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    Young girls at a workshop in Korogocho let balloons fly off into the sky. On the balloons, they had written wishes for their future, such as becoming a journalist or moving to a better community. The exercise also involved writing down things they did not wish to happen (contracting HIV, dropping out of school) on balloons that the girls then burst. © Ronald Dagana/Jhpiego

Empowering Youth to Make Informed Sexual and Reproductive Health Decisions

Rates of unplanned pregnancies and STD infections are high among youth in Kenya’s informal settlements. Jane Otai from Jhpiego calls for comprehensive education and non-judgmental health services.

“We must talk about teen pregnancy”

More than 100 people crowded into the community hall in the Korogocho slums on the outskirts of Nairobi. The topic for the day: how to prevent cholera by observing good hygiene practices such as drinking treated water, washing hands before eating and after using the toilet, and ensuring the latrines are clean. As the public health officer opened the education session, a visibly agitated woman shouted, “Why are we discussing the possibility of a cholera outbreak when all our daughters are not completing school because of pregnancy?”

Salima, the women who had raised her voice, had reason to be upset. “My 16 year old daughter Rukia, who was completing eighth grade, is at home pregnant”, she says. “Three of my neighbours’ daughters in whom we had great hope are all pregnant. They are not getting married but bringing more children for us to take care of. Please forget about cholera for now and let’s talk about our daughters.”

The women and men in the room nodded in agreement. “Salima has a point. Today, we must talk about teenage pregnancy and what we can do to protect our girls,” said the village elder Kinyanjui. “We sacrifice everything we have to educate our children but we never reap any benefits because they soon become pregnant. And it’s always at age 15 to 16. This has to stop!”

Young people lack access to information

Adolescents living in the informal settlements of Nairobi face a distinct set of challenges as they transition to adulthood. They grow up in a hostile environment characterised by poverty, crime, poor sanitation, drugs and substance abuse, high levels of unemployment, poor education opportunities, and a lack of recreational facilities. In the Korogocho slums, families live on $1 a day — the main struggle is to find a paying job. The needs of the community are considered someone else’s problem; neighbours are suspicious of each other and keep to themselves.

In recent research by the African Population and Health Research Centre, much has been done to provide data on adolescent pregnancy and how it affects young women’s lives. But little attention has been paid to understanding what adolescents want and need to make informed choices regarding sexual health and family planning. The specific needs of adolescents living in resource-poor urban settings, such as the slums of Nairobi, have not yet been adequately addressed.

The teenagers don’t know much about how to prevent an unwanted pregnancy or an infection with a sexually transmitted disease (STD). When they try to find out, they are at a loss of how to get reliable and accurate information. The parents believe that teachers are supposed to provide information about sexual and reproductive health. Teachers are not sure how much information they should share, fearing the backlash from religious and community leaders. Health providers have biases due to their religious values and decide who should have access to this information, excluding most adolescents.

In the end, no one takes on the responsibility of sharing facts about sexual and reproductive health with adolescents — but the whole community is quick to condemn and stigmatise those who become pregnant or contract sexually transmitted infections, including HIV.

Advancing education and fighting poverty have to go hand in hand

Adolescents are tomorrow’s adults. Their actions today will determine maternal health, education levels, productivity and the overall health of the next generation. Currently, UNAIDS’ 90-90-90 goal aims at increasing testing so that 90 per cent of people living with HIV will know their status, providing 90 per cent of those who test positive with access to treatment through antiretroviral therapy, and ensuring that 90 per cent of people receiving antiretroviral therapy will have viral suppression by 2020.

However, this goal cannot be achieved if adolescents who form a majority of people living in vulnerable communities are not reached by services for HIV prevention and treatment. Family Planning 2020, a global partnership advocating for women’s rights to access contraceptives, has called on governments, civil society, multilateral organisations, donors, the private sector, and the research and development community to work together to enable 120 million more women and girls worldwide to use contraceptives by 2020. Their call echoes the recommendations by the World Health Organisation to strengthen health services for adolescents and ensuring that they have access to a full range of contraceptives. To achieve this goal, a strong commitment to and investment in adolescents and youth living in the informal settlements is needed, where the levels of unintended pregnancies, STD infections, and sexual violence among youth are high — not least due to poverty.

Kenya has developed a training curriculum that teachers can use for comprehensive sex education in public schools, hoping to ensure adolescents’ sexual and reproductive health and rights. Based on data, non-profit health organisation Jhpiego is advocating with teachers and health care workers to share information with students that will help them make informed decisions.

Offering age appropriate and non-judgmental services

Governments and international organisations should focus on programmes that reach adolescents with sexual and reproductive health services at different stages of their lives. Adolescents in school should have access to age appropriate sex education since it has proven to reduce unwanted pregnancies and STD infections, including HIV. Out-of-school adolescents should be able to access information in settings where they feel comfortable, such as safe spaces in communities where services can be offered in a non-judgmental and non-discriminatory manner.

We must devise ways of reaching every segment of the youth population with the services they require, recognising that one size does not fit all. The different needs of older married and unmarried adolescents must be recognised. In a programme that Jhpiego is implementing in the town of Migori, married adolescents felt uncomfortable joining groups of unmarried adolescents for information sharing and services. Sexual and reproductive health education also has to address very young adolescents who are not yet sexually active—they should receive the education they need before it is too late.

Schools, churches, community halls, and youth centres are plentiful in informal settlements. Adolescents and young people have access to phones, radio, television, and newspapers. There is no shortage of communication channels—we just need to use them. No opportunity should be missed to provide adolescents with the information that will help them make responsible decisions about their sexual health and reproductive lives.

Too much is at stake.

The author would like to thank Ann Lolordo, Jhpiego Senior Director for Communications, for her helpful comments and revision work.

Jane Otai

Jane Otai

Adolescent Health Advisor at Jhpiego
Jane Otai is an Adolescent Health Advisor with Jhpiego and a Johns Hopkins University affiliate in Baltimore, USA. She has worked with programmes in family planning, WASH, HIV, gender-based violence and supporting youth and young mothers in urban informal settlements. Currently, Jane Otai is working with Jhpiego to ensure that sound adolescent health programmes are implemented. She has also published articles in the Huffington Post, the New York Times and on various online platforms.
Jane Otai