By: Catherine Jiang
In 2017, the World Health Organization deemed pregnancy and childbirth complications to be the leading cause of death among adolescent girls ages 15 to 19 (1). Some factors contributing to their increased risk include unsafe abortions, and abnormal labour, delivery, and postnatal periods (2,3). Notably, the COVID-19 pandemic has led to a dramatic rise in teen pregnancy rates in Kenya.
Statistics in History
When looking at data from the 1990s, the especially high rates of teen pregnancy were linked to child marriage, which is relatively common practice in Kenya and other regions in sub-Saharan Africa (4,5). This accounts for up to 33% of adolescent girls dropping out of school, which in turn leads to less employment opportunities, creating a vicious cycle of poverty (4,5).
In 2015, Kenya established a policy around adolescent sexual health and reproductive health (SRH), which increased access to SRH education, information, and services (6). In turn, childbearing before the age of 15 years old declined between 2006 and 2015 (7). However, childbearing between 15 and 19 years of age had not seen much positive change, reported to be 42% in 2003, 42.2% in 2009, and only a slight decline was observed in 2014 (38.9%) (8).
Contributing factors
There are a number of contributing factors to higher rates of teen pregnancy in Kenya. Some include peer pressure, substance use, sexual or gender-based violence, or cultural ceremonies belonging to certain regions that expose youth to sexual activity early (9). Meanwhile, trends indicate that teen pregnancies are most common within marginalized communities (10). Factors such as limited education and employment opportunity, low socioeconomic status, and inaccessible healthcare, typically all contribute to a lack of use of contraceptives and earlier sexual initiation (10).
In 2014, the Kenya Demographic and Health Survey (KDHS) found that pregnancy among girls ages 15 to 19 occurred in 33% of those who did not receive an education, as opposed to 12% among those who did (9). A lack of education can translate into a lack in safety network, structured routine, and protection (9). Further, there is an overall absence of sex education (9,11). Current education is focussed on abstinence and preventative measures against HIV, however, this does not cover sexual and reproductive health (11). Also, parents often neglect providing this type of guidance, with the topic of sex being taboo in many families, which means they rely solely on schools to teach their children (11). Inadequate education, in turn, prevents adolescents from making informed decisions regarding their own bodies and sexual practices, and recognizing positive relationships from coercive ones, and thus empowering them to speak up (9). Kenya’s government is working towards improving sex education, but this has faced controversy and resistance among religious and cultural groups (11).
Moreover, adolescents who experience poverty are more likely to be subjected to motherhood (9). This becomes an obstacle in attending school. For instance, families may experience a lack of funds to support an education, or girls may even have to stay home during periods of menstruation, as they cannot afford pads and other sanitary menstrual products (9). Teenage girls may then be pressured into sexual practices for the financial benefit of themselves or their families (9). Early marriage is also likely to be a factor – according to the 2014 KDHS, the median age for marriage in many regions in Kenya is under 20 years old (9).
Teen pregnancies are further perpetuated by a lack of access to reproductive health services. After consulting community stakeholders, 2 clear concerns have emerged: (1) public health centers are not catered to youth, and do not provide holistic services to address the needs of adolescent mothers due to limited training of healthcare personnel, and (2) social stigma, fear of judgement, and a lack of emotional support among family members and the community, making girls reluctant to seek services (9,12). In turn, there is a lack in the use of contraception (9).
COVID-19’s Role
The pandemic has exacerbated the rates of teenage pregnancy in many ways. Lockdown and the sudden closure of schools has reaped negative effects for girls facing poor home conditions, which can range from neglect to abusive relationships (11). Isolation, and a significant amount of free time, subjected young girls to isolated neighbourhoods and environments with predatory members (11). COVID-19 also further hindered access to healthcare, contraceptives, and family planning services (11).
On the other hand, organizations in Kenya surrounding reproductive health struggled financially, especially with reduced funding from other governments, meaning many were shut down, or unable to offer education and care (11). Clinics were also at risk with limited funding, making it difficult for staff to provide health services, counselling, and contraceptives to adolescents (11). Moreover, hospitals and other facilities redirected their attention and efforts to treating COVID-19 cases, further dwindling the resources put towards reproductive health care (13).
After only 3 months of lockdown, a 40% increase in the monthly average of teenage pregnancies was observed (152,000 girls) (13). The pandemic continued to prevent the delivery of appropriate responses and interventions to this health crisis (13). The previously mentioned contributors, such as poverty, were also worsened due to the pandemic: rural and low-income regions did not have the resources to deliver remote learning, and families struggled further with income loss and livelihood, which pushed girls to engage in sexual activity that was undesired in exchange for money or favours (14).
What can be done?
While the pandemic has subsided, this health crisis still emphasizes the need for better supports among adolescent girls in Kenya. There are many knowledge-based, practical, and institutional gaps that must be addressed in order to improve this. This may include psychosocial support, community empowerment, capacity building and training among healthcare staff to deliver catered/gender-sensitive interventions, and finding other strategies to deliver interventions within low-resource settings (14).
References
1. WHO. World Health Organization. Fact sheet: Adolescents: Health risks and solutions. Geneva: WHO. 2017;2017.
2. Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):1–14.
3. Grønvik T, Fossgard Sandøy I. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. PLoS ONE. 2018;13(9):e0204327.
4. Biddlecom A, Gregory R, Lloyd CB, Mensch BS. Associations between premarital sex and leaving school in four sub-Saharan African countries. Stud Fam Plann. 2008;39(4):337–50.
5. Wodon Q, Male C, Nayihouba A, Onagoruwa A, Savadogo A, Yedan A, et al. Economic impacts of child marriage: global synthesis report. 2017.
6. Ministry of Health K. National Adolescent Sexual and Reproductive Health Policy. In: Reproductive Maternal Health Services Unit R. Nairobi, Kenya. 2015.; 2015.
7. UNICEF. Early Childbearing Data. UNICEF: Geneva, Switzerland; 2019.
8. Mutea L, Were V, Ontiri S, Michielsen K, Gichangi P. Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003–2014. BMC Women’s Health. 2022;22(1):416. doi:10.1186/s12905-022-01986-6
9. United Nations Educational, Scientific and Cultural Organization. Teenage pregnancy and motherhood situation in Kenya: the county burden and driving factors; policy brief | Health and Education Resource Centre. Accessed October 28, 2023. https://healtheducationresources.unesco.org/library/documents/teenage-pregnancy-and-motherhood-situation-kenya-county-burden-and-driving
10. Blum RW, Gates WH. Girlhood, not motherhood: preventing adolescent pregnancy. United Nations Population Fund (UNFPA); 2015.
11. Wadekar N. Kenya’s teen pregnancy crisis: More than COVID-19 is to blame. The New Humanitarian. Published July 13, 2020. Accessed October 28, 2023. https://www.thenewhumanitarian.org/news/2020/07/13/Kenya-teen-pregnancy-coronavirus
12. Kumar M, Huang KY, Othieno C, et al. Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders. Glob Soc Welf. 2018;5(1):11-27. doi:10.1007/s40609-017-0102-8
13. Global Citizen. COVID-19 Lockdown Spurs Increase in Teenage Pregnancies in Kenya. Giving Compass. Published August 20, 2020. Accessed October 28, 2023. https://givingcompass.org/article/covid-19-lockdown-spurs-increase-in-teenage-pregnancies-in-kenya
14. Zulaika G, Bulbarelli M, Nyothach E, et al. Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya. BMJ Glob Health. 2022;7(1):e007666. doi:10.1136/bmjgh-2021-007666