By Clifford Akumu
The mid-morning sun beats down as a young girl, barely 16, slowly makes her way to Samburu County Referral Hospital in Maralal town.
Nasieku*(not her real name) gave birth to a baby boy four months earlier at Loosuk village, Samburu West, Samburu County with the help of a traditional birth attendant.
“I was on the farm with a friend when I felt an unusual pain. I laid down under a tree writhing in pain. My friend panicked and dashed out to call our neighbour,” she begins.
With her mother, whom I will call Miriam* a relatively aged woman, they had traveled almost 8 kilometers on a boda boda (motorbike) to bring the baby for his first check-up at the facility. In practice, a newborn should visit a doctor within three to five days of birth. This was not the case for Nasieku’s baby.
Feeling exhausted and sweaty, they patiently waited for their turn at the newborn clinic section that had now teamed up with young faces and a cocktail of high-pitched screams from babies being put on the weighing scale.
Visiting the clinic for the first time since she gave birth, Nasieku had to be assisted by the mother. For instance, she would easily get emotional towards her son’s reaction as the nurses checked his weight. During this period, Miriam was busy soothing her whimpering grandson as her daughter recounted her ordeal.
“I don’t want to see him crying,” she says while hiding her face as her mother helps the nurse hold the baby. Nasieku is the only girl in a family of three boys.
After recording the baby’s weight, length, and head circumference, the nurse directs them to an adjacent room for further check-up and analysis on the baby, since this is their first visit to the facility.
The nurse tells us that the baby must undergo a complete physical examination to observe the newborn’s vision, hearing, and reflexes. Miriam emerges from the doctor’s room smiling, a clear indication the baby is out of danger.
Every year, an estimated 21 million girls aged 15-19 years in developing regions become pregnant and approximately 12 million of them give birth, according to the World Health Organisation.
Nasieku is part of a statistic that continues to shock the nation. Teen births have been falling nationally but rising in Samburu County-with a population of 65,425 youths aged 15-24 years, according to the 2019 Census figures.
According to the 2022 Kenya Demographic and Health Survey by the Kenya National Bureau of Statistics(KNBS), teenage pregnancies in Kenya dropped marginally to 15 percent from 18 percent in 2014.
However, Samburu County recorded the highest rate of teenage pregnancies at 50 percent among adolescents aged 15-19 years-meaning at least one in every two pregnancies being of an underage girl in the county. It was followed by West Pokot at 36 percent, Marsabit at 29 percent, Narok at 28 percent, and Meru at 24 percent.
Only ten of the 47 counties reported teenage pregnancy levels below 10 percent. Murang’a and Kirinyaga reported seven percent, Vihiga eight percent, and Laikipia, Nairobi, Bomet, and Kitui all reported nine percent. In contrast, Nyeri and Nyandarua counties reported the least number of teenage pregnancies at five percent.
Earlier statistics from the County’s Health Department between January and March of 2022 showed that 832 teenagers had become pregnant. Health officers at that time had warned that the number would skyrocket by the end of the year if measures were not put in place.
Dr Ezra Lekenit, Director of Medical Services Samburu County confirms the high levels of teenage pregnancy noting that “there is an alarming increase in cases as per the latest national and county reports.”
The 2022 Samburu County District Health Information System(DHIS) report puts the figure of pregnant adolescents aged between 10-19 years at 27 percent. While Samburu West sub-county leads at 33.4 percent of pregnant adolescents aged 10-19 years, followed by Samburu North sub-county at 26.1 and Samburu East sub-county trailing at 18.4 percent.
He notes, “The two reports do not tally, but puts our county on the map because, I think, the sample population was very small”.
At the nearby ante-natal clinic wing, a traditional song blared out in the distance from Naisiaye’s* phone-its lively beat at odds with the harrowing stories of stigma, forlorn faces, and agony that are whispered throughout this remote corner of the northeastern part of Kenya.
Naisiaye*,15, from Suguta Marmar village, Samburu Central woke up one day feeling weak. Like any other girl her age, she thought it was just a light headache that would pass.
Naisiaye’s boyfriend- a student at the neighbouring school had engaged her in unprotected sex, she narrates. But she had no cause for alarm since she had been accustomed to the process.
“I thought it was normal nausea or malaria,” says Naisiaye, a form one student at a local secondary school. But the feeling continued for two weeks.
Slowly, the mother started getting concerned. She took her to a nearby public health facility to check her condition. After a few tests, the nurse confirmed her mother’s worst fears; Naisiaye was two months pregnant.
“I felt my world had crumbled. I cried all night,” she explains, matter-of-factly.
Naisiaye did not know how to break the news of her pregnancy to her friends back in school who by now had suspected that all was not well with their friend.
Soon, the pregnancy became visible and she could not hide it anymore from her peers. Like a bunch of other girls her age, she was attending her second antenatal clinic at the facility on that day. She is four months pregnant.
“I aim to go back to school after giving birth,” she wants to become a teacher.
The county’s DHIS report further indicates that a total of 374 adolescents aged between 15-19 years were presenting with pregnancy at the first ANC visit in Maralal ward, followed by 298 in Lodokejek ward,268 in Suguta Mar Mar ward, 260 in Wamba East and 210 in Loosuk ward.
