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KENYA: Herbal Contraceptives Under the Radar

Susan Anyangu-Amu

NAIROBI, Aug 3 2010 (IPS) - An arrow points the way from a busy street along a rough pathway; visitors clutch their bags more closely. The door is open: sachets are displayed on the table with labels indicating treatment for ulcers, diabetes, hypertension, fibroids. But not the contraceptive pill IPS is looking for.

Thirty-five-year-old Sophie – she didn’t want her surname used – came here for six months for a herbal contraceptive.

She says she gained a lot of weight and suffered severe bleeding in connection with the injectable contraceptive she was getting at a government health facility, so she turned to this alternative, oblivious to official warnings that it has been linked to serious health problems.

“I stopped using conventional family planning pills because a friend of mine told me about this particular herbal pill which has no side effects. I used it for a period of six months with no side effects except not having my monthly period for that duration,” she says.

But gynaecologists have alerted the Pharmacy and Poisons Board – whose mandate is to investigate the composition of all drugs in the Kenyan market – that a number of women who were using herbal contraceptives were suffering serious problems.

“This particular herbal contraceptive was being distributed by a Chinese clinic and the packaging was in Chinese,” says Board legal counsel Dr Joseph Yano.

“The side effects being reported by the women included pain and swelling in the legs. Children as young as three years whose mothers were using this pill during breastfeeding were reported to have developed enlarged breasts and uterus.”

Investigations by the Board found that the pills contained high levels of the hormones levonorgestrel and quinestrol.

Yano says loopholes in the country’s legal system are creating an avenue for people to sell unlicensed drugs as “herbal remedies”. The herbal classification requires an import and distribution license only from the Ministry of Culture, which has no capacity to test the products.

”Our law on traditional medicines did not envisage a time when we would have herbal remedies imported from abroad. So they come in through the Ministry of Culture while the Ministry of Health has no idea about them. As a result, all manner of concoctions are being brought into the country and being sold under the guise of being herbal remedies,” Yano says.

Professor Joseph Karanja, an obstetrician and gynaecologist, says due to a combination of difficulties accessing standard family planning and a degree of ignorance of their proper use, many women in Kenya are being exploited by unscrupulous people selling “herbal” alternatives.

“Some of these herbalists are not qualified and their claims to treat all manner of diseases are actually not based on any evidence. These people are simply preying on women’s desperation to avoid pregnancy and are exploiting their ignorance and making money.

“Women need to stay away from such clinics because the products contain high doses of unknown hormones which could have very serious side effects,” Karanja says.

Canny operators

Calls for attention at the back alley dispensary go unanswered; a group of people seated across from the door chat on undisturbed.

Suddenly a voice from across the street says the attendant has stepped out and advises us to call the number displayed on the wall.

When IPS dials and asks about the herbal family planning pill, the person who answers hurriedly says the pill is out of stock and promises to call back when it is available. With that, the phone goes dead.

The people running dispensaries like this one are cautious: According to Sophie, clients are not allowed to take the pills off the premises; instead they come to the clinic once a month and swallow the tablet on site. A helpful call from the operator reminded her when it was time to come in for a next dose.

“You only need to take one pill in a month and they will remind you in good time. It is only 200 shillings (about $2.50) and no one ever needs to know what you are up to,” Sophie says. “Even your husband will have no idea that you are using this pill since you do not take it home with you and have to swallow it everyday like the conventional pills.”

As far as Sophie is concerned, the herbal family planning pills did her no damage – she came off the contraception to have a baby – and she intends to return to using it after she delivers, as she does not want any more children.

National health policy suggests safe family planning methods should be readily available in government hospitals for free or at a heavily subsidised rate. The reality is persistent stock-outs.

“Kenya faces chronic contraceptive stock-outs because the budget allocation towards the health sector is low and that of the family planning division is even lower,” says Dr Charles Ochieng, a gynaecologist at Marie Stopes in the eastern city of Kisumu.

As a result, he says, women are often told that their chosen contraceptive is unavailable and are forced to seek an alternative.

He concedes that conventional family planning methods sometimes have side effects, and these can be worse if one keeps changing from one method to another. Ochieng says this is an important reason why women turn to alternatives of unknown composition, but not the only one.

“Staff attitude in hospitals might also be to blame. There is a misconception that women who want family planning methods are promiscuous and thus they are stigmatised. This can force women to seek services from herbalists.”

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