The economic burden of teen pregnancy

Precious (name changed to protect her privacy and dignity) was running home from school after class one afternoon in the year 2012.

She had an assignment awaiting her. Once she got home at Natirae Village in Loima Sub-county, Turkana County, she needed to proceed to Turkwel River to fetch water in a 20-litre jerrican. On this day, however, her routine was disrupted.

“On my way home, I met my cousin. He was older than me but wasn’t married. He told me he had sold some goats and bought me a gift, which was in his hut,” says Precious.

She is seated on a heap of dry sorghum stalks with her back against an indigenous tree near her home as she narrates her ordeal.

“He asked me to go collect it and we went,” the 25-year-old adds, then goes quiet for close to three minutes.

The barefooted Precious donned in a black skirt and a flowered kanga crisscrossed on her neck, is motionless. The look on her face is indescribable. She stares into the space with her hands behind the tree.

When she finally speaks, she says her cousin defiled her and cautioned her against reporting him to anyone. If she did, then a curse would befall her, he warned her so.

She was aged 15 years then and in Class Five.

Four months later, she found out she was pregnant and dropped out of school.

Only daughter

Now, she is a mother to a nine-year-old son. During the interview, her barefoot son who’s wearing a faded grey polo T-shirt, plays with other boys on a dusty open ground a few yards from where we are seated. She says he’s not going to school.

“I wanted to be a dentist,” Precious says before excusing herself to leave.

She is the eldest of nine children and the only daughter in her family.

Pregnancy among the 10–19-year-olds in Kenya, is popularly known as teenage pregnancy, and this is the variation used by the Ministry of Health in recording the number of pregnant girls seeking prenatal and postnatal services.

The National Gender and Equality Commission (NGEC), a State agency championing gender equality and inclusion in Kenya, has created a distinction by redefining it as a child pregnancy, which limits the pregnancy to girls below 17 years.

At age 18, one is considered an adult as provided in Article 260 of the Constitution and, therefore, may be married by the time they make a hospital visit.

Like in 39 other African countries, thousands of teenagers are impregnated before they reach 18 years.

Teenage pregnancy and motherhood rate in Kenya stands at 18.1 per cent, according to the 2014 Kenya Demographic and Health Survey, the most recent government data.

Further, United Nations Population Fund (UNFPA) data show that 26 per cent of Kenya’s women aged 20-24 years gave birth before age 18, thus putting it among 40 countries with the heaviest burden of teenage pregnancy.

The World Bank provides latest data on the adolescent fertility rate (births per 1,000 women aged 15-19). As of 2020, Kenya had 72 births per 1,000 women aged 15-19.

Varied studies by reputable institutions including UNFPA (2014) and National Crime Research Centre (2020) have found sexual abuse, female genital mutilation (FGM) and child marriages to be the primary drivers of the high prevalence of unplanned pregnancies among the adolescents in a country where the church and conservatives have protested against the introduction of sexuality education in schools, and teenagers’ access to contraceptives is restricted.

FGM is practised in 35 communities in Kenya, and among some, like Maasai and Samburu, girls are married off after the rite.

The National Reproductive Health Policy (2022 – 2032), requires a parent or guardian’s consent for a child to access reproductive health interventions and the decision “must be premised on the best interest of the child, of which continued sexual exploitation and sustained opportunity to premature parenting are not in the best interest of the child.”

Abortion is allowed in Kenya for women and girls who have been violated, but whether they need it or not, is determined by a health professional.

She will have the abortion only if the health profession finds there is a need for emergency treatment or the life or health of the mother is in danger, as provided in the 2010 Constitution and supported by National Guidelines on Management of Sexual Violence in Kenya and Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya.

Unplanned pregnancy has immediate effects on a teenager, including stigma, rejection, or violence by partners, parents, and peers, the World Health Organisation (WHO) indicates.

It also leads to girls dropping out of school, which in the long term jeopardises girls’ future education and employment opportunities, just like it has for Precious.

WHO further explains that adolescent mothers aged 10–19 years face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20–24 years.

Sadly, 3.9 million unsafe abortions among girls aged 15–19 years occur each year, contributing to maternal mortality, morbidity, and lasting health problems, all of which cause a strain on a country’s health structures and provision of health services.

UNFPA, a UN reproductive agency, puts the figure of 10-19-year-old girls visiting hospitals annually with pregnancy at 300,000.

