Early childhood pregnancy and increased rates of sexual infection among adolescent girls continues to be a major public health concern in Kenya. The low uptake of Sexual and Reproductive Health and Rights (SRHR) information and services has been one of the dominant causes. Compounding issues such as negative attitudes and stigma directed towards adolescent girls perceived to be engaging in sexual activities also deter them from seeking any help for fear of social ostracization and isolation. Additionally, efforts aimed at equipping them with Comprehensive Sex Education (CSE) are often met with opposition from groups such as the church and parents. The resulting pregnancies and sexual infections have further led to increased school dropouts and other life stressors that affect them both physically and mentally. This crisis requires action to identify its causes, and solutions such as the rollout of a nationwide information campaign as a policy response for the Ministry of Health (MoH) to tackle the info-/misinformation gap among adolescent girls and subsequently mitigate the risks brought about by risky sexual behaviours.

In Kenya, adolescents aged 10-19 years make up 24.5% of the total 47.6 million population (Kenya National Bureau of Statistics, 2019). The sexual debut age of this demographic is low as 47% of young women and 55% of young men between the ages of 18-24 reported having had sexual intercourse before the age of 18 (Ministry of Health Kenya, 2014). The lack of access to adequate information on Sexual and Reproductive Health (SRH) has been cited as one of the major barriers to addressing the sexual health gap in this group with particularly adverse effects for adolescent girls.

A Two-Fold Public Health Concern: Adolescent Pregnancy and HIV/AIDS

The conversation around adolescent pregnancy centres on its occurrence as a marker of deviant behaviour and a ‘disease’ that needs prevention, ignoring systemic issues such as period poverty, gender-based violence and rampant misinformation. Despite the steady decline in teenage birth rates over the years, the United Nations (2019) approximates the number of female adolescents in Kenya that have given birth before 20 years of age at 11%. Compared to developed countries with an average adolescent birth rate of 19 live births per 1000 women, Kenya’s rate stands at 96 live births per 1000 women. Early pregnancies not only expose adolescent girls to risks such as maternal morbidity and disability but also forces many of them to drop out of school and/or enter early marriages, all of which can be catalysts of exploitation.

As of 2019, Kenya had an estimated 91,634 adolescents living with Human Immunodeficiency Virus (HIV) (National AIDS Control Council,  2020). The evidence further suggests that HIV prevalence among young women (15-24) is two times higher in comparison to their male counterparts (National AIDS and STI Control Programme, 2018). The most common route of infection is through unprotected heterosexual intercourse with multiple sexual partners and a general apathy towards testing due to fear. In low-income areas, economic hardship increases adolescent girls’ involvement in sex for financial reasons and access to basic needs such as food and sanitary pads.

How Did We Get Here?: Existing Barriers to SRHR

These public health concerns are often propagated by individual, interpersonal, community and policy level barriers, leading to low uptake of Adolescent Sexual and Reproductive Health (ASRH) information and services.

At the individual level, many adolescents lack complete knowledge on matters of sexual health ranging from the physiological processes to technicalities like proper condom wearing. This is caused in part by learning about sex from their peers, social media, and pornography. Additionally, the costs tied to SRHR such as transport to the health facilities are often too high for them. Furthermore, the existing negative attitudes cause a dearth of data on their needs as they often lie about their realities for fear of ostracization (Sedgh et al., 2016). Social stigma also translates into medical negligence as healthcare workers (HCWs) are accused of scolding or delaying services to adolescents who seek reproductive health services.

Interpersonally, parental disapproval also deters sex education as they infantilize their children and refuse to acknowledge their engagement in sexual activities. Those who do engage with their children barely get into details for fear of ‘arousing’ their sexual feelings (Hyde et al., 2013). Strong opposition from the church has also played a critical role in the uptake of contraceptives among adolescents. The Catholic Church in Kenya, for example, preaches total abstinence with misleading rhetoric that the use of condoms outside of marriage is a ‘sin’ and a threat to the country’s moral fibre. For those who are already pregnant and seek help from faith-based crisis pregnancy centres, access to abortion is prevented, additionally post-partem services are lacking which could help new adolescent mothers balance childcare and their dreams (Sara Jerving, 2022)

The government policy level is another significant barrier as they oversee putting in place regulations around providing SRHR information to adolescents. Kenya already has the existing policy infrastructure for Comprehensive Sexual Education (CSE) with frameworks such as the 2003 Adolescent Reproductive Health Development Policy and the 2015 National Adolescent Sexual and Reproductive Health Policy. Their scope is however limited as they mostly emphasize abstinence and lack updated content on contraceptives, STIs and reproductive and sexual health services (UNESCO and UNFPA, 2012). A review of these policies indicates that little is known about them in schools with no provisions given on suiting them to local contexts.

These barriers have long-lasting implications not only for girls but for society at large. Adolescent girls are plunged into motherhood without the mental, physical, or financial capacity for such a life-changing event. Many see this stage as an end to their education as they seek alternative means of livelihood to support themselves. This is further exacerbated as they are pushed into single parenthood as their partners abscond from their fatherhood responsibilities (Kumar et al., 2018). The fear and stigma of getting tested for STIs puts them at risk of life-threatening diseases and in extreme cases, death. For those living with HIV, their social integration is severely affected due to discrimination and bullying from their peers and communities, with some refraining from taking their medication as a result (Kimera et al., 2019).

