Alarm over unmet contraception needs

Film-coated tablets and condoms with two orchid flowers isolated on white. Some of the most common contraceptives used in the country. [Photo: Courtesy]

At only 36, Anne is already a grandmother to a three-month old baby girl. In her modest single-room house in Kimilili town, Bungoma County, a bed takes half of the space with a simple wooden chair lining the wall on the remaining half as a table completes the set; this is home for Anne, her two daughters - Maggy and a two-year-old toddler – and her granddaughter.

The family of four is testament to challenges that face Kenya, even as the World Contraceptive Day was celebrated on September 26.

With sexual engagement starting early, adolescents fall under a critical category that has made Kenya come up with policies on how they can be covered under reproductive health programmes.

Sexually active

The Kenya Demographic and Health Survey (KDHS) 2014 shows one in 10 girls aged between 15 and 19 is sexually active.

Maggy, a Form Three student at Kimilili Friends Girls Secondary School, got pregnant last year at only 15. “In March last year I met this boy and we had sex only once,” she says.

Maggy says she asked her partner if he could use a condom but he said that one sexual encounter could not make her pregnant. When she missed her period, Maggy duly informed him and they tested positive for pregnancy.

At one point the teenagers contemplated procuring an abortion but later decided against it.

Maggy’s case is not unique: one in every seven girls aged between 10 and 19 in Bungoma County has a child or is carrying the first pregnancy, according to Millicent Kiplai, the Bungoma County adolescent sexual and reproductive health coordinator.

Nationally, 18 per cent of teenagers are already mothers or are pregnant as figures from the KDHS show. Most of these pregnancies are unintended.

Last year, UNFPA reported that close to 380,000 teenage pregnancies were recorded in Kenya. Figures by KDHS 2014 further show that two in every five pregnancies in Kenya are unintended among women of reproductive age. One in every six women treated for complications arising from unsafe abortions is a teenager and statistics show there is a reason for this – the unmet need among adolescents.

One in every three girls aged 15 to 19 in Kenya has an unmet need for family planning according to KDHS 2014. The number is similar among women aged 20 and 29 but reduces with advanced age.

Albert Obbuyi, executive director of Centre for the Study of Adolescence (CSA) argues that one of the surest ways to prevent pregnancies among young girls is through relevant, timely and age-appropriate information.

With the pregnancy progressing, Maggy had to shelve schooling until next year.

Her baby has underdeveloped genitalia that need corrective surgery; a condition that could have arisen due to her age.

The World Health Organisation (WHO) says children born to teen mothers are likely to have complications such as being underweight, anaemic, could die at birth or have cephalopelvic disproportion whereby the baby’s head is bigger than the pelvic opening.

Figures from the District Health Information System (DHIS) show that 1,495 girls aged between 15 and 19 sought antenatal care services in Bungoma. This can be attributed to early sexual debut, a problem not in the county alone.

Performance Monitoring and Action (PMA) 2020 shows the contraceptive prevalence rate in Kenya among all women of reproductive age as at 2017 was 45 per cent - a drop from 47 per cent in 2015.

Dr Joel Gondi of the Reproductive Health Division, Ministry of Health says Kenya has done well and is ahead of all countries in the region. “Two years ago Kenya was recognised globally as one of the countries which has achieved targets for family planning; on young people we have a framework that deals with sexuality and information,” says Gondi. Earlier this year, Bungoma County was one of the counties that faced a shortage of family planning commodities for six months, a situation that experts argue could have led to a rise in unintended pregnancies.

This led to a campaign dubbed Jaza Shelves by Evidence For Action (E4A) Mama Ye! to push for stocking and constant supply of family planning commodities.

“We did not have a total stock out of family planning commodities since there were other areas that had some types and we had to do a re-distribution depending on the need of an area,” says Kiplai.

This even as she revealed that in current financial year, Bungoma County has set aside Sh21 million for family planning services against a required Sh519 million. Other counties have taken it upon themselves to fund family planning activities, among them Nandi, Trans Nzoia, West Pokot, Nakuru and Laikipia.

Gondi says the government has put in place measures to ensure no shortage of family planning items.

Lucia Laboso, team leader of E4A Mama Ye! in Kenya, says one of the solutions to unwanted pregnancies is through information and implementation of policies.

“We need to implement the policies we have that seem only good on paper and debunk the myth that equipping the youth with information leads to promiscuity,” says Laboso.

She argues that family planning commodities should always be available to those who need them and this can be achieved through improving the supply-chain.

Laboso insists, “There is also need to end retrogressive cultures like female genital cutting which serve to prepare girls for early marriages.”