Address teenage sexual and reproductive health

The continuous rise of Covid-19 cases in the country, which has now surpassed the 30,000 mark (as per August 20), is likely to negatively impact our healthcare system. Majority of the country’s health infrastructure may not be prepared enough to adequately handle this pandemic.

The health infrastructure in our country has been greatly strained for many years. This is evident in the inequalities and inequities in relation to accessibility, affordability and quality of services around the country.

With the focus currently cantered on the Covid-19 mitigation measures by both the national and county governments, access to maternal, sexual and reproductive healthcare services has been a challenge over the past few months.

According to a study published in the Reproductive Health Journal in 2019 titled Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya, indicates that Kenya has poor adolescent sexual and reproductive health indicators – with a teenage pregnancy rate of 18 percent, and an unmet need for family planning as measured by a contraceptive prevalence rate of 49 percent among sexually active, unmarried girls aged 15-19 years.

Similarly, statistics from the Kenya Demographic and Health Survey 2014 show that one in every five girls between 15 and 19 years is either pregnant or already a mother.

With these grim statistics, it’s evident that adolescent girls and young women experience considerable challenges in accessing essential healthcare and information services, and face further risks in crises such as the ongoing Covid-19 pandemic.

This leads to adolescents facing exacerbated mental health issues, sexual and reproductive health challenges such as early pregnancies, STDs and HIV. In particular, the loss of livelihoods in low-income areas and heightened gender gaps in education and employment due to the Covid-19 pandemic may lead to an increase in sexual and gender-based violence (SGBV). For instance, higher incidences of sexual exploitation, child labour or exploitative jobs, forced marriage and unintended pregnancies have been reported.

The consequences of adolescent girls dropping out of school due to unintended pregnancies are dire and a barrier to the improvements in the education, economic and social status of young women in the country, consequently entrenching the poverty cycle in their families.

The statistics of teen pregnancies shared by the media have been contested with claims of exaggeration. Various media reports have noted a steep increase in teenage pregnancies following the Covid-19 related restrictions, and President Uhuru Kenyatta has recently spoken on the growing cases of violation of children’s rights, specifically teen pregnancies. However, several county and health representatives disagree.

Subsequent studies suggest that the incidents of teenage pregnancies have decreased, this is according to the African Institute for Development Policy study, 2020. The study indicates that Nairobi county recorded 11,795 teenage pregnancies from January to May 2020 compared to 11,410 cases reported in 2019 in the same period. Kakamega reported 6,686 cases compared to 8,109 cases last year, and Machakos, which has been the focus of the latest public outcry on teen pregnancy ranks number 14 with 3,966 cases registered this year compared to 4,710 cases last year.

From all the counties, the total numbers reported between January and May 2020 are 151,433 compared to 175,488 for the same period in 2019. These figures, derived from antenatal care services, could indicate a decrease in teen pregnancy or just reflect the fact that women in general, and adolescents in particular have less access to prenatal care due to the Covid-19 pandemic.

Regardless of the varying perspectives, the incidence of teen pregnancies in Kenya is alarming, and poses as a major social issue.

The pressure of the Covid-19 pandemic on the economic and social systems has also affected various households negatively, thereby, limiting the resources that are available to cater for the entire family.

In addition, with the Ministry of Education having entirely scrapped the 2020 education calendar, the situation is bound to get worse. Health Assistance Kenya, which is one of Kenya’s primary frontline response services for SGBV cases, has reported for the months of March, April and May, the helpline’s recorded cases rose from 115, to 461, to 753, respectively.

According to the 2020 Unesco’s Covid-19 Education Response titled Adverse consequences of school closures, indicate that the closure of institutions can lead to increased exposure to violence and exploitation through forced-early marriages, sexual exploitation and child labour.

With the closure of schools until early next year, majority of adolescent girls and young women who depend on the frequent supply of school meals and sanitary pads, could be forced to source for these essential items elsewhere which increases their vulnerability and risk of sexual violence and unintended pregnancy.

In order to curtail these negative outcomes, concerted efforts are required from government and communities, private and key stakeholders in the health and education sectors to develop effective strategies and policies that will ensure that the maternal, sexual and reproductive health services for our women and adolescent a girls stay high on the agenda even during the COVID-19 pandemic.

Prof Temmerman, is Director of the Centre of Excellence in Women and Child Health East Africa, Aga Khan University Medical College

Miss Iyadi, is a former student, BSc in Health Sciences,Deakin University, Melbourne Australia.