Teens and sex: Hot button issue few are willing to touch

Lack of critical sexual and reproductive health information, comprehensive sexuality education as well as sexual and reproductive health services during the Covid-19 period accelerated the increase in unintended adolescent pregnancies. [Jonah Onyango, Standard]

Forty-six-year-old James Kande, from Nyeri, has never been intimate with anyone.

“No woman – except my mother when I was a child – has ever seen my nakedness,” he says.

Kande is an auditor. He is also a Catholic, who believes in “natural law.” He is among bold Kenyans who vocally oppose laws and policies that seek to make contraception available to adolescents and teenagers.

Even though he has remained celibate “out of choice” Kande believes that only God is the author of life. “Nothing else should be allowed to control reproduction.”

“Sex should only be allowed within marriage. Outside marriage, stay celibate. Virginity and celibacy are the best ways to control population,” he says.

Proponents of contraception – those who want clear and progressive laws and policies on reproductive health to be made and adopted – would find Kande’s opinion too radical and uncalled for.

Mwikali Kivuvani, the Executive Director of SRHR Alliance Kenya, says; “The world where adolescents are celibate is utopia and it does not exist.

“We should be driven by data: which overwhelmingly show that young people are sexually active – whether we like it or not.”

Indeed, the news is awash with stories of pregnant teenagers; most of whom are not ready for motherhood and are aloof as to how they got there.

Take the case of 17-year-old Vivian from Bulanda, in Matayos sub-County, in Busia.

“I dropped out of school because of pregnancy,” she told this paper recently. She did not report to her Form Two class school last January “because the pregnancy had started showing,” she says.

This year’s International Women’s Day celebration was themed #BreakTheBias. How girls face bias as a result of teenage pregnancy will be part of the conversation.

“For instance, getting pregnant as a teenager affects if and when a girl will finish education, and hence their shot at a vibrant career, and being able to provide for herself,” Kivuvani says.

For a boy, she says, nothing much changes despite being an equal participant in the act.

“I contend that a boy might get a sexually transmitted infection (STI). Even so, girls are more susceptible to contracting STIs than boys.”

What happens to girls like Vivian? We posed this question to Angeline Ebu, an advocate for the needs and rights of the youth in Busia.

“Usually, they will panic and try an abortion. Some will die in the process or suffer terrible consequences. If she goes on to give birth, most likely she will never go back to school. She may just become another jobless single mother in the village,” Ebu said.

Miss Ebu shares on using contraceptive with her peers. Whenever she can, she will give them some. “The question is not whether they are having sex: it is if they will have safe sex,” she says.

In the latest edition of the Youth Family Planning Policy Scorecard by Population Reference Bureau (PRB), Kenya’s laws and policies on adolescent and youth access to sexual and reproductive rights – including contraception – has been rated better than most countries in Africa.

Article 6 (1) of the Constitution guarantees every person of reproductive age the right to reproductive health care, which includes the right to be informed about, and to have access to reproductive health services including safe, effective, affordable and acceptable family planning.

Regardless of law and policy, opinion is stark divided. Should adolescents and youth be afforded contraceptives – and perhaps comprehensive sexuality education (CSE)?

Cecilia Mwangi who has a daughter says that the old method  of ignoring the topic of sex while warning girls not to ‘walk’ with boys won’t work in today’s world.

“Kids today are exposed and parents assume that kids don’t know ‘these things’. They do. And they are curious,” she says.

Mwangi explains that there is a need for parents to teach their adolescents and teenagers about sex, sexuality and contraception. “You can’t just tell them, ‘don’t walk with boys’ and leave it at that. The reality of life is that this young person may not always abstain in spite of the advice.”

Christine Khasina, a mother of two boys, holds similar sentiments. She says: “Teaching your teenage daughter, or son, about sex, and imploring them to make informed choices, is pure empowerment. Because the reverse leaves them vulnerable to poor decisions that might affect the rest of their lives.”

Ann, a medical doctor who is a Catholic, is opposed to allowing adolescents and young people – or just any other person – to use contraception.

“Contraceptives are only addressing symptoms of the problem. It is not tackling the root of the problem. Contraceptives are chemical drugs that affect the body. And they are not even 100 per cent effective. Sometimes they fail,” she says.

“Young people just need to be taught the human dignity curriculum; which teaches them the dangers of engaging in pre-marital sex.”

On CSE, the doctor said: “It sounds nice but is not meant to educate but rather sexualise children; normalising sex among young people.”

CSE is one of the components captured in the Reproductive Health Bill of 2019. Both Ann and Kande were opposed to the Bill, which they say is anti-life. “Everything we do should be done with the knowledge that God is supreme. He is the author of life: not man,” Dr Ann says.

The 2019 bill, and its earlier version, Reproductive Health Bill 2014, were both shot down, almost entirely by voices from the religious community.

Kenya Conference of Catholic Bishops, National Council of Churches of Kenya and Supreme Council of Kenya Muslims have often been opposed to laws and policies that allow contraceptives and CSE.

