 Good morning once again, my name is Joy Mochache. Welcome back to the Why In The Morning show. You are watching the Health On Monday show. My name is Joy Mochache once again. You can find me on Joy underscore Mochache. And remember if you want to interact with us, you can do so now. Social media handles are right there at the bottom of the screen. And all you have to do is put the hashtag why in the morning and hashtag health on Monday. And please, you guys, I'd like you guys to welcome a very special lady. We've been interacting. She seems pretty cool. Her name is Dr. Ann Wyn Johe. And she's here to tell us a little bit about contraceptives and sex and how it's affecting our youth today. And actually she's going to be telling us a little bit about her practice just before we start this discussion and where she's practicing at. And then we'll start the discussion. Karibu Nisana and welcome in joining me, Dr. Ann Wyn Johe. Thank you so much, Joy. Welcome back. Thank you. Thanks. Yeah, so where are you practicing at? Yeah, my name is Dr. Ann Johe, as you have said. I was working at PCA Kikui Hospital as a medical officer intern. Currently, I'm a medical officer and I'm also involved in advocacy for the youth. Throughout my internship, throughout my undergrad, I was involved in respect. It's a program for educating the teenagers on reproductive health and sexual health. Oh, so that's quite fitting for today's. Yeah, it really is. How did that experience go? It was just a program that was started by Medical School Association of Kenya. So most medical schools in Kenya, if you were interested in advocating for the youth and advocating for their reproductive health and sexual health, you could join. So it was something that I cared about and I joined it. I see. Well, that's quite fitting because today we're talking about things to do with the production, but we're talking about contraceptives. Yeah. And of course, if we're going to be discussing contraceptives, we can't do that without discussing the connection to sex because they are connected ultimately. Yeah. And so the reason why I decided to discuss this topic today is actually first and foremost, this is something that a lot of people need in their lives in order to plan their families, in order to keep things in such a way that their income at home can be controlled and also that the children at home cannot go out of number. And that's exactly how contraception actually came into the picture. Contraception actually was first created for that purpose, for the sake of helping families out and trying to curb the overgrowing of families and other methods that we're going to be talking about today that people are trying to use in order to curb unwanted pregnancies and things like that and unplanned pregnancies. But for today, we want to talk a little bit about more controversial things but just for a second. But right now, we want to talk about the most important and the most basic contraceptives that people not normally tend to use. And some of those, actually, some of those are things like the oral contraception which you all know, which ladies take every single morning. We also have the female condom and the male condom. And these are also used by people on a daily basis and also the IUD, which doctors are going to tell us why it's not so common but also one of them. And we also have the coitus interrupters, which many people know well. It's when a male decides to pull out and also spermicide, which is actually an ointment that you apply in order to reduce the reproductive cells of sperms. And there's so many. The list goes on and on and on. Doctory. We can't find it in Kenya. And those ones are the vagina, well, not find here, but maybe you can, but it's so difficult. So that's the vaginal ring, the diaphragm and the patch. Can we talk about why they're so difficult to find? And then we'll focus more about the ones people have chosen to use. Okay. So the diaphragm, the vaginal ring, the patch, some of them have hormones inside them. But the reason why it's difficult to find them here in Kenya is usually because of the price, the price tag that are associated with them. And then remember we are living in a country where there are people who are doing well financially, there are people who are not. Okay. And we have to cater. In terms of health, we have to cater for all groups, whether you're doing well and whether you're not doing well. So usually the people who are not doing well or people who are young, the places that they will go to are government facilities or mission-based facilities. And these facilities might not have this diaphragm's vaginal rings and usually it's because of the price tag. So the government facilities offer specific types. So they will offer condoms, they will offer pills and they will offer them usually free. So obviously someone who does not have the means, especially the young people or someone who does not have that money, they will end up going to the government facilities and using this rather than using the diaphragms, the patches, etc. But they are there, they are there, yeah. They are there. They are, but like in high-end facilities. Yeah, and at a high cost as well. Yes, and at a high cost, yeah. So that's not very useful to our population right now. It's not really useful. Because our population is very skewed towards, most of the people tend to be under the, actually under the, wow, under the poverty line, literally. Yes, sure. Most of our population. Over 50% of our population is under the