Kenya/fr

INTRODUCTION

Au Kenya, les soins médicaux vont beaucoup varier en fonction de la région. Dans les grandes villes, la contraception et contraception d'urgence (pilule du lendemain) sont légales et ne nécessitent pas d'ordonnance. Cependant, l'usage courant de contraceptif a tendance à être bas. Pour les tests de dépistage des IST, il est recommandé d'aller à Better2Know en tant qu'option abordable, mais il existe aussi des cliniques et laboratoires privés. Vous pouvez trouver de nombreux produits pour les règles à Nairobi, y compris des coupes menstruelles, mais vous trouverez plus facilement des serviettes hygiéniques. Au Kenya, les femmes ont droit à un congé maternité de trois mois. L'avortement est uniquement autorisé dans quelques cas très spécifiques, le rendant illégal pour la majorité des femmes. Cela a créé un marché noir d'avortements clandestins, qui peuvent causer de graves complications et la mort des femmes concernées. Il est recommandé de faire très attention avant de rechercher des personnes effectuant des avortements illégaux.

Contraception

Note : il existe de nombreux moyens de contraception, comme les DIU (dispositifs intra-utérins ou stérilets), les contraceptions orales, les patchs, les injections, les préservatifs, etc. Pour une liste complète, cliquez ici.

Lois et stigmatisation sociale

Au Kenya, vous pouvez vous procurer une contraception sans ordonnance.

Ces dix dernières années, les femmes kenyanes ont de plus en plus utilisé une contraception. En 2003, on estimait à 39,3% le taux de femmes kenyanes utilisant une forme de contraception, avec 7,5% sous pilule contraceptive, 16% utilisant des implants ou des injections, et 6,3% pratiquant l'abstinence périodique (méthode Ogino), entre autres.. Plus tard, en 2008, on estimait à 53,6% le taux de femmes kenyanes utilisant une forme de contraception moderne. Plus récemment, en 2015, on estimait que 57,4% de femmes kenyanes (mariées/en union et en âge de procréer) utilisaient une forme de contraception, incluant les méthodes traditionnelles, et que 18,5% avaient des besoins non satisfaits de planification familiale. Les formes les plus courantes de contraception étaient les injections (28,1%), les implants (10,8%), la pilule (8.6%) et les DIU (stérilet) (3,5%). L'utilisation du préservatif était très bas (1,9%).

Traditionnellement, les hommes ont toujours joué un grand rôle dans la planification familiale. Il est possible que les maris aient refusé l'utilisation de contraceptifs, ce qui fait que les pilules contraceptives (que les femmes devaient prendre tous les jours et étaient visibles), n'étaient pas une méthode sûre.. Ces dernières années, le gouvernement kenyan publia de nouvelles recommandations concernant la planification familiale et l'utilisation de contraceptifs. Selon celles-ci, les travailleurs de santé locaux peuvent effectuer des injections de contraceptifs sur les femmes, et proposer plus d'activités pour promouvoir la contraception et éduquer la population. Ce qui eut pour conséquence de faire augmenter le taux d'utilisation de contraceptifs. Les femmes appréciaient le fait que, grâce aux implants ou aux injections, elles n'avaient pas à se rappeler de prendre un comprimé chaque jour, et elles pouvaient aussi recevoir le traitement discrètement sans que leurs maris soient impliqués ou, dans certains, sans que leurs maris le sachent. Ces dernières années, les femmes pauvres des centres urbains ont beaucoup augmenté leur utilisation de contraceptifs.. Cependant, les travailleurs sociaux pensent toujours qu'il reste beaucoup de travail à faire. Les femmes des régions plus rurales ou isolées ont un taux très bas d'utilisation de la contraception (par exemple, seulement 2% de femmes des régions de Mandera et Wajir utilisent une forme de contraception).

Que prendre et où le trouver

• Pour une liste complète d'options de contraception au Kenya, cliquez ici.
• Au Kenya, vous pourrez trouver plus de 10 marques de pilules contraceptives, parmi lesquelles des pilules combinées et monophasiques. Voici quelques unes de ces marques: Diane, Logynon, Marvelon, Mercilon, Microgynon, Microgynon-30, Microlut, Microval, Nordette et Trinordiol.
• Si vous souhaitez un DIU, vous pourrez trouver Mirena au Kenya.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex to prevent pregnancy. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Kenya, emergency contraception (morning after pill) is legal. No prescription is required and there are no age restrictions. The lowest cadre of workers allowed to dispense EC is nurses.