What Can Be Done?: Tackling the Problem from the Root

Evidence continues to demonstrate that sex education for young people positively leads to safer sexual behaviours. The Ministry of Health (MoH) must therefore seek alternative ways to address these issues in a manner that empowers and protects the said group.  A MoH-backed rollout of a nationwide information campaign to create awareness of the importance of SRHR using already existing and additional CSE material is a viable option to mitigate this issue. For the successful implementation of this campaign, all the necessary stakeholders must be consulted from the initial design phase to promote a sense of ownership by communicating the importance of the voice of the community (Finley et al. 2018). Boys and young men should also be included in the messaging to ensure both parties are interested in protecting themselves. MoH should also review the existing Comprehensive Sex Education (CSE) policies and implementation in schools to slowly inculcate all-round healthy views about sexual health allowing for better choices. Emphasis should be put on removing the fear associated with curiosity on the subject.

Young people are increasingly drawn to digital platforms such as TikTok and Instagram. As such, these spaces can provide adolescent girls with the confidentiality needed as they seek SRHR information. The already existing CSE content can therefore be digitized for a better appeal to this demographic. This can effectively be done through the creation of a standardised online App that has content specifically targeting adolescent girls and provides information on topics such as reproduction, contraception, and gender-based violence in relationships. To resolve the valid data cost concern, MoH can partner with local mobile service providers to enable free access to the app or at subsidized costs. Alternatively, the app can also have offline versions for broader coverage.

Advertising can also be used as a tool for social change using audio-visual aids intended to influence behaviour. In Kenya, the successful Pamoja Tuangamize Ukimwi (Together We Can Defeat AIDS) newspaper campaign run between 2004-2005 by the country’s National Aids Control Council is one such example. This campaign was able to shift the ‘othering’ of those living with AIDS in the country to a more united front whilst calling everyone to action in the fight against the disease (Benard and Felicia, 2015). A similar MoH-backed media campaign would aim to use audio-visual aids to encourage positive norm change by sensitizing communities against stigmatising adolescents seeking SRHR services.

In a nutshell, positive behaviour change among young people is essential for decreased rates of early childhood pregnancies and sexual infection rates in Kenya. The treatment of sex and sexual health as a taboo topic is a disservice, particularly to adolescent girls who are often disproportionately affected. Innovative and creative solutions are therefore needed to deal with this issue at the root by providing adequate comprehensive sex education that allows young people to make better-informed choices.

References

Benard, Kodak; Felicia, Yieke (2015): The Role of Visual Semiotics in Shaping HIV and AIDS discourses in Kenya Print Media: A Case Study of a Newspaper Advertisement. In Multilingual Academic Journal of Education and Social Sciences 3 (1). Available online at dx.doi.org/10.6007/MAJESS/v3-i1/1699.

Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna (2018): Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention. In Health promotion practice 19 (1), pp. 38–50. DOI: 10.1177/1524839917734521.

Hyde, Abbey; Drennan, Jonathan; Butler, Michelle; Howlett, Etaoine; Carney, Marie; Lohan, Maria (2013): Parents' constructions of communication with their children about safer sex. In Journal of clinical nursing 22 (23-24), pp. 3438–3446. DOI: 10.1111/jocn.12367.

Kenya National Bureau of Statistics (2019): Kenya Population and Housing Census Volume: Population by County and Sub-County.

Kimera, Emmanuel; Vindevogel, Sofie; Maeyer, Jessica de; Reynaert, Didier; Engelen, Anne-Mie; Nuwaha, Fred et al. (2019): Challenges and support for quality of life of youths living with HIV/AIDS in schools and larger community in East Africa: a systematic review. In Systematic reviews 8 (1), p. 64. DOI: 10.1186/s13643-019-0980-1.

Kumar, Manasi; Huang, Keng-Yen; Othieno, Caleb; Wamalwa, Dalton; Madeghe, Beatrice; Osok, Judith et al. (2018): Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders. In Global social welfare : research, policy & practice 5 (1), pp. 11–27. DOI: 10.1007/s40609-017-0102-8.

Ministry of Health Kenya (2014): Kenya Demographic and Health Survey 2014. With assistance of Kenya National Bureau of Statistics, National AIDS Control Council/Kenya, Kenya Medical Research Institute, Population NCf, Development/Kenya.

National AIDS and STI Control Programme (2018): Kenya HIV Estimates Report 2018. National AIDS Control Council. Available online at nsdcc.go.ke/wp-content/uploads/2018/12/HIV-estimates-report-Kenya-20182.pdf.

National AIDS Control Council (2020): Kenya AIDS Strategic Framework II 2020/21-2024/25 Sustain Gains, Bridge Gaps, and Accelerate Progress.

Sara Jerving (2022): Is religious influence fueling the teen pregnancy crisis in Kenya?, 2022. Available online at www.devex.com/news/is-religious-influence-fueling-the-teen-pregnancy-crisis-in-kenya-103080, checked on 2/14/2023.

Sedgh, Gilda; Ashford, Lori S.; Rubina Hussain (2016): Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. Available online at www.guttmacher.org/sites/default/files/report_pdf/unmet-need-for-contraception-in-developing-countries-report.pdf, checked on 2/15/2023.

UNESCO and UNFPA (2012): Sexuality Education: A Ten Country Review of School Curricula in Est and Southern Africa. New York.

United Nations (2019): World Population Prospects 2019. Department of Economic and Social Affairs, Population Division. New York.

Image Source: Frontline AIDS, READY (Resilient and Empowered Adolescents and Young People) Programme

~ The views represented in this blog post do not necessarily represent those of the Brandt School. ~