poverty line. Under the poverty line. So these particular ones are not going to cater to them. True, true, very true. What's the point of them bringing them into the market? Why can't we focus on bringing all types and all sorts of the free ones? And right now I know that in offices, actually most offices, they tend to keep condoms in the toilets and the bathrooms. Those are free. Yes. And that's excellent, of course. Yes, of course. Because some people just don't want to spend that money. True, true. And because you don't spend that little money, you end up risking your whole entire life. Yes. So that is excellent. Yes. But then why, why would they, I don't know, maybe do you have an idea as to why, what's the point of providing these high-end ones when we have such a high population of people under the poverty line? Okay, what I can say, and this is a part that not many people say that the government has really tried in terms of reproductive health. And I say this because the government tries to reach people all the way, Hadi Mashinani, let's call it that, yes? Yes. So for the small health facilities, they will mostly just, they will provide what is the basics. So the basics are the condoms, the basics are the pills. It's not for everyone, but usually it's there, yes? So the high-end ones, the high-end, the diaphragms, the patches, they're usually provided by the private facilities. Yes. So if you want them, if that is what you're interested in, you go to the private facilities, but the government really does not offer this. I see. Yeah. Okay. So now that we've covered some of the ones that we can't find and why it's hard to find them in first place, maybe we can talk about, now, focus on what people are using on a daily basis. So our youth nowadays, what do they tend to run for when it comes to contraceptives? When we're talking about youth, because this is a youth-based channel. Yeah. We're talking about teenagers or people who are just above the age of puberty, adolescents, just above the age of adolescents. What do they tend to run to? As an expert, what do you see them tending to run to when it comes to a contraceptive? Okay. So what they will usually run to, we classify them into two types. We classify them into temporary and long-term. So usually the youth will go for the temporary ones and the temporary ones, I'm talking about condoms. I'm talking about the oral contraceptive peel. I'm talking about the plan B, what is called the postinotu. Or P2. P2. Yes, the P2. That's what they usually run to and then the long-term ones. Okay. So the long-term ones are usually the ones that you put the IUCDs, you put them through the uterus and it's put through, it's put by a medical professional, either a nurse who is trained or a doctor who is trained, or the ones that usually go through the hand. It's called Implanon or Jardel. I'm sure you've heard these names. Yes. Yes. So usually why the youth will go for the temporary ones is because they don't need someone to help them to put it. You see, like for example, they can do it themselves. They can just go and you don't even need, currently you don't need a prescription. So you just go and talk to your pharmacist or whoever and say that I need this. I need a condom so you just buy it. You understand? Then second, they're not doing it for family planning. Most of these people who are just out of puberty or they're just young, they're not yet in family, a family setup. You understand? Yes. The long term, the Jardel, the IUCDs, usually it's someone who's had a baby or two, maybe in a family relationship, they're married and they want to plan their baby. They want, I want five years to rest and then I get another baby. So in that way, that's when they will use the long term ones. So because the youth are just, they're breakthrough in the sexual health. So they're just starting to have sex. Also, they are not planned. You understand? So that's why they will take the temporary ones. So they'll take the condoms, they'll take the pills, the P2, they'll take the spermicide, something that they can use. No one can tell them, you know, something that they can easily access. Yes. They can buy themselves. Yes. They can use it themselves without asking for assistance. Exactly. So discretion is the key. Yes. Discretion. Yes. Discretion is something very, and I think it cares quite a number of people, you know. Which is my next question, actually, because I do feel like our youth may run to these temporary measures exactly for that discretion. And now let's touch a little bit about discretion when it comes to contraceptives because this is something that I think even for shamed to buy in the shops. That's very true. You're going to choose the dingiest place to find this. That is very true. Where nobody knows you. That is very true. And wait until the line is like finished. As in, people go through lengths to get these things. Yes. And then you can go to a journey, like, hey, Tuskees, like Shikapap, you know. And so I just want to talk a little bit about the discretion and when it comes to our youth specifically. When they do tend to choose these temporary methods and they want to be discreet about it, is it because they're trying to be discreet because they feel that if they share that, hey, I'm having intercourse or I'm having sex, they might get some judgment or is it because they feel like if they share to their friends or to their parents that, hey, I'm using a contraceptive of this kind and of this kind because I don't want to get HIV or AIDS. They