As the sun sets, Olivia Makoele and George Omondi rest beneath the avocado tree shading their mud-walled home. They laugh and hold hands as they discuss the day’s work on the shamba—their two-acre farm tucked in the hills of Siaya county, located about an hour from Lake Victoria in western Kenya.
The couple raised their two teenage sons and nine-year-old daughter on this tranquil, productive property. The children now attend boarding school in Kisumu, the nearest city. Olivia and George pay their school fees with profits they earn from pig rearing and cassava cropping.
Olivia also serves as the pastor of Faith in Christ Ministries International—a small, tight-knit church in her village of Kodiere. George proudly supports her ministry. But for years, they hid a secret shame from the congregation: George beat his wife.
The couple argued often about finances and family size. Over the years, the tension escalated each time Olivia miscarried.
“George pressured me to have more children and kept impregnating me, although I’d had four miscarriages and was very weak,” recalls Olivia. “He was not working then and there was no food for the children we had.” She says George opposed any method of family planning, insisting that using contraceptive pills or condoms to space pregnancies was “killing unborn children.”
George backed his beliefs with the Bible. “Scripture tells us, ‘Go and multiply,’” he says, paraphrasing Genesis 9:7. “So when I got married, I planned to have more than 10 children. We fought a lot about this. My father pressured me to have many children because he was an only son. Olivia did not want that, so we quarrelled.”
Olivia resented her husband’s disregard for her health and happiness. “I did not agree with him and there was violence between us,” she says, her eyes aaverted, and George quietly sitting beside her.
Following their fights, George usually left the house—once for more than a year. He searched for work in Nairobi, leaving Olivia to care for the children.
“I did not feel good after I hit Olivia,” admits George. “Our children used to see us as enemies because of the quarrelling in the family.”
According to Olivia, such domestic violence is common in households in her community. She believes it is linked to unemployment, financial stress and decision-making rights about how many children a couple will have and when.
“Most women in my congregation got married before they were 18 years old,” says Olivia. “Many of them have given birth to as many as six children—one right after another—and they cannot feed them.”
National statistics support Olivia’s observations. Her province (Nyanza) has one of the highest rates of domestic violence in Kenya, according to the 2014 Demographic and Health Survey. Some 50 percent of women respondents between the ages 15-49 have suffered domestic violence from their spouse or partner—12 percent higher than the national average.[i]
Siaya county, where Olivia lives, also reports one of the country’s highest maternal mortality ratios—a reported 448 mothers die for every 100,000 live births[ii] versus 14 per 100,000 in the United States.[iii] The infant mortality rate (111/100,000) is more than 18 times higher than that of the U.S. (6/100,000).
Early pregnancy is also a problem in Siaya county. The average age for a girl’s first delivery here is about 16.[iv]Expectant girls aged 15 to 19 years are twice as likely to die from pregnancy-related causes as women aged 20 to 24. Their infants face a higher risk of dying before their first birth. And when a child is born less than two years after the previous birth that child is 60 percent more likely to die as an infant than a child who is born three to five years later.[v]
Most of these deaths can be prevented. For instance, timing pregnancies to occur during the mother’s healthiest childbearing years (ages 18-34) and spacing pregnancies by three to five years can help prevent one in three maternal deaths.[vi]
However, until recently only 40 percent of women of reproductive age in Siaya county used a modern contraceptive method.[vii]
“People here believe that if you use family planning methods, you will give birth to deformed children,” says Treza Onyango, a nurse at the Mulaha Dispensary in Siaya county, who specializes in family planning counselling. “They also have the notion that you will become infertile and never give birth again if you use contraceptives. Some say that injectable methods or pills make women weak and unable to have sex. They actually fear family planning.”
Such myths and misconceptions are also shared by many faith leaders and their followers in Siaya county—a predominantly Christian area. Like George, they have concerns about family planning based on their understanding of the Bible, believing it to be “against God’s will.” For instance, some Christian men and women view condom use as being forbidden or unethical. They cite the Old Testament passage (Genesis 38) where Onan dies after “spilling his seed”, as proof of God’s displeasure with contraceptives.
Rev. Gabriel Anyiko Owino strongly disagrees with this interpretation. “This is not an accurate,” says Owino, a respected Anglican priest in Siaya and a leading family planning advocate. “Onan was dealt with because of disobedience, not because he practiced the withdrawal method. Why should we bring children into the world to suffer, if we can’t take care of them? Jesus said, ‘I have come that you may have life in all its fullness.’ When women and children are dying, that is not life in all its fullness. As Christians, we are called to work together to help bring life to people.”
