Perception and Use of Contraceptives Among Kenyan Youth
Dr. Bev Johnson travelled to Kenya in the fall of 2018 to attend a meeting of the Medical Women International Association (MWIA). There, she and Dr. Clarissa Fabre ( President Elect, MWIA) met with Drs. Michelle Musoga and Yvonee Olwang’ and discussed the issues surrounding contraception in young women in Kenya. Hearing this information, they knew they wanted to share their stories with women physicians in Canada and the UK. With the sharing of their stories, Dr. Johnson asks us to think about what we can do to effect change.
Perception and use of contraceptives among Kenyan youth.
Attitudes of health care workers impact take up of contraception among Kenya youth.
The final exams for those completing their primary and secondary school education in Kenya is done in October. This year during the exams, for the students in primary level( ages 13-16) there were over 100 pregnant teenagers sitting for their final exams and 20 new moms, most of whom sat for the same exam from the maternity wards of various hospitals in the country. Students who sat for their finals in secondary level (ages 17-20) saw a record number of more than 449 girls who failed to sit for their exams due to early pregnancies. And over 1000 candidates sat for the exams while pregnant. That is, 18% of the total student female population (13-20) was dealing with a pregnancy or infant child. This is a worrying trend in the country leading to a suggestion it is on the rise.
Unfortunately, a bulk of the blame has been placed on the parents who have been accused of failing to guide their children, resulting in their engagement in antisocial behaviour such as drugs and alcohol abuse. This fails to acknowledge the role that government policies, health care providers and religious restrictions have to play in keeping young girls ignorant of contraception and sex health education.
A study carried out by the Kenya Demographic and Health Survey and the Performance Monitoring and Accountability showed that most women in rural settings begin having sex at the age of 14 years which is 6 yearrs before they start using contraceptives and 4 years before marriage. While in the urban centres, the average age is 16 years, 3 years before they first use contraceptives.
We managed to speak to a few girls who have had teenage pregnancies. These girls hailed from both the urban and rural areas. We found that up to 95% of the girls we spoke too were not on any form of contraception. Most of them also reported that they were aware of the risks of engaging in unprotected sex but still did not seek any medical advice or help.
Most young girls in Kenya are afraid to seek advice or help on family planning from the service providers. Their top most fear was judgement and stigmatization from the people offering the service due to a generational gap between older providers and the younger women. Almost 1/4 of the girls report to have gotten negative reception or heard of a negative reception at the family planning clinics.
They claim to have been offered subpar treatment on account of their age. A number of them reported being told off for having sex at such a young age. The result has been that the young girls prefer not to go to the facilities and seek help amongst themselves. Another fear they cited was lack of privacy at the facilities. In most facilities, the family planning area is located in the same place as the antenatal clinic. Because most of the girls are from the area, they fear a neighbour might spot them and report her to her parents or start a rumour about her in the area.
However, we also found that the girls had a negative attitude towards contraceptives due to side effects. They fear that long term use could cause infertility and create a problem in the future. Another thing they feared is weight gain.
A health care worker in the family planning clinic at one of the biggest county referral hospitals admitted to there being stigma and judgement towards the young girls amongst the older health care workers. She noted, however, that they have been undergoing intensive training on sensitization. This has been going on at the facility level as well as the community level. She notes also that most parents are reluctant to even permit their children to attend such forums.
What is to be done?
There is a need to increase the number of medical camps at the community level with an aim to create sensitization of health care workers.
There is also an urgent need for Continuous Medical Education forums among health care workers to ensure we are speaking the same language for the protection and promotion of women’s rights and women’s health regardless of socio-economic status, religion or ethnicity.
International assistance is needed in:
• Sponsoring programs for sensitization and education at community level.
• Sponsoring training for health care workers both locally and internationally for purposes of exposure and exchange of ideas (reconnaissance).
• Lobbying the Kenyan government to provide sexual education in schools and come up with a curriculum that is acceptable with the society and benefits young people.
• Encouraging pharmaceutical companies to further subsidize and even donate contraceptives and teaching material.
Dr. Michelle Musoga
Dr. Yvonee Olwang’
Drs. Musoga and Olwang’ were kind enough to take the time to answer some questions and provide some background to the situation of young Kenyan women, their reproductive options and the implications for their future. Italics indicate additional information.
According to the current curriculum in place, age of onset for primary education in Kenya is from as early as five years. There are 8 class years to complete primary education. That’s around the ages or 13-16 (depending on when they started school). It is after these 8 years that the students sit for their final exam in order to proceed to secondary school. Primary school tuition is paid for by the government. But all the other needs such as uniform, food and examination fees is paid by the parents/guardians.
Secondary school education in Kenya is 4 years. The ages range from 13-19. After this they sit for their final exam to qualify them for university education. Secondary school education is paid for by the parents/guardians
What is the prevalence of teenage pregnancy overall in Kenya?