don't want to get some kind of judgment. Is that the reason why they might be wanting some kind of discretion? Because I couldn't think of another reason why, but I could be wrong. Yes. I think you are so right. You are so right about that. The first thing that really affects the youth currently is that shame and I feel like it's a shame that is carried all the way from our home setup. Yeah. I feel like it's a shame that is carried all the way even amongst from the school setup from wherever. Yes. That first of all we are taught to approach sex as something of shame rather than something that is a normal human function. Yes. That actually the World Health Organization insists that reproductive health and sexual health should be safe, should be accessible. Accessible. Accessible and should include freedom of choice. Do you understand? Yes. But if you are approaching sex as something to be ashamed of and usually this is seen so many times even in universities, the first thing that someone will do there will be someone who is selling P2 from his suitcase and you will prefer to go and buy the P2 from someone who is selling from a suitcase then walk to a pharmacy and buy. You understand? Yes. Because maybe you are afraid that if I go to the pharmacy someone will see me. Yes. Not only will someone see me Yes. They will judge me what I knew on that day. Like why did you have sex without a condom? Now you come to buy P2s. Yes. Now it's even more scary. Even condoms are something of shame. You're even afraid to buy the condom. So usually they will either buy from illegal sources or they will prefer not to have. Not to have, not to even use the condom. So they go with the coitus-interruptors method? Yes they just go. Exactly. And how many people who are young can actually have the coitus-interruptors method is one amongst the highest failure rates? Because how many people have that self-control? Not very many. It's something that comes with age. It's something that comes with experience. Maybe this is a young boy or 15 years old who is the first, this is the first time the first time they're doing it. They might not have that control and that is the truth. Yes? That's true. So really at the end of the day is that you will see these young girls, these young boys who are afraid to even access, access to even walk and say I want it, to even see. So no wonder again I said I applaud the government by trying to even put those condom dispensers in schools, in public places. So that someone can just take. No one can know that you're taking but someone can take even if it's in a loop. I think it's something good but it's not common and people are ashamed of it and it's a shame that is carried all the way from home from our friends that we don't want to talk about it. We don't want to talk about that our health it has to be safe, accessible and with freedom. Exactly. And we're going to come back a little bit about talking about these substance, these things that are sold from the suitcases, these contraceptives. But before we do that I also wanted to kind of tie in the whole topic of shame with the fact that it begins at home with a question of is it because our parents maybe don't do that awkward awkward let's sit down like no we're going to sit down for about an hour we're going to talk about this. This is not something we're going to talk about for 10 seconds just in passing. No, we're sitting we're talking about this for a very long time and we're going to do it for repeatedly until it gets in here. So is it maybe an issue that parents are not doing that properly because nile shame as well coming from the parents. Then again you have to remember they've been brought up in a different generation. This is very stuff you don't discuss in the generation where parents have come from. And so for them it's sometimes but also at the same time they also have the knowledge and since things have been narratives have been pushed along advocates have been pushing along narratives that hey as a parent this is something you must do. So at the end of the day they do that just when you're going to bonding. In the car even or just at the bus stop when you're holding your things about to climb up they do that kind of thing for don't you find it to be a buyer or something. And it's like what is to be a buyer and why shouldn't I do it and why can't I do it and still be safe. And so this kid goes with a lot of questions goes to school can't talk about it in school once again because now he's filled with a whole bunch of kids whose parents don't tell anything to anyone so they're filling each other with ideas. Ideas like sex is this, sex is this to bring by need, they are not easy. So it builds up a whole idea for them that is not necessarily true. It comes from university and then they're ready to try it out maybe some have tried it even in high school some even in primary. So comes university they don't want to get the condominium open like you said. And so do you think that yes it does set at home and once you do answer that question we'll come back to what we were discussing before about getting things from the suitcases. Okay, alright. So today it does start from home I would say that it does start from home and I would say that as much as parents are bringing us up they're also bringing us up mentally. And it's very hard to break through a mental if you're making a safe house because that's what our parents are there for to create a safe house for us and it's not just giving you shelter it's not just giving you