Improving the well-being of children and families so they can enjoy the fullness of life is World Vision’s goal. In 2013, the organization launched a three-year program 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. Funded by the Bill & Melinda Gates Foundation, MOMENT (Mobilizing for Maternal and Neo-natal Health through Birth Spacing and Advocacy) helps ensure that couples get the information and support they need to make informed family planning choices that are right for them.
“Health workers have been talking about family planning for decades. So why are people not using it?” asks MOMENT manager Bevalyn Kedogo. “Because of the approach used in the past. People’s values and traditions were not always considered or respected. They felt family planning was being forced on them. Many Kenyans believe that it involves killing unborn children, so they ignored or resisted information about it.”
Kedogo says that mobilizing faith leaders to debunk myths and misconceptions about if any family planning outreach is to succeed. MOMENT is using World Vision’s Channels of Hope (CoH) program to train and engage faith leaders.
CoH is a catalyst that transforms and motivates faith leaders, and their congregations to respond to tough development problems that affect their communities, especially related to child well-being. The program directly addresses their perceptions about volatile or taboo issues. It mobilizes faith leaders to break down walls of stigma and discrimination and respond with compassionate. Since the start of CoH for HIV/AIDS in 2005, some 400,000 faith leaders and their community members have participated in more than 17,700 workshops worldwide.
“Faith leaders can be part of the solution—not the problem—to many community challenges,” explains John Mwangi, national CoH coordinator for World Vision Kenya. “As a faith-based organization, World Vision speaks their language and understands their perspective. This enables us to engage them as champions.”
The three-day CoH workshop gives faith leaders a safe space to examine their own attitudes and beliefs about an issue in light of their sacred texts and sound scientific information. They have time and space to unpack important ethical and theological issues. They come to understand Scripture correctly, as well as the social and religious stigma and barriers around issues, such as birth spacing.
When World Vision offered the first CoH course on HTSP/FP in partnership with the Ministry of Health, Olivia registered immediately. She was one of 200 faith leaders from a wide cross-section of denominations who signed up. Spouses were invited to attend the training also.
“I suffered because of my ignorance [about family planning] and I didn’t want that to happen to other women,” she says. “I thought the training would be a good way to learn to help young married women in my community and my church.”
The course was an eye-opener for Olivia, then 35 years old. She learned about the importance of waiting at least six months after a miscarriage before trying to become pregnant again, as well as the risks that women face in giving birth after age 35. The curriculum also covers family planning contraception options and trains pastors how to refer couples to health clinics where trained professionals can advise on the methods right for them. Importantly, Olivia also gained fresh perspective on biblical passages related to family planning—insights and information she eagerly shared with George, who was unable to participate in the training because of demands on the farm.
“After the course, Olivia helped me understand that we are not called to fill the earth with children by ourselves,” reflects George. “We are called to be fruitful and care for the ones we have. It was not easy for me to accept that we would not have more children, but…I realize now that we are blessed to have three.”
Olivia, 37, says the training changed her ministry and her marriage. The violent quarrels with George are long over.
“When I turned 35, George told me to stop having children and rest,” says Olivia. “If it were not for the Channels of Hope course, we would not have reached this consensus. Now we can share and plan for our family together.”
Following the course, the faith leaders organized volunteer committees, known as Congregational Health Teams (CHATs), who educate and mobilize their congregations and communities to support HTSP/FP. They share scriptural principals that remind believers of their God-given responsibility to honor, uphold and restore the dignity and value of every human being, to help ensure that even the most vulnerable experience fullness of life.
They CHAT volunteers tackle myths and misconceptions, encouraging people to practice HTSP/FP to promote better health so that children and their families can enjoy life in all its fullness. They also provide accurate information on family planning methods and refer community members to local health clinic services.
The results of their outreach are impressive. In 2015 alone, the faith leaders referred 4,288 women to family planning services. More than half (2,817) are now using a method of contraception that is right for them.
Faith leaders have effectively increased the demand for family planning in Siaya county, says nurse Treza Onyango. And that has made her job a lot easier.
“We have seen a great change since the program began,” observes Onyango. “Because of World Vision, the community knows about healthy birth spacing. People walk in and they know what they want and how they will benefit from it because they have been informed.” She estimates that the number of women seeking counselling has doubled from 50 clients a month to more than 100.
She credits CoH-trained faith leaders for using their influence to promote family planning. “People trust faith leaders. If a pastor or minister or priest says it, they believe it is right for them.”
Onyango says her clinic is always stocked with family planning materials, which was not always the case before. MOMENT has worked with the Ministry of Health to ensure that supplies are available and has also trained more than 550 health workers like Onyango in counselling and technical skills.
