Suzzie* is a teenage student at Moi University. She is young, impressionable and highly regarded by her peers because she is always the one with the answers.
Suzzie, however, does not know everything, and certainly not the fact that she is on contraceptives. Her mother knows it, and so does the mother’s nurse friend.
When the girl started showing a lot of interest in boys earlier this year, her mother approached the nurse and asked her whether she could help to keep the youngster “safe”.
The nurse said of course she could, and a few days later Suzzie and her mother walked into a small clinic in Ruiru, where she received what she was told was an injection against cervical cancer.
It wasn’t; her mother had arranged with the nurse to give her daughter, whom she believed was sexually active, a contraceptive injection.
On the other side of Nairobi, in South C, Rachel, a 41-year-old mother of two twin daughters, has also put her teenage children on contraceptives. She says it was the hardest thing for her to do, but she had to make the ultimate decision when she chanced upon sexts — texts of a sexual nature — on the mobile phones of the young girls. The girls are injected twice a year with the contraceptive, which, like the one in Ruiru, is disguised as a cancer vaccine.
These mothers are just two among thousands of others in Nairobi and across the country who have deliberately put their teenagers on contraceptives. It is a interesting, if not controversial, trend, which they explain is necessitated by the rather casual way with which today’s adolescents and young adults approach sex. The parents might not be able to control their teenagers, but they believe they can control the outcomes of their misadventures.
So casual is this teenage approach to sex that reproductive health experts keep joking that it is more tragic for the modern young Kenyan girl to realise she is pregnant that to get confirmation that she has a sexually transmitted disease. And so mothers are taking action and preventing the consequences of behaviours they have failed to stop.
They are not that far off the mark though, for pregnancy is the second most common reason for girls’ dropping out of school in Kenya, with 90,000 of them discontinuing their studies after getting pregnant annually, according to Family Planning 2020, a reproductive health organisation.
Cultural taboos prevent open dialogue about sex at home or in school. Few young people receive comprehensive sex education, and often teachers do not have sufficient training or information to provide it. This knowledge gap is blamed for the high rate of teenage pregnancies and STI prevalence within the demographic.
And it could get worse, because the United Nations estimates that the “unmet need” of family planning will grow by 40 per cent in the next 10 years. Kenyan teens, who lack basic education on the subject, will comprise a huge number of that figure.
But why, in the information age, is there such a glaring information gap? Patricia Amuhinda, a teacher and mother of a 19-year-old college, says it is more of an attitude than information problem.
“When you talk about these things with teenagers, they just dismiss you as being ignorant or outdated,” she says.
DANGERS OF TEEN SEX
But mothers know the dangers of teenage sex, both on the girl and the boy. While some are putting their girls on injectable contraceptives, others are buying prophylactic condoms for their condescending boys. Yet others, probably too embarrassed to talk to their children about these matters, are opting to initiate such discussions on Internet chat rooms and social media.
Mwende, who has a 20-year-old son, says she deliberately puts packets of condoms, obtained from local VCT centre in Kasarani, in her son’s bedroom. But what happens when the teenagers ignore all these cautions?
Kim, a pharmacist who runs a clinic in Nairobi, says she has been asked by so many parents of teenage girls to help them abort, which they generously pay for. The parents organise with her to give the girls abortion pills when they visit her clinic for pregnancy tests.
The pharmacist, on confirming that a girl is pregnant, does not break the news to her. Instead, she lies to the girl that all she has is a minor problem with her menstrual cycle, which will be cured by a few pills.
“But the pills are actually abortifacients,” she explains. “If the pregnancy is less than eight weeks old, it is flushed out as menses.” The mother will then pretend to be happy that at least it was not a pregnancy, which she had so much feared for.
On why the mothers find it so easy to risk the lives of their daughters this way, Kim says most of her clients are women of stature who think letting their daughters give birth out of wedlock would affect their social image.
Sociologist Frida Awuor, while disapproving of the trend, says it does not surprise her that much because “parenting is getting harder and harder” as children engage in risky behaviours despite counsel.
“This, therefore, is just the manifestation of how desperate parents have become,” says Awuor. “It is not easy to manage the hormone-charged adolescents.”
Vick, a Nairobi-based doctor, has on several occasions been asked by mothers to prescribe to their daughters drugs that may cause miscarriages or still births.
“You will be surprised to learn how unrelenting they are when they want you to help them,” he says. “Even if you quote a very high price, they are ready to pay.”
Many see children born out wedlock as not only a social burden, but also an unnecessary financial burden in the face of rising inflation, and so, despite legal restrictions and the medical risks associated with abortion, it is still prevalent in the country.
Unsafe abortion methods include inserting foreign objects into the cervix or uterus, overdosing on various drugs, ingesting harmful substances, engaging in extreme physical exertion, and roughly applying pressure to the abdomen.
