A Call for Menopause Inclusion in Kenya's Health System

Kenyan women, like many globally, often navigate menopause with limited support and awareness. While countries like England are moving to integrate menopause questions into routine health checks, a similar proactive approach is urgently needed in Kenya. Experts and advocates are calling for the Ministry of Health to embed menopause into national health policies and routine check-ups, aiming to break the pervasive silence and stigma surrounding this natural life stage.

The transition to menopause, which typically occurs between ages 45 and 57 in Kenya, brings a range of symptoms including hot flashes, night sweats, mood swings, depression, and sleep problems. These symptoms can significantly impact a woman's quality of life and productivity. A study in Kiambu County found that menopausal women experienced a 38% decline in productivity, twice the rate of their non-menopausal peers. Despite this, menopause remains largely unaddressed in Kenya's public health narrative, often dismissed or medicalised without adequate support.

Historical and Political Context

For decades, discussions around women's reproductive health in Kenya have largely focused on menstruation, maternal care, and family planning, often overlooking menopause. This has created a significant gap in policy and public understanding. However, there has been a growing movement to bring menopause into the national conversation. Lady Justice Njoki Ndung'u of the Supreme Court of Kenya has highlighted the legal framework supporting women's rights during menopause, including the right to health and dignity. Similarly, Millie Odhiambo, MP and Minority Party Whip in the National Assembly, has emphasised the need for government attention to chronic conditions affecting older women, including those related to menopause.

Organisations like Menopause Solutions Africa, founded by Sue Mbaya, are actively working to raise awareness and normalise menopause across the continent, including in Kenya. Femnet, a pan-African feminist organisation, is also pioneering the recognition of menopause as part of its female empowerment agenda in Kenya. These efforts are crucial in challenging negative cultural beliefs and societal norms that often marginalise menopausal women.

Laws, Policy, and Governance

Kenya's National Reproductive Health Policy 2022-2032, developed by the Ministry of Health, reflects a commitment to providing high-standard reproductive health services and achieving universal reproductive health coverage. The Constitution of Kenya 2010 also provides for the right of every person to the highest attainable standard of health, including reproductive health. While these frameworks exist, specific provisions and guidelines for menopause care within national health checks are still lacking. Integrating menopause into these policies would ensure that women receive comprehensive care throughout their life course, aligning with Sustainable Development Goals 3 (Good Health and Well-being) and 5 (Gender Equality).

Stakeholders and Testimonies

Many Kenyan women, like Veronica Nyakoboke, have shared experiences of confusion, isolation, and unpreparedness when facing menopause. Nyakoboke's initiative to start a WhatsApp support group, Ova Circle, which quickly grew to 2,000 members, underscores the immense need for open dialogue and support among women. Dr. Nelly Bosire, a gynaecologist, notes that many women do not realise what is happening until they are deep into symptoms, while dietitian Betty Okere highlights common issues like sudden weight gain and aching joints that women often do not associate with menopause.

Healthcare professionals also face challenges. Dr. Kireki Omanwa, president of the Kenya Obstetricians and Gynaecologists Society, has pointed out the lack of localised data and specialised menopause care in Kenya, contrasting it with more developed health systems.

Evidence and Data

• Prevalence of Symptoms: Approximately three-quarters of women globally experience menopausal symptoms, with a quarter describing them as severe. In a study in an urban community in Kenya, mood swings were reported by 74.1% of women over 50, and hot flashes by 41%.
• Age of Menopause: The median age of menopause in a rural population in Western Kenya was found to be 48.28 years. Globally, the average age has shifted from around 45 in previous decades to between 51 and 53 years, with some women experiencing it as late as 57.
• Impact on Productivity: A study in Kiambu County indicated a 38% decline in productivity among menopausal public hospital health workers.
• Awareness Gap: Many women in Kenya are unaware of menopause and its symptoms, often attributing changes to general ageing.

Risks and Implications

The lack of awareness and support for menopause carries significant risks. Beyond the immediate discomfort of symptoms, untreated menopausal changes can lead to long-term health issues such as osteoporosis, cardiovascular diseases, and increased incidence of bone fractures. The economic implications are also substantial; globally, menopause-related absenteeism and productivity losses are estimated to cost over $150 billion annually. In Kenya, the absence of workplace policies addressing menopause means many women consider quitting their jobs due to debilitating symptoms.

Unknowns and Controversies

Despite growing advocacy, there remains a critical shortage of health experts trained in menopause at the community level in Kenya. There is also limited localised research on the specific symptom patterns and social stigma experienced by Kenyan women, which is crucial for developing responsive and equitable policies. Cultural myths and misinformation continue to shroud menopause, contributing to stigma and isolating women.

Timeline and Next Steps

While England aims to implement menopause questions in health checks from 2026, Kenya's timeline for similar integration remains undefined. The ongoing advocacy by various organisations and individuals is a crucial step towards initiating policy changes. The Ministry of Health, in collaboration with stakeholders, needs to develop clear guidelines and training programmes for healthcare providers to effectively address menopause during routine check-ups. The World Health Expo (WHX) Nairobi 2025, supported by the Ministry of Health, is set to discuss advancements in healthcare, including initiatives like 'Women 50/50' which promotes gender balance in healthcare leadership, potentially offering a platform for further discussions on menopause.

What to Watch

Watch for further developments from the Ministry of Health regarding the integration of menopause into national health policies and routine screenings. The impact of ongoing awareness campaigns by organisations like Menopause Solutions Africa and Feminists in Kenya will be critical in shifting public perception and encouraging more open conversations. Additionally, observe how the discussions at events like WHX Nairobi 2025 translate into concrete actions for women's health in Kenya.

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Kenya has made strides in other areas of women's health, such as cervical cancer screening and HPV vaccination programmes. By 2023, over 1.3 million adolescent girls had received the HPV vaccine. Initiatives like community-based cervical cancer screening using HPV DNA testing have also been piloted in Nairobi. These efforts demonstrate the potential for successful integration of women-specific health concerns into the national health agenda, offering a precedent for menopause care.