Adolescents Reproductive Health in Kenya: A Civil Society Approach

Adolescents Reproductive Health in Kenya: A Civil Society Approach

By Cai Yiyan, Huang Yuze, Lv Yiyang, Wang Jiaxuan, Yi Xinyue

Kenya is youthful country. In 2018, adolescents made up of 22.8 percent of the total population, and the median age was 18.9 years old, according to WHO. Being in a crucially informative period of life in many ways, adolescents unfortunately must deal with problems in health, education, substance use, crimes, and employment opportunities, hindering their human development and hence impacting the whole society and its future.

While the problems are complex, some key themes arise. First, health facilities available to the public are unevenly distributed in Kenya. Statistics show that only 42 percent of the population has access to health facilities within 4 kilometers and 75 percent within 8 kilometers. There are also too few medical personnel to adequately meet the health needs of the public, especially those of young people. Currently, there is one doctor for every 33,000 people in rural areas and 1,700 in urban areas. It is estimated that only 12 percent of health facilities are youth-friendly. HIV infection is a major challenge among many other health issues. WHO data show that the leading cause of death for both teenage boys and girls is HIV/AIDS.

Teenage pregnancy is also a big concern, as shown in Picture 1 below. In 2019, a total of 379,573 girls under the age of 18 became pregnant, 59 percent of these pregnancies were unintended, and one in five teenage girls was pregnant or already had a child.

High school dropout rates remain high due to high costs and poverty. In Picture 2, 27 percent of students choose to drop out because of lack of tuition. Most young people either drop out of school or graduate without the skills they need to start their own businesses.

Picture 1

Source: CGTN Africa

Picture 2

Source: semanticscholar.org

Crime and drugs among adolescents in Kenya increased rapidly in the mid-early 1980s. Drug abuse and sexual violence are highly associated with the risk of contracting HIV and other sexually transmitted diseases.

Adolescents who are affected by these issues, such as unemployed youth, out-of-school youth, and young people infected and affected by HIV, have drawn attention from government agencies and civil society.

The Center for The Study of Adolescence (CSA) is a Kenyan NGO dedicated to the promotion of the health, and development of young people through research, technical assistance, advocacy, and capacity building. Founded in 1988 by a group of Kenyans working on adolescent health, the organization works with partners to create resources and options to provide local young people with safer sex and safer, insured, and sustainable treatments. With a background in community health, Albert Obbuyi, the Executive Director of CSA, was drawn to the field of adolescent reproductive health, as he witnessed many challenges in this area in western Kenya where he grew up. He has been committed to this field for decades and has never looked back. According to Albert, the organization helps the teenagers who get pregnant, drop out of school, or live with HIV in Kenya, as the government agencies have not provided enough support for them. CSA is clustered into four main areas: Reproductive Health, Gender and HIV/AIDS; Social Policy, Advocacy and Networking; Research and Publications; and Capacity Building. Each program cluster has several projects currently being implemented.

Many nuances came up in our conversation with CSA staff and closer investigation of the HIV challenge in Kenya. Women are more likely to suffer from HIV than men. For example. Kenya, like many other countries, is a male-dominant society. This is reflected in many aspects including sex. Oftentimes men get to decide whether to take protective measures, as women are expected to submit to men. When it comes to the availability of condoms, Albert said, ideally the government should be able to provide them for free, but in reality, people have to pay for them, so some men also avoid using condoms for this reason. This heavily increases the chances of HIV infection. Meanwhile, poverty has differentiated impact on girls and boys when it comes to their sexual behaviors: many girls are more likely to be driven into commissioned sex as compared to boys. Education is another factor. Girls are more likely to drop out of school as compared to boys, which means they are less likely to have the knowledge required to make informed decisions, despite the fact that sex and reproductive education at school, if offered at all, is limited.

People living with HIV face discrimination and stigma around the world, and Kenya is no exception. It is often assumed that people living with HIV most likely have engaged in “inappropriate” sexual behavior or have used drugs. This is particularly frowned upon in Kenya, where the majority of the population holds conservative religious beliefs. External pressure and internalized social norms have great impact on the self-esteem of people living with HIV, even if they did not get infected through sexual transmission. The negative self-image and the explicit and tacit pressure from society lead to their further isolation, which reinforces the stigma imposed by others and themselves. This viscous cycle causes depression and other mental health problems for people living with HIV, in addition to their unwillingness to receive HIV care and treatment such as counseling and antiretroviral drugs.  Sex workers, transgender people, and drug users living with HIV face even more discrimination and obstacles to receiving care and treatment. Judy Amina, Policy and Advocacy Officer at CSA, said that if the country is determined to protect every one of their rights or access to health services and commodities, the issues of high contraction of HIV in gender minorities and other marginalized groups could be reduced. Therefore, not only does CSA ensure its staff does not use discriminatory language towards people living with HIV, but it also invests significantly in government engagement, social media and public campaigns to change perceptions.

Over the past decades, Kenya has witnessed progress in adolescent reproductive health as a result of the efforts of civil society organizations such as CSA. Increasing numbers of teenagers are equipped with the knowledge to take protective measures. More of them are able to concentrate on their education without early pregnancy. “Hundreds and thousands of young people now have the knowledge and skills to make choices, including when to start having children, who is going to be my friend, who is going to be my government,” said Albert. Even in the challenging field of advocacy, CSA has been able to contribute to the development of policies that enable young people to access health and social service facilities. The organization also works at the community level to create a safe environment for adolescents. One of the achievements Judy mentioned to us is that over time, religious leaders who were once strongly opposed to certain reproductive health agendas show much more understanding now and are easy to work with. Some of them are currently working with CSA to influence the incorporation of sex education into the national school curriculum.

At the same time, just like many other national NGOs, due to lack of financial resources for cash advance and in-house business development capacity, CSA has to work with international NGOs to get a fraction of the grants to implement projects in Kenya. “80% of the funds are in the hands of international NGOs. Their offices and connections are all over the world, so it is easier for them to obtain funding,” said Albert.

Kenya has a long way to go to prevent HIV infection, teen pregnancy, gender-based violence, and other issues that Kenyan adolescents face. We see the hope and solutions from the young people themselves. Judy told us: “I started working in the civil society space when I was 22 years old, with an organization which focuses HIV-related issue. Then I started working on reproductive health issues. I got my capacity and confidence built along the way. From that we can see, more young people who are taking up leadership roles in tackling reproductive health issues and beyond. I don’t know how long it would take for bigger change to happen, but I am hoping that the national government will see the young people’s role in leading the change.”

Reference

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