Given the aforesaid pregnancy burden, the cost of managing them at delivery could be more than Sh2 billion, estimates UN agency.

This is assuming that 85 per cent of teen mothers have vaginal delivery birth at Sh5,000 while the remaining 15 per cent undergo caesarean section at the cost of Sh15,000.

United Nations Children’s Fund (Unicef) child protection specialist Wilson Kisiero, says it is time to protect girls from violence, lest we have a future generation of women with an insignificant contribution to Kenya’s economic growth.

Had Precious completed her studies and become a dentist, she would earn a monthly salary of at least Sh83,256 based on the current pay scale, and in five years, the amount would have increased to Sh130,063.

With a termly fee of Sh30,000, she would simultaneously see her three siblings through secondary school with little pressure.

“There is a huge difference between a girl who was defiled, got pregnant, dropped out of school and either got married or stays at home,  and the one who never got pregnant, finished school and is working,” explains  Mr Kisiero.

“One makes little contribution to the country’s economy and another is not only beneficial to her family but also to the community. Can you imagine how much (in totality) she contributes to the GDP (Gross Domestic Product)?” he asks.

“Studies have shown that investing in preventing violence against children results in higher returns.”

A 2014 ChildFund Alliance study found that ending violence against children would save countries up to five per cent of national GDP, which is otherwise lost in addressing the impacts of violence including teenage pregnancy and risk of HIV infections.

It states that investment in evidence-based violence prevention programmes can avert the economic costs of violence as well as remove a critical barrier to children achieving their health, educational and economic development potential.

Although ending teenage pregnancy makes economic sense, it missed out in the manifestos of the four Presidential candidates in the 2022 election. They include David Mwaure Waihiga (Agano Party), Prof George Wajackoyah (Roots Party), Raila Odinga (Azimio Coalition Political Party) and Dr William Ruto (United Democratic Alliance-UDA).

Dr Ruto won the election and the Supreme Court dismissed the petition challenging his victory on September 5, 2022. The Court upheld his win.

NGEC chairperson Dr Joyce Mutinda, says had the political parties and their respective candidates consulted, the agency would have put forth the issue of taming child pregnancy.

But then, she says, they were “very secretive about their manifestos and did not want interference.”

All is not lost though: the agency has a plan up its sleeve.

She says the commission will soon meet the 47 County Woman Representatives to sell the agenda of utilising the National Government Affirmative Action Fund to fight teenage pregnancy, child marriage and sexual and gender-based violence (SGBV). They also plan a similar mission targeting the 47 governors and their deputies.

In 2006, Kenya introduced harsh penalties for defilement. The penalties are bound to the age of the child abused.

Molesting a child aged below 11 years is punishable with life imprisonment. Defiling a 12-15 years-old girl earns a convict a minimum of 20 years. And a person who violates a child between the age of 16 and 18 is liable to a jail term of not less than 15 years.

Even with these punitive laws, girls continue to be subjected to SGBV, exposing them to teenage pregnancy and HIV infection in what the Ministry of Health calls “triple threat.”

Data from the Health ministry shows that one out of three adolescent girls has experienced some form of violence, including SGBV, which increases their risk of HIV infection.

In 2021, it says about 21 per cent of the total 317,644 pregnancies recorded were among the 10-19 year-olds. And nine counties, namely Nairobi, Kajiado, Homa Bay, Meru, Kericho, Narok, Kisii, Mandera and Bomet contributed 56 per cent of pregnancies among the 10-14 years-olds.

During the same year, 98 new HIV infections occurred weekly among 10-19 year-olds.

Unlike in Tanzania where pregnant girls are not allowed in school, in Kenya, they continue learning until they deliver. The existing return-to-school policy also allows them to resume learning in the same schools or re-enrol in a preferred one.

But stigma from fellow learners and even teachers discourages the adolescent mothers from going back to school.

Vivian Mwende Wambua, Faith Nthambi and Vivian-Hadasha Mwende, gender program advocates at Federation of Women Lawyers have done a joint analysis on status of teenage pregnancy in Kenya, and they state that in cases where the girl returns to school, often times discrimination by her peers and teachers occurs.

“The teenager faces social stigma for what most would term as ‘loose morals’ and as a result, depression becomes inevitable.”