Among adolescents aged 10-14 years, Ndoto ward recorded the highest presenting with pregnancy at the first ANC visit, followed by Angata Nayokie, Lodokejek ward, and Maralal ward.
Dr Lekenit blames cultural practices as a major driver of teenage pregnancy in Samburu County. Beading and Female Genital Mutilation activities are translating to sexual activities putting girls at higher risk.
Every 10-15 years, the Samburu Community ushers in a new age set. During this period, the old age set retires(meaning they (the morans) marry en masse and settle with some of the adolescent girls), he explains.
“Unfortunately, that was the same period the KDHS survey was conducted,” he adds.
Most girls like Naisiaye and Leakono often have little say in decisions affecting their lives due to retrogressive cultural practices. As a result, they are left exposed to numerous risks including violence and lack of necessities. For example, Nasieku dropped out of school while in class five back in 2017.
“Teenage pregnancy problem dims girls’ hope of completing education, starting a career or becoming financially independent,” adds Dr Lekenit.
Kenya is not alone, across the border, Uganda has the highest rate of teenage pregnancy in East Africa at 25 percent- almost double the global average of 14 percent according to the Uganda Demographic and Health Survey 2016.
The KDHS report also revealed a correlation between education levels and teenage pregnancy rates. It noted that 38 percent of girls without education were found to be pregnant, while 20 percent of girls with primary-level education were also pregnant.
Interestingly, only 5 percent of girls in higher education were found to be pregnant.
Not only are the county health departments pulling out all stops to create a bridge for their daughters to access education, and re-admission into institutions, but they are also exploring other approaches to tame the rise in teenage pregnancy.
The county has embarked on focused health education to reduce teenage pregnancy with the affected morans, teenage girls, and their parents. There is also the multi-sectoral approach where the county is on-boarding other departments like the gender and social services, organisations working in the space to fight teenage pregnancy.
“We teach the girls the dangers and complications associated with being a teenage mother such as obstructed labour. We encourage the girls and their parents on the benefits of taking their children to school since it serves as a protective environment for the girls,” says Dr Lekenit.
Back to Nasieku.She recalls how the father of her baby(a moran) had told her to abort. Her dream of becoming a nurse evaporated. She dropped out of school in class seven. The father of her child cut communications.
For teen mothers, the burden of responsibility piles not only on the parents but also on them. It becomes complicated when poverty and illiteracy have taken hold of the residents.
Nasieku now burns and sells charcoal to survive. But with a baby to take care of, she can't do much.
“When I was young I had very high hopes of who I would be, now I face the harsh reality of motherhood. Sometimes we walk with charcoal strapped in my back as far as Maralal town and sell nothing. At worst, I have no option but to sell at a throw-away price of Shs700 for a whole sack. It has not been easy,” says Nasieku amid sobs.
Simon Lemoge, who heads the Adolescent and Youth Sexual Reproductive Program at Samburu County observes that unmet needs for safe, reliable contraception, and sexual and reproductive health rights education in schools remain obstacles to the fight against teenage pregnancy.
For example, the county recorded a decrease in the number of adolescents aged 10-14 years and 15-19 years who received family planning services from 176 in 2021 to 126 in 2022 and 2,278 in 2021 to 2,117 in 2022 respectively.
“We have come up with a policy to help dropouts rejoin school. Under the program, girls who have given birth are encouraged to go back to school,” Lemoge adds.
“We want every child to access education.”
But then there is the triple threat of early pregnancy, defilement, and HIV that is facing teenage girls. Kenya has set a target of ending HIV transmission by 2030, and teen pregnancies and sexual violence by 2026, targets whose realization might not be attained according to the ministry.
According to the latest report estimates by the National Syndemic Disease Control Council(NSDCC), 10 counties are flagged for recording a surge in HIV prevalence raising concern over the targets to attain zero infections.
Homa Bay County had the highest increase at 15.2 percent increase in new cases, Kisumu at 14.5 percent, and Siaya County at 13.2 percent. Samburu recorded a 4.3 percent increase in new cases, Vihiga at 4.2 percent, and Uasin Gishu at 3.7 percent.
“We are totally aware that adolescents are having sex. How do we make sure they are having it in the same manner to avoid sexually transmitted infections and pregnancy? Sex education to some extent has to be communicated to adolescents and youth so that we give them the ability to make the right choices,” explains Prof Omu Anzala, a virologist and director of the Kenya AIDS Vaccine Initiative-Institute of Clinical Research.
“Youth-friendly clinics and corners are critical as we move ahead. And to ensure that we have the rightful commodities in those places, ability to access them.”
Mr. Lemoge adds, “We have established youth-friendly centres for family planning across facilities within the county to deal with the issue of increased teenage pregnancy.”
As Nasieku picks up her son, she looks straight into his eyes and utters, “he is my only joy.” As I leave the facility, a tall lady of almost a similar age, peeps from the newborn clinic section. Another teenage mother from Lodokeyek village.
*Names have been changed to protect their identity and keep them safe from further harm.