By Caroline Kabiru, Research Scientist, APHRC
Adolescent sexual behavior has been the subject of a number of recent discussions in Kenyan print and social media. Many of these discussions have centered on declining moral standards, poor parenting, and a general blame game on who bears responsibility for precocious sexual activity among Kenya’s adolescents. These discussions provide a good impetus for a sober conversation around the sexual and reproductive health needs of young people in the country and, in particular, the needs of marginalized and vulnerable adolescents. This particular piece, focuses on one such group of adolescents—adolescents living in urban informal settlements or slums. The recently launched National Adolescent Sexual and Reproductive Health Policy, underscores the unique vulnerability of the rapidly growing population of young slum dwellers who are at significant risk for early sexual activity, sexual coercion, transactional sex, and early unplanned pregnancies.
Fertility estimates from a 2012 study by APHRC showed that about 116 girls out of every 1000 girls aged 15-19 years in Nairobi’s urban slums had given birth. About one in every two of these births was unplanned. The social, population and public health consequences of high adolescent fertility have been extensively studied. Researchers have shown, for example, that adolescent mothers have poor schooling outcomes and are more likely to suffer ill health compared with older women.
High adolescent fertility stems from a variety of factors including low contraceptive use among sexually active adolescents. Results from APHRC’s 2012 study showed for instance that although 50% of female adolescents aged 15-19 years had initiated sexual activity, only 35% of sexually active females were currently using any method of contraception.
Our conversations with girls and young women in the slums highlight some of the reasons why many young girls may not be using contraceptives. Zawadi (not her real name), participated in a research study that APHRC conducted in two slum communities in Nairobi to understand how adolescents living in urban slums cope with unintended pregnancy. Zawadi, who was 16 years at the time, had a one-year old son whose father had allegedly denied responsibility for the pregnancy. As a result of the pregnancy, Zawadi had dropped out of school and had been chased from her natal home by her mother. In our conversations around her pregnancy, she stated, “In fact I don’t know about family planning, maybe had I known about them I don’t think I would have gotten pregnant…You just hear they are there but they are for adults.” Zawadi’s story is familiar—limited access to sexual and reproductive health information and services is widely acknowledged as a significant barrier to contraceptive use by adolescents in low and middle income settings, such as Kenya.
The current moral debates around adolescents’ sexual behavior are counterproductive for two major reasons. First, irrespective of cultural or religious background, most people would agree that adolescents need to be knowledgeable about issues that affect their health so that they can make well-informed decisions in their youth and later life. In other words, adolescents need age-appropriate, comprehensive sexuality education or scientifically correct information about the human anatomy and physiology, including pregnancy; contraception; sexually transmitted infections; cultural norms; interpersonal relationships; and other social issues that affect human sexuality and reproduction. As the National Adolescent Sexual and Reproductive Health Policy already stipulates that young people need access to age-appropriate comprehensive sexuality education, the debate should center on how we can empower teachers, parents, religious leaders, health care providers and other key persons to ensure that every adolescent is supported to make informed decisions about his or her sexual and reproductive health.
Second, most adults would agree that every person, irrespective of age, has the right to access quality health services. Yet, adolescents face significant barriers in accessing health services. These barriers range from fear of mistreatment, inconvenient hours, to the lack of health care staff with specialized training to meet the needs of adolescents. A recent review on adolescent sexual and reproductive health outlines four key ingredients necessary to increase adolescent use of sexual and reproductive health services: health care providers must be trained and supported to provide services that are friendly to adolescents; health facilities must be welcoming and appealing to adolescents; adolescent must be well-informed about health services and encouraged to use them; and community members must be supportive of the provision of health services to adolescents. Our current debates should therefore center on ways to promote access to quality health services—including sexual and reproductive health services—for all Kenyans, irrespective of age.
As we celebrate the World Contraception Day we need to reflect on our own role in ensuring that every adolescent is fully supported to make decisions that will ensure health and wellbeing for generations of young people today and tomorrow!