Onyango says she has seen improvement in her patients’ health, too. “I look at the women and children who come to the clinic now, and I say, ‘Something is happening in this community.’ The mothers are healthier—they are gaining weight—and they have more time to take better care of their children.” She reports that levels of child malnutrition have decreased because more mothers are practicing exclusive breastfeeding longer now that they are spacing their pregnancies. “Women used to believe they had to stop nursing when they became pregnant again,” says Onyango.
Channels of Hope course graduates are among the new HTSP/FP converts themselves. Faith leaders and their spouses are “walking the talk”, practicing and modeling birth spacing in their own families. For some, this meant dismantling long-held convictions—both theological and personal.
Phanuel Odany Mbande admits that he “strongly opposed” MOMENT when he first heard about the program.
“In my church, we believe that things to do with reproduction and giving birth belonged to God and no man should interfere,” says Mbande, pastor of the Last Trumpet Call, an independent church with 800 members. “I quoted a lot of Scripture to support this. Meanwhile, my life was not pleasing to God. I had six children one year apart and I could not provide for them. My wife and I are farmers, but I could not do the work alone and she was always busy caring for the children. We struggled financially.”
Persuaded by fellow ministers to attend the CoH training, Mbande and his wife, Phoscoria, say it transformed their lives and equipped them to help others.
“I was very moved by what I heard at the course and felt [family planning] was the right thing for me to do personally,” recalls Mbande. “That same week, I buried a woman who died in childbirth. At the funeral, one of the mourners said to me, ‘You pastors are good at burying people, but what are you doing to save the lives of our women and children?’ I came to my senses and realized that God wanted me to share the information I had received through Channels of Hope.”
From opponents to advocates, Phanuel and Phoscoria now practice and preach about the benefits of birth spacing in their church and community.
“If we had had this information before, we would not have suffered the way we did,” reflects Phoscoria. “After the course, I went to the clinic to get implants and I began spreading the message in our church. I talk to youth about not giving birth before age 18 because your body is not ready. I talk to women about not giving birth after age 35 and the importance of delivering in a clinic, not at home unassisted. I teach the word of God and the good news of family planning. I want many people to be blessed by this message.”
The couple also share other life-saving health messages acquired from the training about exclusive breast-feeding and malaria prevention. Their own six children are now measurably healthier. And Phoscoria has started a market gardening business with the additional free time she has now that her last-born is three years old.
Phanuel says many in his congregation have embraced family planning. They also appreciate his new attitude and humility, according to youth group member Jacqueline Olola, 26.
“Before you couldn’t talk about anything to do with family planning with Pastor Mbende,” says Olola. “I got the sense that it was somehow evil. After he came back from the [CoH] course, he was very open and started sharing information about birth spacing with us. I was so relieved, and I told him what happened in my past.”
Olola confided in Mbende about her abortion six years ago—a secret she had entrusted to no one. He invited her to reach out to youth and join the church’s newly-formed CHAT committee. Today, she boldly shares her story across the county in workshops and meetings. “I’m a living example of change. Now I use a family planning method called abstain,” says Olola, with a laugh. “I hope to get married soon, and I’d like to have three children in the nine years left before I reach 35.”
Mbende says the CoH training motivated him to examine and reflect on other areas of his life and teaching. “As pastors, sometimes we just quote words and don’t dig deep into the meaning,” says Mbende, a gentle, soft-spoken man. “We lead others astray because we are not interpreting the Bible in context. As leaders, we should be the first to understand. If you are astray yourself, eventually the whole flock will be nowhere.”
Determined and motivated, the Mbendes are now game-changers in their community, along with more than 200 fellow faith leaders and their spouses Their vision is ambitious if not audacious: zero maternal and infant deaths in Siaya county.
“My prayer is that I continue to be a channel of hope myself and that this program is spread across our county and our country,” says Mbende.
[i] Kenya Demographic and Health Survey 2014. http://dhsprogram.com/publications/publication-FR308-DHS-Final-Reports.cfm
[ii] World Vision MOMENT poster.
[iii] World Bank, Maternal Mortality Ratio. http://data.worldbank.org/indicator/SH.STA.MMRT
[iv] World Vision MOMENT poster.
[v][v] Cleland John, Agustin Conde-Agudelo, Herbert Peterson, John Rose and A. Tsui. Contraception and Health. The Lancet. July 1.14o trained health workers liketerson, John Rose and A. Tsui. dren. "acticiing clinicable and also trained health workers lik2014.14o trained health workers liketerson, John Rose and A. Tsui. dren. "acticiing clinicable and also trained health workers lik
[vi] MOMENT project proposal.
[vi] Statistic provided by O Solomon Osaya, Sub-county Public Health Nurse, Siaya, Kenya