The World Health Organisation (WHO) estimates that one in 55 Kenyan women die from pregnancy-related causes. There are 450 maternal deaths per 100,000 live births annually, and in some urban slums that figure is estimated at 1,200.
While no national figures exist on the contribution of unsafe abortion to maternal mortality in Kenya, studies of hospital records in slum areas of Nairobi have found complications from such procedures to be the fourth greatest cause of maternal mortality. Also, a pilot study in Nakuru Provincial General Hospital has reported that complications from unsafe abortions account for 25 per cent of all maternal deaths.
A 2014 Family Planning 2020 report shows that, in sub-Saharan African countries, more than 15 per cent of girls have their first sexual encounter before their 15th birthday. As they grow into their late teens and early 20s, their sexual relations become more and more spur-of-the-moment, unprotected, slapdash affairs.
The number of women and girls accessing contraceptives in developing countries rose by 8.4 million last year, but efforts to bring family planning to millions of women who have not been reached are not moving fast enough, according to the FP2020 report.
A research report by FHI360, another reproductive health organisation, shows that contraceptive use in the country is still below the projected benchmark of 9.4 million women. However, widening access to family planning services helped avert 125,000 maternal deaths in Kenya last year, compared with 120,000 in 2012; and prevent numerous abortions.
The increase in access to contraceptives is keeping up with population increases in some countries, including Djibouti, Kenya and Rwanda, where contraceptive growth rates exceeded 2.5 per cent last year compared with an average of 0.65 per cent in developing countries. The project has halved the cost of implants, with uptake in developing countries tripling from 2.4 million units in 2011 to about 7.7 million units last year. That is why, in an economic sense, many mothers have been able to afford these processes for their children.
Contraceptive use in the region
In KENYA, reproductive health experts and organisations have started a mobile service which helps women and men in the reproductive age to access information about contraceptives. The service, M4RH (Mobile for Reproductive Health) is available countrywide and is absolutely free.
The Family Health International 360 (FHI360) project has developed a set of text messages on family planning methods that users can access via their mobile phones.
The messages are based on evidence-based information and crafted specifically for short message service or text message use. The M4RH system also provides service delivery information so users can locate clinics to provide more information and the family planning method of their choice.
In TANZANIA, the Tanzania Capacity and Communication Project (TCCP), operated by Johns Hopkins University, incorporated the M4RH service into a Family Planning campaign called ‘Jiamini!’ (Be Confident).
The campaign was incorporated into radio and TV spots with a national reach, leading to a dramatic increase in the use of the service. The increase in use implied a great interest in how to stop pregnancies, something that may be largely related to the situation in Kenya.
In Uganda, the Ministry of Health is developing cost implementation plans and adding contraceptive line items to their budgets. This points to a larger acceptance that this can be a solution to some of the challenges that mothers of teenagers, who risk conception, are grappling with.
Contraceptive use in Kenya: Educated Vs Uneducated
A 2013 Guttmatcher study on contraceptive use in Kenya found that the unmet need for contraception was particularly high among those who are sexually active and unmarried: 45 per cent wanted to avoid pregnancies but were not using any method. Only 31 per cent of sexually active unmarried women used a method of contraception, a rate that has remained the same for over two decades now.
Disparities in modern contraceptive use among Kenyan women are stark. Only 2 to 7 per cent of Kenya’s poorest and uneducated married women use modern contraceptives, compared with 48–52 per cent of the wealthiest and most educated.
According to the organisation’s 2010–2013 data, more than 40 per cent of births in Kenya are unplanned, even those in a marriage setting.
The increase of this trend in Nairobi, therefore, points to the fact that most city girls, and mothers for that matter, are those who are adequately literate, and so can decipher the instructions on how to use the contraceptives without the involvement of medical practitioners.
The nurse who paid a heavy price for abortion
On 25 September last year, Jackson Namunya Tali, 41, was sentenced to death for murder after performing and abortion that led to the deaths of both the mother and her foetus.
Tali told High Court Judge Nicholas Ombija that Christine Atieno had asked for assistance after undergoing a botched abortion elsewhere, but in his ruling, Judge Nicholas Ombija said the nurse, who had been working at Kihara Sub-District Hospital and operating a private clinic in Kiambu, was guilty of murdering Atieno.
A witness told the court that Atieno died in Tali’s vehicle as he drove her from a clinic to another hospital for advanced treatment. “He has killed two people, a foetus and her mother, and the only sentence available in law is the maximum death penalty, which I have handed to him,” the judge ruled.
The verdict caused a national debate on abortion, which is only legal in Kenya if the pregnancy is deemed by a medical professional to be endangering the mother’s health.
The law had previously stated that abortion could only be performed if a woman’s life was endangered. Also, whereas three doctors were previously needed to approve the procedure, the rules have been relaxed so that only one doctor’s consent is needed.
However, in most communities, abortion is regarded taboo and individuals involved in the act can be branded murderers. South Africa, Tunisia and Cape Verde are the only African countries that allow abortion without restrictions on the reasons for it.