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Kenya is signatory to the International Conference on Population and Development Programme of Action, UN Sustainable Development Goals, AU Agenda 2063, and AU Maputo Plan of Action, which call on governments to prioritise and invest in adolescent sexual and reproductive health and rights (ASRHR) because of its central role in sustainable development. Enabling young people including adolescents to access sexual and reproductive health information, education and services can reduce early marriage, teen pregnancy, sexual- and gender-based violence, and the spread of HIV and other sexually transmitted infections (STIs). Investing in ASRHR is also critical in efforts to reduce gender inequalities at all levels, including empowering girls to achieve their greatest potential and contribute to nation building.
Kenya has a youthful population with adolescents (aged 10–19 years) making up a quarter (24%) of its population and those aged 9 years and below (future adolescents) accounting for 26% of its population. Hence, the importance of meeting the sexual and reproductive health and rights needs of adolescents is critical as Kenya seeks to harness its demographic dividend, tapping into the skills, energy and inventiveness of its young. Despite the enormous benefits that come with enhancing ASRHR, the issue is often underprioritised in Kenya, as is in other parts of the world, in large part due to its contentious nature.
Kenya Demographic and Health Survey 2023
The Kenya Demographic and Health Survey (KDHS) report released on 4 July 2023, highlights Kenya’s progress and challenges on girls’ and young women’s sexual and reproductive health, including contraception, teenage pregnancy, and HIV and other STIs. The report also reveals disparities by socio-economic status, particularly by education level, and at county level. For example, according to the report, 15% of girls aged 15–19 years in Kenya were or had ever been pregnant in 2022 (also referred to as the teenage pregnancy rate). Among them, only 5% of those with primary and higher education were or had ever been pregnant compared to 38% of those without education.
Crucially, the teenage pregnancy rate among girls with no education increased from 34% in 2014 to 38% in 2022, but declined among girls with secondary education and higher from 8% to 5%, further showing the importance of keeping girls in school. Samburu county is reported to be leading in teenage pregnancies countrywide at 50%. Trailing behind Samburu are West Pokot (36%), Marsabit (29%), Narok (28%), and Meru (24%). The report also records high fertility rates (children per woman) in some counties compared to the national level of 3.4 with Mandera leading at 7.7, followed by West Pokot (6.9), Wajir (6.8), and Marsabit (6.3). Furthermore, the report shows that 21.6% of married girls aged 15–19 years and 34.5% of sexually active unmarried girls aged 15–19 years had an unmet need for contraceptives in 2022. Also, half of girls aged 15–19 years and boys of the same age had begun having sex by age 18 years and 17 years, respectively in 2022.
Even though Kenya has made strides towards reducing teenage pregnancy compared with the previous report released in 2014[1], the report points to the need for the government of Kenya to prioritise and increase investments in ensuring girls stay in school through secondary school and beyond, and have access to in-school and out-of-school comprehensive sexuality education and sexual and reproductive health services. It is crucial to teach young women and girls about their sexualities, sensuality, gender identities and expression to enable them have control over their lives (life skills), while providing them with a wide range of health information and services including contraceptive methods and HIV testing.
Factors slowing progress towards improving adolescent sexual and reproductive health outcomes in Kenya
Godia et al. (2014) found that young people perceive their ability to access sexual and reproductive health services to be hampered by cultural attitudes, social norms, structural and institutional barriers. The deeply engrained societal values and beliefs pertaining to girls’ sexuality has led to violation of their sexual and reproductive health and rights. In some communities, some girls are forced to undergo barbaric acts like female genital mutilation and early marriage.
Even when they seek sexual and reproductive health services, they endure stigma and prejudice because of social norms in society. They are afraid that their confidentiality would be violated, or they will face discrimination. Furthermore, health facilities, especially in rural counties, are inaccessible. According to a study by Moturi et al. (2021) on geographic accessibility to public and private health facilities in Kenya, out of the 47 counties, only Nairobi, Kirinyaga, Vihiga, Kisii and Nyamira had public health facilities that could be accessed in less than quarter of an hour. In northern Kenya, one had to travel for three hours to get to a health facility.
