The Kenyans saying no to motherhood and yes to sterilisation

For as long as Nelly Naisula Sironka can remember she has never wanted children – and with one irreversible decision the 28-year-old Kenyan has ensured she never will get pregnant.

Last October, she took the definitive step of undergoing a sterilisation procedure known as tubal ligation – permanently closing the door on motherhood.

“I feel liberated,” the organisational development expert tells the BBC, adding that it has ensured her future is now entirely her own.

The operation prevents pregnancy by blocking a woman’s fallopian tubes and is sometimes referred to as “getting your tubes tied”.

Between 2020 and 2023, roughly 16,000 women in the East African country underwent tubal ligation, according to Kenya’s health ministry.

It is unclear, however, how many of these women were childless at the time of the procedure.

Yet Dr Nelly Bosire says the kinds of women coming forward seeking sterilisation in Kenya is changing.

“Traditionally, the most common candidates for tubal ligation were women who already had multiple children,” the Nairobi-based gynaecologist told the BBC.

“But now, we are seeing more women with fewer children opting for the procedure.”

Sterilisation is only recommended for women who are certain they do not want to have biological children in the future, as reversal is difficult.

“Doctors don’t typically encourage tubal ligation because the success rate of a reversal is very poor,” said Dr Bosire.

Despite coming from a large family, Ms Sironka said she never felt pressured to start her own – though societal norms in Kenya do place an expectation on women to have children.

She credits her father with her stance as he encouraged her to focus on education – and gave her a love of reading.

Books by US feminist authors like Toni Morrison, Angela Davis and bell hooks were a revelation.

“I interacted with women’s life stories that didn’t feature children at all,” said Ms Sironka, who is now the chief of operations at Feminists in Kenya, an organisation which works to end gender violence.

“It made me realise that a life like this was possible.”

She had contemplated sterilisation for years, but decided to go ahead after saving up the money for the operation and finding herself in a stable job that allowed her to take time off.

It cost her 30,000 Kenyan shillings (£190; $230) at a private hospital.

Ms Sironka felt that women’s rights were being eroded around the world – especially as women in the US lost the constitutional right to abortion in 2022, which also influenced her decision.

It made her fear that a woman’s right to control her own body might be eroded elsewhere – and that she should do the procedure while she still could.

“Within Africa and in America, there has been a rise in fascism and authoritarian regimes, a perfect example of such is Kenya,” she argued.

When she told her family, it did not come as a surprise to them, as she had always been very vocal about her desire for a child-free life.

And as for dating and relationships?

“I’m still thinking about it,” she said with a shrug.

And Ms Sironka is not alone in choosing a child-free life, challenging traditional expectations of womanhood.

Across social media, there are those speaking openly about their choice not to have children and undergo sterilisation.

Among them is Muthoni Gitau, an interior designer and podcaster.

She shared her tubal ligation journey in a 30-minute YouTube video last March, explaining her decision to have the procedure.

“I think the first time I ever articulated… [that] I did not want to have children, I was about 10,” she told the BBC.

Her mother was heavily pregnant at the time, and a random question about her future popped into the conversation.

“I saw a possible partner. I saw travelling. I just never saw children,” she said.

Like Ms Sironka, Ms Gitau’s decision was driven by a strong conviction to live life on her own terms.

After trying birth control pills, which she said made her nauseous, she sought a more permanent solution.

When she first approached a doctor about tubal ligation at the age of 23, she was met with resistance.

She was given what felt like a sermon about how children were a blessing from God.

“He asked me, ‘What if I meet someone who wants kids?'” she said.

The doctor seemed to have more consideration for an “imaginary person” rather than the actual patient sitting in front of him, she said.

Ms Gitau said the dismissal was “heart breaking”. It was another decade before her wish was finally granted.

Dr Bosire points out that a significant challenge in Kenya is getting medics to shift their mindset and truly appreciate a patient’s right to make decisions about their health.

“This ties in with our culture, where people believe it isn’t normal for women to want a tubal ligation,” she said.

Another Kenyan gynaecologist, Dr Kireki Omanwa, admitted the issue was a matter of debate amongst colleagues and in medical circles.

“It remains inconclusive,” he told the BBC.

But Ms Gitau was not deterred and last year approached another doctor – this time at a non-governmental organisation that provides family planning services.

She was armed with a bullet-point list of reasons to support her decision and was relieved to find there there was no pushback: “The doctor was very kind.”

Currently single, she is living happily with her decision, which she feels gives her control over her own life.

The 34-year-old is also happy with the reaction to her video – and relieved that there has been no major backlash.

She says most people online have been cheering her on, which has seen her confidence grow.

“Women can contribute to the world in so many other ways,” she said.

“It does not have to be through raising a whole human being. I am grateful to live in a generation where choice is a thing.”