptives, according to health department figures.  

“I had my first child at 22 and was pregnant almost every year after that,” says Rose, a soft spoken, reflective woman. “I was exhausted all the time.”

To help couples like Rose and John, in 2013 World Vision launched a three-year project in Siaya county to strengthen community understanding about healthy timing and spacing of pregnancies, and family planning (HTSP/FP), in cooperation with the Ministry of Health.  The project, Mobilizing for Maternal and Neo-natal Health through Birth Spacing and Advocacy (MOMENT) is funded by the Bill & Melinda Gates Foundation. MOMENT is helping to ensure that couples get the information and support they need to make informed family planning choices that are right for them.

Faith leaders play an important role in MOMENT as advocates and champions of HTSP/FP World Vision’s Channels of Hope (CoH) program trained more than 200 faith leaders, who in turn mobilized their congregations to spread the word about the benefits of healthy timing and spacing of pregnancies.

Volunteer Pamela Omondi says her priest, Gabriel Anyiko Owino, benefitted from the CoH training himself and invited her to join the Anglican church’s newly formed Community-Based Hope Action Team (CHAT). The six-member team of men and women would be trained on HTSP/FP and then share the information with church and community members.

“Our congregation was usually silent about family planning, but most people were against it,” says Pamela, 44, a mother of four children. “But that was before we took the CoH training program two years ago.”

The course focused on understanding what Scripture says—and doesn’t say—about family planning, including biblical principles about child well-being and maternal health.

“I like World Vision’s faith focus on birth spacing and family planning,” says Gabriel. “In the past, the information was available, but it was a medical approach and was not well-received. This is the first time we’ve combined family planning information with a faith approach and engaged faith leaders as champions. In our community, when the pastor says it, people believe it is the right thing to do. They trust us as leaders and are now confident about seeking family planning services in the local health facility.”

Pamela says she volunteered for the training because she wanted to develop her own understanding about HTSP/FP and empower her community.

“We learned about caring for pregnant mothers—that they must eat a balanced diet and go for regular clinic check-ups,” says Pamela. “We also heard about the importance of breastfeeding infants until they are 2 years of age. I didn’t know that women who are HIV+ can give birth to a non-HIV+ child and breastfeed the baby safely. There are many HIV+ women and others in our community who needed this information. I wish I’d had it when I was pregnant. I decided to go door-to-door to share information about family planning with my neighbours. Rose was one of the first women I visited.”

Rose vividly remembers the day Pamela knocked on the door of her one-room, mud-walled house. “I was pregnant with this one,” she recalls, holding Lilian, a wriggling 2-year-old, on her lap. “Pamela shared how important it is for women to space pregnancies by three years so that you and your children will be healthier. She talked about the risks of giving birth after age 35. We discussed the many methods of family planning and how to choose the one that is right for me and my husband.”

After Pamela’s visit, Rose approached her husband, but he refused to listen. “John became very harsh and told me never to speak about it again,” she says. “But who was suffering in our home? Myself and the children. I was so thin and tired all the time. I had to do something. I decided to find a solution. I sneaked out of the house and went to the health clinic,” admits Rose shyly.

“We counsel that couples should make family planning decisions together,” says Pamela, a regular visitor to Rose’s home. “But when a woman’s health is in danger, as Rose’s was, then we support her decision.”

At the clinic Rose received free family planning counselling. “The nurse told me about nine different options and I chose the implant method because it was good for three years. I didn’t have to remember to take pills,” says Rose, who reports that the visit was positive. More than 550 community health workers in Siaya county have been trained by MOMENT on counseling, messaging and how to treat clients seeking family planning information with dignity and respect.

Over the following months, Rose’s husband heard more about birth spacing from several friends, who had also taken the CoH course at Gabriel’s church. “John was getting the message from all sides,” says Rose, with a sly smile. “They explained what the Bible says about caring for our children. Eventually, he agreed that practicing family planning would be good for us.”  

Since then, life has measurably improved for the couple. “Before I could not imagine how I was going to buy clothes for my children, let alone educate them. It was a dark time,” says Rose. “Now I proudly watch them going off to school. I have much more time now and I started a tailoring business. I can pay their school fees with the money I earn instead of borrowing. I can also feed and clothe them properly.”

Rose says her marriage is also happier. She and John have decided to limit their family to seven children for now. “John and I used to quarrel a lot, but now there is peace in our home. We even attend the baraza together every month. I am grateful to Pamela for all the things she taught me. She is my best friend. When I have some extra money, I will buy her a soda to thank her. So much has changed in my life. Most of all, I have hope.”

On this hot afternoon, Rose welcomes a visit from Gabriel, who pulls up on his motorcycle. He sports a neon orange reflector vest emblazoned with MOMENT’s HTSP messages. Rose offers him a seat in her modestly furnished living room.

“I have a couch, a table, and two chairs now,” she says proudly, her hand sweeping the room. “I didn’t own a single piece of furniture before.”   

Gabriel is pleased with the progress he sees in her family and many others across his parish. “The more this program is replicated, the more people will be assisted,” he says. “I don’t see it as World Vision’s program; I see it as part of my church.”

He says although the Anglican Church has long supported and promoted HTSP/FP, he appreciates the additional theological and practical information provided by World Vision’s CoH program to faith leaders in Siaya county. “We know more about the different methods of family planning now, and we know to refer people to health services for more information,” says Gabriel. “As local pastors, we were struggling to come up with scriptural validation [for HTSP/FP], but I am thanking God for World Vision who helped us with guiding principles that are scripture-based.”

Gabriel introduces HTSP/FP during premarital counselling sessions with his parishioners. He hopes that equipping young couples with this important information will help them avoid the marital conflict and hardship that Rose and John had to overcome.