Nina Achieng walked into a clinic in Kenya’s largest slum, Kibra, hoping a doctor would inform her of the contraceptive options available. Instead, she was met with a long pause and the sharp sting of being judged unfit to decide for herself.
That moment, she says, sent a clear message, she was mentally ill, therefore invisible. Capable enough to mother three children, but not trusted to choose when, or if, she wanted another.
“The discomfort in the room was noticeable, as if the question was out of place. That single interaction left me feeling undeserving of reproductive choice. It was in that moment that I realized access was about being seen, heard, and respected,” said Achieng’.
Achieng’, is a mother of three who lives with bipolar disorder, a condition she said she manages with medication, therapy, and her commitment to advocacy. Early in the morning her house is still quiet, she takes her medication with warm water and scribbles down her thoughts in a small green notebook. “ It’s part of the daily routine that I have developed to keep my bipolar disorder in check. This grounds me before the world begins to demand too much,”said Achieng’.
Her three children, prepare for school while she checks their uniforms, smooths their collars, and ensures no one forgets a book . “It’s chaos,” she laughs, “but the kind that makes me feel alive,”she added. After her children leave for school, Nina then prepares for the rest of the day. “Some mornings, I attend therapy or follow ups on my medication at a local clinic in Kibra slums,”noted Achieng’.
She described how for over a decade, she has been among strong voices for reproductive justice for individuals living with psychosocial disabilities.“We are often denied our sexual and reproductive health rights,my experience led me to this path,”added Achieng’.
“My partner understands my condition and we live in harmony, He took time to learn about my triggers and supports me during difficult moments without judgment. We have created routines together that help me manage my mental health, like attending therapy and maintaining a calm environment at home. His patience and open communication have made me feel valued and respected. With his support, I’m able to focus on my wellness and parenting without fear or shame,” said Achieng’.
“I use my psychotropic medicine on a daily basis which helps me calm my condition. It has become part of my daily routine and plays a crucial role in stabilizing my moods. It helps me manage anxiety and episodes of depression, allowing me to function more confidently in my daily life. Although some days are still challenging, the medication gives me a sense of control and balance. I also pair it with therapy and self-care practices to support my overall well-being,” added Achieng’.
“People assume we are either incapable of having relationships and too unstable to make decisions,” she said. “But we love, we have desires, and we deserve the same access to information and care as anyone else. My advocacy journey was born out of frustration and later, transformation after being dismissed by healthcare providers who failed to explain to me the various contraception options I would have chosen at the time,”she noted.
“I had opted for a contraceptive since I was sexually active at the time and I was not ready to be pregnant, but on requesting the service, I was left on my own.” My condition contributed to being denied the option for choice. The doctor made a quick judgment on my request. I never received help and went home frustrated. I visited a different health facility and got the help I needed. I was given pills that I used and I still use that type of contraceptive today as I am comfortable with it,” said Achieng’.
These happenings propelled me to work with community health networks to push for inclusive and respectful services for people with mental disorders. “A mental disorder does not erase one’s humanity or their right of choice. We deserve to choose too.” Achieng’ insisted.
According to the World Health Organization, 16% of the global population, approximately 1.3 billion people live with disabilities. This includes physical, sensory, intellectual, and psychosocial impairments. Contraception is a cornerstone of preventive health allowing people to determine if, when, and how they want to become parents. But for persons with mental disorders, existing research shows that access to these services remains uneven, despite existing policies and international frameworks promoting inclusive healthcare.
Expert Perspectives
Dr. Linda Mwangi, a reproductive health expert based in Nairobi, noted that supporting persons with mental disorders in making contraceptive choices is ethical and requires consent.
“The priority must always be the person’s choice, safety, and dignity,” she explained.
She emphasized that mental illness does not negate the right to autonomy. However, certain psychiatric conditions may affect memory and decision-making, making the selection of contraception methods more complex. In such cases, the involvement of mental health professionals and caregivers is essential.
“Forced contraception is unethical and illegal,” Dr. Mwangi warned. “We must ensure people understand their options and are making informed decisions by not being coerced.”
Among the options Dr.Mwangi recommended are Long-Acting Reversible Contraceptives (LARCs) like implants or IUDs, Injectables, Barrier Methods, Oral Pills, and Sterilization, only when fully understood and voluntarily chosen.
“Kenya’s national data shows how widespread contraceptive use is among the general population but it rarely captures the barriers faced by persons with mental disorders.” Data from the 2022 Kenya Demographic Health Survey (KDHS) shows that 63% of married women aged 15–49 use some form of contraception while 57% use a modern method. Injectables (20%) and implants (19%) are the most popular among married women. Among sexually active unmarried women, 70% use contraception, with the male condom being the most common method.
Call for Justice
Achieng believes that change lies in visibility and education. Through workshops, community outreach, and digital platforms, she challenges long-standing myths and stereotypes about people living with mental disorders. “We’re not invisible. We’re not broken. We have a right to control our reproductive futures,” she said.
She urged healthcare providers to undergo disability inclusion training. She called on policymakers to collect data, allocate funding, and develop programs that specifically address the needs of persons with mental disorders. “Healthcare is not charity, it’s a right. And that includes access to contraception for every person, regardless of their mental health status,” added Achieng’.
Dr. Mwangi recommended that persons in need of contraception, especially those living with mental disorders, should visit trusted organizations such as Marie Stopes Kenya, which offers affordable, high-quality family planning services.
