by Malemba Mkongo and Sandra Wekesa

At the age of 15, Joyce Njeri* got pregnant after two months of meeting a 23-year-old man who promised to take her in as his wife.

“I was in Class Seven when I met him. He asked me to be his girlfriend and after a few weeks of seeing each other, we started getting intimate,” she begins.

However, before she could grasp everything that was happening in her new relationship, Joyce found out she was pregnant, something she had never anticipated.

“I was shocked and confused at the turn of events. I did not know that I would get pregnant or whether I needed to do something to prevent it.”

Although her boyfriend eventually accepted to take responsibility for the baby after months of denial, her biggest regret was not having a shred of knowledge about available family planning methods.

The mother of one says she would not have made it in the statistics of teenagers who have gotten pregnant if she was aware of the repercussions of engaging in sexual activities.

“In school, they only taught us that sex is bad, but they did not educate us on how to turn down men’s advances or ways of protecting ourselves, which is crucial education considering a majority of children my age are sexually active,” she says.

After her baby’s delivery, she immediately took a three-year contraceptive, which she believes will protect her against another unplanned pregnancy as she prepares to go back to school.

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female aged 10 and 19 years old, according to the World Health Organisation (WHO).

Catherine Runo, senior nurse in charge of a youth-friendly centre in Gilgil sub-county, Nakuru County Hospital says majority of teenage pregnancy can be eliminated by equipping youths with sexual and reproductive health knowledge early before they start engaging in sex activities.

Runo says most teenagers are in the dark when it comes to making sexual decisions and are influenced into engaging in sex.

“The majority of young girls start learning about sex when already pregnant. The current crop of teenagers need to be educated extensively about Sexual Reproductive Health Rights (SRHR) to help curb unwanted pregnancies,” she says.

Make wise decisions

Runo’s sentiments are echoed by Rehema Wamboi, 22 also from Nakuru County who says her exposure to information about sexual reproductive health, such as family planning while still young has helped her make wise decisions when it comes to sex.

“I was first introduced to the sex education and contraceptives discussion while still in high school where we would openly discuss about sex, its consequences and prevention methods,”she says.

One of the gaps identified as an obstacle in the inclusion of youths on matters of family planning are lack of youth friendly centres, which have been found to play a critical role in improving reproductive health outcomes, including reduction of unintended pregnancy.

Musa Ogony, DSW Staff, presents on the findings of the community score card during a dissemination meeting in Nakuru County.

Other obstacles, include high cost of family planning products and services and unfriendly health workers who stigmatise and discriminate against them.

Consolata Akisa, 18, from Kibra informal settlement in Nairobi County got pregnant while still in school and knew she had to get herself on family planning to avoid getting herself in the same situation again.

However, her efforts to seek guidance from one of the facilities in her area were faced by challenges she never anticipated.

“I was disappointed when the health workers at the clinic said I was too young to use family planning, while another facility demanded Sh500, which I could not afford as a student,” she recounts.

She had to go back a few months after she had raised enough funds to pay for the service.

Obstacles to FP access

This year’s theme for World Population Day commemorated yesterday, July 11, couldn’t be a better one. The theme- A world of eight billion: Towards a resilient future for all – Harnessing opportunities and ensuring rights and choices for all comes hot in the heels of rampant cases of teenage pregnancies across the country with a majority of those affected being primary and secondary school girls.

Media reports have revealed the extent of this menace and some parents have resorted to take their young girls for family planning, as they are running out of options, in dealing with the runaway cases of teenage pregnancy.

Evelyne Bowa, Agape Woman and Child empowerment Foundation (AWOCHE) founder explains that one of the barriers in mitigating teen pregnancies in Kenya is age limit.

“We receive underage, but sexually active girls who are afraid of engaging their parents for consent and others who do not wish for their parents to find out what they are up to,” she reveals.

She adds that with the rising number of teenage pregnancies, she has been hands on in ensuring that she provides comprehensive reproductive health education, as well as assist teenagers access contraceptives.

WHO data shows 23 million adolescents have unmet need for modern birth control methods and are at risk of unintended pregnancy with majority of the girls not aware of the benefits of contraceptives. Those who are aware and would wish to access contraceptives face numerous barriers, including restrictive laws and policies regarding provision of family planning services based on age or marital status, healthcare provider bias or lack of willingness to acknowledge adolescents’ sexual and reproductive health needs.

There is also the challenge of adolescents’ own inability to access contraceptives, because of knowledge, transportation and financial constraints.