What to Get & Where to Get It

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

Dedicated Products / Progestin Only Take 2 pills within 120 hours after unprotected sex:

• ECee2
• Emcon
• Levo-72
• Levogest
• P2
• Postinor-2
• Smart Lady (Pregnon)
• Truston-2

Oral Contraceptives used for EC / Progestin Only

• Take 50 pills within 120 hours after unprotected sex:
• Microlut
• Microval

Oral Contraceptives used for EC / Progestin-Estrogen Combined Note: in 28-day packs, only the first 21 pills can be used Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later:

• Eugynon
• Neogynon

Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:

• Lo-Rondal
• Microgynon
• Microgynon-30
• Nordette

Costs

"A small survey of several pharmacies in Nairobi found prices between KSh 100 and Ksh 200, equivalent to $1.15 – 2.30 (July 2013)," according to the International Consortium for Emergency Contraception.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

There are no known travel restrictions for people with HIV or any other STIs.

What to Get & Where to Get It

Testing Facilities

• Better2Know Kenya: Multiple locations in Kenya. "Having an STI test can be a worrying time. Better2Know are experts in sexual health. We help people like you every year to get fast results and help them get treated, if they test positive. We test for a wide range of STIs including: HIV, Chlamydia, Gonorrhoea, Syphilis, Herpes, Hepatitis B, Hepatitis C, and some infections you may not have heard of such as: ureaplasma, mycoplasma, gardenerella and trichomonas. You can test for these infections individually or choose one of our screens or profiles."
• Marie Stopes Kenya: "At MSK you will have a confidential consultation with a nurse who will discuss your concerns and recommend any tests. We recommend making an appointment for a comprehensive sexual health screening with includes HIV and STI testing for both women and men, as well as a pap smear for women. Marie Stopes has 23 centres across Kenya, to make an appointment for an HIV test, STI screening or comprehensive sexual health screening book online or call us toll free 0800 720005."
• Pathologists Lancet Kenya: You can order tests anonymously and receive results via email or mobile phone. "PATHOLOGISTS LANCET KENYA is an ultramodern laboratory that was established in September 2009 and is now a leading independent laboratory in the region. It is part of the industry leading Lancet Group of Laboratories, founded over 60 years ago in South Africa and now with a presence in more than 14 countries across Africa including Uganda and Tanzania. Lancet Kenya has an extensive branch network with over 15 laboratories and patient service points across Kenya. We also serve clients through collaborative work with other laboratories and hospitals in all towns across the country."

Support

• Nairobi Coptic Hope Center: Ngong Road, P.O.Box 21570, Nairobi, Phone: +254 272 5856, E-mail: mattwa@copticmission.org
• Kisumu FACES: Kisumu at Lumumba Health Centre, Kenya Medical Research Institute, P.O. Box 54840, Kisumu, Phone +254 20 2722541, Fax +254 20 2720030
• Mombasa: Bomu Medical Centre
• Association of People With AIDS in Kenya: E-mail Tapwak@kenyaonline.com
• Family Health International: E-mail fhikenya@fhi.or.ke
• Society on AIDS in Africa: P.O. Box 63 355, Phone: +254 2 711 331, Fax: +254 2 741 383

Medications & Vaccines

What to Get & Where to Get It

• If you have a yeast infection, you can ask the pharmacist for Fluconazole, which is antifungal medication. If they don't have Fluconazole, they may be able to find something that is similar.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

In Kenya, you should be able to access pads, tampons and menstrual cups. You can find pads and tampons (with or without applicators) at major chain stores, such as Nakumatt. Generally speaking, pads will be much easier to find than tampons. You can expect to see brands like Always, Kotex and OB. But remember that, in smaller villages, you won't have such easy access to pads and tampons.

For menstrual cups, you may be able to access MoonCup through Maureen Maina (P.O.Box 18677 - 00500, Nairobi, Kenya , Telephone : +254 720 007738 , e-mail: maureenmaina1@yahoo.com) or Sajni Shah (Telephone : +254 735 061985, e-mail: shahsajni@hotmail.com). You can also get Lunette, another menstrual cup, through The Cup Foundation, which is "a non-profit organization with a mission to educate and empower girls living in challenging environments by giving them life skills training and access to menstrual cups," and they are listed as an official vendor on the Lunette website. However, if you want DivaCup or LadyCup, there are no known sellers in Kenya, so those brands should be bought online.

Gynecological Exams

What to Get & Where to Get It

• The Nairobi Women's Hospital: "Over the years the Nairobi Women’s hospital has grown to be the leading private hospital that provides quality and affordable health care services to low and middle-income Kenyan women and their families."
• Marie Stopes International - Kenya: "Marie Stopes Kenya provides a wide range of high quality, affordable and client centred sexual and reproductive health services and information to men, women and young people throughout Kenya. One of our oldest programmes, it sets the gold standard for clinical quality in sexual reproductive health in Kenya via its extensive service network, which covers the whole country... Our 23 centres and one specialist obstetrics hospital offer many sexual reproductive health services, including the full range of family planning options, post-abortion care, emergency contraception, crisis pregnancy counselling, pre and post natal care, safe delivery, ultrasound, prevention of mother to child transmission (PMTCT) of HIV/AIDS and cervical cancer screening and treatment." Contact Details: Marie Stopes Kenya, Kindaruma Road, Kilimani, Off Ngong Road, Nairobi, Kenya. Office telephone: +254 (0) 57 252 32 17. Call centre telephone: 0800 720 005 (toll free in Kenya).

