By Joyce Chimbi
*Charlotte Anyango was only 13 years old when she attended her first disco matanga, a popular dance held during a funeral especially in rural parts of Kenya.
The dance was held in Nyakwadha village, Rangwe Sub-county of Homabay County some 287 kilometers from the capital, Nairobi.
A village disco that went on until the wee hours of the morning, during which time, Anyango was befriended by a boda boda or a motorcycle taxi rider, who dominate the transport system in rural areas and have contributed significantly to adolescent and teenage pregnancy as per the Ministry of Health.
With that, Anyango entered the cohort of three out of 10 girls who have had sex before age 15 in this East African nation, where unmet need for contraceptives remains remarkably high among adolescent women.
Adolescent women aged 15 to 19 years make up just over one-fifth of the female population in Kenya, and they account for 14 percent of all births, according to the Guttmacher Institute.
Additionally, More than half (54%) of sexually active adolescent women in Kenya who do not want to become pregnant—357,000 in 2018—have an unmet need for modern contraception.
These adolescents either use no contraceptive method or use traditional methods, which typically have low levels of effectiveness. Eighty-six percent of all unintended pregnancies in the country occur among this group.
As such, one in every five girls, 15 and 19 years, is either pregnant or already a mother, as per the most recent Kenya Demographic and Health Survey (KDHS), enduring lifelong impacts of childbearing.
Worst still, as of 2019, Kenya has the third highest teen pregnancy rates with an estimated 82 births in every 1,000 live births, as per the Global Childhood Report.
“We have quality sexual and reproductive health services on one side and young people on the other side. The greatest challenge is building a bridge for adolescents and teenagers to access these services,” says 24 -year-old Philister Adoyo.
Adoyo is a peer mother attached to pregnant adolescents and young people below the age of 24 at the Homabay County Teaching and Referral Hospital.
The Lake Victoria region County of Homabay has a staggering adolescent and teenage pregnancy rate of 33 percent, nearly twice the national average of 18 percent, as per a 2020 report titled, ‘Unintended Pregnancies and HIV Amongst Adolescents and Young People: A situation Analysis of Homabay Kenya’.
Confronted by acute trends in early and unplanned pregnancies, health professionals in Homabay County have expanded the functions of the Partner Notification Services (PNS) to bridge the gap between hard to reach adolescent women and, Sexual and Reproductive Health and Rights services (SRHR).
“Unsafe sexual behavior among young people in the county is a concern and targeted interventions are much needed to address teen pregnancies,” says Mary Akumu, a mentor mother at Homabay County Teaching and Referral Hospital.
This is where PNS comes in, says Beryl Omondi, a PNS nurse in the County. She says PNS is a voluntary and confidential public health strategy provided to people in a sexual relationship with a person diagnosed with HIV.
She says PNS is additionally closing the loop by facilitating access to SRHR information and services among adolescents, 15 to 19 years and young people in general.
“Through PNS, a newly diagnosed HIV positive client is encouraged to provide contact details of all their sexual contacts. We anonymously trace these sexual contacts because of the obvious high risk exposure to HIV. Once contacted, we come up with a story that will ultimately lead to a HIV test and HIV prevention or treatment depending on the results,” she expounds.
She says that HIV and teenage pregnancies are closely interlinked and that by using PNS, health providers are effectively reaching and prioritizing adolescents and teenagers who are already at risk of early and unintended pregnancies.
“As health providers, our first contact with adolescents and teens is often when they are already pregnant and once they get that first pregnancy, a second pregnancy is never far behind. We are now using PNS to find them before there is a pregnancy,” Omondi expounds.
“Young people want SRHR information and services. But they are afraid to seek these services because they are socialized to believe that health providers are like their parents and will rebuke them and shame them for showing an interest in sex before marriage.”
Omondi further says that because of the shame and stigma attached to sex among young people, a majority continue to engage in unsafe sexual practices, because they do not know that health providers are increasingly receiving training in adolescent and young people friendly SRHR services.
“When I first met Anyango, she was only 15-years-old. I traced her because she was at risk of being infected with HIV. She had no knowledge of contraceptives other than for the P2 (morning after pill) that she and her friends buy over the counter and use more often than they should,” she expounds.