Comprehensive RH education

The organisation recommends establishment of youth friendly family planning centres to cater discriminatively for youths, a challenge that Nakuru County has keenly taken up.

Nurse Runo says the county adopted the youth-friendly facilities concept after it was discovered that most youths could not seek sexual and reproductive health services, because of the many challenges they faced at available facilities.

“Most youths face judgmental comments from the society and health workers. There is also fear of a youth meeting her parents seeking family planning services at the same facility, thus separate facilities are critical,” she says.

For example, at the Gilgil Sub-County Hospital, which hosts one of the youth-friendly facilities, the centre is secluded from the main facility, a distance away from the hawk eyes of the society. The youths are served by specialised nurse  who first offer individual counselling before guiding them on the suitable family planning methods.

They use the counselling sessions is to debunk misconceptions surrounding family planning and even test for HIV/AIDS if the youth wishes to.

Runo says privacy of the youths is paramount as they are able to trust the facility and the health workers and that is why they ensure whatever is discussed in the counselling room remains a top secret between the parties.

“Part of our education, includes ridding family planning misconceptions and offering guidance on suitable methods, HIV/AIDS education and how to protect themselves,” she notes.

Game changer

The senior nurse says the impact of such facilities is already significant as most of the teenage pregnancies are no longer of girls between 18 and 24 years old, but those below the legal age. This is because it is illegal for health workers to provide family planning services to an underage girl yet this category of teenagers is sexually active.

Youth champions in a public participation for sector hearing in Nakuru.

Bowa also thinks that reducing the age limit of teenage girls to allow administration of contraceptives will ensure early pregnancies are prevented.

“The government should also ensure that all this sexual and reproductive health services are integrated into one in order cater for a huge number of teenagers and ensure that every person is able to access them without discrimination,” she says.

A social accountability study conducted by Deutsche Stiftung Weltbevoelkerung (DSW), an international non-governmental organisation addressing Sexual and Reproductive Health and population dynamics showed youth’s privacy, provision of quality services and the availability of the services was quite satisfactory in two centres (Gilgil and Bondeni Sub-County hospitals), set up by Nakuru County.

Evelyn Samba, DSW’s country director, says establishment of youth-friendly health facilities as recommended by the WHO is the whole game changer in the fight against unwanted teenage pregnancy.

Samba says with such centres, services are accessible, acceptable and appropriate for the youth with the right price, mostly free of charge and delivered in the right style to be acceptable to young people.

“These services should meet the individual needs of the youth, who return as needed and recommend them to friends, because generally, they are meant to attract young people, meet their needs comfortably and responsively, and succeed in retaining young clients for continuing care,” Samba says.

She says youth-friendly centres mean young people are able to access sexual and reproductive health services, including accurate information on the safest, affordable and acceptable methods of contraception thus giving them powers to decide the appropriate methods. They would also be informed and empowered to protect themselves from sexually transmitted infections.

“At such centres, health providers are not biased and are comfortable serving sexually active youths and the environment is conducive for the youth,” she notes.

Limited resources

Ultimately, youths are more likely to use contraception, meaning more young people will make informed choices on their sexual and reproductive health, including when to have children.

It is not lost on us that young people, especially the girl child face numerous reproductive health challenges as they go through puberty. Many communities also still consider them ready for marriage and childbearing just at the onset of puberty. Yet, these sexually active adolescents have not been fully empowered to make healthy choices and informed decisions.

Teenage pregnancy is also a major contributor to Kenya’s high fertility rate coupled with the high population growth rate as has been observed over the years. The Ministry of Health reports that most early pregnancies are a main cause of death among adolescent girls, a factor which reflects on the unacceptably high maternal mortality rate in Kenya.

Reproductive Health and economic experts agree that the burden of failing to invest in teenage girls is being felt across the country.

“When the population is high, it means that there are more people to take care of with limited resources, especially if parents of the teenagers are not contributing to the economy. It places a huge burden to the already overburdened health sector as well,” says Alfred Mutai, a health economist.

He says resources that could be freed for other aspects of economic development are channelled for instance to adolescent mothers who sometimes develop complications in the course of pregnancy, childbirth or incomplete unsafe abortion.

“Investing in these young ones, therefore, means availing information and services and meaningfully engaging them in matters affecting their lives. It also means investing in youth friendly services as indicated in the just launched National Reproductive Health Policy (2022-2032), and the National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya. Further, it means making reproductive health information and services available to anybody in their reproductive age without discrimination as envisioned in the Constitution and the UN Sustainable Development Goals,” he offers in conclusion.

This article was first published by the People Daily on July 12, 2022.