In fact, the religious community opposed the 2010 Constitution as they argued that it was too liberal on matters of abortion and family planning services.

So, which way for adolescents and youth?

PRB annually updates the Youth Family Planning Policy Scorecard to measure and compare countries’ policy environment on youth access to family planning services.

The scorecard found that Kenya has no law or policy that explicitly allows an adolescent or a young person to access family planning services without having to get consent from a third party: a parent or a spouse.

This is perhaps in tandem with the conservative nature of Kenyan society.

Even so, Dr Kireki Omanwa, president of Kenya Obstetrical and Gynaecological Society, says: “It is important that we provide adolescents with age-appropriate sex education, that includes abstinence as a key option but also contraception.”

According to Dr Omanwa, evidence shows that thousands of young people are finding themselves in difficult situations due to sex.

“What we are recommending would surely cut on deadly backstreet abortions for which young people have more often than not been victims,” he says.

A review of studies on adolescent sexual health spanning 20 years, published in the Journal of Adolescent Health in September 2017, found that abstinence-only-until-marriage (AOUM) programmes are ineffective and causes stigma.

The review looked at studies on AOUM in the US. It concluded that while abstinence is 100 per cent effective at preventing pregnancy and STDs, many adolescents who intend to practice abstinence fail to actually do so, and when they do engage in sex, it’s often without a condom.  

Side Bar

How parents can offer effective sex education at home

Roseline Kigen, a marriage and a family therapist at Nairobi based Intentional Therapy, says that comprehensive sexuality education (CSE) should primarily be done at home, by parents.

“Empower your child with age-appropriate information on what sex is. As they grow, be open to answering questions from them.

“The idea is to arm them with information so that they understand what would be a wrong decision and what would be a prudent decision as they battle hormonal changes in an increasingly sexualized world,” Kigen says.

The Youth FP Scorecard evaluated Kenya’s adoption and implementation of laws and policies on youth family planning.

The PRB Youth FP scorecard focused on eight evidence-based interventions. It concluded that the policy environment surrounding CSE in Kenya is promising but incomplete.

The scorecard found that Kenya’s CSE, as addressed in the National School Health Policy 2019, is abstinence-centric.

Dr Nelly Bosire, an obstetrician and gynaecologist with a focus on adolescent reproductive health, says that indeed the CSE in schools today is a watered-down version.

“There is the argument that it should be left to  parents to talk to young people. But how many parents know what CSE is? How many are comfortable and willing to talk to their teenagers about it?” Bosire posits.

CSE, Kande admits, is not very comfortable. “Can you imagine that you are a parent and you are talking to your child about the vagina and so on?”

Kande believes CSE, anywhere, would not be effective: “It would only serve to make the child want to try out sex.”

Vivian says that she was never taught about sex at home.

CSE, Kigen says, should include discussions on anatomy, hormonal changes, feelings, sex, sexuality, and the consequences that come with sex at an early age.

Dr Bosire insists that contraception is an important aspect of CSE, “since reality is that young people are engaging in sex.”

 THE DATA

• One in every five teenage girls aged between 15 and 19 has either had a baby or is pregnant with their first child in Kenya.
• Proportion of women aged 20–24 who were first married or in a union before age 18 in Kenya is 23 per cent
• Top five counties in teen pregnancy are Narok, Kilifi, Homabay, Kitui, and West Pokot, registering rates of 40 per cent, 40 per cent, 36 per cent, 33 per cent and 29 per cent respectively.
• The country loses seven women daily (2,600 annually) to unsafe abortions.
• 37 per cent of cases of unsafe abortions in Kenya were most common among women aged 10–19.
• For women aged 15-19 years, contraceptive prevalence rate (CPR) stands at 37per cent.
• Approximately 29 per cent of all new HIV infections in Kenya are among adolescents and youth.
• Thirty per cent of new HIV infections in adults are among youth below 24 years.
• Young women aged 15–24 years post the highest number of HIV infections and contribute 21 per cent of all new infections in Kenya.
• In eastern and southern Africa, in 2019, 140,000 adolescent girls were estimated to be newly infected with HIV, compared with 90,000 adolescent boys.
• Only 13 per cent of sexually active 18-24-year-olds used contraception.
• Of the 2.8 million women aged 15–19 in Kenya in 2018, 24 per cent have a need for contraceptives; that is, they are sexually active, and do not want a child for at least two years.
• More than half (54 per cent) of sexually active adolescent women in Kenya who do not want to become pregnant have an unmet need for modern contraception....
• 86 per cent of all unintended pregnancies in the country occur among this group.
• 80 per cent of unemployed Kenyans are under 35 years of age who dropped out of school at teenage.
• Over 13,000 teenage girls drop out of school annually because of pregnancy.

 Complied by Gardy Chacha

SOURCES: National AIDS Control Council, UNICEF, Ministry of Health, PMA2018 Kenya Round 7 Family Planning Brief, Kenya Demographics Health Survey (KDHS 2014)