I lead a support group for mothers ages 12-19, in Kenya. Most of the mothers I work with are out-of-school youth; many live on the streets, work in the informal economy, or are orphaned. As a part of our support program, we provide weekly peer-to-peer sessions focusing on uptake of antenatal care, child welfare, family planning services, post-rape care, and antiretroviral therapy. The support groups for the adolescent mothers are formed to provide social support and reduce stigma.
The majority of the girls who get pregnant at this age never plan the pregnancies. Most of the unplanned pregnancies are a result of transactional sex; sexual and gender-based violence, including rape and incest; or alcohol and substance abuse. Many of these girls have grown up in challenging family environments, and within their communities early pregnancies are often accepted as normal.
It can be very hard for a young woman to receive family planning information or contraceptives. There are many myths and misconceptions in our community about contraceptives, and many girls do not know about the services available for pregnancy prevention. Those who do know about the services are often afraid of being judged by health care workers.
Many health service providers are hesitant to offer these services to girls less than 21 years old who do not yet have children. I remember one girl telling me that when she visited a clinic, the nurses told her that family planning services were for women not girls, and if they provided her with these services it would be equal to them permitting her to go have sex. It is this sort of judgment that often prevents young women from seeking reproductive health services.
Without access to family planning services, many young women end up unintentionally pregnant.
When “Shiro” first came to our group she looked like a 9-year-old. She asked me to take her to the hospital; she said she had stopped going to school after developing vaginal discharge that would wet her dress and make pupils ridicule her. An examination and some tests established that she had not only contracted an STI (sexually transmitted disease), but she was also pregnant. She did not seem to comprehend what this meant. She only wanted to get treated so that she could go back to school.
“Shiro” never went back to school and currently works in an illegal liquor den.
Life is very challenging for adolescent mothers. Often they are unable to secure a meaningful source of income and end up working in illegal liquor dens, as sand harvesters, or as sex workers. Or they marry very early.
One young woman in my support group, “Rozie,” is 18 years old. She has never admitted to being involved in sex work but will occasionally mention having slept with someone in exchange of cash or food. This is sometimes the only means she has to feed her two sons, whom she lives with on the street. Sometimes when I am working with girls like Rozie, I feel totally helpless.
Making family planning and pregnancy prevention services more accessible would greatly improve the lives of girls. They would get to have an education, escape becoming involved in sex work, and avoid HIV infection. We need interventions to reduce their vulnerability, empower them to take charge of their own health, and allow them to become economically independent. The needs of adolescent girls are serious and pressing but currently they are not being addressed.