Pregnancy

Laws & Social Stigmas

In Kenya, the laws permit a 3-month maternity leave with full payment. For men, a 2-week paternity leave is permitted. Women cannot be released from work by employers due to their maternity status.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Kenya, abortion is only legal under certain circumstances, which include: to save the life of the woman, to preserve physical health or to preserve mental health. As stated by Article 26 of the Constitution, "Abortion is not permitted unless, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law." This means that other reasons, including rape or incest, fetal impairment, economic or social reasons or by request, are not permitted. Furthermore, for an abortion to be legal, the woman and her spouse must both consent. Furthermore, two medical opinions (one from a physician and one from a psychiatrist) must approve the abortion before it's performed. The abortion must take place in a hospital.

As reported by the International Women's Health Coalition in 2014, "Despite these greater legal rights, women in Kenya are still forced to resort to unsafe methods. As in many countries where abortion is or has been highly restricted, there is a dearth of access to and information about safe abortion in Kenya. Women continue to ingest herbs or other drugs or seek out untrained “quacks” who perform surgical procedures using unsterilized equipment in unsanitary conditions.".

In 2013, a Guttmacher Institute study found that "More than three-quarters of women who were treated for post-abortion care had moderate or severe complications, including high fever, sepsis, shock, or organ failure, which can require extensive treatment or hospitalization. Delays in seeking care and reporting to the provider that they interfered with the continuation of their pregnancy were highly associated with the severity of complications. Furthermore, "Kenya has a relatively high case-fatality rate of 266 deaths per 100,000 unsafe procedures." Yet abortions continue. According to estimates, about one fifth of pregnancies in Kenya are terminated each year. Unfortunately, only 16% of Kenyan delivery institutions can perform vacuum aspiration, the surgical abortion method recommended by the World Health Organization (WHO). Generally, about half of all abortions are performed in private facilities, which are typically three times as expensive as public facilities, thereby hindering abortions for many low-income women.

What to Get & Where to Get It

• Marie Stopes Kenya: Seems to perform abortions for $25 to $60 (as of 2011). Has many centers in Nairobi and throughout Kenya. "Since 1985 MSK has prided itself in providing a wide range of high quality, affordable and client- centered reproductive services to men, women and young people."
• Nairobi Hospital: Performs abortions but very expensive - about $1000 (as of 2011). Address: Argwings Kodhek Rd, Nairobi, Kenya, Hours: Open 24 hours, Phone: +254 20 2845000.
• Aunty Jane Kenya Safe Choice: Check out the Facebook page or email: kenyanwomenonwaves@gmail.com
• If you are interested in seeking an abortion outside of Kenya, abortions are legally available upon request in Mozambique, South Africa and Tunisia. You can also find legal abortion providers upon request outside of Africa, in countries such as India, Turkey, Vietnam and many European countries. In the East African region, abortions are available in order preserve mental or physical health of the pregnant person (but not on request) in Eritrea, Ethiopia and Seychelles. They are available for economic reasons in Zambia.

Costs

If you are pregnant and considering getting an abortion outside Kenya, you will need to consider the following costs: the processing of the visa and all relevant paperwork to the country where you plan to obtain an abortion, transportation to the country, hotel or accommodation costs in that country, cost of the abortion in the country, and the total amount of days you may need to be in the country both before and after the abortion, among other costs.

Advocacy & Counseling

What to Get & Where to Get It

FIRE AND AMBULANCE SERVICES: DIAL 999

List of Additional Resources

• Click here to learn about LGBTQ rights and laws in Kenya. It is important to note that homosexuality is illegal in Kenya, as of May 2018.
• African Women Link: PO Box 50795, Nairobi, Kenya.
• African Women's Communication And Development Network: P.O. Box 54562, Nairobi, Kenya, Tel: 254-2-440299, Fax: 254-2-443868
• Binti Legacy, Loita House (feminist bookstore): Loita Street, Nairobi, Kenya, Tel: +254.2.33.0854, Fax: +254.2.33.0854
• Coalition on Violence Against Women (COVAW): Ngong Road, near Adams Arcade, P O Box 7631, Nairobi, Kenya, Tel: 254-2-574357/8, Fax: 254-2-574253, Email: covaw@iconnect.co.ke
• Council For Economic Empowerment Of Women In Africa: P.O. Box 42542, Nairobi, Kenya, (254-2) 226742, (254-2) 340367
• East Africa Women's League (EAWL): P.O.Box: 40308, Nairobi, Kenya
• Education Centre for Women in Democracy: P.O. Box 62714 , Nairobi, Kenya, Tel: +254 2 562 304 or +254 2 570 386, Fax: +254 2 561 316, E-mail: ecwd@arcc.or.ke