The latest data shows that within one year, there were approximately 380,000 teenage pregnancies from as early as age 10. Of these 30,000 were between the ages of 10-14. And the rest 15-19 years old.
About 80% of the girls were forced to drop out of school.
According to the United Nations Population Fund, 24% of Kenya’s population is between the ages of 10-19. One in five 15-19 has a child or is pregnant. Only 50% proceed to high school and 13,000 girls drop out of high school.
Who is impregnating girls and young women?
The people responsible for impregnating the girls were found to be : touts who operate the public vehicles, motorcycle riders who also act as public server vehicles, adults who are known as sugar daddies who tend to prey on the naive disadvantaged young girls (because they are able to offer financial support and lavish gifts), some are forced into prostitution at an early age and some are boyfriends who are mostly older than the girls. In the rural areas, the people responsible are mostly relatives and neighbours who prey on the young girls. Most are raped by these men.
What happens to a girl or young women when she gets pregnant?
Once the girls are pregnant, they are often forced into marriage, but in the event that the partner denies the girl and child, the child is taken care of mostly by the girl’s mother. This creates another financial burden in the home and brings ‘shame’ to the family. In some cases the father of the girl ends up abandoning the family because he cannot be associated with people of loose morals. Very few are taken into orphanages. Sadly, there is a percentage of babies dumped in garbage sites and left for dead.
The women face stigma. This is because their peers and society will look at them as girls with loose morals who took part in early sexual activities. They are looked down upon and called names. Other parents discourage their children from associating with them.
In comparison to the western world, sex is still a taboo topic in most African homes. It is not openly and freely discussed. It is almost seen as something to be ashamed of.
What is the status on access to abortion in Kenya?
On abortion, we have noticed a steady rise in the past three years. Patients present to hospital with incomplete abortions, septic abortions and sometimes traumatic abortions. In the urban centres, there is also an increase in the number of safe abortions carried out in private clinics. This is because of the financial capabilities of the clients. Their partners and sometimes parents are able to afford these services. Interestingly even after going through an abortion, parents are still against them getting regular contraceptives. Because they want to preserve the ‘morality’ of the girls. Please note abortions are illegal in Kenya unless they pose a threat to the physical health of the mother. And must be prescribed by a qualified medical doctor.
Is there a sex curriculum taught in the schools?
Currently there is no sexual health curriculum in schools. That’s both at primary and secondary school level. In the news recently, there was an article that says certain schools are on the spot over what the government terms ‘illegal sex education’. The government claims that the sex education being offered is illegal, immoral and unapproved.
What is the role of the health clinic in women’s health?
Clinics are accessible even before conception. However, there is an ‘African’ culture of only seeking help in curative medicine rather than preventive. So unless/until the client feels there is a problem, she will rarely go to the clinic.
What about family physicians?
Family medicine is a fairly newly adapted speciality in Kenya. With the first Kenyan trained graduates just completing their masters. Most of medicine is still ‘decentralized’ so to speak. So the pre-teens will be seen by a paediatrician and the teens by a GP.
And pharmacists? Do they have a role to play in this issue?
We note and mention with caution, that some private chemists and Pharmtechs have been found to be notorious in selling abortion pills illegally to these young girls without prescriptions. And usually this is at an extra/exaggerated cost. Yes pharmacists can play a major role by encouraging preventive medicine through the use of contraceptives. They can also lobby for a reduction in price of the contraceptives.
Are the results with the sensitization training working?
The sensitization and training of health care workers is done through regular training and counselling sessions. They are usually five days long and involve practical classes and field work. Health care workers also get regular updates on current methods. This has helped reduce stigma amongst health care workers across all ages, and most if not all are now encouraging contraceptive use.
What challenges does the religious culture present?
Most churches in Kenya and especially the Catholic Church are against contraceptive use. This is because they see sex before marriage as sinful and believe that contraceptives encourage this. They also believe that women were made to procreate and that was the reason for marriage, it would therefore be going against God’s will to use contraceptives in marriage. Case in point, there are some churches trying to ban abortions even in cases of rape/defilement. Regardless of the mother’s wishes or mental health status. The matter is however still in court.
Thank you to Drs. Michelle Musoga and Yvonee Olwang’ for helping us understand the situation of contraception use among Kenyan girls and young women, and what we can do to effect the situation as international allies.
Dr. Bev Johnson
Chair, Gender Equity Diversity Committee
Federation of Medical Women of Canada
Dr. Clarissa Fabre
Medical Women International Association
Dr. Charissa Patricelli
Six Shocking Facts About Teenage Pregnancy in Kenya, U Report, Standard Media, Nov. 26, 2018
Five Facts About Birth Control in Kenya, Daily Nation, Sept. 26, 2018.