The increased cost of living exacerbates the situation in many households. There have been concerning media reports of girls and young women using goatskins and feathers in place of sanitary pads because of poverty. Some girls feel compelled to engage in transactional sexual activities or intergenerational relationships to meet their needs, further endangering their health, lives and future.
The situation might worsen because of the reduction in the resources allocated to Kenya’s health sector in the recently released budget. For the 2023/24 fiscal year, the government allocated Ksh142.2 billion to the health sector, down from Ksh146.8 billion for the 2022/23 fiscal year. Out of this allocation, Ksh2.8 billion is being directed towards reproductive, maternal, newborn, child and adolescent health (RMNCAH) and the proportion is projected to decrease in the coming fiscal years. During these times of a tight fiscal environment, ASRHR issues that are typically contentious are likely to be underprioritised in favour of issues that are easier to tackle and perceived as affecting more Kenyans (e.g., maternal, neonatal and child healthcare).
AFIDEP’s work in enhancing access to sexual and reproductive health services
For more than a decade AFIDEP has worked with the Kenyan government to support the formulation and implementation of evidence-informed policies and strategies to ensure adolescent sexual and reproductive health needs are met. Among the successes of AFIDEP’s partnerships and collaborations with the government was the formulation of the National Adolescent Sexual and Reproductive Health (NASRH) Policy in 2015 that spelt out comprehensive sexuality education and sexual and reproductive health services among other key interventions, and may explain the progress made so far.
However, there is still strong resistance towards implementing these and other proven interventions among some stakeholders. Importantly, political will for ASRHR can shift positively, negatively or in-between when there are changes in national, sub-national and institutional leadership.
The 2015 NASRH policy is currently being reviewed and will be influenced by the current national, sub-national and institutional leaderships’ position on the issue. AFIDEP considers the political class, Ministry of Education, parents, religious institutions as critical stakeholders that need to be continuously engaged with robust evidence showing the socio-economic value of prioritising and investing in comprehensive sexuality education and sexual and reproductive health services to slowly nurture more champions from among them. At same time, adolescents must be engaged using effective approaches to generate insights from their lived experiences to inform and strengthen implementation of national and sub-national ASRHR policies and programmes.
Recently, AFIDEP completed a study that gathered views from religious young women in Wajir and Mombasa aged between 15 and 25 years on whether their faiths influenced their decision to use modern contraceptives. The Institute, as part of the study’s dissemination activities, held workshops in the two counties with government officials, religious leaders and civil society representatives. Insights from both the study and workshops highlight the need for partnerships and collaborations between religious leaders and healthcare providers to co-create solutions that take into account the diverse views of faith communities. Tailoring reproductive health programmes to specific religious contexts can help ensure their effectiveness by respecting cultural and religious norms. Furthermore, open dialogue and safe spaces for discussions about family planning and sexual and reproductive health is essential in achieving national and international goals.
Stakeholders also emphasised the importance of engaging religious leaders and equipping them with accurate information on sexual and reproductive health to address misconceptions and offer informed advice to their communities. Delivering reproductive health services through non-health sectors is an effective a cross-sectoral approach to expanding access to and use of modern family planning. Implementing these recommendations will go a long way in improving ASRHR outcomes in the two counties and contribute to reducing cross-county disparities revealed in the KDHS report.
What should be done to improve access to sexual and reproductive health services
It is imperative that the Kenyan government places high on its agenda the sexual and reproductive health of adolescents if the country is to harness the demographic dividend from its youthful population.
A multipronged strategy is needed, including adequate financing of the health sector, investment in ensuring girls stay in school through secondary school and beyond, in-school and out-of-school comprehensive sexuality education and sexual and reproductive health services, youth-friendly health services, a formal referral system between schools and youth-friendly health services, and demystifying the norms that underpin the lack of access to services at the community level. The multipronged strategy will require sustained multi-stakeholder engagement across various sectors including health, education, religion, finance, as well as with adolescents and parents.
[1] https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf