POLITICAL MATTER •

“Young people and adolescents are in danger of losing their futures to unplanned pregnancies and a never-ending cycle of poverty”

Kenya has one of the highest adolescent fertility rates in sub-Saharan Africa. A low of 2% at aged 15, rates of childbearing increase to 36% by the age of 19. One of the reasons for the ballooning rate is highlighted by a 2012 WHO report. Not only has Kenya’s progress towards improving maternal and neonatal health been insufficient, but there has been little to no progress in this area for over the last 10 years. The fact that there is a particular lack of data on sexual and reproductive health in adolescents and young people does not help.

What data can be found suggests that Kenya continues to maintain poor adolescent reproductive health indicators. A 2013 WHO report notes that the prevalence of contraceptive use within the population is as low 16%; the paramount cause of high rates of unintended pregnancies in sexually active adolescents. At 47%, the rate of unplanned pregnancy among adolescents aged 15 to 19 is a cause for action.

Young girls and the socio-economic effects of unintended pregnancies

Approximately 103 out of every 1000 live births in Kenya are delivered to girls aged 15 to 19

At least 63% of Kenya’s population is under 25. This places a high degree of importance on sexual and reproductive health policy specifically targeted at the country’s large adolescent and youth population. For instance, adolescents and young women in Kenya experience a higher risk of miss-timed and unwanted pregnancies compared to their older counterparts. Despite a high level of awareness of modern contraceptive tools, many young women fail to make use of them. For young girls and women, this is becoming a major impediment. Unintended pregnancies present a major obstacle to achieving progress in the health of adolescent and young people in Kenya. Unintended pregnancies tend, also, to have long-term health and socio-economic ramifications; especially for young girls.

Early motherhood tends to compete with formal schooling, career development and has the capacity to affect a young girl’s life options in crucial and profound ways. There is an increased risk of becoming poor or of being unable to move out of poverty. Although data is scarce for the incidence of poverty in pregnant youths, the fact that young girls who become pregnant are more likely to drop out of school means that they often fail to acquire skills for technical employment early on.

About a quarter of the growing number of deaths among 10 to 24 year old women in Sub Saharan Africa are due to maternal mortality.

Adolescent mothers may also face a social ostracism that can make it more difficult for them to successfully navigate early motherhood. The long term implications of young girls leaving school early is not only significant at the individual level but also impacts the family unit and the wider community as well. All in all, there are fair risks that adolescent mothers may pass on a legacy of poor health, poor education and low standards of living onto their children. This makes poverty for many, a very tough cycle to break. If the reproductive health and related socio-economic needs of Kenya’s young and adolescent population are not met, the entire country faces the risk of losing out on the demographic dividend.

The poor state of reproductive and sexual health in Kenya is a problem both at the aggregate and individual level. Adolescent pregnancies tend to be more fraught with health complications due to incomplete physiological development of the very young soon-to-be mothers. Adolescents that carry unintended pregnancies to term face increased risks of severe obstetric complications. 65% of women presenting with obstetric fistula would have developed the condition during their adolescence. Other complications include obstructed labours that may be influenced by incomplete pelvic growth in young mothers, and preeclampsia, which can result in long-term morbidity and even death. About a quarter of the growing number of deaths among 10 to 24 year old women in Sub Saharan Africa are due to maternal mortality. Moreover, the risk of maternal mortality is higher in those aged between 15 and 19; far more so than it is for women aged between 20 and 24 years.

Approximately 103 out of every 1000 live births in Kenya are delivered to girls aged 15 to 19. The fact that the majority of these births are unintended further leads to the problem of increased rates of abortion. There is a dearth of statistics on adolescent abortion rates from unintended pregnancies, which limits the extent to which interventions or programmes can be implemented to successfully target this segment of the population.

