Anthony Idowu Ajayi, African Population and Health Research Center
The rate of early unintended pregnancy in Kenya is shockingly high. About one in five girls between the ages of 15 and 19 have begun having children. It’s worse in some areas than others. For instance, the rate is as high as two in five in Narok and Homa Bay counties. Most of these pregnancies are unplanned and unintended.
Getting pregnant at such a young age can harm a girl’s health and socioeconomic wellbeing.
When girls become pregnant, they voluntarily or involuntarily drop out of school. Most of them never return to school, missing out on critical education investment necessary for their empowerment and earning power.
They also face stigma and social exclusion, which contribute to their poor mental health. Some seek abortion in unsanitary settings resulting in complications, disabilities and deaths. Almost half of all deaths from unsafe abortion in sub-Saharan Africa occur among adolescent girls.
Those who carry the pregnancy to term face a higher risk of childbirth complications. This includes eclampsia (potentially life-threatening seizures), preterm delivery and low baby birth weight.
Awareness of the dangers of early unintended pregnancy and knowledge of contraceptives has increased. But many girls continue to become pregnant so early. My colleagues and I carried out a study to understand why.
We analysed data from two Kenya counties in Kenya that had the highest rate of adolescent childbearing. A total of 1,840 adolescent girls, aged 15 to 19, were included in the study, and 60.3% were sexually active. Of those sexually active (1,110), 42% became pregnant, and eight out of ten (77.1%) of the pregnancies were unintended.
There were various reasons why these young women became unintentionally pregnant. We interviewed some of them in depth. They said that they were sometimes tricked into having sex, lacked correct knowledge of contraceptives and their side effects. They also did not have trusted mentors they could confide in when it came to sexual matters.
Knowing these factors is a crucial step in creating pregnancy prevention programs moving forward.
We drew our study data from the baseline data of the “In Their Hands” programme. Operating in 18 Kenyan counties, the programme sought to increase adolescents’ use of high-quality sexual and reproductive health services.
The African Population and Health Center – to which we are affiliated – collected both quantitative and qualitative data as part of the programme evaluation. Our analysis only featured adolescent girls who had had sex.
Our statistical analysis showed that only 46.4% of sexually active adolescent girls had ever used contraceptives. We also found that of the sexually active girls, two-fifths had had an unintended pregnancy. Girls who had never used contraception were about twice more likely to experience an unintended pregnancy than those who had.
Current school attendance lowered the chances of unintended pregnancy by 66% among adolescents. But those living in rural areas were 64% more likely to have an unintended pregnancy relative to those in urban areas.
Why they got pregnant
We interviewed 19 girls who had experienced early unintended pregnancy to get their perspectives on why they were susceptible. They attributed their pregnancy to being tricked into having sex. Boys challenged them to prove their love by having sex with them, and they complied to maintain their relationships and impress their partners. When they got pregnant the boys abandoned or denied them.
Some said they lacked accurate contraceptive information before initiating sex.
Many stated that they only knew how to prevent pregnancy when they were already pregnant. Neither their parents nor teachers taught them about methods of preventing an unwanted pregnancy.
Some who knew about contraception were misinformed about side effects. A 16-year-old interviewee from Homa Bay county who got pregnant and dropped out of school before the age of 15 said:
Yes, we were told, but we were told that if you want to use it, you have to have a child first because if you just get into freely (using contraceptives) you may fail to get a child.
The lack of trusted mentors to counsel them on sexual matters, including preventing pregnancy, was mentioned as one reason for their unintended pregnancy. When asked why she did not consult older women, an interviewee replied:
I don’t have an older woman I can trust. If you tell them, they will know you are having sex, and everyone will soon know.
Our findings suggest the need to prioritise two main proven interventions as policymakers deliberate on effective strategies to end teenage pregnancy in Kenya.
First, comprehensive sexuality education is vital. This is sex education that gives students that right knowledge, attitudes and skills. A good programme will improve their knowledge of sexually transmitted illness, reduce unintended pregnancy and unsafe abortion, increase contraceptive use, delay sexual debut, reduce the number of sexual partners and enhance female autonomy in deciding when, how, and with whom to have sex.
Therefore, it’s critical to fully implement sexuality education before boys and girls have sex. There is currently sex education in Kenya, but it’s not comprehensive. For instance, it mostly focuses on abstinence and HIV, it tends to neglect contraception and how to access it. And often teachers will provide incomplete and sometimes inaccurate information.
It is also important to complement comprehensive sexuality education with increased access to contraceptives to end early unintended pregnancy in Kenya. Unlike in countries like South Africa, there are no programmes intentionally targeting adolescents with contraceptive promotion. In South Africa, condoms are available in schools. While young people may go to access contraceptive in clinics, it is often not straightforward, because providers may be judgemental. There could also be privacy or cost issues. And some adolescents aren’t able to consent to services without their parents.
Even though the Kenya government has committed to ending adolescent childbearing by 2030, cultural norms and values about sex and religious dogma restrict them from implementing what is known to work.
Overcoming barriers such as cultural and religious norms will be critical to ending early unintended pregnancy in the country.
Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research Center
This article is republished from The Conversation under a Creative Commons license. Read the original article.