“At the moment, I am in regular contact with 22 young people traced through PNS. They tell me stories of using P2, douching with detergent to wash away sperms and drinking a certain herb that grows like weed in these areas. They do not know about their rights to access SRHR services.”
Anyango affirms that douching is a particularly popular method among her friends. She also says that they believe standing while having sex prevents pregnancies or drinking a strong mixture of boiled tea leaves and herbs.
Evidence of unsafe sexual practices and lack of access to much needed SRHR services can be found across health facilities in the County.
At Homabay County Teaching and Referral hospital for instance, the average age within the Prevention of Mother to Child Transmission of HIV program is 13 to 42 years.
These damning statistics fly in the face of the country’s legal and policy framework for the provision and access to adolescent and youth friendly sexual and reproductive health services, including a most recent Youth Family Planning Policy Scorecard by the Population Reference Bureau (PRB).
Released in April 2021, the scorecard found that Kenya has some of the most progressive policy environment for the provision of youth-friendly family planning services. Kenya’s law and policy environment is in stark contrast to the prevailing and endemic problem of adolescent and teenage pregnancy.
As per the Youth Family Planning Policy Scorecard 2021, the East African nation scores highly on critical areas of policy provisions and more so, explicit policy language directing providers to offer nondiscriminatory, unbiased care to adolescents based on existing medical eligibility criteria.
As such, laws or policy exist that approve young people’s access to family planning services irrespective of age and marital status.
Overall, Christine Power of PRB finds an inclusive and supportive policy environment for the provision of sexual and reproductive health services to both youth and adolescents. And, that the policy and legal framework in place incorporates core elements of service delivery to adolescents.
Linda Wanjiru Kroeger, a human rights lawyer working as the SRHR team lead at the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) says that the damning statistics are down to social norms and worn out myths and misconceptions.
“The larger Nyanza and Western regions have over the decades registered dismal sexual and reproductive health and rights outcomes,”she says.
“Prevailing harmful social norms play a significant role in the community’s behaviors and attitudes towards SRHR. Even with positive legal and policy provisions, violations to said laws and policies continue to prevail.”
Kroeger decries the prevailing gap between adolescents and health providers, and the consequent lack of information of SRHR, calling for a multifaceted approach that should include SRHR awareness raising across the community.
Immaculate Oliech, Programme Coordinator at the Network for Adolescent and Youth of Africa (NAYA) agrees, saying that dominant sociocultural beliefs and attitudes hinder the realization of young people’s SRHR.
“These include harmful practices such as child, early and forced marriage. Adolescents and young people in Homa Bay also lack access to comprehensive youth friendly services and information,” she says.
“This means healthcare service provision is designed to favour the older members of society and stigmatize the younger generation. According to the most recent WHO Service Availability and Readiness Assessment Measure (SARAM) for Kenya, only about four out of ten healthcare facilities provide comprehensive youth friendly services.”
Oliech says Kenya has a progressive policy and legal environment, including the Constitution of Kenya, 2010 in Article 43 (1) which guarantees all Kenyans the right to the highest attainable standard of health including reproductive health care.
And, the National Adolescent Sexual and Reproductive Health Policy 2015 and the National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya 2016, which she says, “provide for the rights of adolescents and youth to access services that address their needs, are provided in the right place, are available at the right time, at the right price (free where necessary) and are delivered in the right style to be acceptable by young people.”
“The policies and guidelines also provide for the meaningful and inclusive participation of all young people in decision making on their SRHR.”
Nevertheless, Oliech says what really hinders policy implementation is the fact that counties are yet to allocate sufficient resources for SRHR including contraceptives, community education and youth friendly services.
“Existing policies and laws have also not been adequately disseminated to ensure they are fully implemented. Further, despite the mention of youth and adolescents in the titles of draft policy documents, young people are still not meaningfully engaged in policy making processes to express their policy needs,” she observes.
In all, research indicates that poor enforcement of policies to protect children is a key driver of fertility in Kenya.
With an estimated 13,000 teenage girls dropping out of school due to pregnancy every year and at risk of missing out on a lifetime of learning and earning opportunities, SRHR experts say there is an urgent need to increase the percentage of health facilities offering comprehensive adolescents and young people friendly SRHR services.
*not her real name