“Teachers  need to be sensitised on how to handle teen mothers and maintain the confidentiality of their issues,” Ms Dorise Ng’ong’a, Project Officer at Forum for African Women Educationalists – Kenya Chapter, said last year during a Voice for Women and Girls Rights’ forum  involving journalists and education stakeholders, on girls’ access to education.

In order to support teen mothers finish school, private investors and gender equality advocates have established target schools for them.

For instance, Greenland Girls School in Kajiado County, has enrolled 90 teen mothers aged 13-21.

“There is a lot of discrimination against teen mothers, and as a result, they feel they cannot fit in the (conventional) schools,” says the school’s co-director Purity Gikunda.

At the school, the girls are exposed to motivational speakers, and the teachers are trained to counsel them as part of helping them heal their wounds while learning.

But NGEC discourages these kinds of establishments. NGEC chairperson Dr Mutinda notes that these kinds of schools further discrimination and social stigma against adolescent mothers.

Instead, the community should accept them the way they are and be integrated into the social system without bias.

During the 2019 Nairobi Summit, Kenya committed to ending teenage pregnancy by 2030. Experts say for this to be achievable, all stakeholders should put in double efforts.

UNFPA is a major development partner with the Kenyan government and is working towards this target.

“UNFPA works with partners, including governments, civil society, and youth-led organizations, to facilitate access to sexual and reproductive health information and services to all young people,” says UNFPA Representative in Kenya Anders Thomsen.

Between 2018 and 2021, the agency in collaboration with the Ministry of Health, International Centre for Reproductive Health (ICRH)-Kenya and county governments implemented a 2gether4SRHR and first-time young mothers’ project in Kilifi, Homa Bay, Narok, and Kitui counties.

The four-year project targeted 10-24 year-olds pregnant or with a child less than two years old.

Mr Anderson says the initiative sought to increase skilled birth attendance, reduce and eliminate repeat pregnancy, and increase school re-entry.

At the end of the project, they had trained more than 2,000 healthcare workers in the provision of quality and youth-friendly integrated sexual and reproductive health services.

Kenya can borrow some tips from the United Kingdom (UK) on how to tackle teenage pregnancy.

In the ‘90s, the UK had the highest teenage pregnancy rates in Europe,” says Mr Anderson.

“(Then), they came up with a comprehensive 10-year multi-sectoral plan that focused on equipping young people with SRH (sexual and reproductive health) information, facilitating access to friendly services among adolescents, parental engagement and support for teen mums to prevent repeat pregnancy.”

The strategy, he says, was adequately resourced and had an agency tasked with coordinating the response.

“The UK managed to halve the teenage pregnancy rates in a period of 10 years,” says the UN official.

But even with the concerted efforts toward ending the social pandemic, comes the challenge of measuring the progress made.

“There are certainly several interventions done by agencies to address the issue of teenage pregnancy in the country. Nonetheless, most of these programmes are done in silos and may be difficult to measure their real impact nationally or their contribution to the national targets,” notes Mr Anderson.

But for the Kenyan girl whose life is at risk of stagnation, protection from defilement to save them from unplanned pregnancy is all that they need, as Precious puts it into perspective:  “I wish I never met my cousin.”

Mr John Mutunkei can attest to the benefits of an educated girl.

Mr Mutunkei, a pastoralist in Kitengela, Kajiado County, which is 589 kilometres from Turkana, has six children, three of whom are daughters.

He has seen his second-born daughter through university. She graduated with a degree in business administration and is now a banker at a bank branch in Kiambu County.

The fifth born daughter has also studied civil engineering. Presently, she has established a self-help group called Isilan.

Through it, he says, she educates other girls in the community to stand up against child marriage and FGM, in addition to encouraging them to finish school.

“I’m so happy with her work because she is empowering the next generation of leaders,” he acknowledges.

His last born daughter is currently in college studying social health.

“I can tell you for sure that daughters don’t forget their parents,” he says.

“I’m a pastoralist and the effects of drought on my livestock leave me stressed out. So sometimes when I’m seated and wondering how I am going to feed them, my daughter (the banker) calls me to ask ‘Daddy how are you doing with your cows, how can I help you?’ A few minutes later I see an M-Pesa message confirming that I have received Sh10,000 from her.”

“The fact that she has her money to buy credit to call me and give me moral support when I’m in distress, and that she can send me money to buy my livestock hay, makes me a happy father. I would not be enjoying those huge benefits had she not gone to school and completed her studies.”   BY DAILY NATION