Young men are also significantly and adversely affected by Kenya’s poor sexual health infrastructure

In 1994, a Kenyan government circular was released to ensure that pregnant girls are able to stay in school. The national school health policy also provides guidelines on school re-entry to ensure that pregnancies do not affect the education of young girls by providing that girls are able to return to school after the birth takes place. However, approximately 13,000 girls drop out of school due to unintended pregnancies. Many of the policies put in place to protect school education for girls are not optimally enforced and many of them contradict and counteract one another. For example, the school re-entry policy for girls states that girls should be sent away once pregnant, whereas the National school health policy states that girls should have the opportunity to remain in school even if pregnant.

As observed in Kenya, adolescent females experience increased rates of sexual and gender based violence; and they also lack access to sexual reproductive health services. Adolescents and young people in Kenya often feel ashamed to obtain contraceptives in health facilities, most especially if they are unmarried. Many of these young people are less likely to seek health services overall.

Young men are also significantly and adversely affected by Kenya’s poor sexual health infrastructure. There are few youth friendly facilities in Kenya that provide services catered to the needs of adolescent and young men. Most programmes tend to focus on reproduction and contraception that disproportionately targets older females.

Towards Better Policy and Increased Implementation

The serious health risks of early sexual activity and childbearing underlies the need for addressing the sexual and reproductive health requirements in adolescents and young people in Kenya. A later and healthier start to childbearing produces important gains in maternal and child health outcomes and breaks cycles of poor health as well as of poverty. If the sexual and reproductive health requirements of the country’s young people are not adequately addressed, it will have long term consequences for Kenya’s infrastructural development as well as in its employment needs as the population continues to grow.

If the reproductive health and related socio-economic needs of Kenya’s young and adolescent population are not met, the entire country faces the risk of losing out on the demographic dividend.

Although the Kenyan Government, and organizations such as the African Population and Health Research Centre and the African Institute for Development Policy, have attempted to respond to the sexual and reproductive health needs of adolescents and young people through the dissemination of reproductive health information and services, there remain an inadequate number of programmes; and implementation on the ground is poor. Partially, the problem is explained by the fact that the implementers are hobbled by limited capacity. On the one hand, teachers feel inadequate in providing comprehensive sexual education and, on the other, service providers are not fully aware of the new and revised policies and guidelines for adolescent and youth sexual and reproductive health.

This has translated into inadequate dissemination, utilization and implementation of policies and guidelines, and into weak coordination of adolescent and youth sexual and reproductive health interventions nationally. Furthermore, while youth serving organizations that are meant to engage young people in the community are supposed to target all youths in their work, this only works in principle and mainly in the country’s most highly populated areas. Nairobi has the highest concentration of implementers of youth programmes.

The fact that adolescent and youth sexual and reproductive health is not acknowledged in Vision 2030 – Kenya’s development programme launched in 2008 with the aim of ensuring Kenyan citizens enjoy a high quality life by 2030 – suggests that the problem remains a low priority for the Kenyan government. Despite the government’s formulation of many national policies, strategies and programmes in recent years, the often counteracting policies and guidelines for the provision of information and services to adolescents and young people are not well integrated into mainstream sectoral programmes and services.

Youth empowerment centres which were to be promoted, established and operationalised in every constituency in Kenya while offering integrated health services that include sexual and reproductive health have taken off rather slowly. By 2011, there were only eight such centres out of a target of 210. Several gaps also exist between policy and implementation whose monitoring and evaluation systems remain weak.

The problems facing Kenya’s sexual and reproductive health infrastructure are ones that will go on to affect the country’s long-term development if discernible gains are not made; and soon. Young people and adolescents are in danger of losing their futures to unplanned pregnancies and a never-ending cycle of poverty if the government’s policies and implementation are not made more robust. A multi-sectoral approach is urgently needed to reach adolescents and the youth in Kenya and to holistically address the sexual and reproductive health problems facing this demographic.

Elsie Akwara is a Kenyan national. She is currently a Ph.D. candidate at the University of Southampton in the Department of Social Statistics and Demography. She has recently completed pilot fieldwork in Nairobi, Kenya that was focused on sexual behaviour and access of young and adolescent groups to sexual and reproductive health services.