food it's also also building your mind yes and I think building the mind is one of the most important things but parents are afraid of it not only parents guardians are because they feel like if I talk about it then I'm encouraging it you understand that I'm encouraging it if I talk to you about sex you know that there are so many families where even the word sex cannot be spoken about again this parents who grew up in an age where they didn't ever even see their parents engage in any physical activity not even like a handshake it was Babanani and that is your wife so even like any physical contact so you can tell that that barrier is already there it's still there but the truth is that this discussion has to be done and the reason why is that parents are building create a mental safe house for your child let them know let them be armed with knowledge and with the ability to make decisions because please repeat that let them be armed with knowledge and the ability to make decisions very important not making decisions for them it's giving them knowledge and letting them choose wisely and once and believe just like the way it's written in the Bible bring up a child in the way he should go and they will follow it up even in adulthood that remains the truth when they depart they will come back because they know and that is the thing if you tell them first of all I even have a problem with the use of the word tabiambaya in regards to sex because it already gives a negative connotation to sex bad manners yes that it's bad manners and the truth is that it's not it is just a human function it's actually a gift from God it is a gift from God and the truth is that even every gift from God if not used in the right way if not used with knowledge becomes a curse that is the truth you can have so many gifts from God but if you don't use it the right way and that's the same way with sex now the thing is that teenage pregnancies are on the rise in Kenya sexual violence is also a problem in Kenya and that is why you have to be able to create that mental safe house as a parent tell them what sex is tell them the right age to have sex an age of understanding mental understanding tell them the consequences of sex the benefits of sex talk to them and then tell them what are their options if you are not capable of doing it yourself get a reproductive health professional take them to a clinic let someone else talk to them get a nurse to talk because that is their job get someone to cancel them have someone who knows what they are talking about teach them let it not be that they are learning as you have said from each other people who don't know what they are talking about are the ones feeding each other so that's the sad part that's the sad part and you don't want even kids to have fear in their mind because once you have fear in your mind you do those things you behave like you are ashamed you behave like you are ashamed to go and get those condoms you have that fear but once you know about yourself about what sex is in your life then you can make good decisions and I think parents are so they are a key in creating a safe house a mental safe house of knowledge for their children okay, that's very true and then before we actually I don't know if our producers can bring up the one question that we had posted to our people we want to know when your people will talk to you about sex and how that conversation went with your parents was it an awkward thing or was it a comfortable thing that didn't even happen at all or in Bakasai your conversation just didn't happen no no so we just want that little feedback from you guys feel free, feel comfortable once again, this discussion is not here so we can encourage young people to have sex no, not at all, we're not doing that we're here to disseminate knowledge about sex and contraceptives once again so that people can have the ability to make wise decisions on their own and maybe we can move on to discuss the effects now we talked about the fact that there's a stigma around it this kind of taboo in our society in our homes and our people have reached a point where they're getting P2 from the suitcases now they get the P2 from the suitcase what happens within their body at that stage, is there any effect that these things happen and what makes it fake what makes them fail because if it's coming from a suitcase even the condoms, most of the time it's not legit actually almost, I think 100% it's not a legit product it's going to fail them and some of them are not aware of that and so it's just kind of wondering what are the effects that may hit these people when they use such things and let's say when a tumiaquilasa and someone maybe has low sperm count or a girl simply can't get pregnant and she keeps using this P2 she thinks it's working and it's not working, she doesn't know she's simply maybe infertile and then it creates some kind of problem in the uterus because it has chemicals it should not be having what do you know about this doc? what I can say let me start with P2 because it's quite common apparently one of the most counterfeited drugs in Kenya and in Africa is actually P2 and the reason is because it's so easily everyone wants it and everyone wants to buy it from whatever corner this is a public health issue that actually people who are selling such fake drugs should be in jail you should be in jail you should be fined for it but the first thing that needs to be done is people need to protect themselves against it and understand you understand by knowing