In spite of renewed global focus to tackle adolescent SRH challenges in recent years, the picture in Kenya remains rather grim: between June 2016 and June 2017, 378, 397 adolescent girls aged 10-19 years presented with pregnancies in health facilities across 47 counties in the country. This translates to over 300,000 adolescent girls whose lives may drastically be disrupted as a result of compromised educational attainment, limited capability to secure decent economic opportunities and poor health outcomes due to increased risks of pregnancies (resulting in unsafe abortion, pregnancy-related complications such as obstructed labor and obstetric fistula and sexually transmitted infections including HIV). All these factors predispose them to exclusion and exploitation and are likely to trickle down to the next generation entrapping these young girls and their children into a cycle of poverty.
The Lancet Commission on adolescents health and wellbeing states that investing in adolescents leads to a triple dividend (1) now, (2) for the future adult self and (3) for the next generation of children, highlighting how crucial this period in life is. Among others, because decisions made during this period, whether on health or education, set the stage for adolescents’ future life course. Unfortunately, the special needs and vulnerabilities of this population are often riddled by restrictive legal, cultural, religious and political norms and notions, limiting the accessibility, availability, affordability, quality and acceptability of adolescent SRH services such as access to contraceptive counselling and services, HIV testing and counselling, STI prevention and management and comprehensive sexuality education. The (ongoing) marginalization of adolescents and young people has contributed to a rise in HIV infection rates with 51% of new infections in Kenya among 15-24 year-olds, 48% of post-abortion care among adolescents and young women aged 10-24 years, and limited knowledge on SRHR due to inadequate, lack of or incomprehensive sexual education.
With the current UHC momentum in Kenya and growing concern over adolescent SRH, SRHR should be a critical element of the country’s UHC policies and frameworks, aligning with target 3.7 of the SDGs to ensure universal access to SRH services such as family planning, information and education and integration of RH into national strategies and programs. There is no doubt that SRHR will be crucial in fast-tracking UHC in Kenya, however for this to happen, there is a need to take into account (and if necessary, overcome) the strong cultural and religious contexts which often override the ability to provide and access SRH services for adolescents. The reinstatement of the Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya (in June) is one such recent step that will allow providers to offer safe abortion care when the health or life of a woman is in danger, in cases of emergency and for survivors of sexual violence without any fear of prosecution. This is expected to reduce the number of unsafe abortions sought, thus saving lives and costs to not only the patient but the health system as well – the estimated cost of treating complications of unsafe abortion in public facilities in Kenya in 2012 was US $5.1 million. Furthermore, the provision of free sanitary towels in schools by the government, enacted in 2017 by the President, will go a long way in ensuring that the 50% of girls and women without access to adequate menstrual hygiene management facilities will be catered for, which should in turn lead to reduction of school absence and therefore improved educational outcomes, setting the scene for more opportunities for young girls.
SRH cuts across all aspects of life making it a worthwhile investment. Within the financing context, SRHR has been shown to result in massive gains in terms of healthy life years not only for individuals but for the community as well, thus providing a return on financial investment. Meeting the unmet need for modern contraception of adolescent girls, for example, would – globally – reduce unintended pregnancies by 6 million annually averting 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths. Provision of the comprehensive SRHR package as defined by the Guttmacher-Lancet Commission demonstrates interventions needed for maximum benefits throughout the life course including comprehensive sexuality education, counseling and services for a range of modern contraceptives, antenatal, childbirth and postnatal care, safe abortion services and treatment of complications of unsafe abortion and information, counseling and services for subfertility and infertility. In discussing population coverage, UHC should ensure vulnerable populations such as adolescents’ access to the quality health services they need with financial protection in order to harness the triple dividend.
From 12-14 November, “the Nairobi Summit on ICPD25: Accelerating the promise”, will be held in the Kenyan capital. As most of you know by now, this year marks the 25th anniversary of the ground breaking Cairo International Conference on Population and Development (which took place in 1994). The anniversary presents an opportune moment to remind us what we have achieved so far and what remains to be done to ensure SRHR for all – including in Kenya. The upcoming UN High-Level Meeting on UHC also provides a nice window of opportunity to advance and solidify conversations on SRHR within the broader UHC agenda, even if that’s not easy in the current international context. Kenya has already established itself as a front runner in the region towards implementing UHC and all eyes (including dr. Tedros’ eyes) are on the country to see how we make progress on this journey. As we undertake the piloting phase in the 4 UHC counties, it will be imperative that civil society, parliamentarians, academia, service providers, young people among other stakeholders ensure that SRHR is core to our UHC agenda, through monitoring how health services are functioning, service provision, providing evidence, advocacy and implementing social accountability mechanisms. As strongly put by the WHO Director-General Tedros Adhanom Ghebreyesus on various occasions: “There is no UHC without SRHR.”
In line with the theme of ICPD 25+ Anniversary: ‘Accelerating the promise’ we need to revisit the regional and national SRHR commitments made by the government such as the Maputo protocol and the National Adolescent SRH policy and implementation framework 2015 which provide key strategies to guide the country implementation to ensuring adolescents have access to comprehensive SRH services. Taking into account these existing policies and legal frameworks will be key in holding governments accountable. At Women Deliver 2019, President Kenyatta stated that “Women’s rights are human rights” and that women’s rights issues are “Not a rights issue only, it’s also an economic, political as well as a moral issue.” Thus reaffirming the importance of SRHR to the sustainable development of the country.
So let’s seize this double window of opportunity – ICPD25 being organized in our own capital, and the upcoming UN HL meeting on UHC, with Kenya aiming to become a regional role model – and turn SRHR for adolescent girls into reality, in Kenya and elsewhere.