what true P2 looks like should plan B or whatever you call it plan B, morning after pill that it needs to be taken from legal sources legal sources means a governmental facility maybe a private health facility a pharmacy that actually has a certificate that it's supposed to be selling because not all chemists and pharmacies some of them are also fishy places you go there and you're like how am I buying a drug that's supposed to be sold at 150 to 200 for 25 bob or for 50 bob cause they're sold for that but in your head you're not thinking that you're just like oh what a deal I have a buggy and usually now the thing with these counterfeited drugs there are two things they could be placebos completely there is nothing inside that drug it's just a white pill it's just a white pill that has nothing so usually what happens with such is that you can easily get pregnant of course because it doesn't have the desired contraceptive effect usually those are the safe ones they're the good ones if you just have a placebo drug the one that has nothing inside it the ones that are dangerous are the ones where they are selling drugs that has another ingredient for example you could be sold for an anti-diabetic medication they just take any drug but you see those drugs now are dangerous because for example a drug like that a drug like that can lower your sugars and you can end up fainting so you'd actually rather have even the white pill that has nothing rather than the other drugs they can just get any drug that looks the size of the p2 and then they give it to you and tell you that this is p2 or tell you that this is the daily pill actually the truth is that there are so many counterfeited drugs in the market and it is a public health concern because you don't know what it can do to this person either it can result in pregnancy or it can result in other side effects depending on the drug they are giving you because they can be giving you anything yes yes yes so the first thing that needs to be done is you need to know that currently you need to look at the date of manufacture the date of expiry the active ingredient even google it just google just ask p2 what should it have inside and look at it and you should come up with it what you are seeing on the box and then is it closed is it something that does it look like something that has been tampered with look at the manufacturer as well and then at the bottom there is usually a logo to scratch off and it is also written original the fake ones usually when you scratch it off there is nothing written there is like a white part for scratching but then there is nothing yes yes yes so you purchase and then you scratch and you see whether it is written original you need to always approach these things with knowledge and wisdom first go to a legal source even if you want a place that is cheap or rather you go to a governmental facility or a government pharmacy or all this private pharmacies as well it usually goes for around 150 to 200 bob or even condoms whichever condoms sometimes are free or they are the ones that are sold for cheap by those ones and then look at it look at examine it and see and if you do know someone who is actually selling these things that are fake whatever fake drugs you should actually just report to the chief's office there is a public health officer who should actually come and take those drugs so the measures that have been put in place are just in case of this but you see people don't know about them so they even fear so they buy this and they just go in their way and whoops I'm pregnant yes whoops I'm pregnant or I'm just having funny side effects I've been fainting I'm bleeding excessively because you've been given another drug or a fake drug so it's a whole problem and it's a public health concern because sometimes even anyway no it sounded like you were going to say something quite important no no no to me it's a heart breaking issue because people take advantage of people who don't know and people who don't know what to do what to use how it should look like so taking advantage of only one or two who doesn't know and it's a bit too naive and innocent well it's a pretty sad situation and like you said and I think the only way we can curb this is once again everything starts at home I don't think there's something that everything starts at home so whatever you're doing as a parent or whatever it is even as a child if you're having a free relationship with your parent or comfortable relationship you can or if you don't the internet is there thank God for Google but then we still think that this is a sit down kind of conversation because you need a back and forth back and forth interaction when trying to understand contraceptives and sex it's not just something you Google and understand you need to ask some questions you need to be given proper information and you need to do that with an expert and first and foremost do stay safe in any sexual interaction once again we're not encouraging it but in the event that this does happen do have safe measures put in place so that you don't have any mishaps and mistakes that you're going to look back on you're young you have a long wonderful life to live so think twice before you make any mistakes thank you so much for tuning in this has been a wonderful talk on sex and contraceptives we're the wonderful Dr. Juan Jorri, very abled and wonderfully first on this topic coming up next is Barry with Youth and Politics and this has been one in the morning my name is Joy Mochache Santemi Sana